As awareness of attention-deficit/hyperactivity disorder (ADHD) grows, talk about executive functions and executive function disorder (EFD) is also becoming more common. Increasing awareness can help people feel more comfortable talking about their experiences and seeking support for their issues with executive dysfunction, but the situation is still very nuanced. ADHD and executive function disorder are closely related—and even interlinked—so it’s important to understand their similarities and differences.
What is ADHD?
With nearly 10% of children and 8% of adults in the US having diagnosed ADHD, it is among the most prevalent disorders of the time. The American Psychiatric Association’s DSM-5 classifies the condition as a neurodevelopmental disorder, calling it “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
The manual outlines a list of behaviors and symptoms divided into two categories: inattention and hyperactivity. To be diagnosed with ADHD, an individual must meet six or more criteria listed in a single category, and the symptoms must be persistent.
Symptoms in the inattentive category include:
- Difficulties organizing tasks, managing time, or working sequentially
- Failure to pay close attention or frequent, careless mistakes
- Avoidance of tasks that require sustained or ongoing mental effort
- Distractibility, forgetfulness, or a tendency to lose key items
Symptoms in the hyperactivity category include:
- Impulsivity and difficulty waiting for their turn
- Difficulty being or staying quiet or completing tasks quietly
- Restlessness or a desire to move about frenetically.
The Brown model of ADHD classifies the condition as a cognitive disorder rather than a behavioral one, as many previous models did. As part of this classification, the Brown model identifies ADHD as an impairment in a number of executive functions accompanied by other symptoms.
What is Executive Function Disorder?
Although ADHD is defined within the DSM and is, therefore, a diagnosable condition, EFD is not strictly considered diagnosable. Instead, it’s a condition used to evaluate skills and behaviors. Doctors can use these evaluations to identify and treat symptoms or help patients seek coaching in building executive function skills.
Executive functions are the faculties that individuals use to pursue goals and complete activities. They include:
These are skills and abilities individuals develop over the course of their lives, starting in childhood and continuing well into adulthood. At certain ages, deficits in various executive functions are normal, but there are specific milestones people can expect to meet as they develop.
EFD is a deficit in one or more executive functions that is outside the norm for a patient’s age. People with EFD will often have trouble judging the passage of time, focusing on one task or switching between tasks, following instructions with multiple or complicated steps, and/or working toward long-term goals in a cohesive way.
How are these disorders alike?
ADHD and executive function are closely linked, and there is a lot of overlap in how ADHD and EFD are described and evaluated. Both conditions impact how an individual is able to complete tasks, pursue goals, make plans, and even learn.
At the most basic level, ADHD may be described as a deficit in a series of executive functions combined with other symptoms, and both conditions have ramifications for how a person socializes. However, EFD can be related to several other conditions, such as Parkinson’s, dyslexia, and dementia, and it isn’t necessarily the same as or directly related to ADHD.
How are they different?
While ADHD is almost always characterized by a number of deficits in executive function, it also results in many symptoms and behaviors that are not associated with EFD. For a patient to get a diagnosis for ADHD, they must exhibit symptoms that are not characteristic of executive function problems.
Fidgeting and hyperactivity are both symptoms common in ADHD patients that don’t necessarily correlate with EFD. ADHD also tends to manifest in childhood, whereas EFD can occur later in life due to other diseases or medical problems.
Because ADHD is a cognitive disorder, it is the result of a deviation from the normal chemical balance in the brain. This allows for the medical treatment of ADHD through prescriptions, like Adderall and Ritalin. However, mild forms of ADHD can respond to therapy and coaching and may not require medication.
EFD cannot be treated in the same way and is usually addressed through cognitive behavioral therapy, which is designed to build and encourage productive thinking patterns, and through deliberate attempts to build good habits and coping mechanisms.
Both EFD and ADHD coaching programs exist, though there are differences in each program’s curriculum and approach.