What is ‘executive dysfunction’ and how might it affect a person’s ability to work? Suzanne Trask explains.
Executive functioning describes the abilities we use when we think and consider – it’s something we may take for granted in our everyday lives and at work.
It includes the ability to multi-task, solve problems, concentrate, make decisions and think flexibly. It also incorporates other abilities such as controlling our emotions, being self-aware and regulating our behaviour.
Executive dysfunction is the term used to describe when these functions aren’t working properly. This often occurs as a result of traumatic brain injury, leading to a range of cognitive, behavioural, and emotional difficulties. This affects people in different ways, so it is important to remember that as each person is different, how their brain injury affects them is also individual to them.
Executive dysfunction is sometimes referred to as ‘Dysexecutive Syndrome’, because it is usual for several of the symptoms to occur together.Â
What causes it?
Executive functions are controlled by the frontal lobes of the brain. This part of the brain controls our ability to organise, plan, problem solve and pay attention. It also controls our behaviours, emotions, personality and social skills. The frontal lobes are connected to many other areas in the brain and are instrumental in co-ordinating them.
Not all executive dysfunction is caused by brain injury, but brain injury is a very common cause. The frontal lobe is often damaged by brain injury caused by trauma, for example in a road-traffic accident, fall or impact to the head. However, damage can also happen following brain tumours, strokes, or brain infections such as encephalitis or meningitis.
Symptoms
People with executive functioning issues may have some or all of the symptoms below, which are all relevant to considering their return to the workplace:
- Trouble organising themselves
- Trouble planning or completing tasks
- Difficulty concentrating or paying attention
- Difficulty multi-tasking and/or problem-solving
- Difficulty processing new information
- Difficulty paying attention to, or taking part in, conversations
- Acting impulsively, without thinking ahead to the potential consequences
- Difficulty controlling or regulating emotions
- Inability to regulate behaviour appropriately in social situations.
Impact on sufferers
The symptoms of executive dysfunction can be frustrating and confusing for brain injury survivors, as well as their friends and families. The person they knew before their brain injury has changed, and they can often seem like a different person.
Social interaction can become increasingly difficult as sufferers struggle to participate and engage in conversations, particularly in groups. Their inability to regulate behaviour in social situations may lead to the sufferer saying or doing inappropriate things, which can lead to upset, a breakdown of relationships and low self-esteem.
Executive dysfunction can sometimes be misunderstood by friends or family members, or misinterpreted as depression, aggression, selfishness or demotivation. Sadly, this often leads to social isolation, as the sufferer becomes increasingly withdrawn to avoid challenging situations.
Executive dysfunction can sometimes be misunderstood by friends or family members, or misinterpreted as depression, aggression, selfishness or demotivation. Sadly, this often leads to social isolation”
Struggling with multi-tasking, completing tasks, planning and organisation mean that executive dysfunction can impede a sufferer’s return to work after a brain injury. Tasks that they would have previously found straightforward, such as cooking a meal, can be exhausting as sufferers struggle with thinking ahead or planning the sequence of steps needed to complete a task, or having to vary a plan when necessary. Sufferers often experience low motivation or loss of interest in things they used to enjoy, as everything seems more difficult to achieve.
Some brain injury survivors with executive functioning issues may act impulsively and have difficulties anticipating the consequences of their actions. For example, spending more money than they can afford, which can lead to stress and a strain on relationships.
Managing the effects
Managing the effects of executive dysfunction is possible, and organisations such as Headway, the Brain Injury Association, can help.
Strategies can include writing ‘to do’ lists, using a diary to plan your week and breaking all activities into small and manageable chunks, to stop tasks becoming overwhelming. There are apps available to help with organisation and reminders.
Discussing plans with others can be useful. This helps sufferers break tasks into smaller chunks, stay motivated and keep plans on track.
Sufferers should remember to celebrate their daily accomplishments by ticking things off their lists and reflecting on plans they have put into action, but most importantly by being kind to themselves and not worrying too much about things they haven’t managed to do that day.
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Talking therapies can help brain injury survivors who have difficulty managing their moods or emotions. It can help survivors consider difficult situations that have occurred, identify triggers and build skills to help in future.
Learning more
Headway the brain injury association has some fantastic resources for those with brain injuries, their families and anyone interested in this area, with useful links and advice. At Bolt Burdon Kemp we are specialists in supporting those with brain injuries with their legal claims, and in their rehabilitation.
