Executive Function Problems and Inattentive ADHD and SCT (Sluggish Cogntive Tempo)

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.

Brown has divided the EFs into six categories outlined below:


  • Activation is described by Brown as the ability to organize tasks and materials, estimate time, prioritize tasks, and get started on work tasks. 
  • Focus involves 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 commonly seen in people with the combined type 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 EFs 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:

  • Organizational Aids 
  • Visual timers 
  • Study Buddies and Coaches 
  • Sleeping Aids 
  • Multimedia and Multisensory Teaching 
  • Experiential Teaching using Field Trips, Experiments and Manipulatives
  • Mindfulness training 

Since these interventions help everyone, not just people with ADHD, we should incorporate all of these tools into our homes, our schools, and our offices. These types of tools will make us all better.

23 comments:

  1. You got it covered...We have to stay on top of things and when starting to veer off ---stop and correct ASAP.

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  2. Thanks for this...

    i deal with alot of things you mention in the EF are but since I have combo ADHD I am impulsive with my words esp which is how the hyperactivity side of my ADHD affects me

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  3. Ok..sorry for the double comment but I just realized that I now have a question :D

    How do you handle being implusive with the things you say???

    It is the ADHD issue I am dealing with right now and it is making me crazy...cuz when it happens the person it happens to doesn't understand and my intentions behind what I blurt out gets totally misunderstood.

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  4. The impulsive part is one of the hardest things to control without medication. Some coaches advise holding a finger to your mouth as a kind of 'gate keeper'. You have to remove your finger before you speak which sometimes gives you a bit of time to reflect. This pose may make you look contemplative which is sometimes a good 'look'.

    Good luck and thanks for writing in. Tess

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  5. This comment has been removed by the author.

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  6. Many studies have supported the contention that both Methyphenidate and the amphetamines will lessen impulsive behavior. The data on adults is much less clear. Thanks Pete for bringing this to our attention.

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  7. The studies you refer to are statistical in nature and largely funded by drug manufacturers. Not a scrap of actual scientific data to back them up.

    I can offer no perspective on children simply because I was a hyperactive child who grew up to be a hypoactive adult. The one thing - the only thing - I can offer you is that the brain of an SCT/ADD Adult functions much differently than that of an ADHD child.

    My expertise and scientific knowledge applies only to adults and is reflective of noted clinicians like Dr. Daniel Amen who employ functional brain imaging methods.

    I never address areas outside of my realm for fear that misinformation might harm a child.If your child's impulsive behavior is curbed via administration of stims, that's good enough for me.

    For anyone who reads my posts here or anywhere else - I repeat - my knowledge is relevant to adults only.

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  8. Pete you are right. It is so unfortunate that many of the studies we have are funded by companies and organizations that have a vested interest in the products that they are researching.

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  9. Lookie what I just found? Class Action Lawsuit in the works.

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    In a recent phone survey with Generation Rescue, a nonprofit organization publicized by famous actress Jenny McCarthy, they declared that vaccinated boys were 224% more likely to have ADHD. Older vaccinated boys were even more likely at 317%. ( This may be due to late diagnosis. ) The CDC reported in 1985 that 500,000 children in the USA had ADHD compared to 5-7 million today. 1 to 3 children in every classroom of 30 are reported to have ADHD, according to Russell Barkley, PhD.

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    Like I said, ADHD was never a genetic anything - The only family link is that families that get vaccinated together, get ADD/ASD together.

    How sweet it is to have finally exposed this "authority" for the fraud he is.

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  11. Pete, I am as wary of the health care industry as you are and have followed the debate about vaccines and neurotoxicity very closely.

    I have done a lot of research on vaccines and I can tell you that prior to the year 2000 pediatricians that followed the American Academy of Pediatrics recommendation for immunizations ran the risk of exposing infants to toxic levels of mercury because of the preservative used in vaccines at that time (thimerosol). Mercury is a neurotoxin and this is what the FDA reported in 2000 or 2001:

    "depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury.

    ..the Public Health Service (including the FDA, National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) and the American Academy of Pediatrics issued two Joint Statements, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible (CDC 1999) and (CDC 2000). The U.S. Public Health Service agencies have collaborated with various investigators to initiate further studies to better understand any possible health effects from exposure to thimerosal in vaccines.

