Attention Deficit Hyperactivity Disorder (ADHD) and Dysexecutive Syndromes in Adults: Diagnosis and Treatment

🧠 Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder of neurobiological origin characterized by symptoms associated with inattention, hyperactivity, or impulsivity. These symptoms may occur in isolation or in combination and typically have a specific and stable cognitive profile throughout a person's life (Onandia-Hinchado & Del Olmo, 2023). This is why individuals begin to experience impairment in a variety of contexts and settings (APA, 2013). In adults, these symptoms can affect areas related to family life, socialization, work, difficulty adapting to social norms, regulating behavior, and romantic relationships (Onandia-Hinchado & Del Olmo, 2023).

How does ADHD manifest itself in adulthood?

🚘 To give you an idea, an adult with impulsive tendencies may frequently engage in reckless driving, which can eventually lead to numerous traffic tickets. It's important to note that symptoms don't manifest equally in all cases; therefore, a neuropsychological evaluation would allow for an objective assessment of how the symptoms are causing impairment based on each individual's specific circumstances.

ADHD vs. Other causes of inattention and impulsivity symptoms

☝🏻 It is important to mention that not all symptoms related to attention and executive functions are solely due to neurodevelopmental factors. For example, diagnostic manuals such as the DSM-5 state that some clinical conditions, such as major depression, can involve a decrease in the ability to think or concentrate. Similarly, factors such as sleep deprivation, a history of acquired brain injury, diet, emotional factors, prolonged screen time, lack of self-care, hormonal factors, substance use, alcoholism, and unstable routines and habits can influence the appearance of symptoms affecting attention, hyperactivity, or impulsivity (Onandia-Hinchado & Del Olmo, 2023).

The Relationship between ADHD and Executive Functions

📚 Closely related to attention, hyperactivity, and impulsivity are executive functions, processes that, according to Funahashi and Andreau (2013), are defined as higher-order cognitive processes that allow for the coordination of various neural systems in order to pursue a goal flexibly. Therefore, components of executive functions include inhibition, working memory, cognitive flexibility, logical reasoning, planning, decision-making, divided attention to multiple stimuli simultaneously, and processing speed. If you wish to deepen your knowledge of executive functions, we recommend reading the following articles:

Hot and cold executive functions from a neuropsychological assessment

Neuropsychology of executive functions and their importance in education

Dysexecutive Syndromes: What are they and their link to ADHD?

▶️ Similarly, according to Onandia-Hinchado and Del Olmo (2023), advances in neuropsychology present us with other diagnostic frameworks that are worth considering when symptoms affecting a person's cognitive profile are present. We are referring to dysexecutive syndromes, which are a type of cognitive profile that results in impaired impulse control (such as in the case of orbitofrontal syndrome) and impaired ability to manipulate information. This can lead to errors, slowness, and a tendency to disengage from the task, thereby losing sight of the objective and efficiency of the activity being performed (these types of symptoms occur in dorsolateral prefrontal syndrome).

🤓 Based on everything written above, it's also important to clarify that science is constantly researching, and ADHD is recognized as a type of developmental dysexecutive syndrome. However, not every dysexecutive syndrome is considered ADHD. As we've mentioned in this article, a person who hasn't had ADHD of neurobiological origin could, due to environmental factors, develop symptoms of a dysexecutive syndrome in adulthood. Some environmental factors that can act as risk factors for the appearance of dysexecutive symptoms are: lack of structure in the environment, failure to organize before starting an activity, habits that cause distraction while performing a task (such as looking at your cell phone while working or driving), acquired brain injury, or substance use. These are some factors that can interfere with our daily cognitive performance.

Assessment of ADHD and Dysexecutive Syndromes in Adults

🧐 So what does the assessment for ADHD and dysexecutive syndromes in adults involve? Below, we delve deeper into some of the tests commonly used for this purpose:

Diagnostic interview for ADHD in Adults

✅ Diagnostic Interview for ADHD in Adults: To properly assess ADHD in adults, it's important to verify that the symptoms have been present since childhood and have remained consistent throughout the person's life. Therefore, a retrospective interview should gather information about how these symptoms were present in childhood and whether they persist into adulthood. If the symptoms were not present since childhood, as mentioned in this article, it's necessary to explore environmental factors to determine if there are any risk factors that could be impacting cognitive areas.

Visual Attention Assessment (d2-R Test)

✅ Visual Attention (d2-R Test): It is important to evaluate visual attention processes using cancellation tasks. This type of task allows for measuring concentration, processing speed, and accuracy when performing visual tasks that involve a motor response.

