What Is Executive Dysfunction? How It Impacts ADHD

Executive function has been described as “the management system of the brain.”

The skills involved in executive function allow us to set goals, make plans, and accomplish tasks. For those who struggle with executive dysfunction, its symptoms can negatively impact their daily lives at work, at school, and at home.

Many kids with ADHD struggle with goal-directed behavior impairment, and common symptoms of executive dysfunction.

In this article, we’ll take a look at what executive function is, its symptoms, possible causes, and executive dysfunction as it relates to ADHD.

Next, we’ll discuss how executive dysfunction is diagnosed, as well as some common management techniques.

What Is Executive Function?

Executive dysfunction is a term for a range of cognitive or behavioral issues that can be caused by an imbalance or injury to the brain’s frontal lobes.  

Executive function's core responsibilities include immediate conscious perception (working memory), inhibition, and the ability to adjust behavior based on environmental changes (cognitive flexibility).

Children begin developing these skills as young as two years of age and see them grow exponentially during preschool ages. They are essential abilities for navigating the various social structures of school and play an important part in a child’s personal development leading into adolescence and adulthood.

Executive dysfunction impairs this development in daily life and social skills, making it difficult to participate in non-preferred tasks, focus attention, or maintain concentration. It also effects how well a child can switch focus from one task to another or organize thoughts or materials.

In addition to these, there are several other areas that cognative dysfunction can affect in a child’s daily life, including:

Inhibition Control (self-control)

Inhibition control refers to a child’s ability to control or manage thoughts, emotions, and responses. The ability to maintain control of impulses is one of the basic functions of executive function and has a huge impact on our ability to deal with and fit into the world around us.

Working Memory

Executive dysfunction can also pose difficulties to working memory, which is that memory that allows kids to hold onto small pieces of memory for immediate use in the short term. Working memory is an essential skill in our ability to both learn and solve problems. Executive dysfunction can present huge challenges to a child’s ability to access and properly use their working memory, making typical forms of learning very difficult and frustrating.  

Self-Regulation (Planning, Organization, and Time Management)

Self-regulation is the ability to put order to tasks, incorporate time management skills, remember instructions, or form and perform step-by-step processes in a reasonable length of time. Self-regulation can be severely inhibited by executive dysfunction.

One of the most easily noticeable symptoms of (and ADHD) is a general disorganization of space and thoughts, both at home and school.

This inability to organize and plan makes it hard for a child to stick to individual tasks or accomplish them promptly or at all.

Behavioral and Emotional Control

Symptoms of executive dysfunction and ADHD encompass both cognitive and emotional control functions and abilities.

A child’s ability (or inability) to control their emotions is a key factor in their ability to relate and interact with others and with their environment. Executive function symptoms can include difficulties in controlling emotions.

These emotions, in turn, can lead to difficulty in controlling behaviors, followed by interpersonal conflicts.

Symptoms of Executive Dysfunction

Executive functions develop differently in different people. Likewise, symptoms of executive dysfunction can vary greatly in appearance and severity from child to child.

Still, there are some recognizable commonalities, especially in children who are too young to use masking skills that older individuals may develop.

For many people effected by executive dysfunction or ADHD, some of the more recognizable symptoms often include:

• Difficulties organizing school, work, or project materials
• Ongoing struggles with emotion and response control
• Trouble setting and maintaining a schedule
• Frustrations and challenges following through with simple tasks
• Difficulty learning and processing information
• Inappropriate social behavior
• Inability to learn from past consequences

Causes of Executive Dysfunction

Executive dysfunction most often occurs due to irregular or inhibited development in areas of the brain that maintain working memory and regulate emotion.  Specific neurotransmitters, like dopamine and serotonin, work as chemical messengers in the brain.

