When someone talks about executive function skills they are describing a wide range of cognitive abilities that include both planning and plan execution; selective, shifting and sustained attention; appropriately sequenced task completion and the inhibition of competing inappropriate responses. These skills are often described as being frontal lobe in origin and related to the cognitive deficits seen if someone experiences an injury to the frontal lobes of the brain. These are common injuries due to the high risk of injury to the frontal lobes when a physical injury causes twisting and shearing of fibers within the brain. Many of these symptoms are the same symptoms described in a post-concussive brain injury. An understanding of the problems associated with such an injury is vital to appropriate rehabilitation.
Common problems include difficulty with insight and problem discrimination, project planning and realistic expectation setting and all the components of attention. It is clear difficulties with one or all of these issues would hinder cognitive rehabilitation including the ability to identify and respond to social cues while initiating and maintaining relationships.
A return of function does not mean a restoration of past skills or expectations. It means the identification and realization of skills that allow those with executive function disturbances to achieve chosen goals for healthy and successful daily functioning. The focus is on the development of compensatory strategies and accommodations to provide the mechanisms for success in home, work and school environments.
The training of working memory which is the term used to describe our ability to mentally manage and update information is the foundation for executive function rehabilitation and improvement. The use of computerized adaptive programs has shown clear benefits and enhanced performance in children diagnosed as having ADHD. Other potential intervention options include educational approaches that focus on a staged, step by step approach which slows down problem solving and decision making into component parts to encourage thoughtful information assessment. Other training techniques include training that includes dual task completion and the use of reasoning skills to extract essential decision making details.
Difficulty with social awareness and an understanding of the thoughts, words, needs and actions of others are common executive function deficits. In our daily lives we need to decode the social intentions of others. An inability to do so can lead to poor decision making and social disasters. The use of the same techniques discussed above can lead to improvement in social decision making and an awareness of the emotional intents of others. An understanding of contextual emotions is vital for the understanding that provides a bridge for the development of relationships.
As a final note, those with executive function disturbances must be aware of the increased risk of error when fatigue, time pressure and distraction are in play. The need to incorporate an awareness of these stressors into one’s choice of a decision making environment must also be both taught and learned. Such an understanding allows a child or adult to develop intention and action plans that are both reasonable in expectation and outcome.