Is Executive Function Related to ADHD?

The hot debate I never knew existed

When I was a high school teacher, I was fascinated by the ways that we taught students how to learn and do school. Teaching specific content was fine, but I was most excited about working with students on how to set and pursue educational goals, how to break down complex projects into manageable tasks, how to manage their time, and how to collaborate with others while also caring for themselves. 

When I was a college professor teaching adult professionals at the graduate school level, I was surprised at how many of these skills were still instructionally relevant. As I worked with busy doctoral students to complete their dissertations, I found most were eager for support with goal-setting, self-regulation, project management, metacognition, and self-care. 

In my personal life, when I struggled with depression and anxiety, I noticed a paradox: my mental health challenges undermined these skills—and yet, at the same time, these were the very skills that helped me access therapy, schedule doctor’s appointments for medication, and engage in restorative practices like exercise, journaling, meditation, and socializing. 

At some point along the way, I encountered the term executive function, and I had the vague notion that these skills I was so interested in could all be clustered under this umbrella term. I also had the sense that challenges with executive function were a core feature of ADHD.

It turns out, though, that our understanding of what executive function is, and how it relates to ADHD, is way more complicated than I ever realized. 

Here’s a summary of what I’ve learned:

• Scientists don’t agree on a common definition of executive function.

• The majority of ADHDers perform the same as non-ADHDers on lab tests designed to measure executive function. Some scientists think this means ADHD is not an executive function condition.

• The vast majority of ADHDers report executive dysfunction on questionnaires. Some scientists think this means that ADHD is absolutely an executive function condition.

• Neuropsychologist Russell Barkley’s model says that executive function is about regulating ourselves in order to achieve our goals.

• Barkley recommends that ADHDers craft external support for internal executive function challenges.

Maybe the whole idea of a C-suite executive running everything in our heads is a little weird? Photo by Kelly Sikkema on Unsplash

What is Executive Function?

When scientists in the 1800s studied patients with brain injuries, they noticed that patients with injuries to the front part of their brain—the prefrontal cortex—had a particular set of difficulties around things like making plans and controlling impulses. 

In the 1970s, scientists started referring to the prefrontal cortex as the “executive brain"—as if the prefrontal cortex were the CEO of Brain Corp., and the rest of the brain was just a bunch of middle managers and entry-level employees.  At this point, executive function was understood as whatever the prefrontal cortex did.

But we’ve learned a lot more about the brain in the last 50 years. Things long considered to be executive functions—like impulse control—involve not just the prefrontal cortex but lots of other brain regions as well. Also, the prefrontal cortex plays a role in a lot of activities that aren’t considered executive function, like distinguishing between smells. 

As we moved beyond brain anatomy as the defining characteristic of executive function, the whole definition of the concept started to become really murky. The definition is so confusing, in fact, that someone did a whole study just looking at different ways that scientists define executive function. Looking at 106 published journal articles, they found that scientists used 48 (!) different models of executive function. 

There was some overlap among all of these definitions. Everybody seemed to agree that executive function includes processes that:

1. Guide, monitor, and regulate actions related to learning and everyday tasks

2. Involve cognition (thought), behavior, and emotion

But beyond that, everything was pretty varied. 

Many processes that are commonly referred to as executive function, including task initiation, organization, emotional regulation, and metacognition, were mentioned in fewer than 5% of studies. The most commonly mentioned process was inhibition, or impulse control, but even this was only named in about two-thirds of the studies.

Basically, the research world doesn’t have a clear, shared definition of “executive function.”

Does ADHD Cause Executive Function Challenges?

Before researching this post, I thought that difficulties with executive function were a key aspect of ADHD. It actually turns out that this is a hot debate among scientists.¹

On one side, there are many scientists who argue that executive functioning challenges are not central to ADHD. These scientists base their conclusions on executive functioning tests conducted in a lab, intended to measure things like impulse control, working memory, reaction time, or task switching. In these tests, volunteers might be instructed to sort different colored cards, say the color of a word rather than the text of a word, or press a button when only certain letters pop up on a computer screen. 

The majority of people with ADHD perform the same as non-ADHDers on these lab tests. Therefore, some scientists say, executive functioning can’t be a central feature of ADHD.

On the other side, some scientists argue that ADHD is, at its core, all about executive functioning challenges. These scientists say that lab tests aren’t sufficient for understanding how executive function works in day-to-day life. They point out that, on questionnaires where adult ADHDers are asked to self-evaluate their executive function in daily life, almost all of them (over 90%) report major challenges. 

These scientists say that five minutes of pressing a button in a lab tells us nothing about how much this person struggles to pack school lunches for their kids, submit paperwork on time, or meet work deadlines. 

Renowned neuropsychologist Russell Barkley is perhaps the most vocal member of this second group. He is so passionate about this that one of his book chapters on the subject uses an exclamation point (!)—which is the academic writing equivalent of screaming at the top of your lungs.

Barkley believes so strongly in the central role of executive functioning that he has argued that ADHD should be renamed Executive Functioning Deficit Disorder.

Barkley’s Model of Executive Function

Barkley’s model of executive function is popular with clinicians, coaches, and educators working with people with ADHD. It has had less traction in the research community, though.

Barkley says that executive function is all about being able to regulate yourself in order to accomplish your goals. He suggests that executive function operates at four consecutive levels:²

1. Individual thought: self-awareness, impulse control, working memory, self-motivation, problem solving, planning

2. Individual actions: acting to achieve goals, organization, time management, emotional regulation

3. Social behaviors: sharing, turn-taking, cooperating, reciprocity, working with others to achieve goals

4. Collective action: Working with a large social network over extended periods of time on collective goals

Barkley’s theory is that ADHD creates challenges at the lower levels of the model (the individual thought and action levels), which can then ripple outward to disrupt the social and societal levels.

Barkley’s Suggestions for Managing Executive Function Challenges

For people with ADHD or other executive function challenges, Barkley suggests that they work to create external supports for their internal executive function difficulties.³ In other words, create an environment that supports you with the processes that you find challenging. 

For example, Barkley suggests you can:

• Externalize information to help working memory: instead of relying on internal working memory, get important information written down where you’ll see it. Try using signs, labels, whiteboards, and reminder apps.

• Externalize time to help with time awareness: use tools like calendars and visual timers to externally display representations of time

• Externalize rewards to help motivation: implement immediate, short-term rewards for doing goal-directed activities

Barkley also suggests that, when you are doing a lot of self-regulating and executive functioning, your capacity can become depleted. He recommends:

• Taking frequent breaks to recharge

• Regular exercise

• Meditation

• Visualizing success and rewards

• Self-affirmations

***

I always find it fascinating when I investigate a popular idea, only to find out that the history and science behind it are way more complex than I ever realized. For this post, I was surprised to uncover such intense debates over whether executive function is related to ADHD.

I’d love to hear what you think. Has the concept of “executive function” helped you manage ADHD or your life in general? Does Barkley’s model of executive function work for you? What do you think of Barkley’s suggestions for executive function challenges?

Stay curious,

Dr. Taylor Allbright

1. You can find a summary of this debate in Chapters 15–16 of the popular textbook Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 

2. I’m simplifying the model a bit for clarity; if you want to see the full thing, check out Barkley’s book Executive Functions: What They Are, How They Work, and How They Evolved.

3. Barkley’s full list of suggestions can be found in Ch 16 of Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment.