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Executive dysfunction

Executive dysfunction is a neurocognitive impairment characterized by difficulties in the higher-order processes managed by the frontal lobes of the brain, including planning, organizing, initiating and sustaining tasks, regulating emotions, and controlling impulses.^[1] It manifests as challenges in adapting to changing environments, prioritizing information, and executing goal-directed behaviors, often leading to disruptions in daily functioning despite intact intelligence.^[2] This condition is not a standalone diagnosis in major classification systems like the DSM-5 but serves as a symptom cluster associated with various neurological and psychiatric disorders.^[3] Common symptoms of executive dysfunction encompass a wide range of cognitive and behavioral deficits, such as trouble focusing attention, managing time effectively, and shifting between tasks or activities.^[1] Individuals may exhibit poor impulse control, resulting in impulsive decisions or difficulty inhibiting inappropriate responses, alongside challenges in working memory that affect recalling information for immediate use.^[2] Emotional dysregulation is also prevalent, with heightened frustration, mood swings, or social missteps due to impaired self-monitoring and empathy.^[3] These symptoms often emerge in childhood or adolescence when executive functions are still maturing and may become more evident in early adulthood, as these functions continue to develop into the mid-20s; they can persist or worsen with age or underlying conditions.^[2] The causes of executive dysfunction are multifaceted, often stemming from disruptions in brain development, structure, or chemistry, particularly involving neurotransmitters like dopamine and serotonin.^[2] It is frequently linked to neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder, where genetic and environmental factors contribute to frontal lobe inefficiencies.^[3] Acquired causes include traumatic brain injuries, strokes, or neurodegenerative diseases like Alzheimer's and frontotemporal dementia, which damage executive control networks.^[1] Additionally, mental health conditions including depression, anxiety, and substance use disorders can exacerbate or mimic these deficits through chronic stress or altered neural pathways.^[3] Diagnosis typically involves comprehensive neuropsychological assessments, as no single test isolates executive functions, and management strategies focus on behavioral therapies, medications, and compensatory tools to improve outcomes.^[1]

Definition and Overview

Core Concepts

Executive dysfunction is characterized as an impairment in the brain's executive functions, a set of higher-order cognitive processes that enable goal-directed behavior, self-regulation, and adaptation to changing environments. These functions encompass planning and organization, task initiation and sustained effort, inhibitory control to suppress inappropriate responses, working memory for holding and manipulating information, cognitive flexibility for shifting between tasks or perspectives, and self-monitoring to evaluate and adjust ongoing actions.^[4]^[5] Such impairments disrupt the orchestration of lower-level cognitive and behavioral processes, leading to difficulties in managing daily demands without necessarily affecting basic sensory or perceptual abilities.^[6] The concept of executive functions traces its origins to the work of neuropsychologist Alexander Luria in the 1960s, who emphasized the frontal lobes' role in regulating complex voluntary actions, programming behavior, and verifying outcomes through his studies of brain-injured patients.^[7] Luria's framework, detailed in his 1966 book Higher Cortical Functions in Man, portrayed the prefrontal regions as a supervisory system integrating motivational, sensory, and motor elements for purposeful activity. This foundational perspective was later refined through empirical models, notably Miyake et al.'s (2000) influential three-factor structure derived from latent variable analysis of individual differences.^[8] Their model identifies updating (monitoring and revising working memory), inhibition (suppressing prepotent responses), and shifting (flexibly switching mental sets) as core components, revealing both a common executive capacity (unity) and distinct processes (diversity) that contribute to complex frontal-lobe tasks.^[9] At its neural foundation, executive functions rely on distributed circuits centered in the prefrontal cortex (PFC), which coordinates with the anterior cingulate cortex for conflict monitoring and error detection, and the basal ganglia for action selection and habit formation.^[10]^[11] Dopamine modulates PFC activity to optimize working memory and reward-based decision-making, while norepinephrine enhances arousal, attention, and flexible responding across these networks.^[12]^[13] Disruptions in these circuits or neurotransmitter systems, often from injury or developmental anomalies, underlie executive dysfunction.^[4] Executive dysfunction differs from broader cognitive impairments, such as those reducing overall intelligence quotient (IQ) or disrupting basic memory encoding and retrieval, by selectively targeting the self-regulatory mechanisms needed for adaptive, context-dependent behavior in novel or demanding situations.^[14] Individuals may retain intact crystallized knowledge or rote skills but struggle with initiating actions, prioritizing goals, or adapting to interruptions, highlighting its specificity to dynamic executive control rather than static cognitive capacity.^[15]

Symptoms and Behavioral Manifestations

Executive dysfunction is characterized by a range of primary symptoms that disrupt cognitive and behavioral control, including difficulty with task initiation often manifesting as procrastination or avoidance of starting activities; poor planning and organization, such as challenges in breaking down tasks or managing time effectively; impulsivity or disinhibition, leading to hasty decisions or interrupting others; working memory deficits, where individuals struggle to hold and manipulate information like recalling steps in a multi-part process; and perseveration, involving repetitive behaviors or thoughts despite their ineffectiveness.^[16]^[5]^[1] These symptoms appear in observable behaviors across various life domains, profoundly affecting daily functioning. In personal life, they may result in household disorganization, such as misplacing items frequently or failing to maintain routines like cleaning or meal preparation, leading to chaotic living environments.^[16]^[3] In work or school contexts, individuals often face missed deadlines, trouble staying on track with assignments, or inability to balance multiple demands, such as juggling academic responsibilities with extracurricular activities, which can hinder productivity and achievement.^[16]^[17] Socially, behavioral manifestations include emotional dysregulation, like outbursts during conversations, or impulsivity that causes difficulties in sustaining interactions, such as losing track mid-discussion or struggling to adapt to social cues.^[16]^[5] The severity of these manifestations forms a spectrum, ranging from mild forms involving subtle inefficiencies—like occasional forgetfulness or minor delays in task completion—to severe cases where individuals exhibit a near-complete inability to sequence actions independently, fostering dependency on others and elevating stress levels that compromise overall quality of life.^[3]^[1] Observer-rated and self-report measures help capture these variations; for instance, the Behavior Rating Inventory of Executive Function (BRIEF) assesses everyday executive behaviors through scales measuring inhibition, working memory, planning/organization, and emotional control, with versions available for parent/teacher observation in children and self-reports in adults to highlight discrepancies between perceived and observed impairments.^[18]^[19]

Causes and Etiology

Neurobiological Mechanisms

Executive dysfunction arises primarily from disruptions in the prefrontal cortex (PFC), a critical brain region orchestrating higher-order cognitive processes. The dorsolateral prefrontal cortex (DLPFC) is particularly involved in working memory and cognitive flexibility, while the orbitofrontal cortex (OFC) plays a key role in response inhibition and decision-making.^[20] These regions interact with subcortical structures, including the basal ganglia and thalamus, through frontostriatal circuits that facilitate goal-directed behavior and inhibitory control.^[21] Dysfunctions in these circuits, such as reduced connectivity between the DLPFC and striatum, have been linked to impaired executive performance across various disorders.^[22] Neurotransmitter imbalances further contribute to executive dysfunction, with dysregulation of dopamine in mesolimbic and mesocortical pathways affecting reward processing, motivation, and cognitive control.^[23] Dopamine's inverted-U shaped influence on PFC function means that either deficits or excesses can impair working memory and flexibility.^[24] Similarly, norepinephrine deficits disrupt attention and arousal regulation, as this catecholamine modulates PFC neuronal firing to sustain vigilant behavior.^[25] These imbalances often coexist, exacerbating deficits in tasks requiring sustained effort and inhibition.^[26] Pathophysiological processes underlying executive dysfunction include hypofrontality, characterized by reduced activation in the PFC during cognitive tasks, as evidenced by functional magnetic resonance imaging (fMRI) studies showing diminished blood oxygenation level-dependent signals in ADHD and schizophrenia.^[27] White matter disruptions, detected via diffusion tensor imaging (DTI), reveal decreased fractional anisotropy in frontostriatal tracts, correlating with poorer executive performance in neurodevelopmental disorders.^[28] In chronic cases, inflammation and oxidative stress contribute by promoting neuronal damage and synaptic inefficiency in PFC networks.^[29] Animal models provide causal evidence through lesion studies in nonhuman primates, where targeted damage to the DLPFC impairs performance on delayed-response tasks, demonstrating specific deficits in spatial working memory without affecting basic sensory processing.^[30] Orbitofrontal lesions in rhesus monkeys similarly disrupt inhibitory control and reversal learning, mirroring human executive impairments.^[20] These findings underscore the PFC's modular contributions to executive functions, validated across species.^[31]

Genetic and Heritable Factors

Twin studies have consistently demonstrated that genetic factors account for a substantial portion of the variance in executive functions, with heritability estimates typically ranging from 40% to 80%, depending on the specific component assessed.^[32] For instance, inhibition tasks often show higher heritability around 70-80%, while working memory may exhibit slightly lower estimates near 50%.^[33] These findings underscore a strong heritable basis for executive function variability, with a common genetic factor explaining nearly all observed correlations among different executive processes.^[32] Among candidate genes, the catechol-O-methyltransferase (COMT) gene's Val158Met polymorphism (rs4680) has been prominently linked to executive dysfunction through its role in dopamine metabolism in the prefrontal cortex. The Met allele is associated with reduced COMT activity, leading to higher dopamine levels and enhanced prefrontal efficiency, which correlates with improved performance on tasks requiring cognitive flexibility and working memory.^[34] Similarly, variants in the dopamine receptor D2 (DRD2) gene, such as the C957T polymorphism (rs6271), influence working memory and attentional control by modulating dopamine signaling; the C allele has been tied to reduced D2 receptor density and poorer executive performance under high cognitive load.^[35] The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism (rs6265) affects neuroplasticity by altering BDNF secretion, with the Met allele linked to diminished hippocampal and prefrontal plasticity, potentially impairing executive functions like decision-making and inhibitory control.^[36] Genome-wide association studies (GWAS) have revealed a polygenic architecture for executive functions, identifying multiple loci that contribute to trait variance, often with significant overlap to neurodevelopmental disorders like ADHD. For example, a 2022 study found that polygenic risk scores for ADHD predicted impairments in working memory and attention, components central to executive dysfunction, highlighting shared genetic underpinnings across these traits.^[37] More recent GWAS from 2019-2023, including a large-scale analysis of over 38,000 ADHD cases, identified 27 risk loci enriched in genes involved in early brain development, many of which influence executive processes such as inhibitory control.^[38] Epigenetic modifications, which alter gene expression without changing the underlying DNA sequence, also play a role in executive dysfunction by influencing the regulation of genes critical for prefrontal development and function. These heritable changes, such as DNA methylation, can modulate the expression of stress-response and neuroplasticity-related genes, contributing to variability in executive performance.^[39]

