Executive Function Impairment

Executive Function Impairment (EFI) is not a specific disorder, although some do use the term Executive Function Disorder. Instead, it is an umbrella term used to describe types and components of other disorders that are characterized by trouble with planning for the future, time management, being able to initiate and continue tasks and activities, and breaking projects into smaller components to accomplish them. EFI is most commonly associated with attention-deficit/hyperactivity disorder (ADHD), of which a pattern of inattentiveness is one of the primary symptoms. EFI is also associated with other disorders, including autism spectrum disorder, fetal alcohol syndrome, obsessive-compulsive disorder, Tourette’s syndrome, schizophrenia, and substance use disorders. Individuals with traumatic brain injuries (TBI) may also experience executive functioning deficits. However, because the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not contain a diagnostic category for EFI, individuals may have difficulty being accurately assessed and treated for their EFI symptoms.

Signs of Executive Function Impairment

EFI is characterized by mental and behavioral impairments that can give the impression that an individual is lazy, careless, or willfully defiant. Because EFI affects both the ability to accomplish tasks and memory, it can be particularly harmful to an individual’s learning, which can lead to falling behind in school if the individual does not receive appropriate supports. Symptoms of EFI typically interfere with a child’s education, which is one of the primary signs that an individual may have EFI. Signs of EFI include:

• Difficulty in planning and initiation.
• Inability to multitask.
• Difficulty shifting between tasks.
• Difficulty processing, storing, and/or retrieving information.
• Loss of interest in activities.
• Challenges in planning for the future.
• Tendency to make careless errors and not catch them.
• Difficulty with working memory, causing the individual to not remember instructions or tasks.

How Executive Function Impairment Might Impact Behavior

Executive functions are key for coping with unpredictable real-life situations. An individual with EFI may have trouble responding to changes to normal routine, and may react to changes in ways that seem bizarre or potentially offensive. Moreover, EFI may cause a person to lack the filter that

others typically use to avoid making an inappropriate or offensive statement. Positive social interactions may be difficult for individuals with EFI.

Because it is not a standalone disorder, individuals with EFI are generally diagnosed with another disorder such as ADHD. They tend to have a history of behavioral problems in school and poor academic achievement because of their inattentive behavior.

In addition to negatively affecting academic performance, EFI can interfere with day-to-day functioning, including personal and professional relationships and performance at work. It may manifest as:

• Poor social skills and trouble getting along with others.
• Tendency to make inappropriate statements or act oddly.
• Difficulty planning or working towards goals.
• Problems staying on task or holding down a job.
• Trouble adapting to changes in life or daily routine.

Various executive functions, such as goal setting, planning, initiating, self-awareness, self-monitoring, and self-evaluation, may also be affected by traumatic brain injuries (TBI). An individual with TBI may seem disorganized and need help from family or friends.  The person may have trouble starting tasks and setting goals to complete them. The individual may react impulsively to situations.

Resources for Additional Information

• ADDitude: Strategies and Support for ADHD & LD: http://www.additudemag.com/
• Children’s Resource Group: http://www.childrensresourcegroup.com/

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