Executive Function
Executive functions help us organize, begin tasks, direct attention, remember what matters, and regulate our emotions and actions. Everyday activities require us to coordinate a variety of cognitive abilities. You may have strengths in some of these areas and need support in others. ADHD can make that coordination inconsistent: you may handle demanding work yet struggle with something that seems simple.
Your best performance can become the standard you and others expect every time. Falling short can look like a lack of effort or care, leaving you bewildered and the people who depend on you frustrated.
Therapy can help identify where you get stuck and what helps when things go well. We can build on your strengths, develop support for specific challenges, and set realistic expectations without making a partner or parent responsible.
You may be familiar with the idea that people with ADHD have impaired executive function, but what does that mean exactly?
Executive function is an umbrella term for the mental processes that help us direct and coordinate our actions and thoughts. Researchers group these abilities in different ways, but I like Thomas Brown’s model, which groups them into six areas:
Activation: organizing, prioritizing, and beginning a task.
Attention: choosing where to focus, staying focused, and shifting focus.
Arousal and effort: regulating alertness and sustaining mental effort.
Working memory: holding information in mind while using it.
Emotional regulation: managing the intensity of our feelings so we can respond deliberately.
Inhibition and self-monitoring: pausing before acting, stopping an action, and noticing when to change course.
Ordinary tasks are complex
Consider the executive functions involved in getting ready for a therapy appointment. You need to remember it, allow enough time to prepare and travel if necessary, and recognize when to stop what you’re doing. Then you have to actually stop what you are doing—even if you’re absorbed in it—and gather what you need without getting drawn into another task. If you discover that your keys are missing or your internet is down, you need to manage your frustration, change your plan, and stay on task despite the interruption.
“Be ready on time” sounds simple, doesn’t it? Neurologically, it requires that we perfectly coordinate a variety of complex mental processes. ADHD makes that coordination inconsistent.
Inconsistency
One of the most confounding features of ADHD is how inconsistently people with ADHD seem to have access to these abilities. You might catch an obscure error in a complicated project at work, then forget to give your child the medication you set out that night. Your partner sees evidence that you can pay attention and wonders why that attention seems to disappear at home. You may struggle to explain it yourself.
Most people with ADHD don’t struggle with every form of executive function, only some, and their difficulties can vary across situations and over time. Some of my clients show strong inhibition, activation, and sustained effort, yet deficits in working memory lead to frequent mistakes and leave them feeling constantly frazzled. One client has never been late to an appointment but has also never paid their taxes on time, which makes sense because those tasks require vastly different kinds of executive function.
Your best becomes the standard
Neurotypical people often don't experience a significant difference between their best and worst performance. For example, a neurotypical person is much more likely to come home with all of the groceries on their shopping list most of the time. A person with inconsistent executive function may forget at least one thing half the time, and may occasionally forget a third of the items on the list (all of which their partner needed to host a group of friends that night). The challenge is that people with ADHD are often judged—by themselves and others—against the standard of their best performance.
The gap between your best and worst performance can leave you feeling bewildered by your own mind: capable of the most demanding work, yet unable to meet expectations that seem embarrassingly modest. A partner may feel that work gets your best while they absorb the consequences at home. Parents may wonder why their child can remember every detail of their D&D character but can’t remember to bring home their homework regardless the incentive or consequence.
Support for your specific needs
I help clients get specific: do you forget the task, struggle to start it, lose track midway through, or find it difficult to stop doing something else? What seems to help on the occasions when things go well? Your aptitudes matter as much as the the things you struggle with.
Support shouldn’t depend on a partner or parent remembering everything for you; their time, energy, and needs matter too. Understanding ADHD can help us ask more realistic things of one another and take responsibility for the things that need to change moving forward.
