Does ADHD Medication Help Executive Functioning?

Attention-Deficit/Hyperactivity Disorder (ADHD) often goes hand-in-hand with executive functioning (EF) challenges—those crucial mental skills like working memory, flexible thinking, decision-making, problem-solving, and self-control. While medications are commonly used to manage ADHD symptoms, it’s essential to understand that they don’t directly improve executive functioning and can have unwanted side effects. The real key to helping kids with EF issues is to teach them specific skills and address underlying brain dysregulation.

While medications can relieve symptoms, they do not address the root causes of executive functioning difficulties. Executive functioning can be learned. As I always say, “Skills, Not Pills”. In my Ridgefield, CT clinic, I take pride in a more holistic approach to treating ADHD and executive functioning issues. Combining medication with behavioral strategies, skill-building, and natural approaches such as neurofeedback, PEMF therapy, dietary changes, and supplementation can offer a more comprehensive treatment plan. This integrated approach can help improve both symptom management and overall quality of life for kids and teen with ADHD.

ADHD medications can manage symptoms of ADHD (attention deficit hyperactivity disorder). However, they come with potential side effects that can impact the treatment and an individual’s overall well-being. It’s important for patients and caregivers to work closely with their healthcare provider to monitor these side effects and adjust the treatment plan as needed.

ADHD profoundly impacts executive functioning by affecting how the brain manages essential cognitive processes. At the core of this disruption is brain dysregulation, particularly in regions like the prefrontal cortex. This area of the brain is crucial for tasks such as planning, decision-making, and impulse control. In individuals with ADHD, the prefrontal cortex may not function as efficiently, leading to difficulties in regulating attention and behavior.

The brain’s reward system, heavily influenced by dopamine—a neurotransmitter involved in pleasure and motivation—is also disrupted in ADHD. This imbalance can make it challenging to stay focused on tasks that lack immediate rewards, contributing to procrastination and difficulty completing tasks.

Additionally, ADHD affects the connectivity between different brain regions. Neural pathways that connect the prefrontal cortex with other areas responsible for processing and regulating information may be underdeveloped or functionally impaired. This can result in inefficient information processing, making it harder to prioritize tasks, switch between activities, and maintain self-control.

In essence, the brain's disrupted functioning in ADHD impacts executive skills such as organizing, managing time, and regulating emotions. Understanding these underlying neurological issues can help in developing more effective treatments that address both the symptoms and the root causes of executive function difficulties.

Common Attention Deficit Hyperactivity Disorder Medications: How They Work and Their Side Effects

ADHD medications are often prescribed to help manage symptoms of attention-deficit/hyperactivity disorder (ADHD). These medications primarily fall into two categories: stimulants and non-stimulants. Here, we’ll discuss three commonly prescribed ADHD medications (stimulant medication and nonstimulant medications), their mechanisms of action, and their potential side effects.

1. Methylphenidate (Ritalin, Concerta)

Methylphenidate is one of the most frequently prescribed stimulant medication for ADHD. It works by increasing the levels of neurotransmitters—primarily dopamine and norepinephrine—in the brain. This increase helps enhance focus, attention, and impulse control. Methylphenidate achieves this by blocking the reuptake of these neurotransmitters, allowing them to remain in the brain’s synaptic spaces for longer periods.

Side Effects: While effective for many, methylphenidate can have several side effects, including:

• Appetite Loss: Reduced appetite is a common side effect, which can lead to weight loss.
• Insomnia: Difficulty sleeping or insomnia may occur due to the stimulating effects of the medication.
• Headaches: Some individuals report experiencing headaches while on this medication.
• Increased Heart Rate: Methylphenidate can cause an increase in heart rate and blood pressure.
• Mood Changes: Irritability or mood swings can occur, though they are less common.

2. Amphetamine Salts (Adderall, Adderall XR)

Amphetamine salts, which include medications like Adderall and its extended-release version Adderall XR, are another class of stimulant medications used to treat ADHD. These drugs work by increasing the release of dopamine and norepinephrine from nerve terminals in the brain. They also block the reuptake of these neurotransmitters, thereby improving focus, attention, and impulse control. The XR (extended-release) formulation provides a longer duration of action, which can help manage symptoms throughout the day.

Side Effects: Common side effects associated with amphetamine salts include:

• Decreased Appetite: Similar to methylphenidate, amphetamines can lead to reduced appetite and subsequent weight loss.
• Sleep Disturbances: Insomnia or difficulty sleeping is a notable side effect.
• Dry Mouth: A dry mouth can be a bothersome side effect for some individuals.
• Anxiety and Irritability: Increased anxiety or irritability may occur, especially with higher doses.
• Elevated Blood Pressure and Heart Rate: Amphetamines can increase both blood pressure and heart rate, necessitating regular monitoring.

