Executive Function

Karen Lea Hyche, OTD, OTR/L

Define executive function

Difference in executive function and motor planning
Diagnosis that impact executive function
Evaluations
Impact of executive dysfunction
Strategies
Planning & Organizing , Visual schedules , time managment
Treatment
Cognitive based therapies, computer based training thera ex &
thera act

8 Executive Functions
Impulse Control

Self Monitoring

Emotional Control

Planning and Prioritizing

Flexible Thinking

Task Initiation

Working Memory

Organization

Impulse Control
Impulse control has nothing to do with
knowing the rules nor the recognition of
the consequences for breaking them.

Impulsivity for young children, according

to Ronald G. Slaby and his colleagues
(1995), occurs for several reasons:

They have trouble regulating their

emotions
and
often
allow
emotions to dictate actions.
They dont listen carefully and don't
pick
up
on
non-verbal
communication signals.
If they have verbal skills that could
help them to stop and think,
they may not use them.
It doesnt occur to them to consider
what else they could do or what
will happen if they respond
aggressively. To them, passive
or aggressive solutions seem
perfectly all right.

Emotional Control
Emotional control is defined, by
Dawson and Guare, as the ability to
manage emotions to achieve goals,
complete tasks, or control and direct
behavior.

Flexible Thinking
to adapt to new situations, improvise, and
shift strategies to meet different types of
challenges.

weak flexible thinking skills

have trouble knowing when not to use typical
grammar and pronunciation rules.
difficulty understanding abstract concepts in
math and reading.

For example, when taking a test that

contains both multiple choice and essay
questions, a child with good Flexibility
skills will be able to switch easily between
the two formats, while a child who
struggles with Flexibility skills may get
stuck and become frustrated each time
the format changes.

Working Memory

Self Monitoring
is the process of observing ones behavior and evaluating it in relation to goals
can be conscious and deliberate (e.g., a student double checks problems on a
math test to ensure accuracy)
can be subconscious and automatic (e.g., a student subconsciously notices
whether or not others are paying attention to him in conversation).

Planning and Prioritizing

is the ability to create a roadmap to reach a goal or to complete a task
involves being able to make decisions about whats important to focus on and
whats not important

Task Initiation
knowing how to get started on a task and sustaining the attention and
effort levels needed to complete the task

Organization
The ability to impose order on work, play, and storage space

The task

Assess the problem: Understand the current situation,

remember information, screen out irrelevant information
and focus on what is important
Assess
Plan the solution: Look ahead- identify goals and
what is needed to achieve them. This includes
weighting options and looking at long term and
short term outcomes

Execute the plan: Be flexible when things

change. Be in control over your emotions,
behaviors and responses

Evaluate the results

Plan

Evaluate

Execute

Completion of a task
Working memory
Inhibitory Control
Cognitive Flexibility

Executive Functions
are necessary for the cognitive control of behavior: selecting and
successfully monitoring behaviors that facilitate the attainment of
chosen goals.
gradually develop and change across the lifespan of an individual and
can be improved at any time over the course of a person's life.

The anatomy of executive functions

Executive deficits have been associated with damage to the most forward areas of
the frontal lobes (located just above your eyes), as well as the cortical and
subcortical structures that connect to the frontal lobes.
The executive system involves the prefrontal cortex, basal ganglia and thalamus.
The frontal lobes are the last areas of the brain to fully develop
The frontal lobes typically account for about 40% of the human brain.

Frontal Lobe
regulates behaviors and emotions
impulse-control, motivation, planning, decision-making, organization,
sustaining and maintaining attention, processing complex information
understanding social cues, using appropriate judgment, and sustaining ageappropriate conversation
frontal lobe mediates, controls, reasons, and regulates information.

Parietal Lobe
information from other cortical areas is integrated to form the basis of complex
behaviors, including all behavior involving the senses (e.g., vision, touch, body
awareness, spatial orientation).

Language comprehension
Constructional ability
Body positioning and movement
Sensory perception (e.g., touch)
Sensory neglect/Inattention
Right-left differentiation
Self-awareness/Insight (e.g., regarding cognitive limitations)
Arithmetic

Temporal Lobe
primary auditory cortex as well as association areas involved in the comprehension and
production of spoken language. Regions of the temporal lobes, along with the limbic
system (which includes the hippocampus), are also involved in learning and memory.
Injury to the temporal lobes is also common with TBI.

Auditory processing The ability to focus on one sound among many

Comprehension of spoken language
Language production (including fluency and word-finding)
Verbal memory
Visual memory

Occipital Lobe
location of the primary visual cortex and the visual association areas. Injury or lesions to
the primary visual cortex cause vision impairments such as blindness or blind spots in
visual fields. Damage to the association area can cause difficulties including visual
distortions (aka "agnosias") and visual inattention.
Visual recognition
Visual attention
Spatial analysis

Occi

Parietal

Tempo

Frontal

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Lobes

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Lobes

Lobe

Lobes

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Visu

Integrati

Memor

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Reco

behavior

gnitio

involving

vision,

Visu
al
Atten

touch,
body
awarene

Proces
sing
Audito

Personality
Inhibition
Spontaneit
y

ry

Self-

Input

Regulation
of Behavior

ss, and

Object

spatial

Recog

Attention

Spati

orientatio

nition

and

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tion

analy
sis

Languag

Emotio
n

Working
Memory

Executive

compreh

Functionin

Executive Function Skills Are Developed Over

Time
The most important environmental factor in Executive Function growth is the
fact that children learn these skills through experience, cumulatively, over time.
Some children can learn skills such as time management by trial and error.
When they have a bad outcome, they recalibrate and change their approach.
Many others learn best when given explicit strategies to gain awareness of
time and to stay on schedule.
If children are not given opportunities to practice and use skills such as
organization and planning, we cant expect them to be independent planners
and organizers when they reach young adulthood.

