What is an Executive Dysfunction
The executive functions represent a collection of brain processes which are responsible for higher order processing skills necessary for cognitive control of behaviors. The primary skills of executive processing include inititing, guiding, directing and managing all cognitive, emotional, and behavioral function during a variety of tasks. The ability to execute any activity and to solve problems is dependent upon the ability to have purposeful and goal directed behavior. In order for this to occur, there are a variety of interrelated cognitive functions that must work together effectively and efficiently. These cognitive functions can be divided into three primary categories.:
- Working Memory
- Cognitive flexibility
These cognitive functions are responsible for regulating the executive processes by mediating the following behaviors:
- Initiation of a behavior
- Manipulating information in the mind
- Inhibiting competing stimuli
- Behavioral and emotional control
- Problem solving skills
- Distinguishing and selecting relevant tasks from irrelevant tasks
- Planning and organizing information
- Monitoring and evaluating one’s own behavior
From a brain location standpoint, executive functions reside primarily in the frontal lobes of the brain with specific functions located in the prefrontal regions of the brain. These frontal regions have dense neuronal interconnections with other cortical and subcortical regions of the brain such as the limbic system, the reticular activating system, the posterior association cortex, the arousal system, and the motor regions of the brain.
Executive dysfunction can arise from any disorder or dysfunction within any component of this frontal system network which connects the frontal regions of the brain with other cortical and subcortical regions of the brain.
Signs and Symptoms
The signs and symptoms of executive dysfunction vary depending upon the presence of other conditions and the age of the individual (ie. preschool child, adolescent, adult).
The executive system development begins at the preschool level and continues through adulthood and becomes highly differentiated with age. The development of this system is prolonged and is one of the latest developing cognitive systems which extends into adulthood.
In early childhood academic performance is associated with executive functions. Early intentional self-control behaviors and goal directed behaviors are the first signs of a developing executive system. Working memory, shifting attention, inhibition, goal monitoring, and behavioral regulation predict academic achievement and learning ability in later years. As the executive systems develop there are different signs and symptoms that may indicate that there are difficulties with executive functions. The following represents some of the most common signs that their may be an executive dysfunction:
- Difficulties controlling impulses ad behavior
- Difficulties shifting from one activity to the next and making transitions
- Difficulties adjusting behavior to changes in the environment or schedule
- Difficulties with problem solving skills
- Emotional responses do not fit the situation or context, not appropriate
- Unable to monitor one’s own behavior and its impact on others
- Unaware of their own strengths and weaknesses
- Difficulties with memory
- Cannot plan or organize information well
- Cannot keep school or work material organized, workspace or bedroom disorganized
- Difficulties with task completion, does not complete tasks in a timely manner
There is growing evidence that a variety of neurodevelopmental and behavioral disorders or delays in preschoolers can result in difficulties with the development of the executive system. These delays include difficulties with literacy skills, math skills, behavioral regulation, and overall academic struggles. These executive system disturbances are often identified later in school-aged children and adolescents because of the nature of the later development of certain executive functions such as planning, problem solving, reasoning, self-awareness, flexibility and organization. Other external factors such as parent-child relationships, stability of the home environment, and quality of play and early childhood experiences, all impact the development of executive functions. Biological factors such as genetics, hormones, neurotransmitters, and neural circuits which are all sensitive to the external environment also play an impactful role in the development of the executive system.
Impaired executive functions are commonly observed in two specific neurodevelopmental disorders: autism spectrum disorders and attention deficit/hyperactivity disorder with the occurrence in ADHD as high as 1 in every 15 children diagnosed with ADHD. Some other diagnoses that include executive dysfunction as part of the clinical picture include:
- Learning disabilities
- Memory deficits
- Cognitive deficits
- Head injury
- Anxiety disorders
- Mood disorders
- Oppositional defiant disorder
- Conduct disorders
- What is the Treatment for Executive Dysfunction
Many of the treatments for executive dysfunction, especially in older children, adolescents and adults are based on the premise that because they share similar neural circuitry, treatment should target only a limited number of sub-skills of the executive system. An example of this is treating the sub-skills of working memory and/or inhibition, with the hopes of remediating executive dysfunction.
Integrating neurofeedback methods with other direct interventions such as Cogmed, can further increase treatment outcomes by decreasing time spent in treatment and by allowing the client to execute and practice newly acquired skills.
With neurofeedback, we have the capacity to train the neural circuitry directly as opposed to the skills supported by the neural circuitry. This allows us to target the specific neural foundations which control the executive systems which in turn results in remediation of multiple sub-skills simultaneously.
Home and classroom environment interventions are also an integral part of the overall intervention program. Once the brain begins to change through the neurofeedback, both the patient and their family will need to gradually change the environmental modifications which have been put in place to help reduce the impact of the executive dysfunction.