    It would be amazing if tiny infants exposed to the mercury in thimerosol were not affected in some way and I too wonder if the problems that we are seeing today with increased mental health issues in children is not somehow related to this thimerosol issue.

    Not all people in the health care industry are evil. I try to stay as informed as possible and my children have not (I repeat have not) received prescriptions or medications from any medical provider unless I have deemed it absolutely necessary.

    My sons stay incredibly healthy and neither has ever been treated with a prescription medication for a cold or ear infection, my eldest son has received antibiotics a total of 2 times in his entire life. My youngest son, once.

    I have worked in third world countries where I have seen babies die of measles and meningitis Pete. I have cried with those mothers. It is not pretty.

    Immunizations serve a purpose and while I do not agree with giving infants 8 vaccines at once I believe that vaccination is necessary. The majority of pediatricians today do not give them eight at a time any more either.

    Is the thimerisol issue criminal? Probably but I do not feel as though doctors, pediatricians, Physician Assistants, nurses, the CDC, the NIH, etc are all evil. Do I think we have a huge problem with big Pharma? You better believe it!

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  12. Pete, I am as wary of the health care industry as you are and have followed the debate about vaccines and neurotoxicity very closely.

    I have done a lot of research on vaccines and I can tell you that prior to the year 2000 pediatricians that followed the American Academy of Pediatrics recommendation for immunizations ran the risk of exposing infants to toxic levels of mercury because of the preservative used in vaccines at that time (thimerosol). Mercury is a neurotoxin and this is what the FDA reported in 2000 or 2001:

    "depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury.

    ..the Public Health Service (including the FDA, National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) and the American Academy of Pediatrics issued two Joint Statements, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible (CDC 1999) and (CDC 2000). The U.S. Public Health Service agencies have collaborated with various investigators to initiate further studies to better understand any possible health effects from exposure to thimerosal in vaccines.

    It would be amazing if tiny infants exposed to the mercury in thimerosol were not affected in some way and I too wonder if the problems that we are seeing today with increased mental health issues in children is not somehow related to this thimerosol issue.

    Not all people in the health care industry are evil. I try to stay as informed as possible and my children have not (I repeat have not) received prescriptions or medications from any medical provider unless I have deemed it absolutely necessary.

    My sons stay incredibly healthy and neither has ever been treated with a prescription medication for a cold or ear infection, my eldest son has received antibiotics a total of 2 times in his entire life. My youngest son, once.

    I have worked in third world countries where I have seen babies die of measles and meningitis Pete. I have cried with those mothers. It is not pretty.

    Immunizations serve a purpose and while I do not agree with giving infants 8 vaccines at once I believe that vaccination is necessary. The majority of pediatricians today do not give them eight at a time any more either.

    Is the thimerisol issue criminal? Probably but I do not feel as though doctors, pediatricians, Physician Assistants, nurses, the CDC, the NIH, etc are all evil. Do I think we have a huge problem with big Pharma? You better believe it!

    ReplyDelete
  13. Pete, I am as wary of the health care industry as you are and have followed the debate about vaccines and neurotoxicity very closely.

    I have done a lot of research on vaccines and I can tell you that prior to the year 2000 pediatricians that followed the American Academy of Pediatrics recommendation for immunizations ran the risk of exposing infants to toxic levels of mercury because of the preservative used in vaccines at that time (thimerosol). Mercury is a neurotoxin and this is what the FDA reported in 2000 or 2001:

    "depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury.

    ..the Public Health Service (including the FDA, National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) and the American Academy of Pediatrics issued two Joint Statements, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible (CDC 1999) and (CDC 2000). The U.S. Public Health Service agencies have collaborated with various investigators to initiate further studies to better understand any possible health effects from exposure to thimerosal in vaccines.

    It would be amazing if tiny infants exposed to the mercury in thimerosol were not affected in some way and I too wonder if the problems that we are seeing today with increased mental health issues in children is not somehow related to this thimerosol issue.

