EFD refers to the brain's ability to act like a chief executive officer. When faced with a task, you have to analyze it and develop a plan for completing it. As you work on the task, you may need to make adjustments to your plan, but still complete it correctly and in a timely way. A person with executive function difficulties has problems organizing and planning how to approach and carry out a school-related or family-related task, and completing it to meet a deadline.
EFD might look something like this: Your 10-year-old son walks into the house after school. He drops his coat on the floor near the door and takes his shoes off in the living room. You can follow his trail by the mess he leaves behind. His room can be described as chaotic. Clothes are on the floor, and all the dresser drawers are open, with items falling out. The clean clothes that you put on his bed are on the floor, along with his dirty clothes.
What about homework? If you sit with him to help structure the assignments, he may get it done. If you say, "Go do your homework" and check in later, it won't be complete, probably not started. If he does manage to finish his homework, he may leave it at home. At school, his desk and backpack are a mess. He can't finish class assignments unless the teacher provides some structure.
Which Child Had ADHD?
Based on the revised, more complex, criteria for diagnosing ADHD, which of the three children mentioned before has it?
Joey is hyperactive and inattentive, but these behaviors are not observed all the time. They crop up during specific tasks or activities. He has difficulty doing independent classroom work, but he always participates in class discussions, a verbal task. Thus, his difficulties are not pervasive. Joey’s second- and third-grade teachers didn't see such behaviors in their class. In other words, his behaviors were not chronic.
So I ruled out ADHD. Based on my discussions with Joey and his teacher, I requested psycho-educational testing. Tests revealed a learning disability, and we started treatment.
Allison showed inattention and problems with organization at home, in school, and in Sunday School. Her first- and second-grade teachers had seen similar behaviors. After taking her history, I concluded that Allison had a chronic and pervasive history of attention and organizational problems. I diagnosed her with ADHD, Inattentive Type, and started her on methylphenidate, adjusting the dose and time of coverage. Her family and teachers (and Allison) noted a significant improvement in her ability to stay on task and to complete assignments. Her backpack and bedroom became less messy. She began to work with an organizational tutor.
William's difficulties in relating to children or adults had been noticed since his preschool days. He was a loner who did not seek interactions or relationships at home, with the kids in the neighborhood or in school. He was always "lost in his own thoughts." William liked to watch a certain TV show over and over, and knew its episodes so well that he could recite the lines with the characters. Based on the evaluation, William was diagnosed as having Pervasive Developmental Disorder.
All three students had behaviors that looked like ADHD. Each was found to have a different cause of his problems. The point is that all individuals who show hyperactivity, inattention, and/or impulsivity do not have ADHD. Work with your clinician to make sure that all factors and behaviors are considered before a diagnosis is made.
This article appears in the Spring 2013 issue of ADDitude.
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