Executive Function

Executive function is a critical skill that serves as the "boss of the brain", directing all the other higher level brain functions in their tasks. Differences in this area have widespread effects on other skills, so it's critical to be able to determine if problems with other skills are inherent to those skills alone or are actually coming from or influenced by executive function struggles. This article is to introduce the basic concepts of executive function so you can learn to do that yourself!

Why is Executive Function Important?

Whether you are a caregiver, an educator, or a healthcare provider, or your average Joe, you're unlikely to have learned much about executive functioning in school. I have a bachelor's in psychology and a master's in communication sciences and disorders with a concentration in autism. Yet it was only through extensive continuing education (this was my favorite course for in-depth understanding, highly recommend, but if you're looking for something free with practical ideas, this video presentation is great) that I learned about it and WOW did it explain so many things - behavioral struggles foremost among them.

Executive function is the one skill that rules them all. Just like the brain directs the body, executive function directs the brain. That also means that any problems with executive function affect all sorts of different areas and will make them seem like they're the direct sources of weakness.

There are layers of executive function skills. I actually like to think about the layers as parts of a house. You have the bits of the house as you can see it from the outside, the parts of the house that you can see after someone invites you in (though you won't get a full view unless you're actively looking around), and then you have the building frame and foundation that even a building inspector can't observe directly, at least not in full. I think that's a really good metaphor for how easy it is to miss executive functioning deficits. Even someone actively looking for problems the house itself is having might come back and tell you that the house has cracked walls, warped floors, and pests that are getting in somehow. Only someone who actually understands how houses are built will see these for what they truly are; a problem with the home's foundation that is only visible in its effect on the other three. Do the walls and the floors and the pests need addressing? Definitely. But if you don't address the problems in the foundation, you're not going to be able to get to the actual source of the problem.

And that's what often happens with executive function. You'll get a child who comes in having been put on a behavior plan to address their behavior, tutoring for their reading, speech therapy for their social communication, and counseling for their emotional regulation. Like in the house metaphor, yes this is a child who needs supports for areas they're presenting with direct struggles with in, sure. But they also absolutely need an evaluation for executive function because for so many kids like this, that's the underlying root of their struggles. Eventually they may develop enough compensatory behaviors to paper over the cracks, but if you don't address the foundation, they'll just be limping along making do. And worst of all, they'll be attributing these struggles (especially those with behavior) to themselves as people, rather than where they belong - a simple mismatch between their actual executive function skill levels and those demanded by the world.

Foundational Executive Function Skills

Some executive function skills actually are visible if you're looking for them, such as organization abilities and time management. But the deepest executive function skills, the ones that lead to a chain reaction in everything else, are what I'll refer to as the foundation. Attempts to treat the higher level skills directly are often stymied by a failure to identify the needed foundational skills that are missing, so if you're looking at executive function, make sure you check these skills first.

1. Awareness / Perception

This is simply noticing what's going on around you in a broad way, regardless of where your attention is directed. If a child is so involved in the sensory joy of lining up toys, or consistently tripping over materials on the floor because they didn't notice them, those are signs that they have struggles in this area.

2. Attention

Focus: Directing attention to something
Sustained focus: The idea of fully sustained attention is a myth, as our minds will always wander. When we talk about extended periods of attention, we're actually referring to your ability to a) recognize when your mind has wandered and b) bring it back to the original subject of attention. The breakdown could be in either subskill.

