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[00:00:00] Hello, everyone. Welcome to the Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist group practice owner, and private practice coach.

This episode is brought to you by PAR. The BRIEF2 is the gold standard rating scale for measuring executive function. A new score report, an updated interpretive report, and a series of 10 intervention handouts are now available on PARiConnect. Learn more at parinc.com\brief2.

Hey everyone. Welcome back to the Testing Psychologist podcast. Glad to be here with you, just like always.

Today is another episode in the ADHD series, an ongoing series of bite-size episodes where I’m talking about different aspects of ADHD. Frankly, there’s not a lot of organization to these [00:01:00] topics. I’m just taking random questions that have come up over the years, a little bit of background info, some basic stuff, and a little more advanced material. These are meant to be pretty short episodes, where we dive into an ADHD-specific topic for a bit in hopes that you might learn a thing or two to apply in your practice.

Today’s episode is about executive functioning and ADHD. I’ll be talking about definitions for executive functioning. What is it? This is one of those things that talk about a lot but have struggled over the years to come up with a really clear definition that I can give to parents and adults. So, I’ll talk about what is executive functioning, what is the relationship between ADHD and executive functioning, a little bit on does stimulant medication help with executive functioning challenges, and we might get into two other little [00:02:00] offshoots of executive functioning as well.

Before I get to the episode, y’all know what I’m going to say. I’m going to invite you to join a Testing Psychologist Mastermind Group. If you’re in private practice and you’d like support and accountability to develop or launch or grow or manage your practice, there is a mastermind group for that. I’ve got three tiers: Beginner, Intermediate, and Advanced, and these groups are awesome; 6 psychologists all working together, discussing similar things, and holding one another accountable. They’re great.

If that is interesting to you, cohorts are always enrolling. You can get more info at thetestingpsychologist.com/consulting and schedule a pre-group call. We’ll chat and figure out if it’s a good fit for you.

All right, let’s get to the episode on executive functioning and ADHD.

Okay. I am back with you. Let’s dive right in to talk about executive functioning and ADHD.

I wanted to start by defining executive functioning. And this is as much for me as for everyone else. In the past, I would say that executive functioning is a set of higher-level processes that happen in our brains that help us do things like plan, organize, set goals, regulate our behavior, remember things and keep ourselves on task. And that’s pretty good. But I wanted to present [00:04:00] a few different definitions. Hopefully, these are close to what you’ve been using and maybe you’ll pull some themes from these definitions.

One of the definitions I found is mental processes that enable us to plan, focus attention, remember instructions and juggle multiple tasks successfully. Okay. That was pretty good.

Another definition. Executive skills refer to the brain-based cognitive processes that help us to regulate our behavior, make decisions and set and achieve goals.

All right, let’s do one more. Executive function describes a set of cognitive processes and mental skills that help an individual plan monitor and successfully execute their goals.

Some themes here, certainly: cognitive processes that help us to regulate ourselves, identify [00:05:00] and execute our own goals, planning, monitoring. There’s a lot of consistency here between these definitions. So, as long as you’re somewhere in the ballpark using elements of these definitions, I think we’re good

But I think of things visually. And for me, this is like an upside-down pyramid where the largest part of the pyramid, that base of the pyramid, is self-regulation. Self-regulation is the overarching theme of executive functioning. And within self-regulation, there are a number of different executive functioning skills that nest underneath self-regulation. And then nested underneath executive functioning is ADHD.

I don’t know if that helps to [00:06:00] visualize a little bit, but that’s the way that I think of it. As time has gone on, we have zeroed in more or less on the idea that there’s a big relationship between ADHD and executive functioning or executive dysfunction.

Let’s do a little bit of history here.

If you go back to at least the 70s, folks were suspecting that self-regulation was a major component of ADHD. Now, I don’t know if that was the very first time that self-regulation was implicated in ADHD, at least in an academic sense, but that’s when things really started to pick up steam as far as I could find.

Self-regulation, like I said, is that overarching theme that captures most, if not all executive [00:07:00] functions. So, all executive functions are going to be a manifestation of self-regulation in some form or fashion. Over the years this has gained a lot of steam.

You may be familiar with Russell Barkley, a major player in the ADHD world who’s been doing extensive research for at least 30 years. I think he was the one that really put a lot of energy behind this executive dysfunction theory as a driver of ADHD. This is the idea that individuals with ADHD struggle greatly with executive functioning and self-regulation. That’s the cognitive theory of course, and what’s actually happening in ADHD.

