Executive Dysfunction: Signs, Symptoms, & Treatments

What Are Executive Functioning Skills?

Executive function involves the cognitive ability to define, analyze, and find solutions to problems. These skills also relate to impulse control and sustained attention. Executive functions help people accomplish tasks, stay organized, and manage emotions. Loss of executive function can cause focusing, planning, or decision-making difficulties.

Executive function examples and skills include:

• Inhibiting control: This ability relates to the capacity to think before acting and allows time to evaluate a situation.
• Working memory: Working memory is the ability to hold information while performing complex tasks.
• Emotional control: Controlling emotions can help individuals manage their feelings to focus on and complete tasks.
• Sustained attention: This executive function helps people focus on a situation or task despite distractibility, fatigue, or boredom.
• Task initiation: Task initiation means starting a project without procrastinating.
• Planning and prioritization: The ability allows individuals to create a map for reaching a goal.
• Organization: Organization means creating and maintaining systems to keep track of materials or information.
• Goal-directed persistence: This ability relates to following through with and completing goals without becoming distracted by competing demands or interests.
• Cognitive flexibility: Individuals possessing cognitive flexibility are adaptable and can revise plans in the face of challenges, barriers, or mistakes.
• Metacognition: This executive function concerns self-observation and reflection.
• Stress tolerance: Stress tolerance allows individuals to cope with uncertainty and unexpected demands.
• Behavioral control: This skill refers to controlling impulses and thinking through potential consequences before acting.
• Interference control: Interference control allows a person to stay focused despite distracting stimuli.
• Reasoning: Reasoning refers to thinking things through logically, reasonably, and realistically.
• Problem-solving: This executive function allows a person to identify solutions, think creatively, and be flexible when solving problems.

Signs of Executive Dysfunction

Signs and symptoms of executive dysfunction can include difficulties focusing, concentrating, performing complex mental tasks, or managing distractions. For example, executive dysfunction can result in decreased attention or hyperfocusing on one project or topic while ignoring others. Severe executive dysfunction can cause problems at work, school, and in relationships.

Signs of executive dysfunction may include:

• Low tolerance for frustration
• Inability to complete tasks
• Struggling with multiple-step directions
• Forgetfulness
• Poor self-motivation
• Difficulty with emotion regulation
• Time blindness
• Troubles organizing or staying on schedule
• Difficulty processing information

Common Executive Dysfunction Examples

Executive functioning deficits can affect many areas of life, including home, work, or school. People can also experience relationship problems due to an inability to remember important details, stay on task, or problem-solve. Executive dysfunction can make everyday tasks harder and overwhelming.

Below are examples of executive dysfunction:

• Procrastination
• Disorganization
• Inattention
• Lack of attention to detail
• Difficulty planning
• Lack of impulse control
• Poor time management
• Difficulty starting tasks
• Lack of problem-solving skills
• Difficulty with transitions

What Causes Executive Dysfunction?

Various factors can cause executive function problems. Research has closely studied ADHD and executive function, but substance use, addiction, brain injuries, and other mental health disorders can contribute to impaired skills.

Possible executive dysfunction causes and risk factors include:

• Addictions: Addictions can lead to changes in brain function. “Wet brain” is a severe condition caused by alcohol use that results in a loss of cognitive function.
• Substance use: The use of substances can impair decision-making, interfere with problem-solving, and inhibit impulse control.
• Attention-deficit/hyperactivity disorder (ADHD): ADHD is probably the most well-known cause of executive dysfunction, resulting in difficulty with attention, concentration, and impulse control.
• Autism: Autism is associated with neurological changes, processing difficulties, sensory overload, repetitive behaviors, and emotional dysregulation.
• Anxiety disorders: Anxiety and executive functioning are strongly linked. Anxiety can result in rumination, excessive worry, perfectionism, rigid thinking patterns, and avoidance, all of which impair executive functioning.
• Depression: Depression and executive dysfunction are also often related, and symptoms of depression impact attention, concentration, task initiation, motivation, and thought processes.
• Schizophrenia: Executive dysfunction is a common symptom of schizophrenia, contributing to disorganized thinking, mood instability, inflexible or rigid thinking, and difficulty with concentration and attention.
• Obsessive-compulsive disorder (OCD): An individual with OCD becomes hyperfocused on their obsessions and performs repeated compulsions or rituals to manage anxiety. These compulsions require substantial cognitive effort and can impair concentration, focus, and the ability to think clearly and rationally.
• Brain damage: Brain damage can impact many functions, including memory, concentration, mood, processing, and impulse control.
• Neurodegenerative conditions: Alzheimer’s, Parkinson’s, or ALS can damage parts of the brain that control memory and executive functioning. These conditions can eventually leave a person unable to complete basic cognitive tasks.
• Chronic stress: Chronic stress creates excessive levels of cortisol and adrenaline, leaving the individual in a constant state of fight-or-flight. Over time, stress can impact the ability to focus on complex cognitive tasks.
• Sleep disorders: Sleep is imperative for healthy cognitive function. Sleep disturbances can result in problems with memory, attention, concentration, and problem-solving.
• Epilepsy: Seizures, the aftermath, and medications can all impact healthy cognitive functioning and lead to symptoms of executive dysfunction.

