The difference between ADHD and executive function challenges

A brain-based condition that makes it hard for kids to concentrate, use working memory, organize, and manage themselves. They may also be impulsive or hyperactive. These are all challenges with executive function.

Weaknesses in key mental skills that are responsible for attention, memory, organization and time management, and flexible thinking. Kids with ADHD struggle with these skills. But so do some kids who don’t have ADHD.

• Has a hard time paying attention
• Has difficulty with self-control
• Has trouble managing emotions
• Has difficulty holding information in working memory
• Has trouble switching easily from one activity to another
• Has trouble getting started on tasks
• Has problems organizing time or materials
• Has difficulty keeping track of what’s going on
• Has difficulty completing long-term projects
• Has trouble with thinking before acting
• Is easily distracted and often forgetful
• Doesn’t seem to listen when spoken to
• Has trouble taking turns
• Fidgets excessively
• Acts as if “driven by a motor”
• Interrupts others and talks excessively

• Has a hard time paying attention
• Has difficulty with self-control
• Has trouble managing emotions
• Has difficulty holding information in working memory
• Has trouble switching easily from one activity to another
• Has trouble getting started on tasks
• Has problems organizing time and materials
• Has difficulty keeping track of what’s going on
• Has difficulty completing long-term projects
• Has trouble with thinking before acting
• Is easily distracted and often forgetful
• Has trouble taking turns
• Has problems remembering assigned tasks

Impulsivity and trouble managing emotions may cause difficulty making and keeping friends. Frequent negative feedback for acting out or not paying attention can impact self-esteem and motivation. It can result in kids feeling “bad” or “no good.”

Trouble remembering to do what’s expected can cause problems in social relationships. Not thinking flexibly can make it hard to be flexible with others. Poor self-control and self-monitoring can cause problems with friends.

• Pediatricians, neurologists, developmental-behavioral pediatricians, nurse practitioners, psychiatrists: Diagnose ADHD and prescribe medication. Can also look for other challenges, like anxiety. Pediatricians may refer patients to psychologists (or pediatric neuropsychologists) for more complete evaluations.
• Clinical child psychologists: Diagnose ADHD and mental health challenges that may co-occur, like anxiety. May also evaluate for learning differences, including trouble with executive function. Provide behavior therapy to teach kids to manage their actions and interactions. Provide cognitive behavioral therapy to help with emotional challenges related to their ADHD.
• Pediatric neuropsychologists: Evaluate for learning differences. That includes tests that look at executive function. May also evaluate for ADHD and common mental health challenges that might co-occur.
• Educational therapists and organizational coaches: Work on organization and time management skills.

• Pediatricians, neurologists, developmental-behavioral pediatricians, nurse practitioners, psychiatrists: Refer patients to specialists who can evaluate for executive function challenges, along with other learning differences. Can diagnose ADHD and prescribe medication for it (there are no medications just for executive function challenges). Can also look for other related challenges, like anxiety.
• Clinical child psychologists: May evaluate for executive function challenges as part of a full evaluation for learning differences. Provide behavior therapy to teach kids to manage their actions and interactions. Provide cognitive behavioral therapy to help with emotional challenges. May also diagnose for ADHD and mental health challenges that may co-occur, like anxiety.
• Pediatric neuropsychologists: Evaluate for executive function challenges as part of a full evaluation for learning differences. May also evaluate for ADHD and common mental health challenges that might co-occur.
• Educational therapists and organizational coaches: Work on organization and time management skills.

Accommodations under a 504 plan or an IEP. Child might be eligible for an IEP under the category of “other health impairment.”

Examples might include:

• Tutoring or coaching that teaches executive function skills
• Help with organization skills
• Extra time on tests
• Preferential seating
• Opportunities for the student to repeat and rephrase important information
• Additional structure to the day with routines and predictable transitions
• Tasks that have been broken down into their smaller components
• Multisensory teaching techniques
• Increased structure and expectations for learning activities

Accommodations under a 504 plan or an IEP. Child might be eligible for an IEP if there’s a learning disability or ADHD.

Examples might include:

• Tutoring or coaching that teaches executive function skills
• Help with organization skills
• Extra time on tests for kids whose problems with executive function cause them to have slower processing speed
• Preferential seating
• Specific academic skill strategies; these might include reading comprehension strategies, asking questions, predicting, summarizing, and organizing thoughts for writing
• Positive reinforcement and encouragement to increase confidence
• Structured teaching of complex academic skills; multiple opportunities for practice and reinforcement
• A “road map” to solve various problems with examples that explicitly detail each step

• Create daily routines and rituals to provide structure.
• Practice self-regulation skills.
• Model appropriate social behavior.
• Set rules and stick to them.
• Break tasks into smaller chunks.
• Allow for frequent breaks.
• Have clear expectations for behavior and prepare in advance for new experiences.
• Give frequent feedback.
• Provide positive reinforcement for positive behavior.

• Create daily routines and rituals to provide structure.
• Practice self-regulation skills.
• Model appropriate social behavior.
• Teach time management skills.
• Give advance warning of upcoming transitions.
• Talk through difficult tasks. Model thinking aloud during planning and problem-solving situations.
• Improve monitoring skills by asking kids to evaluate their performance. Talk together about the accuracy of the evaluation.