Environmental and Acquired Influences

Acquired brain injuries, particularly traumatic brain injuries (TBIs), represent a major environmental contributor to executive dysfunction by damaging frontal lobe structures critical for cognitive control. TBIs often result in diffuse axonal injury, which disrupts white matter tracts connecting the prefrontal cortex to other brain regions, leading to impairments in planning, inhibition, and working memory. In the United States, approximately 2.8 million TBI-related emergency department visits, hospitalizations, and deaths occur annually, with over 69,000 deaths reported in 2021 alone. These injuries predominantly affect the frontal lobes, where even mild TBIs can cause persistent executive deficits through axonal shearing and secondary neurodegeneration.^[40]^[41]^[42]^[43]^[44] Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, exert long-term effects on executive functions through chronic stress-induced alterations in brain development. The seminal ACE study demonstrated a dose-response relationship, where greater exposure to these traumas correlates with increased risk of adult cognitive and behavioral impairments, mediated by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and resulting prefrontal hypofunction. This leads to reduced prefrontal cortical volume and connectivity, impairing inhibitory control and decision-making. Longitudinal studies from the 2020s confirm these associations, showing that higher ACE scores predict persistent executive deficits across the lifespan, with meta-analyses revealing moderate effect sizes on cognitive control domains like flexibility and working memory.^[45]^[46]^[47]^[48] Substance use and exposure to toxins further contribute to executive dysfunction via neurotoxic damage to dopaminergic pathways essential for reward processing and cognitive regulation. Chronic alcohol consumption impairs prefrontal circuits, leading to deficits in impulse control and problem-solving, while methamphetamine induces severe neurotoxicity in the striatum and frontal lobes, exacerbating disinhibition and attentional lapses. Prenatal alcohol exposure, as seen in fetal alcohol spectrum disorders (FASDs), causes dopaminergic system disruptions in the ventral tegmental area, resulting in lifelong executive impairments such as poor planning and flexibility. These effects highlight how environmental toxins can mimic or amplify innate vulnerabilities in executive networks.^[49]^[50]^[51]^[52]^[53] Chronic conditions like sleep deprivation, malnutrition, and infections also drive acquired executive dysfunction through sustained physiological stress on brain systems. Sleep deprivation, even after one night, impairs prefrontal-dependent tasks such as decision-making and cognitive flexibility by reducing connectivity in frontoparietal networks. Malnutrition in early life or adulthood compromises neurodevelopment and adult cognition, with deficiencies in nutrients like iron and proteins linked to executive deficits in attention and inhibitory control. Emerging research from 2020 to 2025 on post-COVID-19 effects reveals persistent executive impairments, including slowed processing speed and reduced working memory, in up to 20-30% of long COVID cases, attributed to neuroinflammation and microvascular damage in frontal regions.^[54]^[55]^[56]^[57]^[58]^[59]

Assessment and Diagnosis

Neuropsychological Testing

Neuropsychological testing provides objective, standardized measures of executive functions, allowing clinicians and researchers to quantify impairments in areas such as planning, inhibition, cognitive flexibility, and working memory. These assessments are particularly valuable in identifying executive dysfunction across various populations, including those with neurodevelopmental, psychiatric, or neurological conditions, by isolating specific cognitive processes through timed tasks and error analysis. Common batteries incorporate multiple tests to capture the multifaceted nature of executive functions, with performance interpreted against age- and education-adjusted norms to detect deviations indicative of dysfunction.^[60] The Clock Drawing Test (CDT) is a brief screening tool that assesses visuospatial planning, abstraction, and executive control by requiring individuals to draw a clock face, set the time to 10 past 11, and organize elements coherently. Errors such as conceptual deficits (e.g., failure to represent a circular clock face or place numbers outside the perimeter), spatial disorganization, or perseveration highlight executive impairments, with scoring systems evaluating 10-15 criteria for overall accuracy and stimulus-bound responses. Developed as a sensitive indicator of frontal and parietal lobe involvement, the CDT demonstrates high interrater reliability (coefficients of 0.79-0.99 for free-drawn versions) and is adjusted for age and education in normative data spanning adulthood to elderly populations.^[61]^[62] The Stroop Task, originally designed to measure selective attention and cognitive interference, evaluates inhibitory control by presenting color words printed in incongruent ink colors (e.g., the word "red" in blue ink), requiring participants to name the ink color while suppressing the automatic reading response. In executive dysfunction, increased interference effects manifest as slower reaction times on incongruent trials compared to neutral ones, with interference effects typically around 100-150 ms in healthy adults and significantly larger (often >200 ms) in affected individuals, signaling impaired response inhibition and conflict monitoring.^[63] This task's validity for executive assessment is supported by its correlation with prefrontal activation, and normative data account for age-related slowing, showing moderate test-retest reliability in repeated administrations.^[64]^[60] The Trail-Making Test (TMT), particularly Parts A and B, probes attention shifting, task-switching, and motor planning through connecting numbered or alternating number-letter circles in sequence. Part A focuses on visual scanning and speed, while Part B demands cognitive flexibility by alternating between sets, where errors such as sequence violations or perseveration correlate strongly with executive inflexibility and frontal lobe deficits. Completion time for Part B exceeding age-adjusted norms (e.g., >75 seconds in adults) and error rates indicate dysfunction, with the test's reliability enhanced by alternate forms to minimize practice effects; meta-analyses confirm its sensitivity to executive impairments with test-retest correlations around 0.7-0.8.^[64]^[65] The Wisconsin Card Sorting Test (WCST) evaluates abstract reasoning, set-shifting, and perseveration by having participants sort cards based on unspoken rules (color, shape, number) that shift unannounced, with feedback provided after each trial. Key metrics include the number of categories completed (successful rule shifts) and perseverative errors (continued use of outdated rules), where achieving fewer than 3 categories often signifies severe executive dysfunction linked to dorsolateral prefrontal cortex impairment. Normative data from large samples adjust for age, education, and gender, revealing that perseverative errors above 20-30% of trials predict poor flexibility; the test exhibits moderate test-retest reliability (0.6-0.8) in meta-analytic reviews, though practice effects can influence repeated testing.^[64]^[66] Overall, these tests' normative frameworks, derived from diverse populations, incorporate adjustments for demographic factors to ensure accurate identification of dysfunction, with meta-analyses reporting moderate test-retest reliability (0.6-0.8) across executive measures, underscoring their utility despite variability in complex tasks.^[67]^[64] Recent advances include digital and telehealth adaptations of these tests, enabling remote administration and improved accessibility. For example, online versions of the Stroop and WCST have shown validity in detecting executive dysfunction in clinical populations as of 2025.^[68]

Clinical and Behavioral Evaluation

Clinical and behavioral evaluation of executive dysfunction emphasizes holistic, context-driven approaches that complement standardized testing, focusing on real-world manifestations through interviews, observations, and integrated assessments. Structured interviews are a cornerstone, often incorporating DSM-5 criteria for associated disorders such as ADHD, where executive function probes help identify impairments in self-regulation and goal-directed behavior. For instance, the Barkley Deficits in Executive Functioning Scale (BDEFS) serves as a self-report tool within these interviews, assessing dimensions like time management, self-organization, and problem-solving across multiple settings, with strong psychometric properties supporting its use in clinical populations.^[69]^[70] The Structured Clinical Interview for DSM-5 (SCID-5) provides a semi-structured framework to systematically evaluate symptoms, ensuring comprehensive coverage of executive-related criteria while probing for functional impacts.^[71] Behavioral observations offer ecologically valid insights into executive dysfunction by capturing behaviors in natural environments such as schools or workplaces, where checklists target specific failures like task initiation or organizational disarray. These assessments, often using tools like the Behavioral Rating Inventory of Executive Function (BRIEF), reveal discrepancies between controlled settings and daily demands, highlighting issues such as impulsivity or inflexibility that may not emerge in lab-based evaluations.^[72]^[73] In educational contexts, direct observations during classroom activities can document patterns of executive lapses, such as difficulty shifting attention or sustaining effort, informing tailored interventions without relying solely on retrospective reports.^[74] Multidisciplinary evaluations integrate these methods with neuroimaging and self-report scales to provide a fuller picture of executive circuit integrity. Functional MRI (fMRI) is employed to visualize prefrontal and frontostriatal network activity, correlating hypoactivation with observed dysfunction in tasks requiring planning or inhibition.^[75] Self-report instruments like the Dysexecutive Questionnaire (DEX) complement this by quantifying everyday executive problems, such as emotional control or social cognition deficits, with validated subscales that enhance diagnostic precision in rehabilitation settings.^[76]^[77] This collaborative approach, involving psychologists, neurologists, and educators, ensures that behavioral data informs neurobiological interpretations, as seen in studies linking fMRI findings to real-world impairment profiles.^[78] Diagnosing executive dysfunction presents challenges, including subjectivity in mild cases where self-reports may overestimate or underestimate impairments due to metacognitive biases. Cultural biases further complicate reporting, as norms for behaviors like impulsivity vary across contexts, potentially leading to underdiagnosis in diverse populations.^[79]^[80] Longitudinal tracking is essential to distinguish transient from persistent deficits, with repeated assessments revealing trajectories of change that static evaluations might miss. The American Psychological Association's 2022 Guidelines for Assessment and Intervention with Persons with Disabilities underscore the need for culturally sensitive, ongoing monitoring to address these issues and improve diagnostic reliability.^[81]^[82]