Praxis and Executive Function

Praxis is the ability to recognize the affordances of objects, combine that
information with knowledge of ones body to plan, organize, and execute a series
of actions.
Executive functions are necessary for goal-directed behavior. They include the
ability to initiate and stop actions, to monitor and change behavior as needed,
and to plan future behavior when faced with novel tasks and situations.
Executive functions allow us to anticipate outcomes and adapt to changing
situations. The ability to form concepts and think abstractly are often considered
components of executive function.

Praxis is more immediate where executive function encompasses information over time
and space (eg. the course of a day). Often times symptoms of praxis deficits and
executive function appear to overlap and may not be well differentiated by clinicians. If a
child presents with sensory and motor deficits, self-regulation and development of higher
level cognition related to motor actions can be impacted.

While executive functions, sensory, and praxis deficits all impact self-regulation, it is
important to identify the components in each area contributing to the childs total learning
profile in order to determine the best interventions and support strategies.

https://vimeo.com/62835181

Building a Foundation for Executive Function Development

adequate sleep,
good nutrition,
safe surroundings,
and a pain-free body..
According to Harvard Universitys Center for the Developing Child, Adults can facilitate the
development of a childs executive function skills by establishing routines, modeling social
behavior, and creating and maintaining supportive, reliable relationships. It is also
important for children to exercise their developing skills through activities that foster
creative play and social connection, teach them how to cope with stress, involve vigorous
exercise, and over time, provide opportunities for directing their own actions with
decreasing adult supervision.

Internal Factors that Impact Executive Function

intellectual disabilities
struggles with physical or mental health
learning differences such as ADHD
Recent research suggests that the brains of children with ADHD may
mature about three years behind their typical peers (Shaw, et al,
2007). Although there are no differences in how their brains mature;
its more a matter of when. So, you can see why its not surprising to
us when we see a bright 13 year old with ADHD who has a lot of
trouble planning and prioritizing.

Environmental Factors that Affect Executive

Function Development
economic hardship
abusive or neglectful caregivers
violence in the home or community
chaotic surroundings
poor access to nutritious food.
Harvards Center for the Developing Child notes that toxic stress from
environmental factors can actually alter a childs brain and disrupt
normal development of Executive Functioning.

Diagnosis

Executive function deficits are associated with a number of psychiatric

and developmental disorders, including obsessive-compulsive
disorder , Tourette's syndrome, depression, schizophrenia ,
attention-deficit/hyperactivity disorder , and autism .

Bipolar Disorder
Bipolar disorder is a mood disorder that is characterized by both highs (mania)
and lows (depression) in mood. These changes in mood sometimes alternate
rapidly (changes within days or weeks) and sometimes not so rapidly (within
weeks or months).
Current research provides strong evidence of cognitive impairments in
individuals with bipolar disorder, particularly in executive function and verbal
learning.

Depression
Depressed participants performed worse than controls on each of the three tasks, and were
found to use appropriate performance strategies less often. Provision of strategy hints
increased the use of performance strategies in two of the three tasks, memory for
categorised words, and response suppression, but did not significantly improve overall
performance for either group.

Executive function in depression: the role of performance strategies in aiding depressed and non-depressed participants

Borderline Personality Disorder

On average,people with BPD show subtle weaknesses in certain cognitive
functions, especially attention/concentration, memory, and executive functions

Executive function deficits also appear to play a role in antisocial behavior.

Chronic heavy users of drugs and alcohol show impairments on tests of
executive function. Some of these deficits appear to result from heavy
substance use, but there is also evidence suggesting that problems with
executive functions may contribute to the development of substance use
disorders.

All substances of abuse, except cannabis, were associated with sustained deficits in
executive functioning, especially inhibition.
verbal memory decrements were consistently found in cocaine, (meth)amphetamines
and ecstasy users, but not in heroin or cannabis users
Cocaine was associated with diminished cognitive flexibility,
(meth)amphetamines were associated with worse cognitive planning functions
Opiate studies showed lower scores on verbal fluency in opiate dependent subjects
Working memory and visuospatial abilities were compromised in alcohol abusers
In ecstasy users, inconsistent findings have been reported across neuropsychological
domains, with the exception of inhibition and verbal memory.

Criminal Behavior
Prefrontal dysfunction has been found as a marker for persistent, criminal
behavior.
The prefrontal cortex is involved with mental functions including; affective range
of emotions, forethought, and self-control.
There is a scarcity of mental control displayed by individuals with a dysfunction in
this area over their behavior, reduced flexibility and self-control and their difficulty
to conceive behavioral consequences, which may conclude in unstable (or
criminal) behavior.[80]

Criminal Behavior
n a recent study conducted by Barbosa & Monteiro, it was discovered that the

recurrent criminals that were considered in this study suffered from executive
dysfunction.In view of the fact that abnormalities in executive function can limit how
people respond to rehabilitation and re-socialization programsthese findings of the
recurrent criminals are justified.

