Executive Function Disorders

“Difficulty with the process of coordinating, prioritizing, and/or managing information needed to perform tasks successfully may be indicative of a disorder of a child’s executive functioning abilities.”

A child with an executive function disorder may be highly intelligent, but they may also struggle to complete seemingly simple tasks, such as remembering to hand in their homework.

What are Executive Functioning Skills?

Executive functioning skills are cognitive based skills that help individuals plan, direct, and execute actions in their daily lives.

Lower-Level Executive Functioning Skills impact regulation of behaviors.

Higher-Level Executive Functioning Skills are meta-cognitive based.

Some executive functions include…

  • Planning and Prioritizing

This refers to the ability to “see and create” order, related to the individual’s life. Deficits in this area are evidenced by disorganization of materials and home/work spaces, as well as memory deficits.

  • Starting a Task (aka “initiation”)

This refers to the ability to begin actions in regards to activities or tasks. Deficits in this area are evidenced by difficulties “getting started” –even with help. Individuals who struggle in knowing where/when to “start” or those who cannot “get going” without extensive support from others could be experiencing an executive function disorder.

  • Controlling Impulses (aka “inhibition”)

Inhibition refers to the ability to control impulsivity and stop inappropriate actions and/or thoughts at the appropriate time. Delays in this area are evidenced by inappropriate comments and actions. Individuals who struggle with inhibition often “act before they think” or “lack a filter” for the things they say to others.

  • Shifting (aka “transitions”)

Deficits in this area may inhibit a child from switching focus between tasks fluidly or showing “flexibility” in thoughts, words, and actions. Individuals who struggle with transitions may become stuck on certain problems, topics, or activities. (See previous post “Trouble with Transitions”)

  • Controlling Emotions (aka “regulation”)

Deficits in this area are evidenced by mood swings and “dramatic” reactions to seemingly small problems. Individuals who struggle with regulation cannot change their reaction based on facts and may assume information or “jump to conclusions”, which supports their inappropriate reactions.

  • Using Working Memory

This refers to the ability to hold onto information while doing something with it. Deficits in this area are evidenced by difficulty in completing tasks. Individuals who struggle with working memory may start tasks but “lose-track” midway through.

  • Organizing Materials

This refers to the ability to plan and organize tasks related to projects. Individuals who struggle with this area may begin a task at a midway point rather than the beginning, start a task too late, or not have everything they need to complete a task upon starting.

  • Self-Monitoring

This refers to the ability to evaluate and monitor one’s own time and attention. Poor attention, poor timing, and an irregular pace at which to meet the demands of tasks/environment are common features associated with deficits in this area of executive function.

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Some children with executive functioning deficits may develop these skills later than their peers (delay) or experience ongoing weaknesses (deficit).

All of these skills develop differently and vary depending on a child’s age, degree of difficulties, and strengths in other areas.

Executive Function & The Brain:

“It is theorized that, although executive functions use multiple areas of the brain, these skills are based in the frontal lobe, acting as part of the executive system. It is a higher order process that involves connecting past experiences to present novel experiences to control and regulate one’s abilities and behaviors. This allows one to anticipate outcomes and adapt to changing situations in order to manage oneself and one’s resources to complete a task and/or achieve a goal.”

Executive Function Development:

  • Executive functions begin developing in infancy and continue to develop through adulthood.
  • In childhood, executive functioning delays are often seen in individuals with diagnoses such as ADHD, ASD, or other learning disabled.
  • Executive functioning skills may also be infiltrated by strokes, traumatic brain injuries, and the on-set of neurodegenerative disorders in older populations.

Assessment and Treatment:

An SLP’s intervention for executive functioning skills focuses primarily around the language aspects of the disorder. As previously mentioned, higher-level executive functioning skills involve meta-cognition, which is the process of “thinking about thinking”. These skills are language based because they involve self-talk and language processing in order to monitor, plan, and execute actions.

The assessment of executive functioning delays may be completed via formal assessments, informal testing, and observations.

REMEMBER…

“Formal assessments identify delays in an isolated and structured testing environment, while informal testing and observations take into consideration the impact of the delays across a person’s day in a variety of settings.”

THEREFORE…

A combination of assessment styles ensures the SLP or team of professionals working a case have full insight on the individual, and can create an effective and functional therapeutic intervention plan.

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A speech-language pathologist plays a vital role in the identification, evaluation, and management of executive functioning delays and disorders, especially those involving higher-level metacognition and the language-based needs of the individual. A full assessment of the child/adult involves a dynamic assessment as well as observations to help ensure therapy is functional and generalizes across environments. While executive functioning skills impact every aspect of daily living, a solid treatment plan can immediately begin improving an individual’s quality of life.

 

Ashley DiGregorio M.A., CF-SLP, TSSLD

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