All About ADHD and Executive Dysfunction

Executive dysfunction is an impairment in skills that attend to:

• memory
• focus
• organization
• time management

Executive dysfunction disrupts the skills that help people use to manage time and space and higher level thought. Executive dysfunction may cause difficulties with:

• initiating tasks
• completing tasks
• evaluating and processing information
• controlling impulse and behavior
• balancing multiple tasks
• problem solving
• focusing

Planning for the future can also be challenging with EF issues.

According to a 2021 study in 39 college students — 19 of which were diagnosed with ADHD — participants with ADHD who showed strong hyperactivity-impulsivity tended to prefer small, immediate rewards over greater long-term rewards. This discounting of future rewards — a symptom of executive dysfunction — resulted in poorer work habits and grades.

The consequence of difficulties with executive function can be frustrating. Folks with executive function issues can experience challenges in:

• meeting academic and work goals
• regulating moods
• feeling good about themselves
• procrastinating

But knowing you have executive dysfunction can make it easier to figure out how to treat it.

Can executive dysfunction be diagnosed?

Unlike ADHD, executive dysfunction is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). It cannot be diagnosed, but it can be evaluated.

One test used to assess executive functioning skills is the Stroop task. In this test, participants are asked to identify the visual color of a word that spells out a different color.

For example, if the viewer can correctly identify that the word “blue” is colored in yellow, it indicates that they have the ability to avoid an automatic response (i.e., they don’t automatically think the word “blue” would be written in blue) and selectively focus their attention toward a specific task. This speaks well to executive functioning.

Other tests of executive functioning skills involve correctly drawing clocks or sorting cards into categories to assess planning and organization skills.

A 2021 study proposes that EF impairments are likely to affect daily life activities, such as cooking, budgeting, and prioritizing. Psychologists and neuro-psychologists hope to make it easier to assess EF in real life by using virtual reality and technical tools that track eye movement and measure spoken responses and unspoken reaction times.

Your doctor may do other testing to see whether a medical condition, such as ADHD, may cause your executive dysfunction symptoms. You may be referred to someone to look into the possibility of a learning disorder, such as dyslexia, or you may receive an MRI scan to look for signs of a tumor if your doctor has cause for concern.

ADHD vs. executive function disorder

If you think you have ADHD, a healthcare professional can give you a diagnosis through a series of questionnaires and neuropsychology measures. They will look for criteria involving inattention or hyperactivity that may hinder functioning and growth.

In diagnosing ADHD, your doctor or mental health professional will assess criteria, including the following difficulties that are symptoms of executive dysfunction:

• sustaining attention
• completing work
• avoiding mental effort
• tending to lose things

Although a medical professional may use “executive function disorder,” executive dysfunction is not a stand-alone condition. It can be influenced by other conditions, such as:

• ADHD
• Parkinson’s disease
• dementia
• substance misuse
• conduct disorders
• learning disabilities like dyslexia

Executive functioning does seem to be something that can be inherited. Studies of family members and twins show heritability of 20% to 40%.

ADHD, along with other conditions, does seem to cause executive dysfunction. Folks with ADHD have differences in the prefrontal cortex of the brain, and this is the part of the brain that affects executive functioning skills.

A 2016 study proposes the possibility of executive function subtypes within attention deficit hyperactivity disorder. In 357 children with an ADHD diagnosis, a lab test — along with standardized intelligence and achievement tests — suggested those with ADHD fall into different EF clusters, each defined by:

• problems with set-shifting speed (moving back and forward between different tasks)
• problems controlling responses
• “few problems” performing tasks

Those with the lowest set-shifting speeds had the hardest time on intelligence tests and had more behavioral symptoms. Researchers concluded EF deficits might cause problems that require targeted support in those with ADHD. They also suggested that those with “few problems” might have hidden executive dysfunction symptoms that need to be examined.

Symptoms of executive dysfunction are very similar to those associated with ADHD, but you can have executive functioning issues without meeting the criteria for ADHD. You can also have executive dysfunction disorder but not the hyperactivity or restlessness of ADHD.

Here are some signs of executive dysfunction:

• difficulties with life tasks that involve planning and organization like cooking or budgeting
• difficulties with time management
• problems remembering and processing information
• losing things you need to work
• not being able to stick with a project
• challenges inhibiting reactions
• challenges switching activities

If you’re experiencing executive dysfunction as part of your ADHD diagnosis, you may wish to talk with your doctor about using stimulants or antidepressants.

Cognitive behavioral therapy (CBT) may be another option for treating executive functioning issues. This form of therapy teaches new ways of thinking that lead to more helpful behavior.

In addition, here are some simple “tweaks” you might try on your own:

• Exercise. Intense exercise for about 15 minutes a session improved the performance speed on tasks assessing switching and inhibitionl among participants with ADHD in a 2018 study.
• Pomodoro technique. The Pomodoro technique suggests working for a set amount of time, then taking a break, and repeating that cycle. For example, you might set yourself a timer for 25 minutes, work for that time, then take a break (maybe rewarding yourself with a cup of tea or a short walk with the dog). Then you’d start with another block of work time.
• Action items. Consider breaking goals into small concrete action items. Instead of a vague reminder to “be more organized,” you might ask yourself to have your computer charged and open on your desk by 8:00 a.m.
• Step by step. Similarly to the suggestion above, it may help to break large projects into smaller steps.
• Prompts. For some people, it can help to give yourself visual prompts — like a candle or a piece of gum — that you use every day to prompt a desired behavior.
• Tools. Agendas and alerts can be your friends. It may help to check your agenda frequently or let your phone remind you of things that need your attention.

If you know you have executive dysfunction either under the umbrella of the ADHD diagnosis or as part of another medical condition, you may want to consider talking with your doctor about medication. Cognitive behavioral therapy might also work for you.

Sometimes it may be helpful to get a partner to help you organize projects and get things done. You might consider hiring an executive functioning coach to help you outline, organize research, and meet deadlines. Or it’s possible that a professional home organizer or life coach could help you clear space in your home and head.

If a personal coach isn’t in your budget, there are still plenty of apps and other resources that can help you get more organized and focused.