Executive Functioning: What is EF? - PharmPsych Communications - Medical Communications
by Vladimire Herard, M.S. | Apr 29, 2015 | HEALTH & LIFE | 0 comments
by Jane Rosenblum
Executive functioning refers to the ability of the brain to manage multiple events smoothly and behave and interact with others appropriately. To make it easier,we’ll break it down into two components: Executive and Functioning.
Executive refers to the director or head of management which is in charge of an individual’s functioning. Executive skills focus on an ability to synthesize information or take into account the what, where, when, why and how of any given situation.
If you consider the brain as the executor, its components are: self-regulation, goal setting, flexibility, initiation and persistence, planning and organization, execution and goal setting.
Executive skill functioning as defined by Wikipedia states the following: Executive functions (also known as cognitive control and supervisory attentional system) is an umbrella term for the management (regulation, control) of cognitive processes, including working memory, reasoning, task flexibility, and problem solving as well as planning and execution.
Functioning refers to the actual behavior or what is being observed by others in the areas of activities and communication. How does the person function in the real world? Observations occur at home, in the community and school. It’s the symptoms that lead people, primarily teachers, social workers, psychiatrists, psychologists and counselors to think a person is experiencing difficulty in specific areas where they have to utilize many different skills at once.
Functioning also refers to the areas of memory, initiation and completion of tasks, attention and concentration, effort and motivation, coping ability and social skills.
Executive Function Skills Developmentally:
ADULT Can remember multiple tasks, rules, and strategies that may vary by situation
5-16 YEARS Develops ability to search varying locations, remember where something
was found, then exploreother locations (e.g., a game of Concentration or hiding a penny under one of three cups)
4-5 YEARS Comprehends that appearance does not always equal reality (e.g., when given a sponge
that looks like a rock)
3 YEARS Can hold in mind two rules (e.g., red goes here, blue goes there) and act on the basis of the rules
9-10 MONTHS Can execute simple means-to-ends tasks and two-step
plans; also able to integrate looking one place and acting (e.g., reaching) at another place
7-9 MONTHS Develops ability to remember that unseen objects are still there (toy hidden under a cloth); learns to put two actions together in a
sequence (remove cloth, grasp toy)
ADULT Can remember multiple tasks, rules, and strategies that may vary by situation5-16 YEARS Develops ability to search varying locations, remember where something
was found, then explore
other locations (e.g., a game of Concentration or hiding a penny under one of three cups)
sequence (remove cloth, grasp toy) Inhibitory Control
ADULT Consistent self-control; situationally appropriate responses (e.g., resists saying something sociallyinappropriate, resists “tit for tat” response)
10-18 YEARS Continues to develop self-control, such as flexibly switching between a central focus (such as riding a bike or driving) and peripheral stimuli that may or may not need attention (road signs and pedestrians vs. billboards and passing houses)
7 YEARS Children perform at adult levels on learning to ignore irrelevant, peripheral stimuli (such as a dot on the side of a screen) and focus on the central stimulus (such as a picture in the middle of the screen)
4-5 YEARS Reductions in perseverance (persisting
with following a rule even when knowing that the rule has changed). Can delay eating a treat; also can begin to hold an arbitrary rule in mind and follow it to produce a response that differs from their natural instinct (sort
colored cards by shape rather than color)
9-11 MONTHS Able to inhibit reaching straight for a
visible but inaccessible reward, such as a toy on the
other side of a window, and instead delay a moment
to recognize the barrier and detour around it
8-10 MONTHS Begins to maintain focus despite
distractions during brief delays in a task
6 MONTHS Rudimentary response inhibition (able to
not touch something instructed not to touch) Cognitive Flexibility
ADULT Able to revise actions and plans in response to changing circumstances13-18 YEARS Continued
when switching focus and
10-12 YEARS Successfully adapts to changing rules, even along multiple dimensions
(okay to shout on playground, not okay in school, okay sometimes in theater rehearsal)
2-5 YEARS Succeeds at
shifting actions according
to changing rules (e.g., takes shoes off at home, leaves on at school, puts on boots for rain)
9-11 MONTHS Develops ability to seek alternate methods to retrieve objects beyond directly
reaching for what’s in view
Sources: Best & Miller (2010)100;
Diamond (1991a, 1991b, 2002,
2006).101,102,8,103
There is an informal assessment process that begins in the school setting and at home. Teachers might report back to the parent the following: “Your child is exhibiting difficulty with recalling the lesson, integrating the material, has trouble transitioning, doesn’t appear to listen, appears distractible, seems to have difficulty fixing their mistakes, is slow to complete a task and doesn’t appear aware of the concept of cause and effect (they don’t understand how their behavior is setting up the problems they are experiencing) and are having trouble with relationships with their peers.”
