Beyond the Label: Is It ADHD or an Executive Function Challenge?
- Shyla Mathews
- 5 days ago
- 6 min read
Part 1 of a 2-Part Series
When “Can’t Focus” Isn’t What It Seems
It began, as these stories often do, with worry, unanswered questions, and very little support. This was my story 12 years ago, and now I hear it echoed in countless parents’ voices.
“She just can’t focus,” the mother said. “It must be ADHD.”
Her daughter sat beside her, head down, quietly tracing patterns on my notebook. She wasn’t restless or disruptive. She was elsewhere, her attention scattered like confetti.
As we talked, I noticed that she was highly observant. She caught every detail; the cough in the corridor, the chatter outside, the picture on the wall, my pink pen. It wasn’t that she couldn’t focus; it was that her brain hadn’t yet learnt how to focus or where to focus long enough to make meaning.
That moment stayed with me. Because what we often call a “focus problem” may not always be ADHD. Sometimes, it’s something more nuanced, like an executive function challenge.
ADHD and Executive Function: What’s the Difference?
When we hear “attention problem,” we often think “ADHD.”But attention is not a single skill; it’s part of a much larger cognitive network.
What Is ADHD?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily life or development.
Common symptoms include:
Difficulty sustaining attention in tasks or play
Appearing not to listen when spoken to
Difficulty following through on instructions
Poor organisation and forgetfulness
Being easily distracted
To qualify for a diagnosis, symptoms must appear in more than one setting (e.g., home and school), begin in childhood, and cause significant functional impairment.
ADHD has a neurobiological basis - differences in brain structure, neurotransmitter systems (especially dopamine and norepinephrine), and neural connectivity in regions responsible for executive function and self-regulation.
In essence, ADHD reflects differences in how the brain’s “control centre” operates.
What Is Executive Function?
Executive Function (EF) refers to a group of mental processes that help us plan, focus attention, remember instructions, regulate emotions, and complete tasks.
Dr Russell Barkley calls executive function “the management system of the brain” — the mental CEO that coordinates all the other processes required for learning, behaviour, and emotional control.
Key executive function skills include:
Working Memory – holding and manipulating information in mind
Cognitive Flexibility – shifting perspective or adapting to new rules
Inhibitory Control – resisting impulses and staying focused
Planning & Organisation – setting goals and creating a plan to reach them
Self-Monitoring – recognising mistakes and adjusting strategies
Emotional Regulation – managing strong feelings and maintaining focus
These skills underpin every aspect of learning and daily functioning.Without them, focus, motivation, and comprehension crumble.
The Overlap: ADHD as an Executive Function Disorder
Here’s where things get interesting. ADHD and executive function aren’t separate — ADHD is fundamentally an executive function disorder.
In his landmark 1997 paper, Dr Russell Barkley described ADHD as a Self-Regulation Deficit Disorder (SRDD), a difficulty with behavioural inhibition that disrupts all other executive functions.
His “unifying theory of ADHD” reframed the condition as one that impairs:
Working memory
Emotional regulation
Motivation and persistence
Planning and goal-directed behaviour
Subsequent research has consistently confirmed that ADHD involves deficits in executive function, not merely “attention.” The inattention we see is often the visible surface of deeper self-regulation challenges.
Can You Have EF Challenges Without ADHD?
Absolutely. Many children and adults experience executive function weaknesses that look like ADHD, but stem from different causes.
Familiar sources of EF challenges include:
Developmental differences: Some children develop EF skills more slowly.
Learning disabilities: Dyslexia, dyscalculia, and language disorders often co-occur with EF difficulties.
Stress and trauma: Chronic stress and adverse experiences disrupt the brain’s self-regulation systems.
Anxiety and depression: These can impair working memory, flexibility, and attention.
Sleep deprivation: Even mild sleep loss dramatically reduces EF performance.
Over-scaffolding by adults: When parents do all the organising, planning, and problem-solving, children miss opportunities to strengthen their own EF networks.
Reduced play: Unstructured play is where planning, flexibility, and impulse control naturally develop.
Early and excessive device use: Screen exposure during early development can interfere with attention control and working memory.
Lack of explicit instruction: Executive function skills don’t just “emerge” — they must be taught.
