Is ADHD a Behavioral Disorder or a Cognitive Disorder?


What is executive function impairment or disorder, and how is it different than attention deficit hyperactivity disorder (ADD/ADHD)? Are the symptoms ADD/ADHD adults and children experience a result of a behavioral problem, or a cognitive one, a brain issue?


ADDitude Answers

As an attention deficit hyperactivity disorder (ADD/ADHD) researcher, a clinical professor of psychiatry at the Yale University School of Medicine, the author of Attention Deficit Disorder: The Unfocused Mind in Children and Adults, and as a psychologist helping patients manage their symptoms and reclaim their lives, I have seen ADD/ADHD from all sides.

My research into the brain has posited a new model for ADD/ADHD. The old model thinks of ADD/ADHD as a behavioral disorder. Many adults and children living with ADD/ADHD never have had significant behavior problems; they have difficulty focusing their attention on necessary tasks and using working memory effectively, making ADD/ADHD a cognitive disorder, a developmental impairment of executive functions (EFs) — the self-management system of the brain.

My theory of executive function impairment, or executive function disorder (EFD) has been slow to filter down to family doctors who are making diagnoses and prescribing medication. Too many doctors still think about ADD/ADHD in the old way — as a behavior problem accompanied by difficulty in paying attention. They don’t understand that “executive function” is really a broad umbrella. When patients hear the symptoms associated with EFD — finding it hard to get organized or to start tasks, to sustain effort to finish tasks, to hold off instead of jumping impulsively into things, to remember what was just read or heard, to manage emotions — they’ll say, “Yeah, yeah, yeah, that’s me.” A lot of executive function impairment goes beyond the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for ADD/ADHD.

We need to better understand the individual variants of ADD/ADHD in adults. Some adults have big problems in school, but once they get out of school, they are able to specialize in something that they’re good at, or take a job where a secretary helps them, and they do fine. Other adults manage through school, but they don’t do well at jobs or managing a household. We’re beginning to identify the domains of impairment and to recognize that these difficulties with executive functions not only affect people with academic tasks but also in their ability to maintain social relationships and to manage emotions.

The following six clusters of executive functions tend to be impaired in individuals with ADD/ADHD:

  1. Activation: organizing tasks and materials, estimating time, getting started.
  2. Focus: focusing, sustaining focus, and shifting focus between tasks.
  3. Effort: regulating alertness, sustaining effort and processing speed.
  4. Emotion: managing frustration and modulating emotions.
  5. Memory: using working memory and accessing recall.
  6. Action: monitoring/ regulating actions.

Posted by Thomas E. Brown, Ph.D.
Author of A New Understanding of ADHD in Children and Adults

ADDitude Answers

Executive functioning deficits are very common with ADHD. While medication is helpful, it isn’t a “magic pill” or a “cure”—it simply makes an improvement. I think it’s important to note that you cannot “fix” executive functioning issues, as this is part of the physiology of your brain.

Instead, focus on strategies to work around it. The more structure and routine you add to your daily life, the less EFD can trip you up. What is most effective is learning strategies, i.e., work-arounds, to compensate for the planning and organization deficits, things like using lots of alarms and smartphone apps and the like.

Working with an ADHD coach can be great to help kids or adults devise systems to cope with and work around these issues: What You Need to Know About ADHD Coaching.

Posted by Penny Williams
ADDconnect Moderator, Author on Parenting ADHD, Mom to teen boy with ADHD, LDs, and autism

A Reader Answers

Executive Function Disorder (EFD) is a component of ADHD which only some people have. It affects your decision-making abilities adversely, and makes effective time management pretty impossible.

Posted by mamalynxx

A Reader Answers

Yes you can improve your executive function. ADHD is a condition created by low neurotransmitter (Dopamine/Serotonin) levels in the brain.

Executive functions take place in the prefrontal cortex (PFC) of the brain. Insufficient neurotransmitter levels in the PFC disrupt necessary communication with many other areas of the brain, which causes executive functions to be diminished.

Several behaviors can increase neurotransmitters in the brain, but the most important is exercise.

Check out these research studies that explain the benefits of exercise for memory and cognition.

> Cotman, C., Berchtold, N. (2002) Exercise: a behavioural intervention to enhance brain health and plasticity. Trends in Neuroscience. 295-301.

> Hillman, C.H., Erickson, K.I., Kramer, A.F. (2008) Be smart, exercise your heart: exercise effects on brain and cognition. ‘’Neuroscience: Nature Reviews’’ 59-65.

And review this ehow exercise routine .

Posted by ChetBush

A Reader Answers

Executive function is impaired with ADHD. In fact, the powers that be are looking at including poor executive functioning as part of the criteria for diagnosing ADHD. Critical thinking is not usually impaired as part of the wiring in the ADHD brain, although I can see it being impacted by lack of attention.

Posted by Abner

A Reader Answers

Ari Tuckman wrote a book called, Understand Your Brain Get More Done and has an excellent website. The book focuses on understanding the executive function deficits that hold us back and finding strategies to make it easier to get started on tasks.

It can help you understand executive functions, but you really have to do other work to find the most effective treatment option.

These are the four things that Tuckman recommends from a clinical standpoint:

1. Family education as a clinical intervention.

2. Effective medication options.

3. Coaching for better time management, organization, and self-esteem issues.

4. Cognitive behavioral therapy for depression, anxiety, and more.

A well-trained ADHD coach can help you coordinate all of these elements that are essential to a highly fulfilled life.

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This question was asked on the ADDConnect forums. Read the original discussion here.

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Dr. Brown, is an Assistant Clinical Professor of Psychiatry at the Yale University School of Medicine, and Associate Director of the Yale Clinic for Attention and Related Disorders. Dr. Brown was awarded by the National Attention Deficit Disorder Association and has been inducted into the CHADD Hall of Fame for his contributions to research and professional education about ADHD.

He is author of the books: A New Understanding of ADHD in Children and Adults, Smart but Stuck: Emotions in Teens and Adults with ADHD, and Attention Deficit Disorder: The Unfocused Mind in Children and Adults.

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