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Blog:  Expert Corner

The New Thinking About ADHD and Executive Functioning

Expert Corner blog post by Thomas E Brown
May 11, 2016

A driver stopped at a stop sign.

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. People often thought they would outgrow their problems in later childhood or in their early teens. Some still think of ADHD that way.

We now know from research, however, that ADHD affects girls as well as 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.

For most people with ADHD, the primary problem is with attention. Our understanding of what that means has also evolved. Attention doesn’t just refer to listening when someone is talking to you. It’s a much broader idea that refers to the management system of the brain—its “executive functions.”

Executive function involves focus. We think of that concept in broader terms now, as well. Focus is more than just holding steady and zeroing in on something, like “focusing a camera.” It’s more like “focusing on your driving.”

What It Takes to “Focus on Your Driving”

When we focus on driving, we’re not simply gluing our eyes to the bumper of the car in front of us. We’re watching that car, but we’re also watching the stoplight farther down the street. As the light changes from green to yellow, we move a foot from the accelerator to the brake.

As we’re driving, we repeatedly look at our rearview and side mirrors to see cars coming up behind us or beside us. We may also notice a big truck backing out of a driveway ahead of us and a few people running across the street to catch an approaching bus.

We continually shift our gaze, ignoring some things and briefly keeping other things in mind. (We may also be thinking about what we plan to buy when we get to the grocery store.)

At some point, we’re planning to shift over to the left lane to get ready to make a turn at the next corner. Suddenly, a dog runs out into the street in front of the car. Now we have to quickly adapt to a new situation. We need to size it up, decide what to do, monitor the cars behind and to the side of us and then act within seconds.

And throughout it all, we need to remember our goal—our destination—and how to get there.

How Focusing on a Task Requires Executive Functions

As you can see, “focusing on your driving”—or on any task—is a complex process. It 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.

This type of focus involves planning and regulating our actions. Executive functions help us do that. They allow us to handle tasks for ourselves without someone else telling us step by step what to do next. They help us cross busy streets, hold conversations, and manage our work.

These brain functions include all the following—working together:

  • Getting organized, prioritizing and getting started on tasks
  • Focusing on what needs to be done, continuing to focus and shifting focus as needed
  • Regulating sleep and alertness and keeping up effort to finish things on time
  • Managing emotions so they don’t take over too much
  • Using short-term working memory to keep multiple things in mind, recalling as needed

How Executive Function Relates to ADHD

How does this all relate to ADHD? Difficulties with these executive functions are hallmark traits in many kids with ADHD. They cause the behaviors we often associate with ADHD. They also explain why these behaviors often continue past childhood.

Executive functions develop over time. The brain mechanisms that operate them are among the slowest parts of the brain to develop. Executive functions don’t fully mature until people are in their late teens or early twenties.

Some people take longer than most others to develop their executive functions. 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, but it has a lot to do with heredity.

Delay in development of executive function can be an inherited problem. Out of every four people with ADHD, one has a parent with ADHD. The other three are likely to have another close relative with ADHD.

ADHD and Executive Function: The New Equation

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.”

But just because ADHD tends to run in families, and just because executive functions take longer to develop in kids with ADHD, it doesn’t mean you can’t help your child build skills and manage the challenges of ADHD.

Learn about the various treatment options for ADHD. Look into possible accommodations at school. And help your child develop strategies for staying organized.

Also, understand some of the common behaviors of ADHD. Discover why kids with ADHD may frequently lie and struggle to start and finish tasks. And learn why kids with ADHD can focus well for certain activities when they can’t focus well for most others.

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About the Blogger

Portrait of Tom Brown

Thomas E. Brown is a clinical psychologist and clinical associate professor of psychiatry at the Keck School of Medicine of USC.

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