    ReplyDelete
  14. Not all people in the health care industry are evil. I try to stay as informed as possible and my children have not (I repeat have not) received prescriptions or medications from any medical provider unless I have deemed it absolutely necessary.

    My sons stay incredibly healthy and neither has ever been treated with a prescription medication for a cold or ear infection, my eldest son has received antibiotics a total of 2 times in his entire life. My youngest son, once.

    I have worked in third world countries where I have seen babies die of measles and meningitis Pete. I have cried with those mothers. It is not pretty.

    Immunizations serve a purpose and while I do not agree with giving infants 8 vaccines at once I believe that vaccination is necessary. The majority of pediatricians today do not give them eight at a time any more either.

    Is the thimerisol issue criminal? Probably but I do not feel as though doctors, pediatricians, Physician Assistants, nurses, the CDC, the NIH, etc are all evil. Do I think we have a huge problem with big Pharma? You better believe it!

    It is a huge problem that needs fixing but I do not think that organizations such as CHADD and ADDitude are evil. They are trying to survive Pete and in general do very good work in educating and assisting people with ADHD. I think to get rid of these organizations or my web page would be throwing out the baby with the bath water. None of us are perfect but I think we serve a good purpose.

    It is not just Barkley that has found a genetic basis for ADHD and ADD. There is research going on in China, India, the USSR, Europe, Australia that have found a genetic component to this problem. All these countries are not governed or funded by pharmaceutical companies. The majority of studies on the genetics or ADHD are coming out of China.

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  15. I am sorry about your mom but I am not like her. I am wondering if she was a Medical Assistant which is very different from a Physician Assistant. Did she have a Masters in Medicine? I actually have a degree in Medicine and in Environmental Health. Medical Assistants are generally trained by physicians or in vocational training programs.

    The first Physician Assistants graduated from the Duke Program in 1974 and they were all Army medics (and men). In 1976 there were only 2 PA programs in the country and less than 800 PAs that had graduated from these programs. I do not believe that any of the PAs in 1976 were women



    Dang it took three comments to get this all in here!

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  16. Tess,I pray for your sake that the irrational behavioral pattern exhibited in the three posts above (the one I've been noting in all of your responses of late) is indicative of an isolated "phase" or temporary environmental stressor.

    If this degree of overly defensive behavior and false perception of personal attack is the norm with you, it's indicative of a PDD in women that makes ADHD look like a walk in the park.

    For your sake, I really hope you just had a temporary meltdown.

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  17. I am sorry. I should not have been so defensive.

    Peace! Tess

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  18. Tess, I didn't think you came across as defensive or irrational. I found your comments thoughtful and informative. Thank you for sharing.

    Personally, I don't think vaccinations are what affected my son, but I do wonder if low level exposures to lead may have contributed to his attention problems.

    Beth

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  19. I think that low level of many things, lead, mercury, organophosphates and other environmental hazards may be affecting our kids and ourselves. I am trying to buy organic when I can afford it and try to limit exposures to pollutants when possible.

    I think we need to be careful with vaccines as well as with medications but I feel as though they vaccines protect us from other hazards and that we have to weigh the risks and benefits whenever we opt for any medical intervention.

    Thanks so much for your comments!

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  20. It sounds like Pete Sapper is getting a little over his head and I trust Tess more than him. I personaly know people who have benefited from stimulant medication. "In 1985 only 500,000 had add" Well that's because much less was known about it then and now everyone's on the lookout for it now. Plus it is probably overdiagnosed now. Dr. Amen using SPECT scans to diagnose has no scientific backing. Talk about someone who's in it for the money, Dr. Amen is making an extraordinary amount of money. Go to his website and he tries to sell you everything, and if you're lucky enough, you can pay $4000 and have a SPECT scan and a 3 day evaluation.

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  21. Pete Sapper sounds like a jerk suffering from some sort megalomania. Pete if you know so much, start your own ADHD blog and leave this one alone and do not insult Tess. Please provide the research and scientific evidence backing up your statement that ADHD is not genetic, and citing one study from a group which became well known only becaue of a former playboy bunny is not enough. Talk about credentials, what are Jenny McCarthy's and what are your credentials?

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