Executive Dysfunction 101: Signs, Symptoms, and How to Treat It

1. What is Executive Dysfunction?

2. How does Executive Dysfunction relate to ADHD? 

3. What Causes Executive Dysfunction? 

4. Symptoms and Manifestations: What Does It Look Like?

5. How to Fix and Treat Executive Dysfunction

6. How is Executive Dysfunction Diagnosed?
   

1. What is Executive Dysfunction? 

Executive Dysfunction describes a range of cognitive, behavioral, and emotional challenges that impact a person’s capacity to function productively on a day-to-day basis.  More specifically, Executive Dysfunction is a disruption in a person's own “air traffic control” system, affecting the brain’s ability to plan, self-monitor, organize, balance time and  emotions, and complete tasks.

While often referred to as Executive Function Disorder (EFD) or Executive Processing Disorder, Executive Dysfunction is not an official disorder or diagnosis,  but rather an impairment in the parts of the brain that affect the Three Core Pillars of Executive Function:

• Working Memory: Retrieves and processes a limited amount of stored  information in order to effectively focus and maintain attention and manipulate this  information to complete tasks efficiently.
• Cognitive Flexibility: The ability to start tasks and easily switch between different demands and projects, involving preparing, organizing, and ranking a series of steps to reach specific goals and problem solve.
• Inhibitory Control: Managing and adapting emotions to proactively regulate impulses and responses to internal and external influences. 

2. How Does Executive Dysfunction Relate to ADHD?

Although Executive Dysfunction and ADHD are interconnected, they are distinct concepts. ADHD is a neurodevelopmental disorder that's broadly characterized by symptoms of inattention, hyperactivity, and impulsivity. In comparison, Executive Dysfunction refers to difficulties with specific cognitive processes, such as planning, organization, initiation, and completion of tasks, outside the context of the source for those challenges. 

Up to 90% of those diagnosed with ADHD struggle with Executive Dysfunction. However, it's important to note that a person can experience Executive Dysfunction without having ADHD. This is because ADHD regularly involves a number of other symptoms, risk factors, and challenges that are not associated with Executive Dysfunction alone.

Although those without ADHD can and do experience many of these same symptoms from time to time, Executive Dysfunction is far more frequent, disrupting, and all-encompassing than it would be for someone without ADHD -which is why Executive Dysfunction is often called “the hidden symptom” of ADHD. These challenges can cause significant difficulty in school, work, personal relationships, and overall health and well-being. Because of the correlation between ADHD and Executive Dysfunction,  learning to manage the serious consequences is essential for long-term success.

3. What Causes Executive Dysfunction?

Although the full picture of what causes Executive Dysfunction is not completely understood, in most cases, the issues can be traced back to disruptions in brain development and neurochemistry within  the prefrontal cortex (the part of the brain responsible for our Executive Functioning.) These disruptions can have a variety of root causes that vary from person to person including:  

Learning Differences: Certain learning differences such as ADHD, autism, and dyslexia, for example, can lead to Executive Dysfunction. 

Genetic Factors: Research suggests that genetics can play a role in Executive Dysfunction. Some genetic variations have been linked to differences in a number of cognitive functions including Executive Functioning.

Psychological Factors: Psychological factors such as anxiety, depression, trauma, and other mental health issues can also cause Executive Dysfunction

Sleep Deprivation:  Getting enough sleep is essential for optimal cognitive function, including executive functioning.

Environmental Factors: Environmental factors that involve high levels of stress such as tense living environments, hectic schedules, difficult course loads, and hefty work demands can all exacerbate Executive Dysfunction. Other environmental factors that can contribute to Executive Dysfunction include nutrition, exercise (or lack thereof), and overall physical health,

Brain Injury: Brain injuries, such as a concussion or traumatic brain injury (TBI), can lead to Executive Dysfunction. This is largely because the prefrontal cortex is located in the front of the brain, making it particularly vulnerable to injury. The severity and duration of Executive Dysfunction after a brain injury can vary depending on the extent and location of the injury. 