Criminal Behavior
Statistically significant relations have been discerned between anti-social
behavior and executive function deficits.[81] These findings relate to the emotional
instability that is connected with executive function as a detrimental symptom
that can also be linked towards criminal behavior. Conversely, it is unclear as to
the specificity of anti-social behavior to executive function deficits as opposed to
other generalized neuropsychological deficits.[81] The uncontrollable deficiency of
executive function has an increased expectancy for aggressive behavior that can
result in a criminal deed.[82]

Dementia
significant relationship between executive dysfunction and IADL impairment independent of
diagnosis, global cognitive impairment, memory performance, depression, and apathy.
executive dysfunction was linearly or quadratically related to IADL impairment within each
diagnostic group (NC, MCI, and mild AD). This relationship has previously been demonstrated in
AD and other dementias4
executive dysfunction impacts daily function in subjects with milder clinical impairment. In fact,
these results demonstrate that a significant proportion of subjects with MCI and mild AD have
executive dysfunction, earlier in the disease course than typically reported. This subset of MCI
subjects with significant executive dysfunction have greater functional impairment and are
bordering on dementia. It is very important to identify such individuals and treat them as early as
possible in order to preserve their tenuous level of independence.
Executive function and instrumental activities of daily living in MCI and AD

Dementia
Semantic Dementia (SD)
results from progressive damage to parts of the anterior temporal
lobes (the lobes of the brain near your ears). Though more commonly
thought of as a language disorder, people with SD often show changes
in executive function including inappropriate staring, loss of concern
for the emotions of others, poor moral reasoning, lack of initiation,
inappropriate humor, trouble making plans and moderating their diet.
Progressive Nonfluent Aphasia (PNFA)
Executive function changes are less common or less severe in
progressive nonfluent aphasia (PNFA).

Behavioral variant frontotemporal Dementia

(bvFTD)
Progressive shrinking of the tissue in the frontal and anterior temporal
lobes of the brain defines bvFTD. The changes most commonly
associated with bvFTD are a loss of social skills, loss of concern for the
emotions of others, disinhibition and antisocial behaviors, poor moral
reasoning, lack of initiation, inappropriate humor, trouble making plans
and moderating food intake. Sometimes patients with bvFTD also
develop addictive behaviors late in life or show diminished response to
pain.

Parkinsons
Parkinson's disease (PD) primarily involves damage to subcortical brain
structures and is often associated with movement difficulties, in addition to
problems with memory and thought processes.[48] Persons affected by PD often
demonstrate difficulties in working memory, a component of executive
functioning.
Cognitive deficits found in early PD process appear to involve primarily the
fontro-executive functions. In terms of working memory specifically, persons with
PD show deficits in the areas of: a) spatial working memory; b) central executive
aspects of working memory; c) loss of episodic memories; d) locating events in
time

Dopamine
studies of the role of dopamine in the cognition of PD patients have suggested
that PD patients with reduced dopamine supplementation are more impaired in
their performance on measures of executive functioning.[62] This suggests that
dopamine may contribute to executive control processes. Increased distractibility,
problems in set formation and maintaining and shifting attentional sets, deficits in
executive functions such as self-directed planning, problems solving, and
working memory have been reported in PD patients.[61]

CVA
It has been estimated that around 75% of people will
have executive function difficulties after a stroke.
Disorders in EF after stroke are very common and affect participation in
rehabilitation (Skidmore et al., 2010) and recovery (Lesniak, Bak, Czepiel,
Seniow & Czlonkowska, 2008) with high risk of functional dependence (Lesniak
et al., 2008), failure to return to work (Ownsworth & Shum, 2008) and poor social
participation (McDowd, Filion, Pohl, Richards & Stiers, 2003).

Diabetes Mellitus Type 2

verbal fluency, mental flexibility, inhibition, working memory, and attention.
Disease duration significantly moderated the effect of T2DM status on EF.
CONCLUSIONS:
T2DM is associated with a mild-to-moderate EF decrements.

TBI
Older age, lower levels of education, and greater days of
posttraumatic amnesia were associated with poorer functional
outcomes.
the results suggest that specific cognitive domains, particularly
executive functions, are likely to have the strongest effect on
functional outcomes.

TBI
Individuals

with a moderate-to-severe brain injury often have problems in basic cognitive (thinking) skills

such as paying attention, concentrating, and remembering new information and events.
They may think slowly, speak slowly and solve problems slowly.
They may become confused easily when normal routines are changed or when things become too
noisy or hectic around them.
They may stick to a task too long, being unable to switch to different task when having difficulties.
On the other hand, they may jump at the first solution they see without thinking it through.
They may have speech and language problems, such as trouble finding the right word or understanding
others.

Fetal Alcohol Syndrome

Surveys from the United States have found about 10% of pregnant women have drunk alcohol in the
last month, and 20% to 30% drank at some point during the pregnancy.
The risk of problems depends on the amount consumed and the frequency of consumption as well as
when during pregnancy the alcohol is consumed
Other risk factors include an older mother, smoking, and poor diet.
While drinking small amounts of alcohol does not cause abnormalities in the face, it may cause
behavioral issues.
Alcohol crosses the blood brain barrier and both directly and indirectly affects a developing baby.

Most of the executive functions such as learning and memory are

affected in children, who are exposed to alcohol before birth. FAS have
Executive Function Disorder as a major sign of this medical condition.

ADHD
One of the most common childhood brain-based disorders, ADHD is
found in most people, who have Executive Function Disorder.
In this condition, impulse control, activity levels and attention are all
affected. This affects the child in learning and in studies. Learning
issues and disorders are also similar troubles that Executive Function
Disorder has as symptoms.

