Table of Contents
What is Executive Functioning?
Executive functioning refers to the workings of the executive functions (EF), a set of mental processes involved in managing oneself and one’s resources in order to achieve a goal.1 There are three main areas of executive function:
Working Memory
This is the ability to keep information in mind so that it can be put to use (i.e. remembering what you are supposed to be doing when it is your turn again)
Mental/Cognitive Flexibility
The ability to see problems from multiple angles and find different ways to solve them (i.e. adjusting what you will do if something unexpected happens)
Inhibitory Control
This is about the ability to stop before responding on impulse, the ability to control one’s attention and behavior, and to manage one’s emotions. (i.e. taking turns) This also includes self-control.
Those who struggle with EF often have trouble focusing and paying attention, planning and organizing, starting and completing tasks, and shifting focus from one task to another.
Executive Function isn’t a reflection of intelligence, and Executive Dysfunction is not an official diagnosis in the DSM-5.
The ability to work effectively with others, with distractions, or with multiple demands all depend on EFs; EFs ‘manage’ skills that contribute to productivity, to maintaining a marriage or a job, to raising children, and generally to be part of civil society.
Executive Dysfunction
Executive function deficits may result from a variety of neurologic conditions, including traumatic brain injury, neurodegenerative diseases (including frontotemporal dementia), cerebrovascular disease, or a number of psychiatric and developmental disorders (including OCD, Tourette’s syndrome, depression, ADHD, and addiction).2
The prefrontal cortex (the front third of the brain) is important for EF because it is involved in controlling behavior through its interactions with all other parts of the brain. The table below shows the relationship between a region of the brain and the EF with which it is involved.
| Brain Region | Executive Function |
| Prefrontal Cortex | Behavioral Control Use of Rules |
| Anterior Cingulate Cortex | Error Processing |
| Basal Ganglia | Working Memory |
| Orbitofrontal Cortex | Risk/Reward Decisions |
| Hypothalamus, Thalamus | Reactions and Responses |
| Amygdala | Emotions |
Executive Functioning Skills
Self-Regulation
Self-regulation is the ability to monitor and evaluate one’s self efficiently and effectively. To evaluate one’s performance, to check that one is using goal-directed behavior, or that one is using the cognitive flexibility needed to solve problems and revise plans, self-regulation must be used. Self-regulation is key to function independently in all aspects (e.g. social situations) of life.
Cognitive Flexibility
Cognitive flexibility is the ability to adjust to changing demands or priorities and to approach something from different perspectives. This EF allows you to respond to unexpected or sudden situations, as well as to “think outside the box” when working to address a problem.
Working Memory
In addition to holding information in mind, working memory involves doing so while performing one or more mental operations. For example, keeping in mind a comment or question to express at the opportune time while following a discussion involves working memory. Reasoning and problem-solving require working memory since both involve keeping various bits of information in mind and working with it (e.g. by deconstructing it, rearranging, it, etc.).
Organization and Planning
Organization and planning skills are closely tied. Combined with setting priorities and task initiation, organizational EF is responsible for keeping track of things (e.g. belongings, dates, tasks, etc.), and planning EF is responsible for independently imposing structure and order on ideas, as well as thinking through steps toward a goal. While people with executive dysfunction of these skills may understand the value of exercising them, they have trouble implementing them.
Executive Functioning and Learning Disabilities
ADHD
Attention Deficit Hyperactivity Disorder (ADHD) and EF share many commonalities, the main difference between the two is that ADHD is an official diagnosis. ADHD is a brain-based condition that makes it difficult to concentrate, use working memory, organize, and manage oneself. Impulsivity and hyperactivity may also be present. Noticeable signs of ADHD include excessive fidgeting, trouble waiting for one’s turn, forgetfulness, and seemingly not listening when being spoken to. Additionally, a statistically significant percentage of children with ADHD also have dyslexia or learning differences (LD).
Dyslexia
Dyslexia is a brain-based condition that impacts reading, spelling, and writing. A lifelong issue that tends to run in families, dyslexia is a problem with understanding and working with language. Have trouble with rhyming or isolating sounds in words makes it difficult to match letters to their sounds (a process known as decoding). Also, many children with dyslexia have trouble with math.
Dyscalculia
Dyscalculia is a math learning disability. Around half of the children with dyscalculia also have reading issues. Individuals with dyscalculia may have trouble measuring ingredients when baking or calculating change in a transaction. Signs of dyscalculia become more noticeable as children become older and math becomes more complex but can appear as early as preschool.
One of the most common signs is trouble understanding quantity, including the concepts of more versus less, bigger versus smaller, or that a number stands for a quantity. Another sign is not fully knowing what numbers are or how they work- for example, not knowing that the symbol for a number and the written word of that number are the same. Children with dyscalculia may also have difficulties with procedural aspects of math, such as lining up numbers correctly to solve a problem.
New Science on Executive Functioning
Brain Scans
A study published in 2017 used diffusion scans (a type of MRI scan) to study how brain networks specialize with age and the impact this specialization has on EF.3
Such research has shown that EF development begins at a young age and changes over time, improving radically over the first few years of life and continuing through adolescence. By early adulthood, adult-type networks that are strongly activated have grown to connect different brain regions together, so EF is more specialized. The more specialized the brain networks, the better EF.