4. Symptoms and Manifestations: What Does It Look Like?

As explained , Executive Dysfunction relates to a disruption in our ability to plan, organize, initiate tasks, and sustain attention - but what does that actually look like in day-to-day life?  

Executive Dysfunction can manifest as a number of unique symptoms, all of which pose their own problems and can greatly hinder our ability to succeed. Here are the most common symptoms of Executive Dysfunction and how each one connects  to the Executive Function skill they most likely relate to:

Procrastination vs. ADHD Paralysis

Of all the Executive Dysfunction symptoms, procrastination may be the most common and widespread. However, it is important to distinguish the inability to start tasks that seem too overwhelming versus simply choosing to delay. 

At times, even successful, high-achieving individuals may struggle to begin a difficult or less-than-exciting task. Yet,  when this becomes a regular habit - one that leads to last-minute scrambles, wasted time, stress, and missed opportunities - it can have serious consequences on our academic, professional, and personal lives. 

Those experiencing Executive Dysfunction may struggle to start tasks, even when they are aware of what needs to be done. This habit is often a coping mechanism to avoid the discomfort of a difficult task or responsibility.

Related Executive Function Skill: Task Initiation

Time Blindness

Time blindness is a difficulty or inability to sense the passage of time. Disruptions with time awareness, whether minor or substantial, can affect numerous areas of an individual's life. Underestimating or overestimating how much time has passed, how long a task will take, or how much time is left before an appointment starts can greatly reduce productivity. 

Ongoing difficulty meeting deadlines or arriving on time, difficulty forming realistic schedules or sticking to a schedule, and constantly losing track of time are all examples of time blindness. Time blindness can show up in multiple forms and, left unchecked, can greatly diminish our ability to be happy and successful. 

Related Executive Function Skills: Planning & Prioritizing 

Disorganization & Clutter

Executive Dysfunction can lead to difficulties with organization that impact us in a variety of ways both physically and mentally. The term “disorganization” encompasses issues with keeping track of personal belongings, maintaining an orderly space, organizing thoughts and ideas, and managing deadlines. 

Chronic disorganization can have serious consequences including misplaced assignments, heightened stress, relationship problems, financial impacts, and more.

Related Executive Function Skill: Organization 

Emotional Dysregulation: Today's world puts a constant strain on our ability to control inhibitions and regulate emotions.  Challenges with self-care, heightened stress, and intense anxiety often lead to impulse decision making by not allowing a person the time to think through options thoroughly. . 

People struggling with Inhibitory Control experience a rollercoaster of unchecked emotions without the understanding of how to manage even normal levels of emotional highs and lows, causing uncontrolled outbursts and frenzied behavior. Left untreated, this Executive Dysfunction results in rash decision making, hindering these individuals from processing information adequately or weighing out the consequences of decisions clearly.   Related Executive Function Skill: Impulse Control & Sustained Attention 

Working Memory Challenges

As defined, working memory refers to the brain’s ability to hold information in the mind and manipulate it to solve problems or complete tasks. Essentially, it’s processing short term memories and using them to adapt to new situations.  

Individuals with Executive Dysfunction may struggle with working memory, leading to challenges retaining information, applying what they’ve learned, following multi-step instructions, and keeping track of details.This can significantly impact an individual's power to think flexibly and switch between tasks or perspectives, resulting in difficulties adapting to new situations or making decisions. 

Related Executive Function Skill: Working Memory

5. How To Fix and Treat Executive Dysfunction 

Although Executive Dysfunction can make life infinitely more difficult, it’s important to remember that the challenges and symptoms that come with it are indeed treatable.

Some of the most effective executive dysfunction treatments include medication (i.e. stimulants and antidepressants), Cognitive Behavioral Therapy and professional coaching to improve habits, and practical lifestyle changes. 

Explore the 3 most effective support options for Executive Dysfunction treatment  for you and your child so you can consider the right path in how to fix Executive Dysfunction moving forward.

