Attention-Deficit/Hyperactivity Disorder (ADHD) and Executive Functions

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD) is a brain-based, neuro-biological disorder characterized by developmentally inappropriate degrees of inattention, impulsivity and sometimes hyperactivity. While these behaviors are, of course, a natural part of childhood, in children with ADHD, these symptoms are excessive, chronic and cause significant impairment in at least two settings (e.g., school, home). Students with ADHD may or may not have academic problems per se; however, they can be developmentally premature in their behavior, self-management and “executive functions,” which can cause significant school performance difficulties.

Common symptoms of ADHD include:

  • Distractibility, staying on task
  • Failure to complete and turn in assignments
  • Disruptive behavior, poor self-control
  • Difficulty following directions
  • Poor working memory, forgetfulness
  • Poor organization and time management
  • Difficulty getting started on and finishing tasks

Diagnosing ADHD is a challenging task because there are many other factors (e.g., medical concerns, learning challenges, sleep disruption, anxiety and depression) that can make a child appear as if they have ADHD. For this reason, our ADHD assessments are comprehensive and thorough, and a diagnosis is never made without consideration of all the aforementioned factors.

In order to treat attention and executive function challenges, we recommend using a conservative stepped approach. In non-urgent situations, first-line treatment should be the least intensive with a step up only when needed. The first step in this process typically is to educate parents on their child’s particular challenges (e.g., books, websites, community lectures, parent support groups) and the potential accommodations available to their child at school (via intervention services or a Section 504 plan). The second step is participating in parent guidance with a child psychotherapist experienced in treating attention and executive function difficulties in children. The final step is to talk with your child’s primary care physician or, better still, consult a child psychiatrist to discuss the appropriateness of pharmacological intervention for your child’s attention and executive function difficulties.

Executive Functions

Dr. Russell Barkley (2011) has defined executive functions as “self-regulation across time for the attainment of one’s goals, often in the context of others.” This involves several separate, but interrelated skills:

  • Inhibitory control (e.g., the ability to inhibit, resist or not act on an impulse)
  • Shifting of behavior (e.g., the ability to move freely from one situation, activity or aspect of a problem to another, as the circumstances demand)
  • Emotional control (e.g., the ability to modulate emotional responses)
  • Initiation of behavior (e.g., independently generating ideas, responses or problem-solving strategies)
  • Working memory (e.g., the capacity to hold information in mind for the purpose of completing a task, encoding information, or generating goals, plans and sequential steps to achieve goals)
  • Planning and organizing (e.g., the ability to manage current and future-oriented task demands within the situational context)
  • Organization of materials (e.g., organization of her everyday environment with respect to work, play and storage spaces)
  • Self-monitoring (e.g., the extent to which one can keep track of the effect that their behavior has on others)

Other Types of Pediatric Assessments