I’m an executive function coach. Here’s what it’s like for my clients with ADHD.

October is ADHD Awareness Month and I am busier than ever coaching students and adults who need help with their executive functioning skills. What are executive functions, exactly? We all use them every day when we try to get to school on time, start that new project, plan a birthday party, or tackle those five loads of laundry. Executive functions are the basic skills we all need to get through life efficiently. They help us to plan, prioritize, self-regulate, focus, and juggle multiple tasks successfully on a daily basis.

So, what happens when you are a child with ADHD? Attention Deficit Hyperactivity Disorder (ADHD) has many complex symptoms and several types, so the challenges can appear differently from person to person. There are kids who present with hyperactivity, who cannot stop fidgeting, and who are often labeled in school as problematic because of impulsive behaviors. But, the stereotype of the child who is bouncing off the walls does not capture all forms of ADHD. There are those with little or no hyperactivity, who are well-behaved and sit quietly in class, while missing entire chunks of material because they are distracted by their own thoughts. These are the children with predominantly inattentive ADHD, a diagnosis which is often missed because it is more challenging to spot. ADHD tends to show up as predominantly inattentive or predominantly hyperactive. When a child has six or more symptoms of each type, practitioners will consider a diagnosis of combined type ADHD.

While it is not completely understood, ADHD is often underdiagnosed in girls. One possible reason for this is that girls appear to require a more severe presentation of their symptoms in order to be noticed. Another is that most ADHD research studies have been conducted using only boys. It is also thought that most girls with ADHD have the inattentive type, which we know is more difficult to identify. Patricia Quinn, M.D., director of the National Center for Gender Issues and ADHD, and Sharon Wigal, Ph.D., associate clinical professor of pediatrics at the University of California at Irvine, found that “ADHD often expresses itself in girls through excessive talking, poor self-esteem, worrying, perfectionism, risk-taking, and nosiness — not the typical hyperactivity and lack of focus that is often seen in boys.” (https://www.additudemag.com/the-truth-about-girls-adhd/)

For adults, the struggle is also very real. Most people think of kids with ADHD who act out impulsively and lack control over their emotions. In adults, that same process can result in uncontrolled anger, blurting out hurtful statements, or frustrating communication issues. It can damage relationships and cause chaos in the workplace. Adults also suffer from problems related to task initiation, time management, planning, distractibility, and making decisions. I see parents who are barely keeping their heads above water trying to manage work, kids, personal care, and life at home because of executive function impairment. Spouses fight over chores that never get done and bills that are paid too late. Non-ADHD partners may feel neglected because their significant others hyperfocus on other tasks and don’t attend to their needs. Imagine being a 35-yr-old man who is unable to remember to brush his teeth every morning. Or, the mother of a young child who breaks down at the very thought of making dinner because she’s never used a shopping list to buy groceries. For many adults, they don’t figure out they have ADHD until later in life. When poor executive function skills have been in place for years, those patterns are even harder to change.

I work with students and adults with all types of ADHD. Some have never used a planner or calendar. Many will not start their homework unless a parent nags them for hours. Others shut down completely when they have to study for a test or begin a new project for work. Their emotional states can vary from session to session. Remembering to hit the “submit” button for assignments on Google Classroom is one of the biggest struggles I see in school-age children. Knowing how to break down large projects into smaller more manageable tasks is typical for many adults. Procrastination is a huge problem across the board that can manifest itself both in school and at home. And power struggles between parents and kids often erupt as a result of poor understanding of how executive function issues present and how to manage them.

While the neurological differences in people with ADHD are well-documented, the emotional consequences of having ADHD are profound and worth mentioning. Children who are repeatedly unsuccessful in school, or who get blamed by parents and teachers for being “lazy” or “careless”, often create a negative inner narrative that continues through adolescence and into adulthood. Similarly, undiagnosed adults who perceive themselves as complete failures at school, work, relationships, and life in general can suffer from depression, anxiety, and poor coping skills for years. I can’t tell you how many clients I have who refer to themselves as “stupid” before they understand that they just learn differently. Unfortunately, low self-esteem often goes hand in hand with ADHD and executive function challenges.

When I talk to my clients about ADHD, I make sure to mention that it is not just a diagnosis--it can be a lifelong gift! People with ADHD are often described as creative, outside-the-box thinkers. Many excel in art and music or in jobs that require them to manage crisis situations, such as ER doctors, ambulance drivers, and police officers. The tendency to hyperfocus for some with ADHD may not work well as children when they must attend to subjects of little interest. But, as adults, they may thrive in careers where they can delve into work that keeps them engaged for long periods of time, especially in jobs with a lot of structure, such as project managers, data analysts, and lawyers. Being in a fast-paced role often works for people with ADHD who may have racing thoughts and tend to feel stagnant in environments that stay the same. Busy retail stores and jobs requiring frequent travel may work well for these individuals. ADHD brains do work differently. But, in many cases, that puts people at an advantage.

The good news for those who struggle is that if ADHD is identified and support is implemented, executive function skills can improve at any age. With proper strategies, anyone can learn the right tools to help them start new tasks, manage assignments, have better routines, plan ahead, and juggle daily responsibilities. I have seen kids begin to study with confidence when they learn how to sort their notes in a new way. Adults can learn to organize their workspaces, build new habits, and use scheduling systems more effectively. Kids and adults can use focus apps to avoid phone or internet distractions. My new favorite is called Bakery, which allows you to “bake” goodies and collect them in a display case when you successfully stay off your phone for a predetermined amount of time. My high-school-age clients love that one!

ADHD can cause problems in executive functioning, but it can also be celebrated when people learn to work with their differences. This month, help spread awareness by learning something new about ADHD and sharing that with others.

Want to learn more about ADHD, executive functions, and how to find out if you or your child needs help? Here are some useful links:

https://www.beyondbooksmart.com/

https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/I-think-my-child-may-have-ADHD-How-do-I-find-out-for-sure.aspx

https://lifeskillsadvocate.com/blog/executive-function-skills-by-age/

https://www.understood.org/articles/en/what-is-executive-function

Elizabeth Malvino, LCSW is a licensed clinical social worker and executive function coach for Beyond BookSmart. She helps children, teens and adults understand their ADHD differences and build confidence using targeted strategies aimed at improving executive function skills. She also has a particular interest in how school schedules affect the physiological and emotional health of adolescents and is chapter leader for the Northern Westchester County chapter of Start School Later, Inc, a national organization which educates districts about how later start times can improve the lives of students.