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7. Executive problems / planning and organization difficulties in ADHD.


7. Executive problems / planning and organization difficulties in ADHD.

Executive functions are the abilities of the

  • Planning, organization and problem solving1
    and the
  • Inhibition1
    • Reaction inhibition
    • Distractibility control
      • Distractibility (differentiation of relevant / irrelevant stimuli)
      • Task switching / set shifting12
    • Self-regulation
      • Emotional1
      • Motivational

Whereas inhibition is neurophysiologically regulated in the striatum (for review, seeNeurophysiological correlates of inhibition problems and impulsivity in ADHD), planning and problem solving are processed by the dlPFC.
The dlPFC houses the working memory function, which is an important tool in planning and problem solving.

Effortful control seems to describe a similar construct to executive functions.34

Executive problems have a greater negative impact on Quality of Life and daily functionality of affected individuals than delay-related behavior and emotional dysregulation, according to one study.5 Executive problems can be improved ADHD medication and cognitive behavioral therapy.6

7.1. Problems organizing tasks and activities

Specific to ADHD is the impairment to perform a preconceived future directed action. Problems organizing tasks and activities are one of the 9 most accurate symptoms of ADHD in adults.7

  • Disorganization
  • Life is like a string of unfinished projects
  • Lack of overview when organizing tasks (in children as well as in adults)8
  • Important and unimportant can be poorly separated (for adults)8
  • Disorder in the apartment
    • Possibly overcompensation through meticulous order, because disorder is the inner enemy (see also perfectionism)
  • Throwing things away is difficult9 (see also Messi tendency, Hoarding)

Nevertheless, there is no ADHD-typical planning (mis)behavior. The planning behavior seems to differ greatly from person to person.10

7.2. Not (being able to) keep promises or commitments made to others

Not (being able to) keep promises or commitments to others is said to be another of the 9 most accurate symptoms of ADHD in adults.7

  • Appointments/commitments are forgotten (see also forgetfulness)
  • Appointments/agreement are not remembered
  • Life without the (cell phone) calendar would be impossible
    • Everything must be noted immediately
    • What is not immediately noted is already almost forgotten

7.3. Problems doing things in the right order

Problems doing things in the right order is also said to be one of the 9 most accurate symptoms of ADHD in adults.7

7.4. Neurophysiological correlates of executive problems

Executive problems are the result of dysfunction of working memory located in the dorsolateral PFC.
Dopamine / norepinephrine deficiency in dlPFC leads to the described executive problems in ADHD.

See more at Neurophysiological correlates of working memory problems in ADHD

7.5. Executive problems as symptoms of stress

Chronic stress causes decreased levels of dopamine in the PFC, which impairs working memory function in the dlPFC and thus executive functions.11 Acute stress causes limitations of executive functions via increased dopamine levels, which impaired the dlPFC.12

For more on the development of neurotransmitter and hormone systems by chronic stress (stressful periods), see Alteration of the dopaminergic system by chronic stress InProlonged chronic stress in the article Stress damage caused by early/long-lasting stress in the section Stress.
More on the alteration of hormone and neurotransmitter systems over different stress phases Breakdown of neurotransmitter systems across stress phases In the article The stress systems of humans - basics of stress in the chapter Stress.
For more on the impairment of brain functions in the presence of nonoptimal neurotransmitter levels (reversed U), see Optimal neurotransmitter level = optimal information transmission in the article Neurotransmitters during stress in the chapter Stress.

  1. Otterman, Koopman-Verhoeff, White, Tiemeier, Bolhuis, Jansen (2019): Executive functioning and neurodevelopmental disorders in early childhood: a prospective population-based study. Child Adolesc Psychiatry Ment Health. 2019 Oct 22;13:38. doi: 10.1186/s13034-019-0299-7. eCollection 2019.

  2. Luna-Rodriguez, Wendt, Kerner Auch Koerner, Gawrilow, Jacobsen (2018): Selective impairment of attentional set shifting in adults with ADHD. Behav Brain Funct. 2018 Nov 10;14(1):18. doi: 10.1186/s12993-018-0150-y. PMID: 30414619; PMCID: PMC6230251.

  3. Tiego, Bellgrove, Whittle, Pantelis, Testa (2019): Common Mechanisms of Executive Attention Underlie Executive Function and Effortful Control in Children. Dev Sci. 2019 Nov 4. doi: 10.1111/desc.12918.

  4. Bridgett, Oddi, Laake, Murdock, Bachmann (2013): Integrating and differentiating aspects of self-regulation: Effortful control, executive functioning, and links to negative affectivity. Emotion, 13(1), 47–63.

  5. Sjöwall, Thorell (2019): Neuropsychological deficits in relation to ADHD symptoms, quality of life, and daily life functioning in young adulthood. Appl Neuropsychol Adult. 2019 Dec 27:1-9. doi: 10.1080/23279095.2019.1704287.

  6. Surman CBH, Walsh DM (2023): Do ADHD Treatments Improve Executive Behavior Beyond Core ADHD Symptoms in Adults? Evidence From Systematic Analysis of Clinical Trials. J Clin Pharmacol. 2023 Feb 2. doi: 10.1002/jcph.2209. PMID: 36731171.

  7. Barkley, Benton (2010): Das große Handbuch für Erwachsene mit ADHS, Seite 22

  8. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 60

  9. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 214

  10. Zajic, Solari, McIntyre, Lerro, Mundy (2020): Overt planning behaviors during writing in school-age children with autism spectrum disorder and attention-deficit/hyperactivity disorder. Res Dev Disabil. 2020 May;100:103631. doi: 10.1016/j.ridd.2020.103631. Epub 2020 Mar 20. PMID: 32203886. n = 32 von 121

  11. Mizoguchi, Yuzurihara, Ishige, Sasaki, Chui, Tabira (2000): Chronic stress induces impairment of spatial working memory because of prefrontal dopaminergic dysfunction. J Neurosci. 2000;20(4):1568-1574. doi:10.1523/JNEUROSCI.20-04-01568.2000

  12. Bahari, Meftahi, Meftahi (2018): Dopamine effects on stress-induced working memory deficits. Behav Pharmacol. 2018;29(7):584-591. doi:10.1097/FBP.0000000000000429