Executive function is the set of mental skills that manage other mental skills. It includes working memory, holding information in mind while using it; inhibition, stopping an impulse or filtering a distraction; cognitive flexibility, shifting between tasks or viewpoints; planning and organization; task initiation; time management; and emotional self-regulation. These abilities depend on the prefrontal cortex and its connections, and they mature slowly, continuing to develop into the mid-twenties. They are what let you start a boring task, finish it despite interruptions, and adjust when the plan changes.
Executive function deficits are central to ADHD. A person with ADHD may understand exactly what needs to be done and genuinely want to do it, yet be unable to begin, sustain attention or keep track of the steps. This is why ADHD is better understood as a problem of performance than of knowledge, and why advice to try harder rarely works. Executive function also suffers in depression, where concentration and initiative drop, in anxiety, where worry consumes working memory, after head injury, in sleep deprivation, and with aging and dementia. Evaluating executive function involves a careful history, rating scales such as the ASRS, and sometimes formal neuropsychological testing. Treatment depends on the cause: stimulant or non-stimulant medication for ADHD, treating depression or insomnia when those are driving the problem, and practical strategies such as external reminders, breaking tasks into steps and coaching. Stedfast Psychiatry evaluates executive function concerns in children, adults and older adults.
Where this applies at Stedfast
- ADHD
- ADHD Testing and Evaluation for Adults and Children
- Memory and Dementia
- Child and Adolescent Psychiatry