ADHD: Executive Functioning Deficits

According to a report released by the Center for Disease Control and Prevention, the number of reported cases of ADHD (Attention Deficit Hyperactivity Disorder) of students ages 4 through 17, increased from 7.8% to 9.5% between 2003 and 2007.  This appears to be a significant increase in a relatively short period of time.  Perhaps course requirements in all grades have become more stringent.  As children grow older and enter middle school and high school, demands on their organizational skills increase as the number of teachers and subsequent styles and demands increase as well.  This certainly contributes to the statistic that one third of students with ADHD drop out or delay high school graduation, according to a study by researchers at the University of California.  The dropout rate is twice that of students with no psychiatric disorder.  

This certainly contributes to the fact that ADHD is not merely a behavior that consists of lots of hyperactivity and misbehavior.  Many do not understand the scope of impairment that exists within the medical diagnosis of ADHD.  Executive functioning is the brain’s cognitive ability to do many things like control emotion, plan, transition, and initiate.  This umbrella of deficit much of the time is an invisible part of ADHD.

Planning comes into play in high school when projects are assigned.  It becomes necessary to plan content as well as plan what sections should be done and when to insure on time completion.  For the child with ADHD, this can be insurmountable without support.  Initiation just refers to the need to actually start a project or a homework assignment.  The child with ADHD can become frozen, without an ability to move forward with the necessary assignment.  Transition is called upon throughout the day as the child moves from classes and teachers to others with totally different expectations.  In addition, transition occurs during the actual class, as requirements of that period change.  Emotional volatility can occur throughout a day that at times is very difficult to control.  Sometimes it can be in the form of oppositional defiance as the child pushes back in an area that he feels unable to handle.  Negative responses to this only will escalate the negativity.

So what can be done with this child with ADHD and executive functioning deficits?  School support and consistent communication between school and home is paramount to success.  Parental advocacy includes not only the correct diagnosis of the child but follow through for support in the school system as impairments of ADHD are documented.  Parents’ knowledge of ADHD is essential to the success of the child.  Although the child with ADHD most likely has many strengths, it is not evident in the school environment where failure and constant correction occurs, leaving the child with low self-esteem.