Disorder in executive functioning
Executive functions (EF) are the higher control functions of the brain. They control actions and behavior, help set goals and achieve them. They also help keep demands, needs and obligations in balance.
Executive functions include many different processes. "Executive functions" is therefore a so-called "umbrella concept". The executive functions develop from birth to the age of approximately 23 years. This development often takes place in so-called spurts. If a child or young person sustains a brain injury during this period, this has a direct effect on this development and therefore on behavior.
The executive functions can be examined by means of a neuropsychological examination.
Below is an overview of a number of common executive functions.
- Impulsivity: (Response inhibition) The ability to think before action is taken,
- Inhibition: The ability to control an impulse. This also plays an important role in being able to maintain focused attention. (doing / behavior),
- Emotion regulation: regulate emotions to achieve goals or control behavior. (planning / regulation),
- Targeted behavior (metacognition) (doing / behavior)
- Flexibility: The ability to adapt to changing circumstances. But also reviewing your plans if obstacles or setbacks arise, new information presents itself or mistakes are made. Problems with flexibility can lead to perseveration. (doing / behavior)
- Task initiation: The ability to start a task efficiently and without delay. (doing / behavior)
- Working memory: The ability to keep information in memory when performing complex tasks and to filter between what is relevant and what is not relevant to remember. (thinking / cognition)
- Planning: The ability to make a plan, achieve a goal, or complete a task. Decide what is important and what is not. (thinking / cognition)
- Organization: The ability to develop and maintain systems to stay up to date with information or materials required. (thinking / cognition)
Persistent attention (doing / behavior)
- Time management: The ability to estimate time, how much time it will take, how you can best divide the time and how you can work on time. (thinking / cognition)
Problems with executive functions after brain injury
An impairment in executive functioning occurs if (some or more of) the aforementioned functions are no longer possible due to brain injury. Because executive functions play a role in many daily activities, many problems can arise after brain injury.
A number of problems that can occur in someone with a disorder in executive functioning (NB: every injury and every person is different).
- Unable to organize activities,
- Impulsive behavior,
- No longer able to handle changes flexibly (see also perseveration),
- Obsessive behavior (such as always counting, singing, tapping or showing the same behavior),
- Having difficulty responding adequately in social interactions,
- Problems with emotion regulation
Brain areas involved in executive functioning
Neurophysiological and neurocognitive research shows that executive functions are mainly related to the (pre) frontal cortex. When there is damage to the prefrontal cortex, it is sometimes referred to as a "frontal syndrome". With a frontal syndrome there are often a collection of complaints, including problems with executive functions.
In recent years, new research has shown that deeper brain areas such as the striatum also play a role in executive functions. The corpus striatum can be divided into the dorsal striatum, consisting of the caudatus nucleus and the putamen, and the ventral striatum.
Not all problems with executive functioning can therefore be attributed to the (pre) frontal cortex.
Tips to improve your executive functioning
- Schedule demanding tasks at the times when your energy level and alertness are optimal,
- Plan tasks in a simple step-by-step approach,
- Take regular breaks, take a deep breath and make time for physical and mental relaxation. This includes a coffee break, a chat with friends, a nap, or a walk,
- Make use of planning and memory apps (pictogenda, pictoplanner, remember the milk, Assist helps, the work app),
- Take notes and keep them in fixed places,
- Occasionally talk aloud to monitor thoughts and actions,
- Practice different strategies to determine which is the most effective in different situations. Then ask yourself what distracts you and makes your attention drop and note that. Also note what you have to do to make a strategy work. Or what you should do differently next time.
For loved ones it can also sometimes be difficult to know how to deal with someone with a disturbed executive functioning. Below some general tips.
- Try to clearly indicate boundaries and structure,
- Explain plans, tasks and actions well. Sometimes this includes repeating steps,
- Tasks can provoke frustration if it fails. Realize that fear of failure or shame or fear of anger from others can also play a role and give support,
- Avoid discussions and issues, stay calm. Try to stay out of your own emotion and stay out of a power conflict. If things get out of hand, take a time out, then you do not reject the person but you give yourself and the person a moment of rest and distraction. Then try to come back with kindness,
- Ensure peace in the house, also in terms of sounds and other disturbing stimuli. Low-stimulus offers more peace.