Associated Conditions

Neurodevelopmental Disorders

Executive dysfunction is a hallmark feature of attention-deficit/hyperactivity disorder (ADHD), particularly manifesting as core deficits in behavioral inhibition and working memory. These impairments contribute to the disorder's characteristic symptoms of inattention, impulsivity, and hyperactivity, with many individuals, estimates ranging from 20-60% in clinical cohorts, exhibiting measurable executive function deficits across neuropsychological assessments.^[83]^[84] The Multimodal Treatment of ADHD (MTA) study, a landmark longitudinal trial initiated in 1999, demonstrated that stimulant medications, which enhance dopaminergic neurotransmission in prefrontal circuits, lead to significant improvements in these executive domains for approximately 70% of participants, underscoring the role of dopaminergic pathways in mediating response. Ongoing follow-ups from the MTA cohort continue to highlight the persistence of these deficits into adolescence and adulthood, emphasizing the need for targeted interventions early in development.^[85] In autism spectrum disorder (ASD), executive dysfunction presents a distinct profile, often characterized by relative strengths in detail-oriented processing and sustained attention to specifics, contrasted with pronounced weaknesses in cognitive flexibility, planning, and set-shifting. These deficits are linked to challenges in theory of mind, where impairments in executive functions such as inhibitory control and working memory hinder social inference and perspective-taking, contributing to core social communication difficulties.^[86] A 2023 meta-analysis of executive function across neurodevelopmental disorders confirmed these patterns, revealing moderate to large effect sizes for flexibility and planning deficits in ASD, positioning executive dysfunction as a transdiagnostic marker shared with conditions like ADHD but with unique social-executive emphases in autism.^[87] Tourette syndrome frequently co-occurs with ADHD, with comorbidity rates exceeding 50%, and this overlap amplifies executive dysfunction, particularly in response inhibition related to tic suppression and motor control. Tic-related inhibitory challenges stem from fronto-striatal circuit disruptions, where failures in suppressing prepotent responses mirror broader executive impairments observed in comorbid cases.^[88] Recent 2024 research highlights autonomic dysregulation—such as altered heart rate variability and sympathetic arousal—as a modulator of these inhibitory deficits, potentially exacerbating tic severity and executive load during stress, though direct causal links require further longitudinal study.^[89] Across neurodevelopmental disorders, executive dysfunction exhibits dimensional rather than categorical impairments, varying in severity along a spectrum influenced by genetic and environmental factors, with many affected children showing clinically significant profiles.^[90] Early identification opens critical intervention windows, particularly in preschool years, where targeted executive function training—such as cognitive-behavioral programs enhancing inhibition and working memory—has demonstrated moderate effect sizes in improving outcomes for children with ADHD and ASD in randomized trials.^[91]

Psychiatric Disorders

Executive dysfunction is a core feature of schizophrenia, characterized by profound deficits in planning, cognitive flexibility, and inhibitory control, often attributed to hypofrontality involving reduced prefrontal cortex activation and connectivity.^[92] These impairments contribute to functional disabilities and are present in most patients, persisting even in remission phases.^[93] The Positive and Negative Syndrome Scale (PANSS) subscales, particularly those assessing conceptual disorganization and poor attention, provide quantitative measures of executive function deficits, correlating with prefrontal hypoactivity observed in neuroimaging studies.^[94] Recent reviews highlight that these deficits are more severe in chronic cases, exacerbating daily adaptive challenges.^[95] In bipolar disorder, executive dysfunction manifests in an episode-dependent manner, with impairments intensifying during acute phases and varying by mood state. During manic or hypomanic episodes, heightened impulsivity and risk-taking reflect deficits in inhibitory control and decision-making, whereas depressive episodes are marked by apathy, reduced initiation, and slower processing speed.^[96] These cognitive alterations correlate with mood symptom severity, impacting real-world functioning such as occupational performance.^[97] Lithium treatment demonstrates neuroprotective effects on executive function, potentially preserving prefrontal integrity and improving cognitive performance during both manic and depressive states, as evidenced by longitudinal studies and meta-analyses.^[98]^[99] Major depressive disorder (MDD) and anxiety disorders feature executive dysfunction linked to anhedonia, which disrupts reward processing and motivational aspects of goal-directed behavior, leading to deficits in initiation and sustained effort.^[100] Meta-analyses from 2020 to 2025 indicate moderate to large impairments in executive domains like set-shifting and working memory during acute episodes, with these deficits showing partial reversibility upon remission, though residual subtleties may persist.^[101] In MDD specifically, cognitive remediation alongside antidepressant therapy aids recovery of these functions, underscoring their state-dependency.^[102] Anxiety amplifies these issues through heightened interference from worry, further taxing inhibitory control.^[103] Post-traumatic stress disorder (PTSD) involves executive dysfunction driven by trauma-induced hypervigilance, which impairs inhibitory control and attentional shifting, often resulting in persistent intrusive thoughts and avoidance behaviors.^[104] Studies from 2023 highlight decoupling between the hippocampus and prefrontal cortex, contributing to disorganized fear regulation and reduced cognitive flexibility in response to trauma cues.^[105] This neural disconnection exacerbates decision-making errors under stress, with inhibitory deficits correlating with hyperarousal symptoms across diverse trauma populations.^[106] Executive dysfunction is a prominent feature in Parkinson's disease (PD), often emerging in the early stages due to dopamine depletion in the basal ganglia, which disrupts frontostriatal circuits essential for cognitive control.^[107] This neurodegeneration leads to specific impairments such as bradyphrenia, characterized by slowed mental processing, and deficits in set-shifting, where individuals struggle to flexibly switch between tasks or rules.^[108] Approximately 40-60% of patients exhibit mild cognitive impairment involving executive functions within the first few years of diagnosis, as assessed by the cognitive subscale of the Unified Parkinson's Disease Rating Scale (UPDRS), which evaluates mentation and orientation.^[109] In traumatic brain injury (TBI) and stroke, executive dysfunction frequently manifests as dysexecutive syndrome, resulting from damage to frontal lobe regions critical for planning, inhibition, and decision-making.^[110] Frontal lesions disrupt these processes, leading to persistent challenges in initiating actions, organizing behavior, and adapting to novel situations, often compounded by secondary effects like apathy or impulsivity.^[111] Longitudinal data from 2024 studies indicate varied post-acute recovery trajectories, with moderate improvements in executive functions over the first 6-12 months for many patients, though severe cases show plateauing or incomplete restoration, influenced by injury severity and rehabilitation intensity.^[112] Alzheimer's disease (AD) and frontotemporal dementia (FTD) feature early executive function (EF) decline as a key harbinger of progression, with amyloid-beta plaques and tau tangles impairing prefrontal cortex networks that support working memory and cognitive flexibility.^[113] In AD, these pathological changes disrupt neural connectivity in frontoparietal regions, contributing to initial EF deficits that precede widespread memory loss.^[114] The Clock Drawing Test demonstrates high sensitivity for detecting these early EF impairments in AD, with detection rates around 80% in mild cases, outperforming general screening tools for isolating executive components.^[115] In FTD, particularly the behavioral variant, EF deficits arise from selective frontal and temporal atrophy, manifesting as profound early impairments in inhibition, planning, and social cognition, often without initial memory involvement.^[116] Distinguishing normal aging from pathological processes involves recognizing subtle EF changes in mild cognitive impairment (MCI), where vascular contributions exacerbate prefrontal vulnerabilities.^[117] In MCI, individuals may show mild deficits in task-switching or inhibitory control, linked to cerebrovascular factors like hypertension and atherosclerosis that reduce cerebral blood flow to executive networks.^[117] Recent 2025 research highlights how these vascular mechanisms, including white matter hyperintensities, contribute to 30-50% of MCI cases with EF involvement, bridging normal age-related slowing to dementia risk.^[118]

Treatment and Management

Pharmacological Approaches

Pharmacological approaches to executive dysfunction primarily target underlying neurochemical imbalances, such as dysregulation in dopamine, norepinephrine, and other neurotransmitter systems, to enhance cognitive processes like inhibition, working memory, and flexibility. These interventions are often condition-specific, with stimulants commonly used for attention-deficit/hyperactivity disorder (ADHD)-related impairments, while atypical antipsychotics address deficits in schizophrenia. Evidence from meta-analyses indicates moderate efficacy for select agents, though benefits vary by domain and individual factors, and long-term use requires careful monitoring due to potential side effects.^[119] Stimulants, including methylphenidate and amphetamines, are first-line treatments for executive dysfunction in ADHD, acting primarily through inhibition of dopamine and norepinephrine reuptake to bolster prefrontal cortex activity. Methylphenidate, for instance, has been shown to improve inhibitory control and working memory in children and adolescents with ADHD, with meta-analytic effect sizes ranging from 0.5 to 1.0 on tasks assessing response inhibition. Similarly, amphetamines like lisdexamfetamine enhance executive functions such as planning and set-shifting in youth with ADHD, supported by a 2024 systematic review and meta-analysis of randomized controlled trials demonstrating significant improvements over placebo. These agents are particularly effective for ADHD-related executive deficits but show limited generalization to other conditions.^[120]^[121]^[119] Atypical antipsychotics, such as risperidone, are employed for executive dysfunction in schizophrenia, where they exert partial agonism at dopamine D2 receptors to modulate prefrontal signaling and improve cognitive flexibility. Clinical trials indicate that risperidone enhances executive function domains like interpersonal perception and problem-solving in patients with schizophrenia, with improvements observed after 6-12 weeks of treatment compared to placebo. However, these benefits can be offset by side effects including sedation and extrapyramidal symptoms, which may exacerbate cognitive slowing and impair overall executive performance. Meta-analyses confirm modest cognitive gains with atypicals over typical antipsychotics, though effects on executive function specifically remain variable.^[122]^[123]^[124] Other agents offer targeted benefits for executive dysfunction in specific contexts, such as modafinil for apathy-related impairments in depression and traumatic brain injury (TBI). Modafinil, a wakefulness-promoting agent, indirectly enhances dopamine signaling and has demonstrated reductions in fatigue and improvements in aspects of executive function, like sustained attention, in patients with remitted major depressive disorder and chronic TBI, based on randomized trials showing cognitive gains after 4-12 weeks. Selective serotonin reuptake inhibitors (SSRIs) provide indirect executive function benefits in mood disorders by stabilizing affective symptoms, with second-generation antidepressants linked to moderate enhancements in cognitive flexibility and inhibition, as evidenced by a 2020 meta-analysis of treatment outcomes in major depression. Emerging research, including 2025 clinical trials, highlights guanfacine—an alpha-2A adrenergic agonist—as a promising nootropic for working memory deficits across ADHD, depression, and TBI, with case series and stratified trials reporting improved prefrontal network efficiency and executive performance when used adjunctively.^[125]^[126]^[127]^[128]^[129] Efficacy of these pharmacological approaches is monitored through dose-response assessments and regular evaluation of cognitive outcomes, as benefits often peak at optimal dosing while risks like tolerance emerge with chronic use. For stimulants, long-term administration in ADHD can lead to diminished efficacy over time due to neuroadaptations, necessitating periodic dose adjustments or breaks, per guidelines from systematic reviews. Across agents, monitoring includes tracking side effects—such as cardiovascular strain with stimulants or metabolic changes with antipsychotics—and using standardized executive function tests to quantify improvements, ensuring sustained therapeutic value without excessive risk.^[120]^[119]

