Research over the past 20-30 years, has led to significant changes in the way we view ADHD. We now know that ADHD is not a behavioural disorder, as once thought, but a complex neurodevelopmental disorder. We also now know that the majority of children and adolescents with ADHD have deficits in their executive function skills. A meta-analysis of research studies was conducted in 2005 and found that children with ADHD had substantial impairment on measures of executive functions compared to their neurotypical peers.
What are executive functions?
Executive functions are complex cognitive or mental processes that we use to monitor and manage and even inhibit our own behaviour. They are also used for planning, problem-solving, organising ourselves or managing our time. We use our executive functions to control our emotions and motivations.
Dr Russell Barkley therefore identifies ADHD as a disorder of self-regulation, or self-control, which has significant links to the brain’s executive function skills. You can check out a Youtube clip here that explains executive functions.
The part of the brain that is responsible for our executive functions is the pre-frontal cortex. Research tells us that children and adolescents with ADHD have approximately 3-10% overall smaller brain volume, than their neurotypical peers. Interestingly, the smaller the brain volume, the greater the ADHD symptoms. Knowing this, we can then understand why children with ADHD have deficits in executive function skills.
Children and adolescents are asked regularly to use their executive function skills throughout their everyday lives such as:
At school, having to follow instructions in the classroom or complete a maths worksheet independently. When they are doing an assignment, managing their own time to get an activity done or reading. When they have to motivate themselves to continue to do a task, or even just sitting still for a school assembly.
In a clinic appointment with an allied health professional, we ask them to complete a language or learning assessment. They have to sit still to do an activity, do drill work for a speech sound disorder or listen to instructions. We ask them to do fine motor activities, learn a new self-help skill or even learn how to strap their own ankle after a soccer injury.
And even at home: doing homework, cleaning their room, organising themselves to get ready for school, attending music lessons or music practice, even making a meal from a recipe.
In all these activities, we are asking our children to use their executive function skills.
So, what does this mean for a child with ADHD with an executive function skill deficit? So should we stop expecting our children with ADHD to do these activities? Of course not! But it does go a long way to explain why children with ADHD find these, seemingly simple activities, difficult. Difficult, but not impossible. We know that children with ADHD can sometimes engage in these activities quite well. Still, at other times they are unable to even start them. Sometimes they can seem to be doing an activity and then seemingly come to a screaming halt and their ADHD symptoms seem to increase. They can’t be brought back to finish an activity. This can lead to parents, teachers and health professionals believing that the child must be defiant or choosing not to do the activity. This often is not the case at all.
I love the way Dr Barkley talks about the ADHD brain and executive functions. He talks about it like the fuel tank of a car. Cars run on fuel and when we use a car, the amount of fuel in the tank reduces until it is completely depleted. Once it is consumed, no matter how much we try and start that car, it won’t go again until the fuel tank is refilled. It is the same for a brain, even a neurotypical brain, and its executive functions. The brain can’t keep indefinitely using executive function skills, without being re-fuelled. This is based on a theory called the limited strength model of self-regulation. There is a link to read more about it, if you are interested.
Now, of course, not all cars, or brains are created equal.
My Dad bought a new car last year, when he retired. He doesn’t need to drive it much at all. He lives close to the city and so everything he needs is in very short driving distance. So, this car, that he doesn’t drive much, being a new car, is also very efficient. His car can drive a long way before he needs to refuel it. He only spends on average $5 a week on petrol.
My car on the other hand, is a huge 8-seater van. It is also coming up on 14 years old. I do love my good old van, and it gets me from A to B, but it is also very inefficient. Adding to that, we also live out in the suburbs, so we need to drive a lot because most of the activities that we do are approximately 15-20 mins away from us in all directions. So, my car, that is driven a lot and is old and inefficient, can’t go far before it needs to be re-fuelled. It goes through about $85 a week in fuel.
Let’s think about our brains like these two cars. If my dad and I drove to the same place, on the same road, my dad’s car would use far less fuel and therefore, wouldn’t need to be re-fuelled as often as my car. This is like the neurotypical and ADHD brains.
If two children are asked to do the same activity, using the same executive function skills, the child with the neurotypical brain, would be able to go for longer and more efficiently than the child with the ADHD brain, before requiring a re-fuel.
In fact, the ADHD brain’s executive function skill deficit is approximately 30-40% delayed compared with a neurotypical brain. Think of it like this, we have the same expectations of a neurotypical adolescent, who is say in year 10, as an adolescent with ADHD in year 10, but their executive function skills are really at the same level as a neurotypical child who is in year 4 or 5 (around 9 or 10 years old). No wonder our poor children and adolescents with ADHD are unable to keep up with the expectations we set for them. Their fuel tanks are draining far quicker when they are doing their work and therefore need to be re-fuelled far more often.