3. Atomoxetine (Strattera)

Atomoxetine is a non-stimulant medication that is used to treat ADHD. Unlike stimulant medications, atomoxetine works by selectively inhibiting the reuptake of norepinephrine, leading to increased levels of this neurotransmitter in the brain. It does not have the same stimulating effects as stimulant medications and is often chosen for individuals who may not tolerate stimulants well or have a history of substance abuse.

Side Effects: Atomoxetine’s side effects can include:

• Gastrointestinal Issues: Nausea, vomiting, and stomach pain are common.
• Sleep Problems: Insomnia or drowsiness can occur.
• Fatigue: Some individuals may feel fatigued.
• Appetite Loss: Reduced appetite and weight loss are possible.
• Mood Changes: Depression, irritability, or mood swings may occur, particularly in those with a history of mood disorders.

The Effects of ADHD Medication for a Developing Brain

I've said this time and time again, medication should never be the first line of defense for a developing brain. Medications used to treat conditions like attention deficit hyperactivity disorder, anxiety, and depression can provide significant benefits but may also pose risks to a developing brain. Stimulant medications, while effective for symptom management, can impact growth, cause sleep disturbances, and lead to mood changes or potential misuse.

Non-stimulant medications may have delayed effects and cause gastrointestinal issues or mood swings. Antidepressants carry risks such as increased suicidal thoughts, emotional detachment, and physical side effects like weight gain. Antipsychotics can result in metabolic problems, neurological effects, and emotional numbness.

Given the developing brain's sensitivity, it is crucial to balance medication use with careful monitoring and consider alternative or complementary approaches like behavioral therapy and lifestyle changes. Ongoing evaluation is essential to optimize treatment and mitigate potential negative impacts on a child's growth, cognitive, and emotional development.

Why ADHD Medication Isn’t the Solution for Executive Functioning Skills

Taking medications for ADHD such as stimulants, can help manage symptoms like hyperactivity and inattention by increasing neurotransmitters like dopamine and norepinephrine. However, these medications do not teach the brain how to improve executive functions. In fact, reliance on medication alone can sometimes mask the need to develop these essential skills, leading to continued struggles in managing daily life.

Medications can provide temporary relief, but they do not address the root causes of brain dysregulation or teach the necessary skills for long-term success. The solution lies in a comprehensive approach to mental disorders that includes brain regulation techniques and teaching executive function skills.

Brain Dysregulation in ADHD and Executive Functioning

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that is extensively studied for its brain anatomical and functional characteristics, as well as its genetic and familial influences. (Friedman et al, 2015).  Brain dysregulation plays a central role in ADHD and has a significant impact on executive functioning. Executive functions are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. When these processes are impaired, it can lead to difficulties in managing daily activities, particularly for individuals with ADHD.

In ADHD, brain dysregulation refers to the imbalance and irregular activity in key areas of the brain responsible for attention, behavior regulation, and impulse control. These areas include the prefrontal cortex, which is crucial for executive functioning, as well as other regions involved in processing dopamine, a neurotransmitter that plays a key role in reward and motivation.

Prefrontal Cortex Dysfunction:

• The prefrontal cortex is the brain’s control center for executive functions such as planning, decision-making, and impulse control. In individuals with ADHD, this area may not be as active or efficient, leading to challenges in regulating attention, managing time, and organizing tasks. This dysfunction directly contributes to the struggles with executive functioning commonly seen in ADHD.

Dopamine Imbalance:

• Dopamine is a neurotransmitter that helps regulate mood, attention, and motivation. In people with ADHD, there is often a dysregulation of dopamine levels, which affects the brain’s reward system. This imbalance can make it difficult to stay focused on tasks that are not immediately rewarding, leading to procrastination, difficulty in completing tasks, and problems with goal-directed behavior.

Connectivity Issues:

• Brain dysregulation in ADHD also involves irregular communication between different regions of the brain. For instance, the neural pathways that connect the prefrontal cortex with other parts of the brain may be underdeveloped or functionally impaired. This can result in inefficient processing of information, making it harder to prioritize tasks, switch between activities, and maintain self-control.

Impact on Executive Functioning

The brain’s dysregulated state in ADHD profoundly affects executive functioning, making it difficult for individuals to perform tasks that require planning, organization, and sustained attention.

