ADHD and Executive Function

During the beginning of the last century, ADHD was commonly seen as a condition which had resulted from brain damage in the child.

This model was rejected in latter half of the 20th Century, going out of fashion by the end of the 1980’s.

In the decades that have followed research has provided a wealth of new information when it comes to ADHD and how it affects children.

One of the biggest leaps forward in our knowledge has come from research into Executive Function and what impact ADHD has on this.

Neuropsychology research has now shown that there are deficits in the executive functions of the brain which are responsible for self-regulation.

What are Executive Functions?

Written in Attitude Mag, Dr Larry Silver explains aspects of executive functions or ‘EF’ and how they develop.

EF’s are parts of the brain that develop as we grow and are responsible for helping us plan and regulate tasks such as planning, attention and focusing on tasks.

They also affect the way moods are regulated. Research by scholars, in particular, Dr. Thomas Brown, have placed difficulties with EF into 6 main groups or ‘clusters’.

1. Activating Tasks
Issues such as protracted procrastination are observed as well as difficulty in beginning tasks and staying focused on them are impaired. This might affect a child when attempting to begin tasks such as reading or writing.

2. Focusing and Sustaining Attention on Tasks / Shifting Attention Between Tasks
Some children struggle with selecting tasks and others on sustaining concentration. Many children suffer from high distractibility. Paying attention to instructions from teachers and caregivers might be particularly challenging.

3. Regulating Alertness and Processing Speed
These areas can be affected, causing children to have difficulty with staying alert and engaged, as well as how quickly they can process information and tasks.

4. Managing Emotion
Difficulties with regulating frustration and emotional responses. Adhering to boundaries and responding to tasks or instructions could therefore be extremely difficult for a child with impairments in this area of EF.

5. Difficulties Accessing Memory and Using Memory Recall
Children may suffer with difficulties remembering tasks and instructions, or behavioral expectations.

6. Monitoring and Regulating Action
Children may suffer with difficulties with slowing down and regulating their actions. Hyperactivity can be a significant issue.

What we can see from this cluster of difficulties is that different levels of function are impaired and they all have interactions with one another.

This is one reason why ADHD is considered to be such a complex disorder.

The most common form of ADHD is the combined type and this ties in with the different layers of functioning impairments which may be present in children with ADHD.

In addition, there is a separate disorder called ‘Executive Function Disorder,’ which may appear similar to ADHD but is in fact a distinct disorder.

Executive Function is often referred to in terms of how it impacts self-regulation, however there is disagreement and confusion about how these terms relate to one another.

Some people use them interchangeably, however Dr Russell Barkley argues that self-regulation should be understood as a distinct set of terms, which relate to Executive Function. He argues that self-regulation comprises of three main areas:

• Actions that an individual directs himself to
• A resulting change in behavior
• A goal achieved in order to change the outcome of future goals or consequences

For children with ADHD this set of functions can be significantly impaired. For example, a teacher tells the child to sit down and begin a task, however the child is unable to respond in the same way as other children.

They might be slow to process the information, or unable to sit down for extended periods of time. They might find difficulty in managing their emotional state if they didn’t want to stop the task they were already engaged in.

How is the Brain Affected?

Researchers are still investigating how exactly the brain is affected in children with ADHD.

The symptoms of Executive Function disorder – such as inability to process information and regulate emotions in the same way as children without ADHD – have been observed, but with the advent of MRI’s scans, scholars have been able to build a clearer picture of what might be happening inside the brains of children with ADHD.

MRI’s have shown that children with ADHD have slightly smaller brains than children without – around 3% smaller, although brain size in of itself is not responsible for development.

In addition, certain regions of the brain were found to be smaller in children with very severe symptoms of ADHD. Areas such as the frontal lobes, which help to govern concentration, motor control and inhibition were found to be affected.

In addition to structural differences, the way the brain communicates via neurotransmitters appears to be affected.

Areas such as the Corpus Callosum which is responsible for communication between the brain hemispheres, the Anterior Cingulate, which manages emotions and the Basal Ganglia, which governs impulse control have been shown to be affected by inactivity and neurotransmitter imbalances.

In addition to these studies which show areas of EF which are affected, new theories are being proposed with regards to other areas of Executive Function which may be impaired in children with ADHD.

A recent example of this is the theory that children have issues with processing time and space, relative to themselves. For example, they have trouble deciphering the present and the future as concepts and are unable to use self-control in relation to these.

Because ADHD has been shown to have a strong link with how the brain develops, many researchers have been examining the question of whether ADHD is a genetic condition.

Evidence has suggested that there is a strong link between genetics and ADHD.

Studies have shown that children with ADHD have usually at least one relative who has it, and twin studies have shown a majority of identical twins share the trait .

However, the field of Epigenetics – how our genes are expressed as we develop, is still in its infancy, and there is a possibility that environmental influences could play a role.

Further research is needed into this aspect, however because EF impairment in children with ADHD is developmental – meaning that certain systems do not develop in the same way as in other children – it appears that heritability is one of the strongest causes, rather than environmental or factors regarding nurturing.

Studies have shown that a developmental lag of around 3-5 years exists in many children and adolescents with ADHD .

The Importance of Education on Executive Function

The complex interactions of EF impairment with the environment and parenting can help those who are suffering from the disorder, as well as caregivers, to better manage certain assumptions about ADHD.

Common stereotypes still abound which label children with ADHD as merely having behavioral problems, or that a lack of boundaries and discipline has caused the disorder.

Many members of the public, as well as media outlets, have been known to describe ADHD as a disorder that is made up to explain poor parenting or bad teaching.

This demonizes everyone involved, from the child to the parent and associated professionals.

ADHD has suffered from a vast amount of stigma and misunderstanding, so it is important to educate people more fully on the complex aspects of the disorder.

ADHD centers around a cluster of different behaviors which are affected by abnormalities in the way the brain develops, and often these behaviors have been viewed as individual issues, and treatment developed for them.

This might work well for some children, but not for others, especially those who suffer from combined symptoms. For example, the use of medication to control hyperactivity has worked well with children who have primarily inattentive ADHD, but not combined.

In addition, many children may not show signs of some of the difficulties they face with executive function because they have learned how to compensate for it, or mask their difficulties.

Further research is required to more fully understand how ADHD develops and the genetic component.

In addition, the complex way in which the brain and executive functions interact is still not completely understood. However what research has shown us is that ADHD has roots in a developmental process which affects many aspects of how a child is able to respond to his or her environment and to learning as they develop.

For parents or those working with children with ADHD this is vital information, to not only alleviate the effects of stereotypical assumptions and beliefs, but to better support and nurture the child to manage their disorder.