Behavioral and Cognitive Interventions

Behavioral and cognitive interventions for executive dysfunction emphasize structured psychotherapeutic and training approaches aimed at enhancing core executive skills such as planning, inhibition, working memory, and self-monitoring through repeated practice, strategy development, and behavioral modification. These methods differ from pharmacological treatments by focusing on skill-building rather than symptom suppression, often yielding moderate improvements in targeted domains when delivered consistently over weeks to months. Evidence from randomized controlled trials and meta-analyses supports their efficacy, particularly in populations with neurodevelopmental or psychiatric conditions like ADHD and schizophrenia, though transfer to everyday functioning varies by intervention type and individual factors.^[130] Cognitive Behavioral Therapy (CBT) adapted for executive dysfunction typically incorporates modules on problem-solving, organization, and time management to address deficits in planning and initiation. In adults with ADHD, CBT targets executive impairments by teaching compensatory strategies, such as breaking tasks into steps and using external cues, leading to significant reductions in disorganization and procrastination. A 2023 meta-analysis of 12 randomized trials found moderate effect sizes (Hedges' g = 0.52 for core ADHD symptoms and g = 0.58 for executive-related outcomes like planning) favoring CBT over waitlist controls, with gains maintained at 6-month follow-up in approximately 70% of participants. These adaptations have shown particular promise in improving daily adaptive behaviors, though long-term adherence remains a challenge without booster sessions.^[131] Group rehabilitation programs leverage peer support to foster social aspects of executive function, such as perspective-taking and collaborative planning, which are often impaired in conditions like schizophrenia. These interventions, delivered in 8-12 weekly sessions, use role-playing and feedback to build skills in social cue interpretation and conflict resolution. For instance, social skills training groups have demonstrated moderate improvements in social cognition and functional outcomes in schizophrenia patients, with effect sizes around 0.45 for interpersonal competence post-treatment. In bipolar disorder, Interpersonal and Social Rhythm Therapy (IPSRT) integrated into group formats regulates daily routines to support executive stability and reduce mood-related disruptions to planning. Such programs enhance motivation through shared experiences, though benefits are strongest when combined with individual coaching.^[132]^[133] Computerized cognitive training programs, such as Cogmed, focus on working memory through adaptive exercises involving sequential recall and dual-task demands, typically administered 5 days per week for 5 weeks. In children with ADHD or learning difficulties, these tools improve near-transfer working memory capacity, with meta-analyses of randomized trials from 2018-2025 showing small-to-moderate effect sizes (g = 0.31-0.48) on trained tasks. However, effects on broader executive domains like inhibition are inconsistent without integrated metacognitive elements.^[134]^[135] Mindfulness and metacognitive techniques promote self-monitoring and impulse control by training awareness of cognitive processes, often through guided meditation and reflective journaling to interrupt automatic responses. These approaches enhance metacognitive accuracy—knowing one's own thinking limits—reducing impulsivity in ADHD populations. A 2024 study on mindfulness-based cognitive therapy in adults with ADHD found significant decreases in impulsivity scores (effect size d = 0.62) and improvements in self-reported executive control after 8 weeks, with neuroimaging evidence of strengthened prefrontal activation during inhibitory tasks. These methods are accessible and low-cost, fostering long-term self-regulation, though optimal outcomes require practice integration into routines.^[136]^[137]

Rehabilitation and Lifestyle Strategies

Compensatory strategies play a crucial role in managing executive dysfunction by providing external supports to bypass cognitive impairments, particularly in conditions like traumatic brain injury (TBI). These approaches include the use of planners, digital apps such as task management tools, and structured routines to enhance organization, planning, and initiation of activities. For instance, assistive technologies designed for executive function, including reminder apps and scheduling software, have been shown to support independence and reduce the need for human assistance in daily tasks for individuals with TBI. Evidence from systematic reviews indicates that compensatory cognitive strategies, when integrated into rehabilitation protocols, yield moderate improvements in functional outcomes, such as better problem-solving and goal attainment in everyday activities.^[138]^[139]^[140] Lifestyle interventions offer holistic support for executive functions through modifiable behaviors that promote brain health and neuroplasticity. Aerobic exercise, recommended at a minimum of 150 minutes per week, has been linked to enhancements in executive function domains like inhibition and cognitive flexibility, with meta-analyses showing small to moderate effect sizes in older adults and those with mild cognitive impairment. Diets rich in omega-3 polyunsaturated fatty acids, such as those from fish sources, support dopamine regulation and may improve executive performance, as evidenced by meta-analyses demonstrating benefits in middle-aged and elderly populations. Sleep hygiene practices, including consistent bedtimes and minimizing stimulants, mitigate the negative impacts of poor sleep on executive functions, with studies associating better sleep quality to reduced impairments in attention and decision-making.^[141]^[142]^[143] Occupational therapy employs task-specific training to address executive dysfunction, focusing on practical adaptations for real-world application. Techniques like errorless learning, where individuals practice skills with guided cues to minimize mistakes, facilitate initiation and reduce errors in complex tasks, leading to improved occupational performance in cognitive impairments. In Parkinson's disease, such interventions target perseveration and planning deficits, with cognitive rehabilitation programs showing gains in daily functioning and maintenance of skills over time. Outcomes include decreased reliance on prompts and enhanced ability to complete multi-step activities independently.^[144]^[145]^[146] Family and caregiver support programs emphasize education to foster accommodations that alleviate executive dysfunction and prevent secondary stress. Structured training initiatives equip caregivers with strategies to reinforce routines and environmental modifications, resulting in cognitive and functional benefits for care recipients, such as improved quality of life and reduced behavioral challenges. Evidence from randomized studies highlights that these programs enhance caregiver preparedness and lead to measurable gains in daily living skills for individuals with cognitive impairments.^[147]

Developmental and Lifespan Perspectives

In Children and Adolescents

Executive functions (EF) undergo progressive maturation from early childhood through adolescence, with distinct timelines for core components. Inhibitory control, which involves suppressing impulsive responses, shows substantial development by age 5, enabling children to better regulate attention and behavior in structured settings.^[148] In contrast, cognitive flexibility—the ability to shift perspectives or adapt to changing demands—advances more gradually, with notable improvements continuing into middle childhood and relative stabilization around age 12.^[149] Working memory and planning also expand significantly after age 5, supporting more complex task management, though delays in these trajectories, often seen in neurodevelopmental disorders, heighten vulnerability to persistent impairments across domains.^[148] In school-age children, executive dysfunction frequently contributes to academic challenges, such as difficulties with homework organization and completion, affecting an estimated 30-50% of those with ADHD through deficits in working memory and inhibition.^[150] These issues manifest as underachievement in reading and math, with longitudinal data linking early EF weaknesses to poorer standardized test scores and grade retention.^[151] Interventions leveraging play offer promising remediation; for instance, 2025 research demonstrates that brief unstructured playful activities enhance inhibitory control more effectively than structured physical exercises, fostering self-directed regulation in everyday contexts.^[152] Such approaches capitalize on the plasticity of developing brains to mitigate school-related risks. Adolescents face amplified challenges from executive dysfunction amid rapid neurodevelopmental shifts. Peer pressure intensifies impulsivity, as sensation-seeking surges during this period, often overriding prefrontal inhibitory mechanisms and increasing engagement in risky behaviors.^[153] Hormonal fluctuations associated with puberty further influence prefrontal cortex maturation, disrupting emotional regulation and decision-making processes that underpin flexible thinking.^[154] These dynamics heighten susceptibility to social and behavioral maladjustment, underscoring the need for targeted support during this transitional phase. Early screening for executive dysfunction in preschool settings is vital for identifying at-risk children and enabling timely interventions. Longitudinal studies reveal that preschool EF assessments predict later academic achievement and behavioral outcomes, with stronger early inhibitory and working memory skills correlating to reduced underachievement in elementary school.^[155] The ongoing Adolescent Brain Cognitive Development (ABCD) study, tracking cohorts from late childhood through 2025 and beyond, further illustrates how baseline EF measures forecast long-term trajectories in cognition and mental health.^[156]

