In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is executive functioning.
Executive functioning refers to higher-level cognitive processes related to organization and regulation. It’s the C-suite of your brain, or kind of like your brain’s air traffic control system. Tasks that fall under this umbrella include:
- Organization: attention, planning, sequencing, problem-solving, working memory, abstract thinking, selecting relevant information from the senses
- Regulation: initiating actions, self-control, emotional regulation, controlling context-specific behaviour, moral reasoning, decision-making
Executive function involves a few different regions of the brain. A key area is the prefrontal cortex, which is right behind the forehead, is the most evolutionarily advanced part of the brain. It doesn’t fully mature and reach peak activity until people are in their 20s. The thalamus and basal ganglia are also involved.
Impaired executive functioning can lead to:
- Difficulty organizing
- Difficulty in planning and starting tasks
- Inability to multitask
- Problems with information processing, storage, or retrieval
- Mood swings
- Lack of awareness of how one’s behaviour impacts others
- Inability to learn effectively from past mistakes
- Difficulty with abstract thought
Conditions involving executive dysfunction
A number of different conditions can impair executive functioning. Physical damage to the relevant brain areas can occur with traumatic brain injury, stroke, and neurodegenerative diseases like Alzheimer’s. Addictions, neurodevelopmental conditions like autism and ADHD, and mental illnesses like OCD, depression, bipolar, and schizophrenia can all affect executive functioning. Executive functioning also naturally starts to decline in later adulthood.
Schizophrenia can cause episodic memory (i.e. memory for things that happen) to be fragmented. Multi-tasking is often impaired, and there can be problems with cognitive flexibility.
ADHD involves impaired attention and organization. Stimulants used to treat ADHD work by activating dopaminergic neurons in the prefrontal cortex, which plays a key role in executive function.
Autism impairs fluency (ability to generate new ideas and responses), planning, and flexibility. Impairments are focused around aspects of executive function that involve mentalization, which is the ability to understand the mental state underlying an observed behaviour.
People with bipolar disorder, regardless of whether they’re manic or depressed, can experience problems with strategic thinking, inhibitory control, working memory, attention, and initiation as a result of their illness.
Assessing Executive Functioning
Neuropsychological testing can pin down difficulties with specific aspects of executive functioning. The pattern of impairment is influenced by the condition that’s contributing to it, and not all aspects of executive functioning are necessarily impaired in a given individual with executive dysfunction.
The Montreal Cognitive Assessment (MOCA) assesses several aspects of executive function. One of the items is a clock-drawing test, in which the person being tested is asked to draw a clock face and a certain time. That’s unlikely to be an issue with psychiatric-related executive dysfunction, but can be an issue in the case of dementia, stroke, or brain injury.
The Stroop test assesses selective attention. If we see words that give the name of one colour but the letters are displayed in a different font colour (e.g. RED GREEN BLUE), it requires selective attention to identify the font colour while ignoring the meaning of the written word. Impaired selective attention can affect the time this takes and the number of errors that are made.
The THINC-it tool, which is intended for research and clinical use, evaluates cognitive functioning in areas that are often impaired in depression, including aspects of executive functioning.
Executive functioning and depression
I have various issues related to organizational functions because of depression. It doesn’t seem to affect regulation as much, although decision-making can become more of a problem the more mashed potatoes-like my cognitive state is. I definitely notice the working memory issue when I’m writing posts like this and going back and forth between the WordPress editor and whatever reference I’m looking at.
I have a certain level of impairment that’s baseline when I’m depressed, but on top of that, I’ll have fluctuations depending on how slow I am overall (due to psychomotor retardation). Sometimes I can hold a couple of pieces of information, while at other times, a single piece of information is already gone by the time I switch from one tab to another.
Do you ever experience problems with executive functioning? What does that look like for you?
References
- UCSF Weill Institute for Neurosciences: Executive functions
- Wikipedia: Executive functions | Stroop effect
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
My episodic memory is fragmented. I have trouble multi-tasking and more. I relate a lot to this problem. Thanks for the info!
I find it helpful to recognize that there’s a reason that my brain feels like it doesn’t work properly.
I struggle with executive function. It’s not easy to tell what’s from depression and what’s autism, although it would generally just be autism now. I’ve never had a good short-term memory; I need to write everything down or I’ll forget it. I can’t multitask at all; I make plans, but don’t stick to them; I am extremely inflexible about changing plans and the like; and I find it hard to generate new ideas without prompting.
Has getting the autism diagnosis made it easier to accept those problem areas?
A bit, but the practical consequences, particularly in the workplace, are still there even if I don’t beat myself up about them so much.
Yeah, that part doesn’t go away.
My executive function skills decrease as depression increases in severity. I’m unsure, however, whether I lose them or just ignore then as a result of the surfeit of anhedonia. My son has ADHD and the planning and executing can be difficult. He find pulling out of patterns and ruts a challenge. Anxiety interferes, but again, its paralysis rather than a lack of knowing what I should do. ☺️
Basically one big cognitive shitfest.
Basically. At least I remember to buy the chocolate.
Priorities
C and I were talking and she said a lot of complex trauma survivors have executive function deficits.
I’m also on vortioxetine, which is supposed to help the cognitive impairments of depression.
I considered switching to vortioxetine for that reason, but I’m a bit reluctant to mess around with what I’m taking.
That makes complete sense. Vortioxetine gives me bad constipation haha. Enough to be a problem I’m trying to solve, hopefully without going to my GP. 😅😆
And in populations with higher / longer term anti-depressant use, the dose required is higher. Don’t think there’s much data on long term use of Vortioxetine as well – really don’t want this to stop working for me. 😅
The first time I was in hospital they were giving me cyproheptadine to stimulate appetite, but then I needed a couple of different meds to offset the constipation from that. 💩
Currently I’m trying some home remedies and adjusting my diet – one perk of having doctor friends 😆 (I don’t ask them for help often)
Nice!
Well as you know l have Aspergers or autism, pending interpretation and bipolar although the latter is mild … the only EF problems l have ever truly experienced have been an appalling short term memory which although it has worsened with age, it was quite bad when l was young. It levelled out quite well in my thirties to forties and started to drop again by my mid forties.
I am very well organised, spookily so at times – l can lose track of time, but that is when l am uber hyperfocused – then time loses meaning, but if l am to be punctual or have an appointment then l must be on time. I used to have issues with a one tracked mind – but that is also not always a negative if moderated … l suppose the biggest issue today would be an inability to moderate certain behaviours – when younger l was terrible and prone to socially awkward behaviours – but equally when l was younger l wasn’t diagnosed with anything other than he ‘was perceived to be a socially awkward child with severe mental issues’ l remember clearly one teacher telling my parents!! [Hope he was swallowed up by quicksand!!]
That’s so inappropriate for a teacher to say! He belongs in quicksand!
Oh l know, but that ‘s going back to the 70’s and the 70’s was a harsh time for mental health of any kind good or bad – it’s improved today but sadly it has still got a fair way to progress still.
Indeed.
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