ADHD and Children's Delayed Executive Functioning Age - Part 1
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- čas přidán 31. 07. 2023
- As my other videos on this channel demonstrate, ADHD results in delays and deficiencies in the brain's executive functions that are essential for self-regulation. But just how delayed are these executive functions (EF) and the resulting self-regulation? Decades ago, I invented the concept of a child's executive functioning age (EFA). I called it the 30% rule. The 30% rule about which I often speak is merely a rough clinically derived approximation for how far behind a typical child with ADHD may be from their more typical peers in their development of self-regulation (SR)(executive functioning, or EF). I developed the concept while writing the first edition of my book for parents (Taking Charge of ADHD) but also while practicing clinically at the University of Massachusetts Medical Center from 1985-2002. I was searching for a means by which to counsel parents and teachers on the extent to which such children were behind others of their age so as to get adults to understand the concept of a delay and the need to adjust one’s expectations down to a more appropriate level for a child so delayed. Even back then, ADHD was considered to be developmental in nature and best considered as a delay in development, not a loss of previously normal functioning as in someone with an injury. That idea was borrowed from two other neurodevelopmental disorders - intellectual disability and learning disorders. For both, we often speak about the functional developmental level of the child in the domain of their delay, in those cases intelligence and learning (reading, math, spelling, language etc.) specifically. Indeed, in the field of intelligence research, the concept of a mental age rather than an IQ was used for years in clinical work with families of such children.
The rule is not based on a single scientific study of that issue, which would be far too time consuming and expensive to conduct. Instead, I was searching for a clinical rule or concept, not one of exact scientific specification as derived from a single such study. So I went back into my own published research studies and that of many others and simply wrote down the extent to which the ADHD group's performance differed from that of typical children in the same study and looked at a wide range of children’s ages. I did this for a wide variety of measures of EF, child social behaviors, and others. The range of deficits was from about 25-41% or so. The average was 32% but that is not as good for clinical use as is using a nice round number when speaking to parents. So I rounded it down to 30%. On average, then, a child with ADHD seems to perform about 30% behind others of their age in their EF and self-regulation. Don't let the exact number distract you from the point of this exercise. It is clearly a rough (imprecise) rule based on a back of the envelop type of calculation. But it worked brilliantly in advising families and others about how to understand the concept of a delay in EF, or one’s functional executive age, and start thinking about where their own child might be in that level of delay. The point of the rule is for families to understand not just the concept of a delay but, more important to its purpose, also about the need to lower expectations to better fit with their child’s delayed level of EF/SR.
So there is no single scientific paper of mine to send you. And the number itself is a crude approximation. Instead, one views the 30% rule as an imprecise estimate so as to better convey a concept of delayed EF to families and teachers and, most importantly, the need to match expectations to functional levels of EF performance. This video discusses this concept and gives examples of how it can be of value in determining a child's tasks, chores, freedoms, and responsibilities and thereby reduce substantial family conflict while promoting your child's success and welfare.
I'm 23, female, got diagnosed with ADHD at the age of 11-12. I am struggling. I can't seem to bring myself to get a job, I don't know how to drive, and I haven't gone to college. I barely graduated high school and had to repeat a year of it. I have no friends. I live with a single mother and she has no patience with me. I just can't seem to bring myself to do anything and I'm scared. I want to be independent, I want to be able to make decisions on my own and be mature already. I feel and function like a teenager still. I feel like a burden. I recently started to finally get better at my dental hygiene after having so many cavity fillings in the past. I have no schedule and I don't know how to make one.
Wow. It's a very hard truth to learn there. It's hard to have always heard than I'm "older" than my age in terme of how I think by adults and now being an adult to hear that I'm late for EF development.
See my reply above. It’s not that solidified in stone.
Thank you for addressing this question around when to stop applying the 30% rule - I've been wondering about this for the last few weeks! Perfect timing!
Thanks for explaining this! Even as a young adult, I experience a similar delay but couldnt wrap my head around why/how it was happening and what to do until I watched this video. 🙂
12:52 I went to a state university (w/40k students on campus) at 16 and to corporate at 20 and quickly realized there was a disparity. I can laugh about it now but it was a struggle.
Thanks for these insights.
I truly appreciate your videos and all the valuable information you put into them.
My 6 year old daughter was diagnosed last year with ADHD/ODD. We are prepared to have her living with us as long as we can. I pray that she will allow us to help her navigate the world until she reaches her late 20’s. She will always have our support 💜
My daughter have adhd. And i never stopped learning on your video and how to parent a child with ADHD, now i myself do not have It but her dad do. And it helped me understand and be more open about my daughter something i never knew. Thank you for sharing this to bottom of my heart.
As someone with a late diagnosis of ADHD and thinking back on my life and decisions made I can say that you are spot on with your assessment, didn't get my driving license till I think I was 20 and the risks I took driving were stupid not to mention the speeding tickets although I managed to not get as many as I should have.
Wow! Packed a punch this video! Thanks Dr Barkley! Makes so much sense.
It’s a concept to help families reduce conflict with a child or teen.
