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Executive Functions and Attention: A Neuropsychological Assessment Perspective

Executive Functions and Attention: A Neuropsychological Assessment Perspective Executive Functions and Attention: A Neuropsychological Assessment Perspective

Neuropsychological performance can be considered as comprising five domains of functioning: Cognition, Memory & Learning, Verbal Functions, & Visuospatial Functions. Overlap among all 5 aspects should be assumed since the brain is integrated with neural connections across all areas of functioning. The prefrontal cortex (frontal lobes) of the brain houses the executive system. The executive system links up with all the brain systems and regulates them as needed in the service of goal-directed behavior. All cognitive systems are sensitive to frontal lobe pathology and that is why it is referred to as an important overseer of development and functioning in children and young adults.

Developmental neuropsychology uses executive functioning abilities to denote a number of different areas of daily functioning often seen for children in school and the home environment.

• Planning & decision making: organizing one’s choices and being effective about carrying out the completion of a task.
• Working memory: Ability to adopt, maintain, & shift the cognitive set in an organized strategic way.
• Monitor performance: Track the plan for the work that needs to be completed, correct oneself, respond to feedback.
• Overriding habits/inhibition: Ability to choose a more complex and effortful solution to be correct and knowing when to let go of a strategy that is not fruitful. The ability to resist or inhibit impulses to respond to salient aspects of the task that needs to be done.
• Awareness: Knowing and understanding task relevant information & when to apply mental flexibility to get through a task’s completion.
• Feedback/error utilization: Ability to benefit from feedback to infer rules for solving problems.
• Mental/cognitive flexibility: Ability to shift between 2 concepts (from number to letter; from verbal to practical solutions; from adding to ordering numbers; from ordering objects by size to ordering by color).

Executive functioning difficulties and differences can be seen as a spectrum ranging from mild to more significant deficits impacting a person’s functioning. Examples of significant executive functioning difficulties can be seen as a person abandoning complex projects, the inability to multitask, and a reliance on others to plan instrumental activities of daily living or making decisions for the person. Mild issues with executive functioning can manifest by seeing an increased effort in someone to complete multistep projects, difficulty multitasking or resuming a task interrupted by call or visitor, complaints of increased fatigue from the extra effort required to organize, needing to plan extensively to make decisions, and reports that large social gatherings are more taxing or less enjoyable because of the increased effort required to follow shifting conversations.

When a neuropsychological and educational evaluation/assessment reveals that a child or young adult indeed has executive functioning weaknesses there are ways to address skill sets to improve overall functioning. Learning specialists, tutors, and executive functioning coaches work on aspects such as, volition, a complex process of determining what one needs/wants & conceptualizing some kind of future realization of that need/want. Volition is a capacity for intentional behavior and that can be taught, explained, and clarified. Planning skills are also addressed: identification and organization of steps and elements needed to carry intention or achieve a goal. Planning and organization skills subsume that one must be able to conceptualize changes from the present circumstance, deal objectively with oneself, and deal objectively with one’s environment and it’s demands. Purposive action is a skill that is emphasized in executive functioning skills; that is, translating an intention or plan into productive, self-serving activity requiring a person to initiate, maintain, switch, and stop sequences of complex behavior in an orderly and integrated manner. Finally, evaluating effective performance is another way to assist children and young adults with executive functioning skills. One’s ability to monitor, self-correct, and regulate the qualitative aspects of the work they are completing is also called metacognition and is a critical aspect of executive functioning abilities.


Interventions for Executive Functioning Challenges...