Assessing Executive Functioning to Build Workplace Resilience
Executive dysfunction in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) presents significant challenges throughout their lifespan. It can impede various aspects of daily life, including maintaining personal tasks (e.g., paying bills), sustaining positive relationships, and achieving professional goals. This blog explores a case study inspired by a collection of real stories and anecdotes. In this scenario, a clinician uses the Conners Adult ADHD Rating Scales 2nd Edition (CAARS™ 2) and the Comprehensive Executive Function Inventory Adult™ (CEFI Adult™) assessments to contribute to the identification of ADHD, distinguish executive function strengths and weaknesses, and develop a tailored treatment program.
Emily’s Story
Emily is a bright, ambitious, 28-year-old graphic designer at a mid-sized technology startup in a major metropolitan city. While she loves her job, she often finds herself at odds with the demands of her role. Despite her best efforts, Emily struggles with managing deadlines, scattered thoughts, and feeling overwhelmed. Each day feels like an uphill battle, leaving her exhausted as she grapples with the invisible barriers hindering her professional growth. Emily faced similar challenges as a student: prioritizing tasks, maintaining routines, and focusing on assignments. Yet, she adeptly masked her struggles, relying on support from her parents and leveraging her strengths to succeed at school.
For Emily, the tipping point came during a critical project deadline she had meticulously planned for weeks. As the deadline neared, she found herself overwhelmed by a flood of emails, meeting requests, and last-minute changes from her team. Despite her best efforts to stay organized, she missed a crucial update from a key partner, resulting in a significant oversight that jeopardized the project’s success. She felt an overwhelming sense of guilt and embarrassment, realizing that her struggles were not just affecting her performance but also affecting her team. The fatigue of constantly trying to hide her difficulties, coupled with the frustration of falling short of her potential, propelled her to seek a different path to work through her concerns—one that began with a conversation with her primary physician, followed by a comprehensive assessment with a psychologist.
Recognition of the Invisible Struggle Through Comprehensive Evaluations
During their first session, Emily’s psychologist Dr. Rodriguez conducted a comprehensive clinical interview to gather information about her current work-related difficulties and her childhood, social, academic, and personal history. Through this interview, Emily described her struggles at work: especially with attention, organization, time management, and emotional regulation, providing valuable insight into her cognitive functioning.
Following the clinical interview, Dr. Rodriguez administered the Conners Adult ADHD Rating Scales 2nd Edition (CAARS™ 2), a standardized assessment tool designed to evaluate symptoms of ADHD and its associated clinical concerns in adults 18 years and older. The CAARS 2 has key clinical content associated with ADHD and offers scores for Inattention/Executive Dysfunction, Hyperactivity, Impulsivity, Emotional Dysregulation, and Negative Self-Concept, as well as Associated Clinical Concern Items and Impairment & Functional Outcome Items. The measure is designed to gather information from multiple sources, including the person being evaluated (Self-Report) and individuals who are familiar with the person being evaluated (Observer).
Emily completed the Self-Report form, and one of her close friends completed the Observer form. The CAARS 2 results indicated that Emily struggles with inattention, executive dysfunction, emotional dysregulation, and negative self-concept, while her hyperactivity and impulsivity scores were in the typical range. These test scores were consistent with findings from other sources of information, such as the previously conducted clinical interviews, medical examinations, and past job performance evaluations, leading Dr. Rodriguez to a diagnosis of ADHD, with a predominantly Inattentive presentation.
One of the notable findings from the extensive body of research on adult ADHD is the extent to which the disorder increases the risk of serious functional impairments1. While executive dysfunction isn’t an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR®), it is a trans-diagnostic symptom of many other challenges related to physical and mental health, including ADHD. Executive dysfunction can significantly impair an individual’s day-to-day functioning, especially in workplaces or social settings2. Because Emily reported significant difficulties at work, Dr. Rodriguez also administered the Comprehensive Executive Function Inventory Adult™ (CEFI Adult™) along with the CAARS 2. The CEFI Adult rating scale is designed to measure executive function strengths and weaknesses for adults aged 18 years and older. Her friend completed the CEFI Adult Observer form. Emily’s Full Scale score indicated that she had significant problems with executive dysfunction. A thorough review of the CEFI Adult Scale scores helped pinpoint where she struggled the most. Emily struggled with many areas of executive dysfunction, including attention, organization, planning, self-monitoring, emotion regulation, and working memory. In fact, her organization, planning, and emotional regulation skills were noted as executive function weaknesses, indicating that these are areas to be targeted during treatment. On the other hand, her inhibitory control score indicated that she was quite good at controlling her impulses, and this was noted as an executive function strength.
