Overall, ADHD symptoms suggest difficulties with executive functioning, and may highlight that ADHD is partially a disorder of executive functioning. Executive functioning consists of three areas: working memory, cognitive flexibility, and inhibitory control.
Working memory is where information is manipulated or transformed in conscious awareness. Working memory is utilized if you are recalling a mental grocery list and are going around the store picking up items, and then visualizing crossing them off. Alternatively, working memory is also involved if you asked your child to complete three tasks: they have to plan and prioritize the tasks, execute actions to complete the task, and mentally cross those tasks off the list.
Cognitive flexibility is using what has been learned differently as the situation requires, as opposed to rigidly adhering to rules or previous ways of doing things. An adult example would be having to detour from a previously established driving route home. A child example would be adapting to changing afternoon plans when a sibling falls ill and must be taken to the doctor’s office.
Lastly, inhibitory control is resisting urges to act without thinking. For adults, this may be choosing to ignore a text on the phone while driving. For children, this can involve using words instead of aggression (biting, hitting, kicking) when disagreements arise with peers, or raising one’s hand as compared with shouting out to answer a teacher’s question in class.
These three key areas mediate self-regulation and attention. However, rather than talk about them as innate abilities (i.e., immutable, unchangeable characteristics of a child), executive functioning may be more helpfully thought of as a set of skills.
As identified by Dr. Adel C. Najdowski (2017), behavior-based executive functioning treatment targets the following areas:
- Self-awareness
- Inhibition and impulse control
- Self-management
- Attention
- Organization
- Problem solving
- Time management
- Planning
- Working memory
- Emotional self-regulation
- Flexibility
On the face of it, some of these areas look like abstract concepts. However, they may be reframed as occasionally discrete and at times coordinated set of overlapping skills used to successfully navigate one’s environment (i.e., school, social situations, work, community, etc.). When acquiring new skills, children and adults need help in generalizing them across multiple situations. The idea of teaching once and it will be used across environments does not hold. Therefore, a child who learned how to plan one day of afternoon activities cannot be assumed to be able to do this for morning activities, the next day, or for the entire week. The skills need to be practiced often, at different times, and many different situations to “stick.” A fancy, more technical name for this is “multiple exemplar training” or training to a variety of examples. lexapro over the counter
By looking at these targets as skills, we can begin to reframe characteristics of ADHD to promote skill-based treatments, and this will be our focus next time
ADHD Series by Dr. Glenn Sloman
Continue reading using the links below:
- What Is ADHD? Part 1
- ADHD Symptoms Part 2
- Who is Diagnosed with ADHD? Part 3
- Executive Functioning Part 4
- Another Way of Looking at Impulsivity Part 5
- Promoting Success with ADHD Part 6
References
Attention-Deficit / Hyperactivity Disorder (ADHD). (2017, July 18). Retrieved October 02, 2017, from https://www.cdc.gov/ncbddd/adhd
Biederman, J. et al. (April 2010). Adult Psychiatric Outcomes of Girls with Attention Deficit Hyperactivity Disorder: 11-Year Follow-Up in a Longitudinal Case-Control Study. American Journal of Psychiatry 167(4):409-417.
Biederman, J. at al. (July 2012). Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. Journal of Clinical Psychiatry 73(7):941-50.
CHADD – The National Resource on ADHD. (n.d.). General Prevalence of ADHD | CHADD. Retrieved October 02, 2017, from http://www.chadd.org/understanding-adhd/about-adhd
Diagnostic and statistical manual of mental disorders DSM-5. (2013). Arlington, VA: American Psychiatric Association.
Najdowski, A. C. (2017). Flexible and focused: Teaching executive functioning skills to individuals with autism and attention disorders. San Diego, CA: Academic Press.
Thapar A, Cooper M, Jefferies R, et al. What causes attention deficit hyperactivity disorder? Archives of Disease in Childhood 2012; 97:260-265.
The Understood Team. (n.d.). 3 Areas of Executive Function. Retrieved October 02, 2017, from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/3-areas-of-executive-function
About The Author
Glenn M. Sloman, Ph.D., BCBA-D, NSCP is a Licensed Psychologist in New Jersey and Pennsylvania and a Board Certified Behavior Analyst at the Doctoral level. Dr. Sloman is also a Nationally Certified School Psychologist and a Certified School Psychologist in New Jersey. He earned his undergraduate degrees with honors in Psychology and Anthropology at the University of Florida. Dr. Sloman attained his Master’s in Education and Ph.D. in School Psychology at the University of Florida where he specialized in Behavior Analysis. He previously served as a program coordinator for Douglass Developmental Disabilities Center Outreach Program and supervisor of home staff in programming for individuals with an Autism Spectrum Disorder (ASD). Dr. Sloman has worked in New Jersey school districts as a case manager and school psychologist on a child study team developing and implementing individualized education programs (IEPs) and behavior improvement plans (BIPs), providing individual and group psychotherapy, social skills training, and staff and parent consultation.
Dr. Sloman is skilled in conducting psychological and psychoeducational evaluations, and functional behavior assessments (FBAs). He has experience providing outpatient psychotherapy to children, adolescents, and adults from ethnically and economically diverse backgrounds, and providing parent support and training.
Dr. Sloman has extensive experience in the treatment of children through adults who present with symptoms of anxiety, depression, ADHD, ASD, learning disabilities, oppositional defiant disorder, obsessive compulsive disorder, mood disorders, and social skills deficits. He also has expertise assisting individuals transitioning from high school to college life.
Dr. Sloman’s professional interests include Acceptance and Commitment Therapy (ACT) and applying Behavior Analysis in treatment and consultation. Dr. Sloman’s goals for his clients are to increase their psychological flexibility in pursuit of doing what matters to them and creating meaningful behavior change. He is a member of the American Psychological Association, the New Jersey Psychological Association, and the Association for Contextual Behavioral Science.
