What is Executive Function? How it Relates to ADHD and Daily Life

Dr. Tracey Marks introduces executive functioning as a critical set of cognitive skills, emphasizing its profound connection to ADHD. She defines executive function as encompassing planning, organization, prioritizing, initiating actions, self-inhibition (impulse control), self-monitoring, the ability to shift attention (cognitive flexibility), and working memory. The episode meticulously breaks down each of these seven skills, illustrating what optimal functioning looks like and, more importantly, how impairments manifest in daily life, such as chronic procrastination, difficulty managing time, interrupting others, or an inability to adapt to change.

The podcast highlights that ADHD can be understood as a disorder of executive functioning, making a deep understanding of these skills crucial for managing symptoms. Dr. Marks provides concrete examples of how executive dysfunction impacts individuals, from being unprepared despite ample time to struggling with problem-solving due to inadequate working memory. She explains that issues like consistently being late or failing to recognize patterns of unreliability stem from deficits in self-monitoring and working memory, where past experiences are not effectively integrated into current decision-making.

Neurologically, the control center for executive functions is located in the frontal part of the brain, including the frontal lobes, basal ganglia, and specifically the prefrontal cortex. This anatomical detail is significant because stimulant medications like Ritalin and Adderall primarily work by increasing dopamine in the prefrontal cortex to improve these functions. However, the episode notes that even with medication, many individuals still face challenges, underscoring the need for additional strategies.

Beyond ADHD, Dr. Marks identifies other conditions that can impair executive functioning, such as depression, traumatic brain injury, alcohol consumption (temporarily), and strokes affecting the frontal brain regions. She concludes by mentioning that cognitive-behavior therapy (CBT) is a key therapeutic approach focused on managing these executive skills, setting the stage for future discussions on practical tips for addressing executive dysfunction associated with ADHD.

ADHD can be thought of as a disorder of executive functioning, so understanding this is an important lead-in to making behavioral changes.

Executive function is a set of cognitive or thinking skills that are responsible for the following, planning, organization and prioritizing, initiating actions, self-inhibition, self-monitoring your behavior, being able to shift your attention between tasks and working memory.

Anyone can put things off that they don't wanna do but trouble with initiation is at the root of procrastinating. It's like there's a block to being able to just do it.

Self-inhibition. This can be thought of as impulse control. It's the ability to hold back from automatic responses because you're able to anticipate what impact your action will have.

If you have trouble in this area, you may tend to have no idea of what you're doing and how it impacts others. You may have trouble accepting feedback from people because you don't see what the problem is.

Some people refer to this skill as cognitive flexibility. This is a skill that involves being able to shift attention from one thing to another and also involves being able to respond and adapt to change.

Working memory and this is the ability to keep things top of mind, to be able to retrieve and process recently learned information.

The control for your executive functions is located in the front part of your brain that includes the frontal lobes and other structures such as the basal ganglia, which are further down from the lobes.

The stimulant medications, like Ritalin and Adderall, work to increase dopamine in the prefrontal cortex but even with medication, many people are still left with difficulties managing some of these functions and cognitive-behavior therapy focuses on managing some of these executive skills.