ADHD and Developmental Delay in Executive Functions
November 14, 2012
Many of the difficulties people with ADHD experience are due to not only the core symptoms of the disorder (inattention, impulsivity, and hyperactivity), but also weaknesses in some or many of their “executive functions”. In fact, it is estimated that children and teens with ADHD have a developmental delay in their executive functions of approximately 30 percent. Inattention and executive functioning weaknesses are the main causes of academic performance difficulties for students with ADHD.
For all people, the executive functions (located in the prefrontal region of the brain) act as the “CEO” or “overseer” – responsible for the self-directed actions we use to help maintain control of ourselves and accomplish goal-directed behavior. These are the range of central control processes in the brain that activate, organize, focus, integrate, and manage other brain functions. Working memory (the ability to hold information in your head long enough to act on it), planning, organizing, prioritizing, getting started on tasks (activation) and sustaining the level of alertness and effort to get through them, strategy monitoring and revising, emotional control and self-regulation are believed to be among the various components of executive functioning. In those with brain-based disorders (the “hidden disabilities”), in which various regions of the brain are affected, EF weaknesses are typical and often misunderstood by teachers or parents. Executive functioning weaknesses affect every aspect of school life. Problems we see in students with ADHD with forgetfulness, lateness, missing deadlines, losing belongings, not finishing projects, poor work production, etc. are often unfairly misinterpreted as the student being apathetic, lazy, irresponsible, or having a poor attitude.
For students with ADHD, we know from an abundance of research that the prefrontal cortex is underactivated and there are some structural differences in this region of the brain, as well. We know that this area of the brain is slower to develop. So, what does this approximate 30 percent delay in executive functions mean for us as teachers and parents of children/teens with ADHD? It means that these kids can’t “act their age”, and it is important to adjust our expectations that they be able to do so. One teacher I know referred to this as the “illusion effect”, because we might see a 12 year old boy, and the illusion is everyone would expect 12 year old behavior from him. However, this boy may be 12 but have the maturity and executive skills of an 8 or 9 year old child. A 10-year old with ADHD will typically behave more like a 7 year old, and a kindergartner have the self-regulation of a preschooler. Teens with ADHD may be 4-5 years less mature in some or many of their executive skills than their classmates. Regardless of how knowledgeable, intelligent, and academically capable they may be (and often are), kids with ADHD are significantly more immature developmentally in their executive skills than their age-level peers. As such, they typically need a much higher degree of support and assistance from parents and teachers than other children and teens will require for success.
It is also important for parents and teachers to directly and explicitly teach and reinforce executive skills, as all skills can be developed and enhanced with practice and feedback. This is beneficial for all students, but particularly so for those with ADHD, Learning Disabilities, and others with EF weaknesses. There are a number of resources full of specific, practical strategies for helping students build executive skills, and compensate for EF weaknesses, including my books: How to Reach & Teach Children with ADD/ADHD (2nd ed.) , The ADD/ADHD Checklist: A Practical Reference for Parents & Teachers. and laminated card – Executive Function: Practical Applications in the Classroom.
Tags: ADHD, developmental delay, executive function, executive skills