Natural Methods to Address Brain Dysregulation and Improve Executive Functioning

Addressing brain dysregulation is crucial for improving executive functioning. Here are some natural methods that can make a significant difference:

1. Neurofeedback: Rewiring the Brain

Neurofeedback is a non-invasive therapy that helps regulate brain activity by providing real-time feedback on brainwave patterns. During a neurofeedback session, individuals learn to control their brain activity through exercises that promote optimal brain function. 

Over time, this can lead to improved focus, better cognitive functions, better emotional regulation, and enhanced executive functioning. Open-label studies have confirmed the effectiveness of neurofeedback, with no signs of publication bias and no significant side effects reported. (Arns et al, 2020).

Neurofeedback is particularly effective for individuals with ADHD because it targets the specific areas of the brain that are dysregulated. By normalizing brainwave patterns, neurofeedback can help individuals develop the mental clarity and self-control needed to improve executive functioning skills and manage attention deficit disorder. 

With the right strategy, lifestyle change and cognitive behavioral therapy it can be an effective ADHD treatment and significant changes in executive functions can be possible with the right reinforcement from a therapist or even from the support of parents.

2. Magnesium: The Calming Supplement

Magnesium is a vital mineral that plays a crucial role in brain function and regulation. It helps calm the nervous system, reduce hyperactivity, and improve sleep—factors in cognitive and executive functions that are often disrupted in individuals with ADHD. 

Magnesium supplementation can support brain health by improving cognitive and executive functions, and promoting relaxation and reducing anxiety, both of which are essential for effective executive functioning.

Magnesium also aids in the production of neurotransmitters like serotonin, which can help stabilize mood and improve cognitive and executive function too. Including magnesium-rich foods in the diet or taking supplements can be a simple yet effective way to support brain health and enhance executive function skills.

3. Anti-Inflammatory Diet: Fueling the Brain

Diet plays a significant role in brain health, and an anti-inflammatory diet can help reduce brain inflammation that contributes to dysregulation. Inflammation in the brain can impair cognitive function, leading to difficulties with executive functioning. 

By reducing inflammation, individuals can experience clearer thinking, improved cognitive abilities, better focus, and significant differences and improvements in emotional regulation and executive functions.

An anti-inflammatory diet includes foods rich in omega-3 fatty acids, antioxidants, and essential nutrients. Foods like fatty fish, leafy greens, berries, and nuts are excellent choices for supporting brain health. Avoiding processed foods, sugar, and artificial additives can also help reduce inflammation and improve overall cognitive function. 

A change in diet has a lot of positive cognitive benefits that will not only help the body, but most importantly, the brain too.

Teaching Executive Functioning Skills

Once the brain is better regulated, it’s time to focus on teaching executive functioning skills. These skills are not innate; they must be learned and practiced over time. Parents play a crucial role in helping their children develop these skills by providing guidance, structure, and support.

How to Teach Executive Functioning Skills

Teaching EF skills requires a strategic approach that involves structure, positive reinforcement, and teaching with the end in mind. Here’s how parents can effectively teach these skills:

Structure and Routine

Children with ADHD benefit greatly from structure and routine. Routine tasks help reduce anxiety and create a sense of security, making it easier for children to focus and manage their tasks. Establishing a consistent daily schedule with designated times for homework, chores, and relaxation can help children develop time management and organizational skills.

Parents can also use visual aids like calendars, checklists, and timers to reinforce routines and help children stay focused and on track. Breaking tasks into smaller, manageable steps can make them less overwhelming and more achievable.

Positive Reinforcement

Positive reinforcement is a powerful tool for teaching executive function skills. Praising and rewarding children for their efforts and accomplishments can motivate them to continue practicing these skills. It’s important to focus on progress rather than perfection, recognizing small achievements as important milestones.

Parents can use a variety of rewards, such as verbal praise, stickers, or extra playtime, to reinforce positive behavior. Consistent and immediate reinforcement is key to helping children internalize these skills and apply them in different situations.

Teaching with the End in Mind

When teaching executive function skills, it’s essential to have a clear goal in mind. Parents should identify the specific skills they want their child to develop, such task initiation, or emotional regulation. By focusing on these end goals, parents can tailor their teaching methods to meet their child’s needs. Complex tasks can be broken down to smaller to-do's to make it easier for children with deficit hyperactivity disorder ADHD to reach their goals.

For example, if the goal is to improve time management, parents can teach their child how to use a timer to complete tasks within a specific timeframe. If the goal is to enhance emotional regulation, parents can introduce coping strategies like deep breathing or mindfulness exercises.

What Executive Functioning Skills to Teach

There are several key executive functioning skills that parents can teach to help their children manage ADHD symptoms and improve overall functioning:

Planning and Prioritization

Planning and prioritization are essential for managing tasks and responsibilities. Parents can teach their children how to create a to-do list, prioritize tasks based on importance and deadlines, and break larger tasks into smaller, more manageable steps.

