Regardless of age, learning that you or a loved one has ADHD or experiences symptoms of Executive Dysfunction can be difficult to process. One of the reasons that this news can be so overwhelming is that there's simply so much information out there on the subject that it can feel like an impossible task just to decipher what's true or important (let alone decide what the next step is.) Luckily, we have you covered. 
The journey of treating ADHD starts with first understanding how ADHD actually works. There are a number of reasonable places to begin your ADHD deep dive, but we’ve found that deeply understanding the concept of Executive Dysfunction is an important jumping off point for individuals looking to improve ADHD symptoms. In this article, we’ll be exploring everything you need to know about Executive Dysfunction as it relates to ADHD by answering the following questions:
By doing so, you'll have a better understanding of Executive Dysfunction fits into the larger puzzle of ADHD treatment. Let’s dive right in.
1. What is Executive Dysfunction?
Executive Dysfunction is a term used to describe a range of challenges in to self-management, goal-directed behavior, and decision-making. More specifically, Executive Dysfunction is a disruption in a person's ability to plan, self-monitor, organize, balance time, manage emotions, and complete tasks.
It can also impact working memory, flexible thinking, and problem-solving. These abilities are part of the larger constellation of Executive Function skills and are critical for success in school, work, relationships, and our overall well being. Although Executive Dysfunction can have a serious impact on our lives, it’s important to note that Executive Dysfunction is not an official disorder or diagnosis in and of itself, but often a result of internal or external factors that we'll explore by answering the following question...
2. What Causes Executive Dysfunction?
Although the full picture of what causes Executive Dysfunction is not completely understood, in most cases, the issues can be traced back to disruptions in the prefrontal cortex (the part of the brain responsible for our Executive Functioning.) These disruptions can have a variety of root causes that vary from person to person including:
Learning Differences: Certain learning differences such as ADHD, autism, and dyslexia, for example, can lead to Executive Dysfunction.
Genetic Factors: Research suggests that genetics can play a role in Executive Dysfunction. Some genetic variations have been linked to differences in a number of cognitive functions including Executive Functioning.
Psychological Factors: Psychological factors such as anxiety, depression, trauma, and other mental health issues can also cause Executive Dysfunction
Sleep Deprivation: Sleep is important for cognitive function, and a lack of it often leads to Executive Dysfunction.
Environmental factors: Environmental factors that involve high levels of stress such as tense living environments, hectic schedules, difficult course loads, and hefty work demands can all exacerbate Executive Dysfunction. Other environmental factors that can contribute to Executive Dysfunction include nutrition, exercise (or lack thereof), and overall physical health,
Brain Injury: Brain injuries, such as a concussion or traumatic brain injury (TBI), can lead to Executive Dysfunction. This is largely because the prefrontal cortex is located in the front of the brain, making it particularly vulnerable to injury. The severity and duration of Executive Dysfunction after a brain injury can vary depending on the extent and location of the injury.
3. How Does Executive Dysfunction Relate to ADHD?
Although Executive Dysfunction and ADHD are interconnected, they are distinct concepts. As you may already know, ADHD is a neurodevelopmental disorder that's broadly characterized by symptoms of inattention, hyperactivity, and impulsivity. On the other hand, Executive Dysfunction refers to difficulties with specific cognitive processes, such as planning, organization, initiation, and completion of tasks, outside the context of the source for those challenges.
ADHD is thought to cause Executive Dysfunction due to its impact on the brain's reward circuit, resulting in greater difficulty controlling attention, behavior, and emotions. In fact, up to 90% of those diagnosed with ADHD struggle with Executive Dysfunction.
However, it's important to note that not everyone who experiences Executive Dysfunction necessarily has ADHD. Executive Dysfunction may be a typical component of ADHD, but it is not synonymous with the disorder nor is it a sign of having ADHD on its own. This is because ADHD regularly involves a number of other symptoms, risk factors, and challenges that are not associated with Executive Dysfunction alone.