Brain Scans
A study published in 2017 used diffusion scans (a type of MRI scan) to study how brain networks specialize with age and the impact this specialization has on EF.3
Such research has shown that EF development begins at a young age and changes over time, improving radically over the first few years of life and continuing through adolescence. By early adulthood, adult-type networks that are strongly activated have grown to connect different brain regions together, so EF is more specialized. The more specialized the brain networks, the better EF.
Cognitive Studies & Measuring Interventions
A variety of interventions have been tried and tested in efforts to find a method for improving EF. It’s known that EF can be improved, at every age, and via diverse approaches (and indeed, here is a list of standardized interventions).4However, it is tricky to measure the effect of these interventions.
For instance, given that clinical evaluation of EF is typically office-based and individually administered, it has been shown that office-based neuropsychological measures of EF and actual behavior in a typical environment share little commonality.5
One opinion is that while it isn’t known how much EF can be improved or how long benefits last, or what determines how much and for how long they improve, testing whether programs (e.g. cognitive training, physical activity, etc.) characterized by complexity, novelty, and diversity are most successful at improving EF is needed.
Executive Functioning Tests
Tests for executive function can assess a variety of skills, and many tests, including the following, overlap in what they measure in that more than one skill is evaluated in a single test. This list is not comprehensive; there are also tests for executive function that assess skills like concept formation, set-shifting, and word and idea generation.
Testing Attention
The Test of Variables of Attention (TOVA) for children ages 4 and up primarily assesses the ability to pay attention but can also assess processing speed and inhibitory control. In a TOVA, a child is shown different letters flashing on a computer screen and is tasked with pressing a key every time a certain letter appears. In the Conners Continuous Performance Test II (CPT II), the child is instead asked to press a key every time the certain letter does not appear.
Testing Inhibitory Control
The Stroop Color and Word Test has a version for children ages 5 to 14 and an adult version for individuals 15 and up. This test measures the ability to think through a scenario before acting or the ability to restrain oneself from giving an automatic response. The test may also assess processing speed if it is timed. For example, an evaluator may show a child several written words for colors, where the color of each word does not match the color the word spells out. The child may then be asked to state the name of the color as opposed to the written word.
Testing Working Memory
The Digit Span and Spatial Span subtests of the Wechsler Intelligence Test for Children (WISC) assess working memory in children ages 6 to 16 (in addition, working memory tasks in the WJ-III Cognitive battery may be administered to children ages 2 and up). In a Digit Span subtest, an evaluator dictates a series of numbers and the child has to repeat them back in reverse order.
For example, the examiner may say “9, 6, 3,” and the child should repeat the sequence back as “3, 6, 9.” The Digit Span test measures verbal working memory, or the ability to store information that is heard. Similarly, the Spatial test measures visual working memory, or the ability to store information that is seen.
Testing Organization and Planning
For children ages 5 and up, the Tower of Hanoi is a test that primarily assesses the ability to plan, sequence, and organize information for use in problem-solving but can also assess working memory and inhibitory control. Similar tests include the Tower Test of D-KEFS (for ages 8 and up) and the Rey–Osterrieth Complex Figure Test (for ages 6 and up).
In a Tower of Hanoi test, a child is tasked with rearranging beads or discs to match a given model in as few moves as possible. However, the child must simultaneously follow specific rules limiting the way the beads/discs can be rearranged.
Executive Functioning Strategies
EF’s can be improved at any age with training and practice just as physical exercise hones physical fitness (and then individuals must “use it or lose it”)! The following strategies may be helpful for those with executive dysfunction.
Educational Consultants
An educational consultant is a consultant who helps students and parents with educational planning. Educational consultants typically aim to provide structure, promote emotional growth, and assist in developing a sense of personal responsibility. Particular emphasis is placed on developing the abilities to manage time well, follow through with commitments, or seek help when it is needed.
Educational Therapists
An educational therapist is a professional trained to understand a child’s learning challenges and the patterns or behaviors developed to work around/mask these deficits, and to then help develop strategies to get started on school work (ending procrastination), memorizing information, building new skills, and overcoming negative feelings that may be associated with learning.
Working with Schools
Use multisensory approaches to learning math, provide accommodations to give children extra time on tests and assignments, be given manipulatives such as base ten blocks, and number lines to figure out problems. It’s also helpful to play math-related games to work on math skills and everyday activities like cooking/baking.
For reading: specialized reading instruction (one approach, Orton Gillingham, helps children learn to break down words into their component sounds, match the sounds to letters, and blend those sounds together). Audiobooks are also helpful in some cases as well as text-to-speech software and reading apps; reading aloud every day, and playing rhyming games and singing songs.
Organizational Coaching
An organizational coach (also called executive function coach) isn’t the same as an academic tutor- rather than helping with subjects like history and science or skills like reading comprehension, an organizational coach aims to help develop time management and organizational skills that lead to more efficient learning.
Resources
- https://developingchild.harvard.edu/science/key-concepts/executive-function/
- https://memory.ucsf.edu/symptoms/executive-functions
- https://www.cell.com/current-biology/fulltext/S0960-9822(17)30496-7
- https://www.d181.org/uploaded/Parents/Family_Education_Events/STANDARD_INTERVENTIONS_FOR_EXECUTIVE_FUNCTION.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260811/
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