3. Working memory

Working memory is your ability to hold information in your mind for short periods. It breaks down into two components: nonverbal working memory and verbal working memory.
Nonverbal working memory is your brain's ability to simulate the outside world. People sometimes refer to it as the brain's visuospatial sketchpad, but in truth the simulation can be using any of the senses; vision is just the most common. This is also how you hold onto one or more concepts or idea of something in your mind; for instance, when you're comparing a cat and a dog you have to hold your mental simulation of both in your brain at the same time. On top of that, it's how you pull up your long-term memories. The video presentation I referenced earlier does a great job explaining nonverbal working memory and aids.
Have a child who is just missing countless other higher executive function skills? Check nonverbal working memory, because it is a common underlying skill deficit and SO MANY higher level executive function skills build on this. Think about it. Making a plan, predicting the consequence of an action, pacing yourself in a task, keeping track of time, having the comfort of simulating that something unpleasant won't last forever, or that you'll get to go back to something you love later on, just so many skills rely on simulation.
Verbal working memory is how you store speech sounds in your memory for short periods of time. It is also called the "phonological loop" for this reason. You don't have to have physically heard them in your ears, either. You could read this non-word, "quorp", translate the letters into a phonological representation, and then use your verbal working memory to loop that in your head as well.
The thing about verbal working memory is that it is independent of meaning. For example, I could tell you "In ten minutes, there's going to be a visiting group of students from China here. When they leave, say 'zai jian". Unless you happen to speak Mandarin, those words mean nothing to you. Yet you *can* remember the speech sounds and even produce them on demand in ten minutes. How? By repeating it to yourself over and over and over in your mind, using your verbal working memory to keep the sounds in your mind for the period you'll need to hold the information.
Where many general tests of working memory go wrong is that they use real words; meaning that you have both the concept of the word (which your nonverbal working memory can grab hold of) and the speech sounds of the word (which your verbal working memory can replay). If they're both impaired, your results won't be affected, but if only one is impaired, you can compensate for it by using your other form of working memory. This can make it seem as though there is no deficit even if, in fact, there is a very significant deficit in one of the two types of working memory.

4. Inhibition

This is the ability to keep ourselves from acting on our impulses. There are two subcomponents here. First, we need to be able to simulate the future/pull up simulations of memories from the past in order to understand when and why we should inhibit an impulse. And you need to be able to pull that up extremely rapidly, in time for you to use that information to inhibit. And second, you need to have some sort of plan for what to do instead to actually keep yourself from acting on that impulse.
Example: You're trying to diet but someone put your favorite candy on your desk. How do you inhibit the impulse to eat it? First, you need to recognize that this is an impulse that needs to be inhibited. But recognition isn't enough; you need to have something to do to help you act on your desire to inhibit it. Maybe you'll remind yourself that you're working on your health. Or perhaps you'll tell yourself you can have a piece of sugar free candy instead. You could even give it to someone else to get rid of the temptation, or at least move so you can't see it. And all this planning and decision making and future simulating the effect of candy on your health is requiring nonverbal working memory.

Secondary Executive Function Skills

Each of these skills requires one or more of the previous skills in order to be successful.

Task Control Skills

1. Getting started on a task (initiation)

This is often baffling to see, when you have a kid that you present with something really basic (like asking a high schooler to write a paragraph, which you're sure they have the skills to do) and they just...don't. You ask them again to do it. Maybe you tell them they only have to write half a paragraph. You tell them they can go take a break in calm corner and then come back and do it. But no matter what you try, none of it works. Or maybe you ask them to do the same task, but they yell that they can't or they break their pencil or they come up with delaying tactics over and over.

These are just some of the ways that struggles with initiation can present. When you have a task that's on your to do list and it feels overwhelming for you, what do you do? Well, what everyone will tell you to do is break it up into smaller tasks. Why? Because in order to initiate a task a) it has to feel doable [it can't be so overwhelming that you shut down] and b) you have to know where and how to start. One problem that can result in this is that if you don't have the nonverbal working memory to simulate out a task, you can't break it up. It feels too big and you freeze because you can't tell where to start.

Note that the same thing can happen even if you do normally have the executive functioning skills to do a task, but are too emotionally overwhelmed. The simplified metaphor we use to explain it to kids is that their "downstairs brain" (the parts in charge of basic survival and emotional reactions - the limbic system, brain stem, etc - which are lower in the brain) gets overwhelmed and makes it so your brain can't listen to the "upstairs brain" (the cerebrum, which is physically higher in the brain and controls executive function, problem solving, and planning among other things). In short, when something is wrong and we're dysregulated we aren't going to be able to use our executive function skills as well, if at all. So if you've got a kid who has anxiety around writing, they're probably going to struggle with initiation even if they normally don't.