Encouraging children to think ahead and anticipate potential challenges can also help them develop their self management and problem-solving skills and make better decisions.

Time Management

Time management is crucial for completing tasks efficiently and meeting deadlines. Parents can teach their children how to allocate time for different activities, use timers or alarms to stay on track, and develop a sense of urgency when needed.

Creating a visual schedule or using a planner can help children see how much time they have for each task and plan accordingly. Parents can also model good time organization by demonstrating how they prioritize and manage their own responsibilities.

Task Initiation

Task initiation is the ability to start tasks without procrastination. Children with ADHD and executive dysfunction often struggle with getting started on routine tasks, especially with tasks that seem overwhelming or boring. Parents can help by breaking tasks into smaller steps, providing clear instructions, and offering encouragement.

Using a “first, then” approach can be effective—first do one task, complete the task, then enjoy a preferred activity. This technique helps children see the immediate benefits of completing tasks and motivates them to take action. When children with ADHD learn this skill, they can pass projects and homework in a timely fashion, which can result to better academics.

Emotional Regulation

Emotional regulation is the ability to manage and respond to emotions in a healthy way. Children with ADHD may experience intense emotions, leading to impulsive behavior or emotional outbursts. Parents can teach their children coping strategies to manage these emotions, such as deep breathing, counting to ten, or taking a break.

Modeling calm behavior and using positive reinforcement when children demonstrate self-control can reinforce these skills. Teaching children to recognize their emotions and express them verbally rather than through actions is also important for emotional regulation.

Flexibility

Flexibility is the ability to adapt to changes and unexpected situations. Children with ADHD may struggle with rigid thinking and find it difficult to adjust when things don’t go as planned. Parents can teach flexibility by exposing their children to new experiences, encouraging problem-solving, and practicing “what-if” scenarios.

Role-playing different situations and discussing alternative solutions can help children develop the ability to think on their feet, have better reaction time and adapt to changes more easily.

Working Memory

Working memory is the ability to hold and manipulate information in mind for short periods. This skill is essential to solve problems and complete tasks, as well as follow multi-step instructions. It is because working memory is also involved in organizing thoughts and keeping track of the things one has to do to complete a task. Parents can help their children improve working memory by playing memory games, using visual aids, and practicing repeating information aloud.

Encouraging children to write down instructions or break tasks into smaller steps can also help them manage information more effectively.

Self-Monitoring

Self-monitoring is the ability to assess one’s own performance and behavior. Parents can teach this skill by encouraging their children to reflect on their actions and identify areas for improvement. Asking questions like “How do you think you did?” or “What could you do differently next time?” can prompt self-reflection.

Teaching children to set personal goals and track their progress can also help them develop self-monitoring and self management skills. Providing feedback and discussing both successes and challenges can reinforce this skill over time.

Organization

Children with ADHD can often have chronic disorganization. Organization is essential for managing materials, time, and information. Parents can teach organizational skills by helping their children create systems for keeping their belongings in order, such as using labeled bins, folders, or color-coded materials.

Teaching children how to organize their workspace, backpack, and schedule can also improve their ability to manage other tasks and responsibilities. Parents can model good organizational habits and involve their children in organizing family activities or events.

Empowering Parents to Teach Executive Function Skills

As a parent, you hold the power to make a significant impact on your child’s development of executive function skills. While it might seem overwhelming at first, remember that you are in the best position to guide and support your child. You don’t need to be an expert to teach these skills—your everyday involvement, patience, and encouragement can make a world of difference.

Executive function skills are closely tied to emotional regulation. By teaching your child coping strategies and offering a supportive environment, you help them manage their emotions and handle stress. Your presence and understanding can make a significant difference in how they learn to control their impulses and stay focused, transforming emotional challenges into opportunities for growth.

Executive functions can be improved and EF skills can be teached to achieve success not only in their kids' early years but in their adolescent years and when they grow up as adults.

With 30 years of experience as a psychologist and therapist, I created the Executive Functioning Parent Toolkit for parents who want to support and teach regulation skills to their children. Executive functioning skills are teachable, and if you need help in teaching them, understanding more about executive functioning, or addressing attention issues, this parent toolkit is here to assist.

It offers science-based strategies to tackle attention and executive function challenges, providing practical solutions to break the cycle of frustration. By implementing these evidence-backed techniques, you can manage behaviors more effectively, improve your child's focus, and foster their independence—all while reducing stress for both of you. In just 30 days, you’ll see meaningful improvements, transforming daily parenting challenges into a more manageable and positive experience. Learn more here.