A woman writes in her planner while working at her laptop.Executive dysfunction undermines the brain’s ability to control, organize, and manage thoughts. This can affect planning, communication, impulse control, and overall mental health.  Some forms of executive dysfunction are due to chronic conditions such as ADHD. In other cases, executive dysfunction gets progressively worse as a disease like dementia steadily damages the brain. 

Executive dysfunction may also make existing conditions worse. For example, executive dysfunction due to ADHD can cause conflict at school, causing students to struggle even more to control their behavior and emotions. The executive dysfunction that often comes with dementia can lead to depression and isolation. 

A number of treatment strategies can help, even when executive dysfunction is progressive. Therapy can help people cultivate skills related to executive functioning. It can also offer support for any emotional and relationship issues caused by executive dysfunction. 

Therapy for Executive Dysfunction

Treatment for executive dysfunction works best when a mental health practitioner or doctor correctly diagnoses the cause of executive dysfunction. Knowing the underlying cause can guide treatment and help shape expectations for the future. 

Some forms of executive dysfunction improve with medication. People with ADHD often find that stimulant drugs such as Ritalin and Adderall help them focus and better control their thoughts and emotions. Dementia medications such as Aricept and Namenda can slow the progression of some forms of dementia, temporarily improving executive dysfunction. 

Therapy for executive dysfunction can help no matter which condition is the culprit. Common therapy goals include:

  • Identifying triggers for executive dysfunction. Many people find that their symptoms are worse during moments of stress or fatigue. Proactive strategies to counteract these triggers, such as a regular sleep schedule, may be beneficial.
  • Being mindful of one’s thoughts and emotions. Some types of therapy can help people notice when their thoughts are influencing their behavior. Individuals can then take measures to counteract self-defeating thoughts. 
  • Developing a plan for managing executive dysfunction. Paper planners and checklists, assistive devices, digital reminders, and training in time management may help. 
  • Communicating with loved ones. People with executive dysfunction sometimes find that their thoughts feel overwhelming. This can make it difficult to talk to others without interrupting them. Individuals may struggle to navigate conflicts in ways that are healthy and caring rather than impulsive and harmful. 
  • Adapting to life transitions. People with progressive illnesses like dementia may struggle with depression and fear about the future. Therapy can help them understand their illness, make peace with their prognosis, and develop a care plan that supports independence for as long as possible. 

How to Deal with Executive Dysfunction

In addition to psychotherapy, some people with executive dysfunction find immense help from occupational therapy. Talk to your doctor or therapist about whether occupational therapy might be appropriate for your diagnosis. 

Some other strategies that can help include: 

  • Posting reminders in a prominent location. Which items or tasks do you forget most often? A written note can help. For example, a student who frequently forgets their backpack may post a reminder to remember the bag, as well as all of its contents, by the door. 
  • Finding ways to organize your time and your thoughts. When your brain “loses” information, putting this information somewhere else can help compensate for the challenges of executive dysfunction. Paper and digital planners, detailed checklists, and digital apps can help. 
  • Breaking tasks into smaller component parts. People with executive dysfunction often struggle with large, complex tasks, but smaller 5-10 minute tasks can feel more manageable. 
  • Taking frequent breaks from challenging or frustrating tasks. Try setting a timer for 10 or 20 minutes. You may find your brain can work better after it has had a rest.
  • Developing a routine. Executive dysfunction often gets worse when a person’s schedule is unpredictable or their routine is chaotic. Create a ritual surrounding the most important tasks of the day, and stick with it. 

Helping Loved Ones with Executive Functioning

When helping loved ones with executive functioning, patience is often vital. Punishing individuals for losing focus or forgetting a task typically does not work. Instead, it makes them feel stressed and overwhelmed, potentially making executive dysfunction worse. 

Executive dysfunction is not a choice or a failure of willpower. It is a real and often overwhelming condition. Brain injuries, issues with the brain’s dopamine system, and structural abnormalities in the brain can all play a role. Blaming a person for their symptoms is counterproductive.

You can support your loved one by working with them to manage symptoms and encouraging them to keep trying. For example, you may help your loved one find a planning and organization system that works for them. Try showing a child how to use a to-do list, or supporting an elder to log tasks in a reminder app. This can help individuals become more self-sufficient.

Children with executive dysfunction are often eligible for disability accommodations at school under the Americans With Disability Act (ADA). If your child has a disability, you are likely entitled to meet with their teaching team at least annually to develop an Individualized Education Plan (IEP). If you feel your loved one is not getting the accommodations to which they are entitled, a disability lawyer may be able to assist. 

If another person’s executive dysfunction requires extra time and commitment from you, make sure to prioritize self-care. Take frequent breaks, and consider joining a support group for caregivers.

Lastly, while support from friends and family is important, remember that it cannot replace professional treatment. Consider encouraging your loved one to seek therapy. If the individual with executive dysfunction is a child, then family counseling may be appropriate. A family therapist can help your entire family devise strategies that minimize conflict and confusion. If you are a caregiver, you may also benefit from seeing a psychotherapist yourself.

References: 

  1. Accommodations. (n.d.). Retrieved from https://www.dol.gov/odep/topics/Accommodations.htm
  2. Alexopoulos, G. S., Kiosses, D. N., Heo, M., Murphy, C. F., Shanmugham, B., & Gunning-Dixon, F. (2005). Executive dysfunction and the course of geriatric depression. Biological Psychiatry, 58(3), 204-210. Retrieved from https://www.sciencedirect.com/science/article/pii/S0006322305004841
  3. Brocki, K., Fan, J., & Fossella, J. (2008). Placing neuroanatomical models of executive function in a developmental context: Imaging and imaging-genetic strategies. Annals of the New York Academy of Sciences, 1129(1), 246-255. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669085
  4. Diamond, A. (2013). Executive Functions. Annual Review of Psychology, 64(1), 135-168. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861
  5. Ehmke, R. (n.d.). Help kids who struggle with executive functions. Retrieved from https://childmind.org/article/helping-kids-who-struggle-with-executive-functions
  6. Executive dysfunction. (n.d.). Retrieved from https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/executive-dysfunction
  7. Executive functions. (n.d.). Retrieved from https://memory.ucsf.edu/executive-functions
  8. Juby, A., Tench, S., & Baker, V. (2002). The value of clock drawing in identifying executive cognitive dysfunction in people with a normal Mini-Mental State Examination score. Canadian Medical Association Journal, 167(8), 859-864. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC128397
  9. McDonald, B. C., Flashman, L. A., & Saykin, A. J. (2002). Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies. Neurorehabilitation, 17(4), 333-344. Retrieved from C
  10. McGuinness, B., Barrett, S. L., Craig, D., Lawson, J., & Passmore, A. P. (2010). Executive functioning in Alzheimer's disease and vascular dementia. International Journal of Geriatric Psychiatry, 25(6), 562-568. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19810010
  11. Medications for memory. (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
  12. Protecting students with disabilities. (2018, September 25). U.S. Department of Education. Retrieved from https://www2.ed.gov/about/offices/list/ocr/504faq.html
  13. Stachel, J. (2015, October 30). Top 10 frightfully useful tips from executive function coaches. Retrieved from https://www.beyondbooksmart.com/executive-functioning-strategies-blog/adhd-awareness-month-top-10-tips-from-executive-function-coaches