Executive Dysfunction and Its Role in ADHD

By Wasim Kakroo

ADHD is a neuro-developmental condition that affects a person’s ability to exercise executive function. Executive dysfunction is related to brain and nervous system dysfunction, just like other signs of ADHD.

Executive dysfunction is most frequently linked to ADHD, while it is also connected to many other mental health disorders, such as obsessive-compulsive disorder (OCD), depression, and schizophrenia.

In this article, we’ll talk about executive function and dysfunction, including how they manifest, and how they relate to ADHD. We will also talk about the possible treatments of this issue.

What is executive functioning?

Executive functioning is the name given to the ability of the frontal lobe of our brain that helps us in controlling our thoughts, behaviors and emotions. One can plan and organize their time more effectively and control their emotions and behavior with the help of executive functioning skills.

These abilities are required to set priorities, remember information, pay attention, focus, and self-censor (avoid saying or doing the inappropriate thing) whenever required. A person’s executive functioning also helps them in their understanding of how their actions and words today have an impact on their future, for better or worse.

What are the various signs and symptoms of executive dysfunction?

Signs and symptoms of executive dysfunction vary from person to person. Additionally, as a child with ADHD enters into adulthood, their symptoms might alter over time. Executive dysfunction manifests itself in both children and adults as:

1. Having trouble organizing your tasks

2. struggles to control one’s emotions

3. Setting up schedules is difficult

4. Having trouble meeting deadlines

5. Inability to remember things

6. Arriving late for social engagements, appointments, meetings, school, or job

7. difficulties in carrying out simple activities

8. Behavioral outbursts

This may lead to poor academic or professional performance, difficulties working in a team environment, and interpersonal issues with peers, family, and other people. Goal-setting, learning new skills, adjusting to life’s changes, and upholding responsibilities and relationships can be particularly challenging.

What Leads to Executive Dysfunction?

The frontal lobe region of the brain has historically been associated with problems with executive function. In addition, research has also found that problems in the prefrontal cortex, Basal ganglia, Thalamus and cerebellum also lead to executive dysfunction. Therefore, issues with executive function might result from genetic variances, harm to above mentioned brain regions, or neurotransmitter imbalances.

How is executive dysfunction related to ADHD?

Many or all of the signs of executive dysfunction are likely to be present in an individual with ADHD. Executive dysfunction is a collection of symptoms that are linked to ADHD; however it is possible to have executive dysfunction without having ADHD. E.g., Autism sufferers also exhibit it.

Executive dysfunction might also result from other conditions. With illnesses like depression, executive functions may fluctuate based on how a person is feeling, however with ADHD; it’s a persistent brain problem. This may explain why it may present itself differently in people with ADHD.

What types of executive dysfunction are found in people with ADHD?

Various areas of life, especially where self control is needed, are affected by executive dysfunction. Executive dysfunction can lead to impairment in a person’s daily life. The capacity to inhibit one’s tendency to go for a task that is not preferred, maintain attention and concentration, know what to focus on when, shift focus, have working memory (keeping information in mind), and plan and organize oneself are a few of the executive functions that may get impaired.

Some issues that happen because of executive dysfunction include:

1. Issues with working memory: It has been shown that executive dysfunction can lead to problems with working memory. Life can be very challenging for someone who struggles with working memory. The range of memory problems that executive dysfunction can cause is endless; you might forget little particulars or entire occurrences. You can forget what you were supposed to do on a particular day or leave something at home that you required for your day.

2. Issues with organization, planning and time management: We must be able to plan our tasks, organize our resources, and complete them in a fair amount of time if we are to do everything that we want to do. This whole process may be hampered by executive dysfunction. A person with executive dysfunction may be disorganized, have trouble establishing plans or adhering to them once they are created, and be unable to finish tasks within the required time frame.

3. Issues with paying attention and poor concentration: Since deficits in attention is one of the characteristic features of ADHD, thus this aspect of executive dysfunction is an important one that is related to ADHD. To do anything, one needs to be able to focus and concentrate.

It may seem tough to maintain continuous focus for a task when you have executive dysfunction. The person may wind up doing something completely different, sometimes without even recognizing it, even when they try to concentrate and focus on one thing.

4. Issues with behavioral and emotional control: How we behave and manage our emotions greatly affects how we interact with others. The ability to control one’s emotions may be more difficult for those with executive dysfunction than for others. It is quite challenging to control your behavior when you are unable to control your feelings. Interpersonal conflicts and behavioral issues may result from this.

5. Issues with multi-tasking and problem-solving: The capacity to handle multiple tasks at once and solve issues is important, even in childhood. It becomes much more important as you get older. However, they can seem like an insurmountable challenge if you have executive dysfunction.

Someone with executive dysfunction could only be able to handle one task at a time, and they can struggle to solve problems. Problems can seem challenging because executive dysfunction interferes with flexible thinking, which is the capacity to view a situation from various angles.

How is executive dysfunction in ADHD treated?

If you are battling with executive dysfunction as a part of your ADHD, you may talk to a psychiatrist who may help you with medications including stimulants and antidepressants.

Another option for treating executive dysfunction is psychotherapy (including behavior therapy, Cognitive Behavior Therapy, Mindfulness etc.) that is offered by trained Clinical Psychologists. This type of treatment provides fresh perspectives that result in more adaptive behavior.

In addition, below are some tips that might be of some help:

1. To get things done, speak aloud as you go. Try talking yourself through a task if you’re having problems starting it. Even though it may seem insignificant, speaking is a physical activity that occasionally serves as a catalyst for other physical activities, such as standing up to begin your task.

2. Decide where to begin. When you can’t prioritize, you can’t begin since every step of the process seems equally important to starting. Executive dysfunction has the capacity to make you completely forget how to prioritize the steps in a task. Find a suitable starting point, try to calm down, and speak to yourself aloud. It only needs to be a spot where you can begin; it doesn’t even need to be the “best” or “perfect” place to start.

3. Try breaking the task into steps: All of a sudden, everything might seem too complicated while experiencing executive dysfunction. Things can be made simpler by dividing them into manageable tasks.

4. Try to think forward: Getting dressed in the morning can be tough due of executive dysfunction because there are so many choices to be made, such as “Do I want to take a shower?” or “Which outfits are best for the activities I have planned for that day?” Mornings can run much more smoothly when one does a little easy planning, like laying out your clothing the night before.

5. The pomodoro technique: According to the pomodoro technique, you should work for a predetermined period of time, take a break, and then resume the process. As an illustration, you could set a timer for 25 minutes, work for that amount of time, and then take a break (maybe rewarding yourself with a cup of tea or a short walk or watching a funny reel video). You can then begin working for another block of time.

6. Use tools: Use time management tools, computers, or alarm clock watches.

7. Use of visual aids: Make visual schedules or task aids, like flow charts of project milestones, and review them numerous times per day.

• The author is a licensed clinical psychologist (alumni of Govt. Medical College Srinagar) and works as a consultant clinical psychologist at Centre for Mental Health Services (CMHS) at Rambagh Srinagar. He can be reached at 8825067196

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