Autism & Working Memory

Working memory refers to the ability to remember all of the steps needed to
reach a goal. For example, when a parent says: Get ready for school, the child
has to remember all of the steps that make up the morning routine (dressing,
eating, brushing teeth, getting the backpack together, etc.). Even after hundreds
of practice runs (think about how often a child has completed the morning routine
by the time he starts first grade!), many children with autism still cannot get ready
for school independently. Weak working memory is one reason children with
ASDs might have difficulty completing even over-learned activities such as the
morning routine.

Autism & Planning

impairment on tasks requiring planning abilities relative to typically functioning controls, with this
impairment maintained over time. As might be suspected, in the case of autism comorbid with learning
disability, an additive deficit is observed in many cases.
.

Autism & Flexibility

Poor mental flexibility, as demonstrated in individuals with autism, is characterized by perseverative,
stereotyped behaviour, and deficits in both the regulation and modulation of motor acts. Some research
has suggested that individuals with autism experience a sort of stuck-in-set perseveration that is
specific to the disorder, rather than a more global perseveration tendency. These deficits have been
exhibited in cross-cultural samples and have been shown to persist over time

evaluations

The Barkley Deficits in Executive Functioning Scale

(BDEFS for Adults)
Evaluating dimensions of adult executive functioning in daily life. Evidence indicates that the BDEFS is far
more predictive of impairments in major life activities than more time-consuming and costly traditional EF
tests.
The BDEFS offers an ecologically valid snapshot of the capacities involved in time management,
organization and problem solving, self-restraint, self-motivation, and self-regulation of emotions.

Age Range: 18-81

Administration Time: Long Form: 15-20 minutes. Short Form: 4-5 minutes.
Format: Self-report plus other-report (for example, spouse, parent, or sibling) rating scales.

Behavior Rating Inventory of Executive

Function (BRIEF)
Assesses executive function and self-regulation in children and teens
5 though 18 years for BRIEF, 2.0 to 5.11 years for BRIEF-P, 11 to 18 years for BRIEF-SR
10 to 15 minutes for BRIEF, BRIEF-P, BRIEF-SR
Parent and teacher questionnaires for BRIEF, Rating scale completed by teacher, parent,
or day care provider for BRIEF-P, Self-report for BRIEF-SR

Comprehensive Executive Function Inventory

is a behavior rating scale designed to evaluate goaldirected behaviors controlled by executive function
in youth aged 518 years. The CEFI can be used to
guide assessment, diagnosis, and treatment
planning.

Delis-Rating of Executive Function

Overview: A quick measure of an individuals behaviors related to executive function

difficulties
Qualification Level: B
Age Range: Individuals 518 years old
Reading Level: 4th grade
Administration: Online (paper available)
Completion Time: 5-10 minutes per form
Scores/Interpretation: T scores; Composite level

Texas Functional Living Scale

(TFLS)
TFLS provides an ecologically valid, performance-based screening tool to help identify the
level of care an individual requires. Brief and easy to use, the TFLS is especially wellsuited for use in assisted living and nursing home settings.
Users & Applications
TFLS can help support diagnostic work-ups, placement decisions, treatment planning,
evaluation of treatment outcomes, and monitoring of disease progression.
Age Range: 16:090:0 years old

Executive Function Performance Test

http://www.ot.wustl.edu/about/resources/executive-function-performanc
e-test-efpt-308

Adult Checklist for Executive Functions Strengths

and Weaknesses: Task initiation
Strengths

Examples

Efficient

Returns emails and

phone calls
promptly

Prioritizes

Gets out of
bed and gets
going quickly
in the
morning

Activates
him/herself to
start on a task

The Minnesota Executive Function Scale (MEFS)

subscription service for assessing executive function skills using a brief, standardized instrument administered on an
iPad. Executive function refers to the neuro-cognitive skills needed for successful learning and performance in school,
at work, and in life. They include cognitive flexibility, working memory, and inhibitory control.
The MEFS is easy to use, but is intended to be administered only by trained and certified examiners. That is how you
can be sure the MEFS results and norms are reliable and valid. The App will be fully accessible to subscribing
organizations with secure login credentials provided by Reflection Sciences upon signed user license agreement.
FEATURES
+Early childhood version designed for ages 2-7 +

Select an avatar to play along

+Intuitive drag and drop responses +

Adaptive to individual EF ability

Reliable, valid, and normed

+ Virtual card-sorting game with 7 levels of challenge

Takes 3 to 7 min to complete (average 4 min)

Screening provides early detection of potential EF difficulties

complements educational curricula and programs designed to improve EF skills

Formative assessment

Planning
Strengths

Examples

Plans a sequence
that does not
waste time

Puts aside
money to pay for
a down payment
on a car

Sets short- and

long-term goals
at home and
work

Gets out of bed

and gets going
quickly in the
morning; drops
kids at practice,
food shops, goes
to the bank,
makes dinner,
and picks up
kids at the end
of practice

Weaknesses

Examples

Organization
Strengths

Examples

Easily finds
things that
she wants

Uses a
calendar or
planner to
assist in
keeping
activities
organized

Keeps desk
neat and
materials
accessible at
work
Designates a
specified place
for most

Puts away
clothes in
closets and

Time Management
Strengths

Examples

Budgets time
efficiently

Is on time for
meetings and
deadlines

Correctly estimates
the amount of time
needed to
complete a task

Budgets time
according to
priorities at work
and home so that
he/she can be at
kids games or
family gatherings

Paces herself to
start and complete
a job effectively

Pays bills on time

Weaknesses

Examples

Is frequently late

Gets caught up in a
minor detail in
cleaning the house,
so that one room

Flexibility
Strengths

Examples

Can shift his/her

approach

Adapts to
unexpected changes
in schedule

Learns from
mistakes

Is adventurous,
willing to try out new
restaurants or listen
to different music

Looks at other
perspectives

Takes on new
challenges at work
or pursues additional
training to develop
new skills

Changes gears
readily and solves
problems
Weaknesses

Examples

Experiences
problems with

Becomes overly
upset when a

Metacognition
Strengths

Examples

Can take perspective

on herself and
others.

