COUNSELORS & CLINICIANS

Clinician’s Guide to Executive Functions

The phrase “executive functions” is becoming an increasingly common term in discussions of children with attention, learning, and psychosocial disorders. As there are varying definitions of executive functions, clinicians are encouraged to become familiar with a basic understanding of the concept of executive functioning and how it applies to childhood psychiatric and learning disorders. The following section provides a general summary and a brief discussion of a modified Dawson and Guare (2004) model that LearningWorks for Kids recommends for use with children.

Executive functions refer to a set of brain-based cognitive skills that help people regulate their thinking, emotions, and behavior. Executive functions are presumed to be centralized in the prefrontal cortex of the brain, which receives incoming information from all other brain regions and coordinates this information.Sensory experiences, current biological states, and memories all contribute to an individual’s evaluation of the current situation and help coordinate decision making and actions.It is the executive functions that help people to set goals, develop an understanding of the tools necessary to complete a goal, and monitor successes and failures.

The executive functions are built-in brain skills that emerge in infancy and toddlerhood but become more evident as a child becomes ready for school. The necessity for skills such as being able to pay attention, remember what was learned in the past, and regulate one’s behavior become necessary for effective adaptation. While these skills are “built-in”, they develop over the course of childhood, and recent evidence suggests that they continue to develop until the age of 35.

The growth of executive functions directly parallels the brain growth and development in children. Current research indicates that frontal brain systems, including the frontal and prefrontal cortex (which are the last brain regions to mature), are key areas involved in executive functioning. Individuals with significant damage to their frontal lobes and the prefrontal cortex have numerous deficits in executive functioning, including high levels of impulsivity, poor judgment, irresponsibility, and numerous difficulties with decision making and monitoring one's behavior.

As a child's brain matures, it not only grows in size through a regeneration of neurons, but also develops an extraordinary number of branches that allow for nerve cells to communicate with each other, increasing the capacity for complex thinking and decision making. Executive functions do not operate independently in decision making and are highly dependent upon the quality of the information that the brain receives. The quality of executive functioning skills may be based upon accurate sensations (impressions/interpretations? Not sure sensations can be accurate or not) of one's world, emotional and motivational states, memory capacity, and ability to use language. 

Executive functioning in children appears to develop in a sequential fashion. Distinct growth patterns have been observed in which there are periods of intense development between the ages of 5 and 7, 9 and 12, and within adolescence. Babies as early as 1 year old begin to display the ability to be goal-directed.  By the age of 2, children are able to follow single directions, and at 3 they are able to begin following and understanding distinctions amongst directions. 

One prominent theory of executive functioning development has been formulated by Russell Barkley, Ph.D., who proposed that within the first 6 to 12 months of life, children are developing the executive function of behavioral inhibition. Behavioral inhibition allows a child to think before acting and decide when or if to respond to a situation. Barkley suggests that the skill of working memory, which involves holding events in mind, occurs next.  This is followed by the use of internalization of speech, involving the use of language to aid in decision making.  The next stage involves self-regulation of affect, emotional self-control, and regulation of motivation and energy to achieve a goal. This is followed by what Barkley refers to as reconstitution, which involves the ability to analyze and monitor one's behavior and to develop strategies to use one's skills to solve new problems. 

Executive Functions as Executive Skills

A slightly different conceptualization of executive functions refers to them as a set of psychological skills, including decision making, problem solving, resisting distraction and interference, selective attention, and inhibiting inappropriate responses. The skill-based perspective views executive functioning as impacting a child's ability to start tasks; plan; maintain mental information; regulate expression of feelings; sustain attention to tasks; manage time; display persistence and/or flexibility; and think, monitor, and evaluate one's actions. Executive functioning is extremely important in the development of effective goal-directed behaviors. Generally, children are able to display increasing skills in their use of executive functions as they grow older.  Delays in one or many areas of executive functioning skills are seen in many children and adults who have difficulties in diverse areas such as planning; social skills; time management; initiation, persistence, and completion of tasks; and memory and learning.

The following is a list of the executive functions that are most useful in the LearningWorks for Kids model. As noted, there are many definitions of executive functions found in the psychological literature. The descriptions that follow are those that apply most directly to the development of executive functioning skills in children. The format that follows combines many viewpoints but uses the organization of work conducted by Peg Dawson and Richard Guare (2004).

Task Initiation (Getting Started)
Sustained Attention (Keeping Focused)
Planning (and Prioritization)
Working Memory (Keeping It in Mind)
Organization
Goal-directed Persistence (Stick-to-itiveness)
Flexibility
Response Inhibition (Self-control)
Regulation of Affect (Handling Emotion)
Time Management/Prioritization
Metacognition (Thinking about One’s Actions)
Social Thinking

Metaphors for Executive Functioning

A number of psychologists have referred to executive functions as the conductor of an orchestra (Brown, 2005). The conductor is seen as being connected to all aspects of the music that is to be produced (the observable behaviors). The conductor must pay attention to each of the musicians and the instruments and interactions amongst them, and process many channels of information. At the same time, the conductor must be organized, constantly check and monitor what is happening, and be responsive to the here and now. Concurrently, the conductor uses his/her memory of previous experience, identifies strengths and weaknesses, and makes adjustments when necessary to the volume and emphasis of the music being produced. 

A different metaphor that may be helpful to explain executive functions to children is that of a baseball coach or a manager. A coach or manager needs to organize his/her thoughts and actions in response to the environment, history, and strengths and weaknesses.

For example, the manager of a baseball team makes decisions about who to play, which players to start, what aspects of the game require the most attention, and using players when they can be most successful and help the team (such as knowing when to use a pitch hitter or a relief pitcher). Strategies such as juggling a number of options, such as asking oneself, "What will the other team's reaction be if I make a particular move?" and being flexible in response to changing situations in the game will also be important. (Executive and planning skills such as having the team prepared to play a game and keeping their effort focused and sustained on the game have a direct impact upon performance.)  Managers also require other executive function skills in which they need to handle their emotions when the team is doing poorly, have an ability to estimate or judge what might happen in certain circumstances, and then be able to think and review what they are doing and use that learning for future games.

A manager or coach often provides guidance, direction, encouragement, and perspective taking. These are all components of successful executive functioning. Children with difficulties in these areas require external coaches and managers (such as parents, teachers, counselors, or peers) to guide them, provide modeling, and provide effective feedback so that they can enhance their use of executive functioning skills. Parents, teachers, and clinicians are sometimes asked to serve as the “temporal lobes” for children with executive dysfunctions.  In this respect, adults serve as supports or scaffolds for executive skills for these kids.  LearningWorks for Kids provides strategies on using digital technologies and other tools to support executive functions in children. We also strongly believe that these skills can be practiced and learned through the use of digital technologies and other methods. Specific strategies for doing so can be found at LearningWorksforKids.com.