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Is It Executive Function Disorder (EFD) or ADHD?


Children and adults with executive function disorder (EFD) have problems with organizing and schedules. They may also have ADHD and/or learning disabilities, but not always — it's a common misdiagnosis for those who are actually living with EFD.

What is Executive Function Disorder (EFD)?

A child or an adult with attention deficit hyperactivity disorder (ADD/ADHD) might be hyperactive, inattentive, and/or impulsive. Clinicians have always understood hyperactivity and impulsivity. The understanding of inattention, though, has shifted from primarily “the inability to stay on task” to a broader concept called executive function disorder (EFD), which involves a pattern of chronic difficulties in executing daily tasks.

What is Executive Function?

Executive function is a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.

* Executive function helps you:

* Manage time

* Pay attention

* Switch focus

* Plan and organize

* Remember details

* Avoid saying or doing the wrong thing

* Do things based on your experience

What are the types of Executive Function?

Executive function can be divided into two groups:

* Organization: Gathering information and structuring it for evaluation

* Regulation: Taking stock of your surroundings and changing behavior in response to it

What are the steps required to perform an executive function?

The six steps required to perform an executive function are:

1. Analyze a task

2. Plan how to address the task

3. Organize the steps needed to carry out the task

4. Develop timelines for completing the task

5. Adjust or shift the steps, if needed, to complete the task

6. Complete the task in a timely way

What happens when executive function isn’t working as it should?

When executive function isn’t working as it should, your behavior is less controlled. This can affect your ability to:

* Work or go to school

* Do things independently

* Maintain relationships

What is the difference between ADHD and Executive Function Disorder?

While they share some of their respective symptoms, the definitions of Attention Deficit Hyperactivity Disorder and Executive Function Disorder aren’t quite the same. There is a definite difference between ADHD and Executive Function Disorder.

A child or adult with ADHD might be hyperactive, inattentive, and/or impulsive, and while clinicians have always had a grasp on impulsivity and hyperactivity, the concept of inattention has evolved from a simple focus on “inability to stay on task” to a broader concept of “executive functioning”. Executive Functioning problems involve a pattern of chronic difficulties in executing daily tasks.

What are the causes of executive function disorder?

The causes of EFD are heterogeneous and are linked to a number of neurocognitive and behavioral issues. Some EFD’s, such as ADHD, are present in early childhood and often continue well into adulthood. Other EFD’s are acquired as the result of accidents and illnesses or as part of a progressive neurodegenerative disorder, such as Parkinson’s disease.

Individuals who are suffering depression or who are overwhelmed by anxiety and stress may also demonstrate executive functioning difficulties, but these are typically transient and improve as the anxiety, depression or stress is alleviated.

How to recognize the signs and symptoms of executive function disorder(EFD)?

Children and adults with EFD have problems organizing materials and setting schedules. They misplace papers, reports, and other school materials. They might have similar problems keeping track of their personal items or keeping their bedroom organized. No matter how hard they try, they fall short.

How does executive function disorder affect daily activities of children?

It follows naturally that someone with issues with executive functioning may have problems with analyzing, planning, organizing, scheduling, and completing tasks at all — or on deadline.

A child without problems with executive function may appear like this: A middle-schooler's teacher assigns the class a book to read, and writes the due date for the book report on the board. A student must be able to determine where to get the book and how long he thinks it will take to finish reading it. If the teacher has a specific book-report format, the student will have to keep it in mind as he reads the book and takes notes. He needs enough time to write a rough draft, get help from teachers or parents, if needed, and write a final draft by the due date. If the student has good executive function skills, the work will get done on time. If he has EFD, it won’t.

Indeed, ADHD is a common misdiagnosis for those who are actually living with EFD.

How to Manage Executive Function Problems?

Here are some tips from the National Center for Learning Disabilities:

* Take a step-by-step approach to work.

* Rely on visual organizational aids.

* Use tools like time organizers, computers, or watches with alarms.

* Make schedules and look at them several times a day.

* Ask for written and oral instructions whenever possible.

* Plan for transition times and shifts in activities.

To improve time management:

* Create checklists and estimate how long each task will take.

* Break long assignments into chunks, and assign time frames for completing each one.

* Use calendars to keep track of long-term assignments, due dates, chores, and activities.

* Write the due date on the top of each assignment.

To better manage space and keep things from getting lost:

* Have separate work areas with complete sets of supplies for different activities.

* Organize the work space.

* Minimize clutter.

* Schedule a weekly time to clean and organize the work space.

To improve work habits:

* Make a checklist for getting through assignments. For example, a student's checklist could include such items as: get out pencil and paper; put name on paper; put due date on paper; read directions; etc.

* Meet with a teacher or supervisor on a regular basis to review work and troubleshoot problems.

Can medication help with executive functioning?

Research shows clearly that use of ADHD medications lessens symptoms of inattention and impulsivity while a child is taking the medication. There are a lot of executive functions involved in those broad symptoms. But clinical experience also shows that many kids with ADHD, even if they’re taking medication, still need help to manage their executive functioning issues. Then they can do as well as they’re capable of in school and in other areas.

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