Parents need to continually and objectively observe their child at home and might notice the following: My child doesn’t appear to listen, is lazy, can’t remember to do chores and change in plans are difficult to adjust to appropriately. They may say, “My child loses things all the time. I have to re-explain how to do things and my child doesn’t know how to plan ahead.”
Parents can help their child improve their EF skills by utilizing calendars, chore task lists, have your child write the grocery list, prepare the kitchen to make a recipe, assemble toys, play mind stimulating games, and any other activity where they have to think first then act.
Children are quite sensitive about fitting in and doing well in school. They may recognize they are struggling when they see their friends finish the test before them, have the material ready to work on, have no trouble starting or ending a task.
They may say to themselves, “I keep making stupid mistakes. I don’t know where I put my work. It’s difficult for me to remember what the teacher taught today.”
School personnel will be thinking of ways to help the student by giving them organizational tools, specific responsibilities in the classroom that enhance organization, implementation, memory and activities to improve their social skills.
The teacher may utilize a mnemonic tool to teach a child to recall information, put the daily schedule on their desk for cues, develop other visual cues for a child to learn, recall and follow or complete.
The goals for the students are to improve their ability to process information, think objectively, use memory and sequencing skills, problem-solve appropriately, control their behavior and emotions, take turns, adjust to changes in the environment, understand non-verbal social cues and ways to communicate appropriately.
Many of the identified EF areas are also potentially labeled as various diagnoses: learning disabled, autistic or ADHD. It is crucial for the parent and teacher to work together to try to enhance the student’s skills prior to an assessment for special education.
The following table illustrates Dr. Brown’s model (terms used by other experts are shown in italics).
Cognitive cluster Executive functions
Activation Organizing, prioritizing, and activating to work;
Initiating, planning, strategizing, and sequencing
Focus Focusing, sustaining, and shifting attention to tasks
Effort Regulating alertness, sustaining, and processing speed; Pacing, managing time, and resisting distraction
Emotion Managing frustration and regulating emotions
Memory Utilizing working memory and accessing recall;
Action Monitoring and self-regulating action;
The key is to observe a child in any situation; in this way, an adult can determine their strengths and weaknesses. Have discussions with your child’s teachers, family and friends regarding the behaviors they see and are feeling worried about because it doesn’t seem to be age appropriate.
Everyone has strengths and weaknesses and some behaviors can be outgrown and/or compensated. We all have moments of forgetfulness, problems with organization, explaining facts and situations. The important aspect to focus on is the degree of difficulty. Is the functioning seriously below that of their peers? Do they not look like they fit in?
Executive functioning is a key phrase in schools because there is an expectation that a child’s mind has to grow yet they can’t go faster than they are able to process information. Comprehension is critical in a child’s ability to perceive and react to various scenarios in an appropriate manner.
The child has to learn how to interpret the activities and behaviors and tasks around him. He or she have to know how to negotiate, comprehend and act appropriately in any given situation.
Too often EF is taken for granted, thinking the child will learn by observation or osmosis. Taking the time to teach and practice skills are important for growth. The child will need to be given opportunities to learn, realize mistakes are made and recognize each accomplishment.
Children learn by being asked about their opinions. They need to be given opportunities to expand their vocabulary, someone to listen to them and give them feedback which increases their desire to learn.
They need to be motivated to listen, question ideas and formulate hypothesis to be evaluated. This broadens their ability to problem-solve and think rationally.
Executive Functioning is very important for an individual’s ability to function appropriately in the world in the areas of work and relationships. Schools are working on trying to link EF with child development and are attempting to determine the best ways to evaluate this issue effectively.
Currently, there are no official tools to determine if EF is a problem or not. There are other types of interventions that can be offered in the school setting to help offset a potential problem.
Schools may lead toward special education assessments after a period of interventions over a specific period of time, in order to determine if the child has learning problems (learning disability), attentional problems (ADHD) or even depression.
The brain continues to learn and grow throughout life and training the brain is an essential component of strengthening the individual’s Executive Functioning skills to help an individual learn how to manage the complex world in which we live.