The Look and Feel of Executive Dysfunction — and What You Can Do About It

You’ve probably had moments when you forgot to do something, lost track of time, or snapped at someone in a moment of impatience. For most people, it’s an occasional moment that they can easily dismiss as a brief lapse in character. 

But, for people with conditions that cause executive dysfunction, these episodes may be more commonplace. They can disrupt daily life and pose frustrating challenges for people as they try to function at their best. Let’s take a closer look at executive dysfunction, including causes and ways to improve executive function.

What is executive dysfunction? 

Executive function (EF) refers to skills that help you concentrate and pay attention. They’re the brain functions that help you take pause and think before you act, stay on task, and finish the things you need to do. 

Certain conditions that affect the brain — like depression or ADHD (attention-deficit hyperactivity disorder) — can affect these EFs as well. This is executive dysfunction.

Executive dysfunction can affect multiple aspects of someone’s life. For example, executive dysfunction can have a significant effect on:

• Work or school performance: People with executive dysfunction have trouble meeting deadlines or completing tasks. So they may have difficulty holding a steady job or finishing school.

• Social life: It can make it harder to develop or maintain relationships with friends, family, and intimate partners.

• Health: It can make it harder to remember medications or follow diets and exercise routines.

Types of executive function

There are three core categories of executive function and three higher-order categories that are combinations of the core categories. We’ll start by explaining the three core categories.

Core executive functions

1. Working memory

This is the type of memory that allows you to temporarily store information that you need to use in the short term. For example, it allows you to: 

• Follow the events in a story and understand how they’re related to each other

• Make decisions, as it helps you remember the other options and make comparisons to decide 

• Perform mental math by remembering numbers while working out the answer in your head

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2. Self-control

There are several aspects to self-control. It’s what allows you to: 

• Pay attention: This is necessary to have a conversation with someone in a noisy room. It also lets you focus on what you’re reading or watching, even when there’s distraction.

• Regulate your behavior: For example, you may think twice before overindulging in foods that don’t make you feel good. Or if someone does something unkind to you, it keeps you from saying something mean or acting violently toward them. 

• Stay on task: This is why you can prioritize work or a necessary task instead of watching television, for example. 

3. Cognitive flexibility

This EF allows you to see things from another perspective. It develops later in life than the other two. 

Cognitive flexibility also allows you to change plans — an ability you may use more than you realize. Say you were planning to order a specific menu item at a restaurant, if that item isn’t available, cognitive flexibility allows you to pick something else. 

Higher-order executive functions

Sometimes you need two or three of the basic EFs to work together. These are higher-order EFs. There are three main categories. 

1. Planning

This EF requires working memory and cognitive flexibility. It’s the ability to consider all of the factors and make a plan to reach a goal. A basic example of this is when you make a list of things you need to get done in the morning. And then you remember and prioritize those tasks as you make your way through the day. 

2. Reasoning

Reasoning combines all of the core EFs. Reasoning can look like a decision you make based on your previous experiences. Or it can be a conclusion you make based on facts you learned or earlier observations. 

Let’s say you need to get to work on time, but it’s pouring rain. You may have had a previous experience of being late when it was raining — so you leave earlier. Or maybe you have never been late for work because of rain, but you have observed that people tend to drive slower in the rain. So, based on this observation, you still leave earlier. 

3. Problem-solving

This EF also combines all three core EFs. Problem-solving allows you to strategize or develop a plan. 

Let’s say you have a work deadline tomorrow morning, and you also have a family dinner planned that evening. Problem-solving allows you to find a way to accommodate both priorities. Maybe you get your work done a little earlier in the day so you don’t need to work on it at night. Or you may decide to postpone your family dinner. Either way, it requires you to exercise focus and flexibility to fulfill both responsibilities. 

Disorders associated with executive dysfunction 

Executive dysfunction is not a specific diagnosis. It’s often a symptom of another disorder. And many conditions that affect the brain can lead to varying degrees of executive dysfunction. Examples include:

• Neurodevelopmental conditions: These include conditions like ADHD or autism spectrum disorders. Many people with these conditions may have trouble focusing their attention or controlling their impulses.

• Mental health conditions: Mental health conditions can make it hard to concentrate or think in an organized way. So people with conditions like depression or schizophrenia may have challenges with memory, planning, and completing tasks.

• Dementia: There are many types and causes of dementia — from Alzheimer’s disease to Parkinson’s disease. This often leads to changes in memory and problem-solving, and it can span all of the types of executive functions we described above.

• Brain injury: This could be a stroke or a traumatic brain injury. The severity of executive dysfunction depends on which parts of the brain are affected.

What does executive dysfunction feel like?

Executive dysfunction is a spectrum, and everyone experiences it in a different way. It may feel like a daily source of frustration or challenge, especially when it affects someone’s ability to perform regular tasks that are necessary for self-care, work, or family. 

Some people describe it as having trouble getting started. They may feel overwhelmed at what they need to do, and it can even lead to feelings of panic. To cope with those feelings of discomfort, they may allow themselves to be distracted with something else that feels less stressful. 

Others describe it as a frustration when they do things out of order or skip steps, and they need to backtrack to complete the task. But many people learn and develop workarounds to live with executive dysfunction. 

Tips to improve executive function

Many people with executive dysfunction work with specialized therapists who help them learn strategies to cope. But you don’t have to see a provider to get started. 

There are several lifestyle changes that can help improve your executive functions. 

Practice

EFs are a skill. So as you practice them, even in small steps, you build on that improvement over time. A new task may be hard at first, but if you can establish a pattern or habit, it becomes easier to do the same task. 

For example, you may have trouble remembering to take your medication at a certain time. By setting a recurring alarm that reminds you each day, it will eventually become a habit.

Mood

Studies have shown that people have better attention when they’re happy. They’re also able to think more creatively and thus have more cognitive flexibility. 

Stress relief

When someone is stressed, their brain and executive functions do not work as well together. There are many different strategies for managing stress. It can mean practicing mindfulness or yoga. For others, it may mean getting more rest or taking a break with a friend. 

Physical activity

This may have the biggest effect on executive function. People who exercise regularly can improve their mood and decrease stress. Plus, many types of physical activity require you to pay attention to the activity and use your working memory. 

The list of activities is long and includes things like dance, yoga, martial arts, and soccer. Essentially any activity that increases movement can help with your EFs.

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Written by:

Jill L. Jaimes, MD

Jill L. Jaimes, MD, is a board-certified pediatric emergency medicine physician with over 20 years of clinical experience. She received her medical degree from Baylor College of Medicine and completed her residency and fellowship training at Texas Children’s Hospital.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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