ADHD Isn’t Just a Disorder of Attention

By Margarita Tartakovsky, M.S.

Many people think of ADHD as a disorder of attention or lack thereof. This is the traditional view of ADHD. But ADHD is much more complex. It involves issues with executive functioning, a set of cognitive skills, which has far-reaching effects.

In his comprehensive and excellent book Mindful Parenting for ADHD: A Guide to Cultivating Calm, Reducing Stress & Helping Children Thrive, developmental behavioral pediatrician Mark Bertin, MD, likens ADHD to an iceberg.

Above the water, people see poor focus, impulsivity and other noticeable symptoms. However, below the surface are a slew of issues caused by impaired executive function (which Bertin calls “an inefficient, off-task brain manager”).

Understanding the role of executive function in ADHD is critical for parents, so they can find the right tools to address their child’s ADHD. Plus, what may look like deliberate misbehaving may be an issue with ADHD, a symptom that requires a different solution.

And if you’re an adult with ADHD, learning about the underlying issues can help you better understand yourself and find strategies that actually work — versus trying harder, which doesn’t.

It helps to think of executive function as involving six skills. In Mindful Parenting for ADHD, Dr. Bertin models this idea after an outline from ADHD expert Thomas E. Brown. The categories are:
Attention Management

ADHD isn’t an inability to pay attention. ADHD makes it harder to manage your attention. According to Bertin, “It leads to trouble focusing when demands rise, being overly focused when intensely engaged, and difficulty shifting attention.”

For instance, in noisy settings, kids with ADHD can lose the details of a conversation, feel overwhelmed and shut down (or act out). It’s also common for kids with ADHD to be so engrossed in an activity that they won’t register anything you say to them during that time.
Action Management

This is the “ability to monitor your own physical activity and behavior,” Bertin writes. Delays in this type of executive function can lead to fidgeting, hyperactivity and impulsiveness.

It also can take longer to learn from mistakes, which requires being aware of the details and consequences of your actions. And it can cause motor delays, poor coordination and problems with handwriting.
Task Management

This includes organizing, planning, prioritizing and managing time. As kids get older, it’s task management (and not attention) that tends to become the most problematic.

Also, “Unlike some ADHD-related difficulties, task management doesn’t respond robustly to medication,” Bertin writes. This means that it’s important to teach your kids strategies for getting organized.
Information Management

People with ADHD can have poor working memory. “Working memory is the capacity to manage the voluminous information we encounter in the world and integrate it with what we know,” Bertin writes. We need to be able to temporarily hold information for everything from conversations to reading to writing.

This explains why your child may not follow through when you give them a series of requests. They simply lose the details. What can help is to write a list for your child, or give them a shorter list of verbal instructions.
Emotion Management

Kids with ADHD tend to be more emotionally reactive. They get upset and frustrated faster than others. But that’s because they may not have the ability to control their emotions and instead react right away.
Effort Management

Individuals with ADHD have difficulty sustaining effort. It isn’t that they don’t value work or aren’t motivated, but they may run out of steam. Some kids with ADHD also may not work as quickly or efficiently.

Trying to push them can backfire. “For many kids with ADHD, external pressure may decrease productivity …Stress decreases cognitive efficiency, making it harder to solve problems and make choices,” Bertin writes. This can include tasks such as leaving the house and taking tests.
Other Issues

Bertin features a list of other signs in Mindful Parenting for ADHD because many ADHD symptoms involve several parts of executive function. For instance, kids with ADHD tend to struggle with maintaining routines, and parents might need to help them manage these routines longer than other kids.

Kids with ADHD also have inconsistent performance. This leads to a common myth: If you just try harder, you’ll do better. However, as Bertin notes, “Their inconsistency is their ADHD. If they could succeed more often, they would.”

Managing time is another issue. For instance, individuals with ADHD may not initially see all the steps that are required for a project, thereby taking a whole lot more time. They may underestimate how long a task will take (“I’ll watch the movie tonight and write my paper before the bus tomorrow”). They may not track their time accurately or prioritize effectively (playing until it’s too late to do homework).

In addition, people with ADHD often have a hard time finishing what they start. Kids may rarely put things away, leaving cabinets open and leaving their toys and clothes all over the house.

ADHD is complex and disruptions in executive functioning affect all areas of a person’s life. But this doesn’t mean that you or your child is doomed. Rather, by learning more about how ADHD really works, you can find specific strategies to address each challenge.

And thankfully there are many tools to pick from. You can start by typing in “strategies for ADHD” in the search bar on Psych Central and checking out Bertin’s valuable book.