Impacts of Executive Dysfunction

Individuals who experience typical development in childhood and adolescence can typically contribute productively to their communities. However, various environmental factors can impair executive functioning. The impact of these stressors can be significant, leaving individuals unable to solve problems, set priorities, and follow through with plans. They may also struggle with decreased frustration tolerance and hyper-emotionality.

Below are possible complications associated with executive dysfunction:¹⁰

• Inability to manage finances
• Poor housekeeping skills
• Poor medication management
• Cognitive decline in elderly adults
• Decreased working memory
• Impaired abstract thinking
• Poor work or academic performance
• Job loss

How Is Executive Dysfunction Diagnosed?

A clinician can assess executive dysfunction by reviewing symptoms. They may also employ tests to screen for ADHD and other executive function disorders. Parents or teachers can screen children for executive dysfunction, and self-reports are also available for individuals of all ages.

Tests for executive dysfunction may include:

• Behavior Rating Inventory of Executive Function (BRIEF): BRIEF uses questionnaires to assess executive dysfunction in children at home and school.
• Barkley Deficits in Executive Functioning Scale (BDEFS): BDEFS identifies cognitive deficits in adults, including indicators for ADHD.
• Comprehensive Executive Function Inventory: This test is a 100-item screening questionnaire for children.
• Conners 3: The Conners 3 test assesses cognitive, behavioral, and emotional symptoms for children and teens.

Executive Dysfunction Treatment Options

Treatment for executive dysfunction often includes various therapies and, in some cases, medication management. These interventions target problem-solving abilities, emotion regulation, and attention. The goal of treatment is to maximize the learning capacity and teach the affected individual to compensate for skills deficits.

Treatments for executive dysfunction include:

Therapy

Several therapies are available to help with executive dysfunction. Coping with impaired executive function can be challenging, but finding a neurodiversity-affirming therapist or specialist in these symptoms is beneficial. 

Below are therapy options for addressing executive dysfunction:

• Cognitive behavioral therapy (CBT): CBT can help with persistent negative thoughts, low self-esteem, and unhealthy thought patterns associated with executive dysfunction.
• Eye movement desensitization and reprocessing therapy (EMDR): Traumatic life experiences can result in symptoms of executive dysfunction, and EMDR can help an individual reprocess and heal from those past events. 
• Organizational and skills training: Skills training from a qualified therapist or other professional can teach individuals tools and coping skills for improving their executive functioning. 

Medications

While a specific medication for executive dysfunction does not exist yet, stimulants and non-stimulants can help regulate chemicals in the brain to improve attention, focus, and concentration. Some individuals may also benefit from antidepressants to address underlying depressive disorders.

How to Deal With Executive Dysfunction

Specific treatments for deficits in executive functioning are best, but healthy lifestyle choices can aid throughout the process. While problems with executive function can be overwhelming and frustrating, you can improve your situation by implementing realistic goals, minimizing distractions, and staying motivated.

Below are 12 tips for how to overcome executive dysfunction:

1. Set short-term, achievable objectives: The perceived distance between the present and future is part of why goal achievement can be so challenging. Setting massive, unrealistic goals can erode motivation over time, leading to procrastination. Instead, consider breaking large tasks into their components, with objectives targeting the bigger picture.
2. Minimize distractions: Many individuals with attention difficulties have trouble focusing on otherwise uninteresting situations or tasks. When tackling important projects, minimize unnecessary distractions. Doing so can help you stay on task and achieve your goals.
3. Take breaks: Sustaining focus can be effortful and draining, especially when performing mundane or boring tasks. Plan breaks during high-effort activities to increase the likelihood of engagement and information retention. You can also step away if unexpected fatigue impairs your ability to complete a task.
4. Stay motivated: Motivation is key. Remember the role of incentivizing success, whether assisting a family member or tackling an independent activity. The best incentives are often external, especially when working on longer-term projects. Consider withholding preferred activities or items until you meet the intended objectives.
5. Create checklists: Many people find checklists can help them keep track of their lives. Many apps are available for those who prefer mobile to-do lists, but good old pen and paper works well, too. Find a method that works well for you.
6. Set and follow a schedule: Sticking to a routine can help you stay organized, motivated, and focused on important tasks and responsibilities.
7. Ask for written instructions: Some people with executive dysfunction process tasks best with written instructions. They can review steps at their own pace and tackle a project accordingly.
8. Use visual aids: Visual aids, like diagrams or sticky notes, can be useful daily reminders. For example, write your meetings or appointments on a whiteboard on your fridge.
9. Implement transition times: Transitioning from one task to another can be difficult for people with executive dysfunction. Allowing extra time between projects, events, or activities can be helpful.
10. Get rid of clutter: Visual clutter can be distracting. Consider clearing off your work desk or reorganizing your living space. Play around to see which setup works well for you.
11. Make use of resources: Utilize resources at school or work, including counseling, coaching, study skills training, or tutoring. These services exist for a reason, so consider reaching out to local organizations or community centers to learn more about available options.
12. Find a coach or tutor: A coach or tutor can help you determine personalized tools and skills to optimize cognitive functioning and focus.