Inattentive ADHD, Sluggish Cognitive Tempo and Training for Executive Functioning

Thomas Brown of Yale University has interviewed thousands of patients with all the subtypes of ADHD and has determined that people with ADHD have problems with the performance of what is called the brain’s Executive Functions. The Executive Functions are the conductor in the brain that directs our brains to organize, plan and prioritize, inhibit and execute our thoughts and our actions.

Dr. Brown has determined that people with ADHD of all subtypes have some Executive Functions (EF) that work very well sometimes and not at all at other times and that with the appropriate reward of threat, the Executive Functions of people with ADHD can perform normally. The EF of people with Inattentive ADHD (ADHD-PI) and Sluggish Cognitive Tempo are impaired differently from the impairments seen in the combined type of ADHD (ADHD-C) and this is important from a treatment standpoint.

Brown has divided the Executive Functions into six categories outlined below:

 

  • Activation┬áis described by Brown as the ability to organize tasks and materials, estimate time, prioritize tasks, and get started on work tasks. All the subtypes of ADHD including those with ADHD-PI and SCT have this problem.
  • Focus┬áinvolves not only focusing but also the ability to sustain focus and to shift focus from one task to another. For many people with Inattentive ADHD (ADHD-PI), this is their main Executive Function Deficit.
  • Effort: Brown describes the Effort EF as the function that regulates our alertness, and our processing speed. It also is what regulates our ability to sustain effort. People with Sluggish Cognitive Temp (SCT) and Inattentive ADHD often have a great deal of problems with this particular Executive Function. Brown also reports that this EF controls sleep and that this explains why some people with ADHD can’t shut their head off at night ant once asleep, “sleep like dead people and have a big problem getting up in the morning.”
  • Emotion: This EF manages frustration and emotion and is control of this particular EF is what Russell Barkley sees as the central problem of people with ADHD. This problem is seen more often in the combined subtype of ADHD.
  • Memory: Memory pertains to the ability to use our memory to pull out facts when we need them. This is called our working memory and this is what causes those of us with ADHD-PI and SCT to have a very difficult time remembering where we just put our phone or our keys.
  • Action: This EF involves the regulation of our actions. In the case of people with Hyperactive ADHD, their actions are too impulsive and they act without thinking. In the case of Sluggish Cognitive Tempo, their actions are non existent and they fail to act or think.

 

According to brown these Executive Functions overlap and interact and contribute to problems in our lives in a multifaceted way. The good news is that our Executive Functioning can be improved with medicine and with training.

From an education standpoint this is important because if we can train the EFs in a way that engages people with Inattentive ADHD and Sluggish Cognitive Tempo then the plasticity of the brain may change the brain to permanently repair our Executive Function deficiencies.

There are many classroom interventions and lifestyle interventions that help us work better when we have faulty executive functioning. Studies have shown that in classrooms where these interventions have been incorporated, all students, even those without executive function problems do better. Some of these classroom and life interventions include: vyvanse 50 mg capsule

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