Executive Function Disorder

Medically Reviewed by Jabeen Begum, MD on January 23, 2024
7 min read

Executive function is a set of skills that help you get things done. These skills are controlled by an area of your brain called the frontal lobe, and they help you do things such as manage your time, pay attention, plan and organize, remember details, and multitask. Executive function also helps you control your impulses and act in a way that's appropriate to the situation. 

When executive function isn’t working as it should, you have less control over your behavior. This can affect your ability to work or go to school, do things on your own, and have good relationships. 

Executive function involves three main skills:

Working memory is how you think about, use, and recall information in your day-to-day life. Working memory is like a notepad in your brain that stores your daily activities and the processes to complete them. If it’s not working as it should, you may be forgetful, disorganized, or have trouble completing ordinary tasks.

Cognitive flexibility describes your ability to change your behavior in response to things around you changing. If you struggle with this skill, you may have problems reading, easily switching from one task to another, or adapting to stress and unhappy events.

Inhibition control affects how you manage your thoughts, feelings, and behavior. If you have poor inhibition control, you may find it hard to keep quiet when you should or find it hard to manage your thoughts and focus on a certain task or problem. 

Executive function skills start to develop soon after you are born. Development speeds up between the ages of 3 and 5, and your skills continue to build through your teenage years.

Executive dysfunction is when you have problems with your executive function skills. It might be hard for you to plan, organize, strategize, pay attention to details, and manage your time. Executive dysfunction disorder isn't just being forgetful or disorganized occasionally. It's a long-term condition that affects your everyday life. For example, you might have trouble doing tasks that have steps, such as cooking a meal or finishing a work or school project. It's not a matter of how smart you are or how much effort you put in; it's a disconnect in your brain's ability to coordinate and carry out tasks.

There are many possible symptoms of executive dysfunction. You might have executive dysfunction if you have trouble:

  • Planning projects
  • Estimating how much time a project will take to complete
  • Telling stories (verbally or in writing)
  • Memorizing things
  • Starting activities or tasks
  • Shifting plans when situations change
  • Focusing only on one task
  • Motivating yourself to do something that doesn't interest you, such as chores

Other symptoms include:

  • Speaking without thinking first
  • Daydreaming or “spacing out” when you should be paying attention
  • Being easily distracted
  • Having problems with impulse control
  • Having trouble controlling your emotions
  • Misplacing things
  • Forgetting things, such as appointments
  • Losing your train of thought

Experts aren't sure what causes executive dysfunction, but they have linked it to a few conditions that affect your brain function, such as:

  • Attention deficit hyperactivity disorder (ADHD)
  • Depression
  • Autism spectrum disorder
  • Substance abuse
  • Obsessive-compulsive disorder (OCD)
  • Alzheimer's disease
  • Head injuries
  • Brain tumors
  • Stroke
  • Epilepsy
  • Multiple sclerosis
  • Huntington's disease
  • Cerebral hypoxia (brain damage from lack of oxygen)
  • Dementia
  • Infections, such as meningitis and encephalitis

Executive function disorder might also be genetic, meaning it could be passed down from your parents.

There isn't a test that can specifically diagnose executive dysfunction disorder. But there are tests to gauge how well your executive function works, such as:

Barkley Deficits in Executive Functioning Scale: This tool helps screen for problems with executive function tasks such as organization, self-restraint, motivation, emotional control, and time management. There is a self-report and another questionnaire for someone close to you to fill out.

Comprehensive Executive Function Inventory: This scale measures executive function strengths and weaknesses in kids aged 5-18. Parents, teachers, and kids ages 12-18 can take part in the evaluation.

Conners 3 Parent Rating Scale: This uses feedback from parents to assess executive function in kids aged 6-18. It scores areas such as learning problems, hyperactivity/impulsivity, aggression, peer relations, and attention.

Stroop Color and Word Test: This is used to help find things that affect your reading ability. This test has three parts: a word page, a color page, and a word-color page. Children and adults can take it, and it takes about 5 minutes.

