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ADHD and Executive Function

Human Eye with different lines. The line of si...

Human Eye with different lines of sights.

We know that ADHD exists, so I’m not going to go into proofs that the child is not “raised irresponsibily”.  On the other hand, having a child with any disability does require you to be a more sophisticated parent and more sympathetic.

Executive Function (EF)

Executive Functions or EF are the skills used to filter, organize, and prioritize stimulus and cognition to perform a function.  Kids with ADHD  “exhibited significant impairment on neuropsychological
measures of response inhibition, vigilance, working memory, and planning”.   

Tests

From the neuropsych perspective, the Wisconsin Card Sort,  the Rey–Osterreith, and the Tower of Hanoi have been used to test EF.  You may have seen these tests on the Neuropsych Report when you had your child tested at the psychologists office.

EF part of ADHD or IS ADHD?

The International Journal of Disability, Development and Education, published a paper about how ADHD can be looked at with respect to EF with two perspectives: 1) Executive Function is part of the ADHD diagnosis or 2) Executive Function is the reason you have ADHD in the first place. 

Many meta studies have shown that while there is weakness of executive functioning in a part of the ADHD population it is not a singular representation of ADHD behaviors and outcomes.  Some studies show that only 30% of those diagnosed with ADHD have executive functioning problems.  And  people with autism, oppositional defiant, traumatic brain injury and other disorders also show EF problems.

Others like Denckla, Barkley, T.E. Brown and others show that there is significant cognitive impact, especially the ability to inhibit.  Brown has modeled the areas where this cognitive deficit can be seen:

  1. Activation: Organising, prioritising and activating to work.
  2. Focus: Focusing, sustaining, and shifting attention to tasks.
  3. Effort: Regulating alertness, sustaining effort, and processing speed.
  4. Emotion: Managing frustration and regulating emotions.
  5. Memory: Utilising working memory and accessing recall.
  6. Action: Monitoring and self-regulating action.

Brown argues that tests traditionally used in a neuropsych report are insufficient indicators of EF strengths.  The reason for this is that dissecting a problem into constituent parts is reductionist and does not reflect the whole.  While you can put body parts together and add electricity, you will not get a whole functioning human from it.  Rather a test of normal daily functions is a better indicator of EF ability.

Stealth Dyslexia

Sometimes EF problems can result from Stealth Dyslexia.  Have you or child made “stupid mistakes”?  You know that 3+12=15, but on a test you may multiply the left hand side and come up with an answer of 36, and not know you made the mistake.  Even if you go back and check.  Dyslexia originally thought to be a reading disorder may manifest in several ways not currently recognized as dyslexia.  What if the dyslexia manifested cognitively outside of just reading?  Eides and Eides have determined that Stealth Dyslexia have these in common:

  • Characteristic dyslexic difficulties with word processing and written output.  This is sometimes found as high IQ and verbal comprehension but trouble with output: terseness, spelling mistakes etc.
  • Findings on neurological and neuropsychological testing consistent with the visual language, auditory, and motor processing deficits characteristic of dyslexia.  Visual Percepetion issues and not attention could be the cause of coding/tracking problems.  Visual Problems can often be addressed by seeing a Developmental Optometrist.  Central Auditory Processing Disorder (CAPD) is found in many kids (and adults) where one cannot manage and filter background sounds from primary communication.
  • Reading skills that appear to fall within the normal or even superior range for children their age, at least on silent reading comprehension.  But writing and listening may be problematic.  Sometimes one can tape the lecture knowing that ideas will be recorded for later recall, several times if needed.   That way one can listen to the lecture and absorb the concepts.

Processing Speed

Yes slow processing speed is a recognized condition and can contribute to the impulsivity of ADHD.  People with SPS (I just made that up), cannot participate in dynamic conversations because just as they’ve figured out the pace, direction and tone, it has moved on.  They also have trouble “getting” things that are taught.  You might find very intelligent people teaching themselves, and rather than get behind they teach themselves ahead of everyone else. If you cannot keep up, you might just  forget it and decide to go for things.  And this may become a habit, that manifest as EF.  Some studies show that processing speed normalizes around 27 years of age, but if you can’t wait that long…or have regressed because of TBI, you can consider neurofeedback or SimplySmarter which works on sequential processing  and therefore could help processing speed in general. 

Medications have not been known to help with any of these things that interfere with clear EF, but knowledge of these aspects may allow you to have the sympathy to support your child (spouse?) better.

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Categories: Affect/Emotion, Anxiety, Autism
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