Seven Executive Abilities

Today I listened to a podcast featuring an interview with Dr. Russell Barkley discussing Adult ADHD.

In my opinion, the conversation starts off a bit slow (although that may just be my ADHD/impatience), and the host uses ableist language, such as describing "a mild case" of ADHD.  Nevertheless, it does contain some great content, starting around the 2 minute mark.  

The podcast host is possibly self-diagnosed and seems quite new to understanding ADHD, but it is my opinion that anything with Dr. Russell Barkley is worth listening to.  

I decided to blog some notes from the podcast on the parts that I found helpful or intellectually interesting.  

T/W:  It is also important to note that, near the end of the interview, with about 5 minutes left, the podcast host asks Dr. Barkley about being "politically incorrect".  Dr. Barkley speaks about the Neurodiversity movement and does make some comments that some may find controversial or offensive.  If you do not wish to listen to this, I recommend stopping the podcast around the 57 minute mark.  There is so much excellent content shared by Dr. Barkley that we do not wish those comments to detract from this important information.

Dr. Barkley described the seven executive abilities that are impacted by ADHD.  

 

7 Executive Abilities

As described by Dr. Russell Barkley

 

1. Self-Awareness :  People with ADHD experience difficulties with self-monitoring, they’re not as aware of what they’re doing as other people are. 
2. Inhibition :  The ability to stop what you’re doing voluntarily when you realize you’re making mistakes, study those mistakes, and begin to change to a more effective pattern.  
3. Verbal Working Memory :  Talking to yourself in your mind [your inner monologue] and reminding yourself what you’re supposed to do.
4. Visual Working Memory :  The ability to activate [call up in your mind] images toward a goal and use those mental images to get to where you want to go.  
5. Emotional Self-Regulation :  The ability to control your emotions so they don’t interfere with your goals.  Failing to control emotions such as frustration, impatience, hostility, and reactive aggression can cause us to lose the cooperation of other people we need to accomplish our goals.  (Dr. Barkley states that the best predictor of the number of friendships you are going to have in your life is the ability to regulate your emotions).  
6. Self-Motivation : People with ADHD have difficulty motivating themselves to do things they don’t find interesting, rewarding, or enjoyable.  
7. Planning and Problem Solving : The ability to envision a goal and to map out the options to get there.  When one encounters an obstacle, the ability to quickly brainstorm multiple possibilities to overcome those obstacles. 

More important points to note:

• People with ADHD who are brighter than average discover ways on their own to mitigate some of these executive problems.  
• 70-80% of cases of ADHD are genetically mediated.
• The remaining 20-30% come about through pregnancy or birth complications.  
• The frontal lobe is one of the most sensitive [vulnerable] parts of the brain to acquired injury because it still needs to evolve [continues to develop long after birth].  
• Once we acknowledge that we all have flaws, and own our flaws, they can be part of our uniqueness and we can then mitigate and compensate for them.
• We can "niche-pick" by choosing environments that utilize our strengths and allow our ADHD to be expressed without impairing us.  
• No other psychological disorder has medications as effective as those that have been approved for the treatment of ADHD symptoms.  

Another way I have seen these seven executive functioning challenges described, more so in relation to children, are as follows: 

ADHD Results in a Deficit in Executive Functions:

1.  Impulse Control.  The ability to STOP.  The ability to pause between the action and reaction.  The ability to pause before responding.
    

2.  Hindsight.  The ability to think about previous relevant information and use past experience to guide your current response. 
 

3.  Foresight.  Thinking ahead to longer-term consequences of your current behaviour before acting.
 

So often I hear adults ask (and yes, I have heard myself say it!) "why isn't he learning from these consequences?"  That is why.  Impulsivity combined with a deficit in both hindsight and foresight (also referred to as working memory) make it very difficult for children with ADHD to learn from past mistakes. 

This means that a neurological difference is responsible for difficulty learning from consequences, not a desire to be "bad", and not from a lack of a desire to be "good".  

4.  Self-talk.  Self-directed language to facilitate self-control.  
(Also referred to as verbal working memory).  

5.  Emotional regulation.  The ability to manage one’s emotions to make them more socially acceptable.  

Our emotions are our motivation. 

So, if a child with ADHD has "big feelings" (or emotional dysregulation), then they cannot entirely control the resulting behaviour.  They first need help with managing the feelings and developing self-regulation skills, only then can the behaviour change follow.  

We don't hand a kid a basketball and expect them to sink a basket their first try, we teach them skills first.  Why, then, do we expect children to have the skills to manage their emotions if they haven't been taught?  

6.  Self-Motivation.  Children with ADHD are dependant on the environment and its immediate consequences.

This means that we, the adults, have to help them develop tools for self-reinforcing, especially for tasks they find less desirable.

For example, if we start a token economy system in the classroom or at home, it's highly important to involve the child(ren) as much as possible and give them as much ownership and control over the program as possible.  It is even more important that we gradually transition complete ownership and control of the program over to the child(ren) or students, once they are ready for this step.  

Children and students need to find what is reinforcing for them, not have the adults decide what their rewards are, and they eventually need to be able to run this program for themselves so that they can do it on their own when they no longer have a teacher or parent's support.  

Sound a little strange?  Think about the ways you do this for yourself in your own life:

"I had a good workout today, I'll reward myself with a beer"

"I got in all my steps today, I think I've earned a little dessert"

"After I finish this chore, I'll put my feet up and read a book" 

Author's Note 

In my opinion, token economies should be used sparingly, and should only be used for undesirable tasks such as chores or homework, and should never be used to address behaviour challenges.  

The reason for this is because behavioural problems come from a lack of skill, a lack of coping strategies, and/or underlying issues or concerns.  Addressing the presenting behaviour only "trains" a person to comply and do what is being asked of them, completely ignoring the underlying struggle that really needs to be addressed.  It's a bandaid solution because it does not teach skills or provide emotional support, and it puts the onus on the child, rather than on the competent adult with a fully developed prefrontal cortex.  

For more on the problems with behaviourism and behaviour modification, Alfie Kohn wrote a blog post on the topic, as well as books on the subject called "Punished by Rewards" and "Unconditional Parenting".

 

But I digress....  Back to the Executive Abilities

7.  The ability to plan and problem solve.  The ability to simulate multiple possible future options is the highest executive function in humans. 

The ability to quickly run through multiple "hypothetical situations" in our mind, and then the ability to quickly change course when we run into a problem or when one of our options fails.  

A lot of children (and adults) with ADHD struggle with cognitive flexibility (or flexible thinking).  When we have our mind set on something happening a certain way and that changes, it can be very difficult for us to adapt.  This is also a common struggle for people with anxiety, a comorbid condition with ADHD (meaning they commonly occur together).  Sometimes people with anxiety need to mentally prepare themselves for a situation, then if circumstances change this can greatly increase their anxiety because they haven't had an opportunity to mentally prepare.   

Another important note:

Children with undiagnosed, untreated, or inadequately treated ADHD are 30% behind their peers when it comes to executive functioning.

About the Author

Jillian is an ADHD 2e Coach and Child Advocate in Manitoba, Canada.

Jillian has a diploma in Child & Youth Work and a Degree in Psychology, as well as being the parent of an amazing 2e/ADHD child.

Visit ADHDPro.ca and Facebook.com/ADHD2ePro to learn more.