Sensory processing differences: Difficulty filtering sensory input can appear as inattention but originates in perception.
Medical conditions, Such as Thyroid imbalance, nutrition, or other health issues, can affect cognitive function.
So yes, a child may be forgetful, distracted, and disorganised, but for reasons that have nothing to do with ADHD.
Why This Distinction Matters?
Understanding the difference between ADHD and other executive function challenges has profound implications.
1. It Opens Doors to Early Intervention
If we assume every EF difficulty equals ADHD, we might rush to diagnosis and medication, missing the opportunity to teach these skills through coaching or targeted support.
2. It Helps Identify the Root Cause
A child whose attention struggles stem from trauma needs trauma-informed care.A child with dyslexia or oral language difficulties may need a specialist literacy intervention. Another child might need occupational therapy to address sensory regulation or working memory.
3. It Leads to Targeted, Effective Support
Different causes require different interventions:
Behavioural therapy – strengthens self-regulation and coping skills
Cognitive therapy – builds metacognition and awareness
Occupational therapy – supports sensory and motor regulation
Speech-language therapy – builds verbal working memory and comprehension
Educational and literacy intervention – integrates EF into academic learning
4. It Preserves Hope and Agency
When children (and parents) understand that focus, organisation, and self-control are learnable skills, not fixed traits, everything changes. They move from frustration to growth.
5. It Prevents Overdiagnosis
Not every attention challenge needs a clinical label. Some need time, guidance, and structured skill-building.
Before we label, we can teach. And that teaching often reveals whether we’re seeing ADHD or executive functions still under construction.
The Hidden Connection: Literacy and Executive Function
Now let’s return to that phrase parents often say: “My child can’t focus.”
When we unpack it, we find that these difficulties often appear in language-based contexts, such as reading, writing, comprehension, and classroom learning.
Consider these common patterns:
During reading: Eyes move across the page, but comprehension collapses. They reread the same line repeatedly.
During homework: They don’t know how to start. Time slips away. Tasks remain half done.
In class, they forget multi-step instructions or drift halfway through a task.
During writing: Ideas scatter mid-sentence; organisation feels impossible.
During discussions, they lose track, interrupt, or can’t connect ideas.
The assumption? “It must be ADHD.”The reality? Each of these scenarios draws heavily on executive function and literacy integration.
The Research Connection
Over the last two decades, researchers have shown that executive function skills are essential to literacy success.
Dr Kelly B. Cartwright, Director of the READLab at the University of North Carolina at Charlotte, has demonstrated that executive skills such as cognitive flexibility, planning, and organisation directly influence reading comprehension — even beyond decoding or vocabulary ability.
Similarly, Sesma et al. (2009) found that working memory and planning predicted reading comprehension independently of word recognition and fluency.
In 2021, Nouwens et al. confirmed that EF skills measured in Grade 4 predicted reading comprehension outcomes one year later.
This means executive function doesn’t just support literacy, it drives it.
Literacy and Executive Function develop together. When one falters, the other follows.
What Comes Next?
Before we label a child, we must understand why they’re struggling.Sometimes the issue is neurobiological - ADHD.Other times, it’s developmental - EF skills that haven’t yet matured.And often, it’s a mix of both.
In Part 2 — “The Hidden Bridge Between Literacy and Executive Function: Why I Created ThinkVisual™” (Available 23 October), we’ll explore:
How EF and literacy interact in real learning moments
What’s happening inside a child’s brain when “focus” falters
How coaching that integrates both systems transforms learning outcomes
When we understand the brain behind the behaviour, we don’t just label the struggle; we start to build connections.
Further Reading
Barkley, R.A. (1997, 2012, 2020). Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.
Cartwright, K.B. (2015, 2023). Executive Skills and Reading Comprehension. Guilford Press.
Dawson & Guare. (2018). Executive Skills in Children and Adolescents. Guilford Press.
Diamond, A. (2013). “Executive Functions.” Annual Review of Psychology, 64, 135–168.
Sesma et al. (2009). Child Neuropsychology, 15(3), 232–246.
Nouwens et al. (2021). British Journal of Educational Psychology, 91(1), 169–192.
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