The ADHD diagnosis tries to capture people at the very low end of a spectrum of executive functioning, and executive dysfunction is also a big part of autism. It usually looks better under structure, and while the assessment plays out we push non-drug help, ideally working with someone, because there is no magic bullet.
What it is
The ADHD diagnosis tries to capture people with deficits in executive functioning, specifically people in the very low percentile. That makes it a spectrum.
“So what the ADHD diagnosis is trying to capture is it's trying to capture people who have deficits in executive functioning”
6:08ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?Sep 2024 Also said in 1 more episode
“So what ADHD is capturing is people in the super duper low percentile of executive functioning. So that means that we're looking at people who are really on the low percentile of executive functioning. So what that means is it's a spectrum”
7:49ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?Sep 2024 Executive dysfunction is a big one in autism. It used to be considered part of autism spectrum disorder, so ADHD was not diagnosed if an autism diagnosis could be justified.
“Executive dysfunction, I think, is a big one. In fact, back in the day, they wouldn't even diagnose ADHD if you could justify a diagnosis of autism spectrum disorder because executive dysfunction was considered a part of autism spectrum disorder”
25:52Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026
How it shows up
Dysfunction that is better in a structured environment is true of almost everybody with ADHD. That is why some people get worse in college, a less structured setting.
“the dysfunction was better under a structured environment. This is true of almost everybody with ADHD, by the way. This is why we see sometimes worsening in the college environment because it's a less structured environment”
19:37How to Decide When ADHD Is Actually ADHDNov 2025
Treatment approach
While the assessment is under way, advocate non-pharmacological treatments, and tell the patient there is no magic bullet.
“I'm going to be advocating for non-pharmacological treatments as we wait for stuff. And because, and I'm going to tell a patient, you know, there's no magic bullet here”
35:20How to Decide When ADHD Is Actually ADHDNov 2025 Mastering Your Adult ADHD and the Executive Functioning Workbook for Adults are good workbooks, but the best thing is for the patient to work with someone.
“Mastering adult ADHD is a good one. Executive functioning workbook for adults is a good one. But frankly, the best thing is if they work with someone”
36:46How to Decide When ADHD Is Actually ADHDNov 2025
It also comes up on
- ADHDADHD is not just a problem with executive functioning. It is also the self-beliefs and personality that can grow out of years of struggling with it.
- ADHDBiology does not change the plan: stimulants improve executive function wherever someone sits on the bell curve, and psychological tools and environmental changes reduce symptoms wherever they sit.
- BenzodiazepinesBefore starting one, spell it out: a controlled substance that causes addiction, withdrawal, executive function and memory problems and sedation, and probably slows progress in psychotherapy. And if you change doctors, the next one may not continue it.
- StimulantsStimulants improve executive functioning wherever someone sits on the bell curve, and psychological tools and environmental changes reduce symptoms wherever they sit too.
- Treatment goalsThe primary goal is to put the patient on a trajectory toward long-term executive function improvement and a life worth living, in the way they want it. Look for functional, long-term goals, not short-term ones.
- Informed consentBefore a benzodiazepine, say it plainly: this is a controlled substance that causes addiction, withdrawal, executive function and memory problems and sedation, it probably slows progress in psychotherapy, and the next doctor may not continue it.
- PsychoanalysisIt is relevant to know that the unconscious probably exists: a large part of our psychological workings cannot easily be called into conscious thought and manipulated with executive functioning.
From these episodes
- Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026 · 1 point
- How to Decide When ADHD Is Actually ADHDNov 2025 · 3 points
- ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?Sep 2024 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.