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The term Executive Function was first used by behavioral neurologists over 30 years ago, especially in the understanding of dementias in adult patients. Over the past two decades, the theory of Executive Function has been evolving and gaining prominence among psychologists and other professionals who treat individuals with cognitive disabilities, especially ADHD. It is currently on the cutting edge of understanding and treating such disorders While everyone has occasional difficulty with executive functioning, executive skills are viewed as impaired in children and adults diagnosed with learning differences such as ADHD, compared to others of the same age and developmental level. Disorders involving executive functioning can run in families. Problems may be detected at any age but usually become increasingly apparent as children move through elementary school. For example, a child’s difficulty completing classwork independently may be the first signal that such difficulties exist. Thomas Brown, Ph.D., Assistant Clinical Professor of Psychiatry at the Yale University School of Medicine and Associate Director of the Yale Clinic for Attention and Related Disorders, has developed a model that includes six clusters of cognitive function involved in Executive Function. Although Brown’s model shows six distinct and separate clusters, these functions actually work simultaneously and in an integrated way to help each of us manage daily tasks. Dr. Brown, who studied children, adolescents and adults diagnosed with ADHD, found that each age group experienced impairments in all of the six clusters of his model, recreated below: |
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The first cluster, Activation, has to do with organizing tasks and materials, prioritizing tasks, estimating the time required and getting started on the work. Many people with ADHD describe chronic procrastination, often beginning a project only when time is seriously limited and completion is perceived as an emergency. Focus has to do with establishing, sustaining and shifting focus on tasks. Some people describe being easily distracted by things going on around them, as well as by their own thoughts. This lack of focus also can impair reading comprehension The third cluster, Effort, refers to regulating alertness, sustaining effort and processing speed. Many people with ADHD can can perform short-term projects well but have more difficulty sustaining effort over long periods of time. Deficits in this area may interfere with expository writing, as well as sleep and alertness. Some people stay up too late because their minds are hard to shut off and when they finally do get to sleep, they may sleep so deeply that it is hard to wake up in the morning. The Emotion cluster indicates difficulty modulating an array of emotions. Many people with ADHD report chronic difficulties managing frustration, anger, anxiety, disappointment, desire and other emotions. These emotions may take over their thinking, making it hard to focus on anything else. Memory has to do with utilizing working memory and accessing recall. People with ADHD often report that they have a good memory for things that happened long ago, but have great difficulty remembering where they just put something, what someone just said to them or what they were about to say. Sometimes they have difficulty drawing out of memory information they have learned when they need it. The sixth cluster, Action, refers to monitoring and regulating self-action. Individuals with ADHD are often too impulsive in what they say or do, and in the way they think, jumping too quickly to conclusions which may not be well thought out. Many people struggling ADHD also fail to notice when someone is hurt or annoyed by their words or actions, so they may fail to modify their behavior in fit a particular circumstance (Brown). Interestingly, according to Brown, most people with ADHD have a few activities where ADHD impairments are absent. A typical example would be an ADHD child who is focused and adept at playing video or computer games over a long period of time but is not able to sustain attention when completing schoolwork and other tasks. Brown suggests that in such cases, ADHD may look like a willpower problem but, in fact, it is not. Rather, it is part and parcel of a complex neurological profile. |
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At Peter Murphy & Associates, the purpose of utilizing the Executive Function model with clients -- adults and children alike -- is to understand in which specific areas cognitive challenges occur in order to help the client improve overall functioning and to gain a better understanding of areas of strength and ability, which should be encouraged and developed as one of the main focuses of treatment. When parents, teachers and other professionals who work with children are also guided to a greater understanding of a child’s cognitive abilities and deficits, then they can move toward a more supportive and reflective stance in regard to parenting or teaching the child. For example, rather than approaching a child’s behavior from a reactive stance, which focuses on observable behavior and incorrectly assumes motives for poor behavior; parents and teachers can, instead, operate from a reflective stance, which includes an awareness of the mental processes and feelings of both the self and the child. Rather than labels such as manipulative, lazy, stubborn, selfish or rude, a challenging child can be seen as delayed in brain based developmental skills that are critical to academic achievement, behavioral control and social interactions (Slade, A.) Such skill lags must also be considered in the context of environmental demands that may exceed the child’s capacity to perform to adult expectations. The anxiety and frustration experienced by the child in response to demands that exceed his or her capabilities will interfere with the ability to make use of good instruction. If a child who demonstrates difficulty with controlling negative emotions lives in a home where the parents have the same struggles, this child’s self control will not improve unless the parents themselves model appropriate expression of emotion (Murphy, P., 2009). Developing a curiosity about the underlying neurology of a challenging child with executive functioning deficits, can lead to development of a more empathic relationship between child and adult that will only enhance the child’s ability to grow and develop emotionally and cognitively. A child will naturally be more receptive to adult instruction, guidance and limits if the emotional connection is well established, non-shaming and supportive. Adults are encouraged to examine their own histories and the dynamics in their families of origin, as well, because the psychology of past relationships also has an important bearing on the current bond between adult and child. Understanding these early attachments and healing old wounds will most likely lead to improvements in the overall emotional health of adult as well as child. The two are, in fact, inextricably linked. Understanding a child’s executive function profile may also also help parents communicate concerns and observations to teachers and other professionals, who may, in turn, be better prepared to accommodate and intervene in way that best supports a child’s optimal learning and self esteem. As a child matures, he or she may also benefit from understanding his or her own learning profile, including both areas of struggle and areas of ability. Such knowledge can serve to normalize the concept that strengths and weaknesses are something all of us are confronted with to one degree or another and that “playing to one’s strengths” is a key ingredient to success in life. There are several high-profile examples of people with incredible success who also have ADHD. One such example would be Olympic gold medalist Michael Phelps. All the more reason to view ADHD not as an incurable disorder, but rather as an alternative form of brain wiring with its own benefits and challenges. It is also important to point out that a child or adult’s cognitive profile is flexible and will change and develop throughout childhood, into adolescence and beyond (Brown T.E., 2000). |
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