Applies what he/she

has learned in one
situation to another,
such as knowing
what type of
restaurant her family
will like or what kind
of movie to rent for
her children

Is generally accurate
in her assessment of
his/her performance
Knows strengths and
weaknesses
Is a good judge of
her abilities, so that
she is able to take
on manageable
tasks at locations

Regulation of Affect
Strengths

Examples

Can
regulate/control
his/her emotions

Expresses
frustration verbally

Can tolerate
frustration

Finds something
positive about a
situation when
things dont go as
planned

Is optimistic and
positive
Is not overly
reactive when
criticized at work or
by family or friends
and can accept the
criticism or make a
well thought-out
response
Weaknesses

Examples

Response Inhibition
Strengths

Examples

Stops and thinks

before making an
important decision

Delays making
negative comments
to her spouse or
boss

Takes time to read

directions or
analyze a problem
before starting to
do something

Checks over an
important work
assignment before
handing it in

Can postpone
immediate
gratification

Makes a choice not

to engage in an
argument with a
teenage son or
daughter

Weaknesses

Examples

Speaks before
thinking

Agrees to do
something such as
going out or
helping someone
when he/she has

Social Awareness
Strengths

Examples

Reads nonverbal
cues and the
feelings of others

Has many friends

and is well-liked

Recognizes the
needs of others

Is a good host, and

people enjoy
visiting

Sees other peoples

perspectives

Is a good listener
and thoughtful in
times of stress for
others

Weaknesses

Examples

Is unaware of other
peoples feelings

Unknowingly
stands too close in
conversations and
makes others
uncomfortable

Has difficulty
understanding
verbal cues such as

Dominates
conversations and
does not listen to

Sustained Attention
Strengths

Examples

Maintains focus
and attention for a
sustained period of
time

Can pay attention

to something that
may be important,
but boring

Ignores distractions

Keeps focus on a
conversation with a
child, even with
distractions such as
a television or
other conversations
in the room

Returns to an
activity if
interrupted and
reengages
attention

Starts on
household tasks
such as cleaning, is
interrupted by
taking a child to a
practice, then
returns to the task

Weaknesses

Examples

Starts one thing

Reads a book

Goal-Directed Persistence
Strengths

Examples

Sets goals and

sustains ongoing
efforts to complete
them

Completes longterm tasks such as

finishing a
basement or
maintaining a
vegetable garden

Sets and achieves

long-term goals
and persists in the
face of difficulty,
hardship, and
grueling effort

Sets long-term
personal goals such
as building a
business, saving
money for a new
home, or getting a
college degree

Weaknesses

Examples

Is bored by longterm tasks

Starts cleaning the

garage or
basement and
gives up after an
hour

Working Memory
Strengths

Examples

Follows multi-step
directions

Does tasks without

losing sight of other
commitments or
obligations

Remembers
previous
experiences and
applies them in a
current action

Remembers to do
things when asked
by spouse or boss

Remembers the
details of a
conversation, a
project at work, or
driving directions
Weaknesses

Examples

Is absent-minded

Often forgets items

he/she wants when
food shopping

Impact of dysfunction
Social
Education
Career
Independence as adult

Children with less self control have worse health, earn less and
committ more crimes as adults

Social Impact
Forgets Appointments or loses things he has borrowed

Has trouble understanding others viewpoints

Blurts out what is on mind

Meltdown at social events

Executive functions
allow people to initiate and complete tasks and to persevere in the
face of challenges
the environment can be unpredictable, executive functions are vital
to human ability to recognize the significance of unexpected
situations and to make alternative plans quickly when unusual
events arise and interfere with normal routines
Executive functions are an important component of the ability to fit
in socially

Frontal Lobe Injuries

may be unaware that their behaviour is inappropriate.
may appear to be very anti-social and can be misunderstood as
depression

lack of motivation

selfishness

aggression.

Executive functioning problems may also have a significant emotional impact and can lead to
feelings of

frustration

exhaustion

embarrassment

isolation.

It can also be very difficult to return to work due to problems with

Multi-tasking

organisation

motivation

inability to prioritise and complete tasks

Education
Working memory and inhibitory control each independently predict
both math and reading competence through school years

Job success
Poor productivity
Difficulty finding and keeping a job

Independence
Severe deficits in EF can result in the need for assistance throughout
the lifespan

IADLS
A study of older adults used structural equation modeling (SEM) to examine the
relationships between 3 executive processes underlying executive function :
inhibition, task switching, updating in working memory
and 2 types of instrumental activities of daily living
The results of this study uniquely show a direct relationship between executive
processes and performance-based IADLs,

PsycINFO Database Record (c) 2012 APA, all rights reserved)

Health
Lower executive function and emotional regulation are associated
with: Higher BMIs Unhealthy eating behaviors .in adults and
adolescents

Health
Long-term effects of deficiencies in vital nutrients on the brain include poor cognitive
development, behavioral problems, and inability to understand and regulate
emotions. Children who experience severe nutritional deficiencies are subject to
learning disabilities, and executive functioning disorders such as and Attention Deficit
Hyperactive Disorder (ADHD) that make it difficult to concentrate on tasks at hand.
These children exhibit lower academic performance as their ability to learn and retain
information, follow directions, and complete tasks effectively is inhibited.
Studies have shown that there is a direct correlation in nutritional deficiencies and
presence of: Attention Deficit Disorders (with and without hyper activity), memory
deficiency, learning disabilities, impaired academic performance, lower social
intelligence, slower and less effective language development, less effective problem
solving skills, and decreased IQ scores according to the SPOON Foundation.