2. Stopping when asked

As you might imagine, this requires inhibition. If you don't have inhibition, you're not going to be able to stop doing something you're enjoying when someone asks you to. It also requires awareness of the environment, as if you don't notice that you've been asked to stop, you're not going to be able to.

3. Shifting attention

Let's say that you were doing something and someone starts talking to you. Your ability to tear your brain away from what you're doing and move it to listening to them represents a shift in your attention.

4. Pausing a task and then returning to it

This is your ability to shift your attention back to something it had left. This might be after a more significant pause, or it could be after something as simple as pausing during an intercom announcement and then going back.

Skills for Self-Monitoring and Regulating

1. Energy regulation

Are you using the right amount of energy, both for what your task requires and for what you're going to need as the task continues? Projecting the future is part of this. Imagine if a marathon runner thought to themselves "Okay, this is a race where the fastest person wins, so when they say go I'll start running as fast as I can". They would expend all their energy at the beginning and not have enough to actually finish. This is the executive function component of energy regulation. Another skill you need to regulate your energy is sensory regulation, which is a whole other set of critical skills. I'll probably add something about that later on, but for now suffice it to say that occupational therapy is great to get involved if you suspect sensory regulation struggles.

2. Self-monitoring

This is just noticing your accuracy, progress, etc on something you're doing. We have to use this all the time - when we're reading, writing, cooking, even driving. You have to have awareness and attention to do this, as well as the nonverbal working memory to compare what you're intending to do to what you're actually doing.

3. Self-correcting / self-modulating

This is acting on the information that you noticed. It requires the self-monitoring from before, but also the inhibition to stop and correct errors you noticed, plus the nonverbal working memory to figure out how to make the correction.

4. Sense of time

This is pretty straightforward. Do you accurately notice time passing? And can you guess about how long something will take? This requires nonverbal working memory and awareness.

5. Pacing

There are two subskills here. You have to first determine the pace required for the task and then stick to that pace as you go through the task. To determine the pace, you need nonverbal working memory to simulate out how long everything will take. To be able to stick to that pace, you need inhibition and self-monitoring. So this is actually a much more complex skill than it seems.

6. Flexibility

This is the "cognitive flexibility" that so many try to address directly without ever checking to see if the underlying skill required for it - nonverbal working memory - is in place. In order to have flexible thinking, you need to be able to hold multiple ideas in your head at the same time. To flex with a routine change, you need to be able to simulate in your head what the change is going to be like. If you can't simulate that change, it can feel just like a giant, overwhelming abyss. Or even the flexible thinking required to understand multiple meaning words or figurative language. You have to be able to hold both possible interpretations in your mind (nonverbal working memory) and then determine which makes sense.

Top Level Executive Function Skills

These are the executive function skills whose lack is most directly visible to others. These require not only the foundational skills for success, but also one or more of the secondary skills as well.

1. Anticipation

This is a skill that requires nonverbal working memory. Sarah Ward really helped me see how this skill is a big area of difficulty for our kids with executive function struggles. Let's say that it's read aloud time right now and it's always time to do math after reading. As the teacher nears the end of the book, our kids with good executive function are thinking, "Okay, circle time is almost over, then because math is next, the teacher is going to tell us to go get our number lines. Where did I put my number line? Oh yeah, it's in my backpack, I'll need to ask the teacher if I can get it."

