Executive Dysfunction

What is executive dysfunction?

Executive dysfunction is a behavioral symptom that disrupts a person’s ability to manage their own thoughts, emotions and actions. It’s most common with certain mental health conditions, especially addictions, behavioral disorders, brain development disorders and mood disorders.

What are executive functions?

To better understand what executive dysfunction is, it helps to know more about executive functions. The main executive functions are:

• Working memory.
• Cognitive flexibility.
• Inhibition control.

Working memory

Working memory is the kind of memory that involves whatever you’re doing right now. If you’re reading, taking notes or having a conversation, then your working memory is part of the process.

Cognitive flexibility

Also known as fluid or flexible thinking, this refers to how well your brain can shift and move from one topic to another. The more flexible your thinking, the better you can adapt to whatever is happening around you. This also helps you react to unexpected changes in your situation.

People who are better at flexible thinking are often very creative and imaginative. This ability lets them connect concepts and ideas that might not ordinarily seem linked, which also helps with creative problem-solving.

Inhibition control

Inhibition control is your ability to steer or manage your thoughts, emotions and actions. This is a huge part of executive function, and we’d be unable to control our impulses and thoughts without it. There are two main ways that inhibition control works:

• Behavioral control. This is your ability to keep yourself from doing things that you think you shouldn’t do. An example of this is staying silent around an extremely annoying person because you believe in the saying, “If you can’t say anything nice, then don’t say anything at all.”
• Interference control. This is the ability to steer or manage your thoughts. It includes focusing on something that needs your attention and ignoring whatever doesn’t. Sometimes, the attention and focus are outside of your head. Sometimes, you have to apply interference control to your own thoughts, which might distract you from whatever needs your attention.

Higher-level executive functions

Working memory, cognitive flexibility and inhibition control are the foundation of executive function. There are also higher-level processes that can happen, including:

• Planning. This is when you mentally map out a series of actions that’ll help you reach a goal.
• Reasoning. This is the ability to apply critical thinking. It’s a key way for you to build on your stored knowledge to think creatively or break down something complicated into easier-to-understand pieces.
• Problem-solving. This function can involve all three main executive functions, as well as planning and reasoning. This is how you apply what you know and how you think to overcome obstacles or problems that are in front of you.

What are some examples of executive dysfunction?

Because executive functions involve so many processes inside of your brain, executive dysfunction can take many forms. Some examples of executive dysfunction include:

• Being very distractible or having trouble focusing on just one thing.
• Focusing too much on just one thing.
• Daydreaming or “spacing out” when you should be paying attention (such as during a conversation, meeting, class, etc.).
• Trouble planning or carrying out a task because you can’t visualize the finished product or goal.
• Difficulty motivating yourself to start a task that seems difficult or uninteresting.
• Struggling to move from one task to another.
• Getting distracted or interrupted partway through a task, causing you to misplace items or lose your train of thought (like leaving your keys in the refrigerator because you wanted a snack, but your hands were full, so you put your keys down inside the refrigerator and forgot about them).
• Problems with impulse control, like snacking when you’re trying to manage your diet.
• Struggling with thinking before you talk, causing you to blurt out the first thing that pops in your head without considering that it might hurt someone’s feelings.
• Having trouble explaining your thought process clearly because you understand it in your head, but putting it into words for others feels overwhelming.

What are the most common causes of executive dysfunction?

Experts don’t fully understand why executive dysfunction happens, or why it can take so many different forms. However, experts have linked this issue to several conditions that affect the way your brain works, including:

• Addictions (especially alcohol use disorder and drug use disorder).
• Attention-deficit hyperactivity disorder (ADHD).
• Autism spectrum disorder.
• Depression.
• Obsessive-compulsive disorder (OCD).
• Schizophrenia.

Brain damage and degenerative diseases

Executive dysfunction can also happen if there’s damage to or deterioration of the areas of your brain that contribute to executive function abilities. Some common examples of conditions or circumstances that can cause damage or deterioration include:

• Alzheimer’s disease.
• Brain tumors (including cancerous and noncancerous growths).
• Cerebral hypoxia (brain damage from lack of oxygen).
• Dementia and frontotemporal dementia.
• Epilepsy and seizures.
• Head injuries such as concussions or traumatic brain injuries (TBIs).
• Huntington’s disease.
• Infections (such as those that cause encephalitis or meningitis).
• Multiple sclerosis.
• Stroke.
• Toxins, such as carbon monoxide poisoning.

How is executive dysfunction treated?

In general, the treatments for conditions that cause executive dysfunction can vary based on the condition itself and a person’s circumstances, health history and preferences. Because a variety of options is available, your healthcare provider is the best person to tell you what treatments are available and most likely to help you.

For the most part, mental health conditions that cause executive dysfunction are treatable, but this can vary from case to case.

Mental health conditions

When executive dysfunction happens because of a mental health condition, the goal is usually to treat the underlying condition causing it. That’s because executive dysfunction is often just one of the many symptoms that happens along with these disorders.

