Executive Dysfunction in ADHD: Signs, Diagnosis, and Treatment

Imagine this: you wake up ready to go to work and have a productive day ahead. However, you arrive at your desk only to struggle with concentration and actually getting your tasks done. No matter what you do, you can’t will yourself to work. Sound familiar? You might have ADHD executive dysfunction. This symptom can significantly affect everything from school and work to personal relationships. Here, we’ll learn more about what executive dysfunction is, how it relates to ADHD, and how it is treated.

What is Executive Dysfunction?

Executive dysfunction is any impairment in skills that relate to memory, focus, organization, and time management. It disrupts your ability to manage time, space, and higher-level thought. Executive dysfunction can cause difficulties with initiating and completing tasks, processing information, controlling impulse behavior, focusing, and problem-solving. Planning for the future can also be very challenging with executive dysfunction.

Difficulties with executive functioning can be frustrating. Individuals who experience this usually have challenges meeting academic and work goals, regulating moods, procrastinating, and generally feeling good about themselves.

How Does Executive Dysfunction Relate to ADHD?

Executive dysfunction and ADHD are two distinct concepts, but they are very much related to one another.

First, we must define ADHD. ADHD, or attention deficit hyperactivity disorder, is a neurodevelopmental disorder characterized by symptoms of inattention, impulsivity, and hyperactivity.

Research has confirmed that this disorder affects the reward circuitry in the brain. Findings show people with ADHD have lower levels of proteins essential for experiencing reward and motivation [*].

These deficits may explain why people with ADHD suffer from the symptoms associated with executive dysfunction, such as inattention and lack of focus. It also gives insight into why individuals with the condition have less motivation, which can manifest in behaviors such as procrastination and struggling with task completion.

While ADHD often comes with experiences of executive dysfunction, it is not synonymous with the disorder, nor is it a sign of having ADHD on its own. ADHD involves many other symptoms, risk factors, and challenges that are not associated with executive function alone.

Is Executive Dysfunction a Symptom of ADHD?

Research shows that the parts of the brain involving executive functions are smaller or less active in people with ADHD [*]. Although it may point to ADHD, executive dysfunction is not an official symptom when diagnosing the condition [*]. And while they overlap in many ways, executive dysfunction is not synonymous with ADHD and vice versa.

What Causes Executive Dysfunction?

The causes of executive dysfunction are not clear-cut. However, experts have linked this issue to various conditions that affect the way our brains work, including:

• ADHD
• Depression
• Obsessive-compulsive disorder (OCD)
• Autism spectrum disorder
• Schizophrenia
• Brain damage
• Degenerative diseases
• Addictions

This can also occur if there is any damage to or deterioration in the areas of your brain that contribute to executive functioning. Here are some common examples:

• Head injuries such as concussions or traumatic brain injuries
• Epilepsy and seizures
• Alzheimer’s disease
• Brain tumors (whether cancerous or non-cancerous)
• Cerebral hypoxia (brain damage resulting from lack of oxygen)
• Dementia
• Huntington’s disease
• Stroke
• Multiple sclerosis
• Infections
• Toxins (e.g, carbon monoxide poisoning)

What are the Signs of Executive Dysfunction in ADHD?

There are many signs of executive dysfunction that can present in people with ADHD. They include the following:

• Procrastination
• Time blindness
• Disorganization
• Distractibility/Difficulty concentrating
• Working memory challenges
• Problem-solving challenges
• Emotional dysregulation
• Difficulty multitasking
• Difficulty in task completion
• Having trouble planning or organizing activities
• Organizational problems
• Trouble meeting deadlines
• Difficulty analyzing or processing information
• Ineffective time management
• Losing track of belongings
• Challenges in switching activities
• Difficulty setting schedules
• Impulsivity
• Trouble paying attention

How is Executive Dysfunction in ADHD Diagnosed?

While executive function disorder and ADHD are not the same, and you cannot get a diagnosis for the former, your doctor can still investigate the underlying causes of your executive dysfunction. They may assess its severity and how your daily life is affected by it.

A mental health professional may ask you about the symptoms you experience related to executive dysfunction, including problem-solving, focus, planning, and organization [*]. They may also carry out executive functioning tests, such as the Barkley Deficits in Executive Functioning Scale (BDEFS) [*], to assess skills such as working memory or inhibition control.

Apart from that, the mental health professional you consult will also assess your child for symptoms of ADHD. No one test will determine whether an individual has ADHD, but specialists typically conduct an assessment, including a physical examination, a series of interviews, and some checklists to learn more about one’s behavior.

