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"Executive Functioning"
New Research About Familiar Behavior
A Report from the Recent IECA Conference
By Loi Eberle, M.A., Educational Consultant
208-267-5550
loi@woodbury.com
Speakers at the recent Independent Educational Consultant Association
conference in Washington, D.C. presented some interesting research about how we can better educate our youth. Many psycho-neurological
studies that were described focused on ”executive functioning”, which has to do with the kind of “goal-directed behavior” that is considered
to be important for success in most activities.
One IECA Conference speaker was Dr. William R. Stixrud, a psychologist described as “one of the DC area’s leading experts.” He
described executive functioning as a set of processes that include “planning, organizational skill, maintaining a mental set, selective
attention, and inhibitory control – for which the prefrontal regions of the brain are specialized.” He quoted a variety of researchers
who work in this area, including Elkhonon Goldberg, who describes the functions of the frontal lobe using the metaphor of the
orchestra conductor.
Dr. Martha Denckla, Director of the Developmental Cognitive Neurology Clinic at the Kennedy Kreiger Institute,
a featured speaker at the IECA conference, described some key characteristics of executive functioning which include: interference control,
effortful and flexible organization and strategic planning, or, anticipatory goal-directed preparedness to act. She also includes “working
memory,” which involves maintaining internal representations to guide one’s actions.” When there is dysfunction in the executive function,
she claims it occurs within the “infrastructure” she refers to as “ISIS”; actions that require a person to: “Initiate, Sustain, Inhibit,
Shift.” Those of us who work with troubled adolescents would probably agree that when these skills are deficient, students definitely
struggle.
According to Dr. Stixrud, there is ‘a low correlation between IQ and executive functioning; patients with frontal lobe damage can do
well on IQ tests.” He shares an opinion that frequently appears in current academic literature: “traditional IQ tests are weak predictions
of academic success and very poor predictors of success in careers and relationships.” Difficulties in executive function are associated
with several conditions including: ADHD, Tourette’s Syndrome, Obesessive-Compulsive Disorder, Traumatic Brain Injury, Depression, Learning
Disabilities, and Autism Spectrum Disorders. [see Bradshaw JL (2001).]
Almost everyone agrees that ADD and ADHD reflect developmental impairment of multiple executive functions. Some, including Russell
Barkley, argue that the main problem is in the inability to self-regulate, or, inhibit behavior by delaying one’s response, thus
lacking a “sense of time, timing, and timeliness to behavior.” Others, such as Thomas Brown and Virginia Douglas argue
that inhibiting behavior is not the primary executive deficit in ADHD, they feel problems with activating one’s behavior are also very
important. Dr. Stixrud cites “Achenbach et al. who reports “inattention, disorganization and poor activation persist into early
adulthood and are more impairing than impulsivity/hyperactivity.”
Dr. Stixrud also summarized how problems with skills associated with executive functioning are responsible for a variety of learning
disabilities in reading, writing, math skills and content area learning. For example, dysfunctions in working memory, an important aspect
of executive functioning, can cause difficulties in reading comprehension. Also, poor readers have trouble suppressing the activation
of irrelevant information. Writing is adversely affected by problems with sequencing, organizational and self-monitoring skills, and
holding ideas in working memory. There is also a strong overlap between dysgraphia and ADHD. Students with poor math skills have trouble
with multiple-step procedures that require working memory. Executive dysfunction can also cause difficulties using mental strategies
involved in memorization and retrieval.
What was exciting about the presentations for educators and therapists was the indication that difficulties in these areas can be positively
impacted through proper development. Dr. Denckla discussed how adolescent’s brains are still changing in a physical way. The frontal
lobe continues to develop late in adolescence, and in fact, myleination is not complete until the fourth or fifth decade of adult life.