4. What Are the Symptoms of Executive Dysfunction?
As you now know, Executive Dysfunction relates to a disruption in our ability to plan, organize, initiate tasks, and sustain attention - but what does that actually look like in day-to-day life?
Executive Dysfunction can manifest as a number of unique symptoms, all of which pose their own problems and can greatly hinder our ability to succeed. We’ll break down a few of the most common symptoms of Executive Dysfunction and connect each one to the Executive Function skill they most likely relate to.
Procrastination
Of all the Executive Dysfunction symptoms, procrastination may be the most common and widespread. At times, even successful, high-achieving individuals may struggle to begin a difficult or less-than-exciting task. However, when this becomes a regular habit - one that leads to last-minute scrambles, wasted time, stress, and missed opportunities - it can have serious consequences on our academic, professional, and personal lives. Those experiencing Executive Dysfunction may struggle to start tasks, even when they are aware of what needs to be done. This habit is often a coping mechanism to avoid the discomfort of a difficult task or responsibility.
Related Executive Function Skill: Task Initiation
Time Blindness
Time blindness is a difficulty or inability to sense the passage of time. Disruptions with time awareness, whether minor or substantial, can affect numerous areas of an individual's life. Underestimating or overestimating how much time has passed, how long a task will take, or how much time is left before an appointment starts; ongoing difficulty meeting deadlines or arriving on time; difficulty forming realistic schedules or sticking to a schedule, and constantly losing track of time are all examples of time blindness. Time blindness can show up in multiple forms and, left unchecked, can greatly diminish our ability to be happy and successful.
Related Executive Function Skills: Planning & Prioritizing
Disorganization
Executive Dysfunction can lead to difficulties with organization that affect us in a variety of ways both physically and mentally. The term “disorganization” encompasses issues with keeping track of personal belongings, maintaining an orderly space, organizing thoughts and ideas, and managing deadlines. Chronic disorganization can have serious consequences including misplaced assignments, heightened stress, relationship problems, financial impacts, and more.
Related Executive Function Skill: Organization
Distractibility/Difficulty Concentrating
Today's world puts a constant strain on our ability to sustain attention. Left unchecked, this can result in Executive Dysfunction symptoms around distractibility and concentration Although it's normal to occasionally find yourself distracted, regularly struggling to stay focused has a number of serious consequences that can hold us back, including poor grades, relationship challenges, challenges with self-care, and heightened stress and anxiety overall. These issues can sometimes relate to a lack of impulse control, but this is not always the case as individuals may simply struggle to filter out distractions and stay focused on tasks, resulting in frequent interruptions, forgetfulness, and difficulty paying attention to important details.
Related Executive Function Skill: Impulse Control & Sustained Attention
Working Memory Challenges
Working memory refers to the ability to hold information in mind and manipulate it to solve problems or complete tasks. Individuals with Executive Dysfunction may struggle with working memory, leading to difficulties retaining information, applying what they’ve learned, following multi-step instructions, and keeping track of details.
Related Executive Function Skill: Working Memory
Problem-Solving Challenges
Executive Dysfunction can impact an individual's ability to think flexibly and switch between tasks or perspectives. This can result in difficulties adapting to new situations or making decisions. Additionally, those with Executive Dysfunction may struggle with problem-solving, as they may have difficulty generating and evaluating options.
Related Executive Function Skill: Cognitive Flexibility
Executive Dysfunction's Unique Impact on Those with ADHD
Although those without ADHD can and do experience many of these symptoms from time to time, those with the disorder experience these symptoms both more frequently and more severely. In other words, Executive Dysfunction is typically an ongoing challenge for a vast majority of those with ADHD. As a result, Executive Dysfunction is far more frequent, disrupting, and all-encompassing than it would be for someone without ADHD. As a result, these challenges can cause significant difficulty in school, work, personal relationships, and overall health and well-being. Because of these serious consequences, learning to manage the Executive Dysfunction associated with ADHD is essential for long-term success and day-to-day functioning. In doing so, you can even unlock the superpowers of ADHD. This point leads us to the most important question of all...
