ADHD and Executive Function Disorder


Problems with organization, planning, inability to get things done on time or in the right order are often diagnosed as ADHD (Attention Deficit Hyperactivity Disorder), and then again sometimes referred to as EFD (Executive Function Disorder).  The question often comes up: "Aren't these the same thing?"  Well that depend on who you talk to.

You see the terms ADHD and Executive Dysfunction are now often used interchangeably. But that isn't necessarily a good thing because some of the finer points of both disorders get confused. A child, adolescent or adult might have ADHD (or sometimes it's called ADD, a leftover term from the last decade) and have problems with hyperactivity, being inattentive, procrastination, or be highly impulsive. The hyperactivity and impulsivity is common, but not always the case. Some individuals have ADHD without hyperactivity or impulsivity. These individuals have what is more commonly know as "inattentive type" of ADHD. Some may be labeled with "slow cognitive processing," a newer form of the disorder that is being defined by Dr. Russell Barley, a leader in the field. These individuals may not have any of the outward signs of symptoms that parents and teachers associate with ADHD. They don't move around, fidget at their desk, or act impulsively during class blurting out answers or simply talking out loud. Instead they can't seem to stay on-taks, focused and seldom reach a state of task completion. They may also have trouble following what is being said or red because they simply cannot stay focused. A subgroup also has problems with handwriting.

EFD, Executive Function Disorder, is often used to refer to a broader and less focused set of problems which involves a pattern of chronic difficulties with executing every day tasks 

What are Executive Tasks? And do they relate to ADHD?
Executive taks include the ability to understand the whole and analyze a task, being able to plan how you will address a task and get it done, organizing the steps you need to take to carry out a task, developing a time line for task completion and understanding how long and how much energy it will take to complete a task (without this skill we can easily drift off from what should be focused on. The task may appear to have no beginning, middle and end.

Children with EFD have trouble getting assignment handed in, lose them, misplace them, do the wrong assignment, hand in the wrong assignment even when the correct one is done, have trouble organizing materials, including personal items, and can't keep their room, locker or desk clear. 

What is important to note is that one student or adult with ADHD may do very well on medication and with minimal support and coaching. Another with very similar test scores during a psychoeducational assessment may improve, but continue to have problems understanding the materials, organizing them, and perhaps even getting how to find an answer within all the materials in front of them. This student most likely has an EFD and a Learning Disability and needs very different supports and accommodations to support them in the classroom.

EDF can be reflective of ADHD, or it can tell us that there is a more serious Learning Disability present that needs support. Reading, writing and math fluency are often problems for these students, and interventions that support those specific issues need to be implemented. This is why we are often reluctant to provide a quick and simply ADHD diagnosis. (Often, regrettably, family doctors look only for signs of the list of symptoms that match ADHD, they use quick "screeners" like the SNAP-4 and other "symptom lists" and quickly prescribe medicine for what appears to be ADHD. Any student with ADHD should really be assessed for Learning Disabilities, this includes either a full psychoeducational evaluation or a neuropsychological evaluation. When might this not be necessary? Well, I suppose when a student had ADHD but is doing well academically. But even in this situation the difficulty and complexity of the school curriculum changes year after year, and often a student doing well in grade 2-3 suddenly finds failure in grade 4 because tasks that were simple now require Executive Functions far beyond what was previously necessary. Similar curriculum changes happen in the middle school and high school. In high school this can happen due to the very different learning requirements of different subjects now taught in different ways.

Not all professionals and practitioners understand that these same symptoms can bring about a diagnosis of ADHD AND Learning Disabilities based upon deficits in executive functioning. Very few medical doctors are knowledgeable about school based learning issues, and few can perform the necessary assessments.

If you suspect you child has ADHD, or you yourself have ADHD, a psychologist with a background in both ADHD and Education is your best bet. A full and comprehensive evaluation may be more expensive, but it may also be necessary in order to understand the exact nature of your ADHD symptoms and to then develop a logical and focused intervention.

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Forn information about my practice serving clients with ADHD in Vancouver, Burnaby, Coquitlam and the surrounding areas please go to my web page at www.relatedminds.com or www.adhdhelp.ca

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KEY WORDS: ADHD, ADD, Vancouver, Burnaby, East Vancouver, West Vancouver, North Vancouver, New Westminster, Coquitlam, Port Moody, Maple ridge, Assessment, Testing, ADHD Coaching