What is it like to live with ADHD on a daily basis? Distractibility, restlessness, difficulty organizing self, tendency to act or blurt out before thinking, frustrations, forgetfulness, difficulty maintaining long-term relationships, isolation – these are just a few of the issues individuals with ADHD and their loved ones must learn to cope with and develop strategies for navigating,
(Low, 2017).
At Beacon we find that one of the biggest difficulties our students with ADHD experience is procrastination. There is good reason for this. With the new paradigm of ADHD has come an increasing focus on executive function. Executive function is related to the prioritising, integrating and regulation of cognitive functions (Lezak, Howieson and Loring, 2004). It is an amalgamation of complex cognitive processes that, through self-directed behaviours, facilitate successful task completion. Executive function is also related to a set of cognitive control skills such as attention, inhibitory control, and flexibility. Within an educational setting, executive function is of significance as it is the part of the brain responsible for initiating and inhibiting action, working memory, self-monitoring, emotional regulation, planning, concentrating, decision making and organising (Grieve et al., 2014).
Whilst difficulties relating to focusing, sustaining effort, working memory, and getting started on tasks are experienced to varying degrees among the general population, the individual with ADHD is chronically impaired by them (Brown, 2013a). Executive functioning is not correlated with intellect; nonetheless, it does enable the individual to engage in self-governing, self-serving behaviour and interact in social relationships.
Despite the cynicism of some researchers, there is notable research which has established a link between executive function and ADHD (Brown, 2009). Bierderman et al.’s (2006) study found that deficits in executive function were significantly more present in individuals with ADHD than in comparison subjects. Where deficits in executive function were present in either group, there was evidence of lower academic achievement. Grieve et al. (2011) who examined executive functioning in college students with disabilities, outlined a complex skills approach which understands executive function via a behavioural perspective. This incorporates observable executive functions including planning, problem-solving, reasoning, organizing and social awareness. Additionally, researchers have found that older college students identifying with the profile of ADHD and psychiatric challenges, report raised executive function difficulties relating to behavioural regulation and metacognition. This links to Brown’s (2009) rationale for including ‘Emotion’ within his model. Brown (2013) proposes that ADHD individuals typically report chronic difficulties with negative emotion such as anger, frustration and frustration.
It is generally recognized that there are three core executive functions, namely, inhibitory control, working memory, and cognitive flexibility (Miyake, Emerson, & Freidman, 2000; Lehto, Juujärvi, Kooistra, & Pulkkinen, 2003; Logue & Gould, 2013, in Diamond, 2013) which contribute towards the individual’s ability to reason, problem-solve and plan. Inhibitory control regulates attention, behaviour, emotions, impulsivity and thoughts. Impairment in this area leads to acting or speaking without thinking, procrastination, poor concentration, and the inability to instill self-discipline or self-control (Levy & Wagner, 2011; Macdonald, Beauchamp, Crigan, & Anderson, 2013; Simpson et al., 2012; van den Wildenberg et al., 2010; Watson & Bell, 2013; Wiebe, Sheffield, & Espy, 2012, in Diamond 2013). Learners with impairments in this area report experiencing difficulties in starting or completing a task as they are highly distractible, unable to resist the temptation to be sidetracked, and unable to forgo an immediate pleasure for a greater distant reward. This causes significant difficulties for learners in higher education where assessment is based on future gain as opposed to instant gratification.
Working Memory is the ability to hold information in the mind whilst mentally manipulating it. Working Memory is correlated with academic achievement and a low working memory can result in reading and wider learning difficulties. According to Alloway (2007) approximately seventy percent of students with learning difficulties in reading have poor Working Memory. This function is necessary for making sense of oral or written language as the listener or reader has to retain sequences of information in order to make overall sense of it (Diamond, 2013). Within a Higher Education context, a reduced working memory will impact upon retention and the ability to mentally manipulate information. This can lead to frustration and errors in multiple contexts including lectures, seminars, reading, writing, note taking, verbal processing, aural tests and examinations. Reasoning cannot be achieved without working memory as this function allows the individual to mentally relate information to derive a general principle and to see connections between concepts and seemingly unrelated things. As a function, working memory is highly involved in decision making and drawing up plans as it enables the person to apply conceptual knowledge to any choices that are made (Davidson et al., 2006).