In Adults and Older Populations

Executive dysfunction in adults often represents a persistence of impairments originating in youth, compounded by emerging life stressors. Longitudinal studies demonstrate that childhood deficits in executive functions, such as inhibition and working memory, continue to influence adult outcomes, including occupational performance and daily functioning, even in the absence of diagnosed neurodevelopmental disorders.^[157] In midlife, particularly during the 30s to 50s, occupational overload and chronic work demands can exacerbate these issues, leading to burnout characterized by emotional exhaustion and cognitive weariness that impairs planning, decision-making, and task initiation.^[158] Initial carryover vulnerabilities amplify the impact of these stressors.^[159] As individuals enter later adulthood post-60, normal aging contributes to a progressive decline in executive functions, with working memory and cognitive flexibility showing notable reductions that affect multitasking and problem-solving. Research indicates substantial age-related drops in these domains, with longitudinal data revealing consistent deterioration in performance on executive tasks from midlife onward. Vascular factors, including arterial stiffness and reduced cerebral blood flow, play a key role in this decline by compromising prefrontal cortex integrity, while chronic low-grade inflammation accelerates executive impairments. Recent 2024 cohort analyses from large-scale studies confirm that elevated inflammatory markers, such as C-reactive protein trajectories starting in early adulthood, predict poorer executive function and processing speed in midlife, independent of other health confounders.^[160]^[161] Midlife hormonal transitions further intensify executive vulnerabilities, as chronic stress elevates cortisol levels that disrupt prefrontal networks essential for inhibition and shifting. In women, perimenopause and menopause involve estrogen fluctuations that correlate with new-onset difficulties in verbal fluency and cognitive switching, often manifesting as subtle but pervasive executive lapses. Similarly, in men experiencing andropause, declining testosterone levels are linked to diminished executive performance, including slower response inhibition and reduced mental flexibility, as evidenced by cross-sectional and prospective data on aging cohorts. To mitigate these effects, building cognitive reserve through midlife engagement—such as intellectually demanding occupations or lifelong learning—has shown protective benefits, buffering against executive decline by enhancing neural efficiency and adaptability.^[162]^[163]^[164] In late life, strategies emphasizing lifelong cognitive engagement offer promise for preventing executive dysfunction from progressing to dementia-related impairments. The ACTIVE trial, a multicenter randomized controlled study initiated in 2002 and followed longitudinally, provides robust evidence that targeted training in reasoning and processing speed sustains executive abilities for up to 10 years, reducing the trajectory toward functional dependence in older adults. Such interventions, when integrated early, leverage accumulated cognitive reserve to counteract age-related vascular and inflammatory insults, promoting sustained independence.^[165]

Comorbidities and Differential Considerations

Common Co-occurring Impairments

Executive dysfunction frequently co-occurs with learning disabilities, particularly dyslexia and dyscalculia, where impairments in planning and organization overlap significantly with core deficits in these conditions. Studies highlight shared mechanisms such as working memory and attention dysfunctions that exacerbate planning deficits.^[166]^[167] Emotional dysregulation often accompanies executive dysfunction, with anxiety amplifying failures in behavioral inhibition and flexibility. Studies demonstrate bidirectional links, wherein executive function deficits contribute to heightened emotional reactivity and mood instability, while poor emotion regulation further impairs cognitive control processes like inhibitory control.^[168]^[169] Substance use disorders exhibit strong associations with executive dysfunction, often manifesting in self-medication cycles where individuals seek relief from cognitive and emotional strains. Recent research as of 2025 underscores that executive function deficits, particularly in cognitive flexibility, predict higher relapse rates following treatment, with impairments in decision-making and impulse control driving recurrent substance-seeking behaviors.^[170] Sleep disorders, including insomnia, commonly exacerbate all domains of executive function, leading to worsened working memory, attention, and inhibitory control. Polysomnography studies from 2025 reveal correlations between fragmented sleep architecture and executive impairments, where chronic sleep deprivation disrupts prefrontal cortex activity underlying these functions.^[171]^[172] Executive dysfunction is often differentiated from primary attention deficits, such as those seen in the inattentive presentation of attention-deficit/hyperactivity disorder (ADHD), by its broader scope encompassing not just difficulties in sustaining focus but also impairments in planning, foresight, and goal-directed behavior. For instance, individuals with pure inattention may struggle with maintaining attention on tasks without the additional challenges of organizing steps or anticipating consequences that characterize executive dysfunction. This distinction is crucial in clinical settings, as executive dysfunction involves higher-order cognitive processes beyond mere attentional lapses, often requiring targeted assessments of inhibitory control and working memory.^[1]^[173] In contrast to memory disorders like amnesia, which primarily impair the encoding, storage, or retrieval of past information, executive dysfunction affects the strategic utilization and prospective application of memory, particularly in prospective memory tasks where individuals must remember to perform intended actions in the future. Amnesic syndromes, such as those in early Alzheimer's disease, lead to deficits in recalling factual or episodic details, but patients can often compensate with preserved executive skills; however, executive dysfunction uniquely disrupts the initiation and monitoring required for prospective memory, leading to failures in time- or event-based intentions independent of basic recall issues. This differentiation highlights how executive impairments hinder the adaptive use of memory rather than its core storage mechanisms.^[174]^[175] Distinguishing executive dysfunction from apathy and depression involves recognizing that executive-specific initiation failures occur without the pervasive mood alterations or anhedonia central to depressive disorders, whereas apathy may overlap but can be parsed through targeted scales. Apathy, characterized by diminished motivation and goal pursuit, is frequently linked to executive deficits in conditions like Parkinson's disease or small vessel disease, yet it lacks the emotional distress and somatic symptoms of depression; for example, the Apathy Evaluation Scale (AES) quantifies behavioral, cognitive, and emotional apathy components to isolate these from depressive features, aiding in identifying pure executive initiation problems. In depression, executive impairments may co-occur but are secondary to affective symptoms, whereas isolated executive dysfunction manifests as task disengagement without global mood changes.^[176]^[177]^[178]^[179] Cultural and diagnostic pitfalls in identifying executive dysfunction arise from overlaps with normative behaviors in diverse contexts and variations between classification systems like DSM-5 and ICD-11. In collectivist cultures, such as those in East Asia, task approaches emphasizing group harmony may mask or mimic individualist-oriented executive deficits, leading to biased assessments on Western-normed tests that undervalue relational planning skills. For example, children from collectivist backgrounds might perform differently on cognitive flexibility tasks due to socialization practices prioritizing conformity over rapid shifting, necessitating culturally adapted evaluations to avoid misdiagnosis. Additionally, DSM-5 integrates executive function impairments within neurodevelopmental disorders like ADHD through symptom clusters, while ICD-11 emphasizes functional impairments with fewer rigid criteria, potentially broadening or narrowing recognition of executive issues across global settings. These nuances underscore the need for context-sensitive diagnostics to prevent over- or under-pathologizing based on cultural norms.^[180]^[181]^[182]^[183]

Societal and Cultural Dimensions

Impacts on Education and Employment

Executive dysfunction significantly impairs academic performance, leading to challenges such as difficulties in planning, organizing tasks, and sustaining attention, which contribute to higher rates of grade retention and school dropout. For instance, students with attention-deficit/hyperactivity disorder (ADHD), a condition often associated with executive dysfunction, exhibit dropout rates from high school that are approximately twice as high as those without the disorder, with 32.2% of students with combined-type ADHD dropping out compared to 15% of teens with no psychiatric disorder.^[184] These educational setbacks are exacerbated by comorbid conditions and the lack of early intervention, resulting in long-term academic underachievement.^[83] In employment settings, executive dysfunction creates barriers to maintaining productivity and job stability, often manifesting as difficulties with time management, task initiation, and adapting to workplace demands. Adults with ADHD report higher levels of underemployment and job instability due to these impairments, with symptoms correlating to reduced work performance and increased burnout.^[185] Recent analyses indicate that executive dysfunction contributes to notable productivity losses in affected workers, particularly in roles requiring sustained organization; however, flexible arrangements like remote work can mitigate these effects by allowing customized routines.^[186] Accommodations play a crucial role in supporting individuals with executive dysfunction in both educational and professional environments. Under the Individuals with Disabilities Education Act (IDEA) of 2004, Individualized Education Programs (IEPs) can include supports such as extended time on assignments, visual schedules, and organizational tools to address executive function deficits that impact learning.^[74] In workplaces, similar strategies like voice-to-text software and executive function coaching help overcome organizational hurdles, while vocational rehabilitation programs have demonstrated success in facilitating employment outcomes, such as job placement and retention for individuals with ADHD-related challenges.^[187]^[188] Despite these options, policy gaps persist, with executive dysfunction often underrecognized in educational systems, leading to inadequate screening and support. Recent initiatives, including the 2023 State of Neurodiversity report, highlight the need for better educator training and awareness to address these issues early, aiming to close disparities in student outcomes.^[167] Executive dysfunction is frequently stigmatized and misconstrued as laziness or lack of motivation, particularly in professional settings, which can perpetuate discrimination against individuals with conditions like ADHD or autism where such deficits are common. A 2023 survey of employees with ADHD revealed that 56% believed their condition contributed to workplace setbacks such as demotions, missed promotions, or reduced responsibilities, while 92% perceived widespread misconceptions among colleagues that ADHD symptoms reflect insufficient effort rather than neurological differences. This stigma often leads to increased micromanagement (reported by 75% of affected employees) and reluctance to disclose diagnoses, exacerbating isolation and barriers to support.^[189] Under U.S. law, executive dysfunction can qualify as a disability under the Americans with Disabilities Act (ADA) if it substantially limits major life activities such as learning, concentrating, or working, entitling individuals to reasonable accommodations in employment, education, and public services. For instance, employers may be required to provide tools like written checklists, flexible scheduling, or organized workspaces to address deficits in memory, prioritization, or multitasking, as outlined by the Job Accommodation Network. In forensic contexts, evidence of executive dysfunction has been used to argue for reduced culpability in criminal sentencing, recognizing its impact on impulse control and decision-making; developmental neuroscience on immature executive functions in young adults (ages 18-24) supports arguments for leniency, as these impairments parallel those in adolescents and influence moral responsibility.^[190]^[191]^[192] Ethically, the diagnosis and treatment of executive dysfunction in children raise concerns about overdiagnosis, particularly in ADHD where symptoms overlap with normative developmental variations, potentially leading to unnecessary labeling and medication. With millions of children diagnosed annually, critics argue that broad diagnostic criteria may pathologize behaviors influenced by environmental or cultural factors, resulting in overreliance on stimulants despite limited evidence of long-term benefits and risks like side effects or reduced autonomy. Equity issues further complicate access to interventions, as socioeconomic disparities, racial biases, and gender differences limit support for executive function development; for instance, students from low-income or minority backgrounds often lack explicit instruction in skills like planning, while girls with ADHD are underdiagnosed due to subtler presentations, denying them tailored accommodations. Cultural variations in executive function norms also pose ethical challenges, as Western assessments emphasizing cognitive flexibility may undervalue collectivist approaches in non-Western societies, leading to biased evaluations and inequitable global standards.^[193]^[194]^[195]^[180] The neurodiversity movement has emerged as a key social advocacy effort, reframing executive dysfunction not as a deficit to cure but as a natural variation requiring societal accommodations to foster inclusion. Advocates promote environmental adjustments, such as assistive technologies for time management, over normalization therapies, emphasizing the interaction between individual neurology and societal barriers. By 2025, initiatives like corporate neurodiversity hiring programs and educational fellowships have integrated executive function support into broader equity frameworks, highlighting strengths in divergent thinking while addressing challenges through policy and awareness campaigns. This paradigm shift challenges traditional medical models, advocating for research that incorporates neurodivergent voices to reduce stigma and promote public health integration.^[196]^[197]^[198]

