Executive Dysfunction

Executive Dysfunction, Explained!

Executive dysfunction is a brain-based impairment that impacts a person’s ability to analyze, organize, decide, and execute things on time. It causes assignments to be lost, deadlines to be missed, and projects to overwhelm. Learn how to recognize the signs of executive dysfunction, and how to differentiate them from ADHD and/or learning disabilities.

Conceptual image of an ADHD woman not knowing what to do
Conceptual image of an ADHD woman not knowing what to do

Is It ADHD? Does It Cause Executive Dysfunction?

A child or an adult with attention deficit disorder (ADHD or ADD) might be hyperactive, inattentive, and/or impulsive. Clinicians have always understood hyperactivity and impulsivity. The understanding of inattention, though, has shifted from primarily “the inability to stay on task” to a broader concept called executive function disorder (EFD), which involves a pattern of chronic difficulties in executing daily tasks. This is sometimes called executive dysfunction.

What Is Executive Function?

Think of executive function as what the chief executive officer of a company must do — analyze, organize, decide, and execute. Around the time of puberty, the frontal part of the cortex of the brain matures, allowing individuals to perform higher-level tasks like these:

  1. Analyze a task
  2. Plan how to address the task
  3. Organize the steps needed to carry out the task
  4. Develop timelines for completing the task
  5. Adjust or shift the steps, if needed, to complete the task
  6. Complete the task in a timely way

What Is Executive Dysfunction?

And what is executive function disorder (EFD)?

Executive dysfunction is a brain-based impairment that causes problems with analyzing, planning, organizing, scheduling, and completing tasks at all — or on deadline.

A child without problems with executive function may appear like this: A middle-schooler’s teacher assigns the class a book to read, and writes the due date for the book report on the board. A student must be able to determine where to get the book and how long he thinks it will take to finish reading it. If the teacher has a specific book-report format, the student will have to keep it in mind as he reads the book and takes notes. He needs enough time to write a rough draft, get help from teachers or parents, if needed, and write a final draft by the due date. If the student has good executive function skills, the work will get done on time. If he has EFD, it won’t.

[Self-Test: Could Your Child Have an Executive Dysfunction?]

Recognize the signs and symptoms of executive dysfunction.

Children and adults with EFD have problems organizing materials and setting schedules. They misplace papers, reports, and other school materials. They might have similar problems keeping track of their personal items or keeping their bedroom organized. No matter how hard they try, they fall short.

A Tale of Two Children: One Diagnosed With EFD and ADHD, One Diagnosed With EFD and LD

Marcus, a fifth-grader, had difficulty staying on task and completing his schoolwork. He also had problems keeping his backpack and papers organized and remembering what to bring home from or take to school. Psycho-educational testing showed that he was bright, but that he had difficulties with processing speed and working memory. These findings, plus other studies, showed evidence of difficulties with executive function. The psychologist concluded that Marcus had ADHD, inattentive type, and started him on a stimulant medication. He showed significant improvement in all areas.

Ethan, a sixth-grader, received the same diagnosis but had a different result. The presenting problems, and the psycho-educational test results, were the same as Marcus’. Ethan was given a stimulant, but his symptoms didn’t improve. A closer review of his psycho-educational test results showed that he had problems retaining what he read and with written work. Ethan had EFD, but his problems resulted in Learning Disabilities (LD). He needed tutoring, plus accommodations, to overcome his challenges.

Signs and Symptoms of EFD and LD

If you look at the criteria used to diagnose ADHD, inattentive type, you could understand why a child with EFD might be diagnosed as having ADHD. But it’s important to know that EFD can cause learning disabilities (LD).

[Free Download: Executive Function Worksheet]

Martha Bridge Denckla, M.D., an expert on executive function disorder, says, “EFD can be a reflection of ADHD, but it might also indicate an LD.” When a professional evaluating a child or adult finds evidence of EFD, it is essential for her to clarify whether the disorder results in ADHD, LD, or both. Only then can the child or adult receive the appropriate treatment for his specific problem.

In elementary school, a child learns to read, to write, and the basics of spelling, grammar, punctuation, and capitalization. She learns basic math concepts — addition, subtraction, fractions, and decimals. In middle and high school, with expanded executive function abilities, the student has a greater ability to organize and process information.

When reading, the student must organize the content before it can be stored. This is reading fluency. When writing, a student must be able to pull information from memory and to organize this information before he can start. A teacher might ask, “Can you tell me the theme of the book, and give examples to illustrate it?” The ability to retrieve and organize information in order to write a response is called writing fluency. Solving math problems requires retrieving learned concepts (formulas, rules) as well as known facts (multiplication tables) — and to use this information to find the answer.

A student with executive dysfunction might have difficulty organizing information before storing it in memory, or difficulty organizing information that is retrieved from memory. He might read a chapter but not retain what he has read. He might know the material but be unable to write an answer or start a paper because he cannot organize his thoughts. He might be able to write out math equations, but makes careless errors along the way.

