# Tele-Assessment of Executive Functions in Young Adults with ADHD: A Pilot Study
## 3 Executive Functions in Adults with ADHD  
Executive functions (EFs) refer to a collection of cognitive control processes that help manage thoughts and behaviors, particularly in situations that are complex or unfamiliar. According to fractionated models of EFs, e.g., [52; 53], there are three core components: inhibition, which involves the ability to resist inappropriate actions or distractions; working memory updating, which entails actively manipulating information held in memory; and shifting (or cognitive flexibility), which is the capacity to adapt one's thinking or actions in response to changing rules or goals [54]. Assessing executive functions poses several challenges [55; 56]. While the models developed by [PERSON] and [PERSON] suggest that these EF components are distinct, they are also closely interconnected and can influence each other [52; 57]. For example, tasks requiring cognitive flexibility also demand working memory updates and the inhibition of previous strategies. Moreover, researchers have pointed out inconsistencies in how EF components are defined across studies, as well as concerns about the validity of the tools used to assess them, e.g., [55; 58; 59]. Each EF component likely includes multiple sub-processes that differ in how well they align with the main construct being measured. In this context, selecting suitable tools to evaluate the various components of executive functioning (EF) proves to be a complex task, which can influence the study outcomes. This issue is particularly important due to the bidirectional relationship between EF impairments and clinical symptoms, e.g., [60]. On the one hand, deficits in the EF can lead to or worsen certain symptoms; on the other hand, the primary symptoms of a disorder may also negatively affect the EF performance [61]. Executive function impairments are widely recognized as a core feature of ADHD in both pediatric and adult populations. In a comprehensive review of the literature, [PERSON], [PERSON], and [PERSON] [9] conducted a documentary analysis of 33 peer-reviewed studies published within the past decade, focusing on executive functioning in adults with ADHD. The review examined a range of variables, including the publication year and country, diagnostic criteria, participant demographics, comorbid conditions, ADHD subtypes, medication status, assessment instruments, and specific executive function processes evaluated. When comparing individuals with ADHD to a control group without any medical or psychiatric conditions, significant differences were observed in several executive function (EF) areas, particularly in inhibitory control, working memory, planning, and sustained attention. These findings align with previous research by [PERSON] [62; 63; 64] and [PERSON] et al. [65], who argue that individuals with ADHD have impaired inhibitory control. This impairment negatively impacts overall executive functioning, leading to the reduced regulation of motor and emotional responses to stimuli, difficulty suppressing impulsive actions, and challenges in planning, focusing, and problem-solving. However, no notable differences in the processing speed, verbal fluency, or reaction time were found between the two groups. The findings indicate a substantial prevalence of executive function deficits among adults with ADHD, as evidenced by their lower performance on standardized assessments compared to both neurotypical individuals and those with other psychiatric conditions. However, outcomes have varied across studies, reflecting the heterogeneous nature of ADHD and underscoring the influence of methodological differences and participant characteristics. The review also identified commonly employed diagnostic criteria and assessment tools for evaluating the executive function in this population. While the results substantiate the established association between ADHD, executive dysfunction, and challenges in major life domains, the authors note several methodological limitations.