References

[1]
Executive Dysfunction: What It Is, Symptoms & Treatment
Executive dysfunction is a symptom that happens with conditions that disrupt your brain's ability to control thoughts, emotions and behavior.
[2]
What Is Executive Dysfunction? Causes, Diagnosis, Treatment
Apr 13, 2018 · Executive dysfunction is a term for a range of cognitive and behavioral difficulties that can occur after injury to the frontal lobes of the brain.Examples · Symptoms · Causes · Diagnosis
[3]
Executive Function Disorders: Types, Symptoms, and Solutions
Jan 23, 2024 · Executive dysfunction is when you have problems with your executive function skills. It might be hard for you to plan, organize, strategize, pay attention to ...
[4]
Executive Dysfunction - PMC - PubMed Central - NIH
Executive dysfunction can also be the presenting cognitive deficit in vascular dementia, Lewy body diseases, and frontotemporal dementia, among other ...Working Memory · Table 4-1 · Table 4-2
[5]
The Role of Executive Dysfunction and Dysexecutive Behavior ... - NIH
The clinical expression of executive dysfunction includes disorganization, mental inflexibility, disinhibition, and poor problem-solving. Executive dysfunction ...
[6]
Neuropsychopharmacology and Neurogenetic Aspects of Executive ...
Executive dysfunction describes the inability to delay reward, modify behavior, match context and a lack of capacity for self control, an underestimation of ...
[7]
Higher Cortical Functions in Man - SpringerLink
In stock Free deliveryThis full-length translation of Professor Luria's book introduces to the English speaking world a major document in neuropsychology.
[8]
The Unity and Diversity of Executive Functions and Their ...
This individual differences study examined the separability of three often postulated executive functions—mental set shifting (“Shifting”), information updating ...
[9]
The unity and diversity of executive functions and their contributions ...
This individual differences study examined the separability of three often postulated executive functions-mental set shifting ("Shifting"), information ...Missing: PDF | Show results with:PDF
[10]
The role of PFC networks in cognitive control and executive function
Cognitive control, the coordination of mental processes and action in accordance with current goals and future plans, is a primary function of the prefrontal ...
[11]
computational models of the prefrontal cortex/basal ganglia system
The prefrontal cortex (PFC) has long been thought to serve as an 'executive' that controls the selection of actions and cognitive functions more generally.
[12]
The Neural and Genetic Basis of Executive Function - PubMed Central
In this review, we will examine the influence of dopamine, norepinephrine, serotonin, and acetylcholine on the following measures of executive function.
[13]
Differential Cognitive Actions of Norepinephrine α2 and α1 Receptor ...
The prefrontal cortex (PFC) supports a coordinated set of cognitive and behavioral processes that guide goal-directed behavior, particularly under distracting ...Ne And The Pfc · 3. Focused Attention... · Figure 2
[14]
Executive Functions - PMC - PubMed Central - NIH
Prefrontal cortex dysfunction and “jumping to conclusions”: bias or deficit? J. Neuropsychol. 2012;6:65–78. doi: 10.1111/j.1748-6653.2011.02005.x. [DOI] ...
[15]
Independence of Hot and Cold Executive Function Deficits in High ...
Feb 5, 2016 · ... executive dysfunction. For example, deficits in working memory were reported in a number of studies (e.g., Bennetto et al., 1996; Williams ...
[16]
Executive Dysfunction? Sign and Symptoms of EFD
### General Symptoms of Executive Dysfunction
[17]
10 Executive Dysfunction Signs: Is It Affecting You? | New Frontiers
Dec 14, 2023 · Academic: Distractibility during classes or study sessions. · Social: Losing track in conversations. · Career: Inability to focus in meetings or ...
[18]
brief®2 - Behavior Rating Inventory of Executive Function - PAR, Inc.
The BRIEF2 gives you the information you need to help children and adolescents with executive dysfunction. It digs deeper than similar measures.
[19]
Behavior Rating Inventory of Executive Function - Parent ...
Aug 31, 2022 · The BRIEF is a measure used to assess executive function in children and adolescents ages 5-18 through parent report.Discover Careers at Shirley... · Pediatric and Congenital... · Neurologic Conditions
[20]
The role of prefrontal cortex in cognitive control and executive function
Aug 18, 2021 · Concepts of cognitive control (CC) and executive function (EF) are defined in terms of their relationships with goal-directed behavior versus habits.
[21]
An Examination of Executive Dysfunction Associated with ... - NIH
The three nonmotor frontostriatal circuits, which connect frontal cortical regions to the basal ganglia, originate from the dorsolateral prefrontal cortex ( ...
[22]
Frontostriatal regulation of brain circuits contributes to flexible ...
Feb 14, 2025 · Frontostriatal circuit dysfunction leads to cognitive inflexibility in neuroligin-3 R451C knockin mice ... Executive dysfunction in Parkinson's ...
[23]
The roles of dopamine and noradrenaline in the pathophysiology ...
Jun 15, 2011 · dopamine and noradrenaline play important roles in high-level executive functions often reported to be impaired in attention-deficit/hyperactivity disorder ( ...
[24]
A Review of Executive Function Deficits and Pharmacological ...
One of the most consistently replicated cognitive deficits in individuals diagnosed with autism is executive dysfunction. Recent structural and functional ...<|control11|><|separator|>
[25]
Arousal dysregulation and executive dysfunction in attention deficit ...
Jan 16, 2024 · Anatomical and functional studies have found evidence of structural differences and altered activation of the prefrontal cortex, frontoparietal ...
[26]
The Roles of Dopamine and Noradrenaline in the Pathophysiology ...
Jun 15, 2011 · Dopamine and noradrenaline play important roles in high-level executive functions often reported to be impaired in attention-deficit/hyperactivity disorder ( ...
[27]
Hypofrontality in Attention Deficit Hyperactivity Disorder During ...
The neuropsychological deficits involve higher-order executive control functions, such as response inhibition (1) and motor timing (2). Experimental studies ...
[28]
Diffusion tensor imaging reveals white matter abnormalities in ... - NIH
Diffusion tensor imaging (DTI) was used to investigate WM in 12 adolescent males diagnosed with ADHD only and 12 typically developing controls.
[29]
Relationship between Inflammation and Oxidative Stress and ...
Feb 26, 2015 · Thus, the purpose of this study was to assess whether inflammation and oxidative damage are associated with low cognitive performance in the ...
[30]
Insights into Human Behavior from Lesions to the Prefrontal Cortex
... response tasks following lateral PFC lesions in primates centered in the sulcus principalis. ... executive dysfunction in patients with more focal PFC lesions.
[31]
Distinct manifestations of executive dysfunction in aged rats
As with set-shifting tasks, performance on working memory tasks is impaired after damage to primate dorsolateral or rodent medial PFC, and such lesions tend to ...
[32]
Individual Differences in Executive Functions Are Almost Entirely ...
(2001) found that children with ADHD, reading disorders, and both disorders combined showed different profiles of executive dysfunction, with the ADHD children ...Missing: distinction | Show results with:distinction
[33]
A longitudinal twin study on IQ, executive functioning, and attention ...
For IQ the heritability estimates increased from 30% at age 5, to 80% at age 12. For executive functioning performance genetic factors accounted for around 50% ...
[34]
COMT Val158Met Genotype and Individual Differences in Executive ...
We hypothesized that COMT Met allele homozygosity, which is associated with higher levels of prefrontal dopamine, would predict better executive function as ...
[35]
Polymorphisms in human dopamine D2 receptor gene affect ... - PNAS
... DRD2 splicing appears to affect working memory and attentional control at high task loads. These results are consistent with the known role of dopamine and ...Missing: executive | Show results with:executive
[36]
BDNF mediates improvements in executive function following a 1 ...
The present study examined BDNF as a mediator of the effects of a 1-year walking intervention on executive function in 90 older adults.
[37]
Polygenic risk for ADHD and ASD and their relation with cognitive ...
We aim to examine the genetic overlap between ADHD and ASD and cognitive measures of working memory (WM) and attention performance among schoolchildren using a ...
[38]
Genome-wide analyses of ADHD identify 27 risk loci ... - PubMed - NIH
We identified 27 genome-wide significant loci, highlighting 76 potential risk genes enriched among genes expressed particularly in early brain development.Missing: polygenic overlap
[39]
An emerging role for epigenetic factors in relation to executive function
Nov 20, 2017 · Epigenetics encompasses factors that influence expression of the genome, but which do not involve changes to the underlying DNA sequence.
[40]
TBI Data | Traumatic Brain Injury & Concussion - CDC
Oct 29, 2024 · There were approximately 214,110 TBI-related hospitalizations in 2020A and 69,473 TBI-related deaths in 2021. · This represents more than 586 TBI ...Facts About TBI · Publications · Comparing Head Impacts
[41]
Facts About TBI | Traumatic Brain Injury & Concussion - CDC
Aug 4, 2025 · There were over 69,000 TBI-related deaths in the United States in 2021.1 That's about 190 TBI-related deaths every day. TBIs affect the lives of ...What It Is · Populations · Tbis May Be Missed In Older...
[42]
Diffuse Axonal Injury - StatPearls - NCBI Bookshelf - NIH
Jul 7, 2025 · DAI affects numerous functional areas of the brain. Widespread disconnection of cortical and subcortical networks depresses consciousness. ...
[43]
Cognitive Sequelae of Diffuse Axonal Injury - JAMA Network
Memory and executive dysfunctions were most frequent, the former reaching a moderate to severe degree in half of the patients. In comparison, deficits of ...
[44]
Executive (dys)function after traumatic brain injury - PubMed Central
In this review, we have identified major changes in executive function following TBI, namely impulsivity, behavioral flexibility, and working memory.
