Tourette Syndrome Plus - Conditions - Executive Dysfunction - Overview of Executive Dysfunction Pg. 2

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Information Section: Conditions
Condition: Executive Dysfunction
Article: Overview of Executive Dysfunction¹
Source: Leslie E. Packer, PhD, 1999
This File Last Updated: December, 2004

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FUNCTIONS AND SIGNS OF DYSFUNCTION

Let us take a closer look at each of the functions we identified earlier, and consider what dysfunction might look like. In looking at this chart, keep in mind that there are only a few examples of what dysfunction might look like.

Function	Description	Possible Signs or Symptoms of Dysfunction
Goal	Identify goal or set goal.	Acts as if "future-blind" (Barkley, 2002), i.e. not working towards the future.
Plan	Develop steps towards goal, identify materials needed, set completion date.	- May start project without necessary materials - May not leave enough time to complete - May not make plans for the weekend with peers
Sequence	Arrange (and enact) steps in proper order spatially or temporally.	- May skip steps in multi-step task - May have difficulty relating story chronologically - May "jump the gun" socially
Prioritize	Establish ranking of needs or tasks.	- May waste time doing small project and fail to do big project - May have difficulty identifying what material to record in note-taking
Organize	Obtain and maintain necessary materials and aids to completing sequence and achieving goal.	- May lose important papers or possessions - May fail to turn in completed work - May create unrealistic schedule
Initiate	Begin or start task.	Difficulty getting started on tasks may appear as oppositional behavior
Inhibit	Stop oneself from responding to distractors. Delay gratification in service of more important, long-term goal.	- May appear distractible and/or impulsive - May pick smaller, immediate reward over larger, delayed reward
Pace	Establish and adjust work or production rate so that goal is met by specified completion time or date.	May run out of time
Shift	Move from one task to another smoothly and quickly. Respond to feedback by adjusting plan or steps.	May have difficulty making transitions and/or coping with unforeseen events
Self-Monitor	Assessing one's performance and progress towards goal.	- Doesn’t check to insure that each step is completed - Doesn’t monitor pace to determine if goal will be met on time, - Doesn’t check work before submitting it
Emotional Control	Regulating and modulating responses to situations.	May exhibit inappropriate or over-reactive response to situations
Complete	Reaching the self-set or other-set goal.	May start tasks but not finish them

In other articles in this section of the web site, you can find helpful tips and strategies for addressing some of the deficits identified in the chart above.

WORKING MEMORY AND EDF

As noted earlier, the foundations of learning are: (1) attention, (2) memory, and (3) executive functions. Where memory, executive function, and attention overlap, you have "working memory" -- the process of holding new visual or auditory information in mind as you retrieve older knowledge or procedures to apply to the new material. For example, you may have already learned the procedure for solving a two-digit multiplication problem. When I tell you the numbers to multiply, you need to hold them in your mind while you retrieve the procedural memory and apply the steps, keeping track of your calculations as you do this. Or if I ask you a question, you keep the question in mind as you mentally search through all your "memory files or folders" to pull out the information you are looking for.

But what if your memory's "filing system" is a disorganized mess? You'd know that the information was "in there," but it would take you longer to find it and you might not always find it in time. Additionally, the capacity of working memory is thought to be relatively fixed: you can only retain so much information at any one time. If a thought that is irrelevant to what you are working on suddenly intrudes on your thoughts, it may 'bump' important information from your working memory.

"TIME HAS COME TODAY..... TIME!"²

On a day-to-day level, perhaps one of the most frustrating things parents encounter is what appears to be their child's lack of time sense. It took me a while, but eventually I learned that asking my son if he would "take out the garbage in 5 minutes" was as effective as saying, "Justin, sometime before the end of your life, would you take out the garbage?" How could he not realize that more than 5 minutes had gone by? That 30 minutes had gone by..... 40.... 50.... Was he forgetting or distracted by what he was doing, or was he unable to estimate time accurately? Even if I offered him a huge reward for doing something on time, he might miss the deadline, so I knew this wasn't just motivational.

Most of us probably know a child or an adult who waits until the last minute to start a huge project. They may tell us that they work better under pressure (if they tell you that, tell them that the research doesn't support them on that point), but when people consistently have problems starting big projects or leave everything until the night before, we should be curious about what's going on and whether there's some EDF involved. And in addition to considering whether there are learning disabilities and/or executive dysfunction in initiating or planning problems, one thing we will also need to consider is whether there is an impaired sense of time.

Russell Barkley and other researchers have been looking at time issues in children with ADHD. So far, although most studies are finding evidence for different kinds of time impairment, we do not have enough data to draw any clear inferences about the nature of the impairment. Thus, your child or student or spouse may be able to accurately estimate how long an activity will take, but another child or student or spouse may underestimate how long something will take and eventually run out of time, while yet another child or student or spouse will be overestimating time intervals and nagging you (e.g., the child who says, "Mom, you said we'd go in 10 minutes and it's already been 15," when in fact, only 4 minutes have gone by.)

FOOTNOTES

1 The author is deeply indebted to Sheryl K. Pruitt, M.Ed., for her input and contributions to this section, but the author retains full responsibility for any errors.

2 From the song, "Time Has Come Today," recorded by the Chambers Brothers in 1968. If you don't know what I'm talking about, you're too young and should go away. :)

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