Attention-Deficit/Hyperactivity Disorder (ADHD) is marked by two categories of symptoms that are consistent with inattentiveness and/or with hyperactivity and impulsivity. To meet criteria for one or both of these presentations of ADHD, someone must often have trouble with several difficult behaviors, experience impairment from it, and have had struggled with these challenges since they were 12 or younger.
The skills affected comprise what we call executive function skills; these are the abilities you need in order to efficiently reach long-term goals. These executive functions can be broken down into the “hot” executive functions, which are the kinds of skills needed to manage oneself when emotions run high (including cognitive shifting/flexibility, inhibition of impulses, self-monitoring, and emotional control) and the “cool” executive functions, which are those needed to reach long-term goals when emotions are less involved (including efficient problem solving, working memory, and planning/organization).
These skills all stem from the same fundamental ability: self-regulation. Self-regulation is at the heart of executive functioning, and some believe that all executive functions stem from the ability to regulate oneself. The hot executive functions and the cool executive functions are both needed to efficiently reach long-term goals. Unfortunately, disordered self-regulation is at the core of Attention-Deficit/Hyperactivity Disorder (ADHD). Individuals with ADHD have a very difficult time imposing their own restrictions on their executive functioning, and they rely on external factors to help them. This is why some children are able to show laser-like focus and organization when working on tasks they enjoy or find soothing or that are very stimulating (like screen time), but they can’t maintain focus with dull material.
So ADHD typically shows these hallmark problems with self-regulation. Unfortunately, many other disorders show these symptoms too! Executive function deficits also exist in other disorders, like Autism Spectrum Disorder, learning disorders, anxiety, and Disruptive Mood Dysregulation Disorder. Problems with executive functioning are like a fever—the symptom tells you that something is problematic (it’s sensitive) but not what the problem is (it’s not specific).
Because of this, it’s not enough to have you fill out a questionnaire listing these behaviors and then give you an ADHD diagnosis! It’s also important to rule out other potential causes for the executive function problems. When we investigate executive function deficits, we also do a broad evaluation of general cognitive and academic abilities, memory skills, and emotional factors. We also carefully gather information about you throughout your development, in order to help us establish your developmental trajectory. With this information, we can make sure we know what is and what isn’t contributing to your or your child’s current picture, and we’ll help you know how to move forward with this information.