Written by Heather McCurdy, M.S., CCC-SLP, CBIS
Heather provides in home speech therapy services in Northwest IN, and virtual services for the IN residents.
What is executive function?
Executive function is a really big umbrella term that encompasses many cognitive functions. These may include (but aren't limited to): abstract thought, analyzing all aspects of a situation, considering potential solutions to a problem, executing those solutions, maintaining cognitive flexibility, and self-monitoring or self-awareness and difficulty regulating emotions. In addition, one might have difficulty inhibiting responses.
Deficits with executive function are common.
Why is this? Executive functioning occurs primarily in the frontal lobe. The frontal lobe (the very front of the brain) is vulnerable to hit or being jostled because it hits the bony ridges of the inside of the skull.
What might difficulty with executive function look like?
--> Being unable to problem solve everyday activity when your original plan doesn't work
--> Having uncontrollable outbursts with communication partners (i.e. spouse, family members)
--> Difficulty getting started on a task
--> Lack awareness of deficits (either with memory, attention, or information processing)
--> Being socially inappropriate (i.e. using cuss words with small child) and maybe lacking awareness that this is a problem
--> Difficulty managing time or being completely wrong about how long a task will take
--> Difficulty thinking before acting (i.e. being impulsive)
Depression & executive functioning deficits may look similar at times.
Depression, especially after a traumatic brain injury (TBI or mTBI), is one of the most common diagnoses. Other symptoms of depression are: changes in appetite, weight loss/gain, decreased energy, feelings of worthlessness, suicidal ideations & more.
Some individuals who are depressed may have trouble getting started on a task (i.e. lack of initiation) as do individuals with executive function deficits which can sometimes make it difficult to determine if depression is present OR an executive function deficit.
To target executive functioning deficits, we may...
--> Train for strategies to encourage self-monitoring
--> Train for strategies to assist with managing emotions
--> Train formal problem-solving strategies
--> Implement strategies to decrease working memory demands
There is new evidence to suggest utilization of virtual reality and/or music therapy programs in the remediation of executive functioning deficits may be beneficial!
Interestingly enough, it is recommended that executive function is targeted at the start of care because it can show greater predictive values than targeting memory (short-term and long-term), attention or information processing. This doesn't mean memory, attention, and information processing won't be targeted, it simply means therapy is recommended to start with executive functioning. It is written that "the strongest predictor of successful treatment outcome was improved self-awareness."
Let's start training for strategies today!
Heather McCurdy is the owner and speech-language pathologist (SLP) at Mindful Speech Therapy. She is particularly passionate about those who sustain traumatic brain injuries and strives to provide functional, meaningful and relevant treatment.
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