5. How Can You Treat Executive Dysfunction in ADHD?
Although Executive Dysfunction can make life infinitely more difficult, it’s important to remember that the challenges and symptoms that come with it are indeed treatable.
Some of the most effective executive dysfunction treatments include medication (i.e. stimulants and antidepressants), therapy or professional coaching to improve habits, and healthy lifestyle changes. These treatments have been proven to provide relief and improved quality of life in individuals experiencing executive dysfunction.
Let's look at 4 of the most effective support options for Executive Dysfunction in ADHD so you can begin to consider what the path toward success can look like for you or your child. Before we dive into each, also remember that treatment for complex issues like ADHD and Executive Dysfunction often requires a combination of approaches. You may find just one of these approaches does the trick, or you may require more than just these three. The key takeaway here is to try and understand what the support process may consist of for the challenges you're currently facing.
Support Option #1: ADHD Medication for Executive Dysfunction
Medication can help with Executive Dysfunction by targeting the underlying causes of the disorder within the brain. Medications used to treat Executive Dysfunction include stimulants and non-stimulants often prescribed for ADHD, antidepressants, and sometimes antipsychotics.
Pharmaceuticals that also help manage ADHD, such as stimulants and non-stimulants, work to improve Executive Dysfunction by increasing the levels of dopamine and norepinephrine, key neurotransmitters in the brain, a process that helps alleviate many of the Executive Dysfunction symptoms we’ve discussed so far (particularly ones rooted in chemical imbalances in the brain such as inattention, poor impulse control, and hyperactivity.) In other words, by increasing the levels of these neurotransmitters, ADHD medication can improve attention, working memory, and impulse control and help individuals with ADHD to better plan, organize, and complete tasks.
However, it's important to note that medication is rarely a one-stop, magical cure for Executive Dysfunction and it's often used in combination with the other interventions we’ll be discussing. After all, pills can’t teach skills nor can they reprogram deeply ingrained habits that can be contributing to Executive Dysfunction. The decision to try an ADHD medication for Executive Dysfunction should always be done under the supervision of a licensed medical professional, particularly those with expertise in the field of ADHD, who can help determine the best course of treatment based on individual needs and circumstances.
Support Option #2: Accommodations for Executive Dysfunction
When learning how to deal with Executive Dysfunction and ADHD, it’s important to build accommodations that support cognitive deficits. However, it may take some time and persistence to find the accommodations that work best for you at home and in the classroom or office as they should be tailored to specific needs and preferences. Some Executive Dysfunction strategies to try include:
- Sit at the front of the classroom to manage distractions
- Use checklists to organize tasks
- Follow daily routines
- Use timers to set focus time
- Give daily report cards to track and encourage progress
- Use rewards to encourage behavior
- Try assistive technology like apps
- Meditate to stay positive and calm
Everyone has strengths and weaknesses. By providing the right support and resources, individuals with executive dysfunction can focus on their strengths and better manage their symptoms. This gives them a fair chance to succeed in academic, professional, and social settings.
Support Option #3: Lifestyle Changes for Executive Dysfunction
Lifestyle changes can be a critical component to better managing Executive Function as our brain’s functioning is directly related to our overall health and well-being. Studies have found that the following lifestyle changes can greatly improve the overall symptoms of Executive Dysfunction:
Exercise: Regular physical exercise has been shown to improve executive functioning by increasing blood flow to the brain, promoting the growth of new brain cells, and reducing inflammation. Exercise can also help to reduce stress, which can be a contributing factor to Executive Dysfunction.
Sleep: Getting enough sleep is essential for optimal cognitive function, including executive functioning. It is important to establish a regular sleep routine and aim for 7-8 hours of sleep per night. This is particularly true for those with ADHD as sleep problems and ADHD can go hand-in-hand. If one of those problems includes insomnia, it may be worth working with a professional who specializes in Cognitive Behavioral Therapy for Insomnia (CBT-I). Sleep medication could be a last resort and should be carefully administered and monitored by a licensed professional.
