Over the past two decades, there has been considerable progress in understanding the functions of the prefrontal cortex of the brain and its regulation of mental activities that allow for self-control and goal-directed behaviors. These mental activities are unified under the term executive functions.
Executive functions are thought to enable a person to successfully engage in independent, purposeful and self-serving behaviors. The major executive functions include response inhibition, which permits impulse control, resistance to distraction and delay of gratification; nonverbal working memory, which permits the holding of events in the mind and allows self-awareness across time; verbal working memory, which comprises the internalization of speech and permits self-description, questioning and reading comprehension; and self-regulation of emotion and motivation, which permits motivation, persistence toward a goal and emotional self-control.
Executive functions are thus a collection of varying abilities that involve regulatory control over thought and behavior in the service of goal-directed or intentional action, problem solving, and flexible shifting of actions to meet task demands. Besides formal neuropsychological testing, clinical data about executive function can be obtained by observing an individual's ability to problem-solve in the natural environment and assessing how flexible a person is when faced with a changing routine.
In recent years, the executive functions have been applied as a concept to help explain attention-deficit/hyperactivity disorder (ADHD) pathophysiology. Although the importance of executive functions in understanding ADHD seems clear, a less obvious, yet important, correlation is the relationship between executive functions and the management of families with children who have ADHD. This relationship is significant since one-quarter of children presenting with ADHD will have at least one parent who also has ADHD.
The fact that parents with ADHD probably suffer from impairments in executive functions creates challenges in the treatment of their children. This article discusses some of the specific challenges that I have observed in regard to parents with ADHD and executive function impairments.
Problems with distraction control should be considered when parents display difficulty with group participation treatment programs. Group treatment settings can be overwhelming for parents with ADHD, much as classroom settings can compromise the distraction control of children with ADHD. Even in the office setting, the activities of their children can distract these parents, resulting in failure to understand medication and therapy instructions.
Problems with delay of gratification and impulse control can lead parents with ADHD to feel quickly disenchanted with treatment. Consequently, they are vulnerable to alternative treatments that promise miraculous results. This vulnerability to frustration can also result in these parents feeling that the treating psychiatrist is not sufficiently skilled or motivated to help their child. Conversely, the psychiatrist might perceive such parents as demanding and unreasonable. Empathy with the parents' desire for an acute resolution can help greatly in building a therapeutic rapport.
