If you have ADHD, you may have heard the words executive dysfunction thrown around. This term may feel quite loaded or maybe you’re not too familiar with what it really means. Either way, you may be quite familiar with the feeling of falling short of your own expectations and those of others, the message that you’re not living up to your full potential, the sense that you’re always a bit behind everyone else, or a general feeling of shame around how you function in your daily life. This may be impacted by the fact that ADHD affects the cognitive processes responsible for time management, organization, self-regulation, and much more - basically the things that help you direct your behaviors toward long-term goals. In this article, we’ll clarify what executive functioning and dysfunction is, explore how struggles with executive dysfunction can be compounded by shame, and discuss how the effects of executive dysfunction can be important to bring to therapy.
When you hear the words “executive dysfunction,” what images, ideas, experiences, or judgments come to mind?
What is Executive Functioning?
Executive functioning is a set of cognitive processes that help us self-regulate so we can effectively plan, prioritize, and sustain effort toward our long-term goals. These processes help us go from wanting to do something to actually getting it done. Examples of executive functions include things like:
- Self-awareness: self-directed attention
- Inhibition: self-restraint, delaying gratification
- Nonverbal working memory: visual imagery or the ability to hold things in your mind as you work with that information
- Planning and problem-solving: how you come up with new ways of doing things, taking things apart and recombining them to plan solutions to problems, self-play
- Emotional regulation: using words, images, and self-awareness to process and alter emotional states
- Self-motivation: motivating yourself toward a task with no immediate consequence or reward
- Verbal working memory: self-speech, internal monologue
Common symptoms of having executive functioning difficulties are time blindness (aka difficulty planning for and keeping in mind future events), difficulty stringing together actions to meet long term goals, trouble organizing materials and setting schedules, trouble soothing intense emotions or regulating impulses, struggles in efficiently shifting attention back and forth between different sets of information or tasks, and difficulty analyzing or processing information. PHEW. I know, it’s a lot.
Some common signs that you may have trouble with executive functioning are:
- Forgetting to complete tasks
- Losing your train of thought
- Struggling to remember steps in multi-step processes
- Problems breaking big projects into steps
- Trouble following conversations
- Difficulty multitasking
- Struggling to remember names or the meaning of common abbreviations
There are lots of reasons that people may experience difficulties in executive functioning. As we’ve already mentioned, ADHD is a condition that significantly impacts executive functioning over a person’s lifetime. However, you do not have to have ADHD to have trouble with executive functions. Other things that can cause executive dysfunction in the long-term include autism, learning disabilities, physical trauma to the prefrontal cortex, and in vitro exposure to substances. Additionally, difficulties with executive functioning can be a symptom of anxiety, depression, and trauma. COVID-19 has been shown to cause temporary disruption in executive functioning as well (Delgado-Alonso et al., 2022).
Executive Dysfunction and Shame
“What we don’t need in the midst of struggle is shame for being human.” - Brene Brown
If you experience difficulties with executive functioning, the words “lazy,” “undisciplined,” or “unmotivated” may have a special sting and familiarity to you. Maybe teachers would tell you or your parents that you have so much potential that could be reached if you only applied yourself. Maybe your parents struggled to understand why it was impossible for you to remember to defrost the chicken before they got home. That is, unless you set at least three alarms, wrote down a reminder, and had luck on your side. Overly specific example? Maybe. But something similar happened to you too, right? Executive dysfunction is something that impacts how you operate all the time. Fueled often by desperation and necessity and assisted by lots of creativity and resourcefulness, folks with ADHD often learn tricks and develop systems to operate within a society designed for neurotypical people. This whole process can feel tiring and it can be confusing to try to untangle the threads of difficulties across your life on your own. This is where understanding friends and fellow ADHDers, ADHD support groups, ADHD coaches, and neurodivergent-affirming therapists can be huge supports.
Executive Function In Therapy
A lifetime of others being confused or judgmental about your struggles with executive functioning can leave you with a deeply internalized sense of confusion and judgment toward yourself too. In therapy, it can be beneficial to unpack the messages you’ve heard regarding what others may have perceived as lack of care, laziness, flightiness, etc. Learning to differentiate between executive dysfunction and an actual lack of interest/care/commitment can be important in understanding how you function and building systems of support, accommodations, and care for yourself rather than feeling buried and paralyzed by shame.
