Executive function (EF) in ADHD refers to management of the cognitive functions of the brain. ADD is not merely a deficit of attention as well as excessive movement but a deficit in the brain circuits that prioritize, integrate, and regulate other cognitive functions. EF provides the mechanism for self-regulation.

Thomas E. Brown, Ph.D. (2005) uses the metaphor of the symphony orchestra to show EF. All the members of the orchestra can play their instruments beautifully, but if no conductor organizes the players of individual instruments to begin or to convey the overall interpretation of music as a whole, the orchestra will not produce good music. Everyone will be doing his or her own thing. Symptoms of ADD can be compared to impairments, not in the work of the individual musicians, but in the orchestra's conductor. On occasion persons with ADD may be able to do well an individual task that they are interested in, but the problem lies in their chronic inability to activate and manage these functions in the right way at the right time. Therein lies the similarity to the orchestra: The problem lies not with the individual musicians who can play instruments perfectly but with the conductor, who must start and guide all the individual players.

Brown uses another illustration given by Martha Bridge Denckla, Johns Hopkins, describing patients with high intelligence and no specific learning disabilities but who have problems dealing with tasks. She compares these people to a disorganized cook trying to get a meal on the table. A person, who has a well-equipped kitchen and shelves stocked with all the essentials, is preparing lasagna. She can even read the recipe. However, she forgets to thaw the meat, searches through the shelves to find the spices, and forgets to turn on the heat in the oven. This cook is motivated but disheveled and is unlikely to get her dish on the table in time. This metaphor again describes the executive function of a person who wants to accomplish a task but is unable to get it all together.

Brown relates three concepts to EF: intelligence, awareness, and the brain's signaling system:

1. EF and intelligence. As seen in the example of the disorganized cook, disorganization can be independent of general intelligence. Persons can be extremely bright on standard measurements of IQ, but this has little to do with whether they meet the diagnostic criteria for ADD.

2. EF and awareness. The metaphor of a person getting ready to fix a screen on his window shows how awareness plays into the picture. He went to the basement to get some nails and found the garage was a mess, so he started cleaning it. He decided to put up some pegboard to hang tools, so he jumped in the car to go to the store to buy it. At the store, he found paint on sale and realized the porch needed painting; he forgot the pegboard. The original focus and awareness of his intent of fixing the screen was lost.

3. EF and the brain's signaling system. Considerable evidence exists that those with ADD have significant impairments in the executive functions of the brain. EF is not concentrated in one area of the brain but is decentralized and supported by many complex networks within the prefrontal cortex. Some essential EF functions are related to the amygdala and subcortical structures, whereas others depend of the reticular portions of the cerebellum. Complex neuronal networks and signals move signals along with two important neurotransmitters: dopamine and norepinephrine.

Brown describes six executive functions that are impaired in ADD syndrome:

1. Activation. Organizing, prioritizing, and getting ready to work

2. Focus. Keeping on task

3. Effort. Keeping alert, maintaining effort, and regulating speed

4. Emotion. Managing frustration

5. Memory. Using working memory and accessing recall

6. Action. Keeping self-control

Bibliography:

1) Barkley, Russell. 2006. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 3rd ed. New York: Guilford Press.

2) Barkley, R. 1997. ADHD and the nature of self-control. New York: Guilford Press.

3) Brown, T. E. et al. 2006. ADHD gender differences in a clinic-referred sample. In Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 3rd ed., edited by Russell Barkley. 108. New York: Guilford Press.

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