ADHD & Executive Dysfunction Services

ADHD & Executive Dysfunction

As a psychiatrist in New York, I find people frequently wonder if they have ADHD. Sometimes they aren’t sure if they have true ADHD or if they just have too much on their plate, are overworked, and are reasonably overwhelmed.

ADHD or Attention Deficit-Hyperactivity Disorder is a developmental disorder that begins to show symptoms in childhood. Symptoms like difficulty staying organized, remembering tasks, losing things, and running late. Symptoms can also include difficulty waiting for your turn to speak, staying seated when it is expected of you, and difficulty reigning in impulses in general. Girls typically show more inattentive symptoms than hyperactive symptoms. As kids age, the hyperactive symptoms tend to lessen, while the inattention and impulsivity tend to persist, with up to 80% persisting into adulthood.

In adulthood, symptoms of ADHD can often go hidden due to stigma or because of overlap with other disorders. Symptoms can include mood dysregulation, often saying the “wrong thing” at the wrong time which can lead to relationship issues, premature termination of relationships, quitting jobs without having an alternative, as well as driving errors and substance abuse. Recently ADHD has been thought of more as a developmental disorder of self-regulation/executive functioning rather than purely disordered attention and activity level.

Executive functioning is defined as “self-directed actions needed to choose goals and create, enact, and sustain actions towards those goals.” Executive dysfunction can look like problems with working memory, task-shifting, self-monitoring, initiation of tasks (procrastination), self-inhibition, and “time blindness” or not having a realistic sense of how much time is left and how quickly it is passing.

Our current understanding is that there is no such thing as adult-onset ADHD, it must have been present in childhood. That being said, concentration issues and problems with executive functioning can exist outside of ADHD, and are still valid problems with tangible solutions.

What makes ADHD somewhat unique among other mental health disorders is that it tends to be very responsive to medicines alone with good results relatively quickly, whereas a lot of other illnesses often require both therapy and medicines and take time for optimal success. That being said, there is a role for therapy in learning executive functioning skills, as well as addressing a lot of the negative self-talk that comes from a lifetime of not performing at your best.

The goal of this practice is to make use of diagnostic tools to determine if there is an ADHD diagnosis, and to come up with a treatment plan which can involve medicines, therapy, or both.

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