People with executive function disorder (EFD) often experience time blindness, or an inability to plan for and keep in mind future events that aren’t in the near-term. They also have difficulty stringing together actions to meet long-term goals. This is not an attention problem in the present tense, but rather a sustained attention problem. People with EFD have trouble organizing materials and setting schedules. They will often misplace papers, reports, and other materials for school or work. They might have difficulty keeping track of personal items or keeping their home or bedroom organized. Even if they try very hard, they will fall short.
Executive functions allow people to do the following:
1. Analyze a task
2. Plan how to address the task
3. Organize the steps needed to carry out the task
4. Develop timelines for completing the task
5. Adjust or shift the steps, if needed, to complete the task
6. Complete the task in a timely way
When a person’s executive functions fail, he has trouble with analyzing, planning, organizing, scheduling, and completing tasks. People with EFD commonly lack the ability to handle frustration, start and finish tasks, recall and follow multi-step directions, stay on track, self monitor, and balance tasks (like sports and academic demands). Fixing the area of deficit is key to fixing academic or work difficulties.
Signs and Symptoms of Executive Function Disorder in Children
If your child has trouble getting started, can only remember two or three things at a time, struggles with problem solving, or feels overwhelmed at school, he or she might have an executive function deficit. The condition often appears during the transition to middle school, when the structure of elementary school disappears, and academic expectations increase. Common signs and symptoms of EFD in children include:
• Forgetting tasks and homework
• Trouble starting homework independently
• Difficulty estimating how long a task will take
• Being distracted easily
• Difficulty keeping track of belongings
• Inability to remember names and other key details
• Trouble listening to and following instructions
• Moving on to another task before one is finished
• Difficulty remembering and following multi-step instructions
• Problems understanding roles in multi-part organizations, like sports teams
• Trouble transitioning between tasks
Awareness of these symptoms can help parents set up an early detection system so they can seek an evaluation and treatment before a child begins to struggle in school.
Signs and Symptoms of Executive Function Disorder in Adults
Executive functions are the skills that adults must master to manage everyday life. Common signs and symptoms of EFD in adults include:
• Forgetting to complete tasks
• Inability to keep track of personal items like keys and cell phones
• Trouble following conversations
• Losing train of thought
• Difficulty remembering steps in multi-step processes
• Inability to remember names
• Often late
• Problems breaking big projects into steps
• Trouble meeting deadlines
• Unable to multitask
• Difficulty remembering abbreviations and acronyms
Identifying symptoms can help adults set up external supports to supplement areas where they struggle.
An EFD evaluation typically begins with an exam to rule out other conditions with similar symptoms. Your primary care physician may refer you to a neurologist or audiologist for additional testing. The specialist will consult previous medical records, and examine performance at school/work, and administer additional tests.
The most common EFD evaluation is the Behavior Rating Inventory of Executive Function (BRIEF), a written survey that kids/young adults, parents, and teachers complete to assess executive functioning. It comprises 86 questions designed to pinpoint the biggest area of difficulty. Additional evaluations include:
• Conners 3: a rating scale that evaluates ADHD and EFD using parent, self, and teacher reports
• Barkley Deficits in Executive Functioning Scale (BDEFS) for Adults: Assesses EFD using self and other reports
• Comprehensive Executive Function Inventory (CEFI): Compares a person to a norm group using parent, teacher, and self-report assessments
The specialist may want to conduct an intelligence test to compare potential with actual functioning, and interview the person with executive function difficulties.