Understanding Executive Function Deficits in ADHD

Executive function is a set of cognitive skills that help us plan, prioritize, and execute complex tasks. These skills are commonly impaired in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), both in children and adults. In this article, we'll explore what executive function is, how it relates to ADHD, and the specific deficits often seen in those with the disorder.

What is Executive Function?

Executive function refers to the mental processes that allow us to organize thoughts, prioritize tasks, manage time efficiently, and make decisions. These skills help us establish strategies for managing projects and determine the actions required to move each project forward. Individuals with executive dysfunction often struggle to analyze, plan, organize, schedule, and complete tasks on time. They may misplace materials, prioritize the wrong things, and feel overwhelmed by big projects.

Executive Dysfunction and ADHD

There is often confusion around the relationship between executive function and ADHD. While ADHD is not the only cause of executive function deficits, it is a common factor. The term "executive functioning" was coined in the 1970s by Karl Pribram, whose research indicated that these functions are primarily mediated by the prefrontal cortex of the brain.

The Four Circuits of Executive Function

According to ADHD expert Russell Barkley, Ph.D., there are four main circuits in the prefrontal cortex that relate to executive function and dysfunction:

1. The "What" Circuit: Linked to working memory, this circuit helps guide our thoughts and actions towards goals and the future.
2. The "When" Circuit: Responsible for timing and sequence, this circuit explains why individuals with ADHD often struggle with time management.
3. The "Why" Circuit: Connecting the frontal lobe to the amygdala, this "hot" circuit is where emotions influence decision-making.
4. The "Who" Circuit: Involved in self-awareness, this circuit helps us monitor our own behavior, feelings, and experiences.

The Seven Core Executive Function Skills

Executive function can be broken down into seven key skills:

1. Self-awareness
2. Inhibition
3. Non-verbal working memory
4. Verbal working memory
5. Emotional self-regulation
6. Self-motivation
7. Planning and problem-solving

Individuals with ADHD often experience deficits in most or all of these areas, leading to symptoms like impulsivity, emotional outbursts, and difficulty completing tasks. ADHD can be considered an executive function deficit disorder (EFDD), as the core symptoms of the disorder are closely tied to these cognitive skills.

Developmental Delays in Executive Function

Executive functions develop over time, with self-awareness emerging around age 2 and planning/problem-solving fully developing by around age 30 in neurotypical individuals. However, those with ADHD are typically 30-40% behind their peers in the development of these skills. This explains why children and adults with ADHD may struggle with age-appropriate situations, as their executive function is more akin to that of a younger person.

Conclusion

Understanding executive function deficits is crucial for managing ADHD effectively. By recognizing the specific areas of impairment, individuals with ADHD and their caregivers can seek appropriate accommodations, treatment, and strategies to strengthen these vital cognitive skills over time.

For more information on executive function and ADHD, check out these resources: