Executive Dysfunction

Executive functioning generally refers to mental processes such as working memory, cognitive flexibility, and self-regulation, which enable us to perform fundamental tasks in our day-to-day lives. 

Experiencing executive dysfunction symptoms may be a cause for concern and may impact a person’s ability to complete tasks. Executive dysfunction can be linked to many different conditions or illnesses, including mental health conditions like depression. Read on to learn how to recognize signs of executive function deficits and how they may be related to your mental health.

Executive function skills and brain development

Executive functioning refers to the skills that are involved in a wide variety of daily tasks, such as time management and completing tasks. Executive functioning skills can be split into two types: those used for organization and those used for regulation. Organizational functions include attention, planning, verbal working memory, problem solving, and flexible thinking, which are crucial as higher-level executive functions. Regulatory functions involve monitoring internal and external stimuli, exercising self-control, emotional regulation, moral reasoning, and decision-making as it relates to time, money, and other areas of management.

These functions develop from around two years of age in one’s brain (specifically memory-related areas) and are usually fully formed by 30. However, there are individual differences in the rate of this development, which can affect how executive functions develop in adults. Each function plays a crucial role in everyday life, which is why deficits in executive functioning can be challenging or even debilitating, depending on the severity of the issue.

Examples of difficulties with executive functions

Experiencing executive dysfunction means having difficulty with any of the abilities listed above. Signs of executive dysfunction can include:

• Trouble shifting attention from one task to the next (such as you may see in those who live with attention deficit disorder)
• Getting distracted easily or having trouble focusing on complex tasks
• Working memory deficits
• Frequently daydreaming during conversations at work or school
• Difficulty with self-motivation (which can be commonly associated with conditions such as executive function disorder)
• Trouble organizing or planning ahead, perhaps showing up as poor time management skills 
• Focusing too much on one thing, as executive function skills may be required to switch between priorities 
• Frequently misplacing school materials or items, which can be associated with a limited or divergent working memory 
• Experiencing problems with impulse control (snacking when trying to stick to a diet, blurting out thoughts you didn’t mean to, having inappropriate emotional reactions, or struggling to regulate emotions)

Executive dysfunction disorder

Common causes of executive dysfunction

According to the British Medical Bulletin, executive dysfunction can have or be linked to a variety of different causes, including:

• Traumatic brain injury
• Toxins (such as carbon monoxide poisoning)
• Vitamin deficiencies
• Alzheimer’s or dementia
• Epilepsy
• Substance use disorders
• Bipolar disorder
• Schizophrenia
• Obsessive-compulsive disorder (OCD)
• Anxiety disorders
• Depression

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Brain damage and executive dysfunction

In general, executive dysfunction is related to damage to or deterioration of some parts of the brain. It can also range widely in severity and duration or frequency based on the main cause. 

Various tools and self-tests can provide valuable insights into an individual’s executive functioning abilities and help clinicians develop a treatment plan. Additionally, these assessments can be repeated over time to chart progress or determine if any changes need to be made to the plan.

Executive dysfunction self-test tools

To assess the individual’s executive function, clinicians may use a variety of tools, such as the Behavior Rating Inventory of Executive Functioning (BRIEF) and Comprehensive Executive Function Inventory (CEFI). The BRIEF is administered as an interview or self-report questionnaire that provides information about behavior regulation, emotional control, and problem-solving skills, while the CEFI is a performance-based assessment that measures executive functioning in areas such as cognitive flexibility and self-regulation. 

The Barkley Deficits in Executive Functioning Scale (BDEFS), Montreal Cognitive Assessment (MoCA), and Stroop color and word test are other tools that can help measure executive dysfunction. They provide both qualitative and quantitative information about an individual’s cognitive skills. 

How executive dysfunction can be related to depression

Isolating the exact cause of executive dysfunction can be challenging in some behavioral therapy cases. There are many possible contributing factors, and some can be congenital or undiagnosed, making the main source of executive dysfunction harder to isolate. However, a brief review of research does show that those who have depression or people with ADHD are likely to experience some level of executive dysfunction as a symptom, which might be linked to the prefrontal cortex.

What is depression?

• Loss of interest in previously enjoyed activities
• Significant fluctuations in appetite or weight
• Significant fluctuations in sleep
• Problems with planning or completing goal-directed activities
• Lack of energy
• Feelings of worthlessness, hopelessness, or guilt
• Trouble thinking or making decisions

As you can see, some of the symptoms of depression overlap with executive dysfunction symptoms. However, that doesn’t mean that someone experiencing executive dysfunction has depression. There can be other factors at play, as outlined in a previous section. That’s why a mental health professional would need to take an overview of your situation and learn more about what you’re feeling to decide if depression may be the root cause. 

Executive dysfunction and depression

If you've noticed the symptoms of executive dysfunction manifesting in your daily life and you've noticed some symptoms of depression as well, there may be a link. Speaking with a medical professional or a therapist can be a helpful first step in determining the underlying cause of executive dysfunction and exploring potential treatment options if the cause is mental-health related.

Mental health treatment options for depression

Online therapy

Studies have shown online cognitive behavioral therapy (CBT) to actually be slightly more effective in treating certain mental illnesses than the face-to-face modality, though both are recognized as valid treatments. One literature review of 17 studies on the topic, likely including experimental psychology research, suggests that online CBT is more effective than traditional, in-person therapy for reducing symptoms of depression, specifically. It also notes that virtual CBT can be less expensive than in-person therapy. CBT may also help executive dysfunction.

If you’re interested in trying online therapy, consider a platform like BetterHelp. After filling out a brief questionnaire, you can get matched with a licensed mental health professional who suits your needs and preferences. If you prefer face-to-face therapy, you can search for providers who are located near you and specialize in the areas in which you need support, such as interference control. Regardless of the format you choose, a therapist can help you manage symptoms of depression or executive dysfunction.