Back to Blog

Ask Dr B – about Co-Existing ADHD & Executive Function Disorder - 046

adhd ask dr. b executive function podcast Sep 29, 2017

Hey ADDers!  I’m so glad you could join me today, and hope that you’ve taken the time to listen to a few key episodes that seem to be on the minds of many of my listeners; perhaps you are one of them:  Episode 036, Ask Dr B About The High Cost Of Not Knowing About Executive Function, Episode 027, Figuring Out Where To Start When So Much Needs Your Attention Now, and Episode 001, It’s Not Your Fault & You’re Not Off The Hook Either.  If you’ve listened to all three of these episodes, you know what I’m talking about and if you haven’t I highly recommend that you listen to them soon.

Today, I want to talk about how ADHD and Executive Function Disorder or EFD co-exist and what that looks like.  I feel it’s important for me to talk about this because I keep hearing people talk about their ADHD symptoms and they are confusing their ADHD symptoms with their EFD symptoms.  So, I want to shed some light on EFD symptoms, ADHD symptoms, how they co-exist, and what you can start to do about this very complex challenge.

Before I give you a brief overview of the EF skills, if you’ve ever wondered what the purpose of the EF skills is; in brief, it’s to organize and act on information.  So, here’s an overview:

  • Impulse control (or inhibition) helps you think before you act.  Without it, you might blurt out inappropriate things.
  • Emotional control (or self-regulation) helps you keep your feelings in check or alter how you feel about things.  Without it, you might overreact, as well as have trouble dealing with criticism or regrouping when things go wrong.
  • Flexible thinking helps you adjust to the unexpected events of life.  It also helps you shift your attention from one thing to another.  Without it, your thinking is “rigid” and you can’t roll with the punches.  You might even get frustrated when someone wants you to see things from their point of view. 
  • Working memory (non-verbal) helps you keep key information in your mind while you are learning something new.  It also helps you to multi-task and to remember what you are doing in each task or project.  Without it, you could have trouble remembering directions or steps in a project, even if you’ve taken notes or repeated the information to yourself many times; it just falls away.
  • Working memory (verbal) helps you direct your life via self-speech or an internal dialogue.  “Self-Talk.”  I prefer to externalize this speaking.
  • Self-monitoring (or self-awareness) helps you assess how you’re doing.  Without it, you might be surprised when things turn out as they do because you aren’t accurately tracking yourself and how what you do or don’t do impacts other people or outcomes.
  • Planning and prioritizing helps you set a goal and a plan to meet your goal.  Also known as “self-play” which is how you play with information in your mind and come up with new ways of doing something.  You experiment with combining parts of things in different ways to come up with the best solution for you.  Without it, you might not know which tasks are most important to get done first or which parts of a project are the most important or which information you are reading is the most important; since not everything you read is the most important.
  • Task initiation (or self-motivation) helps you take action and get started on something; it’s what activates you, particularly when there is no immediate external consequence.  Without it, you might freeze up and have no idea where to begin with a task or project; you could feel lost or overwhelmed.
  • Organization helps you keep track of things; both physically and mentally.  Without it, you could lose things as well as thoughts; just draw a blank.

Today’s episode is all about answering the questions you have about issues or challenges you experience as an adult living with ADHD, and offering you hope.  I have one story for you today about the complexities of ADHD and Executive Function Disorder plus action steps.  How much time do we have?  Not much.  So let’s get to it.

If you’re feeling a bit overwhelmed by all of this information and feeling that you’re going to need some help working with the complexities of ADHD and Executive Function Disorder, so you can develop the skills you need to increase your happiness, productivity, and success, I suggest you put your name on the Waitlist for my online program, ADDventures in Achievement.  Enrollment closed the end of August and I’m not planning on opening up again until later this year, however that could very well change.  So, be sure to get on the Waitlist now if you’d like to learn more about this program and what it can do for you.  I plan on recording some informative videos for those of you on the Waitlist so you can benefit while you’re waiting for enrollment to open up again.  I’ve been adding some exciting new content to the program about Executive Function skills and look forward to you benefiting from it.  ADDventures in Achievement is definitely the place to be if you want help understanding what’s been holding you back and want to learn the skills to break free of your stuckness.

