What is Executive Dysfunction and How Does it Relate to ADHD?

It seems like the term ‘executive function’ is being talked about more than ever. But how is it different than ADHD? Well, the truth is, it’s not. Attention is the cornerstone of ADHD, and our executive functions include attention as well as other areas like:

• Memory (Working memory is the  ability to hold things together in your mind while working with them)
• Time management (understanding the passage of time and how to use it)
• Planning/prioritizing (knowing what to do and how to do it)
• Organization (not just stuff but thoughts)
• Initiation (how to start something)
• Inhibition (how to stop)
• Flexibility (mentally able to switch from task to task without emotional interference)
• Emotional regulation  (self-awareness and ability to manage emotions)

ADHD is a diagnosis based on a cluster of observable behaviors. All diagnoses of ADHD have some aspects of executive dysfunction. Executive Dysfunction, or EFD, can also stand alone without an ADHD diagnosis but if so, it is usually caused by an acute trauma to the frontal lobe of the brain or interference due to cancer treatments or as a subset of symptoms from other diagnoses. EFD is a delay in the rate of development of self-regulatory skills. The ADHD brain is different from non-ADHD brains. These brains exhibit different profiles of emotional control and attention problems. They display a different pattern of maturation of brain networks and are on average, 10% smaller than neurotypical (non-ADHD) brains. So basically, the connections in the brain network are underdeveloped, and this can cause slower processing of information, less awareness of surroundings and one’s actions.

Executive dysfunction is a performance disability, not a learning disability. A person with EFD may know what to do but can’t do it. It’s not a disorder you can teach away. What is needed is modeling of supports, or scaffolding, by others over many years. These scaffoldings will support the person for life but may change in nature depending on the environment and the age of the person. Let’s use a simplified example. If a person needs a ramp to enter a building and that ramp is straight, they may master the use of the ramp. Just because they have mastered using  a straight ramp does not mean they will not need a ramp anymore or in other situations. So, when they encounter a building with a curved ramp, they know that they need a ramp but know they need to adjust how they use it. If you are a person that has poor time awareness and memory, you may always need some sort of timer or alarm system to alert you to stop, get ready to leave, or even check what’s in the oven for dinner.

While ADHD is the accepted term and recognized medically as a disability, it is really the executive functions that are being addressed. From the ability to attend long enough to a task to remembering what to do, or stopping your behaviors, EFD is the overarching parts of ADHD and need the support to help you get through life.