Executive Functions in Children with ADHD

Main Article Content

Prakasit Wannapaschaiyong
Soranant Kiewkong
Sitthiphon Bunman


Executive Functions (EFs) play an important role in everyday life, lifelong achievement, and quality of life. Patients with developmental problems are more likely to have executive dysfunctions, especially those with attention deficit hyperactivity disorder (ADHD), who often have impaired working memory, inhibitory control, and organization. Currently, many studies have shown that poor EFs are not directly related to behavioral problems and social impairments due to ADHD symptoms. However, ADHD patients with executive dysfunctions tend to have difficulties in the learning process. Therefore, evaluating EFs along with ADHD symptoms is essential. The most widely used tools for EF assessment include the Behavior Rating Inventory of Executive Function (BRIEF) and the Executive Function assessment in Mahidol University version (MU-EF). Promoting EFs should be done in conjunction with treating ADHD symptoms in ADHD patients with executive dysfunctions. This article aims to review the knowledge of EFs, EF assessment, and evidence-based interventions promoting EFs in ADHD patients, such as pharmacological treatment (Methylphenidate), cognitive training, exercise, white noise, and organization skill intervention.

Article Details

How to Cite
Wannapaschaiyong P, Kiewkong S, Bunman S. Executive Functions in Children with ADHD. BKK Med J [Internet]. 2022 Sep. 30 [cited 2024 Feb. 22];18(2):141. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/258730
Reviews Article


Miyake A, Friedman NP. The Nature and Organization of Individual Differences in Executive Functions: Four General Conclusions. Curr Dir Psychol Sci 2012;21(1):8-14.

Garon N, Bryson SE, Smith IM. Executive function in preschoolers: a review using an integrative framework. Psychol Bull 2008;134(1):31-60.

Hughes C, Ensor R. Executive function and theory of mind: Predictive relations from ages 2 to 4. Dev Psychol 2007;43(6):1447-59.

Hughes C, Ensor R. Does executive function matter for preschoolers' problem behaviors? J Abnorm Child Psychol 2008;36(1):1-14.

Blair C, Razza RP. Relating effortful control, executive function, and false belief understanding to emerging math and literacy ability in kindergarten. Child Dev 2007;78(2):647-63.

Miller HV, Barnes JC, Beaver KM. Self-control and health outcomes in a nationally representative sample. Am J Health Behav 2011;35(1):15-27.

Riggs NR, Spruijt-Metz D, Sakuma KL, et al. Executive cognitive function and food intake in children. J Nutr Educ Behav 2010;42(6):398-403.

Will Crescioni A, Ehrlinger J, Alquist JL, et al. High trait self-control predicts positive health behaviors and success in weight loss. J Health Psychol 2011;16(5):750-9.

Moffitt TE, Arseneault L, Belsky D, et al. A gradient of childhood self-control predicts health, wealth, and public safety. Proc Natl Acad Sci 2011;108(7):2693-8.

Baler RD, Volkow ND. Drug addiction: the neurobiology of disrupted self-control. Trends Mol Med 2006;12(12):559-66.

Lui M, Tannock R. Working memory and inattentive behaviour in a community sample of children. Behav Brain Funct 2007;3:12.

Fairchild G, van Goozen SH, Stollery SJ, et al. Decision making and executive function in male adolescents with early-onset or adolescence-onset conduct disorder and control subjects. Biol Psychiatry 2009;66(2):162-8.

Taylor Tavares JV, Clark L, Cannon DM, et al. Distinct profiles of neurocognitive function in unmedicated unipolar depression and bipolar II depression. Biol Psychiatry 2007;62(8):917-24.

Penades R, Catalan R, Rubia K, et al. Impaired response inhibition in obsessive compulsive disorder. Eur Psychiatry 2007;22(6):404-10.

Borella E, Carretti B, Pelegrina S. The specific role of inhibition in reading comprehension in good and poor comprehenders. J Learn Disabil 2010;43(6):541-52.

Bailey CE. Cognitive accuracy and intelligent executive function in the brain and in business. Ann N Y Acad Sci 2007;1118:122-41.

Eakin L, Minde K, Hechtman L, et al. The marital and family functioning of adults with ADHD and their spouses. J Atten Disord 2004;8(1):1-10.

Denson TF, Pedersen WC, Friese M, et al. Understanding impulsive aggression: Angry rumination and reduced self-control capacity are mechanisms underlying the provocation-aggression relationship. Pers Soc Psychol Bull 2011;37(6):850-62.

Broidy LM, Nagin DS, Tremblay RE, et al. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Dev Psychol 2003;39(2):222-45.

Best JR, Miller PH, Jones LL. Executive Functions after Age 5: Changes and Correlates. Dev Rev 2009;29(3):180-200.

Tang YY, Holzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci 2015;16(4):213-25.

Bergmeier H, Skouteris H, Horwood S, et al. Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: a systematic review of the literature. Obes Rev 2014;15(1):9-18.

Perry V, Ellis K, Moss J, et al. Executive function, repetitive behaviour and restricted interests in neurodevelopmental disorders. Res Dev Disabil 2022;122:104166.

