Executive Functioning 101
Executive functioning is a term we often hear when discussing our kids’ academic progress, but executive functioning skills are not limited to children in school. Executive functioning is a cognitive process that allows us to regulate our behavior and actively control our attention in order to accomplish a goal. These skills are the foundation for academic achievement in school as well as success in social settings and independent living.
During stressful times, people of all ages — including parents — will find their executive functioning impacted, forgetting appointments, struggling to complete work tasks quickly, and more. Students with ADHD, autism, and other learning disabilities who experience executive functioning challenges may have difficulty navigating tasks and assignments, retaining information shared during a lesson, and effectively managing their time while completing independent work.
So what exactly is executive function and what does executive dysfunction look like in kids? We spoke with Dr. Emily Haranin, child and adolescent psychologist at Children’s Hospital Los Angeles and clinical assistant professor of pediatrics at Keck School of Medicine at USC, as well as educational therapist Dr. Marcy Dann, Ed.D, BCET, FAET, of Bridges Academy to learn more about executive functioning and to find out how we can better support our children’s executive functioning skills.
What is executive functioning?
Executive functioning (EF) skills are the actions that enable self-regulation. As explained by the National Center for Biotechnology Information, EF is an “overarching term that refers to mental control processes that enable physical, cognitive, and emotional self-control and are necessary to maintain effective goal-directed behavior. Executive functions generally include response inhibition, working memory, cognitive flexibility (set shifting), planning and fluency. Deficits in EF are frequently observed in neurodevelopmental disorders, including autism and attention deficit hyperactivity disorder (ADHD).”
What does all of this mean, exactly? Executive dysfunction occurs when a person has difficulties managing their behaviors, thoughts, and emotions that are needed for everyday, self-driven activities. As Dr. Haranin reminds us, “Attention is one aspect of executive functioning — focus, shifting between tasks, going from one thing to another thing, self-regulation, memory.” But being able to sustain attention is only one aspect of executive function. A child with executive functioning challenges may also have difficulty with time management skills (being able to get everything in order, keeping track of all of the tasks to be completed, etc.). And there may also be difficulties with emotional regulation.
For example, without “inhibition control,” we would not be able to stop ourselves from doing things we shouldn’t do (impulse control) and focus on tasks of higher priority instead of following other competing thoughts (inference control). Working memory is part of the brain’s process of remembering and focusing on tasks you’re doing at the moment. (By reading and being able to understand and remember the contents in this article, you are using working memory.) Cognitive flexibility allows us to shift from one topic to another. These three processes — response inhibition, working memory, and cognitive flexibility — are the foundation of executive function. As these skills develop, higher-level functioning such as planning, fluency, reasoning, and problem-solving can occur.
As summarized by ADDitude Magazine, there are seven major types of self-control associated with executive functioning. These are:
- Self-awareness: commanding self-directed attention
- Self-restraint: inhibiting yourself
- Non-verbal working memory: holding things in your mind to guide behavior
- Verbal working memory: retaining internal speech
- Emotional: using words and images along with self-awareness to alter how you feel about things
- Self-motivation: motivating yourself to do things when no outside consequences exist
- Planning and problem-solving: finding new approaches and solutions
What are the signs of executive dysfunction?
Since executive function involves a number of processes, executive dysfunction can look different in everybody. As Dr. Haranin explains, “Executive functioning encompasses a range of different cognitive processes and strategies.” She uses the metaphor of an air traffic controller to describe how the brain has to work to prioritize information and make decisions to accomplish tasks. For example, she says, “How do I prioritize different information to work toward a certain goal? What information do I pay attention to? And what information do I screen out?”
Here are some examples of what difficulties with executive functioning may look like:
- Being very distractible or having trouble focusing on just one thing
- Focusing too much on just one thing
- Daydreaming or “spacing out” instead of paying attention (such as during a conversation, meeting, class, etc.)
- Having trouble planning or carrying out a task due to an inability to visualize the finished product or goal
- Having difficulty motivating oneself to start a task that seems difficult or uninteresting
- Struggling to move from one task to another
- Getting distracted or interrupted partway through a task, thus misplacing items or losing the train of thought
- Having problems with impulse control
- Struggling with thinking before you talk
- Having trouble explaining your thought process clearly because you understand it in your head, but putting it into words for others feels overwhelming
In a school setting, Dr. Dann explains that difficulties with executive functioning can look like struggling to meet deadlines, remember assignments, or recall the morning routine like needing to brush teeth and get dressed for the school day. It can also look like completing the assignment and then forgetting to turn it in, or forgetting the school books, supplies, and/or personal belongings needed to be successful. She describes these as production-oriented problems that parents usually begin to notice when they become concerned about organization and independence with school work.
How are executive functioning issues diagnosed?
There is no mention of "executive function disorder" in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, Dr. Haranin says, “we do know that most individuals with ADHD experience impairment in some of their executive functioning. So my goal as a psychologist is always to help figure out what a child’s executive functioning strengths and weaknesses are and how we can work with those to create interventions that are supportive.”
