ADHD and Executive Function Skills
ADHD (Attention Deficit Hyperactivity Disorder) or ADD (Attention Deficit Disorder) is a neurological condition that is usually genetic. It is characterized by difficulties with self-regulation. Symptoms are present from childhood on, and though everyone has times when self-regulation is impaired, people with ADHD have varying degrees of impairments that consistently interfere with everyday life.
In 2011, the Centers for Disease Control and Prevention reported that as many as 10% of children in the United States may have ADHD. The Harvard/NIMH National Comorbidity Survey Replication found that over 4% of adults experience persistent symptoms consistent with a diagnosis of ADHD. ADHD affects people of every age, gender, IQ, and socioeconomic status. It can have an impact on every aspect of one’s life, including school, work, and personal relationships.
ADHD is a misnomer in the opinion of Edward Hallowell, MD, founder of the highly respected Hallowell Centers in New York and Massachusetts and author of 18 books on ADHD (see Resources). He views ADHD as neither a disorder, nor a deficit of attention. Having ADHD himself, Dr. Hallowell sees ADHD as a trait, not a disability; and when managed properly, ADHD can become an asset in one’s life. He believes that having ADHD is like having a powerful race car for a brain, but with bicycle brakes. Managing ADD is like strengthening your brakes–so you start to win races in your life.
The "brakes" that Dr. Hallowell refers to are the brain's executive function skills. Thomas Brown, Ph.D., Asst. Clinical Professor of Psychiatry at the Yale University School of Medicine, Associate Director of the Yale Clinic for Attention and Related Disorders, and author of Attention Deficit Disorder: The Unfocused Mind in Children and Adults (Yale University Press, September, 2005; see Resources) uses another analogy to describe the role of executive function in ADHD:
"Imagine a symphony orchestra in which each musician plays his or her instrument very well. If there is no conductor to organize the orchestra, to signal the introduction of the woodwinds or the fading out of the strings, or to convey the overall interpretation of the music to all players, the orchestra will not produce good music.
Symptoms of ADD can be compared to impairments, not in the musicians, but in the conductor. Typically, people with ADD are able to pay attention, to start and stop their actions, to keep up their alertness and effort, and the use their short term memory effectively when engaged in certain favorite activities. They can play their instruments very well - but only sometimes. The problem lies in their chronic inability to activate and manage these functions in the right way at the right time."
Dr. Brown has described six clusters of executive functions (below). It is the impairment of any of these functions that defines ADD/ADHD according to Dr. Brown (www.drthomasebrown.com/pdfs/Executive_Functions_by_Thomas_Brown.pdf). Furthermore, it is honing of executive function skills that is the primary target of ADHD coaching. While medication is effective in relieving symptoms of ADHD in many patients, medication alone may not be effective in improving executive function skills.
Valerie English Cooper
VEC Coaching, LLC