For decades, ADHD was understood to be a behavior problem of young boys. The thinking was that kids with ADHD simply were hyperactive, wouldn’t listen when spoken to, and were frustrating to their teachers and parents.
We now know from research that ADHD is as common in girls as in boys. More often than not, it persists into the teenage and adult years. And many people with ADHD have never had any significant behavior problems. In fact, for most people with ADHD, the main challenge is with attention.
Our understanding of attention has evolved, as well. It doesn’t just refer to listening when someone is talking to you. Attention and focus refer to the management system of the brain — its “executive function.” So, when people with ADHD have trouble with focus, it’s a problem with executive function.
The real meaning of focus
Focusing on a task is a complex process. It’s not just holding steady and zeroing in on something, like “focusing a camera.” It’s more like “focusing on your driving.”
When we focus on driving, we don’t simply glue our eyes to the car in front of us. We also watch the stoplight down the street and check our rearview and side mirrors.
As we drive, we continually shift our gaze, ignoring some things and briefly keeping other things in mind. And we quickly adapt to new situations, like a dog running into the street. Throughout it all, we need to remember our destination — and how to get there.
The process of focusing involves many actions of starting, stopping, and noticing one thing after another. It requires that we keep in mind what we just saw or heard, and ignore many other sights that would be distracting. It also involves managing our emotions so we can keep a cool head and not overreact to frustrations.
These are all executive function skills.
The link between ADHD and executive function
How does this relate to ADHD? Difficulties with executive skills are hallmark traits in many kids with ADHD. These difficulties cause the behaviors we often associate with ADHD. They also explain why these behaviors often continue past childhood.
Executive function skills develop over time. The brain mechanisms that operate them are among the slowest parts of the brain to develop. Executive function doesn’t fully mature until people are in their late teens or early 20s.
Some people take longer than most others to develop their executive skills. For those with ADHD, it may be an average of three to five years longer, sometimes more. That delay has nothing to do with intelligence, however.
As research continues into ADHD, our understanding grows. Many researchers now agree that we can write an equation saying: “ADHD = developmental impairment of the brain’s executive functions.”
ADHD is a lifelong condition, although some of the executive function challenges may lessen over time. But there are strategies to improve executive skills and treat ADHD symptoms.
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About the author
About the author
Thomas E. Brown, PhD is a clinical psychologist and clinical associate professor of psychiatry at the Keck School of Medicine of USC.