The Association Between Executive Dysfunction and ADHD

The well-known symptoms of attention deficit hyperactivity disorder (ADHD)—inattentiveness and hyperactivity—stem from the impairment of a person’s executive functioning skills. This is linked to dysfunction in the brain and the neurological or nervous system.

While also associated with many other mental health conditions, including obsessive-compulsive disorder (OCD), depression, and schizophrenia, executive dysfunction is most commonly associated with ADHD.  

This article will discuss executive function and dysfunction, what it looks like, how it's evaluated, and how it's related to ADHD.

What Is Executive Function?

Executive functioning is what’s responsible for controlling thoughts, behaviors, and emotions. Executive functioning skills help a person with planning and organizing their time and regulating their emotions and actions. 

These skills are necessary for prioritizing tasks, remembering details, paying attention, focusing, and self-censoring (avoiding saying or doing the wrong things) when necessary. Executive functioning also helps a person understand how the things they say and do now have future consequences for better or worse. 

Signs and Symptoms of Executive Dysfunction

Signs and symptoms of executive dysfunction will vary among people. Symptoms also can change over time, such as when a child with ADHD grows into adulthood. In children and adults, executive dysfunction looks like:

• Difficulties organizing school or work materials
• Struggles with regulating emotions
• Trouble with setting schedules
• Challenges following through with simple tasks

This can result in poor academic or work performance, challenges working in team settings, and interpersonal problems with peers, family, and others. Meeting goals, learning new things and adapting to life changes, and maintaining responsibilities and relationships can be particularly difficult. 

What Causes Executive Function Problems?

Executive function problems have been historically linked to the frontal lobe area in the brain. More recently, researchers have determined that other brain areas also are involved through the neural network, or network of neurons communicating via nodes. This neural network helps our brains process data.

Areas that play a role in executive function include:

• Prefrontal cortex (in front of the frontal lobe)
• Parietal cortex (in the upper back portion of the skull)
• Basal ganglia (primarily responsible for motor control)
• Thalamus (above the brain stem and responsible for sending sensory and motor signals)
• Cerebellum (involved in physical movements)

Executive function problems arise then from genetic differences, injury, or damage to these brain regions, their associated white matter connections, or neurotransmitter systems. In other words, your brain is made up of interworking regions and any trauma to one area can have an impact on executive functioning. 

Evaluating Executive Function

Executive functioning skills aren’t something you either have or don’t have; they exist on a spectrum for all of us. Evaluation is a multistep process that helps the medical professional (primary care physician or psychiatrist) assess what the underlying cause or causes may be and how greatly executive dysfunction is impairing everyday life.

Evaluation typically begins with the doctor taking down a full patient history, including any and all symptoms you think are relevant, and a neurological examination. The evaluation will include a variety of questions aimed at revealing the level of overall functioning in specific areas like planning or organizing, multitasking, decision-making, attention keeping and focusing, problem-solving, adapting to change, memory, and impulsivity.

How Executive Dysfunction Overlaps With ADHD

Executive dysfunction isn’t a diagnosis on its own. It’s also not the same thing as ADHD (which is an official diagnosis). While people with ADHD experience executive dysfunctions, people can also experience them without ADHD. 

There is an overlap between ADHD symptoms and executive dysfunction, though. This can be explained by the fact that many symptoms of ADHD, as discussed earlier, stem from issues with executive functioning.

Overlaps in ADHD symptoms and executive dysfunction include difficulties with:

• Paying attention
• Self-control
• Working memory (ability to memory, use, and apply information)
• Switching tasks
• Focusing
• Organizing or planning
• Completing long-term projects 
• Considering consequences of actions

Managing Executive Function Issues

Executive function issues are also linked to traumatic brain injury, executive function disorder, and various learning disabilities. In any case, the goal of managing executive function issues is to strengthen the executive function skills that are perceived as deficient. In other words, working out the problems is the primary focus. This process is highly personal and depends on both the cause of the dysfunction and the areas requiring the most work.

The National Center for Learning Disabilities (NCLD) offers the following general suggestions that can help strengthen executive function issues:

• Take step-by-step approaches to work or break down tasks into smaller tasks.
• Use tools like time organizers, computers, or watches with alarms.
• Prepare visual schedules or visual task aids, such as flow charts of project milestones, and review them several times a day.
• Request written directions with oral instructions whenever possible.
• Plan and structure transition times and shifts in activities.
  

Behavioral therapies, including cognitive behavioral therapy (CBT) and occupational therapy, may also be recommended to help a person learn to change their thought patterns and regulate emotions. CBT can also be useful for identifying any environmental triggers that are making symptoms worse. School support services or accommodations may also help a person with ADHD and executive functioning with behavior management and building social skills.

Summary

Executive dysfunction is a symptom of ADHD. Both are associated with differences in the brain regions responsible for thoughts, emotions, and behavior. This is also why they have so many overlapping characteristics.

Managing executive dysfunction depends on its cause and the ways it’s impacting everyday functioning. If associated with ADHD, medications for ADHD may help manage symptoms. Other strategies include therapy, skill-building, and receiving accommodation or support services in the school and work setting.

A Word From Verywell 

If you see signs and symptoms of executive dysfunction, you may want to consider talking to your primary care physician. Determining the cause of dysfunction is an essential step in receiving the appropriate treatment. Once you know why you’ve been having difficulties, it becomes much easier to develop a management strategy that will help.

Keep in mind that many people experience such difficulties even in the absence of ADHD, so it’s not necessarily the case that ADHD is causing your issues.