Health
Minerals such as calcium, and vitamins such as vitamin B, C, and D
have proven essential in proper emotional development and regulation
in children as well as adults.
Nutritional deficiencies and imbalances in children have also proven to
be correlated with the development of emotional issues related to:
autism, hyperactivity, anxiety and depression, bipolar disorder, and
schizophrenia, as well as other psychological disorders and learning
disabilities.
Nutritional deficiencies in fetal development, infancy, and childhood
can render a child unable to learn, adapt normally to social situations,
and control and understand their emotions (Proshob & Chandrashekar,
2015).

Treatment

Parents
According to Harvard Universitys Center for the Developing Child, Adults

can facilitate the

development of a childs executive function skills by establishing

routines, modeling social behavior, and creating and maintaining
supportive, reliable relationships. It is also important for children to
exercise their developing skills through activities that foster creative
play and social connection, teach them how to cope with stress,
involve vigorous exercise, and over time, provide opportunities for
directing their own actions with decreasing adult supervision.

Exercise
The team found the overall relationship between cardiorespiratory fitness levels and higher executive function may
be partially explained through activation in a region of the brain called the anterior cingulate cortex and the
supplementary motor area (ACC/SMA).
We analyzed areas of the brain that were activated while the participants were completing two tasks, and found
that the ACC/SMA activation was associated with higher cardiorespiratory fitness. Its an important area for higher
level functions, such as conflict monitoring, multitasking, and dual-task processing itself, said Wong.
This research adds to our growing understanding of the relationship among physical activity and cognitive and
brain functionand suggests that we can improve our brain health by changing our lifestyle even as we age, said
Kramer.
This work was supported by the National Institute on Aging.

Neurodevelopmental Disorders & Exercise

moderate acute aerobic exercise can transiently improve executive function in
children with and without neurodevelopmental disorders.

Vitamins
Vitamin B is associated with proper cognitive and metabolic functioning
as it helps to convert carbohydrates into energy that the body needs to
carry out various processes
Vitamins C and D work together to ensure proper growth and repair of
tissues within the body, as well as proper bone growth and density.
These vitamins also promote a healthy immune system and are linked to
mood regulation.
Deficiencies in these vitamins can give way to: stunted physical
growth, depression, fatigue, a compromised immune system, obesity as
it relates to hormones released in the brain and produced throughout
the body, and problems with mood, emotions, and behavior in children
(Prado & Dewey, 2014).

Iodine is essential in the functioning of the thyroid gland, which is

responsible for regulating metabolism and growth. Iodine deficiency is
the primary cause of learning disabilities and brain damage. Thyroid
issues later in life can lead to chronic fatigue, weight gain, hair loss,
and mental confusion (Prado & Dewey, 2014)
Omega fatty acids are essential in the healthy brain development of
children as the majority of the brain is composed of them. Deficiencies
in omega fatty acids are related to the presence of mental and
behavioral disorders such as: ADHD, depression, impulsive and
aggressive behavior, as well as dyspraxia and dementia later in life
(Reeves, 2008).

Nutrient from

Percentage of dietary

food alone,

intakes below the

ranked by the

estimated average

occurrence of

requirement for a

dietary

specific population*

inadequacy
among adults

2-to-

14- Ad

8-

to- ult

year-

18-

old

ye

19

childr ar- an
en

old

girl ol
s

de
r

Vita

6 5 51

min

%7 %

Calci 2 8 49
um

3 1 %
%%

Vita

2 4 43

min

%5 %

Vita

0 1 15

min

. 8 %

B6

1 %
%

Iron

0.7% 12% 8%

Thiamin

0.1% 10% 7%

Copper

0%

16% 5%

Vitamin

0%

7%

B12

4%

ACCi
ar
l o
c n
i
u
m

t B
h6
a
m
i
n

p100111
o0
000
p%
t
a
r
t
40200

CBT with medication showed best

outcomes for all age groups.
Common CBT strategies used among
children included problem solving coping,
organizational skills, self-instruction and
lately, mindfulness.
Adolescents underwent CBT training
similar to adults, i.e., training in time
management, organization, planning,
problem solving, motivation, and
emotional regulation.
Attention-Deficit Hyperactivity Disorder Across
the Lifespan: Review of Literature on Cognitive
Behavior Therapy. Monica Mongia, Lily Hechtman

Cognitive Based Therapy

Cognitive behavioral therapy can be
thought of as a combination of
psychotherapy and behavioral therapy.
Psychotherapy emphasizes the importance
of the personal meaning we place on things
and how thinking patterns begin in
childhood.

CR and Borderline Personality

Disorder
Cognitive rehabilitation and
psychoeducational interventions
appeared to show good efficacy in
improving disabilities in daily life in
subjects with BPD. These interventions
are easily implemented in mental
health settings and have the
advantage of improving general
functioning and clinical symptoms.

