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Executive Functioning and ADHD
Executive functioning has been a key term for several years regarding ADHD. Executive functioning is sometimes thought of as the brain's self-management system or how a person is able to be goal directed and engage in problem solving and persistence. Currently it is common for ADHD to be considered an appropriate diagnosis when a person has difficulty in this area, often termed executive dysfunction. Two theories that are both popular regarding executive functioning are those put for by Russell Barkley and Tom Brown.
Barkley's Theory of Executive Function [1]
Step 1: Response Delay--need to be able to control impulses and slow down responses.
Step 2: Prolongation--need to ask myself from previous experience what's been the right thing to do (based on an internal feeling of past, present, and future)
Step 3: Rule Governed Behavior--need to have internal speech developed and is connected to morality and ethics
Step 4: Dismemberment of the Environment--need be be able to tell a story in sequence from beginning, middle, and end and also rotate a figure in space in order to do this task.
In this theory by Barkley, if a person has difficulty with Response Delay, he or she will also have difficulty with later steps such as Prolongation, and if the person has difficulty in these two areas the person will also struggle with Rule Governed Behavior. There is some evidence to suggest that people with attention difficulties have difficulty with Rule Governed Behavior since there is often a delay in internalized speech and this is a step that has to be talked through.
Tom Brown's Theory of Executive Function [2]
1) Organizing and activating for work (getting started on a task)
2) Sustaining attention and concentration (focusing including sustaining and shifting attention)
3) Sustain energy and effort (regulate alertness, sustain effort, and processing speed)
4) Managing affective interference (manage frustrations and modulate emotions)
5) Utilizing working memory and accessing recall (working memory is often referred to as the brain system that provides temporary storage and manipulation of the information necessary for such complex tasks as language comprehension, learning, and reasoning.)
6) Being able to predict the reaction of others due to their behavior
While these challenges and delays are real for children and adults with attention difficulties, there are interventions that can be done to assist with executive functioning. Barkley suggests an 80/20% rule in which 80% of our interventions should be focused on changing the environment for the person with ADHD and 20% goes into teaching skills [3]. Examples of this 80% can be how we use the latest in ADHD theory and research to inform our interventions such as how we structure our programs (highly reinforcing reward programs with lots of feedback, immediate consequences, clearly posted expectations, extra prompts and accommodations, etc). In our program at Quest when we are focused on the aspects related to teaching skills to children it is a constant goal to teach children in a way that they will be able to access what we are presenting most fully. In addition, a multimodal study demonstrated at the 8 year followup that for children with ADHD that the best recommendations for treatment was uninterrupted treatment with medication and behavior support [4]. I find this study particularly interesting since it included therapeutic summer camp interventions as part of the behavioral support given. Ultimately, executive functioning is a complex process and a breakdown in this area for children with ADHD is a challenge that will take many people working together, but with this teamwork and a child's growth and maturity over time great things are possible.
[1-3] Blake, K.T. (2014) Getting back on track: Understanding and treating executive dysfunction in ADHD. Cross Country Education Continuing Education Webinar.
[4] Swanson et. al. (2011) as cited in Blake, K.T. (2014) Getting back on track: Understanding and treating executive dysfunction in ADHD. Cross Country Education Continuing Education Webinar.
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