Executive Functioning and ADHD

Introduction

If you’ve been searching for ways to help your child, you’ve probably come across executive function training for ADHD.

For many parents, the idea of improving executive functioning is incredibly appealing, especially if it means avoiding medication.

There are countless games, books, apps, and programs marketed to improve executive functioning in children. Some families I work with have their child doing 30 minutes a day of “brain training” because a device is marketed for attention or executive function challenges.

Many parents ask whether executive function training is effective…

For instance: 

“ How can I improve my child’s focus and impulsivity without medication?”

These are important questions that deserve answers rooted in research.

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The Reality Parents Experience

Many families invest time and money in programs designed to improve executive functioning in kids, only to find that the changes don’t last or don’t translate into real-life success.

If you’ve tried to:

• Help a child with impulsivity.

• Improve focus during homework.

• Teach better self-control

…then you already know how difficult it is to create lasting change.

In real-world situations, especially when a child is frustrated or bored, these skills are much harder to access.

The Truth About Executive Function Training

Here’s the truth that is not communicated to parents:

Most executive function training programs help children improve at the specific task they practice, but not necessarily in everyday life.

For example: A child may improve at a memory game but still struggle with homework, routines, or behavior. This is one of the biggest limitations of working memory training: the skills often don’t transfer.

What the Research Shows

1. Improvements Don’t Transfer Well

Research shows that while kids may improve on training tasks, there is limited improvement in:

• School performance

• Behavior at home

• Daily functioning

In other words, gains don’t consistently carry over into real life.

2. Gains Often Fade Over Time

Even when improvements are seen:

• They often fade

• They require continued practice to maintain

• This makes many executive function interventions less effective in the long term.

3. Larger Studies Provide a Clearer Picture of What’s Going On

When researchers combine results from multiple studies on Executive Function Training, the overall findings don’t deliver.

Across studies:

• Working memory training shows minimal real-world impact.

• Executive function training shows small or inconsistent effects.

This is especially important when comparing ADHD treatment options.

Why Executive Function Training Doesn’t Work Well in Real Life

Executive functioning isn’t stable across situations; it shifts depending on the environments a child is in.

A child may struggle more when:

• They are frustrated

• They are told “no.”

• They are bored

• They are overwhelmed

As a result, executive functioning skills in children don’t automatically improve just from practice-based programs.

What, in fact, helps children with ADHD

If you’re looking for ADHD treatments or effective supports, research supports the following interventions:

1. Medication (Strongest Evidence Base)

For children with ADHD, medication has the strongest and most consistent evidence for improving:

• Attention

• Impulse control

• Follow-through

Medication directly supports the brain systems involved in executive functioning.

Many families consider other interventions before deciding on medication. However, medication is still the most effective, research-supported treatment currently available.

2. Parent-Based Interventions

Approaches that coach parents, such as Parent-Child Interaction Therapy, that are structured, evidence-based therapies, help improve:

• Child behavior

• Frustration tolerance

• Listening and cooperation

• Parent Confidence

These approaches create real-world change, not just practice-based improvement.

1. Environmental Supports

If your goal is to improve Executive Functioning in kids, external supports are critical. However, these supports may require significant time and effort to implement, and their effectiveness can vary.

• Visual Schedules: These need to be updated frequently to maintain novelty. Including images that resonate with the child and help capture their attention makes the schedule more engaging.

• Routines: Establishing routines can be challenging, as children may consistently resist them. Environmental supports, such as visual schedules, reminders, or structured settings, can assist in this process. Hygiene tasks, for example, often remain painfully dull unless paired with external motivators that make them a priority.

• Reminders: While reminders are essential, they can be bothersome for both parents and children. Creative approaches, such as delivering a reminder via a paper airplane rather than a verbal prompt, can make them less intrusive and more effective.

These environmental strategies are designed to reduce the amount of mental effort children need to exert when managing daily responsibilities. By providing clear, external structures and supports, parents can help offset challenges in executive functioning.

4. Emotional Dysregulation

If a child is overwhelmed, frustrated, or dysregulated, executive functioning skills will not show up.

Because of this, addressing low frustration tolerance is critical when helping a child with limited executive functioning skills.

A Better Question to Ask

Instead of asking:

“How do I improve executive functioning in my child?”

A more helpful question is:

“What workarounds should I try to help my child function better with this limitation?” Privately acknowledging this will be a lifelong challenge, and that finding effective work arounds now can help if one sticks.

Take Homes:

So, does executive function training work for ADHD?

The research suggests:

• Improvements are often limited to the task at hand.

• Gains don’t last

• Real-world impact is inconsistent.

What works better is:

o Evidence-based parent training (Parent-Child Interaction Therapy [PCIT])

o Environmental accommodations and external supports (anchors, cues)

o Interventions targeting emotion regulation (planned sensory breaks)

o Pharmacotherapy (medications), when other interventions have failed

References

1. Cortese, S., Ferrin, M., Brandeis, D., et al. (2015). Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 54(3), 164-174.

2. Rapport, M. D., Orban, S. A., Kofler, M. J., & Friedman, L. M. (2013). Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clinical Psychology Review, 33(8), 1237-1252.

3. Sonuga-Barke, E. J. S., Brandeis, D., Holtmann, M., et al. (2013). Computer-based cognitive training for ADHD: a review of current evidence. Child and Adolescent Psychiatric Clinics, 22(2), 345-365.

4. Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527-551.

5. Abikoff, H., Gallagher, R., Wells, K. C., et al. (2013). Remediating organizational functioning in children with ADHD: Immediate and long-term effects from a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(1), 113-128.