AN EXECUTIVE SUMMARY ON EXECUTIVE FUNCTIONING
By Louise O'Donnell, PhD, and Bridgette Soileau, MA
Thanks to the research at the Chromosome 18 Clinical Research Center, we know that children and adults with chromosome 18 changes frequently have problems with executive functioning. But what exactly does this mean?

What are executive functions?

Executive functions are a group of brain based processes that guide, direct, and manage cognitive, emotional and behavior activities. Dr. Russell Barkley, a pioneer in ADHD research, uses a metaphor to give a visual image of executive functions in action. In his metaphor, he compares executive function to the conductor's role in an orchestra. "The conductor organizes various instruments to begin playing singularly or in combination, integrates the music by bringing in and fading certain actions, and controls the pace and intensity of the music."

How is the brain organized, and what part controls executive functions?
  • Total brain size is 90% of its adult size by age 6
  • Motor and sensory regions mature earliest
  • Higher-order association areas which integrate function mature later
  • The prefrontal cortex (in the frontal lobe) is one of the last brain regions to mature. This is the part of the brain that controls executive function.
How can we assess executive functions?

One of the easiest ways to assess executive function is through a questionnaire. A questionnaire can ask about all kinds of behaviors across the lifespan of the child. In contrast, a test session with a psychologist will only gather a relative small sample of behaviors. We usually ask parents to fill out the questionnaire. Although teachers and other professionals may provide important observations, parents know their children the best. They see the "good days", "celebrate the triumphs" and provide support, guidance and love during the "not so good times". The research center uses the Behavior Rating Inventory of Executive Function (and the adult age equivalent) which asks parents to observe their child's behavior in multiple settings and rate the frequency of occurrence of specific kinds of behaviors.

Here are a few examples of some situations that require executive function control:
  • Make plans
  • Keep track of time and finish work on time
  • Handle our emotions
  • Keep track of more than one thing at once
  • Evaluate ideas and reflect on our work
  • Handle a change in schedule easily
  • Wait to speak until we're called on
  • Shift easily from an enjoyable activity to a less enjoyable activity
  • Ask for help or seek more information when we need it
  • Awareness of others reaction to us and modifying our behaviors accordingly
A person may have problems with executive functioning when he or she as trouble with:
  • Planning projects
  • Setting goals and sticking to them
  • Comprehending how much time a project will take to complete
  • Getting started on a project
  • Telling stories (verbally or in writing), struggling to communicate details in an organized manner
  • Memorizing and retrieving information from memory
  • Initiating activities or tasks, or generating ideas independently
  • Retaining information while doing something with it, for example, remembering phone number while dialing
  • Coming up with ideas and problem solving strategies by themselves

Selected strategies for improving selected executive functions:

  • Take step-by-step approaches to school or work; rely on visual organizational aides
  • Use tools like time organizers, computers or watches with alarms
  • Prepare visual schedules and review them several times a day
  • Ask for written directs with oral instructions whenever possible
  • Plan and structure transition times and shifts in activities
  • Create checklists and "to do" lists, estimating how long tasks will take
  • Meet with teacher or supervisor on a regular basis to review work; troubleshoot problems
  • Schedule a weekly time to clean and organize the work space
Resources:

Organizing From The Inside Out for Teenagers: The Foolproof System for Organizing Your Room, Your Time, and Your Life by Julie Morgenstern (ISBN: 0805064702) 

Executive Function Fact Sheet: http://www.ldonline.org/article/24880
Bridgette Soileau, MA
Psychometrist 
Chromosome 18 Clinical Research Center
UT Health San Antonio
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