ADHD Questions
Does ADHD affect executive function?
Charles Li, MD
May 16, 2023
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Most with ADHD also struggle to some degree with executive function, the higher-level thought processes of the brain.
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These include struggles with self-control, planning, and working memory. These traits are shared in families and may have a genetic basis but are mostly unrelated to IQ.
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Difficulties with executive function have been linked to challenges at home, work, and school.
While difficulties with attention and hyperactivity define ADHD, experts are increasingly seeing that deficits in executive function, the management system of your brain, are foundational to ADHD.
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Many clinicians mistakenly continue to
think of this as a behavior disorder characterized
by hyperactivity in children and excessive restlessness or impulsivity in adults. In fact, ADD/ADHD
is essentially a cognitive disorder, a developmental
impairment of executive functions (EFs), the self management system of the brain.
Executive function covers the high-level thought processes in your brain.
What is executive function?
These include inhibiting yourself, self-control, attention, and working memory, among other functions.
These are essential to solving long and complex tasks. Studies have shown that those with ADHD can have difficulty with these functions compared to those without ADHD.
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There is general agreement that there are three core EFs....inhibition [inhibitory control, including self-control (behavioral inhibition) and interference control (selective attention and cognitive inhibition)], working memory (WM), and cognitive flexibility (also called set shifting, mental flexibility, or mental set shifting and closely linked to creativity). From these, higher-order EFs are built such as reasoning, problem solving, and planning
What executive function deficits are most common in ADHD?
A meta-analysis looked at which executive function deficits are most common in ADHD. They combined data from 83 studies and ran statistical analyses.
What is a meta-analysis?
Results showed that executive function deficits were quite common among those with ADHD, though not everyone had them.
The most common deficits were found in inhibition, planning, and attention. These are consistent with the symptoms of ADHD that can make it hard to pay attention and control oneself.
Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review
The genetics of executive function and ADHD
This link between executive function and ADHD also extends into our genetics.
One study examining families with ADHD and families without ADHD found evidence that executive function has a genetic basis for those with ADHD.
A person with a brother or sister that had executive function deficits and ADHD was more likely to also struggle with executive function deficits themselves.
Support for an independent familial segregation of executive and intelligence endophenotypes in ADHD families
However, deficits in executive function, including inhibition and working memory, arenot strongly correlated with IQ.
IQ and executive function are mostly separate measures. Many individuals with high IQ can still suffer from executive function deficits.
Consequences of executive function deficits in ADHD
Having deficits in executive function has been linked with significant difficulties on the job.
One study found that those with ADHD who had difficulty inhibiting themselves tended to have fewer jobs held and quit more jobs due to hostility.
A study on executive function, ADHD, and employment outcomes, found that those with poor inhibition held fewer jobs, had more trouble with behavior, and quit more jobs due to hostility.
The effect of executive function on personal lives
Executive function deficits also extend into our personal lives. One critical consequence of difficulties with self-control is the risk of substance abuse.
Studies have consistently demonstrated that those with ADHD have a higher risk of engaging in risky behaviors, most notably substance abuse.
An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use
Key takeaways
Executive function is foundational to ADHD. Most individuals with ADHD struggle with it to some degree. It affects our academic lives, our careers, and our personal lives.
It is important to note that executive function is not related to IQ. It isn’t a personal failure or a mark of weakness. Instead, it’s a symptom of a very common medical condition.