Executive Skills and ADHD (Attention Deficit Hyperactivity Disorder)

Often patients come to the office for a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) and they have heard that ADHD is related to what is called "Executive Function." This is true, and deficits in executive function are a critical issue in ADHD. Coming up with useful interventions for ADHD usually brings us right to the front door of executive disorders. Schools are often at a loss as to how to approach ADHD in the classroom, and the last set of IEP's I reviewed from school districts here in BC (including IEP's from Burnaby, Vancouver, North Vancouver, Coquitlam, Langley, New Westminister and Maple Ridge all seems to fall off the track and miss the point that ADHD is primarily a function of executive deficit and dysfunction.

Too many times the Individualized Education Plans, usually developed from the Psychoeducational Assessment, focused on increasing academic outcome, getting work completed and increasing scores with very little understanding of the effect of executive deficits and their relationship to ADHD.

(For instance, starting a task may very well be related to difficulty with switching mental sets, changing what we are doing, moving from one task to another. This is an executive deficit ...sometimes we might call it "procrastination" or simply ADHD, but we need to understand the nature of the executive disfunction in order to develop an appropriate intervention plan. This might include both environmental changes, such as cues and prompts, and teaching new skills such as what to do next, how to set up a project and move forward with a step to step plan. There is additionally the problem that changing behaviours, not procrastinating but instead changing tasks and moving forward, may not be inherently rewarding or reinforcing. Honestly, if you have been avoiding work for two years and now someone gets you to deal with it ....your reward is usually more work! And for an 8 year old, more work isn't the reward he or she was looking for (And it's even worse for adults with ADHD!) So, developing a plan means not just following a script but also finding a good behavioural therapist to help develop and watch the plan.

So where can yo get some help in developing an intervention plan for ADHD, including a school IEP, that takes into account issues relating to executive dysfunction and deficits? Here are two good executive dysfunction and skill resources:

First, an excellent book from the Guilford Practical Intervention in the Schools Series: Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention by Peg Dawson and Richard Guare.  This book covers the basics of executive skills and brain development, reviews methods that we use in psychoeducational assessments and neuropsychological assessments to assess executive skills, talks about how to make behavioural observations with formal assessment measures of specific executive skill areas such as 1) Self Regualtion of Affect, 2) Metacognition, 3) Goal-Directed Persistence, 4) Cognitive Flexibility, 5) Sustained Attention, 6) Working Memory, 7) Response Inhibition (Impulsivity), 8) Planning and Prioritizing, 9) Time Management, 10) Organization, 11) Task Initiation (avoiding Procrastination).

The book also gives home simple case examples of developing and implementing simple plans to address each of these specific areas of deficit. This list (above) should give you some idea of how your school should be assessing your child and addressing specific deficits for intervention in the classroom.

The book also addresses developing interventions that promote executive skills for those with ADHD. These plans involve addressing the psychical and social environment; changing the nature of the tasks at hand; improving how cues and prompts are given; and for the schools, changing how adults and students interact.

Specific interventions for the classroom and individual are also discussed, as well as applications of these interventions to specific populations, such as children with Aspergers Syndrome or autism spectrum disorder who may also have ADHD symptoms or executive function deficits that interfere with learning. This is an great, evidence based book that any school team should have.

On my ADHD website page (http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/) you will also find information and a link to a short article by Thomas Brown on executive dysfunction and it's relationship to ADHD.

Finally, Russell Barkley has an excellent article on ADHD and Executive Function which you can download here: http://www.relatedminds.com/wp-content/uploads/2011/06/ADHD_EF_and_SR.pdf

KEYWORDS:  ADHD, ADD, Attention Deficit Hyperactivity Disorder, Psychologist, Diagnosis, Treatment, Registered Psychologist, Burnaby, Vancouver, Port Moody, Coquitlam, New Westminster, North Vancouver, Coaching, ADHD Coaching, Professional Coaching, Assessment, Psychoeducational Assessment, Testing.

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