Let’s cut to the chase: Executive dysfunction looks a lot like attention-deficit/hyperactivity disorder (ADHD). Distractibility. Organizational challenges. Trouble managing big emotions. And academic ups and downs. Assessing executive function can give you a window into how a child functions every day and which skills to prioritize in an intervention plan.  

Early intervention is key because better executive function can mean fewer ADHD symptoms, fewer conduct and defiance symptoms, less substance use, and less depression in the long run (Yang et al., 2022).  

Here’s what researchers say you should look for when assessing executive function in an ADHD evaluation. 

The Relationship Between ADHD and Executive Function: Why It’s So Important to Test in Children

Which skills are part of executive function? 

Executive function is an umbrella term for a group of processes that help people manage how they think, feel, and behave. The processes that usually fall under the executive function umbrella include 

• visual (or nonverbal) working memory, which is the ability to “see” images while working on a task or goal (such as picturing an outcome or the steps in a process); 
• verbal working memory, which is a kind of internal voice that enables people to talk themselves through a task or problem; 
• inhibitory control, which is the ability to stop or change behaviors and to manage emotions; and 
• set shifting, which is the ability to direct your attention from one task or stimuli to another so you can accomplish something. 

In fact, some studies have shown that ADHD affects at least one aspect of executive function for around 89% of children with the condition. Working memory can be a problem for around 62% of children with ADHD. Roughly 38% have difficulty with set shifting, and 27% with inhibitory control (Kofler et al., 2019; Veloso et al., 2022). 

These skills don’t operate independently. They interact. Together, they enable people to 

• organize themselves,  
• solve problems,  
• cope with emotions, 
• respond flexibly to new situations, and  
• focus their attention.  

ADHD and Executive Function: Common Difficulties 

Not every person with delayed executive function development has the same concerns. That’s why it’s so important to assess each person’s executive function in an ADHD evaluation. 

Here are some factors to consider as you do.  

ADHD affects working memory. 

Working memory is a kind of brain-space where we hold the information we’re using to complete immediate cognitive tasks. We can think of working memory as a mental whiteboard on which we sketch pictures or jot words we need to access quickly (Emch et al., 2019). 

The capacity of a person’s working memory can determine  

• how fast they learn,  
• how well they comprehend what they read,  
• how effectively they solve problems using reason, and  
• how efficiently they acquire language.  

Studies suggest that visual working memory doesn’t develop as quickly in children with ADHD as it does in children with typical development. Researchers found that children with delayed visual working memory showed higher inattention symptoms. Visual working memory deficits may not have as much impact on hyperactivity and impulsivity symptoms (Karalunas et al., 2018). 

Other studies have linked working memory to 

• difficulty with applied math problems (Friedman et al., 2018); 
• organizational difficulties (Kofler et al., 2019); and 
• classroom functioning difficulties, including trouble taking notes, following instructions, and keeping up with materials (Kofler et al., 2019).  

Learn more about assessments that measure school motivation and learning strategies.  

ADHD may shape inhibitory control and set shifting. 

Inhibitory control is another umbrella term. It refers to a group of thinking processes that, together, enable people to restrain or stop what they’re doing. These abilities are often measured by “stop” and “go” tasks in assessments.  

When researchers study inhibitory control in children with ADHD, it isn’t always clear whether ADHD or another factor is at the root of a deficit. For example, a 2020 study found that sleep disturbance, rather than ADHD, led to inhibitory control problems (Wollf et al., 2021). So, while children with ADHD may have inhibitory control issues, you may have to take a closer look to pinpoint the source of the difficulty.   

Evidence is also mixed with respect to set-shifting abilities in children with ADHD. In some studies, children with ADHD can quickly move from one task to another. In others, children have slower shifting abilities. At least one study found that shifting speed was not different in children with ADHD, but that some accuracy could be sacrificed in the process. Researchers said less accuracy may point to problems with other aspects of executive function, not set shifting (Irwin et al., 2019).  

Learn more about the interaction of ADHD and other neurodevelopmental conditions.  

ADHD and executive function are linked to emotion regulation, too. 

Difficulty managing emotions isn’t one of the diagnostic criteria for ADHD. But the DSM-5-TR lists emotional dysregulation and emotional impulsivity as common features of the condition.  

The neural networks and brain structures involved with executive function overlap with those that process emotions. ADHD affects those brain areas in complex and highly individual patterns (Rubia, 2018). 

For example, studies show that people with ADHD can have trouble noticing their own physical and emotional states (Ide-Okochi et al., 2022). Other researchers found that working memory influences how well children with ADHD manage their feelings (Groves et al., 2022).  

Learn more about how you can help strengthen interoception, the awareness of inner states. 

Other factors can slow development of executive function. 

ADHD isn’t the only factor that can disrupt the development of executive function. You may need to consider what else could be contributing to executive dysfunction. Research shows that both childhood trauma and lower socioeconomic status can influence executive function in children, for example.  

When children experience serious hardships or trauma at a young age, the stress they feel can change how the brain develops. This is especially true when stress  

• lasts a long time; 
• is severe (as it is with abuse, exposure to violence, or long-term financial need); and 
• happens during a crucial developmental period.   

For example, researchers have linked serious adversity to smaller amounts of gray and white matter in areas of the brain related to executive function (Nelson et al., 2020).  

