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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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