How is Executive Dysfunction in ADHD Treated?

The treatment that will be administered to adults or children with ADHD for executive dysfunction will depend on the underlying cause. It is best to consult a mental health specialist who can tailor a plan that will suit you best. Usually, these are the treatments that are provided to people with executive dysfunction in ADHD.

Medication

Stimulant or non-stimulant medications are usually prescribed for individuals with ADHD. Which one your doctor decides to give you will depend on your medical history and symptoms.

Therapy

Therapeutic techniques such as cognitive behavioral therapy (CBT) are excellent treatment options for managing executive dysfunction or executive function disorder in ADHD [*]. CBT allows individuals to identify unhealthy thinking patterns and habits before replacing them with healthier ones that get them closer to their goals. This type of therapy can help you improve your organization, time management, prioritization, and other executive functions.

It is common to involve only therapy or medication in treatment, but there are also times when the two are combined.

How Can Parents Support Children with Executive Dysfunction?

There are many ways parents can support their children who are experiencing executive dysfunction. Here are some things you can try:

• Establish a routine. Establishing a consistent homework routine, especially for older kids, is essential. Many experts recommend starting homework immediately after school. Avoid waiting for motivation, which often doesn’t come. Create a dedicated workspace with the necessary supplies to minimize distractions.
• Checklists. Kids with executive dysfunction often struggle to break down tasks into manageable steps. A clear checklist can help them stay focused and reduce stress. Children often get overwhelmed by decision-making, so a checklist can help them avoid getting stuck and actually complete the task.
• Set time limits. Therapists often suggest adding time limits to checklists, especially for larger projects. This helps kids understand the steps involved and how long each might take. This is because many children with ADHD and executive dysfunction often overlook the time required for research and preparation when creating checklists.
• Use rewards. Reward systems can be powerful motivators for younger children, and encouraging and supporting older kids is essential. It is helpful to check in with your kids and express appreciation for their efforts.
• Use a planner. Educational specialists emphasize the importance of using a planner. Schools often require planners but don’t teach kids how to use them effectively. This can be especially challenging for kids with executive dysfunction. Planners help these children remember tasks like homework assignments to reduce stress. Many schools also use online platforms to post assignments and provide additional support, so it is best to help your child take advantage of these.
• Explore different ways of learning. Educational specialists also recommend various strategies to help kids learn and remember information. Visual learners often benefit from graphic organizers, while auditory learners have an easier time saying things out loud. It really depends on your child’s inclinations and learning style, so experiment with different things until you find something that sticks.
• Explain the rationale. Kids need to understand why planning is important. They often feel overwhelmed and resist delay. Planning can seem like a waste of time if they don’t see the benefit. Explaining the rationale to your children can help them adopt new strategies.

Related Product: Executive Functioning Strategies For Kids (PDF)

The Bottom Line

Dealing with executive dysfunction can be a struggle, no matter your age or background. While it may be frustrating and seem hopeless at times, there is still hope, as there are treatment options available. And some of the tips and tricks we’ve outlined above for children can also be used by adults who have difficulty with their daily tasks due to executive dysfunction. The key is finding a balance in what coping mechanisms, medicines, and therapies work for you.

Using the right resources can help in your ADHD journey. Check out some of our ADHD worksheets for additional support and our ADHD related articles:

• ADHD in Children: Symptoms, Causes, and Treatment
• ADHD in Teenagers: Symptoms, Diagnosis, and Treatment
• ADHD in Boys: Symptoms, Diagnosis, and Treatment
• ADHD in Girls: Symptoms, Diagnosis, and Treatment

References:

1. DOE/Brookhaven National Laboratory. Deficits In Brain's Reward System Observed In ADHD Patients; Low Levels Of Dopamine Markers May Underlie Symptoms. 10 September 2009.
2. Arnsten A. The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex. 1 May 2009.
3. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. June 2016.
4. Rabinovici G, Stephens M, Possin K. Executive Dysfunction. June 2015.
5. Kamradt J, Nikolas M, Burns G, et al. Barkley Deficits in Executive Functioning Scale (BDEFS): Validation in a large multisite college sample. 20 August 2019.
6. Puente A & Mitchell J. Cognitive-Behavioral Therapy for Adult ADHD: A Case Study of Multi-Method Assessment of Executive Functioning in Clinical Practice and Manualized Treatment Adaptation. December 2015.