Adults with ADHD who Struggle with Executive Functions

By: Lewis S. Odell, Ph.D.

Randy Kulman, Ph.D. is the Founder and President of LearningWorks for Kids, an educational technology company that specializes in using video games and interactive digital media to teach executive-functioning and academic skills. For the past 25 years, Dr. Odell has also been the Clinical Director and President of South County Child and Family Consultants, a multidisciplinary group of private practitioners that specializes in assessment and interventions for children with learning disorders and attention difficulties.

ADHD is frequently identified by leading psychologists and psychiatrists as an executive- functioning disorder, one that affects brain-based self-management skills such as working memory, flexibility, organization, planning, metacognition, and self-control. This observation is consistent with many of the difficulties that children with ADHD experience such as forgetfulness (working memory), losing things (organization), and impulsive behavior (response inhibition). Adults with ADHD who struggle with executive functions often experience difficulties at work, in their personal lives, and even in their leisure activities.

Work lives can be particularly impacted by executive dysfunctions. Adults with ADHD who struggle with executive functions report minor concerns such as offices or desks being disorganized or memory lapses that mean forgetting why they left their workspace or dialed a co-worker’s extension. More seriously, problems with relationships may be observed due to tendencies to anger easily or to overreact to minor stressors. For the majority of adults these issues only minimally impact their day-to-day lives or their performance in their jobs. However for some individuals, these executive difficulties cause serious problems at work.

The good news (at least for younger adults) is that new studies suggest that executive-functioning skills continue to develop and improve through the mid-30s. There is a series of new studies suggesting that sustained “brain exercise” can result in maintaining a high level of executive functioning, as well as developing new neuronal connections in the brain. “Brain-training” programs are continually being developed and marketed for older adults.

Executive-functioning strengths and weaknesses manifest themselves differently in adults than in children. Difficulty with executive skills may play a larger role in relationship issues for adults than they do with children. Because many adults with executive-functioning difficulty have never received any type of intervention they probably have not identified these concerns or do not realize they are treatable.

The following are 12 executive-functioning skills and behaviors that are characteristic of executive dysfunctions in adults:

Executive Function	Real World Example
Task Initiation	Displays procrastination – puts off minor household tasks such as changing lights or doing the dishes after dinner
Planning	Cannot explain priorities and goals – loses out on opportunities such as going to a favorite restaurant due to not making reservations or planning ahead
Organization	Is always looking for something – loses money, keys, wallet, or cell phone on a regular basis
Time Management	Works very slowly – underestimates how much time it will take to complete tasks such as going food shopping or making dinner
Flexibility	Experiences problems with changes in routine and schedule – becomes overly upset when a meeting or plans are changed
Metacognition	Cannot explain how she intends to approach or solve a problem – often feels that things that happen to her are outside of her control
Response Inhibition	Can be impulsive – drinks or gambles too much without considering the impact
Regulation of Affect	Gets angry or upset easily – goes into a rage or angry display in response to a perceived criticism
Social Awareness	Is unaware of other people’s feelings – unknowingly stands too close in conversations or otherwise makes them uncomfortable
Sustained Attention	Starts one thing after another without finishing them or reads a book without paying attention to the content and needs to reread it
Goal-Directed Persistence	Is bored by long-term tasks – starts cleaning the garage or basement and gives up after an hour
Working Memory	Is absent-minded – often forgets items she wants when food shopping

Learn more about Dr. Odell:

Dr. Odell is the author of numerous essays on the use of digital technologies for improving executive-functioning skills in children in which he has developed concepts such as “play diets” and “engamement” to help parents and teachers understand the impact of digital technologies on children. He is the author of Train Your Brain for Success: A Teenager’s Guide to Executive Functions and the author of LearningWorks for Kids: Playing Smarter in a Digital World.