CR consisted of group sessions (5 individuals

per group) of 120 min, twice a week during a
total period of 16 weeks (32 sessions). The
exercises addressed neurocognitive issues
related to sustained attention, processing
speed, memory and executive functioning. The
whole program aimed at getting new strategies
to improve functional adaptation, thus tasks
were carried out in the clinical setting and at
home. Some homework tasks were based on
their daily life difficulties and problems. The
main objective of this program was the
generalization of rehabilitated cognitive
functions to daily life activities.

Mindfulness
Mindfulness is the psychological process of bringing one's attention to the internal and
external experiences occurring in the present moment which can be developed through the
practice of meditation and other training.

Recent interest has emerged for studying the effects of mindfulness on the brain using
neuroimaging techniques, physiological measures and behavioral tests. Research on the
neural perspective of how mindfulness meditation works suggests that it exerts its effects
in components of attention regulation, body awareness and emotional regulation

Cogmed Working Memory Training

For individuals

Were born with a deficit

Acquired a deficit through brain injury or disease
Developed a deficit through natural decline caused by aging
Face career demands and wish to improve job performance or test performance
By training working memory, individuals are better able to stay focused, ignore
distractions, plan next steps, remember instructions, and start and finish tasks.

Alert Program: FASD

This study examining structural brain changes associated with the Alert Program for Self-Regulation in
children with FASD is the first to identify the neuroanatomical changes following treatment for their core
deficit in executive functioning. Our findings showing Alert succeeds in increasing cortical gray

matter in children with FASD, particularly in regions underlying response inhibition,

outcome monitoring, and emotion regulation signify it is possible to ameliorate, at an
endophenotypic level, some of the brain damage caused by PAE. Thus, our research offers
preliminary hope for improving functional outcome in children with FASD.
Self-regulation therapy increases frontal gray matter in children with fetal alcohol spectrum disorder: evaluation by voxelbased morphometry

Alert Program
Supports children, teachers, parents, and therapists to choose appropriate
strategies to change or maintain states of alertness. Students learn what they can
do before a spelling test or homework time to attain an optimal state of alertness
for their tasks. Teachers learn what they can do after lunch, when their adult
nervous systems are in a low alert state and their students are in a high alert
state. Parents learn what they can do to help their child's nervous system change
from a high alert state to a more appropriate low state at bedtime.

Alert Program
How does your engine run
Test Drive
Songs
Games

Sensational Brain / BrainWorks

BrainWorks simplifies the process of creating sensory diets and teaches self-modulation
through its use.
A sensory diet is the strategic use of sensory activities.

Zones of Regulation
The Zones is a systematic, cognitive behavior approach used to teach selfregulation by categorizing all the different ways we feel and states of alertness
we experience into four concrete zones. The Zones curriculum provides
strategies to teach students to become more aware of, and independent in
controlling their emotions and impulses, managing their sensory needs, and
improving their ability to problem solve conflicts.

Bal-A-Vis-X is a series of some 300 exercises, most of which are done

with sand-filled bags and/or racquetballs, often while standing on a
Bal-A-Vis-X balance board. Requiring multiple thousands of mid-line
crossings in three dimensions, these exercises are steadily rhythmic,
with a pronounced auditory foundation, executed at a pace that
naturally results from proper physical techniques. Bal-A-Vis-X enables
the whole mind-body system to experience the symmetrical flow of a
pendulum.

Motor Cognition Squared (MC2) is a method of blending physical and cognitive exercises
that begin simply and build to become progressively more complex. MC2 exercises are
based upon the concepts of neuronal migration, neural-pathway development, and
learning theory.

a non-medication neurocognitive program that is used to treat ADHD/executive

function deficit, concussions, traumatic brain injury including stroke, gifted
asynchronous development, fetal drug and alcohol exposure, and mild
autism/Aspergers syndrome.
MC2 has shown positive results in improving handwriting, classroom behavior, homework
completion, and home behavior as well as improvement in working memory, sustained
attention, inhibition, and cognitive flexibility.

BrainWare Safari
builds 41 cognitive skills in 6 areas: Attention, Memory, Thinking, Visual Processing,
Auditory Processing and Sensory Integration
20 exercises based on decades of proven clinical practice from multiple disciplines
is easy to incorporate in practice to enhance outcomes, to gain insight into client
strengths and weaknesses, and to individualize therapy.

Interactive Metronome
an assessment and treatment tool used by therapists and other professionals who work with pediatric and
adult patients with neurological conditions that affect cognitive and motor functioning. IM provides an
objective method for measuring deficits and for tracking improvement.
IM is an evidence-based, engaging therapeutic modality that improves cognitive and motor skills. The
design of the program ensures that patients recognize progress as it is occurring, increasing their
motivation toward therapy and their ultimate recovery. IM is used to improve:
Attention
Coordination
Language processing
Reading and math fluency
Control of impulsivity/aggression

Working Memory App - Quizlet

Quizlet is an app and a website that allows

children to create their own digital flashcards so they
can learn their terms and definitions.
The app is great for studying on the go
the online version is better for inputting the
information.
offers mini-games to make the process more
engaging
flashcards can be organized by class and
subject

SLP
Dr. Fletcher-Janzen made the statement, Teach executive functions from the top
down. Demand organization and then help them organize. This made me think
about narrative-based interventions are these interventions so successful in
the research because they support student executive functioning skills, too? Do
they support student organization of language which, in turn, helps students
support their understanding of language?

