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Michael Silverstein’s Research Provides Answers for People with ADHD, EFD in Highly Cited Paper

By Alli Fossner

Michael Silverstein


May 24, 2021

Imagine your brain as an orchestra. The conductor (executive function) stands in front (or in the frontal lobe) to direct and organize their ensemble (other parts of the brain). Each musician relies on the conductor to know when to play, how fast or slow and when to stop. If the conductor is off, the music suffers. If a person is struggling with executive dysfunction, the other parts of the brain become confused. Processes like goal-directed behavior, planning, organization, future thinking and working memory all begin to deteriorate.

Michael Silverstein, a doctoral candidate in clinical psychology, and his team wanted to investigate the relationship between attention deficit hyperactivity disorder (ADHD) and executive dysfunction symptoms in adults. Silverstein found that ADHD symptoms were strongly correlated with and predictive of executive function deficits (EFDs), guiding clinicians to take a more holistic approach to treatment. As a result, “The Relationship Between Executive Function Deficits and DSM-5-Defined ADHD Symptoms” was recognized by the Web of Science Group, a Clarivate Analytics company, as a highly cited paper in 2020. The paper, published in The Journal of Attention Disorder, received enough citations to place it in the top one percent of the academic field of psychiatry/psychology based on a highly cited threshold for the field and publication year.

“Research has generally suggested that [ADHD and executive function] are associated, but exactly which symptoms of ADHD tend to associate with which executive functioning deficits isn't always so clear,” explained Silverstein. “That's important as we start to think about what's going on with ADHD, how to best understand it and how best to treat it. What we found was those symptoms of inattention in ADHD – like being careless, distractibility, forgetfulness – those tend to be more related to those higher-order cognitive processes than symptoms of hyperactivity and impulsivity.”

This question has persisted in the field of psychology for quite some time, with top scientists arguing both sides, but Silverstein was able to reexamine the issue with a different method, a large, diverse sample and high-quality clinician ratings.

“There is some disagreement among scientists about whether executive function deficits co-occur frequently for adults with ADHD,” said Brian Daly, PhD, department head of Psychology at Drexel and Silverstein’s mentor. “His study helped add a lot more evidence to the side that argues, yes, they actually do co-occur. But even more than that, they may precede some of the symptoms of ADHD.

“Michael, to his credit, is the first author on that that publication, but those other five co-authors listed are arguably the top-10 ADHD researchers in the country,” continued Daly. “It’s really impressive for a graduate student to be a lead author on a paper where you have some of the foremost experts in ADHD.”

The conclusion of Silverstein’s work is also impressive because clinicians now have more information about their patients’ impairments and can treat accordingly.

“What’s challenging is that ADHD responds really well to medication, but executive functioning deficits do not,” said Silverstein. “We’ve shown, through this paper, that a lot of people with ADHD symptoms have a lot of executive functioning deficits. Our paper clearly demonstrates the critical importance of suggesting adults with ADHD get skills training and get therapy to support them. That was something that was really exciting.

“Research using the same data set, that we haven’t published but presented at a conference, shows that these executives functioning deficits, which relate to ADHD, uniquely predict impairments even beyond the ADHD symptoms,” he continued. “We really believe it's important that these people get combined treatments, which is unfortunately not always done.”

“It's an important paper because it's really applied in terms of the findings,” concluded Daly. “It's not theoretical. The conclusions are things that clinicians can take tomorrow and do something with. And in the end, it's about improving the quality of life for those individuals who have some level of executive dysfunction. I’m proud of him because he did [the paper] with such eminent scientists, but also because you can take those results and actually improve people's lives with them.”