Executive Functioning (EF)

Executive Functioning (EF) is an 'umbrella' term that essentially describes a set of skills that allow us to regulate our own behavior. Most experts agree that EF likley includes the following skills:1

Attention skills

Selective attention: the ability to efficiently 'filter' information; to detect information that is relevant and ignore irrelevant or distracting information.
Sustained attention: the ability to actively attend to a task, goal, or own behavior despite there being little stimulation for such continued processing.
Divided attention: the ability to monitor or attend to two things at once.
Shifting attention: the ability to shift attention between two or more tasks.

Thinking skills

Organization: the ability to arrange or place things in a meaningful system.
Planning: the ability to create a 'blueprint' or strategy for reaching goals or completing a task.
Time management: the ability to effectively estimate how much time one has, how to spend that time, and how to stay within time limits and meet deadlines.
Working memory: the ability to hold information in immediate awareness while performing a mental operation on that information.
Metacognition: the ability to think about one's own thoughts, behaviors, and feelings in a given situation. It involves being able to self-monitor or evaluate one's skills.

Monitoring/modifying behavior skills

Response inhibition: the ability to think before acting. Doing so, gives one the time to evaluate a situation and determine how one's behavior might affect it.
Self-regulation of affect: the ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior.
Task initiation: the ability to start a task without procrastinating.
Flexibility: the ability to revise plans or directed behavior when there are obstacles, setbacks, new information, or mistakes; adapting to environmental changes.
Goal-directed persistence: the ability to self-motivate and see things through to completion or reaching of a goal.

All of these skills encompass what we call "Executive Functioning" (EF) and as you can probably imagine, we are not born with them. However, as we develop past childhood they influence nearly all aspects of our day to day functioning. Importantly, people with ADHD have been identified as having deficits in these EF abilities. If you were to look at the list again, you will likely see how weak EF skills overlap with symptoms of ADHD.

But how are all of these skills related? How do we make sense of it? First, remember that all of these skills involve regulating and controlling some other aspect of our behavior. The ability to sustain attention, for example, involves having to sit still, turn your head toward an object, direct your eyes, avoid focusing on irrelevant stimuli, and so on. This one skill involves the collaboration of multiple behaviors and many different parts of the brain. This job of orchestrating and directing multi-component behaviors involves skills that we typically learn with time and through normal development. Even in adolescence, we are still working on these skills. Think about a teen learning how to drive a car. At first, the teen is not able to handle distractions very well and so much energy goes into the task of just driving the car. Parents (and sometimes law makers) ask that they do not talk on a cell phone, drink coffee while driving, turn the radio up too loud or engage in any behavior that might act as a distraction. All of this advice makes sense until the adolescent has developed those important EF abilities that make these tasks more managable.

Most EF skills are mediated by a part of the brain called the prefrontal cortex. It is esentially the "executive" part of the brain because it directs and controls many other areas. It is also the last area of the brain to fully develop. In fact, research suggests that it is still undergoing changes well into the second decade of life. This might explain why most of us do not get good at 'muli-tasking' until late adolescence or young adulthood. Unfortunately, this late development also means that it is most suseptible or sensitive to negative environmental influences. As a result, many neuological traumas and childhood neurodevelopmental disorders will often affect the prefrontal cortex and aspects of EF. ADHD is probably the most recognized disorder involving EF abilities.

The orchestra

If all of this still sounds a bit abstract, consider the following analogy of a musical orchestra.

An orchestra is divided into sections that include strings, woodwinds, brass, and precussion. All have important roles and add something to the overall sound. In the same way, the brain has different parts and functions, all contributing, but adding something different to how we experience the world and interact with it. But there is another part missing: the orchestra conductor. The conductor plays no instruments and adds nothing tangible to the mix, but is nonetheless very important. He or she controls the volume, tempo, pitch, and timing, and ensures that all parts of the orchestra are seamlessly working together. You might think of "executive function" to have a role similar to the conductor in an orchestra. It controls the volume, tempo, pitch, and timing of our behavior, thought, and emotions.

Interventions for weak EF skills

What can be done about weak EF abilities? Well, it depends on the cause. As already stated, EF involves a part of the brain that is still developing in the second decade of life; this means that these abilities will eventually come to most children. In other situations where these deficits appear to have an underlying cause, such as in ADHD, one might need to take a different approach.

Often times, it is neccessary for parents to become a "surrogate frontal lobe" for their child. What this means is essentially assisting the child with many of the things that they are unable to do, either because of developmental age, ADHD, or neurological injury. It is important to state that parents do not do the behavior for them (i.e. clean their room), but that they act as the "conductor," which would involve reminding them (often multiple times) about their need to clean their room and structure how they could go about doing that (i.e. start with the closet, put your books in one pile, your clothes in another, etc.). Again, the issue is not an inability to do a behavior... just to organize and orchestrate it. Parents need to be exceptionally patient in this role, but realize that by being the 'conductor,' you are teaching your child (and your child's brain) how to manage behavior and how to accomplish tasks and goals on their own. With practice, parents can begin to teach their children how to be their own conductor (i.e. "if the goal is to clean up your room, what would be a good first step? What could we do next?")

The following are some general suggestions for EF difficulties:

Structure and organization (keep an organized space at home and school)
Memory aids (i.e. use calendars, watches, reminders)
Planning ahead (anticipate challenges and plan how they will be handled)
Small steps (break down large tasks into smaller chunks)
Consistency with routines (i.e. have a set schedule at school & home)
Supervision (especially with children: help them when they get stuck)

Executive skills are broad and diffuse, so interventions need to be individually tailored, however, some of the basic things in the ADHD section also apply here; if you have not read it, you may want to review that article and some of the suggestions.