What are Executive Functioning Symptoms for ADHD?

ADHD is a neurodevelopment disorder that is highly heritable and impacts the frontal lobe’s ability to effectively manage neurotransmitters. The exact biomechanisms of ADHD have not yet been precisely identified, although various theories and possibilities are being researched. The important thing to understand functionally is that individuals with ADHD experience inconsistency or variability in their executive functioning.

Executive functions are the abilities and/or processes that the frontal lobe utilizes to help the rest of the brain to function effectively and consistently. The frontal lobe is like a control center that keeps other brain systems running efficiently, on time. Executive functions include:

• Working Memory- Have you ever lost your train of thought mid sentence and said something like, “What was I just talking about?”. That is related to failing working memory. Individuals with ADHD may notice difficulties with remembering more than 3 steps in directions, remembering someone’s name they have just met, remembering a seven digit phone number long enough to dial it into a phone, and need to frequently reread individual sentences due to not remembering what they just read.

• Emotional Regulation- The ability to identify and effectively manage emotions is partly mediated by the frontal lobe. Individuals with ADHD struggle to effectively manage emotions even when they know coping skills. Everyone deals with emotional dysregulation differently including shutting down, becoming anxious, getting over-stimulated, growing irritated, etc. Often an entire family with ADHD will each display drastically different compensation strategies for dealing with emotional dysregulation.

• Hyperactivity (and Hypoactivity)- Most everyone is aware of common hyperactive symptoms like fidgeting, restlessness, always being on the move; but many are not aware that individuals with ADHD also struggle with hypoactivity. This is noticeable with slow processing of information and communication. Most with ADHD will notice variability between hyper and hypo activity. It is also important to note that many individuals minimize or conceal external signs of hyper/hypoactivity from others, although these processes are still a part of their internal experience (thought process). For example, many with ADHD are unable to turn their mind off at night to fall asleep due to their hyperactive thought process.

• Inattention (and Over-attention)- Most everyone is aware of common inattention symptoms like careless errors, difficulty tracking conversations, day dreaming; but many are not aware that individuals with ADHD also struggle with over-attention, which is typically called hyper-focusing. Both cause different types of problems as inattention is more common for non-stimulating tasks, while hyper-focusing takes over when tasks are sufficiently stimulating. Most individuals notice shifting back and forth between these extremes daily.

• Word Retrieval and Speech Organization- Ever had that experience of saying mid conversation, “I can’t think of that word. It is on the tip of my tongue.” That is a moment of word retrieval difficulty, which is very common for individuals with ADHD. They also struggle with effectively planning their speech. It is common to hear complaints like “When I talk, I talk….too fast, too slow, words are out of order, or I use the wrong words.” Speech difficulties are often overlooked as a major symptom cluster for ADHD.

• Impulsivity- Poor planning can show up in countless ways for individuals with ADHD including driving too fast, rapid speech, interrupting others, invading other’s personal space, clumsiness due to poor motor planning, impatience for waiting turn, spending habits, stimulation eating, sloppy handwriting, rushed reading or test taking, decision making, etc. Poor self-monitoring of behaviors and decisions often follows behind impulsivity. It is also important to note that many individuals compensate for impulsivity by going the other direction: Obsessive over-compensation.

• Visual Processing Speed- This ability impacts reading speed, test taking speed, and eye hand coordination to some degree for video games and driving reaction speed. Individuals with ADHD will often notice variability in their ability to complete these types of tasks efficiently.

• Auditory Processing Speed- Similar to visual processing speed, variability in auditory processing is also common for ADHD. This one is less known and rarely included in screening measures, but is important to consider. One research study showed that 50% of individuals with ADHD met sufficient criteria for a diagnosis of Auditory Processing Disorder. Individuals with ADHD may notice that sometimes it feels like others are talking too fast, unable to track with audio books, delays in responding in communication become socially awkward, need to watch movies with subtitles, poor ability to identify lyrics in music, and poor discrimination between competing directional sounds.

• Time Management- It is common to see poor awareness of time (time blindness), poor estimation of how long tasks will take, poor management of multiple tasks to get ready in a certain amount of time, and being late to appointments.

• Organization- Due to issues with impulsivity, it is common to see organizational difficulties for individuals with ADHD in their management of physical space (keeping room or house clean), speech, writing, and planning and organization of complex task schedules.

• Motivation- For individuals with ADHD it is common to hear that motivation is all or nothing. Much like attention, motivation naturally follows when they are sufficiently stimulated by something. For non-preferred tasks, avoidance, procrastination, and/or refusal/defiance can be common.

• Shame and Rejection Sensitivity- While these are not specific executive functions, they are worth mentioning as they are common secondary effects of ADHD symptoms. When executive functioning is chronically variable, reoccurring shame and social difficulties will ensue. Over time social anxiety and rejection sensitivity are common.

These are some of the most common executive functions, although there are certainly others. As I alluded to in several of the executive functioning examples, everyone compensates for their ADHD symptoms differently, which is important to consider when evaluating for ADHD. Females, intelligent individuals, and adults are more likely to display significant over-compensation strategies as compared to the most diagnosed population (5-8 year old males). Over-compensation may result in other problems developing such as Obsessive-Compulsive Disorder, emotional eating patterns and obesity, substance abuse via self-medication behaviors, anxiety disorders, depression, etc.