Clinical Treatment & Therapies

ADHD Medication: 

Medications used to treat Executive Dysfunction are often the same ones used to treat ADHD symptoms because they target the underlying causes of the disorder within the brain and can include stimulants and non-stimulants often prescribed for ADHD, antidepressants, and sometimes antipsychotics 

Stimulants and non-stimulants pharmaceuticals that help manage ADHD, work to improve Executive Dysfunction by increasing the levels of dopamine and norepinephrine. These key neurotransmitters in the brain aid in  alleviating many of the Executive Dysfunction symptoms we’ve discussed so far (particularly ones rooted in chemical imbalances in the brain such as inattention, poor impulse control, and hyperactivity.)  By increasing the levels of these neurotransmitters, ADHD medication can improve attention, working memory, and impulse control and help individuals with ADHD to better plan, organize, and complete tasks. 

However, it's important to mention that medication is rarely a one-stop, magical cure for Executive Dysfunction and it's often used in combination with the other interventions addressed later. . The decision to try an ADHD medication for Executive Dysfunction should always be done under the supervision of a licensed medical professional, particularly those with expertise in the field of ADHD, who can help determine the best course of treatment based on individual needs and circumstances.

Cognitive Behavioral Therapy (CBT):

This type of Executive Dysfunction therapy takes a structured, evidence-based, and goal-focused approach. Cognitive Behavioral Therapy treatment involves talk therapy to combat anxiety and depression associated with negative self-talk and provides coping strategies for stress and other Executive Function symptoms to promote healthy thought patterns.

During CBT for Executive Dysfunction treatment,  a mental health professional or counselor will engage in a supportive, safe, and open dialogue format based on the set goals you want to accomplish. These sessions include both discovery and positive behavioral adoption:

• The discovery process allows your therapist to ask questions to clearly understand your challenges, symptoms, and past behaviors in a nonjudgemental way. You’ll both uncover any fears, unhealthy emotions, or negative thoughts that might be delaying the path in reaching your goals.
• The next phase is taking what you’ve learned and applying effective strategies to overcome challenges and reverse negative thinking and behaviors. With the support of your therapist, you’ll explore ways to implement positive thought patterns and healthier habits. 

Professional Support Systems

Executive Dysfunction affects the ability to perform efficiently at home, school, and work. However, professional support treatment exists to assist in managing day-to-day projects and responsibilities to help you excel in these critical areas.

Executive Dysfunction Coaching:

Although medication and therapy can significantly improve Executive Dysfunction symptoms, they may not be able to overhaul deeply ingrained habits that could be perpetuating the problem, nor can they provide flexible support, accountability, or mentorship to guide the difficult journey of behavior change. When more support is needed to adequately address the full scope of the challenges you're seeing, Executive Function coaching may be the ideal support option.

Executive Function coaching is an Executive Dysfunction treatment approach that teaches people of all ages how to better manage their tasks and responsibilities. EF coaches accomplish this by providing tools and strategies that are used to help clients better manage their time, plan, organize, prioritize, focus, and work more efficiently. Through ongoing 1:1 support, those in coaching use their demands in school, work, or in their personal lives as the proving ground for implementing new strategies and approaches that, in time, help transform deeply ingrained habits and behaviors that hinder one's ability to function at their peak potential. 

Since 2006, we have worked with thousands of individuals with Executive Dysfunction and associated ADHD to help them successfully plan their work, persist with those plans, and gain true insight into who they are and what they need to be happy, productive, and confident. In fact, over half of the clients we work with have ADHD. You can learn more about our outcomes for Executive Function coaching across age groups here. 

School & Workplace Accommodations:

When learning how to deal with Executive Dysfunction and ADHD, it’s important to build accommodations that support cognitive deficits and build skills for success. However, it may take some time and persistence to find the accommodations that work best for you at home and in the classroom or office as they should be tailored to specific needs and preferences. Some Executive Dysfunction strategies to try include:

• Sit at the front of the classroom to manage distractions
• Use checklists to organize tasks
• Follow daily routines
• Use timers to set focus time
• Give daily report cards to track and encourage progress
• Use rewards to encourage behavior
• Try assistive technology like apps
• Meditate to stay positive and calm

Everyone has strengths and weaknesses. By providing the right support and resources, individuals with executive dysfunction can focus on their strengths and better manage their symptoms. This gives them a fair chance to succeed in academic, professional, and social settings.