Addressing shame related to executive dysfunction in therapy can be done in a myriad of ways. This may involve processing your life experiences through a new lens and putting together a narrative of your life that takes your ADHD and struggles with executive functioning into account. You may spend time acknowledging and grieving the struggles you have experienced and the struggles that continue to be a part of your daily life. As you go along, opportunities to attune to your rhythms of functioning, particularly as they may be different from others, will arise. It’s in these times that you can extend grace and care to yourself and can intentionally develop accommodations for yourself. Dealing with difficulties with executive functioning is just that: difficult. It is important to bring in support and understanding wherever you can.
Here are some ideas of practical ways to support yourself when executive functioning struggles arise:
- Talk through tasks out loud
- Identify a starting point
- Have a friend or partner help you prioritize
- List all the things you’ve already accomplished today (even if it’s things like “got out of bed,” “went to the bathroom,” “fed my dog,” “and “checked my email”)
- Break the task down into steps
- Commiserate with friends who get the struggle too, whether it be due to their own experiences with ADHD, autism, depression, etc.
- Toss the unnecessary steps and reduce obstacles whenever possible
- Avoid the task well (e.g., allow rest without shame)
- Create an ADHD-friendly environment (learn how to break the “rules” – take the doors off your closet if it helps you get to your clothes and put them away, label cabinets with their contents so you don’t forget about what’s in there, put a waste basket in every room of your house if it helps you organize trash)
- Take care of your sensory needs to reduce your stress and overall mental load - This will always look different for everyone, but some examples could include wearing more comfortable clothes to work, using noise reducing headphones while going about your day, adjusting the lighting in your environment, bringing a comfort item or fidget with you, or taking time to allow yourself to stim.
- In the moments it is possible, plan ahead
Finding ways of functioning that work best for you is highly individual and has to be personalized. So all those random ideas and ADHD “hacks” you might come across on reddit or TikTok - try them, play around with them, and ultimately, know that whatever helps helps. And what helps now may not help tomorrow - sometimes the things that help seem to shift and change every few days, weeks, or months. As you come to understand and accept yourself in all the ways you tend to function, you will likely develop your ability to realistically contend with your struggles and limits more often with creativity and acceptance rather than self-punishment or shame.
Difficulties in executive functioning impact daily operations and processes that require self-regulation and organization. Understanding why these difficulties exist and unpacking the stories you have been taught about these lifelong struggles are important steps in coming to accept yourself in all your ADHD glory and hardship. You’re not supposed to figure it out all alone. The support of friends, family, partners, or a therapist can be instrumental in helping you along the way. If you want to learn about your executive function, there are actual tests you can take that help you understand this part of you! We have practitioners at Relational Psych who specialize in these kinds of assessments (view them here!) as well as therapy. If you are not yet connected with a therapist but have resonated with the experiences outlined in this article, reach out to us to get started right away.
Delgado-Alonso, C., Valles-Salgado, M., Delgado-Álvarez, A., Yus, M., Gómez-Ruiz, N., Jorquera, M., Polidura, C., Gil, M. J., Marcos, A., Matías-Guiu, J., & Matías-Guiu, J. A. (2022). Cognitive dysfunction associated with COVID-19: A comprehensive neuropsychological study. Journal of Psychiatric Research, 150, 40–46. https://doi.org/10.1016/j.jpsychires.2022.03.033
Rodden, J. (2022, November 18). What Is Executive Dysfunction? Sign and Symptoms of EFD. ADDitude Magazine. https://www.additudemag.com/what-is-executive-function-disorder/
ADHD Alien. [@ADHD_Alien]. (2019, May 27). Here is one of my biggest daily struggles #adhd #adhs #comics #adhdalien. [Photograph] Twitter. https://twitter.com/ADHD_Alien/status/1133133623148916736?s=20&t=r9B_Rjc8Y3_fbbwYdPDcVQ
ADHD Bri. [@ADHD_bri]. (2021, January 2). This is actually based on an earlier comic I did about a task I’d normally do easily, suddenly being much… [Photograph] Instagram. https://www.instagram.com/p/CKklSpWDhun/?igshid=TmMyMTA2MY=