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The Relationship Between Adult ADHD and Executive Function Deficits

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Stressed adult man with hands on his head, sitting at a desk with books, representing the executive function challenges assessed by the BRIEF2A tool for adult ADHD

Executive function (EF) skills are essential for managing daily tasks and responsibilities. However, adults with ADHD often face significant EF challenges that disrupt their ability to stay organized, focused, and on task. Approximately 4.4% of U.S. adults—about 10.5 million people—are affected by ADHD (NIMH, 2016). Studies show they score 10-15 points lower on EF measures than those without the condition (Pesantez, 2022), and these EF deficits disrupt personal and professional lives, highlighting the need for effective support strategies. 

Traditional assessment methods often focus on ADHD symptoms or EF deficits in isolation, leading to an incomplete understanding of an individual’s challenges. The updated Behavior Rating Inventory of Executive Function®, Second Edition-Adult Version (BRIEF2A), stands out as a comprehensive assessment tool designed to assess ADHD and EF deficits simultaneously. This dual-purpose instrument streamlines the assessment process and offers valuable insights to improve support strategies for adults with these challenges. 

What is ADHD? 

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that impacts individuals of all ages, from childhood through adulthood. Characterized by ongoing patterns of inattention, hyperactivity, and impulsivity, ADHD can significantly interfere with daily functioning and quality of life (Magnus, 2023). 

ADHD Types and Common Symptoms 

The disorder is classified into three types based on the symptom combination (NIMH, 2024). 

1. Inattention: Difficulty staying focused, leading to disorganization and missed details. Common symptoms include:  

  • Difficulty staying on task 

  • Frequent mistakes in work or activities 

  • Trouble organizing tasks 

  • Avoidance of mentally taxing activities 

  • Forgetfulness in daily activities 

  • Losing items  

2. Hyperactive-Impulsive: Restlessness and impulsivity, acting without thinking, resulting in poor decision-making. Common symptoms include:  

  • Fidgeting or difficulty staying seated 

  • Interrupting others 

3. Combined: A combination of symptoms from both inattention and impulsivity. 

How ADHD Manifests in Adults 

ADHD is often not recognized until adulthood, when work and family responsibilities intensify. Approximately 22% of adults experience late-onset symptoms (Breda, 2021). Adult ADHD commonly presents as: 

  • Inattention: Difficulty staying focused, leading to disorganization and missed details. 

  • Impulsivity: Acting without thinking, leading to poor decision-making. 

  • Organization and Time Management: Struggles with planning, prioritizing, and meeting deadlines. 

Adults with ADHD also face self-esteem and emotional regulation challenges due to lifelong struggles with criticism and feedback (Beaton, 2022). 

What is Executive Function (EF), and How do Deficits Manifest in Adults? 

Executive function (EF) refers to cognitive processes that help individuals plan, focus, and execute tasks to achieve their goals. EF skills are essential for managing everyday responsibilities, such as decision-making, problem-solving, and time management (Stuss & Alexander, 2000).  

Adults with ADHD often experience significant EF deficits, which can affect various aspects of their personal and professional lives. Research shows that around 40%-60% of adults experience significant EF challenges, leading to difficulties in time management, organization, and decision-making (Mohamed, 2021; Holst, 2020).  

Common EF deficits in adults with ADHD include:

  • Working Memory Impairments: Difficulty remembering instructions or important details, making tasks like reading, problem-solving, and following through on assignments challenging (Breda, 2021). 

  • Inhibition and Impulse Control: Trouble filtering distractions or controlling impulses, leading to impulsive decisions or inability to stay focused (Breda, 2021). 

  • Cognitive Flexibility: Difficulty adapting to changes, managing multiple tasks at once, or shifting between different activities (Beaton, 2022). 

  • Planning and Organization: Struggles with planning, organizing, and prioritizing tasks, leading to disorganization and missed opportunities (Beaton, 2022). 

The Connection Between Adult ADHD and EF 

ADHD in adults goes beyond inattention and impulsivity. Many symptoms directly relate to EF challenges, impacting daily life and work performance (Breda, 2021; da Silva, 2022; Friedman, 2022).  

Common EF Challenges in Adults with ADHD:

  • Time Management and Organization: EF deficits in planning and prioritizing make it difficult to manage tasks effectively. Many adults with ADHD experience challenges that contribute to burnout. Studies show that 58% of employees with ADHD report high burnout levels, largely due to EF difficulties in these areas (Turjeman-Levi, 2024). 

  • Higher-Level Cognitive Functions: Tasks that require decision-making, task-switching, and problem-solving are especially difficult for those with ADHD, affecting both personal and professional life (Surman, 2023). 

  • Attention Regulation and Emotional Control: Adults with ADHD often struggle with regulating attention, leading to procrastination, missed deadlines, and heightened emotional sensitivity. These challenges often lead to stress and lower self-esteem (Ceroni, 2022; Beaton, 2022; da Silva, 2022). 

Evaluating ADHD and Executive Function Deficits with BRIEF2A 

Best-practice ADHD assessments for adults increasingly emphasize the importance of evaluating executive function (EF). Integrating EF assessments helps clinicians and patients gain deeper insights into individual challenges, particularly in work and educational settings (Eng, 2024). This enhanced understanding serves as a foundation for developing tailored support strategies to address real-world difficulties. 

Evaluating ADHD and executive function (EF) deficits in adults is complex due to overlapping symptoms with other conditions and the development of coping strategies—the absence of a childhood symptom history adds to the challenge. The BRIEF2A tool is valuable for this process, as it gathers ratings from both the individual and informants, providing a comprehensive view of how ADHD and EF deficits impact daily life. This multirater approach effectively captures the full scope of deficits, especially when self-reports are incomplete, or the individual is unable to reliably rate themselves. 

Key Features of the BRIEF2A for ADHD and EF Assessment 

  • Updated normative sample: Based on a 2021 U.S. census sample, providing a more accurate reflection of the adult population. 

  • 3-Factor structure: Divides executive function deficits into behavioral regulation, emotional regulation, and cognitive regulation, aiding in the differentiation between ADHD and other conditions. 

  • Multirater reports:  Offers feedback from multiple informants that can reveal discrepancies between raters and provide valuable insights.   

  • Progress Monitoring reports:  Track symptom changes over time, enabling clinicians to monitor intervention effectiveness and assess progress in real-world contexts. 

  • Expanded age range: Suitable for adults aged 18-99, including older adults whose executive function may change with age or other factors. 

  • New Spanish forms: Ensures broader accessibility in diverse clinical settings. 

Who Can Purchase the BRIEF2A? 

The BRIEF2A is designed for use by qualified professionals working in clinical and educational settings. This includes clinical psychologists, neuropsychologists, and counseling psychologists in private practices, hospitals, or rehabilitation clinics.  

Qualification Requirements 

To purchase the BRIEF2A, professionals must meet the Qualification Level B requirements. This includes: 

  • A degree from an accredited 4-year institution in psychology, counseling, speech-language pathology, or a closely related field. 

  • Completion of coursework in test interpretation, psychometrics, educational statistics, or a related subject. 

  • Alternatively, a valid license or certification, including appropriate training and experience in the ethical and competent use of psychological tests. 

Qualified professionals can purchase the BRIEF2A and other Level A, S, and B products. 

Ready to improve your ADHD assessments? 

Discover how the Behavior Rating Inventory of Executive Function®, Second Edition-Adult Version (BRIEF2A), provides valuable insights into managing Adult ADHD and executive function deficits—empowering you to offer more effective support and strategies.  


Sources 

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