Developing your Executive Function Skills and shifting your limiting beliefs is the fastest and most effective way to overcome ADHD limitations, find focus, gain confidence, and newfound freedom in your life!

My mission is to put an end to the worldwide needless suffering of adults with ADHD and those with under-developed Executive Function Skills - whether from ADHD, chronic depression or anxiety, trauma, addictions, or chronic illnesses.  And, you don't need a formal diagnosis to know you need help developing these executive function skills in order to greatly reduce your suffering.

 

Full Episode Transcript Hey ADDers! I’m so glad you could join me today, and hope that you’ve taken the time to listen to a few key episodes that seem to be on the minds of many of my listeners; perhaps you are one of them: Episode 036, Ask Dr B About The High Cost Of Not Knowing About Executive Function, Episode 027, Figuring Out Where To Start When So Much Needs Your Attention Now, and Episode 001, It’s Not Your Fault & You’re Not Off The Hook Either. If you’ve listened to all three of these episodes, you know what I’m talking about and if you haven’t I highly recommend that you listen to them soon.

Today, I want to talk about how ADHD and Executive Function Disorder or EFD co-exist and what that looks like. I feel it’s important for me to talk about this because I keep hearing people talk about their ADHD symptoms and they are confusing their ADHD symptoms with their EFD symptoms. So, I want to shed some light on EFD symptoms, ADHD symptoms, how they co-exist, and what you can start to do about this very complex challenge.

I’ve talked about some of this information in another episode, however it bears repeating. Generally speaking, adults with EFD often lack the ability to plan or sequence events, they lack foresight or just can’t seem to look into the future and predict how things might unfold, and they often don’t sense the passing of time and are surprised when hours have disappeared, not minutes. Other symptoms often include being late, disorganized, and unable to prioritize, plus not able to schedule or create structure; and all of these are the skills necessary for a functional and successful adult life. Another huge aspect of EFD in my opinion is “immaturity” which to me is a state of mind, not an age. The pre-frontal cortex is supposed to “mature” by a certain age, making it possible to manifest the executive function skills, and when it doesn’t, I feel this state of mind has also not matured. And lastly, the literature indicates that all adults with ADHD have EFD, and that adults can have EFD and not ADHD.

Before I give you a brief overview of the EF skills, if you’ve ever wondered what the purpose of the EF skills is; in brief, it’s to organize and act on information. So, here’s an overview:

· Impulse control (or inhibition) helps you think before you act. Without it, you might blurt out inappropriate things.

· Emotional control (or self-regulation) helps you keep your feelings in check or alter how you feel about things. Without it, you might overreact, as well as have trouble dealing with criticism or regrouping when things go wrong.

· Flexible thinking helps you adjust to the unexpected events of life. It also helps you shift your attention from one thing to another. Without it, your thinking is “rigid” and you can’t roll with the punches. You might even get frustrated when someone wants you to see things from their point of view.

· Working memory (non-verbal) helps you keep key information in your mind while you are learning something new. It also helps you to multi-task and to remember what you are doing in each task or project. Without it, you could have trouble remembering directions or steps in a project, even if you’ve taken notes or repeated the information to yourself many times; it just falls away.

· Working memory (verbal) helps you direct your life via self-speech or an internal dialogue. “Self-Talk.” I prefer to externalize this speaking.

· Self-monitoring (or self-awareness) helps you assess how you’re doing. Without it, you might be surprised when things turn out as they do because you aren’t accurately tracking yourself and how what you do or don’t do impacts other people or outcomes.

· Planning and prioritizing helps you set a goal and a plan to meet your goal. Also known as “self-play” which is how you play with information in your mind and come up with new ways of doing something. You experiment with combining parts of things in different ways to come up with the best solution for you. Without it, you might not know which tasks are most important to get done first or which parts of a project are the most important or which information you are reading is the most important; since not everything you read is the most important.

· Task initiation (or self-motivation) helps you take action and get started on something; it’s what activates you, particularly when there is no immediate external consequence. Without it, you might freeze up and have no idea where to begin with a task or project; you could feel lost or overwhelmed.