A number of EEG studies have found a dramatic spurt in frontal lobe maturation between the ages of 17 and 20, which can explain “late
bloomers”. Also sex hormones are relevant; there is a relationship between psychosexual development and cognitive ability. According
to the work done by Deborah Yurgelun-Todd at the Mclean Hospital, teens have more trouble than adults identifying expressions
of fear. The cerebellum, which coordinates movement, is clearly involved in executive functioning, particularly when motor behaviors
are performed. It also appears also to monitor the appropriateness of actions. Another IECA Conference speaker, Dr. J. Giedd,
a neuroscientist with the National Institute of Mental Health, in Maryland, points out that the cerebellum keeps developing
well into adolescence, and since it is not as genetically programmed as many other structures, it seems to be influenced strongly by
experience. Kurt Fischer has identified cognitive changes through age 25, as well as significant growth in the myelin connecting the
frontal lobes and limbic regions in adults between the ages of 40 and 50, apparently allowing for a “second chance” at reflective thinking.
Dr. Denckla’s research has also shown that frontal brain growth is shaped by what is called “pruning”. If these connections are not
utilized, they are not maintained. It is truly a “use it or lose it” situation, she explains, emphasizing that this circuitry in the
brain is very important, and may actually be the cause of problems that are often misdiagnosed as a malfunction in a part of the brain.
She also described how the cortex can over-grow a problem with ADHD that is caused by another part of the brain.
The idea that the brain continues to mature and develop connections well into adulthood provides some exciting possibilities for the
practical application of neuropsychological studies. Not only are we developing an increasingly detailed picture of the activity within
our brains, we also are learning more about what factors can negatively or positively affect the way our brains function. Some factors,
very prevalent in a adolescent’s life, such as anxiety, sleep deprivation, dehydration, and inactivity can seriously impair their executive
functioning, which plays such an important role in creating and maintaining goal-directed activity.
Research shows that depression and stress both have major impact on executive functioning. The World Health Organization recently
found depression to be the world’s number one disability, affecting 340 million people worldwide, according to Dr. J. Giedd. Statistics
show the incidence of depression is increasing dramatically, even with medicine. Dr. Denckla explains anxiety can mimic ADHD/executive
dysfunction, causing too much dopamine to flood the brain, causing a “disconnect” in the frontal lobes’ central executive function from
other brain functions. Dr. Stixrud described researching showing that high levels of anxiety kill cells in the Hippocampus. There is
also some indication that “the early brain can become hard wired to deal with high fear states, and the normal state will thus be to
have a lot of adrenaline flowing. As adults, these individuals may feel empty or bored when not on edge.” Dr. Stixrud states “sleep
is extremely important for learning and memory consolidation throughout the life span. There is a strong relationship between control
of sleep and regulation of mood and behavior when awake….Without enough REM sleep, one sees increased anxiety, depression, poor judgement
and memory, slow reaction time, hypersexuality, decreased immunity and increased accidents.” One’s brain is also more vulnerable to
stress, which causes increased cortisol production, when one is dehydrated.
One exciting part of the research is the relationship between what Dr. Denckla calls, motor control and mental control. Research shows
that the three parts of the brain that are most heavily involved in ADHD are the areas of the brain that also control motor activity.
Due to the overlap between motor and mental control, activities that encourage aerobic exercise, strengthening, and stretching, stimulate
the executive brain, priming the “executive pump.” Also, there is evidence that motor control can be improved through patterned programmed
movements thought to be particularly beneficial for executive functioning, which include martial arts, yoga, dance, swimming, and drumming.
Dr. Stixrud also described research showing there is evidence that aspects of executive function can be improved, especially in terms
of working memory (Schweitzer, et al), rapid shifting (Cedpeda, et al) and effortful processing (Tannock, et al).