[45]
Relationship of childhood abuse and household dysfunction to ...
We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors.
[46]
Linking the hemodynamic consequences of adverse childhood ...
A shift towards HPA axis hypoactivity occurs in response to ACEs exposure and is proposed to contribute towards altered cortisol secretion, chronic low-grade ...Missing: primary prefrontal hypofunction
[47]
Childhood Trauma, the HPA Axis and Psychiatric Illnesses
Using the Adverse Childhood Experiences (ACE) study, Felliti et al. designed ... prefrontal cortex in medication-naive individuals with major depressive disorder.Missing: source | Show results with:source
[48]
(PDF) The Impact of Adverse Childhood Experiences on Cognitive ...
Oct 16, 2024 · This systematic review and meta-analysis evaluated the overall impact of ACEs on each of these cognitive control domains and explored moderating ...
[49]
The impact of drugs of abuse on executive function - PubMed Central
Addiction has long been characterized by diminished executive function, control, and impulsivity management. In particular, these deficits often manifest ...
[50]
Associations of executive function and age of first use of ... - Frontiers
Oct 12, 2022 · Long-term use of MA is associated with mental disorders, executive dysfunction, aggressive behaviors, and impulsivity among patients with MUD.
[51]
Is Cognitive Functioning Impaired in Methamphetamine Users? A ...
Nov 16, 2011 · The prevailing view is that recreational methamphetamine use causes a broad range of severe cognitive deficits, despite the fact that ...<|separator|>
[52]
Corticostriatal circuit models of cognitive impairments induced ... - NIH
We propose three non-mutually exclusive circuit models of corticostriatal dysfunctions to account for some of the FAE-induced cognitive deficits.
[53]
The Fetal Alcohol Spectrum Disorders—An Overview of ... - MDPI
Alcohol exposure causes dysfunction of the midbrain dopaminergic neurons, especially those located in the ventral tegmental area, which might account for ...
[54]
Vulnerability in Executive Functions to Sleep Deprivation Is ...
Archival Report. Vulnerability in Executive Functions to Sleep Deprivation Is Predicted by Subclinical Attention-Deficit/Hyperactivity Disorder Symptoms.
[55]
One night of sleep deprivation impairs executive function but does ...
The present study showed that one night of sleep deprivation resulted in executive function deterioration but did not modify motor control or maximal effort.
[56]
Neurodevelopmental, cognitive, behavioural and mental health ...
Eight of these studies (three from BNS) found impaired intelligence/executive function in those exposed to malnutrition in childhood compared with controls.
[57]
Impact of Early Childhood Malnutrition on Adult Brain Function
Prenatally malnourished rats also show a significant impairment in executive function and attentional tasks (McGaughy et al., 2014; Newman et al., 2019).
[58]
Neurocognitive trajectories in long COVID - ScienceDirect.com
While cognitive impairment occurring after COVID-19 improved over time in most domains, processing speed and executive functioning remained below the normal ...
[59]
Neurocognitive Impairment in Long COVID: A Systematic Review
Jun 8, 2024 · Executive function, memory, attention, and processing speed appear to be the cognitive domains that are predominantly associated with long-COVID syndrome.
[60]
The most frequently used tests for assessing executive functions in ...
Executive dysfunction in aging can be measured objectively with neuropsychological tests. There are several executive functions tests available, which ...
[61]
Clock drawing: A neuropsychological analysis. - APA PsycNet
This book provides normative data on clock drawing from ages 20 to 90 yrs. A practical guide to the quantitative assessment of clock drawing.
[62]
Clock Drawing Test (CDT) – Strokengine - Stroke Engine
The CDT is used to quickly assess visuospatial and praxis abilities, and may determine the presence of both attention and executive dysfunctions.
[63]
Assessment of executive functions: Review of instruments and ...
Within the third unit, the prefrontal cortex is considered by Luria as a superstructure that regulates or control mental activity and behavior. Damage to the ...
[64]
Limitations of the trail making test part-B in assessing frontal ...
Feb 20, 2015 · Our findings suggest that the TMT-B is a robust test for detection of brain dysfunction. However, its capacity for detecting frontal executive dysfunction ...
[65]
The Reliability of the Wisconsin Card Sorting Test in Clinical Practice
The linear combination of number of categories and perseverative errors approximates the Executive Function Composite as described in the M-WCST manual ( ...Abstract · Method · Results
[66]
Assessing Executive Function in Adolescence: A Scoping Review of ...
Feb 28, 2019 · Such findings mirror the observation that “complex executive tasks tend to suffer from relatively low internal and/or test–retest reliability” ( ...Missing: 0.6-0.8 | Show results with:0.6-0.8
[67]
Psychometric properties of the Barkley Deficits in Executive ... - NIH
The Barkley Deficits in Executive Functioning Scale (BDEFS; Barkley, 2011) is an 89 item self-report measure of executive functioning. Its scores provide a ...
[68]
The Relationship Between Executive Function Deficits and DSM-5 ...
Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive ...
[69]
The Structured Clinical Interview for DSM-5 - APA
The Structured Clinical Interview for DSM-5 (SCID-5) is a semistructured interview guide for making the major DSM-5 diagnoses.SET of SCID-5-CV and SCID-5... · SET of SCID-5-PD and SCID-5...
[70]
Executive functioning rating scales: Ecologically valid or construct ...
Executive function tests showed significantly higher cross-method predictive validity and significantly better within-method prediction.
[71]
Ecological Assessment of Executive Dysfunction in the Psychosis ...
This study evaluates behavioral manifestations of EF deficits, assessed by the Behavioral Rating Inventory of Executive Functioning (BRIEF), and their clinical ...
[72]
https://pmc.ncbi.nlm.nih.gov/articles/PMC7483691/
[73]
Systematic Review of Neuroimaging Correlates of Executive ...
Functional neuroimaging methods (fMRI and PET/SPECT) tended to employ single tests of EF whereas structural methods (MRI, DTI) included multiple tests. Neural ...Missing: hypofrontality | Show results with:hypofrontality
[74]
Measuring executive dysfunction in an acute rehabilitation setting
Our results indicate that the DEX can be used with some confidence as a screening instrument to identify executive dysfunction in an acute rehabilitation ...
[75]
Dysexecutive Questionnaire
The Dysexecutive Questionnaire (DEX; Wilson et al., 1997) screens for changes in observable everyday manifestations of executive dysfunction after an ...
[76]
FMRI ACTIVATION DURING EXECUTIVE FUNCTION PREDICTS ...
Several studies have implicated executive dysfunction in LLD, and several fMRI studies have demonstrated that prefrontal regions subserve executive dysfunction ...Missing: hypofrontality | Show results with:hypofrontality
[77]
Executive dysfunction in schizophrenia: Predictors of the ...
This study aimed to investigate what characterizes individuals with schizophrenia who experience more or less subjective executive dysfunction in everyday life
[78]
Executive Functions in Social Context - PubMed Central
Variations in executive functioning predict concurrent success in schooling, relationships, and behavior, as well as important life outcomes years later.
[79]
Longitudinal relations between impaired executive function and ...
Apr 27, 2022 · Longitudinal relations between depressive symptoms and executive functions from adolescence to early adulthood: A twin study. Clinical ...
[80]
Guidelines for Assessment and Intervention with Persons with ...
The Guidelines for Assessment and Intervention with Persons with Disabilities were adopted by the APA Council of Representatives in February 2022 and replace ...Missing: executive | Show results with:executive
[81]
Executive Function in Children with Attention Deficit/Hyperactivity ...
It is possible that children with ADHD and no comorbid learning or behavioral disorder may be better at compensating for working memory weaknesses when it comes ...
[82]
ADHD, Multimodal Treatment, and Longitudinal Outcome - NIH
Attention-deficit hyperactivity disorder (ADHD) is a highly impairing neurodevelopmental disorder that originates in childhood. This condition is newsworthy on ...
[83]
Executive Function Deficits in High‐Functioning Autistic Individuals ...
The relationship of executive function and theory of mind deficits to each other, and their primacy to autism, are discussed.<|control11|><|separator|>
[84]
Do ASD and ADHD Have Distinct Executive Function Deficits? A ...
Aug 11, 2023 · Therefore, the primary aim of this systematic review and meta-analysis is to evaluate the differences in EF deficits in ADHD and ASD in studies ...
[85]
Executive function in children with Tourette syndrome and attention ...
We found little evidence for executive function impairments inherent to TS. Executive function problems appear to manifest predominantly in relation to ADHD ...
[86]
Tourette syndrome research highlights from 2024 - PMC
Jun 19, 2025 · We summarize research reports from 2024 relevant to Tourette syndrome, which the authors consider the most important or interesting.Missing: autonomic | Show results with:autonomic
[87]
Executive functioning and neurodevelopmental disorders in early ...
Oct 22, 2019 · Executive functioning and ADHD traits ... Towards a cognitive phenotype for autism: increased prevalence of executive dysfunction and superior ...
[88]
Effects of Cognitive Training Programs on Executive Function in ...
Most of the interventions identified were effective in enhancing EFs and reducing symptoms in children and young people with ASD.
[89]
Executive Dysfunctions in Schizophrenia: A Critical Review ... - MDPI
This paper aims to characterize executive dysfunction in schizophrenia by comparing ecological and virtual reality assessments with traditional tools.1. Introduction · 5. Assessment With... · 9. Challenges And Future...
[90]