· Organization helps you keep track of things; both physically and mentally. Without it, you could lose things as well as thoughts; just draw a blank.


And please remember that taking medication for ADHD symptoms isn’t going to “fix” your EFD symptoms. It might help support you learning them by treating your inattentiveness or hyperactivity or impulsivity but there are no skills in pills and you have to learn the skills that you are missing; that’s just what has to happen. And not just learn them, but also learn them in a particular way; a way similar to how children learn them when they do, with a scaffold learning approach.

I know this might seem like a lot of effort you’re going to have to put forth to solve this problem. In fact, you might be upset that you were diagnosed with ADHD years ago and have been struggling for years in spite of receiving a diagnosis because your EFD wasn’t diagnosed or addressed. We can’t turn back the hands of time; not for any of us. The adults I know or see who have been diagnosed with ADHD were not diagnosed with EFD; I know I wasn’t and if I had been, it would have made me focus on learning these skills much sooner than I did.

And because I know that I have a responsibility or stake in how my life turns out and so do you, this is no time to be feeling like a victim of the places in life where this should have been identified and it wasn’t. The fact is that it wasn’t and we have to move forward and do what needs doing now to correct the challenges. I know that my mindset or attitude is critically important to the successful outcomes in my life and so is yours. A bad attitude doesn’t help me or you get a good outcome.

So get comfortable, perhaps take a couple of deep relaxing breaths and help yourself as best you can to be fully present for the next 20 or 30 minutes.

I want to introduce you to what EFD symptoms might look like in your personal life, as well as in your work life.


· Personal life

o You want to ask a friend about the details of the concert you and they will be attending but your friend needs 5 minutes to finish up what they’re working on. That means that your “working memory” has to be working well enough so you can hold the questions you have about the details of the concert in your mind for the 5 minutes or so, and if it’s not working well, you will most likely forget what you wanted to ask your friend unless you write down your questions while you’re waiting to ask them.

o You want to be social and converse with your friends but you have a really hard time tracking a conversation, and remembering what your friends said earlier on in the conversation, because you can only seem to remember the most recent information or details of what they said. If you ask them to repeat something, and if they don’t know about your EFD and neither do you, they might say something to you that’s very hurtful because they might think you weren’t listening to them. You were listening but just couldn’t remember everything they said.

o You are given a task to do, like building a very simple study desk, and there aren’t all that many steps. However, you continue to get lost in the process of building the desk because you can’t seem to remember which step comes next and how to actually finish building the desk – and worse yet, you’ve misplaced the instructions that could have helped you.

o If you’re anything like me as a reader, and have had to go back time and time again to re-read what you just read, it can be very frustrating. It’s like the information just isn’t getting into your long-term memory; only in short-term memory and then gone before it converts to long-term.

o Since you don’t have specific “homes” for your things or if you do, you don’t take the time to put them where they live, or don’t remember where you said they live, you are constantly misplacing stuff, and spending a ton of time looking for things, rather than knowing exactly where something is, going there to get it and there it is.

o You have a hard time planning out how much time to give to any of your activities or tasks to maintain your home. Either you add in something you want to your life, and then you end up dropping the ball with a few others things that you need to continue to do, or you just can’t get into the habit of doing the new thing.


· Work life

o You have no effective morning ritual and so you rush around to get ready for work and often arrive late

o You bring work home regularly, with the intention of getting caught up, and never do the work, but keep shuffling the papers back and forth day after day. (I can relate to this behavior a lot from years ago.)

o You lack the ability to follow through, even when you give your word or make a note on your calendar of something you committed to do.

o You could lack the ability to remember co-workers names even though you see them regularly.

o It’s hard to get started on your work even with deadlines. You might be unable to sense how far out in time the deadlines actually is.

o If things don’t work out the way you anticipate, you get frustrated.


Background Facts:

· Clearly so much of what I’ve just shared is viewed as ADHD, not as EFD, yet it is EF symptoms and not ADHD symptoms.

· Again, around the time of puberty, the pre-frontal cortex of the brain is supposed to mature, and allow us to perform higher-level tasks, like those required in executive function, and it might not have.

