Cognitive Skills

 

The “boss”, the “chief”, the “head honcho”. These are all words used to describe an ‘executive’, someone who heads an organization, sets the agenda and determines the day-to-day functioning of the company. Just like an executive, the brain controls all the functions of the body.
Executive functions are those tasks that require special, higher-level ability. A CEO might be technically responsible for making sure the toilets get cleaned, but most CEO’s won’t actually clean the toilet. The brain has all kinds of functions, including lower level biological functions that are more or less “automatic”, like many functions in a well-run office. But the brain also has CEO-type responsibilities, like planning, managing, organizing, monitoring and regulating.
Executive functions help control what you want to do and help stop you from doing things you think you should not be doing. When your brain says “Stop!” before you take that extra piece of cake you know you should not be eating, that’s an example of executive functioning. When you plan, figure out and stick to a budget, that’s executive functioning.
In people with advanced dementia, we sometimes see a loss of control in a breakdown of executive functioning and a regression to infantile and socially inappropriate behavior. Examples of executive functioning gone wrong are:

When someone starts exhibiting sexually inappropriate behavior
Not “getting it” when you make a point that requires using an abstract concept
Difficulty getting started on an activity or multi-tasking simple things
Problems controlling emotions without any obvious reason
Having “no clue” that anything is wrong
Suddenly not being able to do more complex fine-motor “technical” tasks, like writing, peeling vegetables, sewing, etc.

There are special tests that evaluate executive functions that can help in determining if something needs further looking into. When it comes to memory, executive function deficits are more related to short-term “working” memory than any other type because of the need in working memory to retain different bits of information for short periods of time and determine the right time to retrieve it.
Problems with executive functioning are not limited to older people. Even young children have some of these problems. When school-age children show symptoms of executive function problems, we often give the problem a diagnostic label, like “attention-deficit disorder”. The problems these children show are seen in academic related tasks like doing work more slowly and needing constant and repeat reminders to get things done.
There’s a great difference in attitude and perception when it comes to problem with executive function in children versus adults. With adults, these problems translate into feelings of the ‘beginning of the end’ and angst about getting older. A sense of doom begins to develop, and people simply don’t know what to do and often give up—making the problem worse.
With children these types of problems can be serious and indeed cause a variety of behavioral issues. The big difference is that there are many intervention strategies used to deal with attention and executive function problems with children—and we assume that there is a method to deal with it. So, when it comes to children, professionals give a number of ‘tips”, like:

Using ‘post-it’ notes
Allow more time to do things
Highlighting important information (e.g., using color)
Using a tape recorder to review ideas that pop into your head but don’t easily remember
Simply learning to ask for help (helps to create new learning patterns)

In short, there are strategies that can help people deal with executive function deficits. The same types of exercises that children are given can effectively be used by adults to help improve organization, sequencing, planning and executing important behavior.