Eli5 What is executive disfunction?
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So imagine your brain is a race track and the car continuously loops cuz the brain is always working right?
People who don’t experience executive dysfunction can navigate the car into certain pitstops without issues. These pitstops are literally anything your brain is telling you to do like “i will get out of bed now”
A person who experiences executive dysfunction has the same thing except the car has no good brakes. So the car keeps looping in attempt to pull out to the exact pitstop of “i will get out of bed now.”
It doesn’t matter how many times we think it, we can’t get out of bed until the message reaches the rest of the body – but our brains are literally lacking in the brain function of being able to get that message to the rest of the body at an efficient time
Sometimes, we get lucky and we can do something at the first few tries; but more often than not we’re stuck trying to get the command to rest of the body.
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I think [this](https://musingsofanaspie.com/executive-function-series/) is an amazing explanation
It mostly defines what executive functioning is – executive *dys*function are deficits in executive functioning. Some people with EF deficits have problems in all areas, many just with some.
In short, executive functioning describes the cognitive processes that help you organize and control your own thoughts and actions. I’ve seen it described as the “control center” of the brain. While that is wrong (it’s not one place, or even one thing, but an umbrella term for multiple things your brain can do) I still think it’s a helpful description to give you a general idea
I am bipolar and I have ExDy. The way this manifests is like those books- *If you give a mouse a cookie* or *If you give a moose a muffin* (excellent examples if you aren’t familiar). I will go to the store for groceries and then decide to vacuum the living room. While I’m vacuuming I notice a broken face plate on an electrical outlet so I leave the vacuum out and go to Lowe’s to buy a new one. While I’m there I forget all of the other things I need from Lowe’s. Then I get back home and realize there’s ice cream melting in the trunk because I forgot to put the groceries away.
Trying for a true ELI5…
You’ve been playing in your room for a while, but now it’s time to go to school. You know that you need to clean up your room. You even think to yourself, “I should clean up my room.” But the very thought of doing it seems to make you tired and unable to complete the job. You think about it a long time. You feel guilty about not getting up and just doing it. You start to feel anxious about it. Now it’s time to go to school and you don’t have time any more.
When you get home the anxiety and guilt has made the problem seem much, much bigger than it actually is, which means you feel like you did before you left, but worse. Your room stays unclean.
The acronym I use to teach residents and medical students the components of executive function is SOAP: sequencing, organizing, abstracting, planning. Impairment in those abilities suggests a problem in executive function, which implies frontal lobe dysfunction, which is where executive function lives.
I’m going to speak from ADHD since that’s what I have. Executive Functions are your brain’s self control motors. It’s your ability to motivate yourself to do a task, your ability to focus on a specific thing and tune everything else out, it’s your ability to assess a situation and determine what you’re supposed to be doing. Emotional regulation, impulse control, inhibition are also examples of executive functions. It’s all the things your brain is doing moment to moment to control your behavior to be aligned with your desires and goals.
In ADHD patients, all of these (and more) are impaired. People with ADHD struggle to begin tasks, we get bogged down in distractions and details, we get overwhelmed when presented with something too complicated to do as our brains fail to break it down into smaller chunks for us. We have poorer emotional control so our emotions are very intense and disproportionate to situations, we lack the ability to resist impulses that we know are harmful, we have trouble inhibiting ourselves during conversation. Etc etc. “Executive dysfunction” is how we describe the breakdown of these processes, a person experiencing it will not be able to perform actions they want to perform. Sometimes for days or weeks despite planning and making time for it every single day. The example I like is homework, when I was in school I’d get a math worksheet right? And I knew the math, I could work equations, I could look at a problem and come up with the right answer in my head. But translating that to the paper? Picking up my pencil? Focusing my thoughts to what I actually need to show for credit? Putting my pencil on the paper and actually *writing* it all? All of those tiny steps felt insurmountable. They all took an inordinate amount of effort because my unconscious brain wasn’t helping with it, it was like I’m out of gas but need to turn the engine myself. It’s *stressful* and people with ADHD often take multiple times the mental effort in order to do simple things as other people because our brains are not helping us do them. And it’s not a motivation problem. It’s not a knowledge problem. A psychologist I saw give a lecture once said it best, ADHD is not a problem of knowing what to do. It’s a problem of *doing what you know.* And that’s why reminding us, trying to motivate us, giving us things that “work for you” are unhelpful and often frustrate us. Because we know everything. We’re motivated to do it. We *want* to do it. But none of those things are what our problem is. Our problem is the *doing.* Our brains provide nothing that your brain does to help you *do* things without you even noticing. That’s executive dysfunction.
Executive function is actually huge and full of steps. To brush my teeth I need to get up, walk to the bathroom, remember where I keep my toothbrush, pull it out, get it wet, remember where the toothpaste is, get it out, remember how to open it and then put the correct amount on the toothbrush, then put it in my mouth, remember to brush all sides of my teeth, etc.
Executive dysfunction happens when any one of these steps gets derailed, or maybe the process doesn’t happen in the first place. The two most common conditions that cause executive dysfunction are ADHD and dementia.
Executive Dysfunction is the inability to follow through on planned tasks in a timely manner.
This happens when we do not move our bodies enough (sedentary lifestyle), when our diet causes systemic inflammation (due to low fiber, low nutrition content and ultra-processed foods), and in specific conditions such as ADHD. ALL OF US struggle with procrastination at some points in our lives, but this dysfunction is when it becomes a very common and frustrating occurrence.
Exercise can help to regrow the connections in the frontal lobe that support executive function but it only helps, cannot fully cure, issues related to procrastination and inability to follow through/stay on-task.
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