By treating the underlying disorder, it’s often possible to reduce the impact of executive dysfunction. With treatment, the effects of executive dysfunction are often minimal or barely noticeable. The most common treatment methods for mental health conditions that cause executive dysfunction include:

• Medication. Medication(s) depends on the underlying condition. Potential medication types include stimulants (especially for ADHD), antidepressants and antipsychotics.
• Psychotherapy (mental health therapy). Cognitive behavioral therapy (CBT) is a very common form of mental health therapy for conditions that cause executive dysfunction. It’s common for treatment to involve only therapy or in combination with medication treatment.

Brain damage and degenerative disease treatments

The treatments for executive dysfunction from brain damage or degenerative brain conditions can vary widely. For some of these conditions, direct treatment or supportive care can help. For others, the underlying condition may improve on its own without treatment. Unfortunately, some of these conditions aren’t treatable. Your healthcare provider is the best person to tell you what kind of treatments are available and what results you can expect.

What can I do at home to deal with executive dysfunction?

It’s not possible to self-diagnose and treat conditions that cause executive dysfunction on your own. Because of this, you should see your healthcare provider if you suspect you have symptoms of executive dysfunction. They can either offer you treatment recommendations, such as medication, or suggest providers who can help you with other treatment options.

Is executive dysfunction preventable?

Executive dysfunction isn’t preventable when it happens because of mental health conditions or degenerative brain diseases.

The only ways to prevent executive dysfunction involve avoiding brain injuries that can cause it. Ways you can avoid this kind of damage include:

• Wear safety equipment.Head injuries can result in brain damage that cause executive dysfunction. Helmets, seat belts and other protective gear can help you avoid head injuries whether you’re at work or at play. Other types of safety equipment can also help you avoid exposure from toxic chemicals or other substances that can also cause brain damage.
• Don’t ignore infections. Eye and ear infections need fast treatment. If these infections spread to your brain, then they can become serious or even deadly. They can cause brain damage that leads to executive dysfunction.
• Eat a balanced diet and maintain a healthy weight.Many conditions related to your circulatory and heart health, especially stroke, can damage areas of your brain. Preventing — or at least delaying — stroke and similar conditions is a key way to reduce your risk of developing executive dysfunction.
• Install carbon monoxide detectors in your home. Carbon monoxide poisoning can cause severe brain damage (including executive dysfunction) if it isn’t discovered and treated quickly.

When should a doctor or healthcare provider diagnose and treat executive dysfunction?

If you notice this symptom and it’s disrupting your life and usual activities, then you should talk to your healthcare provider. You should also talk to your child’s pediatrician if you notice they’re showing signs of executive dysfunction, especially the symptoms that overlap with ADHD or any other mental health conditions.

What’s the difference between executive dysfunction and procrastination?

Procrastination doesn’t happen because of an issue or problem with part of your brain. It’s a conscious choice to delay doing something.

When you have a condition that causes executive dysfunction, the parts of your brain that control self-motivation, planning and inhibition control don’t work as they would in a person without this condition. That means it’s not something you can easily control, if you can control it at all. Because of this, executive dysfunction isn’t procrastination, laziness or simply not caring.

Is executive dysfunction a symptom of ADHD?

Yes, executive dysfunction is one of the key symptoms of ADHD. Research shows that the parts of the brain involving executive functions tend to be smaller, less developed or less active in people with ADHD. That’s why ADHD nearly always involves this symptom. It’s also a common feature among many conditions that affect people who are neurodivergent.

What does executive dysfunction feel like?

People who have executive dysfunction are often very — even painfully — aware of the dysfunction. How it feels can take different forms, depending on what people are doing when they experience it:

• When you’re trying to self-motivate to do a task. One way to describe it is like a vinyl record player that’s skipping over the same part of a song repeatedly. You want to fix the problem and make it play correctly, but the record is stuck in the same pattern.
• In social situations. A person who has executive dysfunction can often struggle when interacting with others. This can feel like your words getting ahead of your thoughts or tripping over what you want to say. This often makes people with executive dysfunction feel very anxious or worried in social situations.
• When trying to focus or concentrate.People with executive dysfunction can struggle to focus on something that needs their attention. They may find other sights, sounds and things happening around them extremely distracting to the point where concentrating is impossible.

A note from Cleveland Clinic

Executive dysfunction is a symptom that experts are still researching and trying to better understand. What experts do know is that executive dysfunction disrupts some of the key functions of your brain that help you manage and control your thoughts, emotions and actions. On the outside, a person with executive dysfunction might seem careless or indifferent, but many people who experience this are uncomfortably — even painfully — aware of their struggle.

If this is something you face, then talking to your healthcare provider can be the first step to managing or even overcoming this issue. A trained provider can offer suggestions and resources that can help you. If you have a loved one who struggles with executive dysfunction, then patience, listening, understanding and support can make a big difference. With the right support and treatment, many people can learn to manage this symptom and reduce the disruption it has on their lives.