Dr. Dann explains that age and co-occurring diagnoses both determine when executive functioning difficulties present in kids. Most parents become concerned around fourth or fifth grade, as around this time, many kids start to show signs of more independence with the establishment of homework and school routines.
There are informal and formal ways of evaluating children to identify difficulties with executive functioning. Parents and/or the school can conduct at-home checklists, questionnaires, and evaluations to track behaviors seen at home and elsewhere. To help parents begin thinking about whether their child struggles with executive function, Dr. Dann recommends the questionnaire and book from Peg Dawson and Richard Guare as well as looking into the George McCloskey approach. Parents can also consider a formal psychoeducational or neuropsychological evaluation that addresses all learning areas, including executive functioning skills, conducted by a psychologist.
Executive functioning difficulties with co-occurring diagnoses
As Dr. Haranin points out, “Executive functioning is very broad, and there are a number of different diagnoses or conditions that can cause executive functioning impairment.” Because executive functioning plays a large role in learning and academic achievement, difficulties with EF are associated with a variety of learning disabilities. Executive functioning difficulties are also associated with autism, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). Children with executive functioning difficulties don’t always have these common co-occurring diagnoses, but children with autism, OCD, and ADHD likely struggle with executive functioning skills. While “it is currently unclear to what extent difficulties with EF contribute to the broad category of emotional and behavioral disorders,” the National Center for Education Research states that there have been several studies linking EF to social competence and social skills, especially in younger children.
Executive functioning and ADHD
While ADHD and executive functioning are tightly connected and may be approached similarly, they are not the same thing. Statistically, most people with ADHD struggle with executive functioning, but you can have executive dysfunction without ADHD. And according to Dr. Martha Bridge Denckla, while executive functioning difficulties can indicate ADHD, they can also indicate a learning disability, which is sometimes missed during evaluation, or misdiagnosed as inattentive ADHD.
It can be overwhelming trying to distinguish between EF and ADHD, and what treatment options are right for your child, but Dr. Haranin tells us the core interventions for ADHD and executive functioning difficulties are often the same: behavioral training or therapy with a focus on building strengths and addressing weaknesses. For example:
As Dr. Dann explains, since there can be so much overlap with EF and attention issues, it is good to have a licensed practitioner conduct a clinical comprehensive evaluation to help unravel and understand whether these EF difficulties are a part of a co-occurring condition. Students with executive dysfunction don’t always show the same behaviors seen in those with autism, OCD, and ADHD, but all sets of students benefit from having a structured environment.
How to help kids with executive functioning
As Dr. Dann puts it: prompting, prompting, and more prompting! Children with executive function difficulties can benefit from regular prompts and reminders that will help them meet their goals. Constant reminders can be frustrating for both parties, and can contribute to a child’s negative self-image, but we can get creative with how we supply these reminders. The Child Mind Institute lists a few different methods:
- Writing checklists
- Setting time limits
- Using a planner
- Explaining the rationale behind the action
- Exploring different ways of learning
- Establishing a routine
- Using rewards
In this clip, Dr. Dann shares a common piece of advice she gives parents to help them ensure their kid has everything they need before they leave school for the day, as well as how to reword questions in order to get the specific answer needed from their student.
Getting support at school for executive functioning skills
Eligible students can receive support at school through behavioral plans, IEPs, or 504 plans. In particular, IEP goals in vocational education, behavior, social-emotional needs, and academic function may be written to include executive functioning behaviors. Goals that target executive functioning behaviors should be strongly related to whatever educational goals the student is working on, and should be supported by providing students with structure in their learning environment. This can come from clearly knowing what is expected of the student and knowing what goals they are working toward.
Executive functioning skills can be worked on in 1-on-1 settings, whether it’s with an aide, a therapist, or a teacher, as well as in the classroom. For some students, learning to take turns during class discussions and withholding the need to blurt out is a great way to exercise the use of executive function.
Accommodations can also be incredibly helpful for students with executive functioning difficulties. Dr. Dann suggests the following:
- Mild to moderate prompting with school tasks
- Providing differentiations between these tasks, such as which tasks need more time or what should be prioritized
- Allowing extra time for transitions, i.e., moving from one task to another
- Getting explicit descriptions and making sure the student knows the task is meaningful to have a better understanding of “why”
In short, a student’s learning environment can be structured for success by providing prompting, differentiation, and extra time:
It’s important to remember, Dr. Dann says, that kids who struggle with executive functioning can experience greater anxiety when they begin to realize they’re not remembering on their own and have to rely on others. We can handle this sensitively and with compassion! The goal is to help our kids keep their self-esteem intact by supporting them with prompts, which helps them build that neurological connection so that fewer reminders are needed over time.
After all, supporting and improving executive functioning skills is a long process. Dr. Dann says that in her experience, students with EF difficulties are “consistently inconsistent,” but once parents realize this and look at improvement as long-term, frustration levels begin to go down. Over time, the amount of prompting can be reduced as the student becomes more independent.