Executive Function Disorder                                by Rachel Archambault

In the last decade or so, the terms inattentive, hyperactive, or impulsive have been commonly associated with ADD/ADHD.  Until recently, the word “inattentive was used to describe “the inability to stay on task”, but is now part of a much larger concept, now called executive function disorder (EFD).

Executive Function Disorder is essentially when a person has difficulties going through the steps to complete a task. In simpler terms, in order for a task to be done, one must: analyze the task, plan how to address the task, organize the steps to carry out the task, develop timelines for completing the task, adjust or shift steps if needed, and complete the task in a timely matter. A child with EFD may have problems with organization, planning, analyzing, and scheduling in order to complete the tasks. They may also misplace papers, reports, or have trouble keeping their personal items organized.  Some other diagnoses that have deficits in executive functions are Autism, Asperger’s, attention deficit disorders, conduct disorder, Tourette’s, fetal alcohol syndrome, and childhood schizophrenia. Parents may describe their kids as disorganized or scattered.

If a parent gives a direction to their child with EFD, such as, “pick up your toys”, the child will not be able to complete the task. Instead, the parents must tell the child each step in order to get to the goal that will look like, “Pick up your toys, take out the basket, place all the toys inside the basket, and put the basket with the toys back on the shelf”.

To diagnose EFD, a speech pathologist will have the child demonstrate their executive function skills.  This may start as an interview with the parent, teacher, and child. Then there is an observation of problem solving skills and social interaction skills. The SLP will then determine the strengths and weaknesses so an effective intervention can be designed. There are a number of standardized tests that rate executive function so the SLP must choose a test that is of correct difficulty and accommodates any other disorders that the child may have.

Martha Bridge Denckla, M.D., an expert on executive function disorder, says, “EFD can be a reflection of ADHD, but it might also indicate an LD.” When a professional evaluating a child or adult finds evidence of EFD, it is essential for her to clarify whether the disorder results in ADD/ADHD, LD, or both. Only then can the child or adult receive the appropriate treatment for his specific problem.

Just by the description you can see how executive function disorder may be confused with ADD/ADHD, especially with these diagnoses being so commonly reported and medicated. Parents may want to look into another diagnosis if their child is on medication for an attention deficit disorder and sees no improvements. Consider EFD as a learning disorder, as the symptoms will not improve with medicine. The best way to manage learning disorders is through specialized accommodations and one-on-one work with a learning specialist. Many students with EFD require tutoring or different accommodations to improve learning.

The earlier that executive functioning disorder (EFD) is diagnosed, the more helpful it is to find intervention as well as specific accommodations needed for the child. Once the child is diagnosed, parents, teachers, and an SLP can determine a course of action to make sure the child is not struggling because of EFD.