Practical Lifestyle Strategies (How to "Fix" It Daily)

Lifestyle changes can be a critical component to greater understanding and better managing Executive Function as our brain’s performance is directly related to our overall health and well-being. Following these practical lifestyle strategies can help improve the overall symptoms and  guide you through how to fix  Executive Dysfunction: 

Externalizing Executive Functions: Alleviate some burden from your working memory by utilizing tools that help support the brain’s process of holding, manipulating, and calculating information:

• Planners and apps offer a powerful solution for scheduling, project organization and time management.
• Visualization helps connect information with memorable visual images or cues for faster recall from the mind later on.
• Chunking captures information and breaks it down to smaller groups of data for better long-term retention.
• Note taking is a proven approach to summarizing and organizing larger amounts of information into more manageable talking points for easier comprehension. 

The Environment:  As previously stated, there are many external factors that can interfere with Inhibitory Control and how the brain is able to stop impulses and distractions from taking over. Using these effective strategies, you are better equipped in reducing friction and distractions in order to make good choices and lower cognitive overload:

• Determine what leads you to continued distractions by identifying the triggers which promote them. Factors like TV’s, phones, loud rooms, or busy locations cause unnecessary, yet preventable distractions.
• Removing and rethinking temptation by considering the consequences of succumbing to such temptations can help deter acting on them. 
• Working in intervals and scheduling time for specific tasks like checking email or messages, engaging with social media helps keep focus and reduce fatigue.

Gamification & Technology: Use applications that can help turn chores and habits into reward systems and dopamine hits for improved task completion: 

• To-do list apps like Habitica and Todoist make a game out of completing tasks by tackling quests or finishing chores  to earn gold or points. These apps allow you to track progress for consistent productivity. 
• Brain training apps such as Lumosity, Peak, and Elevate offer puzzles and games with quick mental rewards to improve cognitive skills. 

Strategies for Adults vs. Strategies for Parents:

Understanding the difference between adult accountability and scaffolding parenting - bridging the gap between a child’s existing skills and knowledge and new ones - provides a good foundation for combating Executive Dysfunction.

Adults need self-accountability systems in place to take ownership of choices and responsibility for the mistakes they make to help build trust and confidence in themselves and from their child. Scaffolding parenting, in comparison, relates to being a good role model for your child and being able to demonstrate positive behavior while effectively describing new concepts to your child. When you’re scaffolding, you’re starting with a solid adult foundation and building around what your child is building.

6. How is Executive Dysfunction Diagnosed? 

Executive Dysfunction is not an official disorder that can be diagnosed by a medical professional. However, there are a number of evidence-based tools used by psychologists and other mental health specialists that can be used to evaluate executive function skills and rule out any underlying conditions. These screening assessments include:

Comprehensive Executive Function Inventory: This scale illuminates EF strengths and weaknesses in children from 5-18 years old by evaluating questionnaires completed by adults close to the child. These can include parents, teachers, family friends, and other adults who spend a significant amount of time with them.

The Conners Comprehensive Behavior Rating Scale (CBRS): Like the previous assessment, this evaluation involves adults close to a child filling out a multiple choice rating scale to recognize whether ADHD symptoms are present. 

Barkley Deficits in Executive Functioning Scale for Adults: When undertaking this evaluation, you and an adult who knows you well both report on your EF skills including organization, planning, time management, and emotional control.

Stroop Color and Word Test: This neuropsychological assessment evaluates your ability to think before speaking or reacting to stimuli. It is to look at impulse control in both adults and children.

If Executive Dysfunction is negatively impacting your daily life, these evaluations may give you clarity on causes, along with your strengths and weaknesses. Some are available online, but others are administered by a medical professional.

The Takeaway

Although Executive Dysfunction can be difficult to manage, you are not alone. Support systems are in place to  properly treat  Executive Dysfunction with the right combination of knowledge, treatment strategies and therapies,  and diagnostic tools.  Start conquering the Executive Dysfunction that's preventing you or your child from living a healthy, happy, and successful life. Get personalized guidance and answer all of your questions.  Book a free consultation today!