Executive functioning often comes up in my Facebook group where I provide free educational advocacy advice.  Many schools fail to recognize a child with executive functioning issues even though it is common for children with ADD, ADHD, and Autism along with many other conditions.   It is important a public school recognizes executive functioning problems and works with the child to put systems in place to help the child overcome their executive functioning issues.  Without help from teachers and adults, along with having positive supports in place, many children will feel overwhelmed and shut down in the educational setting.  Since the issue of executive functioning (EF) is so complex I have written another blog post to cover other areas of EF.

Executive function is a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.

For example, seeing a piece of chocolate cake on a dessert cart at a restaurant may be tempting. That’s where executive functioning can step in. The organizational part reminds you that the slice is likely to have hundreds of calories. Regulation tells you that eating the cake conflicts with goals you may have, like eating less sugar or losing weight.

ADHD/ADD is the hallmark condition for executive function impairment. The condition of ADHD/ADD is so pervasive in life it deserved its own blog post and is in the Blog section as well as hyperlinked in this article.  It is possible to distinguish someone with an executive function disorder from someone with ADHD by trying ADHD medication.  Someone with true Executive Function Disorder will not improve on ADHD medication.  My daughter, Margaret, is a great example of this.  We also happen to know she has Hypoxic Ischemic Encephalopathy (HIE).  She has a cyst, or hole, in her right frontal lobe.  The right frontal lobe controls reasoning, impulsivity, and emotional regulation. For her, ADHD medication would not improve her impulsivity and inattentiveness. She has a true executive function disorder versus ADHD but she also carries the medical diagnosis of ADHD. The ADHD label is appropriate since she has some ADHD characteristics too like always being in motion and people understand what ADHD entails versus executive function disorder.

Autism is another co-occurring condition that typically entails executive function disorder and/or ADHD. I am seeing more and more children with high-functioning autism being mislabeled as behavioral. I think much of this stems from poor executive functioning and lack of addressing sensory issues.  In a study released in 2017 showed children with Autism are often diagnosed with a host of learning and behavioral disorders including ADHD, Anxiety, Depression, and Disruptive Impulse Conduct Disorder.  I think all of these are related to executive functioning disorder and untreated sensory problems. I often hear from parents in my Facebook group (IEP/504 Assistance) say teachers make comments about their child saying, “Your child could have made better choices this year.” Really?  I think this is an indication the teacher needs training.  Obviously, the teacher does not understand how executive functioning works.  Students NEED structure and rules in place to HELP them make good decisions.
 

How it works: The evaluator shows a child the words for different colors written out. But the color of the ink doesn’t match the word that’s spelled out. For example, the word red might be written in green ink. As quickly as possible, the child must say the color she sees, as opposed to the word. The test is usually timed, so it also looks at processing speed. Kids who haven’t learned to read yet may perform a similar task with shapes instead of words. In this case, the child might see a circle in red ink. She then has to say the color, not the shape.

How it works: A child must rearrange beads or disks to match a model while following specific rules. A rule might be that the child can’t place a larger bead on top of a smaller one. The goal is to complete the task in as few moves as possible.

How it works: A child sees a grid of four boxes with pictures in them. The top row might have a big house next to a big apple. The box below the big house has a little house. The box under the big apple is empty. The child has to pick what logically belongs there (a little apple) from five choices. (The analogies are more complex for older kids.)

How it works: A child names as many words as she can, based on a certain letter. For example, she might have to come up with words that start with M. Or, on a harder version of the test, she may have to name as many kinds of fruit and furniture as she can, in pairs. She might start with apple/chair or banana/couch, and so on.

The Picture Arrangement (PA) sub-test of the Wechsler Adult Intelligence Scales (WAIS) is not really known as an executive test. In the ‘bible’ of neuropsychological diagnostics, Lezak’s Neuropsychological Assessment (2004), this test is never described as an executive function test.

Remember, executive functions are really several different cognitive functions all humped together: concept formation, formulating a plan (planning), formulating a goal, sequencing the correct order of steps to take in order to reach a goal or follow a plan (logical reasoning), executing the steps and monitoring your own actions, mental flexibility to reformulate a plan and change the actions to reach your goal/plan and the ability to control your automatic, instinctive or impulsive reactions in order to follow your action plan consistently. In short, executive functions are functions that represent goal-directed actions: taking initiative, planning, executing actions, monitoring and self-correcting those actions.