7. Executive problems / planning and organizational difficulties with ADHD

Review: Dipl.-Psych. Waldemar Zdero

ADHD causes various problems in the area of organizing and carrying out tasks and activities. A specific impairment in ADHD is having difficulty implementing planned future-oriented action. Symptoms include disorganization, a life full of unfinished projects and a lack of overview when organizing tasks.
Adults with ADHD often have difficulty distinguishing between important and unimportant tasks. They find it difficult to keep their home tidy and throw things away. Not keeping promises or commitments to others is also typical of ADHD. Appointments and agreements are often forgotten and must be noted down immediately, otherwise they are quickly forgotten.
People with ADHD often have problems doing things in the right Order of priority. These problems in the area of organization and execution of tasks are neurophysiologically caused by a dysfunction of the working memory in the dorsolateral prefrontal cortex (dlPFC) due to a lack of dopamine and noradrenaline. Chronic and acute stress can further exacerbate these executive problems.

Executive functions are based on three basic processes:

• Shifting¹²
  • Changing the focus of attention
• Inhibition¹
  • Inhibition of dominant response tendencies
  • Control of distractibility
    • Differentiation of relevant / irrelevant stimuli
  • Self-regulation
    • Emotional¹
    • Motivational
• Updating
  • Updating working memory content

While inhibition is neurophysiologically regulated in the striatum (see*⇒ Neurophysiological 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 for planning and problem solving.

Effortful control seems to describe a similar construct to executive functions.³⁴ Planning, organizing and problem solving require executive functions.¹
One study describes deficits in cognitive reactive and proactive control processes in people with ADHD.⁵

Executive problems have a greater negative impact on the quality of life and daily functioning of people with ADHD than delay-related behavior and emotional dysregulation, according to a study.⁶ Executive problems can be improved by ADHD medication and cognitive behavioral therapy.⁷

• 7.1. Problems organizing tasks and activities
• 7.2. Not (being able to) keep promises or commitments to others
• 7.3. Problems doing things in the right Order of priority
• 7.4. Neurophysiological correlates of executive problems
• 7.5. Executive problems in ADHD and ASD
• 7.6. Executive problems as symptoms of stress

7.1. Problems organizing tasks and activities¶

Specific to ADHD is the impairment to carry out a pre-planned future directed action. Problems organizing tasks and activities are one of the 9 most accurate symptoms of ADHD in adults.⁸

• Disorganization
• Life is like a series of unfinished projects
• Lack of overview when organizing tasks (for children as well as adults)⁹
• Important and unimportant are difficult to separate (for adults)⁹
• Clutter in the home
  • Possibly overcompensation through meticulous order, because disorder is the enemy within (see also perfectionism)
• It is difficult to throw things away¹⁰ (see also Messi tendency, Hoarding)

Nevertheless, there is no typical ADHD planning (mis)behavior. Planning behavior seems to differ greatly from person with ADHD to person with ADHD.¹¹

7.2. Not (being able to) keep promises or commitments 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.⁸

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

7.3. Problems doing things in the right Order of priority¶

Problems doing things in the correct Order of priority is also said to be one of the 9 most accurate symptoms of ADHD in adults.⁸

7.4. Neurophysiological correlates of executive problems¶

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

More on this at ⇒ Neurophysiological correlates of working memory problems in ADHD

7.5. Executive problems in ADHD and ASD¶

A meta-analysis examined 58 studies on executive functions in ADHD and ASD and found them to be impaired in identical ways in ADHD and ASD.¹²
A recent study found relative differences between ADHD, ASD, anxiety and ODD:¹³

ADHD correlated with

• poorer cognitive inhibition
• poorer visual-spatial episodic memory

ASS correlated with

• better cognitive inhibition

Anxiety correlated with

• better cognitive flexibility

ODD correlated with

• poorer cognitive flexibility

7.6. Executive problems as symptoms of stress¶

Chronic stress causes reduced dopamine levels in the PFC, which impairs working memory function in the dlPFC and thus executive functions.¹⁴ Acute stress causes impairment of executive functions via increased dopamine levels, which impair the dlPFC.¹⁵

More on the development of neurotransmitter and hormone systems due to chronic stress (stress phases) at ⇒ Changes in the dopaminergic system due to chronic stress In the section*⇒ Long-lasting, chronic stress* in the article ⇒ Stress damage due to early / prolonged stress in the chapter ⇒ Stress.
More on changes in hormone and neurotransmitter systems across different stress phases ⇒ Breakdown of neurotransmitter systems over the stress phases In the article ⇒ The human stress systems - the basics of stress in the chapter ⇒ Stress.
More on the impairment of brain functions with non-optimal neurotransmitter levels (reversed U) at ⇒ Optimal neurotransmitter levels = optimal information transmission in the article ⇒ Neurotransmitters during stress in the chapter ⇒ Stress.