ADHD & Executive Functions

By Ho Shee Wai

Director/Registered Psychologist

ADHD & Executive Functions

Have you ever wondered what is the link between ADHD and how our brain work? Find out what is executive functions and how it’s impacted by ADHD. Learn how Cogmed Working Memory Training can help.

What is Executive Function?

There are many processes in our brain. Executive Functions are complex cognitive processes that we need for social, goal directed and efficient behavior. It governs our inhibition, emotional regulation, working memory, self monitoring, flexibility, and planning.

It helps us:

• Remembering the instructions (working memory)

• Finishing task within given time (planning & self-monitoring)

• Think of solution when confronted with a problem (flexibility)

• Staying focused despite external distractions (inhibition)

• Check work on possible mistakes before handing it over (self- monitoring)

• Remember the steps when solving a math calculation (working memory)

• Being on time for the school bus (time management)

The seven major types of self-regulation associated with executive functioning includes:

1. Self-Awareness: commanding self-directed attention

2. Self-Restraint: inhibiting yourself

3. Non-Verbal Working Memory: holding things in your mind to guide behavior

4. Verbal Working Memory: retaining internal speech

5. Emotional: using words and images along with self-awareness to alter how you feel about things

6. Self-Motivation: motivating yourself to do things when no outside consequences exist

7. Planning and Problem Solving: finding new approaches and solutions

Some indication of struggles in executive function are:

• Doesn’t pay attention when instructions are provided

• Can’t start with a task independently

• Necessary material is not displayed

• Forgets the instructions

• Starts immediately with a task without making a plan  and stops working when faced with challenges

• Makes many careless mistakes

Deficit in Executive Function for ADHD

Deficits in response inhibition, planning and working memory are often seen in children with Attention Deficit and Hyperactivity Disorder (ADHD).  This is the core of the disorder according to some causal models.  Executive Function impairments have been linked to core symptoms of ADHD and associated problems such as academic performance.  Working memory problems are among the most frequent mentioned problems.  Working Memory is the ability to actively hold in mind and manipulate information, relevant for a goal, for brief periods of time.

The consequences of weak executive function are:

• Child requires extra attention from teacher and parents

• Possible academic failure

• Negative interaction with the environment

• Self-esteem issues

Children and adults with executive dysfunction often struggle to organize materials, regulate emotions, set schedules and stick with tasks. They misplace papers, reports, and other school materials. They might have similar problems keeping track of their personal items or keeping their bedroom organized.

What is working memory?

Working memory is like a temporary post-it note in the brain. It’s a skill that lets us work with information without losing track of what we’re doing. Working memory holds actively in mind a small amount of information such as digits, letters, words, or other units, for only a few seconds, while also processing and prioritizing this same information. Working memory isn’t just for short-term use. It also helps the brain organize new information for long-term storage. When people have trouble with working memory, the brain may store information in a jumbled way. Or it may not store it for the long term at all.

Some examples of working memory:

• Remembering a phone number in order to place a call,

• Doing mental math calculations to arrive at an answer,

• Remembering multiple steps in a process to complete the tasks successfully, and

• Remembering a question long enough to provide an answer.

Working memory deficit and ADHD

Many who have been diagnosed with ADHD experience working memory deficits. These deficits are often link to difficulty with attention, language and reading and may look like:

• Difficulty planning, organizing, and carrying out everyday tasks such as getting ready for school. This requires a mental list organized by time and location in the home.

• Challenges with keeping track of priorities and suppressing distractions may impact study skills,

• Difficulty starting work, which makes staying on task challenging,

• Poor attention to detail, and

• Not following instructions.

Those with ADHD can hold and process a smaller amount of information for a shorter time than their peers. They may hear and see the instructions. As more information overwhelms their working memory, the information needed to complete the task successfully is lost. This can lead to frustration to everyone. Working memory is negatively impacted further when the person is overtired, anxious or otherwise stressed.

What can we do to improve our working memory?

• Establish and maintain regular routines. Routines become automatic when practiced repeatedly.  Automatic routines are more easily encoded in memory and less taxing on working memory.

• Create visual directions and checklists for reference. These can be written with words or created with images.

• Keep instructions brief and with limited steps.

• Document, chunk and plan out key tasks and deliverables. Regular use of a planner and step-by-step checklists provides at-a-glance reminders of how and when to complete which tasks. Importantly, checklists and planners also provide a visual representation of accomplishments which can be motivating.

• Foster a habit of setting and honouring automated reminders. Alarms, timers, calendar notifications, etc., can be set for important tasks to reduce the demand on working memory.

• Provide notes and/or encourage note-taking. Research shows that the old-fashioned paper and pen technique is faster and more accurate than typing notes. Neuroscience also suggests that physical writing on paper is associated with stronger brain activation and better memory recall. However, typed notes also provide a helpful reference.

• Use rehearsal to help transfer information from working memory into long-term memory. Research shows that associating the new information (in working memory) with existing information (in long-term memory), such as a place, name, word or event, can effectively help consolidate it.

Treatment options

Behavior modification programs like token systems and daily report cards generally work well, however the nature of ADHD is such that they get bored with token systems unless they collaborated on creating them.

Techniques like Cogmed Working Memory Training has been proven to effectively improve working memory long term. Sign up for Cogmed Working Memory Training with The Counselling Place.