Executive Function Disorder

Your Executive Functions Are Weak. Here’s Why.

ADHD and Executive Function Disorder (EFD) are tightly linked, but far from synonymous. They both make it exceedingly difficult to complete tasks and stay organized, but EFD impacts nearly all goal-directed behavior. How to tell the difference — and get it under control.

A woman with weak executive functions trying to get her laundry done.
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What Are Executive Functions?

Up to 90 percent of kids with ADHD also also have executive function challenges, many of which last into adulthood. But, what are your executive functions, exactly? Broadly speaking, executive function refers to the cognitive or mental abilities that people need to actively pursue goals. In other words, how we behave toward our future goals and what mental abilities we need to accomplish them. People with EFD struggle to change their behavior in ways that will make the future better.

An illustration of an ADHD brain with weak executive functions.
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What Does EFD Look Like?

People with EFD often experience time blindness, or an inability to plan for and keep in mind future events. They also have difficulty stringing together actions to meet long-term goals. This is not an attention problem in the present tense, but rather a sustained attention problem.

Even if they try very hard, people with EFD will fall short and struggle to do the following:

  • Handle frustration
  • Start and finish tasks
  • Recall and follow multi-step directions
  • Stay on track
  • Plan, organize and self-monitor
  • Balance tasks (like sports and academic demands)
Woman writing illustrates one of your executive functions.
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Why Does EFD Matter?

Executive functions enable us to function productively everyday. Specifically, they help us to...

  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 steps
  6. Complete the task in a timely way

When our executive functions fail, we have trouble analyzing, planning, organizing, scheduling, and completing tasks. People with EFD commonly lack the ability to handle frustration, start and finish tasks, recall and follow multi-step directions, stay on track, self monitor, and balance tasks (like sports and academic demands).

Woman driving and on the phone illustrates the ability to multi-task -- one of your executive functions.
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How Do We Know It's EFD?

Executive function is judged by the strength of these seven skills:
1. Self-awareness: Simply put, this is self-directed attention
2. Inhibition: Also known as self-restraint
3. Non-Verbal Working Memory: The ability to hold things in your mind. Essentially, visual imagery — how well you can picture things mentally
4. Verbal Working Memory: Self-speech, or internal speech. Most people think of this as their “inner monologue”
5. Emotional Self-Regulation: The ability to take the previous four executive functions and use them to manipulate your own emotional state. This means learning to use words, images, and your own self-awareness to process and alter how we feel about things

A teen with ADHD uses a laptop on the couch
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EFD Symptoms, Continued

6. Self-Motivation: How well you can motivate yourself to complete a task when there is no immediate external consequence
7. Planning and Problem Solving: Experts sometimes like to think of this as “self-play” — how we play with information in our minds to come up with new ways of doing something. By taking things apart and recombining them in different ways, we’re planning solutions to our problems

Does this list sound familiar? If so, speak with your doctor about the Behavior Rating Inventory of Executive Function (BRIEF), a written survey that kids/young adults, parents, and teachers complete to assess executive functioning.

Kids with ADHD often struggle in school due to poor executive functions.
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When Does EFD Show Up?

The seven executive functions develop over time. Self-awareness starts to develop around age 2, and by age 30, planning and problem solving should be fully developed in a neurotypical person. Individuals with ADHD are generally about 30 to 40 percent behind their peers in transitioning from one executive function to the next.

EFD is often difficult to ignore during the transitions to 6th or 9th grade, when the structure of elementary school disappears, and academic expectations increase. Parents and teachers often don’t get why kids can’t work independently on an assignment, and assume they'll “pick up” the necessary skills. It's important to start helping kids with ADHD/EFD early, and acknowledge the problems those disorders cause so that kids don't feel stupid or lazy.

Depressed girl talks to doctor in order to diagnose executive function disorder.
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What's the Treatment for EFD?

Experts recommend a range of strategies to help strengthen the areas of weakness that EFD creates. The first method uses occupational or speech therapists, psychologists, or reading tutors to learn how to work around problem areas. Cognitive behavioral therapy, used in combination with medication to treat any coexisting conditions like ADHD, is very effective at treating executive functioning deficits including problems with inhibition, emotion regulation, time management, and planning in adults. CBT is less effective with children.

Mom helps child get ready for school to help with executive function disorder.
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How Can We Help Kids with EFD?

Kids with EFD and ADHD typically respond well to behavior modification programs like token systems and daily report cards. Parents can request special accommodations at school via a 504 Plan or individualized education program (IEP), or informally request accommodations to help them understand assignments, getting started, and staying focused. Parents and teachers can help lessen the effects of EFD and ADHD with the following strategies and accommodations for help at school.

Accommodations for executive function disorder in kids and adults with ADHD.
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Accommodations Ideas

If a child needs an IEP or 504 Plan, identify the two or three most important deficits. Then pick accommodations that will address that problem, and build those into the plan. For example:

  • A note taking buddy
  • A front row seat
  • Extra time to take tests

Parents and teachers should work together to balance what's done at home and what's done at school to help.

Mom helps boy with homework to help with executive function disorder.
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Helping with Assignments at School

Kids with EFD often lose homework or forget assignments. Try this!

  • Post tasks on the board
  • Read them out loud
  • Have kids repeat them
  • Appoint a row captain to check that everyone has written it down
  • Teach note-taking skills
  • Use color — put tasks on different color cards
Bored kids in the classroom need help with executive functions.
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Helping Kids Focus at School

Kids with ADHD/EFD can get frustrated easily. Help them stay on track with these strategies:

  • Have kids run in place or be active for a minute
  • Have two work stations so that kids can get up and move between assignments
  • Let kids use fidget toys
  • Give kids graphic organizers (like key steps to write an essay)
Create a study area to help combat poor executive function.
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Helping at Home

Children, particularly those with ADHD, need structure to help overcome EFD difficulties.

Have a special place for kids to work on assignments. Organize the space with a launch pad that has everything they need to get started. Give your child a break after school. Set a time to start, but give your child a choice of 4:00pm or 4:15pm. Sit with kids to make sure they start, and then check the homework when it’s finished.

A teen girl uses headphones and a tablet to get homework done despite executive function disorder.
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Helping with Homework

Break homework into segments so your child gets a brain break. Give your child a snack, or encourage him to run around for a few minutes in between tasks. Let him listen to music while he works — it can actually stimulate focus.

Have a phone number and address for someone in class in case you need the assignment or to borrow a book. After the assignment is done, have your child put all the homework back in his backpack, and put it by the door for the next day, as a visual cue.

A frustrated student puts her head down and refuses help for executive function disorder.
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When Kids Don't Want Help

Some kids, especially older ones, resist help at school.

When kids get frustrated, give them time to do something they enjoy, or have them teach you something they know well (like how to play a game). This will help them feel successful and show off a strength.

Girls are trying to overcome executive function disorder using tablets.
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Tech to Try

In addition to what parents can do, and what schools can do, there is technology that can help:

  • Computer if handwriting is messy or difficult
  • Timer, like Time Timer
  • Software kids can dictate to
  • iPads and iPhones for organization apps

Some video games can help build executive function skills. Use this website to find out which ones – kids will play them anyhow!

Father and son play checkers to learn executive functions.
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Go for Games

Games can help ADHD kids improve executive function.

Games like Checkers, Monopoly and Clue use planning, sustained attention, response inhibition, working memory and metacognition.

Games like Zelda and SimCity help with problem solving, and goal-directed persistence.

Managing a fantasy sports team also uses executive skills, task initiation, and time management skills — all while having fun!

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