The final core of executive functions, Cognitive Flexibility, is the ability to change perspectives, which is linked to the other two core functions as it requires the ability to inhibit a previous perspective and develop a new one. It allows flexibility of thought, something that has long been recognised as being impaired in individuals with ASD. Flexibility of thought includes the ability to predict what could happen next or to determine what is expected. A deficit in this area will have negative consequences in numerous areas, including academic performance (Riddell et al., 2005). Cognitive flexibility allows the individual to suddenly change priorities or a task, adapt to new situation, overcome unexpected challenges, and recognise and learn from personal mistakes; it is essential in emotional, social and learning development.
Many researchers concur that executive function is even more important for success in the learning environment than IQ (Blair & Razza, 2007; Hughes & Ensor, 2008; Morrison, Ponitz, & McClelland, 2010, in Diamond, 2013) and eventual success in higher education (Alloway & Alloway, 2010; Borella, Carretti, & Pelgrina, 2010; Loosli, Buschkuehl, Perrig, & Jaeggi, 2012;, in Diamond, 2013). This is in keeping with Kovalchikova’s (2014) research which proposed that underdeveloped executive function is at the core of the majority of dysontogensis syndromes which influence social, emotional and learning behaviours.
Returning to Brown’s model, it is possible to see how impaired executive function will adversely affect the individual in a higher education environ. Brown (2013) describes impaired executive function as being responsible for weakness relating to organization, prioritizing, starting work, maintaining focus and sustaining effort, self-regulation, managing emotion and working memory. He also proposes that ADHD impairments of executive function are situationally variable (Brown, 2013) which would explain the often contradictory profile of ADHD which has given rise to so many myths. Analysis of extensive clinical case studies has shown that the majority of participants who demonstrated no impairment in executive functions in certain domains of activity, demonstrated impairment in other situations (Brown, 2013). This could explain why the ADHD learner is often labelled as ‘lazy’ given that they are witnessed to perform well in certain settings and, to the observer, a contradictory poor performance in other settings might suggest lack of effort. Being misunderstood within a learning environment can result in decreased motivation, poor wellbeing and, ultimately, failure. At Beacon, we are passionate about supporting our students so that they avoid the stigma of failure. This is why we are continuing our research into developing effective learning strategies for individuals with ADHD.
References
Biederman, J., Petty, C. R., Fried, R., Black, S., Faneuil, A., Doyle, A. E., Seidman, L. J., & Faraone, S. V. (2008) ‘Discordance between psychometric testing and questionnaire-based definitions of executive function deficits in individuals with ADHD,’ Journal of Attention Disorders, 12, pp. 92-102.
Brown, T. E. (2009) ‘Developmental complexities of attentional disorders. ADHD Comorbidities Handbook for ADHD complications in children and adults, ed. Brown, T.E. Washington, DC: American Psychiatric Publishing.
Brown, T. E. (2013) A New Understanding of ADHD in Children and Adults. London: Routledge.
Davidson, M. C., Amso, D., Anderson, L. C., & Diamond, A. (2006) ‘Development of cognitive control and executive functions from 4 to 13 years: Evidence from manipulations of memory, inhibition, and task switching,’ Neuropsychologia, 44, pp. 2037–2078.
Diamond,
A. (2013) ‘Executive Functions,’ Annual
Review of Psychology, 64, pp.135-168.
Grieve, Adam; Webne-Behrman, Lisa; Couillou, Ryan; Sieben-Schneider, J. (2014) ‘Self-Report Assessment of Executive Functioning in College Students with Disabilities’ Journal of Postsecondary Education and Disability, 27(1) pp. 19-32.
