Monday, August 8, 2011

The Importance of Executive Function with ADHD

by Emily Suggs, LPC

When thinking about ADHD, it is essential to recognize the importance executive function plays in our day-to-day functioning. First you may be wondering what is executive function?

“Executive Function is a set of mental processes that helps connect past experiences with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details and managing time and space”  (CHADD ATTENTION magazine, February 2002).

As adults we use executive function all day long to help remember tasks and responsibilities. We make list to carry to the grocery store (planning/strategic thinking). We don’t answer a phone call when we are trying to get kids out the door to school because we don’t want them to be late to school (interference control). After working all day we come home and cook supper (initiating task). We make list of things we need to remember to accomplish during the day (planning). We set three alarm clocks so we don’t oversleep (sense of time).

These are examples of how the different mental processes guide us through our day-to-day functions. These mental processes are believed to be based in the pre-frontal region of the brain. For many individuals, these processes occur naturally and allow one to move through day-to-day tasks easily; however, for an individual with ADHD, there is an impairment or deficit in executive function. An example of what this might look like is:

Emma’s mother tells her to start her homework (initiating task). Five minutes passes and Emma still has not started her homework (lack of motivation). When she finally sits down to start her homework, she cannot find where she wrote down her assignments (lack of planning and strategic thinking). She calls a friend to get her assignment but gets distracted by talking to her friend about her new toy (no sense of time/interference control).  Emma looks at her assignments and is overwhelmed by all the work she has to accomplish (lack of initiating task). Not sure where to begin she begins watching television (interference control/lack of motivation). Her mom redirects her to start her homework. She picks up her pencil and notices it is dull. She wonders where her sharpener could be. This leads Emma to dumping out her backpack looking for a pencil sharpener (interference control). By this time an hour has passed and Emma has not completed any of her homework (no sense of time).

Because these deficits exist for individuals with ADHD, it is important for individuals to exercise skills that will improve their executive function.  The following are suggestions and tools that may help improve these mental processes:
  • Planning/strategic functioning/working memory: planners, checklists, calendars, charts, reminders
  • Regulating emotions: talking, drawing, writing, exercising
  • Internalized language: positive self-talk, post or memorize sayings, proverbs, and Bible verses,      meditating/reflecting
  • Interference control: turn off television, limit distractions, silence cell phones, and prioritize tasks
  • Self-motivation/initiating action: small/easy tasks first, set deadlines/due dates, evaluate reward/consequence
Here is how the above story might be different when focus is placed on improving executive functions. (Notice the mother’s role is to equip and empower her child to improve her executive function.)

Emma’s mother tells her to start her homework (initiating task). Emma, with her mother’s help, unpacks and organizes her books and assignment notebook/folder from her backpack. She decides what assignments she will do first (strategic thinking/planning.) Emma notices her favorite show is coming on later that night and her mother reminds her that if she plans to watch television later, she must complete her homework.(sense of time). Emma’s mom decides to turn off the television so she does not get distracted (interference control). To help her stay on task with each assignment, Emma’s mom sets a timer that allows Emma to know when it is time to move to the next assignment (shifting between task/sense of time). While working on her math, Emma’s pencil lead breaks. But Emma knows her sharpener is located in her pencil bag because she organized her backpack and zipper binder before starting homework (strategic thinking/planning). An hour passes and Emma is about to check off her last homework assignment.

Of course it is never quite this easy, however the goal is to equip the child with these skills so as the brain continues to develop, so will the executive function. Just like a young baseball player does not start out knowing all the skills and techniques of baseball but begins learning the basic skills and techniques. As he grows and develops, it becomes a natural part of playing baseball.

Dendy, Chris A. Zeigler M.S. “Executive Function: What Is This Anyway?” CHADD ATTENTION magazine: February 2002.

Yeager, Marcia LCSW, RPT-S. “Executive Function: A Key to Understanding the ADHD Mind.” Play Therapy Magazine: June 2009.

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