Executive Dysfunction
Differential brain activity in those with and without ADHD during cognitive tasks.
How do attention, working memory and AD(H)D fit together? They are all associated with Executive Functions, the mental processes that originate in our brain's Pre-Frontal Cortex (PFC). Everything we do successfully - whether personal, social, academic or professional - depends on adequate executive functioning. In fact, regardless of intellect, talent, personality or creativity, poor executive functions eventually translate into poor functioning or performance - or at least, a high degree of stress related to effective functioning or performance.
Executive functions enable us to pay attention to the right thing for the right amount of time. Staying attentive facilitates Working Memory, the ability to hold information "online" long enough to use it, and both attention and working memory affect our ability to access and juggle many thinking skills at the same time, which is highly important in today's busy world. So executive functions allow us to plan ahead, remember and learn from the past, start and finish a task, and manage our time effectively. They affect what we do in the present as well as how we plan and organize for the future. On another level, executive functions help us control our emotions and impulses, evaluate our thoughts and problem-solve.
According to brain scan research (see examples above), people with AD(H)D have a smaller, less active Pre-Frontal Cortex and, thus, poor executive functioning. They also have less dopamine (see below). This means that except when highly interested, motivated or fearful of grave consequences, these individuals have trouble staying attentive, avoiding distractions, remembering, getting started on tasks, sustaining steady effort, keeping track of possessions or time, and controlling impulses. So people with ADHD are not simply lazy, uncaring, manipulative or unintelligent - it's a brain thing, it's genetic (the most genetic of all disorders!) and it's no one's fault. We simply need to acknowledge it, do our best to modify it, and learn to work around it.
Executive functions enable us to pay attention to the right thing for the right amount of time. Staying attentive facilitates Working Memory, the ability to hold information "online" long enough to use it, and both attention and working memory affect our ability to access and juggle many thinking skills at the same time, which is highly important in today's busy world. So executive functions allow us to plan ahead, remember and learn from the past, start and finish a task, and manage our time effectively. They affect what we do in the present as well as how we plan and organize for the future. On another level, executive functions help us control our emotions and impulses, evaluate our thoughts and problem-solve.
According to brain scan research (see examples above), people with AD(H)D have a smaller, less active Pre-Frontal Cortex and, thus, poor executive functioning. They also have less dopamine (see below). This means that except when highly interested, motivated or fearful of grave consequences, these individuals have trouble staying attentive, avoiding distractions, remembering, getting started on tasks, sustaining steady effort, keeping track of possessions or time, and controlling impulses. So people with ADHD are not simply lazy, uncaring, manipulative or unintelligent - it's a brain thing, it's genetic (the most genetic of all disorders!) and it's no one's fault. We simply need to acknowledge it, do our best to modify it, and learn to work around it.
Individuals with ADHD/poor executive functioning can learn to cope better at school, at work or at home. In addition to medical treatment (if desired) and neurocognitive interventions (e.g., Cogmed Working Memory Training), we can create an individualized Executive Functioning Profile made up of your specific strengths and weaknesses. Based on that profile, specific goals can be set and monitored. There is also individual treatment using Cognitive Behavioural Therapy (CBT) and Mindfulness techniques, proven to improve functioning in those with ADHD. We usually begin with weekly sessions, based on a schedule that fits your needs. Sessions are then gradually spread out until the new skills are well-integrated and life is going more smoothly. Refresher sessions may be held as needed thereafter.
Group treatment for ADHD (and for parents of children with ADHD) meet for 10 weekly 90-minute sessions, held in the afternoon or evening. Each meeting covers a particular skill or skill area, which is practiced during the session and at home during the week. Individual sessions can be held in conjunction with or following group treatment, as needed.
