By Marian Betancourt
In today’s fast-paced world, where the average day may include not only multi-tasking at work and at home but continuous news and social media alerts on our phones, it is more difficult than ever to keep track of each day’s many responsibilities. It is perfectly normal to be confused at times by such information overload.
But if we have more difficulty than usual keeping track of everything and getting things done at work, home, and school, it could be a condition called Executive Function Disorder or EFD.
Executive Function (EF) is controlled by the brain’s frontal lobe. This part of the brain, which matures during puberty, helps us manage time, pay attention, switch focus, remember details, and avoid saying and doing the wrong thing. EF involves attention and memory as well as emotion including negative emotions from the past.
Encompassing our ability to organize as well as regulate, Executive Function skills allow us to carry out our daily tasks and create a timetable for completion in order to meet deadlines.
Imagine the tasks of a corporate CEO responsible for analyzing, organizing, deciding and executing most aspects of the business operations. Similarly, the six clusters of human executive function are: activation, focus, effort, emotion, memory, and action, as described by Patricia Newhall in her book, Executive Function, part of the Landmark language-based teaching series.
Executive function skills are critical for managing everyday life and long-term goals and it includes self-awareness or self-directed attention as well as self-restraint. A non-verbal working memory, or visual imagery, is part of this. It is the ability to visualize, to hold things in our mind, and mentally “picture” the steps needed to get things done.
Some experts compare planning and problem solving to self-play, that is, how we play with information in our minds to come up with new ways of doing something. By taking things apart and recombining them in different ways, we can “see” and plan solutions to our problems.
Deficits in EF make it difficult to gather information and structure it for evaluation and to take stock of our surroundings and change our behavior accordingly. While some adults with EFD may have learned tricks or strategies to help them compensate, others are unable to meet their daily responsibilities and have difficulty at work, home, or school.
Common Signs and Symptoms of EFD
EFD may cause us to forget to complete tasks and fail to keep track of personal items like keys and cell phones. We may be unable to remember names, have trouble following conversations, and easily lose our train of thought. Planning and visualizing each step in multi-step processes such as gathering information for a report from several sources and consolidating and analyzing it in a presentation at work may be impossible.
Executive functioning problems often causes being late because we haven’t gauged time or have problems breaking big projects into realistic steps. In other words, we are not able to multi-task very well.
Time blindness is an effect of EFD, that is, we are unable to plan for and keep in mind future events. EFD also follows us home where there may be less stress, but similar problems confront us. We may forget what we wanted to ask our friend when he is on the phone. Forgetting one or more steps of multi-step tasks involved in the laundry, or cooking, or having to re-read recipe directions because we keep forgetting them before we finish the task.
While many of these individual events happen to everyone, it becomes disabling when it is the daily norm. When we have trouble analyzing, planning, organizing, scheduling, and completing tasks our EF is failing us. This means we may lack the ability to handle frustration, start and finish tasks, recall and follow multi-step directions, stay on track, self-monitor, and balance priorities.
The inability to handle frustration may also be a sign of EFD, as is becoming easily distracted or losing interest in a task or becoming so involved, that all other obligations are forgotten. For example, you may begin a task initiation with enthusiasm and lose interest, or find it difficult to do things that are not necessary or highly stimulating.
Some with EFD get so absorbed in tasks, they may forget about people around them or other obligations. The inability to deal with clutter is another indicator, or losing keys or a cell phone at least once a day.
Causes of Executive Function Disorder
There are a variety of causes of EFD. Some people are born with it. People with attention-deficit/hyperactivity disorder (ADHD), depression, autism spectrum disorder or learning disabilities often have EF weaknesses.
In fact, EFD is commonly misdiagnosed as ADHD and while the symptoms overlap in significant ways, the conditions are not the same. A child or adult with ADHD might be hyperactive, impulsive and inattentive.
Scientists have always understood impulsivity and hyperactivity, but the concept of inattention has evolved from a simple focus on “inability to stay on task” to a broader concept of “executive functioning” involving a pattern of chronic difficulties in executing daily tasks. EFD is also associated with the adult bipolar disorder and obsessive-compulsive disorder (OCD). Experiencing a brain injury, suffering a stroke or mental damage from Alzheimer’s disease can also cause EFD.
According to studies by the National Institutes of Health, EFD is commonly seen in major depression including problems with planning, initiating, and completing goal-directed activities. EFD may vary with the degree of depression. A subset of geriatric depression is also characterized by EFD. Studies also indicate that the stresses of poverty may lead to this condition in children, along with ADHD.
Treatment of Executive Function Disorder
There are a number of executive function treatment options available.
There are no medications to treat people affected by EFD. However, there is some evidence that stimulant medications may benefit some aspects of the condition. A therapist or coach may also help a person with EFD improve time management and help you avoid losing track of things. Cognitive behavioral therapy may help to self-monitor thoughts educational purposes only and behavior and social skills training may help create a better response in social situations.
The National Center for Learning Disabilities created a free ebook to help people better understand the Executive Dysfunction Disorder. They also offer helpful tips for people with Executive Functioning Issues.
- Take a step by step approach to work
- Rely on visual organizational aids
- Use tools like time graphic organizers, computers or watches with alarms
- Make schedules and look at them several times a day
- Ask for written or oral instruction whenever possible
- Plan for transition time and shifts in activities
Other helpful EFD resources:
- US National Library of Medicine. National Institute of Health – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455841/
- National Institutes of Health www.ncbi.nlm.gov/once/articles/pcm4084861
- Manhattan Psychology Group – www.manhattanpsychologygroup.com
- Landmarkoutreach – www.landmarkoutreach.org
- ADDitudemag – www.ADDitudemag.com
- National Center for Learning Disabilities www.ncld.org
LD Resources Team: Marian Betancourt is a professional writer who has written many books and articles about healthcare.