Executive Function Disorder (EFD) & Strategies

 

Sometimes, someone may speak of being unable to function well. Common examples include the inability to: pay attention; remember & manipulate new information & sensory input; stay on task & ignore distractions; multitask and ;regulate emotions. An onlooker may likely call this 'laziness'. While 'laziness' may relate to an unwillingness to function, a key aspect of this state of disfunction is that sufferers do not want to be dysfunctional; to not stay on task, to not focus and so on. The state is therefore one of great turmoil.

Unlike some of the other disorders that I have already discussed, EFD is not an official condition listed in the DSM-5. Consequently, mental health professionals will not diagnose EFDs specifically on the basis of a set of criteria. Rather, they will recognize its poor function and simply provide help for managing the associated issues or perceived cause(s). For this reason, it may be useful to think of EFD as being similar to a symptom (of other disorders listed below) rather than a condition on its own. If you wish to get some type of measurement, you can use special scales like the Barkley scale.

Executive Function Explained

Executive Function is an umbrella term. It refers to a group of interconnected processes in the brain. Together, they form a coordinating system. (Deborah Philips from Georgetown University refers to it as the 'air traffic control of the brain' that manages many 'planes' (or dynamic life variables) with perfect precision in order to avert disaster. It allows an individual to plan, remember instructions, juggle tasks and prioritize tasks to successfully complete everything that requires action during the day or life. Together they allow someone to set and complete goals. The 3 main components of executive function are as follows.

1. Working Memory involves processing information and managing many details in mind (so that they can be put into use). Good executive function allows us to best use our intelligence. (BTW, its function is not intrinsically related to levels of intelligence). 
2. Cognitive Flexibility (aka flexible thinking) refers to the ability to learn and adapt quickly (to unfamiliar or unplanned changes in the environment). When functioning well, one can not only switch to new vantage points from which to perceive problems but can also figure when and how to quickly shift between problem-solving strategies or mindsets.
3. Inhibitory Control (including emotional / self control) refers to the ability to concentrate and regulate emotions. It is particularly noteworthy during stressful situations and essential for changing (childhood) habits. If working well, it restrains someone from reacting on impulse in a way that may be deemed (socially) inappropriate.

Executive Functions Disorder (EFD) aka Executive DysFunction Examples

EFD occurs when executive function does not occur optimally. The experience is highly personal with signs and symptoms varying considerably. 

• Working memory (including organization): This involves the inability to keep details in mind so that they can be put into use. Examples include the following.
• Challenges holding information in mind so that it can be used later. This is particularly the case if the information is provided in disjointed bits and needs to be held in suspension and then processed along the way before a task can be completed. 
• Challenges following complex thoughts.
• Challenges remembering to complete tasks.
• Challenges keeping track of what needs to be done and organizing the day to ensure that everything is done by the required time. 
• This also includes challenges procrastination as initiating a (potentially complex) project can feel overwhelming.
• Planning tasks, especially complex ones with many steps, like planning a wedding can be particularly overwhelming for someone with an executive dysfunction.
• Challenge organizing materials in a way that allows the individual to retrieve them subsequently when needed.
• Challenges with reading comprehension in which the individual can not remember earlier parts of the content. 
• Challenges memorizing and repeating (long) phrases, telephone numbers, etc.
• Cognitive flexibility. This involves the inability to see problems from different angels and find solutions. The individual can become stuck without a solution. Example(s).
• Challenges being able to shift the approach to competing a task if some aspect of the project changes midway. In this case, the individual is likely to love schedules and to-do lists that are agreed upon in advance and can be honored precisely. Others, especially those who are not very disorganized are likely to consider such individuals too stubborn & inflexible, anal-retentive and or having tunnel vision.
• Difficulty shifting language and presentation styles when addressing different audiences. This may be evident when relaying information from a source that is different to the individual's audience.
• Difficulty switching from rigid techniques taught to creating new ones for unique situations.
• Not surprisingly, compromised executive function relates to learning disabilities. I imagine that processing many new details can become difficult.
• Inhibitory control (including self control). Self control refers to the ability to restrain oneself before reacting immediately on impulse. Example(s).
• Suffering Post traumatic stress disorder (PTSD) / Complex post traumatic stress disorder (C-PTSD) and I think dissociative disorders indicates lack of inhibitory control.
• I think another example is the lack of discipline that results in reliance on vices to manage stressful situations. Examples include addictions to food, alcohol, drugs and so on. Someone with greater executive function would be better able to resist excessive eating, drinking and so on.
• I also think nervous tics belong here because they suggest psychomotor agitation 
• Challenges resisting the urge to consume food that is detrimental to one's health, especially when emotionally distressed.
• Challenges of reacting without restraint (rather than rely on the rational mind to respond). Examples include acting with premature anger or other such instincts when being bullied.
• Challenges remaining dedicated to a single task, especially one that is neither urgent nor a passion. Consequently, such a person will become easily distracted and can easily end up with multiple tasks left partially done, especially complex tasks. Such an individual may be considered air headed. 
• Challenges controlling the urge to connect with other people in unsuitable ways like prematurely sharing very personal information strangers or 'friending' the profile of strangers after very pleasant conversations. This is likely to occur for someone that lacks sufficient support systems
• Anxiety with public speaking.

Causes of Executive Function Disorder

Understanding this disorder is still under develop. However, related to executive function disorder are several factors that include the following. 