What about our kid with poor executive function? Well, they're surprised when the book ends because they didn't notice that there weren't many pages left (poor awareness). Their thoughts are all over the place - they could be thinking about the book, but they might just as easily be thinking, "The fluff on the carpet looks like my dog's fur, I wonder if dogs come in here after the kids leave for the day?" (Low attention) Then the teacher says "Okay, it's math time!" (Which our kid didn't simulate coming up, because of their poor nonverbal working memory.) And our kid says, "Wait, what? I don't want to do math!" And then has to rapidly adjust to this "change in plans"...even though it's the exact same thing they do every day. This is what poor anticipation looks like.

2. Organization

This isn't just "their desk is messy" sort of organization; it's also the organization of your approach to a task. Are you reading the directions or jumping right in? Have you figured out what needs to be done first, or are you just doing the first thing that comes to mind? This skill requires nonverbal working memory, inhibition, awareness, self-monitoring/correcting, and many other previously listed skills.

3. Planning

This goes along with organization. To make a plan you have to both identify what you want to achieve (your goal) and then how to get there. And what do you need in order to do that? You've probably guessed at this point that the answer is nonverbal working memory. This time you're not just holding one or two concepts in your mind, but rather you're trying to hold a whole sequence. And you're actually going to be self-monitoring and correcting your own simulation!

4. Decision making and prioritizing

Okay, so you've made it through everything else. But you've hit a point where you're going to have to make a judgment call. Do you freeze up, or can you make a choice (including what you need to prioritize first)? You have to simulate multiple possibilities in order to make the call.

The Effects

You can probably see many of the effects that trouble with these skills would have in daily life. However, there are also domains that are affected by proxy.

If verbal working memory is a struggle, you may have trouble with the decoding portion of reading or remembering a direction a teacher gives you (which often looks like intentionally not following directions, when in fact they simply weren't remembered).

If nonverbal working memory is a struggle, the effects can be even more broad. Anything that requires holding one or more concepts in your brain can be a struggle. In language arts you may have trouble with reading comprehension, telling a coherent story, and vocabulary skills such as multiple-meaning words and comparing and contrasting. In math, mental math and understanding word problems can be difficult. Socially you may have trouble with perspective taking and anticipating what others will do.

And attention? Attention is treated as though it's something you should just be able to turn on and off. Classes are constructed in such a way as to educate for those with typical attention skills; even for those children, they're still often taxing. For someone with struggles with attention? Forget it. Even if you know you really, really need to listen to what the teacher is saying, you can't help but think about how shiny the posters on the wall are, how uncomfortable your bunched up sock is, what you're going to do as soon as you get home - and in the blink of an eye, you've missed critical material. The problems don't stay behind in childhood, either. (Long office meetings, anyone?)

Let's say inhibition is hard. Well, that's going to look a lot like a person who is just "misbehaving" and it's treated like a moral issue. Even though your teacher has told you a million times to raise your hand in class instead of blurting out your question, you just can't seem to stop. You're not supposed to leave your desk without permission and you *know* you're not supposed to leave your desk, but in the heat of the moment you still end up doing so. It's really hard to stop and think a problem all the way through without jumping on to the next one, which affects your test scores and other grades, too. People try to motivate you to "behave" with star charts and rewards or even punishments, but even when you most want to avoid a punishment or get a treat, you still can't completely inhibit impulsive reactions.

This is just a small sampling of the effects of executive function skill struggles on other areas. For a much more in-depth look at these, I recommend reading Tera Sumpter's book "The Seeds of Learning: A Cognitive Processing Model for Speech, Language, Literacy, and Executive Functioning". It's got a long title but it's actually quite a short book which is very readable. Her Seeds of Learning cohort is also pretty great! (I promise I'm not affiliated, it's just very good! It's where I got the basis for a lot of what I know about executive function, along with the McCloskey assessment of executive functioning, Sarah Ward's trainings, the book "Peak Mind", and a lot of attempts at deciphering some dense neuroscience research articles. Look up the relationship between the salience network, default mode network, and central executive network in the brain some time if you ever want to dive deep down a neuroscience rabbit hole.)

Hopefully this has been a helpful crash course! You now know more about executive function than 99% of the population and you'll start to see it everywhere!