Eli5 What is executive disfunction?
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**Executive functions** are the mental processes (or “skills,” if you will) responsible for ~~goal-oriented tasks~~ helping you get things done, such as…
* ~~focus~~ paying attention and ignoring distractions
* following instructions
* ~~working memory~~ remembering stuff that isn’t necessarily a “forever” thing, but is important to do at certain times or in certain situations *(e.g., returning a library book before it’s due)*
* ~~decision-making, including reasoning and judgement~~ making choices, but also taking into consideration the good and bad things that could happen when you act on them, so that you can make the right choice
* ~~self-monitoring, impulse-control, and emotional regulation~~ being aware of and “controlling” yourself & your own actions, even when you are excited, upset, or having strong urges you want to act on, as well as resisting habits when you have to do things differently than what you’re used to
* problem-solving
* ~~planning, organization, and prioritization~~ figuring out all the steps needed to do a task before starting, including in the right order and time in which those tasks need to be carried out, and staying on top of everything
* ~~time-awareness and time-management~~ setting aside the right amount of time needed to do tasks, and keeping track of how much time is passing while you are working
* ~~task-initiation, set-shifting, and multitasking~~ starting an activity, moving on to the next step when you finish one of the many tasks involved in an activity, and doing more than one thing at the same time
These skills are controlled by a part of the brain called “the prefrontal cortex.”
**Executive _dysfunction_** happens when that area of your brain is ~~impaired~~ less capable of carrying out these tasks, which can happen for many different reasons.
For example, in people with **developmental disabilities** *(e.g., ADHD, autism, dyspraxia, intellectual disabilities, down syndrome, fetal alcohol syndrome, etc.)*, ~~their frontal lobe has structural and connective abnormalities due to atypical early brain development~~ that part of their brain simply developed differently than other people’s when they were still in their mothers’ belly or shortly after they were born. This is just how their brain *naturally* is, and **no surgery, medication, or healthy diet can undo that**.
In people whose early brain development was more or less “typical,” the prefrontal cortex can still be damaged or go through changes for many different reasons *(e.g., brain injury, epilepsy, neurodegenerative diseases like alzheimer’s, lyme disease, fibromyalgia, insomnia, substance abuse disorders, malnutrition, depression, schizophrenia — to name only a few)*, but not all of them are a “forever” (or even “always”) thing.
Executive function is the brain’s job of prioritizing, organizing and carrying out behaviors (ANY kind of behavior–from picking up your socks to getting a job to deciding what movie to watch).
The “executive function” is like the boss at a job. If they are a good boss, then tasks are clearly prioritized, organized and given out for execution by the workers. Things get done and people are generally happy.
If, on the other hand, the boss is forgetful, anxious, easily distracted by phone calls, tired, or any of a number of other things, then they will not be good at the executive functions of prioritizing, organizing and delegating. People generally don’t like working in a place like that–stuff doesn’t get done, people get in trouble, nobody’s really happy with the result. We all hate working for that kind of boss.
People who have ADHD or other problems with executive function struggle with the same issues as the bad boss. It is hard to get organized, prioritize and carry out tasks when you’re forgetful, easily distracted, etc. In order to thrive, these folks need to find ways to stimulate the executive function part of the brain They need to “wake the boss up.” That can done through ADHD meds. The boss can also get woken up with other forms of stimulation, such as music, high-stimulation environments, social interaction, high-risk work environments, etc. Learning & using these other techniques should be part of a solid treatment plan for ADHD and related disorders. Medication alone is not a whole plan.
Part of our brain controls things for us (like pumping our blood, changing hormone levels, etc.)
Other parts we have control over (like moving our arms or feet).
Other parts both systems have control over (like breathing).
Executive function is your ability to put something into action.
The best metaphor I’ve been able to think of to explain ADHD (executive dysfunction) is pooping.
For the most part we only have a very little executive control over our bowels, but it is a little. We can hold it – *a little*. And we can force it – *a little*. But for the most part, it’s just on automatic.
Say you have to leave for work in an hour and know how much better it would be to poop at home. So you go to your usual toilet with all the privacy and the right soaps and on a seat that knows your butt well. And you try to force it out. And you try. And you try. In about 10 minutes you get maybe a single turd. Maybe even you’re sweating from the effort.