McClain MB, Golson ME, Murphy LE. Executive functioning skills in early childhood children with autism, intellectual disability, and co-occurring autism and intellectual disability. Res Dev Disabil 2022;122:104169.

Farah R, Ionta S, Horowitz-Kraus T. Neuro-Behavioral Correlates of Executive Dysfunctions in Dyslexia Over Development From Childhood to Adulthood. Front Psychol 2021;12:708863.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition: DSM-5. Washington, DC: American Psychiatric Association; 2013.

Barkley RA. Attention-deficit hyperactivity disorder. Sci Am. 1998;279(3):66-71

Barkley RA. Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. J Clin Child Adolesc Psychol 2013;42(2):161-73.

Brown TE. ADD/ADHD and Impaired Executive Function in Clinical Practice. Curr Psychiatry Rep 2008;10(5):407-11.

Rapport MD, Alderson RM, Kofler MJ, et al. Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of central executive and subsystem processes. J Abnorm Child Psychol 2008;36(6):825-37.

Coghill DR, Seth S, Matthews K. A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: advancing beyond the three-pathway models. Psychol Med 2014;44(9):1989-2001.

Silverstein MJ, Faraone SV, Leon TL, et al. The Relationship Between Executive Function Deficits and DSM-5-Defined ADHD Symptoms. J Atten Disord 2020;24(1):41-51.

Krieger V, Amador-Campos JA, Guardia-Olmos J. Executive functions, Personality traits and ADHD symptoms in adolescents: A mediation analysis. PLoS One 2020;15(5):e0232470.

Gordon CT, Hinshaw SP. Executive Functions in Girls With and Without Childhood ADHD Followed Through Emerging Adulthood: Developmental Trajectories. J Clin Child Adolesc Psychol 2020;49(4):509-23.

Tamm L, Loren REA, Peugh J, et al. The Association of Executive Functioning With Academic, Behavior, and Social Performance Ratings in Children With ADHD. J Learn Disabil 2021;54(2):124-38.

LeJeune B, Beebe D, Noll J, et al. Psychometric support for an abbreviated version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form. Child Neuropsychol 2010;16(2):182-201.

Lertladaluck K, Chutabhakdikul N, Chevalier N, et al. Effects of social and nonsocial reward on executive function in preschoolers. Brain Behav 2020;10(9):e01763.

Tamminga HG, Reneman L, Huizenga HM, et al. Effects of methylphenidate on executive functioning in attention-deficit/hyperactivity disorder across the lifespan: a meta-regression analysis. Psychol Med 2016;46(9):1791-807.

Kowalczyk OS, Cubillo AI, Smith A, et al. Methylphenidate and atomoxetine normalise fronto-parietal underactivation during sustained attention in ADHD adolescents. Eur Neuropsychopharmacol 2019;29(10):1102-16.

Cortese S, Ferrin M, Brandeis D, et al. Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry 2015;54(3):164-74.

Moore AL, Carpenter DM, 2nd, Miller TM, Ledbetter C. Clinician-delivered cognitive training for children with attention problems: effects on cognition and behavior from the ThinkRx randomized controlled trial. Neuropsychiatr Dis Treat 2018;14:1671-83.

Bioulac S, Micoulaud-Franchi JA, Maire J, et al. Virtual Remediation Versus Methylphenidate to Improve Distractibility in Children With ADHD: A Controlled Randomized Clinical Trial Study. J Atten Disord 2020;24(2):326-35.

Liang X, Li R, Wong SHS, et al. The impact of exercise interventions concerning executive functions of children and adolescents with attention-deficit/hyperactive disorder: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021;18(1):68.

Christiansen L, Beck MM, Bilenberg N, et al. Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. J Clin Med 2019;8(6):841.

Best JR. Effects of Physical Activity on Children's Executive Function: Contributions of Experimental Research on Aerobic Exercise. Dev Rev 2010;30(4):331-551.

Soderlund GB, Sikstrom S, Loftesnes JM, et al. The effects of background white noise on memory performance in inattentive school children. Behav Brain Funct 2010;6:55.

Baijot S, Slama H, Soderlund G, et al. Neuropsychological and neurophysiological benefits from white noise in children with and without ADHD. Behav Brain Funct 2016;12(1):11.

Langberg JM, Epstein JN, Graham AJ. Organizational-skills interventions in the treatment of ADHD. Expert Rev Neurother 2008;8(10):1549-61.

Garrison DR. Ending the homework wars : featuring the results-producing homework success program. Rev. ed. Cameron Park, CA: Leading Edge Press; 2005. 264 p. p.

Evans SW, Schultz BK, Demars CE, et al. Effectiveness of the Challenging Horizons After-School Program for young adolescents with ADHD. Behav Ther 2011;42(3):462-74.

Oliva F, Malandrone F, di Girolamo G, et al. The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression. J Affect Disord 2021;292:475-86.

Louthrenoo O, Boonchooduang N, Likhitweerawong N, et al. The Effects of Neurofeedback on Executive Functioning in Children With ADHD: A Meta-Analysis. J Atten Disord 2022;26(7):976-984.

Westwood SJ, Radua J, Rubia K. Noninvasive brain stimulation in children and adults with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Psychiatry Neurosci 2021;46(1):E14-E33.