· If I personify executive function (turn it into a character of sorts), it’s like what a CEO is supposed to do:

o Analyze a task

o Plan how to address the task

o Organize the steps needed to carry out the task

o Develop the timelines for completing the task

o Adjust or shift the steps, as needed, to complete the task

o Complete the task in a timely manner


Before I shift to what ADHD symptoms might look like in your personal life, as well as in your work life, I want to mention learning disabilities or LD. It’s important that we don’t just assume ADHD and/or EFD and leave it there, when there might also be a LD. If there are problems with what or how you read and write, or how you process information, and it’s not due to inattention, the challenges might be due to a LD and this certainly deserves to be assessed so you know the whole story about what needs to be learned.

So, what does ADHD look like in adults?

· You might be inattentive and lack the ability to pay attention to what you need to pay attention to, when you need to pay attention to it and can get distracted very easily. Perhaps you are sitting at your desk ready to do the assignment in front of you, but you are distracted by the conversation in the next room.

· You might be hyperactive and are unusually active; you just need to move, and this moving or fidgeting often helps you to focus or pay attention. Even rocking in a chair might help you to focus because you are moving or active; not just sitting.

· You might be impulsive and act on a whim with little or no forethought or consideration of the consequences of a situation. To me this can also be the EFD but it’s the impulsive energy itself not the cognitive pieces.

· Just to recap here, ADHD expresses itself as more than just the 3 core symptoms of being inattentive, hyperactive or impulsive because of the co-existence of EF deficits. It’s mostly the EFD symptoms we are seeing and not the ADHD symptoms; they are not the same thing.

So, what can you start doing to help yourself? For your ADHD, you can take care of some of the basics like your sleep, food, hydration and physical activity. And I know this is asking a lot of you; I do!! You may need an accountability buddy or a coach or a friend or something more than just yourself to ensure you are successful in putting the basics into place in your life. You need these basics because they are the strong foundation on which you will build your EF skills. And it’s not that you can’t be learning EF skills while you are working on the basics; it would just be easier on you if you had the basics handled first, and then learned the skills because a sleepy ADHD mind isn’t the best student.

So, how are you going to help yourself FEEL that the effort is worth it? If you don’t FEEL that it is, you aren’t going to make the effort because we are definitely “FEELING DRIVEN PEOPLE.” One-way is by celebrating your WINS; seriously! I talked about attitude and mindset earlier today and this is precisely what I am referring to. You are able to shift your mindset and your attitude when you pay attention to what’s right instead of what’s wrong. That means it is essential that you look for your WINS every day and celebrate them, whether you live with depression, anxiety, LD, EFD or ADHD. Every WIN you acknowledge and celebrate with emotional authenticity, is changing your neurology and mindset in a positive way. Every single one of them matter; big or small if you celebrate them!

And please, don't short-change yourself by thinking that it’s pointless or stupid to reward yourself for things you’re “supposed to do” like brush your teeth or pay your bills or wash your clothes. That couldn’t be further from the truth. Are you really going to wait until something HUGE happens to celebrate? Does something HUGE happen everyday? Probably not! But the kind of WINS I’m talking about do. And from what I see, they are an absolute necessity to getting yourself out of the emotional ditch of depression, anxiety, LD, EFD or ADHD and into a better attitude and way of living. And based on the feedback I get from the students in my program, this regular practice of celebrating their WINS is changing their lives for the better.

So, what’s it going to be for you today? Maybe you decided to be proud of your achievements and to share them with others in the hopes of inspiring them to seek their own achievements; that’s a WIN. Perhaps you’ve decided to take care of something that you’ve been putting off for a long time now; that’s certainly a WIN. Maybe you’ve decided it’s time to “go for it” and live more fully as yourself; that’s definitely a WIN. You get the point; celebrate all of them. And none of this “half-hearted celebrating”; mean it. Exaggerate your emotions. YES!!!! WOW!! AWESOME!! You want your acknowledgement and celebration to register in your neurology. Many of us need a higher level of stimulation or intensity for things to register. So, if that’s you, give that to yourself and exaggerate your celebration so you can actually feel it.