So then you go to work. And in two hours your intestines are like *surprise!* and you get the urge to poop the rest. But you’re in a meeting, and you have to hold it. And you force yourself the best you can and try to let out a fart but instantly you know it wasn’t a fart. And you have to excuse yourself and go right then and there to that company bathroom on the strange toilet and odd stains and weird smells, and have to use that single ply toilet paper that you hate.
Humans only have the bare minimum executive function on when we poop. We can’t just will it the way we can will a raising of an arm. The best we can do is try to affect the habits and external circumstances to get ourselves to poop when it’s more convenient, like diet, or going the same time every day. Barring that we can medicate, for diarrhea and constipation.
For people who have executive dysfunction, like ADHD, it’s like pooping — but with everything. Everything.
My own executive control to write a paper, work on job applications, do the dishes, whatever – is like trying to take a poop. I only have the bare minimum control. Likewise when something is really interesting, I only have the bare minimum control to not do it. For some of us that could be a video game or learning something about neutron stars or spacetime or the political structures of ancient Phoenicia or going for a walk.
Just like with pooping, the best we can do is structure things with habits, doing certain things at certain times of the day, and medicate. Otherwise we get stuck with (e.g.,) dishes constipation, and no matter how hard we try we can’t get a single dish washed.
When you think of executive function, think of your ability to will your body to do something, like going poop, or holding in a poop.
Executive functioning refers to the part of your brain responsible for decision making, memory, and emotional regulation.
A little more specifically, this involves skills like planning and prioritizing, organization, emotional control, adapting to changes, etc.
When someone has executive dysfunction, this part of the brain isn’t working properly – in those with ADHD, the frontal lobe, where most of the executive tasks take place, is actually smaller and underdeveloped. This can cause issues with memory, the ability to prioritize tasks, the ability to start focusing on a task (and likewise the ability to stop focusing on a task – many people with ADHD will tell you that they have times where they are so focused that they neglect eating or using the bathroom for long periods of time), the ability to control your emotional response (emotions often feel more intense than to someone with regular brain function), etc
Another way to look at it is that basically the part of your brain that tells you, “hey, you need to do these things because they are good for your survival, and you might get a reward out of it” is off taking a nap, while the emotional part of your brain that is realizing just how important this thing you need to be doing is is sitting their screaming at your frontal lobe to “for the love of God wake up and do something with your life”
I have ADHD and executive dysfunction, this is how it feels for me:
Imagine you’re two people in a car, the person in the driver’s seat and the person in the passenger’s seat. Both of these are you.
You in the passenger’s seat keeps track of the map (keeping track of what to do), and you in the driver’s seat is in charge of turning the car and all that (actually doing the things).
If both of them are acting maturely and focused, then there is no issue. The problem is that the one in the driver’s seat breaks down under high amounts of stress, and the one in the passenger’s seat is easily distracted.
If you’re watching a show, or see a butterfly, or anything more interesting than staring at the road ahead and analyzing the map, then the driver will just follow those things and be none the wiser. Or, if you’re feeling like you need to do something, but it takes you over a rickety bridge, and the driver gets stressed, they’ll shut down in the middle of a bridge.
If your normal healthy human brain had a secretary, executive dysfunction is the lack of that secretary.
Most notably is the lacking “working memory” – this is similar to computer RAM. It’s the memory you use to hold two numbers in your mind as you do math for example. It’s the memory you use to remember the previous words in a sentence as omeone is speaking to you.
This manifest just like ADHD. You’ll notice they can’t stay on topic in conversation. It is hard to have organized thoughts. They are impulsive and “live in the moment” due to their inability to parse and prioritize thoughts.
Executive dysfunction also gets its name due to how it effects the “control” center of the brain. Literally “executive functions.” They have trouble prioritizing task. Remembering that thing you told them to do earlier. They act on impulse. Sometimes react emotionally.
Sleep… sleep is generally a struggle as that is something the control center of the brain regulates. They have a high “mental inertia” …. which means they are not quick to fall asleep, but when they are sleeping they are slow to wake up. This is probably one of the worst symptoms that causes unhealthy feedback loops and they feel like they suck at normal life. Sleeping through alarms despite wishing they could get up. It’s almost out of their control.
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