Understanding Diagnosis and Building Awareness
A thorough assessment of executive functioning provides invaluable insights into the specific cognitive challenges impeding workplace performance3. Through the assessment process, Emily gained a deeper understanding of the underlying cognitive challenges contributing to her workplace difficulties, and she began to understand that her struggles were not due to personal failings. This newfound awareness empowered Emily to recognize patterns in her behavior and responses, enabling her to implement more effective strategies for managing her workload. Additionally, by understanding her specific executive function weaknesses such as planning, organization, and emotion regulation, her clinician could tailor a treatment plan to address her unique needs.
Skill-Building Treatment and Services
Emily worked with her clinician to develop adaptive skills to enhance her functioning. Mindfulness practices, such as meditation and deep breathing exercises, enhanced her emotional regulation skills, and increased awareness and management of emotions. Time management and organization skills fostered resilience and self-efficacy, empowering Emily to navigate professional challenges with confidence and competence. As Emily engaged in treatment, she began to experience tangible improvements in various aspects of her life, not just in the workplace. For example, she noticed that she was able to plan and manage household chores and social engagements without feeling overwhelmed. The CEFI Adult results collected at the beginning of her treatment acted as a baseline, and Emily saw improvement in results over the following months.
Advocacy for Accommodations
The CEFI Adult and CAARS 2 reports highlighted key areas of impairment. Emily’s clinician drafted her report to include this information and worked with her to develop self-advocacy skills, such as effectively communicating her needs and negotiating accommodations with her employer. Emily took this information to her manager and HR. Specifically, she reported having trouble listening to instructions, and they modified her work to ensure that instructions were communicated in writing (e.g., transcription of meetings, closed captions, and requests came through email, rather than phone calls). Organization was another executive function weakness, and in response, they offered a flexible work schedule so that Emily could adjust what time she begins work each day. This allowed her to manage her time more effectively, minimize distractions, and reduce the stress of adhering to rigid deadlines. These changes provided the scaffolding she needed to navigate her role more confidently and effectively.
Empowerment Through Education
As Emily shared her journey with her colleagues and leadership, she also became a catalyst for change, sparking conversations about neurodiversity and the importance of inclusive practices in the workplace4. Drawing from her conversations with her clinician, she was able to articulate her journey and the supports that worked for her. Through educational initiatives and awareness campaigns, she began to help foster a culture of empathy and understanding, paving the way for greater acceptance and support.
Emily’s journey is an example of the struggles of many individuals. Her treatment plan, developed in collaboration with her clinician, focused on improving executive function skills. As she embarked on this path of self-discovery and advocacy, Emily experienced several pivotal moments, beginning with a comprehensive evaluation and moving to skill building, which reshaped her professional trajectory.
Integrating CAARS 2 and CEFI Adult for Comprehensive Insights
The severity of executive function impairments varies widely among individuals with ADHD and can serve as consistent and discriminating predictors of ADHD persisting into adulthood5. Some individuals may struggle with multiple aspects of executive functioning, while others may have specific deficits. Using the CAARS 2 and the CEFI Adult together allows clinicians to gain valuable insights into how ADHD symptoms and executive functioning deficits intersect, develop personalized treatment plans, and evaluate the effectiveness of interventions over time.
Have questions about how the CAARS 2 and CEFI Adult can provide better outcomes? Get in touch with a member of our team.
References
1 Hinshaw, S. P., & Ellison, K. (2016). ADHD: What everyone needs to know. Oxford University Press.
2 Silverstein, M. J., Faraone, S. V., Leon, T. L., Biederman, J., Spencer, T. J., & Adler, L. A. (2020). The relationship between executive function deficits and DSM-5-defined ADHD symptoms. Journal of Attention Disorders, 24(1), 41–51.
3 Zhang, S.-Y., Qiu, S.-W., Pan, M.-R., Zhao, M.-J., Zhao, R.-J., Liu, L., Li, H.-M., Wang, Y.-F., & Qian, Q.-J. (2021). Adult ADHD, executive function, depressive/anxiety symptoms, and quality of life: A serial two-mediator model. Journal of Affective Disorders, 293. doi:10.1016/j.jad.2021.06.020
4 McIntosh, C. K., Hyde, S. A., Bell, M. P., & Yeatts, P. E. (2023). Thriving at work with ADHD: Antecedents and outcomes of proactive disclosure. Equality, Diversity and Inclusion: An International Journal, 42(2), 228–247.
5 Mitchell, J. T., McIntyre, E. M., English, J. S., Dennis, M. F., Beckham, J. C., & Kollins, S. H. (2017). A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. Journal of Attention Disorders, 21(13), 1105–1120.