Now, there are other influences, but I’m not getting into genes and environment and that sort of thing. I’m just [00:08:00] talking about the actual theory of the deficits in ADHD.

So, a big relationship between executive dysfunction and ADHD. If you look down the list of ADHD symptoms, of course, you’re going to see that there is a big overlap between ADHD symptoms and executive functioning. The symptoms are just illustrations or examples of what happens when self-regulation and executive functioning isn’t operating as effectively as it could, like impulsivity- that’s pretty directly related to self-regulation and self-control, hyperactivity, regulation of motor behavior, sustained attention remembering things getting started on tasks. These are all examples of [00:09:00] self-regulation gone awry. Lots of overlap there which is maybe a no-brainer.

All right. Let’s take a break to hear from our featured partner.

The BRIEF2 is the gold standard rating scale for measuring executive function. A new score report and updated interpretive report available on PARiConnect help you get the answers you need about EF and ADHD quickly. Also available is a series of 10 downloadable, easy-to-understand BRIEF2 interventions handouts designed to provide parents, students, and teachers with strategies to support and improve behaviors at home and in school. Learn more at parinc.com\brief2.

All right. Let’s get back to the podcast.

I’ve had friends and colleagues and trainees ask, how do we think about this? How do we think [00:10:00] about executive functioning and ADHD? Does everyone with ADHD have executive functioning problems? Does everyone with executive functioning problems have ADHD? I think that’s an important thing to discuss quickly.

Executive functioning concerns are trans-diagnostic in the sense that they occur in many different diagnoses and in neurotypical folks. Executive functioning, in my mind, operates on a spectrum of sorts. All of us struggle with executive functioning to some degree at certain times in our lives or times of day- when we’re tired or when we’re hungry, things like that.

So, executive functioning problems can happen for many folks, not just folks with ADHD. So that answers that question, does everyone with executive functioning difficulties have ADHD? [00:11:00] No, they don’t. But does everyone with ADHD have executive functioning problems? Yes. We can say pretty clearly that’s a yes.

An example of what I mean when I say executive functioning problems are transdiagnostic. For example, folks who are depressed often have trouble with activation, getting started on things, and future forecasting- anticipating what might happen in the future accurately. Autistic folks often have trouble with rigidity and inflexibility, which is an aspect of executive functioning. Anxious folks have trouble self-regulating their anxious thoughts.

There are lots of examples of executive functioning coming into play in a number of different diagnoses. So, don’t get stuck in this idea that just because someone has trouble with self-regulation, [00:12:00] that means that they have ADHD necessarily. Although, there’s a high likelihood that you should at least consider an ADHD diagnosis if people are describing executive functioning concerns.

I touched on this idea at the beginning of stimulant medication, a psychiatrist friend asked about this not too long ago. Stimulant medication can help for executive functioning concerns, but it really depends on what we’re talking about. As we know, medication or stimulant medication, at least, tends to help with impulse control, sustained attention, and some motor skills and motor speed kind of stuff.

Those are certainly aspects of executive functioning. So, I think it’s safe to say medication does help with those particular aspects of executive functioning. And [00:13:00] once you get into more of the, I would say, behavioral aspects of executive functioning like planning, organization, goal setting, task initiation, task completion, at least in my mind, those are more skills that an individual might need to learn.

Medication is not going to teach those skills. You’ve probably heard that phrase; pills don’t teach skills. And that’s a good example of how that might break down. So, medication can help with some aspects of executive functioning but not all of them by any means.

That’s a very quick and dirty synopsis of the relationship between executive functioning and ADHD. There is so much out there to read about this. Any ADHD book that you pick up is probably going to mention executive functioning. Russell Barkley has done a tremendous amount of research in this [00:14:00] area, and lots of other folks are digging into this as well.

Now, there are competing theories about what might “cause ADHD.” Those are worth a look as well, but executive functioning is certainly a major player in that world.

So again, hopefully just one or two things you might take away and be thinking about in your practice.

Thanks for tuning in as always.

If you’re a practice owner and you’d like to join a group to get some accountability and less in your professional life, I would love to chat with you-thetestingpsychologist.com/consulting is a great place to go book a pre-group call and we’ll see if it’s a good fit.

Okay, everybody. Take care. I will be back on Thursday with a business episode and more ADHD topics in the weeks to come.

The information contained in this podcast and on the Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you [00:16:00] need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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