Recently Dr. Thomas E. Brown gave a free ADDitude Magazine Expert Webinar: The ADHD-Executive Function Connection. The webinar promised to provide strategies for helping improve skills in each of Dr. Brown’s six areas of executive function (EF) impairment that are common to ADHD. While Dr. Brown does an excellent job of explaining executive functions and how they are expressed for people with ADHD, this webinar was limited to his solutions for “getting the chemistry straight” using medication and ADHD coaching for skill development. Near the end of the hour, Wayne Kalyn, ADDitude’s editor and host of the webinar, noticed that people on the line were “feeling a little despair” because additional practical solutions for helping improve skills for the six EF impairments were not being provided.
One of the participants on the line was a coaching client of mine. After the webinar, she emailed me to let me know how frustrated she felt. Like many of those listening to Dr. Brown, she wanted more non-medication solutions for her EF challenges. In her email to me she complains that, “Unfortunately, while his presentation included an explanation of the six executive function impairments, there were no strategies for ‘improving skills’ in any of these areas, other than trying medication, which ‘works for 8 out of 10’ people . . . and coaching.” She and the other despairing listeners were expressing their need for help to alleviate EF impairments, rather than what felt to them like merely a description of EF impairments and the suggestion that they take medication and try coaching.
The value of Dr. Brown’s Model
Unlike some people listening to this webinar, as a practitioner who works with people with ADHD, I was enriched, enthralled, and empowered. I never tire of listening to Dr. Brown present his cogent EF model, which provides a new definition of ADHD that is a powerful beginning point for addressing ADHD/EF challenges. He reiterates the view that ADHD is not a willpower deficit, and it goes far beyond an attention deficit. But, if we remove those old versions of ADHD, then we have to replace them with a better understanding. This is where Brown’s six “buckets” of executive functions come in really handy.
Brown’s talk is titled The ADHD-Executive Function Connection and is focused on elucidating the essential problem in ADHD. Although the landing page advertised that Brown gives “strategies for helping your child or helping yourself improve skills for each executive function,” this is not really what Brown’s presentation was about. Brown asserts that the best, most scientifically-proven way to treat ADHD is to get the “body chemistry straight,” using ADHD medication. And, because this is backed up by current scientific research on ADHD, I can only agree. He also adds that “pills are not skills” and that some people would also benefit from ADHD coaching. This might not be the answer listeners were hoping for, but that does not make it less true. The value in Brown’s response lies in that “getting the chemistry straight” really is a solution that will impact skills in each of the six EFs because it addresses the overall EF impairment.
Optimizing Executive Functions
Even if we can all agree that medication is the most effective, scientifically supported approach to treating EF impairments, I observe that people with ADHD (and listeners to this webinar) still want to know: Is medication the only way to help improve executive function?
To explore this question, I find it helpful to shift my way of thinking slightly away from “improving executive functions” toward “optimizing executive functions.” While this might appear like a small semantic difference, there are significant implications for treatment when we stop asking how to change our brains and start asking how to make sure our brains are running at their optimum capacity. The relevance of this shift is clear when I coach. Most of my clients arrive to their coaching sessions in a state that would deplete anyone’s executive function abilities: they have forgotten to eat or eaten too much, are often sleep deprived, can’t seem to take a breath, and haven’t moved for hours, much less exercised. In order to follow Dr. Brown’s advice and “get the chemistry straight,” a good place to start for these clients, other than meds, is to pay attention to their bodies so they can optimize the way their brains function. In my practice, I simply call this “Eat, Sleep, Breathe, Move.”
Here are the research-backed approaches to non-medication executive function optimization in “Eat, Sleep, Breathe, Move:”
A healthy diet will support optimum brain function. It might help to check for food sensitivities. And, although the effect is small, it is well worth it to take a high quality fatty acid supplement.
Make sure you are getting enough sleep at regular times. This sounds a lot easier than it is for most of my clients with ADHD, so if sleep is a problem for you, you need to make it a top priority and implement very intentional tactics. Your dopamine, a critical brain chemical for ADHD, will thank you! Read more about how to get to bed on time here.
The exciting news is that there are recent research studies that show mindfulness leads to overall EF improvements. Do short meditation and mindfulness practices regularly so you can train yourself to pay attention. In addition to mindfulness, we know that people with ADHD benefit from taking periodic breaks to de-stress and replenish cognitive energy. Read more about mindfulness for ADHD here. You can also check out MindfullyADD, my website featuring guided mindfulness practices for folks with ADHD here.
Frequent aerobic exercise benefits cognitive functioning more than other types of exercise. Being outside (“green time”) is also showing a little efficacy. When I asked my network of adults with ADHD how to get unstuck, their number 1 recommendation was to get some exercise.
It has become increasingly clear to me during my years of coaching people with ADHD that “getting the chemistry straight” really means taking meds (if that works for you) and focusing on being an optimized organism: paying attention to the basic needs of your body-brain to optimize whatever happens to be wired there. For some, this might sound overly simplistic, but it is clear from my practice that not sleeping well, a poor diet, lack of exercise, or not taking a breath to notice the present moment are both extremely common and pervasive for adults with ADHD. Frankly, “solutions” like to-do lists, timers, organizing, and managing time come secondary to optimizing the brain’s chemical functioning.
Executive functions are complicated. Likewise, potential solutions designed to help improve how people with ADHD deal with EF impairments are equally complex and numerous. It would be impossible for Dr. Brown to provide solutions for each EF impairment during a 1-hour webinar. I am also confronted with the same issue when writing this article. Changing how you experience your own executive functions could be a matter of optimization rather than improvement. After getting the “chemistry straight” via medication and optimization, you can turn to designing external tactics for internal brain functions that are not always reliable. While not an ending point that provides all of the solutions you will need, Brown’s model provides a very effective starting framework for thinking about ADHD so we can design solutions that actually work.
Download my free eBook. Fill Your Tank for ADHD: How to Create Cognitive Fuel to Keep You Going is full of tips to help you keep your brain running at optimum capacity.
This eBook explores how you can fill your tank with eating, sleep, breathing or mindfulness, and exercise. In my practice, I simply call this: Eat Sleep Breathe Move
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