Definition of Executive Functions

Executive functions (EF) are those abilities that we use when we solve problems. They include the abilities to examine a problem, define it, decide upon a course of action, implement a plan, assess how well the plan is working, and take corrective action when necessary. We do things so automatically that we think of them, if we think of them at all, as taking place together; however, this is not the case. One might decide to go shopping and begin almost automatically to carry out that decision, only to discover that one’s keys are missing. One has used various executive functions (mental abilities) to assess the fact that a product is needed, decide to go buy it, and head out the door, but executive dysfunction in one small part of the brain has thrown off the whole plan. One of the executive functions (working memory) did not work as well as the rest.

In neurocognitive disorders problems are caused by executive dysfunctions.  Executive dysfunction due to problems in brain development or injury can lead to serious consequences. Communication, social functioning, school and career, and behavior can be expected to be impaired without normal executive functions. These, then, are what we must improve to pave the way for neurocognitive impaired individuals to reach their full potential.

Our executive functions have many components, all of which contribute to our understanding of the world around us:

Most people have the ability to perform all of these executive functions to some degree. The average person will find some of these functions easy and perform them with great success. That same person may find other functions more challenging and perform less well on tasks that require that type of cognitive ability. For example a person may find themselves easily distracted while completing a task but can calculate very well the amount of time required to perform that task based on past performance. Another person may have difficulty in realistically evaluating the time constraints but can devote unwavering attention to the task at hand.

Executive Functions and Neurological Disorders

Extensive research has shown that the problems patients face with autism, ADHD, stroke, and traumatic brain injuries are due to actual physical underdevelopment or injury to the brain. Most of the difficulties they face are due to dysfunction of the part of the brain known as the frontal lobes, where most of our thinking takes place. This is not to say that these individuals are mentally retarded—on the contrary, if intelligence is assessed in a way that accounts for functional deficits in some cognitive domains, these patients may have normal or above average intelligence. The ability to score high on a particular test of intelligence does not tell the whole story of how the brain is functioning. Individual parts of the brain have specific functions, and woe to the individual who lacks one of the many functions needed for communication, behavior, or cognition.

Executive Functions and Social Functioning

When it comes to social functioning, two of the most important executive functions are our working memory and our inhibitory control. Our working memory lets us hold a picture in our mind of the final goals while completing the intermediate steps. For example we can remember where we put our keys (most of the time), and we can remember to buy bread on the way home from work if we ran out at breakfast.

Our inhibitory control allows us to put restraints on ourselves and not succumb to thoughts or impulses that may render us socially unacceptable or even get us into trouble – like losing your temper when you cannot find your keys or not paying for the bread at the store. We can evaluate the consequences of our actions, and make sure that negative consequences do not happen to us.

Assessing Executive Dysfunction

There are a number of different tests that are used to check for the possibility of executive dysfunction in children. Generally, people closest to the child (such as parents or teachers) identify key traits in the child that may be linked to executive dysfunction, such as a short attention span or the inability to complete simple tasks despite an otherwise normal level of intelligence. Parent’s often voice concern when the child is unable to regulate his or her behavior in common situations. Whether directly or through a pediatrician or teacher, the child is then seen by a neuropsychologist.

Remedies for Executive Dysfunction at Home

For the majority of us executive functions are automatic and require very little thought (take the earlier example of crossing the road). For a child with executive dysfunction, however, it can be a difficult path—literally.

Unfortunately for children with autism, typical schooling techniques assume that executive functions are already present and reasonably developed upon starting kindergarten. This is usually why children with executive dysfunction struggle in a normal school environment. In fact, the best place for executive function training is usually within the home, by using normal everyday activities as a training tool. When presented with a particular task within the home, the child should be asked to rate how difficult he feels the task will be and why in his own language. This encourages the child to think about all possible outcomes and helps to identify any obstacles or barriers as they arise. Throughout the task, ask the child how he or she is doing; this encourages more thought as to how to complete the task. When the task is complete, ask the child how he thinks he did on the task. This will motivate him to evaluate his performance and think about the task as a whole.

A simple example of this sort of task is asking the child to put away his toys. The goal has been presented to the child and the parent can guide the child along the logical steps to achieve that goal. There is an obvious path to completion of the task however the parent must ensure that the child is taking the correct steps, in the correct order, and understands why he has made the decision to follow those steps:

In his groundbreaking work, Vygotsky discovered that children do better at a task with adult mediation than on their own. This led to the idea of the adult as a mediator of cognitive skills, or a collaborator, rather than as a storehouse of information. The mediator serves as the child’s consciousness, constantly evaluating the task, rather than as a human instruction manual.

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References:

Dawson, P. & Guare, R. (2004. Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention. New York, NY: Guildford Press; 2004.

Lezak, M. (1995). Neuropsychological Assessment. (3^rd ed.). New York: Oxford University Press.

Marlowe, W. B. (1992). The impact of a right prefrontal lesion on the developing brain. Brain and Cognition, 20, 205-213.

Vygotsky, L. S. (1978). Mind in Society. Cambridge, MA: Harvard University Press.

Williams, D., & Mateer, C. A. (1992). Developmental impact of frontal lobe injury in middle childhood. Brain and Cognition, 20, 196-204.