And listen…you’re not broken! You aren’t!! You’re missing skills, and they can be learned, if you are willing to invest the time, effort and energy to learn them. I know this is true because my students are learning skills they’ve been missing and it’s amazing to share in the transformation of their thinking and behaviors.

And you’re also not alone in this. I’m a work in progress just like you. I like to be in the trenches where all the action is, where you all are struggling or winning or trying to figure things out. I love to hear how you think and put pieces of information together; all of this is so very exciting to me because I learn from each and every one of you that I spend time with. My life may look pretty good to some of you who are struggling with the things that I no longer struggle with but that doesn’t mean that I no longer struggle with things because I do. This episode is being released a day or so later than it is scheduled to be released because of some personal challenges I’ve had this week and I was determined to have this released before Yom Kippur eve if humanly possible for me to do so, without compromising my health. I thought I could get it out by Thursday evening and found that I couldn’t and so it coming to you Friday morning instead of early Thursday morning. I’ll be talking more about this in the next episode because I think it’s important for me to share with you.

So whether this is your first or forty-sixth time of listening to my show, you’ll hear me say time and again, that YOU are NOT what you do or don’t do; that YOU are more than that. WE are NOT defective or less than as people – as human beings; we’re just wired differently, and that difference doesn’t have to be a limitation, once you understand how your mind works, what you love to feel, how to sustain your effort with the least amount of stress possible, and have a lot of new tools to live your best life. It’s my hope that you’ll get some of what you need here.

Today’s episode is all about answering the questions you have about issues or challenges you experience as an adult living with ADHD, and offering you hope. I have one story for you today about the complexities of ADHD and Executive Function Disorder plus action steps. How much time do we have? Not much. So let’s get to it.

Now back to being an adult with ADHD in today’s world.


So, let’s me introduce you to Ricky and his life with ADHD and Executive Function challenges

· Ricky was diagnosed with ADHD when he was 14; but not with Executive Function Disorder until just recently. At 24, he’s been struggling more than he did as a kid. In fact, he feels that adult life is twice as challenging as childhood was.

· He’s been pretty bitter about the fact that 10 years passed before he got his second diagnosis. He’s ruminated a lot on how different his life could have been if he had been learning the skills he was missing while transitioning from adolescence to adulthood. His bitterness was eating him up inside and he finally sought the help of therapist to work through these negative feelings.

· After working through the worst of his bitterness in therapy, he was ready to start learning the skills he was missing.

· Initially his therapist asked him to make a non-judgmental inventory of his strengths, and his weaknesses or those things that he was challenged doing day-to-day. As Ricky was writing out his list, it seemed like it went on forever. Here’s some of what he wrote:

o I forget to complete tasks

o I can’t seem to keep track of my stuff

o I can fall asleep sitting up in a chair when I’m not paying attention to anything and just sitting

o I daydream a lot because I get bored with how slow things happen

o I get lost in conversations

o I feel like my mind is shot because I lose my train of thought a lot

o I’m embarrassed when I meet someone because I can’t remember their name

o I can’t seem to control my mouth and just blurt out stupid things

o I’m tired of people telling me that my finger tapping annoys them

o I’m always late turning in assignments or projects

o I can only do one thing at a time and it takes me forever to do just one thing

o I’m consistently late to appointments; even important ones

o I need to be given one step at a time to complete, rather than all the steps because I can’t remember all of them or do them all that way

· Just like many of you, Ricky was thoroughly confused about where he was to start when there were so many challenges competing for his precious time.

· Ricky’s therapist told him that he had several choices of where to start, based on what his “criteria” was. Ricky didn’t understand what his therapist meant by his “criteria.” The therapist went on to explain that it’s very hard to make a decision when you don’t know what needs or points have to be met. In other words, Ricky needed to decide if working on the easiest issue would be best because he could have a quick win, or working on the hardest issue would be best because he would be so relieved that was out of the way or maybe it would be best to work on being comfortable as Ricky first because if he wasn’t comfortable in his own skin as himself, what would the rest matter anyways.

· And what this really meant was “accepting” himself for who he was at the time (because that was a given and true) as well as getting excited about his dreams of how he wanted to be in the future. Ricky hadn’t been excited about much of anything for a very long time.

