blogThe Myth of Executive Functioning (EF) Part IV: What Does EF Look Like in Kids/Teens with ADHD?

Welcome back to our Blog Series on Executive Functioning!

As we talked about last time, Executive Functioning, or EF, involves 2 main areas of brain processing:

  1. Inhibition of Responses: Impulse control/self-restraint (e.g., stopping yourself from making an inappropriate comment, or acting inappropriately)
  2. Awareness: Awareness of own thoughts and emotions. Also, self-speech/internalized speech (e.g., thinking to yourself about how you are going to do something, or thinking to yourself about the consequences of doing something, before you do it)

These brain processes are the basis of many other types of executive functions, listed below, all of which assist us achieve goals, act in socially appropriate ways, and complete tasks:

  1. Concentration
  2. Working Memory: holds information long enough to be processed into short term, and then long term memory
  3. Emotion Regulation: Ability to modulate emotions/emotional reactions
  4. Planning
  5. Problem Solving
  6. Time Management
  7. Self-Motivation/Self Initiative
  8. Organization

So, what happens to EF when a youth is experiencing Attention Deficit Hyperactivity Disorder (ADHD)?

ADHD interferes with EF in a variety of ways, and each youth experiencing ADHD will experience EF difficulties specific to him/her (not every person will experience all possible EF difficulties).

Listed below are a few common EF issues which can occur with ADHD:

  1. Trouble in regulating emotional reactions, and need for sensory input:

Youths with ADHD may react with a level of intensity that is out of proportion to the situation, having big emotional reactions to minor events.   Others often feel baffled as to why the youth is reacting with such intensity.  This can cause problems in developing and maintaining friendships, as peers may not want to play or socialize with him/her, due to feeling uncomfortable with their intense emotional reaction.

Another area of struggle is becoming over excited in fun situations (e.g., birthday parties, class trips, vacations, festivals, social outings/get togethers with friends, cannot fall asleep at sleepovers and keeps other kids awake). For example, in these situations, youths with ADHD may talk loudly, run or climb where not appropriate, have difficulty waiting their turn, talk excessively, and act impulsively in a variety of ways (e.g., screaming above and beyond the level of other youths, grabbing others’ things, jumping around more than their peers, running off, hanging all over other youths, acting silly and younger than their age).

Additionally, many youths with ADHD have a need for movement and sensory input (need for oral, motor, or auditory activity).  For example, they may benefit from chewing gum, doodling, fidgeting with rings/stretch bracelets/paper clips/erasers/pencil grips, and having music on at a low volume in a nearby room while completing homework.  Or, some children benefit from moving around while learning math facts or vocabulary definitions in various subjects (hula hooping, jumping on an indoor trampoline, walking on a treadmill or stepping on a stepper, only if they are of an appropriate age for this. Likewise, doing movement activities prior to starting homework, and movement breaks in between doing homework assignments or study blocks, assists them (e.g., trampoline, hula hooping, cartwheels, somersaults, swinging, tossing a heavier ball with someone, wall push-ups, chair push-ups, jumping jacks, jumping rope, etc.). They actually pay attention, and maintain effort and concentration better, if they are doing these types of movements/fidgeting and obtaining such sensory input, because their brain is seeking and needing such types of sensory and movement inputs.

  1. Difficulty in self-starting and completing tasks (particularly non-preferred tasks), and following through with directions:

Youths with ADHD frequently have trouble with initiating non-preferred tasks on their own (homework, schoolwork, chores, showering, brushing teeth, brushing hair, projects, SAT/ACT prep, doing college applications, studying for driver’s license, etc.), without at least a few prompts. They often need multiple prompts to start these types of tasks.

Moreover, they have difficulty in continuing to put forth concentration and effort to finish a non-preferred task, and only partially finish non-preferred tasks.  For example, they may start the chore of putting away their things, or emptying a dishwasher, and then become distracted by something and walk off/do something else, with the task only partly completed.  Or, they may only partly finish class work/homework, with unfinished sentences, careless mistakes, and/or skipping of items.

While completing tasks, youths with ADHD frequently need prompts/reminders to stay focused, to complete the activity. This can occur even with activities they select to do, which require sustained effort and concentration (e.g., Scout badges and pins).  Such behaviors can be frustrating and confusing for parents/extended family members, as youths with ADHD can start and maintain concentration/effort on preferred tasks for longer periods of time (e.g., Minecraft, Xbox/ phone/ devices, computer games, reading if reading is a preferred task, fantasy play).

Similarly, due to the inattention aspect of ADHD, many youths struggle with following through with directions, only finishing one part of a directive (e.g., only putting away half of a laundry basket of their clothes, only completing one part of a school assignment, partly packing their backpack).

  1. Poor problem solving, difficulty in planning ahead, and difficulty in thinking ahead to the consequences of his/her actions:

Youths with ADHD often have quick, impulsive reactions/responses to situations that can be inappropriate.  They frequently lack the ability to think ahead to the consequences of their verbal comments or actions, and to figure out more than one solution to a problem.  When problems happen, brainstorming a few solutions, and figuring out the steps to solve the problem, is hard for them. For example, when having a disagreement with a

peer (s)/sibling(s)/adult, such youths can only figure out one way to deal with this situation, instead of thinking of 2 or 3 solutions; they then act impulsively on the only solution they identified, which may not be effective. Furthermore, they may not learn from mistakes/consequences initially, continuing to do the same negative behaviors, even with repeated consequences.

Another area of struggle involves planning ahead for projects, tests, taking the ACTs/SATS, driving, and applying for colleges; youths with ADHD have may have difficulty in preparing for/doing these tasks over time, waiting until shortly before the deadline to start.  They then experience stress and feelings of being overwhelmed, resulting in avoidance, shutting down, crying, and/or yelling, as well as worsening of inattention and problem solving/ planning/ organizational issues.

Likewise, when faced with more challenging schoolwork/homework/projects/tests, or a challenging sports/social/recreational situation, they may become overloaded/frustrated/angry, and may give up easily, because they have trouble with figuring out an effective way to manage that situation.

  1. Poor awareness of own emotions, poor perspective taking, and poor awareness of how one’s comments/actions/behaviors affect other people.

Due to lacking such awareness, youths with ADHD frequently do not realize how what they are saying and doing negatively affects others.  For example, they often do not realize their loud voice volume, that they have made an inappropriate comment, their interrupting, the negative effect of their impulsive behaviors, and that they are talking excessively about a preferred topic without allowing others to talk.

Similarly, taking the perspective of others is a struggle for them, leading to difficulty in understanding why others feel a certain way in response to their comments/behaviors.  Therefore, they may be confused as to why others are becoming frustrated/annoyed with them, OR they completely lack any awareness that others are becoming annoyed/frustrated with them.  All of this can cause them to appear unempathethic, and to look like they do not care about how they treating others.

Moreover, children with ADHD may have difficulty figuring out, and understanding their own feelings, and trouble identifying and expressing their own emotional reactions to situations.  Consequently, coping with, and working through, stressors and problems can be challenging for them.

Directly below are parts I, II, and III of the series that were written throughout the past year. Thank you so much for joining into our series on EF in ADHD, and take care,

Leah Murphy, Psy.D

 

Cited References:

Barkley, Russell, A. (2013). ADHD: Executive Functioning, Life Course, and Outcomes Management. Premier Education Solutions

Barkley, Russell, A. (2013). Taking Charge of ADHD, Third Edition: The Complete, Authoritative Guide for Parents. Guilford Press, NY, NY