Understanding Executive Dysfunction and How It Shows Up

Executive function describes the cognitive skills, or mental processes, that allow you to do things like:

• pay attention
• absorb, remember, and manipulate new information and sensory input
• stay on task and ignore distractions
• multitask
• regulate emotions
• monitor and adjust your own behavior according to new information or changes in your environment

The three core areas of executive function include working memory, cognitive flexibility, and inhibition, which includes both self-control and selective attention.

These skills start developing around the age of 2, with a rapid burst in development during the preschool years. Development continues during adolescence and early adulthood.

These functions play an important role in development, and they become particularly essential at school and, later in life, on the job.

Executive function skills fall into two main categories:

• Organization. You use these skills to pay attention to details, plan and strategize, solve problems, and think abstractly.
• Regulation. You use these skills to regulate behavior and emotions, monitor thoughts and input from your environment, reason and make decisions, manage time, and control impulses.

Executive dysfunction refers to difficulties developing or using any of these abilities or behaviors. Difficulty with executive function can relate to a health or mental health condition or result from an event like a traumatic brain injury.

While executive dysfunction is sometimes referred to as executive function disorder (EFD), this term doesn’t reflect an official clinical diagnosis.

You may use these skills frequently in daily life, including when you:

• “go with the flow” to accommodate changes in your plans
• remember to take all of your books and papers home at the end of the day
• recall everything you needed to pick up at the store
• follow complex or detailed requests and instructions
• plan and execute a projectat work

Executive function skills don’t develop in the exact same way for everyone, so the signs of executive dysfunction can vary from person to person.

If you have trouble with certain executive function skills, you might:

• frequently misplace papers, homework, and other work or school materials
• find it difficult to manage time, make plans, multitask, or stick to your schedule
• often forget appointments and tasks
• find it challenging to get started on tasks, even for things you want to do
• have a hard time keeping your office, workspace, and home organized
• frequently lose or misplace personal items
• find it challenging to navigate frustration or setbacks
• have difficulty remembering information or following directions that involve multiple steps
• find it challenging to control impulses, emotions and changes in mood, or behavior
• have trouble putting complex thoughts or abstract concepts into words

Generally, executive dysfunction happens due to irregular or slower development in the parts of the brain responsible for working memory and emotion regulation.

Imbalances in certain neurotransmitters, or chemical messengers in the brain, including noradrenaline, dopamine, and serotonin, also play a part.

These brain differences also factor into a range of physical and mental health conditions, so executive dysfunction often shows up as a symptom of these conditions.

Health and mental health conditions that might affect executive function skills include:

• attention deficit hyperactivity disorder (ADHD)
• conduct disorder
• depression
• schizophrenia
• fetal alcohol spectrum disorders
• learning disorders, including dyslexia or dyscalculia
• autism spectrum disorders (ASD)
• Alzheimer’s disease and other neurodegenerative conditions
• substance use disorders
• anxiety disorders
• chronic stress
• sleep disorders
• obsessive-compulsive disorder
• autoimmune conditions

Executive dysfunction doesn’t always relate to an underlying condition, though.

A traumatic brain injury can lead to problems with executive function skills, especially an injury that damages your frontal lobes. Your frontal lobes are associated with behavior and learning, as well as higher-order thinking processes like planning and organization.

Evidence also suggests executive function has a genetic component. In other words, having a close family member, like a parent or sibling, who has trouble with some executive function skills means you have a higher chance of also experiencing executive dysfunction.

Executive dysfunction and executive function disorder aren’t official conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), so a doctor or mental health professional won’t diagnose these conditions specifically.

Rather, they’ll offer guidance with narrowing down the cause of executive dysfunction, whether that’s an injury, stress, or underlying condition.

If you’ve noticed your child having difficulties with executive function skills, ask one of their teachers about the behavior rating inventory of executive function (BRIEF).

This 15-minute questionnaire, which both you and your child’s teachers will complete, doesn’t diagnose any specific condition or disorder, but it can provide more information about executive dysfunction and how it affects daily life.

A psychologist or other mental health professional can offer support by:

• helping identify any injuries or health conditions responsible for executive dysfunction
• referring you to a specialist, such as a neurologist or audiologist, for further testing
• referring you to a psychologist or other mental health professional who can evaluate mental health symptoms and offer a diagnosis

A psychologist will ask questions about your executive functioning in daily life, plus any other mental health or emotional symptoms. A better understanding of your day-to-day experience can help them get a clearer picture of any challenges that result from executive dysfunction, along with potential causes.

