Guest post by Gayle M. Pape, LCSW
Daily life can be both complicated and simple. We might design an architectural blueprint (complex) and get to work on time (simple). The mental skills – executive functioning skills – to do those tasks are typically used without any awareness. Those skills include effective time management, meeting deadlines, focusing on the task at hand, organizing thoughts, prioritizing tasks, and planning long-term goals. What do you do when those skills are impaired, like if you have Executive Functioning Disorder or ADHD?
I’ll answer that question in just a bit, but first let’s take a deeper look at executive functioning in adults. Think about the tasks that make up your day: waking up on time, remembering to pick up laundry at the dry cleaners, remembering the date of your child’s college graduation ceremony, keeping your cool when Netflix or cable doesn’t work when you want to watch your favorite show, completing all the errands on your list without stopping at Barnes and Noble just because, and meeting your sales deadline at work… I could go on, but I think you get the picture.
These are your executive functioning skills at work. They are the skills you use to manage your time efficiently, prioritize tasks, organize your thoughts, make decisions, and plan and finish tasks in a timely manner. These skills help you to reason and think before acting, meet new challenges with flexibility, and stay focused on your goals.
Executive functioning skills are housed in the prefrontal cortex in our frontal lobe, or the “brain center”. It is the area responsible for higher-level thinking skills like executive decision making, analytical processing, and self-regulation behaviors. (And as you’ll see later, these areas and more are where there can be impairment when ADHD is present.)
7 Executive Function Skills
Russell Barkley, Ph.D. explains that executive functioning is judged by the strength of these seven skills:
1.Self-awareness: Simply put, this is self-directed attention.
2.Inhibition: Also known as self-restraint.
3.Non-Verbal Working Memory: The ability to hold things in your mind. Essentially, visual imagery — how well you can picture things mentally.
4.Verbal Working Memory: Self-speech, or internal speech. Most people think of this as their “inner monologue.”
5.Emotional Self-Regulation: The ability to take the previous four executive functions and use them to manipulate your own emotional state. This means learning to use words, images, and your own self-awareness to process and alter how we feel about things.
6.Self-motivation: How well you can motivate yourself to complete a task when there is no immediate external consequence.
7.Planning and Problem Solving: Experts sometimes like to think of this as “self-play” — how we play with information in our minds to come up with new ways of doing something. By taking things apart and recombining them in different ways, we’re planning solutions to our problems.
Barkley’s model is based on the idea that inabilities to self-regulate lie at the root of many challenges faced by individuals with ADHD (Attention Deficit/Hyperactivity Disorder). For example, he explains that people with ADHD may be unable to delay responses, thus acting impulsively and without adequate consideration of future consequences. This can be either beneficial or negative.
Related Reading: How Childhood Trauma Could be Mistaken for ADHD
6 Clusters of Executive Functions
Tom Brown, PhD. breaks executive functions down into six different “clusters.”
- Organizing, prioritizing, and activating for tasks
- Focusing, sustaining, and shifting attention to a task
- Regulating alertness, sustaining effort and processing speed
- Managing frustration and modulating emotions
- Utilizing working memory and accessing recall
- Monitoring and self-regulating action
According to Brown, these clusters operate in an integrated way. People with ADHD tend to suffer impairments in at least some aspects of each cluster. Because these impairments seem to show up together much of the time, Brown believes they are clinically related.
Under Brown’s model, difficulties in these clusters lead to attentional deficits because individuals have difficulty organizing tasks, getting started, remaining engaged, remaining alert, maintaining a level emotional state, applying working memory and recall, and self-monitoring and regulating actions.
The Development of Executive Functions
Research indicates the development of executive functions starts at age two and is complete by age thirty. They develop in a sequence and interact with each other via four circuits in the prefrontal cortex. These are:
- The “what” circuit: controls working memory. What we think starts to guide what we do, i.e.: setting plans, goals and the future.
- The “when” circuit: the timing circuit of the brain. It coordinates the timeliness of actions and when things get done.
- The “why” circuit: controls emotions. What we think controls how we feel, and what we feel controls how we think. It is the decision maker in all our plans.
- The “how” circuit: the final circuit where self-awareness takes place with our internal and external feelings and experiences.
Those with weakened executive functions and/or ADHD may experience impairments in one or more of these circuits. People with ADHD are often up to 40% delayed in development and are more likely to be motivated by short term rather than long term goals.
Executive Dysfunction and the ADHD brain
Dysfunction in executive functioning and ADHD are biologically based impairments. They can be the result of genetics or from damage to the prefrontal cortex (brain center) through trauma, maternal substance use during pregnancy, or neglect.
These impairments can be intertwined or separate. In other words, one can have executive functioning impairments without having ADHD. However, those with ADHD typically have executive functioning impairments. While ADHD is technically a mental illness because it affects mood, thinking, and behavior, it is better thought of simply as a behavior disorder. Specifically, we see the six clusters of executive functions mentioned above impaired in individuals with ADHD.
Russell Barkley, Ph.D., who has been at the forefront of exploring the relationship between executive functioning disorder and ADHD, says, “It is not that the individual does not know what to do. It is that somehow it does not get done.” Dr. Barkley explains that individuals with executive dysfunction often struggle to analyze, plan, organize, schedule, and complete tasks. They misplace materials, prioritize the wrong things, and get overwhelmed by big projects.
Signs of executive dysfunction involve misplacing school or work materials, difficulty keeping track of personal items (keys or wallet), trouble keeping items and rooms organized, missing deadlines, and being late to work. The emotional side of executive dysfunction involves procrastination, negative self-talk, low self-esteem, worry, and lack of motivation. In addition, this can include symptoms of anxiety and depression. People with executive dysfunction impairments and/or ADHD that go untreated can be negatively impacted in many areas of their lives, including work, relationships, and mental health. Stress, even if mild, can hinder their executive functioning skills.
ADHD and Executive Dysfunction Treatment
There are a variety of ways to work with impaired executive functioning skills and/or symptoms of ADHD. These are the primary methods of ADHD and executive dysfunction treatment:
Cognitive Behavioral Therapy (CBT) is often helpful because it offers interventions in the moment. CBT challenges accountability, includes practice of skills to see improvement, and ultimately reduces stress.
EMDR is a treatment that can assist with processing mental, emotional, and physical sensations that may be caused by past trauma, or biological impairments.
Medication and psychoeducation can be given by a psychiatrist or medical doctor to treat symptoms of ADHD.
ADHD Coaches can help develop executive functioning skills that are impaired. It is important to remember that ADHD coaches aren’t therapists, medical experts, or mentors. They are proactive and there to help you achieve specific goals. They do not necessarily deal with psychological issues associated with ADHD or executive dysfunction.
If you would like help dealing with Executive Functioning and ADHD issues, therapists at Life Care Wellness can provide appropriate treatment options for you. Please reach out to us at our Glen Ellyn, Chicago (Jefferson Park), or Sycamore offices.
Gayle Pape works with both children and adults. She utilizes Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Mindfulness Based Therapy, Strength-Based Therapy, Solution Focused Therapy, Art Therapy and Play Therapy. Gayle treats anxiety, depression, trauma, emotional, and behavioral issues, along with the effects of divorce, grief, stress, and school-related issues. She sees clients in the Glen Ellyn office.