In the same way, when researchers analyzed records from the Harvard Early Learning Study, they found that children from the highest-income families showed better executive function and self-regulation than children from the lowest-income families. Those differences were present whether researchers looked at assessments, parent reports, or teacher reports (Cuartas et al., 2022).   

Key Message 

In an ADHD evaluation, assessing executive function can yield powerful insights into the specific difficulties each child has at school, at home, and in relationships. Executive functioning and ADHD overlap in unique patterns. Discovering each person’s abilities can help you pinpoint the interventions most likely to bring positive change to a child’s life.  

Learn more about the tests many researchers use to assess the characteristics of ADHD:  Behavior Rating Inventory of Executive Function (BRIEF-2) and Conners 4™, the leading ADHD assessment for young people ages 6–18 years. 

Research and Resources: 

Chen, S., Yu, J., Zhang, Q., Zhang, J., Zhang, Y., & Wang, J. (2022). Which factor is more relevant to the effectiveness of the cognitive intervention? A meta-analysis of randomized controlled trials of cognitive training on symptoms and executive function behaviors of children with attention deficit hyperactivity disorder. Frontiers in Psychology, 12, 810298. https://doi.org/10.3389/fpsyg.2021.810298

Cuartas, J., Hanno, E., Lesaux, N. K., & Jones, S. M. (2022). Executive function, self-regulation skills, behaviors, and socioeconomic status in early childhood. PloS One, 17(11), e0277013. https://doi.org/10.1371/journal.pone.0277013 

Emch, M., von Bastian, C. C., & Koch, K. (2019). Neural correlates of verbal working memory: An fMRI meta-analysis. Frontiers in Human Neuroscience, 13, 180. https://doi.org/10.3389/fnhum.2019.00180

Friedman, L. M., Rapport, M. D., Orban, S. A., Eckrich, S. J., & Calub, C. A. (2018). Applied problem solving in children with ADHD: The mediating roles of working memory and mathematical calculation. Journal of Abnormal Child Psychology, 46(3), 491–504. https://doi.org/10.1007/s10802-017-0312-7 

Ide-Okochi, A., Matsunaga, N., & Sato, H. (2022). A preliminary study of assessing gaze, interoception and school performance among children with neurodevelopmental disorders: The feasibility of VR classroom. Children, 9(2), 250. https://doi.org/10.3390/children9020250 

Irwin, L. N., Kofler, M. J., Soto, E. F., & Groves, N. B. (2019). Do children with attention-deficit/hyperactivity disorder (ADHD) have set shifting deficits? Neuropsychology, 33(4), 470–481. https://doi.org/10.1037/neu0000546 

Kofler, M. J., Irwin, L. N., Soto, E. F., Groves, N. B., Harmon, S. L., & Sarver, D. E. (2019). Executive functioning heterogeneity in pediatric ADHD. Journal of Abnormal Child Psychology, 47(2), 273–286. https://doi.org/10.1007/s10802-018-0438-2 

Kofler, M. J., Sarver, D. E., Harmon, S. L., Moltisanti, A., Aduen, P. A., Soto, E. F., & Ferretti, N. (2018). Working memory and organizational skills problems in ADHD. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59(1), 57–67. https://doi.org/10.1111/jcpp.12773 

Miklós, M., Futó, J., Komáromy, D., & Balázs, J. (2019). Executive function and attention performance in children with ADHD: Effects of medication and comparison with typically developing children. International Journal of Environmental Research and Public Health, 16(20), 3822. https://doi.org/10.3390/ijerph16203822 

Nelson, C. A., Scott, R. D., Bhutta, Z. A., Harris, N. B., Danese, A., & Samara, M. (2020). Adversity in childhood is linked to mental and physical health throughout life. British Medical Journal (Clinical research ed.), 371, m3048. https://doi.org/10.1136/bmj.m3048 

Rubia K. (2018). Cognitive neuroscience of attention-deficit/hyperactivity disorder (ADHD) and its clinical translation. Frontiers in Human Neuroscience, 12, 100. https://doi.org/10.3389/fnhum.2018.00100

Soto, E. F., Irwin, L. N., Chan, E. S. M., Spiegel, J. A., & Kofler, M. J. (2021). Executive functions and writing skills in children with and without ADHD. Neuropsychology, 35(8), 792–808. https://doi.org/10.1037/neu0000769

Veloso, A. S., Vicente, S. G., & Filipe, M. G. (2022). Assessment of “cool” and “hot” executive skills in children with ADHD: The role of performance measures and behavioral ratings. European Journal of Investigation in Health, Psychology and Education, 12(11), 1657–1672. https://doi.org/10.3390/ejihpe12110116

Wolff, B., Sciberras, E., He, J., Youssef, G., Anderson, V., & Silk, T. J. (2021). The role of sleep in the relationship between ADHD symptoms and stop signal task performance. Journal of Attention Disorders, 25(13), 1881–1894. https://doi.org/10.1177/1087054720943290

Yang, Y., Shields, G. S., Zhang, Y., Wu, H., Chen, H., & Romer, A. L. (2022). Child executive function and future externalizing and internalizing problems: A meta-analysis of prospective longitudinal studies. Clinical Psychology Review, 97, 102194. https://doi.org/10.1016/j.cpr.2022.102194