ADHD, executive functioning and Covid-19: A TOXIC MIX

ADHD, Covid-19 Executive functioning skills, toxic mix

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Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common learning barriers, with research suggesting that anywhere between 2 and 16% of school-going learners are struggling with either inattentive, hyperactive/impulsive or a combination of both types of this neurological disorder[i].

Alarmingly, these numbers appear to be on the rise with research showing significant increases in ADHD diagnoses between 1997 and 2016[ii]. There are many reasons to explain this increase but it helps to understand some of the basics.

ADHD – A closer inspection

There are three presentations of ADHD – inattentive, hyperactive/impulsive and a combination of the two. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), many aspects need to be considered before a diagnosis is made.

Some of the most common symptoms of inattentive ADHD (previously referred to Attention Deficit Disorder or ADD) include a difficulty: sustaining attention, paying close attention to detail, following through with instructions, organizing tasks and activities, avoiding tasks such as homework and a tendency to become distracted by external stimuli and/or one’s thoughts.

You would be forgiven for thinking that these symptoms fit your teenager to a tee. However, many teens can relate to these in a world where novelty and instant gratification are just a swipe away on their phones; but it is important to differentiate between normal inattentive-like behaviour and behaviour actually causing distress and poor academic functioning.

On the other side of the coin is the hyperactive/impulsive presentation which tends to see individuals fidgeting, moving their body frequently (often unaware that they are doing it), needing to move around even when inappropriate to do so, often being in an almost manic state as if ‘driven by a motor’ and/or struggling to moderate emotions and/or behaviours. The latter of these symptoms is often overlooked but can be a strong indicator of difficulties with ADHD.

In my experience, it is all too often this emotional challenge that causes the most conflict in the home between parents and their children.

Covid-19 and the rise of home-based learning with ADHD

As we find ourselves in the midst of an international pandemic I have seen a sharp increase in referrals from parents concerned about their child’s challenges with time management, procrastination, addictive-like behaviours (often involving screens), and low frustration tolerance to name a few. Parents, now able to observe their children first hand in a working environment, are often overwhelmed. At the heart of this, it seems, is the extent to which their children find self-management skills inaccessible.

Assistant clinical professor of psychiatry at Yale, Thomas E Brown describes these skills as executive functions or the skills we use on a daily basis to learn, work and manage our lives[iii]. The correlation between deficits in these skills and ADHD is well documented[iv] and, to add fuel to the fire, we have also known for decades that stress, anxiety, depression and trauma contribute significantly to how our brains work.

If we consider the significant loss children and adolescents have endured in the form of lost learning time, fewer social gatherings, sports events and celebrations; it is clear to see that the toxic mix of ADHD, poor executive functioning and the COVID-19 pandemic needs attention.

Where to from here with your child’s ADHD?

Treatment options can be a challenging discussion for parents. Particularly as opinions are often polarized when it comes to the use of stimulants such as Ritalin. However, the research is overwhelmingly clear that drug therapy is highly effective for the treatment of ADHD symptoms[v].

In effect, their aim is to minimize the symptoms and therefore make it easier for the individual to lead a healthy and functional life. One can, in some ways liken this to the medical approach used to treat depression. Generally healthcare practitioners may suggest a trial of medication, such as anti-depressants to treat the symptoms, while suggesting psychotherapy as a means to address the underlying cause and/or gain tools to better manage future episodes.

In the case of ADHD a similar approach is gaining momentum as practitioners are, in addition to medication, encouraging executive functioning training in order to strengthen and equip children and teens with the tools needed to manage these areas more effectively.

The truth is that the vast majority of Adolescent ADHD cases report symptoms that last into adulthood. Therefore, learning practical skills in childhood and adolescence, that can be used long-term, is in the best interest of your child.

Executive functions are essential for our day-to-day functioning

Executive functions are important for all of us. They are the essential self-regulating skills that we all use every day to accomplish just about everything. They help us plan, organize, make decisions, shift between situations or thoughts, control our emotions and impulsivity, and learn from past mistakes. Children rely on their executive functions for everything from taking a shower to packing a backpack and picking priorities.

Executive functioning skills include:

  1. Flexible Thinking – adjust behaviour to unexpected changes
  2. Working Memory – keep key information in mind temporarily
  3. Self-Monitoring – self-awareness to how one is doing in the moment
  4. Planning and Prioritising – to set and meet goals
  5. Task Initiation – take action to get started on tasks
  6. Organisation – keep track of things physically and mentally
  7. Emotional Control – keep feelings and emotions in check
  8. Impulse Control – thinking before acting

Learning disorder specialists can help to bolster the executive functioning skills skills that don’t come naturally to a child with poor executive functioning. They teach a mix of specific strategies and alternative learning styles that complement or enhance a child’s particular abilities. They provide the tools for both child and parent to help them tackle school work as well as other responsibilities that take organization and follow-through.

Developing new strategies for learning isn’t easy at any age. Initially, it can put the already uncomfortable or self-conscious individual even further outside their comfort zone. In the long term, it is however well worth the effort and builds confidence that one can competently handle what is expected of them.


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This article was co-written and supervised by Dayne Williams, Educational Psychologist practicing in Cape Town. Dayne works with patients presenting with a wide range of learning barriers and has a particular interest in the area of ADHD. Want to speak to Dayne?  Click here to instantly book a consultation which you can conduct online or in-person.



[i] Schoeman, R. and de Klerk, M., 2017. Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance. South African Journal of Psychiatry23. https://sajp.org.za/index.php/sajp/article/view/1010/766

[ii] Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open. 2018;1(4):e181471. https://pubmed.ncbi.nlm.nih.gov/30646132/

[iii] Brown, Thomas E. “Executive functions and attention deficit hyperactivity disorder: Implications of two conflicting views.” International Journal of Disability, Development and Education 53, no. 1 (2006): 35-46. https://www.researchgate.net/publication/241621227_Executive_Functions_and_Attention_Deficit_Hyperactivity_Disorder_Implications_of_two_conflicting_views

[iv] Schroeder, V.M. and Kelley, M.L., 2009. Associations between family environment, parenting practices, and executive functioning of children with and without ADHD. Journal of child and family studies18(2), pp.227-235. https://www.researchgate.net/publication/225897159_Associations_Between_Family_Environment_Parenting_Practices_and_Executive_Functioning_of_Children_with_and_Without_ADHD

[v] Aghaee, M.H. and Tarkhan, M., 2017. A comparative study of effectiveness of medicinal therapy and combined therapy (cognitive–behavioral and drug) of students diagnosed with attention deficit hyperactivity disorder (ADHD). Bali Medical Journal6(1), pp.82-89; https://www.researchgate.net/publication/315902306_A_Comparative_Study_of_Effectiveness_of_Medicinal_Therapy_and_Combined_Therapy_Cognitive_-Behavioral_and_Drug_of_Students_Diagnosed_with_Attention_Deficit_Hyperactivity_Disorder_ADHD

López, F.A. and Leroux, J.R., 2013. Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: a focus on extended-release formulations and the prodrug lisdexamfetamine dimesylate to address continuing clinical challenges. ADHD Attention Deficit and Hyperactivity Disorders5(3), pp.249-265. https://pubmed.ncbi.nlm.nih.gov/23564273/

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