An imbalance in these neurotransmitters can lead to a wide variety of physical and mental health conditions, including:

• conduct disorder
• depression
• schizophrenia
•  learning disorders, including dyslexia or dyscalculia
• autism spectrum disorders (ASD)
• Alzheimer’s disease and other neurodegenerative conditions
• substance use disorders
•  anxiety disorders
•  sleep disorders
• obsessive-compulsive disorder
• autoimmune conditions

Executive dysfunction isn’t necessarily related to an underlying condition, however, recent psychological and neuropsychological research suggests executive functions and dysfunctions may share a genetic component as well. This may mean that children with a direct family relation (parent or sibling), who struggle with executive function skills may have a higher chance of also experiencing symptoms of executive dysfunction.

The Connection to ADHD

While it’s true that executive dysfunction is associated with a variety of mental health conditions, it’s most commonly associated with ADHD. Most people, both kids, and adults, who are diagnosed with ADHD exhibit most or all of the commonly accepted symptoms of executive dysfunction, though to varying degrees.

That said, while it’s important to understand that executive dysfunction and ADHD are not the same thing. The first is not a stand-alone diagnosis, but a group of symptoms that can be exhibited across a spectrum of conditions (including or excluding ADHD), while the latter (ADHD) is an official diagnosis of a permanent brain condition.

Diagnosis & Management

Executive functioning skills aren’t something someone either has or doesn’t have, but a spectrum of skills that exist differently in every person.

Evaluation and diagnosis of executive dysfunction symptoms are carried out by medical professionals like PCPs or psychiatrists to both assess the underlying causes (brain injury, chemical imbalance, etc.,) of the dysfunction symptoms, as well as the extent to which they are affecting the patient’s daily life.

This can include evaluating full medical history, discussing all of the symptoms being exhibited, and (if deemed necessary) conducting a neurological examination.

This examination typically includes:

•  Mental status assessment (awareness of person, place, time, etc.)
•  Passive and active motor function and balance tests.
•  A sensory exam that checks their ability to feel touch, sense temperatures, etc.
•  Testing of reflexes in older children and adults. Often with the use of a reflex hammer.
•  Cranial nerve evaluation of the 12 nerves of the brain (olfactory, optic, oculomotor,  trochlear, etc.)
•  And finally, a coordination exam where patients may walk a line on the floor, or close their eyes and touch their nose or ear.

Usually, these evaluations will include questions to reveal the level of functionality of specific executive operations like organization, paying attention, problem-solving, adapting to change, memory, and impulsivity control.

Managing Executive Dysfunction

Interventions targeting executive functions and dysfunction in children have rapidly increased over the last decade. Evidence varies as to the amount of benefit in these therapies, and can depend greatly on the child’s personal cognitive characteristics and underlying medical or psychological conditions.

Behavior therapy and cognitive behavioral therapy (CBT) is a popular therapy for helping people mitigate negative actions and behaviors with more positive or socially acceptable ones. CBT can be helpful for kids with ADHD and executive dysfunction. It helps kids struggling with impulse control issues to deal with thoughts and feelings and manage behaviors related.

While there are no medications specifically for the executive dysfunction itself, there are, of course, a variety of ADHD medications for children. These should be discussed with the child’s primary care physician and various options should be tested and monitored for effectiveness and possible side effects.

Many schools now offer psychologists who partner with kids to develop strategies to improve social skills and behavior management.

Likewise, teachers are receiving more training in offering specialized curricula and teaching approaches that help kids experiencing executive dysfunction symptoms. As well as to overcome academic, social, and organizational difficulties while managing behavior.  

Much like ADHD itself, executive dysfunction symptoms can present many challenges in a child’s life but, also like ADHD, its symptoms can be manageable, especially with the help of a trained mental health professional.

Medication can help as well and is most effective when combined with management strategies like skill-building exercises, cognitive behavioral therapy, parent coaching, and educational accommodations and support.

If your child seems to be having difficulties with executive dysfunction symptoms, contact your primary care physician to discuss what may be causing them and how to develop an appropriate treatment to help them.