People still expect kids with ADHD to perform and behave just like their age equivalent NT peers. It’s insanity! No matter how many times you explain, people still act as though the child is purposely being difficult. This includes close family members who ought to know better. On another note, It would be interesting and helpful if Dr Barkley explained the difference between ADHD and ASD. it seems really tricky in practice to try and determine whether certain characteristics such as social deficits are a result of ASD or ADHD. It seems many kids are diagnosed with both.
Please see my video on ADHD and ASD to see if that helps explain things.
Guilty as charged! I swear, I KNOW about ADHD and still find myself having to constantly adjust my expectations for my 15-year-old son. 🤦♀This video really helped my husband and me see that we were setting NT expectations on some things. I honestly don't know where we would be without Dr. Barkley. It sounds like you might be a therapist or clinician of some sort, and if so, thank you for your work!
I'm recently diagnosed as a 29 year old with inattentive ADHD. To think my executive age is only 18-24 and that's where it will stay is pretty depressing. Then again my whole life has been pretty depressing because of this shitty developmental disorder i didn't even know i had. Can medication raise the executive age, at least temporarily? I'm on atomoxetine which has helped somewhat, but I eventually am going to add stimulants.
Yes, it can. And remember this is just a concept, not an exact number. The degree of delay will vary with the severity of the symptoms with mild cases being far less than severe ones. And about 15% or more will outgrow it by age 30. Also, one can learn ways to compensate for these difficulties so they don’t adversely impact major life activities so much. This also implies that you need to seek out job situations that are a better fit for these difficulties and do not place such heavy demands on them.
@@russellbarkleyphd2023 it’s good to know it isn’t an exact science. I’ve always felt less developed and beneath my peers growing up but maybe my apparent autism has something to do with that as well… thanks for your response, Dr Barkley
Love your work. Thank you
Thanks!
Thank you for this info that is useful for setting my expectations of my child. On reflection of my own life I can now better understand why i failed at my first go of going to a large university when I was only 17. I dropped out in my first semester, tried again the following year at a smaller university but dropped out again. Only when I turned 21 was I better able to manage my EF and finished by going part time over 5 years.
I'm 29 and unable to really take care for myself much. Sucks a lot. But when I have "good dopamine days" or am less depressed and stuff, I can suddenly feel or function like an adult. It's crazy and weird. Really hope it can still get better in the future. At least a great friend with ADHD as well showed me that it can get better and I'll hope I can feel as capable and good again in the future, even if things seem hopeless since the last 6-7 years due to lack of or no progress in my life and my family's (all with issues) at all. ADHD and all this stuff sucks. Meds are my best bet and I hope if I can finally find a psychiatrist after those 4 years or smth, I'll be able to somewhat have a life and be able to do anything. Same goes for my brothers and mom :(
And I have (severe) issues with all of this, yay. But always got told I'd be the best with most things if I was just able to
always be good/normal. But yeah, I feel severely impaired with all of these areas since I was a little kid and I'm 29 now.
Can't really function much without anyone else.
EDIT: Would be lying if this didn't make me really depressed, though :') ik you mean this for context and reference, though, but sucks to face such harsh possible realities and as if life has been hopeless from the start :(
Wow, I wish that I had this information and your explanation when my boys were younger. It's crystal clear now why we have our 32 and 42 year old sons living at home with us. They still have trouble functioning 😢
Thank you so much Dr. Barkley for generously sharing your insights and nuggets of wisdom. If you have a moment, please share thoughts on ways to secure the "buy-in" of spouses who are not as receptive to expert guidance (e.g., driver's license at 16, prescription medication, etc.) and who treat ADHD behavior as "normal" teenage behavior.
Have them watch my health outcomes lecture. If a 2-5x increase in early death and an 11-13 year reduction in life expectancy, along with all the other myriad health risks, doesn’t convince someone of the seriousness of this condition, then nothing will.
Many thanks again Dr. Barkley. Your "Health and Life Expectancy in ADHD. Treatment Matters More Than You Think" (czcams.com/video/fP2DhUtYJ5s/video.html) is invaluable.
Could you offer any advice for children/ pre-teens who are (and always have been) high achievers but emotionally dysregulated please?
Does this EFA delay continue into adult hood because I have a large delay in that area and I'm.in.my 40 s but my EFA level.feels as if I'm at a teenager level I feel i.will never catch up.?
Dr. Barkley, i have daughther 3 years old, she has almost all ADHD symptoms but how can i know the severity of it? Also I wonder how effective treatment could be on ADHD starting from early chilhood? Is there any research about it?
We determine severity by number of symptoms that occur often or more frequently as well as by the number of life domains in which the person is impaired,such as home, school, social with peers, community, etc. treatments can be started as young as age 3.
Have I have a question my son just got diagnosed with adhd he is speech delayed he speaks but not as much as his peers in school they are all five though and he is being compared by his in school speech therapist. How should I go about this with her? To make her stop because I was told with adhd that affected his speech
does this age discrepancy apply in their emotional regulation as well? The somewhat easy part is to get your child accommodations at school or a parent can prevent certain things from happening. (babysitting/driving) BUT if your teenager EF age is 16 is her ER age 12.5? How do you navigate social sitations cause that is a huge gap.