So now that we know that our children with ADHD are using up their fuel at a greater rate, when and how can we re-fuel it?
There are lots of ways to re-fuel, but here are 4 evidence-based yet simple ways to quickly re-fuel the child with ADHD’s petrol tank, so they can keep powering on.
- Ensure you have a plan for regular breaks
Children with ADHD’s fuel tank is only good for around 10 mins. Does that shock you? It shocked me, but also makes perfect sense as why our children can’t stick at a task for very long.
After each 10 min use of executive function skills, allow a 3 min break to re-fuel. And this is for children around 10 years and over, for younger children, it is estimated that their fuel tank is only going to last for 5 mins prior to requiring a re-fuel, and that re-fuel should go for approximately 2 mins.
- Support the executive function system during ‘high fuel activities’.
It is so important that we support the child or adolescent with ADHD’s executive function skills. This is where visuals, time management trackers and scaffolds come into play. We know there is limited fuel in the executive function tank for learning, so if we can support some of those executive function skills externally, the child can spend their fuel on what they need to learn.
If you ask your child with ADHD to clean their room at home, immediately their whole executive function skills are put to the test. They need to first control their emotions, and not to tell you off, because they hate cleaning their room, and then activate some sort of motivation to get started, they then have to access an sort of organisational chart in their mind of all the steps that are required to clean their room, they have to hold all of that information in their mind, before they even start to clean, and the fuel in their tanks are almost all gone already.
So, what if we can get rid of them needing to do any of those executive function skills prior to cleaning? We will significantly reduce the amount of fuel our children are using up, so they have full tanks ready to clean.
We could promise a reward, “It’s time to clean your room. I know that it’s not your favourite part of the week, but let’s get it done, and then we can play Fortnite together!” (this will take care of their motivation and also feel as thought you already understand their emotions), then you can print off our free clean your room visual, so that they don’t have to rely on their executive functions for planning and organisation as it is already done for them.
They can now start the activity without using any fuel.
- Get moving!
Exercise benefits the ADHD brain so significantly, it not only can re-fuel the tank, but it can actually make the fuel tank bigger.
During the 3-minute breaks, get the child or adolescent with ADHD up and moving! This re-fuels their tank, so they are ready to engage again in the next activity.
In my speech pathology clinic, if I am seeing a child with ADHD, I will often use yoga dice, or a yoga spinner, bouncing or rolling on an exercise ball, my printable movement break exercise stations, put on some music and have a dance party and pre-COVID-19, I would even challenge the child to an arm wrestle in the 3 min breaks, to re-fuel before jumping back in to another activity.
Teachers can do the same, get them to run around the playground once or twice, or even have a special area in the classroom where they can do some sit ups or push ups, or set up my movement break exercise stations around the room or at desks. You can even use the children with ADHD to do an errand like getting the lunch orders, or take a note or item to another classroom.
Parents at home, send your child outside to jump on the trampoline, play soccer with the dog, have running races, or go for a walk as a family.
But this doesn’t even have to be restricted to the 3 min break time as research shows that the ADHD brain works better if they are moving WHILE engaging in activities that require executive functions. Keep in mind though, that this was not the same for their neurotypical peers, they actually performed worse while doing the same exercises if they were required to move at the same time.
So think, about using a standing desk in the classroom, do speech drill work in a clinic standing on one foot or jumping on different coloured mats, allow your child to read to you while they are rolling around on an exercise ball. This worked so well for my son when he was younger. He would be rolling back and forward on an exercise ball while reading me his home readers.
- Teach positive self-talk
This strategy is actually so simple, but so powerful and really shows how amazingly complex a human brain is. Did you know that by simply teaching your child to become their own cheerleader they can re-fuel their tank?
By teaching our children to use simple phrases such as “I can do this!” or “mistakes are ok, that is how I learn” or “I WILL finish this activity”, can actually increase their motivation and self-confidence. It will actually lead to better performance on an activity. (Tod, Harvey & Oliver, 2011). And interestingly, children with ADHD usually have lower levels of self-talk and more negative self-talk than their neurotypical peers. We need to take the time to teach them how to do positive self-talk so they can re-fuel their own tanks. I have made a mini-kit of self-talk Printables available here to print and put up around your child’s room, classroom or clinic, to remind them of things they can say to cheer themselves on. Grab them here.
I love Big Life Kids, their journal and podcasts. Part of what they teach is this exactly this. Positive self-talk! If you haven’t already checked them out, make sure you do. I am an affiliate to Big Life Journal, so I will make a small commission if you buy anything from this link, but I only do this because I truly believe in their product. Try it for yourself, I know you won’t be disappointed.
Give these strategies a go and share with us how they went!
I love hearing how you are getting ADHD Done Differently!