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What is Executive Functioning? Issues, Diagnosis, & Treatments

What is Executive Functioning? Issues, Diagnosis, & Treatments

What is Executive Functioning?

When looking at early childhood development, it is important to assess executive functioning abilities. Executive functions are a set of cognitive abilities and processes that are broken down into four main areas: working memory, cognitive flexibility and inhibitory control, sequencing and organizing, and abstract thinking. These are skills that are used throughout daily life, including skills for learning, working, setting goals, making plans, organization, regulating emotions, and controlling our overall behavior.

Executive functioning skills develop throughout early childhood and continue to develop into early adulthood following the development of the frontal lobe of the brain until a person is in their mid-20s. Issues with executive functioning can lead to problems in all areas of life from managing activities of personal care and daily life to doing things efficiently at school or at work.

Executive Functioning Issues

Issues with executive functioning abilities are often found with individuals also experiencing attention deficits or poor impulse control and thus most people with a form of ADHD often have weaknesses in areas of executive functioning although executive functioning problems can exist on their own or in the presence of other mental health problems. Executive functioning issues often show up as difficulty starting, completing, switching between, or prioritizing tasks; struggling with short-term memory, such as forgetting something that was just said, following directions, or forgetting where belongings were placed; difficulty managing and organizing thoughts, belongings, and time; struggling with changes of routines or rules, and becoming overly emotional.

The causes of executive functioning issues are thought to derive from two main factors:

  • Differences in brain development. Research has shown that certain areas of the brain particularly the frontal lobes, develop at different rates in different people, and those whose brains develop more slowly or in a different way tend to struggle with executive functioning.
  • Genetic predisposition. Difficulties with executive functioning are often found to be hereditary, as they are often found to run in families similar to the genetic heritability of ADHD

Diagnosing Executive Functioning Issues

There are many different tests to assess the specific skills associated with executive function and ways to assess underlying brain functional problems that can be associated with executive function problems. These tests should be done as part of a full evaluation, as they will give a fuller picture of the different challenges and issues a child or an adult is facing. Testing is generally done by a psychologist, though it is possible for it to be done by other professionals in certain instances.

Tests for executive functioning are available in two forms: 1) behavior ratings to help assess the presence and degree of executive problems as provided by the patient themselves and others who observe the patient frequently and 2) performance tests that require the patient to actually perform tasks associated with the class of executive function problems and behavior problems often associated with them. As ADHD type of problems often coexists with Executive functioning problems, behavioral ratings and performance measures of attention are often conducted. There are several rating forms that are available to be used and there are several forms of computerized continuous performance tests (CPTs) that can be administered to measure attention and response control abilities. There are also specific tests to assess aspects of working memory, mental flexibility, ability to plan or sequence and organize information, and the ability to think abstractly. Abstract thinking is the ability to understand concepts that are real, such as freedom or vulnerability, but which are not directly tied to concrete physical objects and experiences. Abstract thinking is the ability to absorb information from our senses and make connections to the wider world. All measures are scored and then compared to expected scores for age and these abilities are expected to change with age and the development of the brain.
Sometimes, functional measures for the brain such as quantitative EEG (qEEG) can be used to assess brain function in order to determine if areas of the brain involved in attention regulation and aspects of executive functioning are not working in an expected way for the age of the patient. This tool is another way to further confirm problems in the brain-behavior relationship that can lead to problems with executive functioning.

Treatments for Executive Functioning Issues

There is no one size fits all treatment for executive functioning issues. As there are many ways these issues can present, the way it is treated will vary. Different techniques for treatment include forms of psychotherapy, such as cognitive behavioral therapy (CBT), which is designed to help manage specific behaviors; medications, such as ADHD medication for those diagnosed with ADHD; forms of Neurotherapy such as neurofeedback therapy: teach” the brain to improve its abilities that can then help to improve the development of these skills, and various “coaching” methods that often provided by counselors, teachers, or occupational therapists to develop strategies and habits and promote executive function skills.

Get in Touch with Us

As treatments will vary from one child to another, it’s important to have you or your family member be assessed to ensure that specific needs are being met. Contact us today to see how our team of highly trained mental health and occupational therapists can work with you and your family to help overcome executive functioning challenges.

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