My comments apply to all 7 EFs, including emotional self control but remember its just a concept to use in adjusting your expectations.
@@russellbarkleyphd2023 this makes perfect sense with situations you can control, . but are there any strategies to help an adhd teenager engage with her peeps in a productive non offensive way? As a parent i can manage my expectations that fitting in with her peers might be difficult however, are there any ways to help her through?
@@user-mp4gp7po4w I have the same questions! My seven-year-old is often not perceived well by his peers, because he does not know how to interact appropriately at times
How do we navigate when a child who has a lower EFA but understands their CA and wants to do things other kids do and thinks they are old enough etc?
Another question, does EFA catch up to CA at some point? Will an adult( especially dx at adulthood, age 46) stay at a certain EFA for the rest of their life and is there away to raise to EFA to actual age?
Please see Part II of this lecture.
its difficult for my parents because i was born a gifted child but then my younger brother was born so they had to take care of him as well as me and they weren't able to put me in a gifted school and i was diagnosed with adhd when i was 6 and now I'm 21, yet i feel as though I'm still a child. i just learned about this, my therapist told me about it and it helped me understand myself a little better. my parents have always had such high expectations of me and I've always felt so burdoned with them. how do you think my parents can help me? i already told my mom about the age thing but how can she help me? also i live in a Hispanic house hold so sometimes my parents say it's all in my head and i just need to do better. how can i make them understand me better?
I have listened to an additude podcast with Dr. Dodson where he said that he does not believe in the concept of executive functions - though without telling why.
Is the topic of exectuive functions widely accepted within the adhd-realted scientific community, or is it a matter of debate?
IT IS BASICALLY THE *BASIS* OF NUERO BEHAVIOR THAT THE DISORDER (ADHD) IS DEFINED UPON.
It is now widely accepted. The debate, which is declining I believe, was about whether it was common to most or all those with ADHD or just a subset. Therefore, if the latter, then multiple theories of ADHD would be needed, as a multi-pathway model for instance. But the problem, as my video on the topic explains, was relying too heavily on EF testing as the gold standard for proving or disproving that EF was involved in ADHD. The tests don't detect it very often but rating scales of EF find such symptoms in daily life to be a factor in the vast majority of those with ADHD and to better predictors of functioning and impairments in daily life. So its not being debated so much anymore.
Dr. Barkley, Is there any research to suggest that untreated ADHD increases the chance of Neurological diseases such as Alzheimer’s or Parkinson’s?
Yes
As a young adult with ADHD (21), this has made me realize why I act or acted certain ways. Very informative
🙏🙏🙏🙏♥️♥️♥️♥️♥️
I went to a majority white school as a kid. Not once was ADHD considered, just labled as problematic and emotionally disturbed. Suspended often, calls home from school often, even put in a behavorial class which didnt last long because I was around kids with legit behavorial problems and wasnt anywhere near theirl level. Im 41 and my ADHD was never tended to, I have social problems, suffer depression, have self-esteem issues, and huge trust issues now from being dealt with as a lazy, bad kid
Id focus more on motivation/intuition/social sense/social instinct/unknown automatic/halvautomatic/contious executive functions. The idea of people feeling the same and just "dont know to do X" i think is what many people read into this even if it may not be ment like that. I agree that public perceptions are strongly going in that direction tho.
No such thing as ADHD. It's just a label that those who should know better use to identify kids that are as thick as bricks.
OK DUDE!!! WHY DID YOU HAVE TO GO AND THROW THIS CURVEBALL AT ME?? LOL NOW IM ALMOST CONVINCED THIS IS WHAT IVE ACTUALLY HAD SINCE SEVENTH GRADE!! I WAS THE ONE WHO WAS NOT ADHD BUT I WAS ADD.... AND SO MANY SYMPTOMS ARE ACTUALLY A MATCH AND MAKING MORE SINCE NOW THAT YOU ARE SEPERATING THE TWO DISORDERS... HOWEVER WOULD LIKE TO POINT OUT THAT WHILE I NEVER DID ANY SCHOOL HOMEWORK... I WAS A MATHEMATICAL WIZARD.... NO DEFICIENCY THERE... THE REST OF THE SYMPTOMS , YOU NAILED IT... RITILIN WORKED FOR A WHILE FOR ME,... DESOXYN WORKS THE BEST NOW... THE L ISOMER OF AMPHETAMINE GIVES ME PROBLEMS... DEXEDRINE WORKED WELL TOO... DESOXYN IS MUCH MORE COMFORTABLE AND I LIVE NORMAL AND FEEL NORMAL AT 43 YEARS OF AGE... LUCKILY I HAVE DOCTOR WHO DOES NOT FOLLOW THE STIGMA AND BULLSHIT THEY TELL YOU ABOUT CERTAIN ILLICIT DRUGS BEING OF NO USE MEDICINALLY.