Nutrition: Eating a healthy, balanced diet with plenty of fruits, vegetables, and whole grains can provide the brain with the nutrients it needs for optimal functioning. It is also important to stay hydrated by drinking plenty of water.
Mindfulness and Relaxation techniques: Mindfulness meditation and relaxation techniques such as deep breathing, progressive muscle relaxation, and yoga can help to reduce stress and improve focus and attention. Studies have found that meditating just 10 minutes a day can lead to a whole range of cognitive benefits, many of which directly relate to our Executive Functions.
When these lifestyle changes are implemented, you may see a major improvement in your Executive Dysfunction symptoms. However, for many people struggling with their Executive Functioning, it can be difficult to maintain significant changes in these areas due to the resulting deficits in skills like task initiation, planning & prioritizing, and time management. When this happens, 1:1 Executive Dysfunction help and support is often the most critical missing piece of the treatment puzzle, which leads us to our third and final support option...
Support Option #4: Coaching for Executive Dysfunction
As we were just saying, although medication and lifestyle changes and personal accommodations can significantly improve Executive Dysfunction symptoms, they cannot overhaul deeply ingrained habits that may be perpetuating the problem, nor can they provide flexible support, accountability, or mentorship to guide the difficult journey of behavior change. When these supports fail to adequately address the full scope of the challenges you're seeing, Executive Function coaching may be the ideal support option. So what is Executive Function coaching and how it can help with the symptoms of Executive Dysfunction and ADHD?
EF coaching is an Executive Dysfunction treatment approach that teaches people of all ages how to better manage their tasks and responsibilities. Executive Function coaches accomplish this by providing tools and strategies that are used to help clients better manage their time, plan, organize, prioritize, focus, and work more efficiently. Through ongoing 1:1 support, those in coaching use their demands in school, work, or in their personal lives as the proving ground for implementing new strategies and approaches that, in time, help transform deeply ingrained habits and behaviors that hinder one's ability to function at their peak potential.
Since 2006, we have worked with thousands of individuals with ADHD to help them successfully plan their work, persist with those plans, and gain true insight into who they are and what they need to be happy, productive, and confident. In fact, over half of the clients we work with have ADHD. You can learn more about our outcomes for Executive Function coaching across age groups here.
6. How Do You Evaluate Executive Dysfunction?
Executive Dysfunction is not an official disorder that can be diagnosed by a medical professional. However, there are a number of evidence-based tools used by psychologists and other mental health specialists that can be used to evaluate executive function skills and rule out any underlying conditions. These screening assessments include:
- Comprehensive Executive Function Inventory:
This scale illuminates EF strengths and weaknesses in children from 5-18 years old by evaluating questionnaires completed by adults close to the child. These can include parents, teachers, family friends, and other adults who spend a significant amount of time with them.
- The Conners Comprehensive Behavior Rating Scale (CBRS):
Like the previous assessment, this evaluation involves adults close to a child filling out a multiple choice rating scale to recognize whether ADHD symptoms are present.
- Barkley Deficits in Executive Functioning Scale for Adults:
When undertaking this evaluation, you and an adult who knows you well both report on your EF skills including organization, planning, time management, and emotional control. - Stroop Color and Word Test:
This neuropsychological assessment evaluates your ability to think before speaking or reacting to stimuli. It is to look at impulse control in both adults and children.
If Executive Dysfunction is negatively impacting your daily life, these evaluations may give you clarity on causes, along with your strengths and weaknesses. Some are available online, but others are administered by a medical professional.
The Takeaway
Although Executive Dysfunction and ADHD can be difficult to manage, they can be properly treated with the right combination of knowledge, support, and strategies in place. Hopefully, you’ve learned what you need to in order to conquer the Executive Dysfunction that's preventing you or your child from discovering the hidden gifts inside an ADHD brain.
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