The Executive Functions Impaired in Teen ADD and ADHD

Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity Disorder (ADHD) have received much attention in recent years. This is partly because of a rise in adolescent and teen ADD/ADHD cases in the past 20 years. And this is partly because of the tendency for clinicians to make this diagnosis freely and the tendency to prescribe amphetamines as a result.

 

There are 18 listed symptoms in the DSM that would facilitate a clinician in diagnosing a child with either ADD or ADHD. The symptoms are divided into two groups: inattention and hyperactivity. Those whose symptoms indicate attention impairment are diagnosed with teen ADD, whereas those with symptoms of inattention and hyperactivity are diagnosed with ADHD.

 

For the most part, symptoms of ADHD include difficulty with paying attention, difficulty with organization, excessive talking, fidgeting, along with hyperactivity and impulsivity. These symptoms can impair a child’s functioning in school, and for this reason, those children with ADHD are often easily recognized because of the behavioral and academic issues that surface as a result of their symptoms. The symptoms of ADD are similar to ADHD minus the hyperactivity and impulsivity.

 

Typically, children with these symptoms of ADHD are recognized and diagnosed in early childhood because they tend to result in behavioral issues that are easy to spot in the classroom. However, a child with Attention Deficit Disorder (ADD) is not as easily recognized as having a problem. For this reason, ADD is more typically diagnosed later in childhood, such as in adolescence.

 

Thomas Brown, Ph.D., author of The Unfocused Mind in Children and the Associate Director of the Yale Clinic for Attention and Related Disorders, highlights six executive functions that are impaired with both these disorders. However, he writes that everyone has occasional impairments of the executive functions, but that those with teen ADD and ADHD have much more difficulty in development and use of these functions. Furthermore, he explains that those with ADD/ADHD symptoms might experience these impairments in most areas of their life, but that when they are playing sports or engaging in art or playing video games, these impairments might be absent.  The following list goes describes these impairments in detail:

 

  • Activation – The function of organizing prioritizing, and getting started on tasks is impaired. There will be excessive procrastination to the point where they begin to see completing the task as a minor emergency.
  • Focus – The function of focusing, sustaining and shifting attention to tasks is impaired. Those with ADD/ADHD may experience being distracted very easily and an inability to stay focused on the words when reading.
  • Effort – The function of regulating alertness, sustaining effort, and processing speed is impaired. Those with ADD/ADHD report that they can complete short-term projects well but have trouble with longer projects that require sustained attention over longer periods of time. They may also experience problems with regulating sleep patterns.
  • Emotion – The function of managing frustration and modulating emotions is impaired. Those with ADD/ADHD describe that certain emotions tend to take over and gets in the way of thinking and as a result their communication is flavored by the emotion, whether it’s frustration, anger, worry, disappointment, or desire.
  • Memory – The function of utilizing working memory and accessing recall is impaired. Often, those with ADD/ADHD tend to have long-term memory but forget what they had for breakfast that day. They have difficulty holding pieces of information while focusing on a specific task.
  • Action – The function of monitoring and self-regulating action is impaired. Even those with ADD (without hyperactivity) might experience acting impulsively. They may jump too quickly to conclusions and have problems with regulating the pace of their actions.

 

In order for a child to be diagnosed with teen ADD or ADHD, he or she should be assessed first. There are a variety of assessments that can be used to determine the type of impairment in attention or hyperactivity. If a diagnosis is made, treatment will frequently include medication or therapy or a combination of these.

 

Therapy, such as Cognitive Behavioral Therapy, will explore the relationships between thinking, feeling, and behaving. In this way, children can become more aware of his or her patterns of thought and how they influence their behavior, and more importantly, make better choices. Both medication and therapy combined can significantly support a teen in their success at school, home and work.

 

 

Reference:

Brown, Thomas E. (February 2008). Executive Functions: Six Aspects of a Complex Syndrome. Retrieved on June 26, 2014 from: http://www.drthomasebrown.com/pdfs/Executive_Functions_by_Thomas_Brown.pdf

 

 

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