· Ricky opted for whatever would be the easiest thing to learn and have success with because he felt he really needed a quick fix for his mood and sense of himself. So, he chose his issue with not being able to keep track of his stuff. He chose this because he used to keep is stuff in order pretty well years ago and had just let things slide. He felt that this would be easy to get back to and have a fairly quick win from resuming how he used to do things or even learn some new ways or shortcuts for how he could keep track of his stuff.


Background Facts:

· Many of the challenges that adults with ADHD encounter are not due to the 3 core symptoms of ADHD, which are being inattentive, hyperactive or impulsive. These 3 core symptoms seem to subside as we age.

· However, what becomes more challenging and more apparent with age are the missing executive function skills. To effectively and efficiently run an adult life, one needs to be able to manage time and themselves within time, to plan and schedule and follow the plan and prioritize and sequence events and handle so many different things in the course of a day or week or month.

· Most adults who receive a diagnosis of adult ADHD do not receive a diagnosis of Executive Function Deficits at the same time. If they did and received the skill training they needed, it could make all the difference in the world in terms of their quality of life and personal success.


If you relate to Ricky’s story, your action steps are:

· Focus on assessing what you real challenges are and don’t just assume that it’s your ADHD

· Follow Through with what you learn about yourself and your gaps and get the skill training you desperately need to be your best self and succeed

· Self-Management of your feelings about how much you have had to struggle in your lifetime with your ADHD when it wasn’t just your ADHD that was making your life so difficult. Have compassion for yourself and for the fact that there just isn’t the training of professionals that there needs to be in order for them to see what all your challenges were and help you.

If you’re feeling a bit overwhelmed by all of this information and feeling that you’re going to need some help working with the complexities of ADHD and Executive Function Disorder, so you can develop the skills you need to increase your happiness, productivity, and success, I suggest you put your name on the Waitlist for my online program, ADDventures in Achievement. Enrollment closed the end of August and I’m not planning on opening up again until later this year, however that could very well change. So, be sure to get on the Waitlist now if you’d like to learn more about this program and what it can do for you. I plan on recording some informative videos for those of you on the Waitlist so you can benefit while you’re waiting for enrollment to open up again. I’ve been adding some exciting new content to the program about Executive Function skills and look forward to you benefiting from it. ADDventures in Achievement is definitely the place to be if you want help understanding what’s been holding you back and want to learn the skills to break free of your stuckness.


A Favorite Quote:

William James said, “Act as if what you do makes a difference. It does.” The question I have for you at this point of our journey together is, “Are you willing to take an honest, yet non-judgmental inventory of your strengths and weakness, and start doing something about both of them?” I hope so because it will make all the difference in the quality of your life going forward.

That’s about it for today’s episode about some of the differences between ADHD and Executive Function Disorder and how they impact each other. It means a lot to me to know that your life is getting a little bit better every time we get together. I do hope that you will take some of the action steps I’ve suggested because for things to change, you have to change. And that means taking action, like checking out the episode links so you can benefit from all of the resources I continue to create for you in addition to this podcast show, that is, if that’s of interest to you. Remember, there’s a PDF transcription of this episode in the resources. Plus, I’d love to get to know you in the community group I created on Facebook and interact with you there when I go live.

So, if you benefited from today’s episode, take action now and share this show with your friends and family; perhaps rate the show or even write up an honest review of this episode so I know what you think of the content. Whatever you’re willing to take action on today will ripple out into the world and impact the course of your life as well as that of others you may never know about.

And if you don’t want to have to remember to look for new episodes, just subscribe and the newest episode will be in your feed by 1 am Pacific Time on Mondays and Thursdays.

So thanks for listening… Until the next time… Bye for now…

 

Episode Resources:

 

To Help The Show:

Subscribe at your favorite listening spot and my podcast player has social media links (icons) in the episode player so you can share episodes you love with others! 

Please rate the show and leave a thoughtful review on iTunes so I know you're benefiting from the episodes.  The greater the number of reviews, the higher the ranking, and the easier it will be for others to find the show; people who also need this information.  

Let's put an end to the worldwide needless suffering together! We can do this!