What are Executive Functions?

Let me start this post by saying I'm not a doctor or psychiatrist. Nor do I want to be. Although I want what's best for you, a true medical professional can help you with what treatments work best with your body and not some random lady on a blog that recently figured out how to see the bottom of her sink without almost crying...

Now then. With that settled, I've been asked about what it feels like to be on medication and off medication, and my answer is pretty complicated and requires you to understand what ADHD feels like, and it's symptoms. For now, let me just say that ADHD is a poorly named neurodevelopmental disorder (aka, you have to be born with it). When you have ADHD, the things that makes us truly human, our executive functions, are developmentally delayed. Some people can catch up, and others don't. I haven't, and it's doubtful that in the 2 years that my brain is still developing its executive functions that I will. It's okay. I don't know any different way to live and in some ways it can be oddly useful. In fact, in caveman days, scientist theorize that having warriors with ADHD was an advantage because they would be the first to react to threats. That said, today in the US I haven't been stalked by any tigers recently, so that advantage has been lost on me.

So why can people be so smart and such a space cadet when they have ADHD? It's simple. It's not a problem with knowledge, it's a problem with performance. The prefrontal cortex (the front of your brain) doesn't filter out distractions properly, so when I "focus" on something (without meds) I can only focus 300% or not at all. I don't have control over how much I can do, my brain gets to pick.

When you have ADHD, there are seven executive functions that are lagging behind everyone else, and most of these things fly under the radar when you have a quick conversation with people. Those functions are self-awareness, inhibition, non-verbal working memory (the ability to hold pictures in your mind), verbal working memory (the ability to hold sounds in your mind), emotional self-regulation, self motivation, and planning/problem solving.

Here's the ones I think most people can piece out for themselves. Self-awareness is self-directed attention. Now add inhibition, the ability to not do what feels good to avoid bad things. Self-motivation, AKA willpower so you can make yourself do things that aren't interesting or fun. The last easier to guess function is emotional self-regulation, this is the ability to mask your emotions to avoid consequences. Now, if you aren't familiar with ADHD, the rest might need a bit of explaining.

Non-verbal working memory seems like something hard to explain, but it's something you do all the time. In fact, I want you to close your eyes and picture Hawaii in your mind. That ability to hold a picture in your mind is your non-verbal working memory at work. It's holding a picture in your mind so you can use it, like when you think of the mac and cheese box when you're gathering things for dinner. You can see the blue box with the white letters and the orange cheese on the front. ADHD people have a hard time holding onto that image while they search.

Verbal working memory is your inner monologue, or the voice in your head that you use to talk to yourself. You know the one you use to mentally give yourself a pep-talk before taking a hard test... Yeah. That one.

What you're left with now is planning and problem-solving. Now I know that you believe you know what this is, but psychology doesn't define this as making a flow-chart (though you definitely need it to make one). This one is considered "mental play" or manipulating information in your mind to make new ideas. Kind of a big deal when you try to do anything new.

So what does this all mean? How do all of these things fit together? It's a self-regulation disorder that results in time blindness and the "Wall of Awful". You can't make a mental goal, hold it in mind, and think of different ways to complete it in the moment. You can't use past experiences to modify your behavior in the moment because your brain just can't access them. The memory is still there, but the link between it and the part of our brain that does the things is on the fritz. You can't regulate yourself enough to make yourself do an unpreferred task without significant help, and due to your lack of mind's eye and internal dialogue, telling yourself to just get up and do it doesn't work nearly as well as someone without ADHD. This is an incredibly disabling disorder, and isn't due to lack of intelligence or lack of love for the people around them. It's faulty wiring in the brain that keeps you from doing the things you already know you should do. I hope that this helps you understand either yourself, or someone you love a little bit better.