While neurodiversity and mental health have progressively attained recognition and respect, a core symptom that plagues many—executive dysfunction—continues to face stigma and misunderstanding. It’s about time we talk about it—what is executive dysfunction, and why is it important to be aware of it?
To have a discussion about executive dysfunction, it is important to first understand what executive function is. Executive function, thought to primarily be managed by our prefrontal cortex, is defined by Cleveland Clinic as the interplay of cognitive (thinking) processes that regulate our thoughts, behavior, and emotions. Executive functioning is imperative to productivity and satisfaction in day-to-day life. Essentially, it is our brain’s manager; it’s how we organize and prioritize our thoughts, and it helps us get to work on goals, whether that means doing the dishes, learning an instrument, or writing a thesis.
When we discuss executive function, it is commonly split into a few major components:
- Working memory (our ability to work with temporary information, such as by manipulating numbers in a mental math problem)
- Planning and problem-solving
- Inhibition (impulse control)
- Cognitive flexibility (smoothly switching between tasks, adapting to changes, or thinking about multiple things at roughly the same time)
- Emotional regulation and motivation
- Focused attention
- Awareness of self and environment
Executive dysfunction is the disruption of this essential interplay. Most often, it occurs in those who are neurodivergent or struggle with mental illnesses such as depression, anxiety, and PTSD. Since the demands of modern life often require extensive planning, time management, and self-regulation, executive dysfunction can make life exceedingly difficult for those who struggle with it. If executive function is your brain’s manager, executive dysfunction is the angry customer screaming at the manager and refusing to leave the store while you try to do your work. Symptoms of executive dysfunction include:
- Struggling to focus on tasks/distractibility, or hyper-focusing on one thing
- Issues with managing time
- Frequent daydreaming or “zoning out,” even at inopportune times
- Struggling to switch between tasks, or struggling to stick with one task
- Poor impulse control and susceptibility to addiction
- Difficulty regulating emotions, or keeping them “in check”
- Struggling with memory, such as with remembering a detailed procedure or remembering to complete a task in the future
- Struggling to articulate complex thoughts
- Issues with motivating oneself, starting tasks, or following through with goals
Executive dysfunction is a highly complex issue, the exact causes of which cannot be simply or definitively explained. It is believed that it is often due in part to a deficit in neurotransmitters (chemical messengers in the brain) such as dopamine, a neurotransmitter primarily responsible for motivation and satisfaction. Another neurotransmitter that is thought to have an effect is norepinephrine, a neurotransmitter responsible for arousal, attention, and memory. A deficiency here can incline us to be less motivated, struggle more to focus on tasks, and derive less satisfaction from the completion of tasks. The structure of the brain itself can also play a role—for example, neuroimaging studies have shown smaller volume in the hippocampus(primarily responsible for memory storage) in those who suffer from PTSD.
At school, this could look like falling behind on assignments, spacing out during lessons, or the inability to focus when people around are speaking. At home, one might struggle to keep their space clean, or consistently lose their things. One might have increased difficulty managing anxiety, or calming themselves from flares of anger, causing emotions to spiral. One might try to pick up the same hobby over and over again, only to inevitably give up. Oftentimes, especially in educational or work settings, these symptoms are misunderstood as laziness or a lack of intelligence. As a result, people struggling are led to doubt themselves, inclining them not to seek out help or positive coping strategies.
If any of this sounds familiar to you, you might not be lazy. You might be struggling with executive dysfunction.
I do believe that laziness exists. Leaving a cart in the middle of a parking lot, for example, because one does not feel like walking for two minutes to put it in a cart return, is more often than not the product of unwillingness. But a clear distinction needs to be made between “won’t” and “can’t”. When people avoid tasks as a result of executive dysfunction, they are usually not enjoying themselves, or deliberately choosing to avoid the task.
For me, at least, my thoughts and emotions often feel like a tumultuous sea, waves that rise and crash and batter me with scattered flotsam. They never stop rushing and crashing, threatening to pull me under. Focus, for me, feels like I am fighting for air, trying to stay afloat among the storm of stimuli. I have a task: say, put away laundry. It is not that I am reading, playing video games, or scrolling through my phone. It is that I am laying in bed, staring at the wall, drowning, willing myself to rise, to swim for just long enough, but I am being thrust below the surface. It’s just laundry. I want to do my laundry. I am stressed that I am not doing my laundry. 1, 2, 3, get up, come on, just get up, 1, 2, 3, it’s just laundry, oh my god, where do you expect to get in this life, if you cannot get out of bed for fifteen minutes to do your laundry? And then my thoughts begin to wander, or spiral, and I forget that I wanted to do my laundry in the first place. So, I continue to stare at the wall for about an hour while the waves wash the reality off of me.
For this, I am dumb and lazy, a slob and a horrible student. At least, I was treated this way growing up, and I believed it. I believe that our culture is rooted in a standard of “normal” for how people are supposed to behave or the capacity at which they are supposed to function. This, of course, is the structure by which we have established our educational systems, or workplace environments. Executive dysfunction—or neurodiversity and mental health, in general—is often not the first thought of a teacher when a student falls behind on their assignments, or a parent when a child doesn’t shower for a week. It is not often proposed that you need help and support—rather, you are to expect a visit from your fairy godmother, who will wave a magic wand to reacquaint you with reality and flood your brain with dopamine. Just… just do it, it’s not hard for me, how could it possibly be hard for you?
That is not to say that those who struggle are incapable of doing things. We just have a different way that we need to do them, and that is okay. I put away my laundry, of course, but I sometimes need to split that into very small tasks, such as sitting up, putting my feet on the floor, standing, and walking to the laundry basket. Sometimes, I need to write those down for myself, with a journal that I keep by the bed for times like this. Sometimes, I need music in the background to give my mind something to focus on. Sometimes, I just need to wait a day, and that is fine. None of these negatively impact the quality of my laundry-doing, nor are they that disruptive to others in my house. If we perpetuate the idea that you need to have certain abilities to do things a certain way, those who struggle will fall behind very quickly. So what if a student needs to doodle around their notes or work in the hallway? Whose right is it to say that this is any less of an article if I need to finish writing it in bed?
Executive dysfunction is an unfortunate fact of life for many. With therapy, medications, and effective coping mechanisms, it can very much be treatable and livable. Even then, some days are worse than others, and some symptoms are hard to kick. As I write this, my hairstyling products are still scattered about from days ago, but that is fine, because it means that I washed and did my hair. A week into writing this article, I had about three sentences, but that is fine, because I got it done in the end. My laundry is not done, but I was able to dump it on the floor for a photo. If we are not going to be successful in the perceptions of others, the least we can do is be successful in our own, in whichever way we can be.
