30 Aug Relationship Between Executive Functions and ADHD
What is the Relationship Between Executive Functions and ADHD?
by Dr. Elizabeth Hayward
Parents of a child with Attention Deficit Hyperactivity Disorder (ADHD) often learn that their child struggles with executive functioning. It can be confusing to parents how executive functioning is actually related to ADHD.
Executive functioning is a broad term, involving many different types of skills. Executive functioning skills allow a child to engage successfully in goal-oriented behavior independently. Parents wonder: do all children with ADHD struggle with executive functioning? Does trouble with executive functioning automatically indicate ADHD?
What is relationship between executive functions and ADHD.
First, let’s start by clarifying how a diagnosis of ADHD is made.
A psychologist, psychiatrist, or pediatrician will make a diagnosis of ADHD when parents and teachers recognize elevated levels of inattentive and/or hyperactive impulsive behaviors in a child.
When a child is inattentive, their parents or teachers may see that they are forgetful, make careless mistakes, don’t follow through on instructions or complete tasks, have difficulty with organization, avoid sustained mental effort, or are easily distracted.
Parents and teachers would note hyperactive or impulsive behaviors if they see a child frequently fidgeting, leaving their seat, running or climbing excessively, acting as if “driven by a motor,” talking excessively, calling out or interrupting.
In order to make a formal diagnosis of ADHD, there must be a history of these symptoms during childhood, and the symptoms must be evident in two or more settings, like at home and at school.
Children with ADHD often have difficulty with executive functioning tasks, though this alone is not sufficient to make a diagnosis.
Remember, executive functioning are the skills that support a child in independent problem solving.
These skills include initiating or getting started on a task, planning, holding relevant information in mind while working, shifting or thinking flexibly, self monitoring, self-regulating, persisting in tasks, and inhibiting or blocking out distractions.
For example, when working on an assignment, executive functioning skills form the basis of a child’s ability to:
- Sit down and get started promptly,
- Plan out the steps necessary to complete the task
- Change their approach or strategy if they face challenges,
- Monitor or review their work for errors,
- Stop themselves from engaging in activities that are not relevant to the assignment (like chatting with a peer),
- Keep at it when the answer doesn’t come easily, and block out the distractions that may arise around them while they work.
A child may have the academic knowledge necessary to complete an assignment, but if they don’t have these other skills as well, they won’t be successful in completing the task.
Children with ADHD often have difficulty with many aspects of executive functioning, as both inattention and impulsivity are closely related to executive functioning deficits.
A student who regularly fails to follow through on instructions may be having difficulty holding information in mind as they work.
When a student makes careless errors in their work, or appears inattentive to details, it may well be because they struggle with self-monitoring.
If they seem distractible, it is entirely plausible that they struggle more than others their age in terms of inhibition, or stopping impulsive responses.
In the course of a thorough neuropsychological evaluation, executive functioning skills can be directly assessed using standardized measures.
Neuropsychologists use standardized testing to directly measure many executive skills such as how quickly a child responds, how well they hold rules or information in mind while problem solving, how well they organize information, or how successful they are at inhibiting or regulating their responses.
When formally evaluated by a neuropsychologist, typically in a structured setting with one-on-one support, many children with ADHD perform well on direct measures of executive functioning.
They may have difficulties with tasks of inhibition, but otherwise perform well on measures of sustaining attention, planning and organizing information.
It is important to recognize that the testing environment facilitates performance in many ways. Compared to a busy classroom, the testing room is typically quiet and free of distractions.
While a classroom teacher is splitting his or her attention between 25 to 30 students, the neuropsychologist devotes all of his or her attention to the child being tested.
Therefore, in some instances, children who seem to struggle in school or at home perform well on direct measures of executive functioning.
In addition to direct measures, parent and teacher reports of behaviors are also included in a thorough neuropsychological evaluation.
It is these behavioral reports that are most closely related to a diagnosis of ADHD. In other words, if parents and teachers are both seeing behaviors that indicate difficulty with executive functioning ability, children are likely to receive a diagnosis of ADHD.
Despite the considerable overlap between ADHD symptoms and executive functioning skills, having difficulties with executive functioning tasks is not unique to ADHD.
Rather, difficulties with executive functioning tasks can be symptomatic of many different disorders in childhood.
In that way, struggling with executive functioning is not unlike a fever- having a fever is symptomatic of many different types of illnesses, and not specific to any one particular illness.
For example, children who struggle with depression or anxiety often have trouble with executive functioning tasks, like getting started on a task or working efficiently.
This is all to say that yes, typically, children with ADHD struggle with executive functioning skills, but many children who do not meet criteria for ADHD also have difficulty in such tasks.
A comprehensive neuropsychological evaluation will typically clarify whether or not a student who has trouble with these types of tasks also meets the criteria for an ADHD diagnosis.
If parents of a child with ADHD know specifically what areas of executive functioning are most troublesome for their child, they will be better able to provide support with well-targeted interventions to ensure success both at school and at home.
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