If you are an older adult and think your cognitive skills are getting worse, these are some tests that you could take:

Mini-Cog: This test takes about 3 minutes and includes drawing a clock and remembering three items.

Montreal cognitive assessment: This takes about 15 minutes and includes remembering words from a list, copying a picture, and identifying animals by name.

Mini-mental state exam: This takes about 10 minutes and includes knowing today’s date, counting in reverse, and naming common items.

Verbal fluency test: This test requires you to come up with as many words as possible in one minute in a certain category, or words starting with the same letter.

Test of variables of attention: This test is given on a computer and takes 21 minutes. It measures things such as your response time and your ability to pay attention.

If your doctor thinks your executive function problems are being caused by a specific disorder such as ADHD or OCD, they may skip these tests and do tests that help them diagnose the disorder.

Your doctor might also order other tests such as blood tests, CT scans, or brain MRIs to rule out other causes.

Managing executive function disorder may involve a combination of things, such as therapy and medication. It depends on your symptoms and what causes your problems. There are some things you can do on your own that can make it easier to function in everyday life:

  • Take a step-by-step approach to work.
  • Use visual aids to get organized.
  • Use tools such as time organizers, computers, or watches with alarms.
  • Make schedules, and look at them several times a day.
  • Ask for written and oral instructions whenever possible.

To improve time management:

  • Create checklists, and estimate how long each task will take.
  • Break long assignments into chunks, and assign times for completing each one.
  • Use calendars to keep track of long-term assignments, due dates, chores, and activities.
  • Write the due date on the top of each assignment.

To better manage your space and keep things from getting lost:

  • Organize your workspace.
  • Donate things you don't need to reduce clutter.
  • Schedule a weekly time to clean and organize your workspace.
  • Make a designated space for everything you own.

To improve work habits:

  • Make a checklist for getting through assignments. For example, a student's checklist could include items such as: get out pencil and paper; put name on paper; put due date on paper; read directions; etc.
  • Meet with a teacher or supervisor regularly to review your work and troubleshoot problems.
  • Find an executive function coach or tutor who can help you improve the way you plan and carry out tasks.

 

 

A variety of health-related causes may lead to executive functioning problems. Your doctor will determine the appropriate treatment, based on the cause:

Mental health conditions. Your doctor may prescribe medications, such as stimulants for ADHD or antidepressants for depression. Cognitive behavioral therapy also is a common treatment for some mental health conditions.

Brain injuries or degenerative diseases. Your doctor will develop the right treatment plan for your condition, which might include medication and other therapies. Not all brain injuries or degenerative diseases are treatable, but having a supportive team of health care providers may help you deal with your issue.

Infections. This can include meningitis, in which case you may be given antibiotics, antifungals, or antivirals, depending on the exact cause.

There are a variety of other therapies you can try, to help treat your executive dysfunction, such as:

Coaching. Often called ADHD coaching, this is designed to help you carry out the typical activities of daily life. Studies show that college students with coaches can improve their executive functioning skills.

Occupational therapy. An occupational therapist can teach you to make lists and track performance, break big tasks into smaller tasks, and write reminders to aid with memory.

If you struggle with executive function skills, you have a variety of options to manage those challenges. Visit your doctor and tell them your symptoms. They can rule out any health conditions and help you make a plan to gain more control over your life. That might include therapy, medication, coaching, lifestyle changes, and more.

What is executive functioning in ADHD?

It includes managing your time, focusing, remembering details, stopping yourself from blurting out inappropriate comments, and more.

What is the executive function of the brain?

It plays a crucial role when you have tasks or problems and need to make the right decision or do the right thing. When working properly, executive function helps your brain make the best choices.

What are the symptoms of executive function disorder?

Symptoms include trouble paying attention, remembering, organizing, managing your time, and thinking creatively.

What is the 30% rule for ADHD?

A leading expert on ADHD believes that children with ADHD typically lag behind their peers by 30%, which means that their emotional age is roughly 30% less than their actual age.