When such students are tested, the results might show that their problems stem from EFD, but professionals are too quick to decide that the problem is ADHD. Professionals must look closely at the educational part of the assessment. If the results show that the student has difficulties with reading, writing, or math fluency, the EFD is also a reflection of an LD. It is vital to make the correct diagnosis — for the child’s sake.

Not all practitioners understand that executive function disorder can bring a diagnosis of ADHD, LD, or both. Even when psycho-educational test results support a diagnosis of LD, some conclude that the child has ADHD, inattentive type.

Signs and Symptoms of ADHD and EFD

Russell Barkley, Ph.D., who has been at the forefront of exploring the relationship between ADHD and EFD, says, “It is not that the individual does not know what to do. It is that somehow it does not get done.”

The symptoms of ADHD, inattentive type, often improve with a stimulant. The symptoms of LD don’t improve with medication. The best way to manage LD is through specialized accommodations and one-on-one work with a learning specialist.

Observe your child closely at home. Now that you understand how EFD affects learning, look for signs of LD and ADHD. If the only focus is on ADHD, talk with your family doctor and school professionals about your concerns.

If necessary, share this article with the school administrators and other professionals to educate them about the relationship between EFD, LD, and attention deficit.

[How ADHD (Inattentive Type) Looks A Lot Like Learning Disabilities]

Larry Silver, M.D., is a member of ADDitude’s ADHD Medical Review Panel.

9 Comments & Reviews

  1. sometimes I wish that these articles would relate on a home and self care aspect rather education. My son does fairly well educationally but falls short on self care and at home basics. Maybe my son is fine academically because of all the pressure put on for success in education, there are unjust punishments for kids struggling with meeting standards, look at all the testing, add more work, and more work, fall short get held back, missed days tardy and warnings and fines. So focus gets put on the schooling being as successful as possible, focus even by way of this article from an education view, and the self care, survival things go on a back burner. Eventually they are out of school, then what? I just wish it were more relatable to the home self care and survival aspect, so I could relate when it comes to my sons. Why are the articles so education focused?

    1. I get where you’re coming from. All the way through undergrad, I did great at school. I’ve always been very intelligent (not bragging I promise), and school gave me the structure I needed to fly under the radar. I think that’s why everyone, myself included, completely missed my issues. I’ve always had issues with time management, organization, planning, etc. in my personal life…my self care has its highs and lows, and I’ve never been consistently on time for school or work. I didn’t really hit a wall until grad school, but I managed to make it through with help from my more organized classmates. I always assumed I was just burnt out from undergrad, so I never comsidered it. Now that I’m advanced in employment, I’ve finally crashed big time…its taken this failure for me to finally put the dots of of my life together. Procrastination/time management plus, as you put it, issues with self-care and survival, were the main clues to the issues I’m experiencing now. I just wish people recognized them as signs earlier.

    2. I agree. There are lots of ways in which school helps my son. It’s at home where we have the most trouble. Simply doing things on his own and understanding time in general is very difficult for him. And he’s 10 years old.

  2. “He might know the material but be unable to write an answer or start a paper because he cannot organize his thoughts.”
    Oh my god I do that all the time!!! I think I’m gonna cry; I’ve been diagnosed with ADHD since I was like 6 (so like a decade now), and I’d never realized that this is part of the Executive Dysfunction part of it,,
    I actually think I might cry – I can’t believe it… I’d always just thought I was broken, or dumb, or something along those lines… I don’t think I’ve ever felt relief like this in my entire life
    I’m so relieved right now, thank you so much for putting this info out there; I can’t even put into words how grateful I am

  3. So my 26 yr old daughter was diagnosed ADD at 4. We are always learning more about it. Back then many didn’t believe it was a real thing, just poor parenting. It was an eye opener when Dr Amen started showing brain scans of ADD patients. The lack of frontal lobe activity was heartbreaking to see. But we all have our strengths, the type of work an ADD person should look for should avoid the type with unflexible deadlines and quick change overs. The at home self care is a learned skill. Time blocked out for laundry and cleaning, printed lists for daily and weekly tasks and their times is helpful for all brain types. I grew up with the luxury of a stay at home mom, sadly my child had a mom who work 40+ in an unairconditioned factory. I may have a bit of ADD, but mostly exhaustion. Getting some organizing books helped me with at least a few good techniques. A designated place for each kind of item, and a designated time for each activity. One organizer simply says “put like with like” all books together, all clothes together, jewelry, bills, etc., even if piled in a cardboard box or on the floor. Then at least you only have one place to look for an item. I would say that some close friends or family might be willing to come over and pitch in for the pleasure of seeing you a little less frazzled. With ADD it may never be perfect, but it can be doable.

  4. Great article. How do I find the right professional to help my child to train his brain to work within his abilities of having EFD, LD and Add? Is ithis kind of help found in an educator, tutor or life coach. It’s making me nuts that I can’t seem to help my child to organize himself , this is something he will need to be able to do throughout his life!

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