They might also suggest screening tools, such as:

• The Conners comprehensive behavior rating scale (CBRS). Clinicians use this multiple choice rating scale to help screen children for ADHD symptoms, including difficulties with executive function skills. Parents, teachers, and the child will all complete a separate questionnaire.
• Barkley deficits in executive functioning scale for adults. With this scale, both you and another adult, like a partner, sibling, or parent, will answer questions about your emotions, organization, problem-solving skills, and other aspects of executive function in everyday life.
• Comprehensive executive function inventory. This scale helps evaluate specific areas of strength and weakness with executive function skills and related behaviors in children between the ages of 5 and 18. Like the Conners CBRS, it involves separate questionnaires for parents, teachers, and children.
• Stroopcolor and word test. This scale helps assess the ability to keep automatic responses or impulses in check and think before reacting, especially in the context of new situations. Versions exist for both children and adults.

Examples of other scales that help evaluate difficulties with executive function, particularly in older adults who may experience age-related cognitive decline, include:

• the Montreal cognitive assessment
• the mini-mental state examination
• verbal fluency test
• test of variables of attention

You can find plenty of self-tests to help evaluate your executive function skills online, but another route to consider involves asking yourself a few key questions:

• Do I have trouble processing and remembering things I learn?
• Is it tough for me to switch from one task to another?
• Do I have difficulty when plans change abruptly, especially if they disrupt my regular routine?
• Do I find focusing and paying attention challenging?
• Can I get started on things easily, or do I tend to delay tasks or forget about them?
• Does a habit of misplacing or forgetting things affect my relationships and daily life?
• Do I have trouble organizing my time, work, or office space?

Some honest exploration of your answers can help you pinpoint areas worth bringing up with a mental health professional, who can offer more guidance on steps to get treatment and support.

The most helpful treatment for executive dysfunction generally depends on the underlying cause. That’s why working with a mental health professional or specialist can make such a big difference.

A therapist might recommend, for example, that children and students having trouble with executive function skills work with a speech therapist, tutor, or occupational therapist, depending on the specific challenges they experience.

School services, including special education or social skills coaching, can also help students develop social and academic skills.

Therapy, such as cognitive behavioral therapy (CBT), can also do a lot to help improve executive functioning skills. This approach can teach you how to:

• recognize and address unhelpful thoughts and behaviors
• replace unwanted behaviors with more helpful ones
• learn and practice new skills to manage difficult emotions and cope with stress
• establish routines to better manage time and daily responsibilities

Learn more about CBT techniques.

Organizational coaching offers another potential approach to improving executive function. This involves hiring a trained coach who can offer guidance with learning and practicing skills like time management, planning, and organization, depending on your specific needs.

For example, if you have trouble with sticking to a schedule, finding needed items, or frequent procrastination, they might help you find and put into practice effective methods of staying on task, such as:

• organizational apps or timers
• sticky notes and other reminder cues
• a whiteboard or paper schedule
• efficient workspace organization

Along with seeking support from a therapist or other mental health professional, you can also take steps to manage executive dysfunction with lifestyle changes and other coping strategies.

• Try meditation. A regular meditation practice can help boost present moment awareness, which can go a long way toward improving concentration and focus. Meditation can also help improve sleep and relieve anxiety, depression, and stress — all of which can play a part in executive dysfunction.
• Break down larger tasks. It’s easy to feel daunted by the scope of complex tasks or a jam-packed schedule. Dividing your workload into smaller components and focusing on just one “chunk” at a time can make a difference. A list of four specific tasks — wash dishes, sweep floors, do laundry, take out trash — will likely leave you less overwhelmed than the much broader “clean the house.”
• Ask for help. If you’re having trouble managing responsibilities at home or on the job, consider asking family, friends, or co-workers for some assistance. It’s not always easy to open up when you find tasks challenging, but explaining where you’re having difficulty could help you get the support you need to make changes.
• Encourage yourself. You might feel frustrated with yourself when you forget important events or have trouble staying organized and remaining on task. But self-criticism and self-punishment usually leave you feeling worse. Try swapping self-blame for self-supportive affirmations, and practice praising yourself for your successes instead.
• Take breaks when needed. Forcing yourself to push through a task when you already feel drained often just derails your concentration and productivity further. Instead, try breaking for 5 to 10 minutes every hour or so to stretch your legs, drink some water, and reset.
• Check in on your sleep needs. Getting the right amount of rest may not “cure” executive dysfunction, but quality sleep can have a positive impact on your focus, productivity, and overall well-being. As a result, you might find it easier to regulate emotions, handle tasks, and cope with challenges as they come up.

Executive dysfunction isn’t a mental health diagnosis, but it can happen as a symptom of many different conditions.

When these conditions go untreated, executive dysfunction and any other symptoms you experience can eventually begin to interfere with school, work, and everyday life and relationships.

But there’s a lot you can do to address difficulties with executive function and improve these skills, not to mention your emotional and mental health and overall quality of life.

If you or your child has trouble with certain areas of executive function, it’s worth reaching out to a trained mental health professional sooner rather than later.

Professional support can help you begin to identify possible factors contributing to executive dysfunction and explore strategies for addressing these concerns and any related symptoms — in a way that works for you.