Executive functioning refers to cognitive processes that regulate thought and behavior, including planning,working memory, impulse control, and cognitive flexibility.
Deficits in these domains of executive functioning are common in individuals withattention-deficit/hyperactivity disorder (ADHD)and may significantly contribute to the symptoms of inattention, hyperactivity, and impulsivity as well as functional impairment related to disorganization, emotional dysregulation, and poor self-monitoring.
Key Points
Rationale
ADHD often persists into adolescence and adulthood with high rates of functional impairment. While medication and psychosocial interventions are recommended, outcomes remain suboptimal for many.
Executive functional deficits (EFDs) are increasingly recognized as an important contributor to impairment in ADHD, but few studies have examined multi-informant perspectives on EFDs in adolescents with persistent ADHDdespite treatment.
As adolescents transition to more independent academic and social environments requiring higher-order EFs, gaining a better understanding of EFD profiles and informant discrepancies can help guide more targeted, individualized interventions.
This study aimed to describe EF profiles and informant agreement using teacher, parent, and self-reports in a sample of 100 clinically impaired adolescents aged 14-18 with rigorously diagnosed ADHD despite ongoing standard treatments.
Method
Results
Overall, teachers reported significantly higher levels of EFDs across domains compared to adolescents and parents. The metacognition index was rated higher than the behavioral regulation index across informants. Hyperactivity was rated as less impaired relative to other domains.
The strongest agreement occurred between adolescents and parents (r = 0.64-0.79 across indexes), especially for female participants (r = 0.73-0.82). Agreement was lower between male adolescents and teachers (r = 0.23-0.58) compared to female adolescents and teachers (r = 0.61-0.75).
Paired t-tests showed teachers reported significantly more problems than adolescents across all indexes except for organization of materials and monitor.
Adolescents reported significantly fewer problems on most indexes compared to parents, withsmall effect sizes.Parents reported more problems compared to teachers on shift, emotional control, and monitoring.
Insight
This study provides valuable insights into EF profiles and informant discrepancies in adolescents with rigorously diagnosed ADHD and ongoing impairment despite standard management methods.
It highlights the significant EF deficits persisting across domains for many adolescents, underscoring the need for interventions targeting these processes critical to adaptive functioning.
Notably, teachers reported the highest levels of EFDs compared to parents and adolescents themselves. As teachers observe adolescents interacting with peers across structured and unstructured contexts, they may detect EF challenges less apparent in the home setting.
The study also found adolescents tended to rate their own EFs as less impaired, suggesting potential difficulties with self-awareness that could pose barriers to self-advocacy and treatment engagement.
Gaining multiple informant perspectives allows clinicians to form a more comprehensive picture of adolescents’ EF profiles across settings to better inform intervention planning.
Understanding common patterns of disagreement can aid interpretation. For example, higher parent-adolescent agreement may reflect better awareness of observable challenges at home.
Lower male adolescent-teacher agreement highlights the need to follow up on divergent ratings through interviews,observations, or performance-based measures.
Strengths
The study had several key methodological strengths:
Limitations
However, some limitations should be considered when interpreting findings:
Implications
This study highlights the need to thoroughly assess EFDs in adolescents with rigorously diagnosed ADHD who have persistent impairment despite standard treatments.
For research, including comparison samples would clarify unique versus generalized EF deficits in ADHD.
Longitudinal and intervention studies are needed to elucidate developmental trajectories and causal relationships between improving EFs and functional gains. Studies combining rating scales with performance-based measures would help determine optimal assessment approaches.
Clinically, findings reinforce the importance of monitoring ADHD symptoms and impairment into the adolescent years rather than assuming prior treatment will sustain gains over time.
They highlight the need to expand interventions to specifically target EFs related to planning, organization, emotional and behavioral regulation – not just core ADHD symptoms. Improving adolescent and parent awareness of EF challenges may facilitate better self-advocacy and treatment engagement.
References
Primary reference
Other references
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).https://doi.org/10.1176/appi.books.9780890425596
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/ hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111(2), 279–289.https://doi.org/10.1037/0021-843X. 111.2.279
Chan, E., Fogler, J. M., & Hammerness, P. G. (2016). Treatment of attention-deficit/hyperactivity disorder in adolescents: A systematic review. JAMA, 315(18), 1997–2008.https://doi.org/10. 1001/jama.2016.5453
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