Adult Intelligence Assessment (WAIS-IV)

✅ Intelligence in adults (WAIS-IV): intelligence should be measured with comprehensive intelligence tests that allow the measurement of verbal tasks (comprehension, vocabulary, verbal recognition of pictures), abstract reasoning, working memory and processing speed.

Assessment of Cognitive Flexibility, Planning and Organization (Trails Test)

✅ Cognitive Flexibility, Planning, and Organization (Trails Test): Using tests that assess planning, flexibility, and organization can be achieved through the use of the Trails Test. Planning involves organizing cognitive resources to accomplish a task, considering constraints and feedback received to adjust behavior toward achieving a specific goal. Flexibility refers to seeking alternative solutions to a problem and being able to adjust behavior when results do not meet expectations.

Assessment of Alternating Attention and Inhibition (Five Digit Test)

✅ Alternating Attention and Inhibition (Five-Digit Test): Inhibition relates to the ability to control the interference of irrelevant stimuli and, at the same time, redirect our cognitive resources to relevant or target stimuli. Similarly, alternating attention refers to the ability to attend to and alternate between two types of target stimuli simultaneously. The Five-Digit Test is an excellent tool for evaluating both inhibition and alternating attention.

Treatment of ADHD and Dysexecutive Syndromes in Adults

🧐 What does the treatment for ADHD and dysexecutive syndromes in adults consist of?

⭐️ Regarding treatment, international guidelines such as NICE (National Institute for Health and Care Excellence) initially recommend starting treatment with psychological therapy, and in cases of more severe symptoms, combining psychological therapy with medication. Within psychological therapy, cognitive therapy, that is, cognitive training or cognitive stimulation, is recommended. The techniques used in therapy to compensate for attentional or executive deficits should include environmental supports, external aids, self-control strategies, training in different attentional components, and psychosocial support, especially for adults who may have suffered some type of significant brain damage (Arango et al., 2020).

Strategies to Improve Concentration, Hyperactivity and Impulsivity

Whether or not I have ADHD or Dysexecutive Syndrome, is there anything I can do to improve my concentration and symptoms of hyperactivity/impulsivity?

We repeatedly recommend that each case should be evaluated individually; however, in general, people of all ages, including adults, can make use of the following strategies (click on the blue link to expand with a YouTube Shorts on that topic).

Pomodoro Technique

▶️ Pomodoro Technique: This technique involves using physical or digital timers to track work time. It's important to avoid multitasking when using this technique. Once the work period is over, you can reward yourself with a break. During your break, avoid screen time. Instead, you can take an active break, drink water, take a short 5-minute nap, or simply socialize with someone from work or home.

Using the One Sec app for inhibition

▶️ Using the One Sec app: The One Sec app allows us to monitor and regulate our screen time when using our phones. When we try to open an app, it will ask us if we really want to open it. This can be useful for controlling and reducing our screen time while we are doing important work. If you are a parent, this app will also allow you to control your children's screen time.

Recommendations for Strengthening Executive Functions in Children

▶️ Recommendations for parents regarding executive functions in children: As adults, we may also need to strengthen executive functions in the youngest members of the family. Creating a structured work environment, implementing extracurricular activities, and establishing family board game routines are key allies in strengthening executive functions within the family.

Contact for Evaluation

🤩 If you're interested in an ADHD or executive dysfunction assessment for adults, remember that the Comprehensive Center for Educational Neuropsychology is your partner for these services. For more information, you can contact us at +507 6535 6362 , and we'll be happy to assist you.

Bibliographic References

📚 References

✅American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C. (2013). doi:10.1176/appi.books.9780890425596

✅ Arango Lasprilla, JC, Wilson, B., & Olabarrieta Landa, L. (2020). Principles of neuropsychological rehabilitation (1st edition). Mexico City. Editorial Manual Moderno.

✅ Funahashi, S., & Andreau, JM (2013). Prefrontal cortex and neural mechanisms of executive function. Journal of Physiology, Paris, 107(6), 471-482. https://doi.org/10.1016/j.jphysparis.2013.05.001

✅ Onandia-Hinchado, I., & Del Olmo, A. (2023). Manual of Child and Adolescent Neuropsychology (Second edition). Sara Ediciones.

✅NICE. (2019). Attention deficit hyperactivity disorder: Diagnosis and management. NICE guideline [NG87]. https://www.nice.org.uk/guidance/ng87