February 7, 2015

The overlap of Executive Function and ADHD

Executive functions, and the difficulties some students face with executive function,  are not as familiar in the greater sphere of education, learning disabilities, and specialized academic programming, as compared to well-known learning disorders like dyslexia or ADHD. As such, the fine differences and nuances that separate executive function deficits from learning disorders can often be confusing. In fact, some of the primary signs of attentional disorders in children are the same indicators used by clinicians to identify executive function inefficiencies. So how can we make sense of EF as it relates to and differs from ADHD?

Executive functions and ADHD are closely interrelated across many levels, skillsets, and tasks. While ADHD is an executive function deficit disorder (EFDD), not every executive functioning difficulty stems from problems with attention and impulse control. Every student is unique, develops at their own rate, and has their own executive strengths and weaknesses. So, while one student with an EFDD may have ADHD, not all students who struggle with executive functions do. Therefore, each student must be taught according to their individual learning needs and in keeping with the layers of executive functioning skills that build upon one another.

ADDitude, a website created to share strategies and support for students with ADHD and learning disorders, recently posted an article explaining more about the connections between executive functioning and attention deficit hyperactivity disorder. In the article, Dr. Russell Barkley of the Medical University of South Carolina raises several key questions that parents and educators may also find themselves asking: Is ADHD an executive function disorder? Is every executive function difficulty also ADHD?

Dr. Barkley concludes that ADHD is, in fact, a type of Executive Function Deficit Disorder (EFDD). However, every EFDD is not always ADHD. The relationship between EFDD and ADHD is similar to a concept many children learn in geometry: Every square is also a rectangle, but not every rectangle meets the criteria to be a square.

Likewise, each student with executive functioning difficulties develops an individualized learning profile, with weaknesses in a specific combination of executive functioning areas. ADHD is just one of those many unique combinations, where a student experiences difficulties specifically in attention and impulse control. Attention controls and impulsivity are just two components of a wide array of skills that make up executive functioning. However, these two areas do not encompass all of executive function.

The Intersections of ADHD and EF:

Engaging Minds focuses on the following executive function skills: organization, planning, time-management, task initiation, flexibility and transitions, memory (short-term, working, and long-term), follow-through and self-monitoring, verbal and physical impulsivity, and emotional control. Meanwhile, ADHD deals predominantly with attentional control and impulsivity, though some additional symptoms appear as a result of these two deficits. ADHD and executive functioning intersect because both deal with the management, regulation, or control of cognitive processes. Specifically, they have these areas in common:

  1. Self-monitoring, follow-through, and attentional control: Controlling and directing attention is part of the larger skill set of self-monitoring. Self-monitoring is “the process of observing one’s behavior and evaluating it in relation to goals” or in relation to a current situation. It can occur in both conscious and unconscious ways, requiring deliberate self-directed attention or automatic socially-directed attention. It is also a crucial skill required to see tasks through to completion and employ “follow-through.” When attention or impulsivity is compromised, as is the case with ADHD students, self-monitoring or following through with tasks and plans can be extremely difficult.
  2. Verbal/Physical Impulsivity: Inhibition, also known as “self-restraint” or “impulse control,” is another area of executive functioning with which ADHD sufferers have particular trouble. Impulse control requires the ability to direct, monitor, and maintain attention, rather than succumb to immediate and fluctuating impulses. ADHD and EFDD intersect here, too, since controlling impulse factors heavily into the coordinated processes of flexibly planning, initiating, and solving various tasks.  
  3. Emotional Regulation: Children with ADHD can also experience difficulty with emotional regulation because of impulse control problems and shifting attention. Constantly shifting attention can make students with ADHD hyper-aware of sensory information, like noisiness or an uncomfortable seat, that others might traditionally ignore. And–impulsivity can cause persons with ADHD to react with intense, unmitigated emotions.
  4. Planning, Time-management, Memory: One of the most basic elements of any executive function is attention. Without attention, a student is less likely to transfer content from their short-term to their long-term memory. They may also struggle to use their working memory to hold ideas or images in their mind. ADHD can also lead to consistent interruptions in focus or activity, making time-management or long-term thinking especially challenging.

Although ADHD is traditionally understood to reflect only attentional and impulsivity problems, deficits in these two executive functions can pose challenges with higher order thinking and organization, often mimicking other types of EFDDs that lack an attention deficit component. To explain this phenomenon further, Dr. Barkley also isolates seven fundamental EF skills and shows how someone with ADHD might share deficits in some of those areas (read more!).

Executive Function Coaches: The Right Fit for Students with ADHD?

Because of the many intersections between EFDDs and ADHD, executive function tutors or coaches can be excellent assets to students with ADHD. Executive function coaches can help students build attentional endurance, improve their emotional control, and apply self-monitoring skills to better their overall academic performance. EF coaches can also help students with ADHD develop long-term planning and organizational skills that can, in some cases, support and counteract difficulties those students face in other areas.

At Engaging Minds, we make it our priority to find every student the appropriate problem-solving strategies to fit with their unique way of thinking and managing their own lives as students. In this way, executive function coaches help students with ADHD and EFDDs prevent “fires” before they happen, rather than put them out after.