Verbal Reasoning is an iPad app created by a certified speech and

language pathologist for adults and children ages 12 and up.
targets reasoning and critical thinking skills
challenging users with over 1000 stimuli
app allows speech and language pathologists and educators to set a reward system
when working with children to make therapy more fun and motivating
children are rewarded with puzzle pieces, and when they accumulate enough pieces
they can do various puzzles. This feature can be turned off when working with adults.
$12.99

Impulse Control
Taking turn and waiting games

Emotional Control
Teach emotions
Books and songs
Self Calming
Yoga

Flexiable Thinking
Games
QBitz
Rush Hour
Mastermind
Connect 4

Working Memory
Memory Games

Self Monitoring
Video

Plan and Prioritize

Goal sheet
Formulate plan
State what you will do

Strategy games

Organization
Demonstration
Models

Strategie
s

Visual Schedules

Visual Schedules
Place simple visual schedules in each room

Smartphones and Tablets

Set alarms and reminders

Apps
Evernote is an easy-to-use, free app that helps you remember everything across
all of the devices you use. Stay organized, save your ideas and improve your
productivity. Evernote lets you take notes, snap photos, create to-do lists, scan
business cards, record voice reminders--and it makes everything searchable,
whether you are at home, at work, or on the go.

Nudge - Reminders by Simple Tailor Software

This app is more detailed and customizable than the standard calendar app. You can set up
reminders for a specific time and have it repeat as needed. There are a variety of sound effect
choices to accompany your reminder ranging from soft to obnoxious. I like this app because you
can send a "nudge" to someone else. "Find your lunch card" nudges come in handy at our house.
I find that my son responds better to an app reminder than "another mom lecture". If the person
you are nudging has the app, it goes right into their reminders and if they don't, they will receive
an e-mail with the information.

Plan It, Do It, Check It Off by I Get It, LLC

This is a To Do List app that uses real photos to
represent what needs to be done. You can choose from
26 pages of photos or customize by uploading your
own photos. You can add text to the pictures you
upload and there is an audio recording option as well.
This is a great way to make lists for pre-readers. You
can add a check mark to the picture when the task is
complete. Create step by step "books" for activities
like cleaning your room, getting ready for bed,
completing a project and more. There is even an
option to send a PDF document of each list to email,
so you can print it out.

Toodledo - To Do List by Toodledo

This is one of the top productivity apps. It has countless features including: tracking
priority of tasks, assigning folders, flagging certain tasks, audible pop up alarms, start
and stop timers and it can be synced with other devices. This app would work best for
adults or older students with multiple classes/projects.

30/30 by Binary Hammer

This is time management at its finest and it's FREE. Set up a list
of tasks to accomplish and a length of time to complete them. The
timer will tell you when to move on to the next task. You can
incorporate break times into tasks with this app. It's a great way to
break up a long evening of homework for children who can't sit and
complete it all in one sitting. The visual component is so important
and will help kids "see" when they need to work faster or when it's
almost break time.

Functional Planning System by The Conover Company

The Functional Planning System utilizes video modeling to help children (and
adults) create visual to do lists. Choose from a video library through in app
purchases or create your own videos and step by step sequences for tasks that
need to be completed daily or in preparation for a new task. This would be great
for creating social stories in video form. An amazing tool and can be used in so
many different ways.

Headphones
For distractions

Notetaking
Columns
Peer notes
Teachers notes

2 column on word doc

Daily Living
List
Planners

Safety at home
CookStop continuously checks for movement in the kitchen.
If the person leaves the room or falls asleep while cooking, CookStop shuts the stove off.
While CookStop can be configured for many different levels of security, it is functional upon
installation, immediately reducing the chances of an accident.

Safety at home
Automatic turn off for small appliances
Automatic pill dispenser
Door alarms
Bathtub water level alarm
Motion lights

Fu

Description

Possible

nc

Signs or

tio

Symptoms

of
Dysfunction

Setting a

Acts as if

oa

goal.

future-blind

(Barkley,
2002), i.e. not
working
towards the
future.

Pl

Develop steps

May start

an

towards goal,

project

identify

without

materials

necessary

Pri

Establis

May waste time

orit

doing small project

ize

ranking

and fail to do big

of

project

needs

May have difficulty

or

identifying what

tasks.

material to record in
note-taking
May include the
wrong amount of
detail in written
expression (too
much detail, too little
detail, irrelevant
detail)
May fight every
fight as if were life or
death

Inhi

Stop oneself

May

bit

from responding

appear

to distractors.

distractibl

Delay

e and/or

gratification in

impulsive

service of more

May

important, long-

pick

term goal.

smaller,
immediat
e reward
over
larger,
delayed
reward

Pac

Establish and

May run

Shift

Move from

May have

one task to

difficulty

another

making

smoothly

transitions

and quickly.

and/or

Respond to

coping with

feedback by

unforeseen

adjusting

events

plan or
steps.
Self-

Assessing

Doesnt

Monitor

ones

check to

performance

insure that

and

each step is

progress

completed

towards

Doesnt

goal.

monitor pace
to determine
if goal will be
met on time

When there are EF deficits - 90% of the time there may also be problems
with motivation, depression, anxiety, or some other disabling force such as
a learnig problem or attention deficit. Therefore, we believe tha EF
mentoring and psychotherapy go hand-in-hand.

http://www.tandfonline.com/doi/abs/10.1080/21622965.2013.821652