• Depression
• anxiety disorders
• obsessive-compulsive disorder (OCD)
• chronic stress
• autoimmune conditions
• Alzheimer's disease
• poor nutrition
• poor sleep patterns
• lack of exposure to language
• low quality of caregiving
• stroke
• learning disabilities. Children who have EFD often have at least one parent who also suffers from it. Although there is a correlation between ADHD and EFD, persons who are not diagnosed with ADHD may also suffer from EFD. 
• Inhibitory Control. Example(s)
• After a traumatic event, the brain reacts rapidly when triggered by a subsequent event that is similar. The brain reacts as if re-experiencing the initial trauma with the same physiological reactions. Examples include panic attacks when triggered by an event that is reminiscent of an earlier trauma. Parallels to the panic attack include muscle tightness, shallow breathing, over-eating, anger even fawning in relationships and psychosomatic illness (like dysfunction of the liver, kidneys or aggravation of a physical weakness). In short, the brain of a traumatized individual goes into a mode of fight, flight, freeze or fawn as a means of survival against a (perceived) threat. The rational mind is unable to function because he amygdala (the part of the brain that responses with fight and flight for instance) is engaged fully.

Strategies for managing challenges with executive dysfunction

As mentioned above, individuals experience executive function disorder differently. Consequently, it ideal to establish the area(s) of weakness beforehand to respond with the most suitable strategies. 

• Working Memory (re receiving information). 
• Pause and reflect at intervals rather than attempt to absorb all of the content at once.
• Put things in writing or request written instructions.
• Use a recorder (audio or video)
• Working Memory (re execution / organization). 
• Carefully breakdown large tasks into smaller ones, along with due dates. Avoid overwhelming yourself by allowing yourself to see only the current list of small tasks.
• Organize your work and play spaces apart. For instance, resist the temptation of doing hobbies in spaces that are best suited for working. This helps the brain to settle into gear better and to avoid distractions.
• For speaking, write outlines with bullet points.
• Inhibitory Control
• Practice emotional regulation techniques when you are not in the height of an emotionally de-regulated state. This involves reducing the level of emotional and physiological arousal, thereby allowing the brain to allow the rational mind to function in the face of the trigger. 
• Sit or stand in a dominant way. Allow yourself to think about the trauma and the physiological reactions. Breath slowing in and out, counting equally for inhaling, holding and exhaling. This requires practice in order to work  
• Use planners, to-do lists (on the phone, a whiteboard or through other means that are very accessible throughout the day), organizers and alarms on the phone or computer. If organization skills must involve receiving information from others, consider using automatic surveys and other electronic applications.
• Consume learning material about current challenges and solutions that provide new perspectives and behavioral strategic responses.

• Cognitive Flexibility
• Do activities that improve neuroplasticity. Neuroplasticity helps trauma survivors of all types to learn new ways of experiencing or doing things after the trauma. The brain forms and reorganizes synaptic (ie nerve) connections in the re-learning process. If the new connections are practiced repeatedly, they strengthen to create the new pathway that the brain learns to do the task. This can be achieved at any age, with faster progress among younger people. The key is to focus attention on new experiences. Examples include
• Break routines with exposure to new experiences. Take new routes to a single destination, eat different foods, do different physical exercises to remain mindful throughout each new experience, ie rather than slip into the rut of dissociative states.
• Enhance gut health as a means of regulating serotonin and gaba levels. These in turn improve cognitive flexibility. Useful items include probiotics, prebiotic, 5-hydroxytryptophan (5-htp), B12 and folate (NOT the same as folic acid) and foods high in folates and B12 like chickpeas and beets. 
• Frequently practice meditation, proper sleep, relaxation and breath work to calm the nervous system. (This even helps to improve the immune system). Do these things until they become new habits.
• Engage in activities that encourage switching gears. Examples include 
• playing games that encourage quick strategic decision-making like football, netball and so on.
• looking for other perspective of dual-perspective images.
• Learn about topics from different schools of thought.
• Teach multiple approaches or strategies from which individuals can select a solution for a single problem. 

CONTENT RELATED TO EXECUTIVE FUNCTION DISORDER

• Emotional control can help to maintain better executive function. Here is how to improve emotional control with the practice of stoicism
  
• Be patient with yourself. Dr Femke Bakker used a lovely analogy of how loving parents would respond encouraging to a child who falters while learning to walk. (They would not shout and condescend their child.) List to her Ted Talk about 'self-gentleness (aka radical self-acceptance)', especially for perfectionists for situations during which you are not performing perfectly. Since perfectionism is often a trauma response, the concept of self-gentleness is particularly important as you learn how to 'walk'.
• Link between neurodivergence and executive function disorders

Challenges with executive function is one clue that helps in recognizing neurodivergence, especially for boomers and generation Xers. 

• Nervous system dysregulation. In addition to this YouTube short explainer video, see more details and examples. 
  
   
• Adults can be evaluated too. Get evaluated (for 'learning and thinking differences') by any of the following. 
• psychologist
• psychiatrist
• advanced practice registered nurse with additional training n ADHD
• learning behavior specialist
• Mental health agencies or counseling
• study skills center at a university or hospital-based program
• clinics that conduct evaluations within 'special education' programs at universities. This can be a lower cost option.
• Adult education office may provide practitioners and their costs, including those that are lower cost options.
• Learning disability associations (LDAs) in the US