One of the more unusual findings is that kids with ADHD who looked in the mirror while working had better executive functioning, suggesting
that it enhances emotional regulation. Cognitive rehabilitation studies by Mateer, Kearns, Selmud-Clikeman
and others show that attention training is beneficial for children with attentional difficulties. Also, deep rest has been shown to
heal the nervous system of stress, in part by lowering cortisol levels. Certain meditation techniques have been documented to improve
emotional regulation and sleep, and reduce blood pressure as effectively as medication. Meditation techniques have also been shown to
increase one’s ability to focus attention, even increasing resistance to drugs and alcohol by normalizing the brain’s reward system.
Proper diet is also considered to be important, Dr. Stixrud states, as is “obvious in children’s limited attention and emotional regulation
when hungry,” or experiencing blood sugar difficulties.
This growing body of research that was discussed with educational consultants and academic and special purpose program personnel at
the recent IECA Conference, helps to provide a clearer picture of how the brain processes information and behavior. What was probably
most useful is the validation that there are effective techniques for further developing and improving these skills, so that they will
not be lost.
Brain Development
Byrnes, J. (2001) Minds, Brains, and Learning: Understanding the Psychological and Educational Relevance of Neuroscientific Research.
New York: Guilford Press.
Diamond, M. & Hopson, J. (1998) Magic Trees of the Mind. How to Nuture Your Child’s Intelligence, Creativity, and Healthy Emotions
from Birth Through Adolescence. New York: Plume
Fischer, K., and Rose, S. (1998) Growth Cycles in brain and mind. Educational Leadership, November 1998, 56-60.
Khalsa, K. (1997) Brain Longevity. New York. Warner Books.
Executive Functioning
Barkley, R. (1997). Attention-deficit hyperactivity disorder, self-regulation, and time: Toward a more comprehensive theory. Developmental
and Behavioral Pediatrics, 18, 4, 271-279.
Bradshaw, J. (2001). Developmental Disorders of the Fronto-Striatal System. Philadelphia: Psychiatric Press.
Brown, T. (Ed.) (2000). Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults. Washington: American
Psychiatric Press.
Brown, T. (1999) Does ADHD diagnosis require impulsivity-hyperactivity?: A response to Gordon & Barkley. The ADHD Report
(Guilford Press), 7, 6, 1-7.
Bull, R. et al (1999). Exploring the roles of the visual-spatial sketch pad and central executive in children’s memory skills. Developmental
Neoropsychology, 15, 3, 421-442.
Castellanos, X., et al. (2002). JAMA, October, 2002.
Denckla, M.B. (1994). Measurement of executive functioning. In G.R. Lyon (Ed.), Frames of Reference for the Assessment of Learning
Disabilities: New Views on Measurement Issues (pp117-142). Baltimore: Paul H. Brookes Publishing Company.
Gioia, G.A., Isquith, P.K. and Guy, S.C., and Kenworthy, L. (2000). Behavior Rating Inventory of Executive Functions. Odessa,
FL: Psychological Assessment Resources.
Goldberg, E. (2001). The Executive Brain: Frontal Lobes and the Civilized Mind. New York: Oxford University Press.
Pennington, B.L. (1991). Diagnosing Learning Disorders: A Neuropsychological Framework. New York: Guliford Press.
Pliszka, S. (2002). ADHD Report. New York: Guildford Press.
Pressley, M., & Woloshyn, V. (1995). Cognitive Strategy Instruction that Really Improves Children’s Academic Performance – Second
Edition. Cambridge, MA: Brookline Books.
Other Useful Books
Amen, D. (2001). Healing ADD. New York: Putnam
Conlan, R. (Ed.) (1999). States of Mind. New York: John Wiley.
Dement, W. (2001). The Promise of Sleep.
Durand, M. (2000). Sleep Better.
Goleman, D. (1995). Emotional Intelligence. New York: Bantam Books.
Hartman, T. (1998). Healing ADD.
Levine, M. (1994). Educational Care. Cambridge, MA: Educational Publishing Service.
Levine, M. (2002). One Mind at a Time. New York: Simon & Schuster.
Ratey, J. (2001). A User’s Guide to the Brain. New York: Pantheon Books.
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