Prevalence and correlates of cognitive impairment in schizophrenia
Nov 17, 2022 · While working memory, verbal fluency, verbal learning and memory, and executive functioning ... Although cognitive dysfunction in schizophrenia ...
[91]
[PDF] relationship between cognitive functioning and symptom domains ...
Dec 12, 2024 · findings that studied prefrontal cognitive dysfunction with WCST and PANSS ... Probing prefrontal function in schizophrenia with neuropsy-.
[92]
Cognitive impairment in schizophrenia: aetiology, pathophysiology ...
Jan 23, 2023 · Executive dysfunction in schizophrenia: predictors of the discrepancy between subjective and objective measures. Schizophr Res Cogn. 2021;26 ...
[93]
Cognitive Function Across Manic or Hypomanic, Depressed, and ...
CONCLUSIONS: A poorer performance was observed in all bipolar groups regarding executive function and verbal memory in relation to the healthy comparison ...
[94]
Correlates of Real World Executive Dysfunction in Bipolar I Disorder
Individuals in this study reported significant impairment in every domain of executive functioning. As hypothesized, severity of mood symptoms robustly ...
[95]
Lithium bidirectionally regulates depression- and mania-related ...
Lithium alone improved cognitive performance during depressive and manic episodes; other tested treatments have no such effect or worsened cognitive ability.
[96]
Lithium-induced neuroprotection in bipolar disorder - PubMed Central
Oct 9, 2025 · Several studies have suggested that lithium can control bipolar psychosis via BD which is often associated with manic episodes and psychotic ...
[97]
The characteristics of anhedonia in depression: a review ... - Nature
Mar 21, 2025 · Deficits in cognitive function as a contributory factor to the psychosocial disabilities in MDD may throughout the whole course of the disease ...Missing: reversible | Show results with:reversible
[98]
Systematic review and meta-analysis of executive function following ...
Sep 16, 2025 · CONCLUSIONS. The executive dysfunction observed in auditory working memory, set-shifting, inhibition, planning, fluency and intellectual ...
[99]
Systematic review and meta-analysis of executive function following ...
Sep 16, 2025 · Methods: We aimed to systematically evaluate how executive function following MDD remission compares to normal function, specify the pattern and ...Missing: anxiety anhedonia 2020-2025
[100]
Deficits in specific executive functions manifest by severity in major ...
Oct 2, 2023 · Cognitive deficits, including executive dysfunction, often persist during remission and may contribute to the recurrence and prolongation of MDD ...Missing: reversible | Show results with:reversible
[101]
Executive Function and PTSD: Disengaging from Trauma - PMC - NIH
... studies investigating executive function associated with PTSD ... Such inhibitory dysfunction may specifically relate to reexperiencing and hyperarousal symptoms.
[102]
Altered Resting-State functional connectivity in the anterior and ...
The case for hippocampal dysfunction in PTSD. Hippocampal-related abnormalities are linked to some PTSD symptoms, such as intrusive trauma memories, impaired ...
[103]
The neural circuits and molecular mechanisms underlying fear ...
Decreased hippocampal volume and executive function have also been reported in women with PTSD during declarative memory tasks as measured by magnetic ...
[104]
Executive dysfunction in Parkinson's disease and timing deficits
Dopaminergic therapy does not reliably improve executive dysfunction in high-functioning (Pascual-Sedano et al., 2008) or moderate PD patients (Morrison et al., ...Missing: 40-60% | Show results with:40-60%<|separator|>
[105]
Executive dysfunction in Parkinson's disease: a review - PubMed
Executive dysfunction can be present from the early stages of Parkinson's disease (PD). It is characterized by deficits in internal control of attention.Missing: bradyphrenia UPDRS subscale prevalence 40-60%
[106]
Cognitive Impairment in Parkinson's Disease: An Updated Overview ...
It has been proposed that the executive dysfunction associated with PD is potentially related to a hyperdopaminergic state in the prefrontal cortex of pwPD, ...<|separator|>
[107]
Executive dysfunction following traumatic brain injury - PubMed - NIH
Executive dysfunction is among the most common and disabling aspects of cognitive impairment following traumatic brain injury (TBI), and may include ...Missing: stroke acute trajectories 2024 longitudinal data
[108]
Executive Function Poststroke: Concepts, Recovery, and Interventions
Dec 21, 2022 · Comparison of two cognitive interventions for adults experiencing executive dysfunction post-stroke: a pilot study. Disabil Rehabil. 2017;39 ...
[109]
Profiles of executive functioning following traumatic brain injury and ...
Jan 18, 2024 · Neurobehavioral abnormalities associated with executive dysfunction after traumatic brain injury. ... stroke and other acquired brain injuries ...
[110]
Executive dysfunction in early Alzheimer's disease - PubMed
Executive dysfunction may be an early additional feature in a subgroup of patients with mild Alzheimer's disease. Impairment on frontal lobe tests does not ...Missing: dementia EF decline amyloid tau prefrontal networks Clock Drawing sensitivity 80%
[111]
Executive Functions in Alzheimer's Disease: A Systematic Review
The aim of this study is to take a global view of executive functions and place the concept within the theoretical framework of Alzheimer's disease dementia.
[112]
The value of clock drawing in identifying executive cognitive ... - NIH
An abnormal clock drawing may suggest executive cognitive dysfunction and should prompt further testing or referral. The clock-drawing test is not designed ...
[113]
Executive dysfunction in frontotemporal dementia and corticobasal ...
Feb 3, 2009 · Patients with FTD and patients with CBS often have deficits in executive function, a term that encompasses complex cognitive functions ...Missing: early | Show results with:early
[114]
Vascular Contributions to Cognitive Impairment and Dementia in the ...
Aug 18, 2025 · In the ARIC study, cerebrovascular disease was the primary or contributing cause in 32% of MCI cases and 46% of dementia cases. PREVALENCE AND ...
[115]
The future of biomarkers for vascular contributions to cognitive ...
Jun 21, 2025 · Advances in biomarkers and pathophysiology of vascular contributions to cognitive impairment and dementia (VCID) are expected to bring greater mechanistic ...
[116]
Systematic Review and Meta-Analysis: Effects of Pharmacological ...
May 29, 2024 · Overall, we conducted 3 meta-analyses, one for each type of medication: amphetamines (lisdexamfetamine and triple-bead mixed amphetamine salts; ...
[117]
Methylphenidate for children and adolescents with attention deficit ...
Mar 27, 2023 · Methylphenidate is a stimulant that helps to increase activity in parts of the brain, such as those involved with concentration. ...Missing: amphetamines executive function
[118]
Effects of methylphenidate on executive functioning in children and ...
Mar 28, 2021 · Methylphenidate may improve executive functioning in children with attention-deficit/hyperactivity disorder (ADHD).<|separator|>
[119]
Risperidone improves interpersonal perception and executive ...
Individuals with schizophrenia have impairments in social cognitive and executive function, which might be improved by risperidone.
[120]
Antipsychotics-induced improvement of cool executive function in ...
Apr 26, 2023 · Our current study explored the change of brain network under the cool executive tasks in individuals living with schizophrenia before and after atypical ...
[121]
Cognitive effects of atypical antipsychotic drugs in first-episode drug ...
These results suggest that the atypical antipsychotics, olanzapine, risperidone and aripiprazole may improve specific cognitive domains with similar global ...
[122]
Modafinil: A Review and Its Potential Use in the Treatment of Long ...
Jun 28, 2022 · Modafinil administration has resulted in cognitive improvement in patients with attention-deficit hyperactivity disorder, major depression, and ...
[123]
Pharmacological targeting of cognitive impairment in depression
Nov 17, 2022 · In patients who have recovered from depression, modafinil was shown to improve episodic memory but not executive functioning after one week in ...
[124]
THE EFFECT OF SECOND-GENERATION ANTIDEPRESSANT ...
Treatment with antidepressant drugs was associated with a moderate improvement in the EFs of set shifting, cognitive flexibility, fluency, and inhibition.
[125]
A novel multimodal pharmacologic approach using guanfacine, N ...
Oct 23, 2025 · ... functioning (30). Clinically, guanfacine leads to improvement in both executive function and working memory (31). In a study by McAllister et al ...
[126]
A stratified precision medicine trial targeting α 2A - Nature
Oct 13, 2025 · Even among treatment responders, residual cognitive dysfunction remains common and can be severely debilitating. In this study, we focus on ...
[127]
A randomized clinical trial of Cogmed Working Memory Training in ...
CWMT Active participants demonstrated significantly greater improvements in verbal and nonverbal working memory storage, but evidenced no discernible gains.Missing: 2018-2025 | Show results with:2018-2025
[128]
Effectiveness of cognitive behavioural‐based interventions for adults ...
Feb 16, 2023 · This meta-analysis indicates that CBT for adults with ADHD was effective in reducing both core and emotional symptoms. Decreases in depression ...Data Synthesis And... · Study And Patient... · Therapeutic Efficacy
[129]
Recent Advances in Social Skills Training for Schizophrenia - PMC
Social skills training consists of learning activities utilizing behavioral techniques that enable persons with schizophrenia and other disabling mental ...
[130]
Randomised controlled trial of Interpersonal and Social Rhythm ...
Feb 14, 2022 · To compare the effectiveness of a 12-month intervention involving IPSRT combined with group-based CR (IPSRT-CR), with IPSRT alone, on cognitive ...
[131]
Cogmed cognitive training for working memory: a systematic review ...
Aug 16, 2025 · The meta-analysis revealed that participants in the Cogmed group showed significant improvements in verbal and visuospatial WM scores ...
[132]
The Effectiveness of Working Memory Training for Children With ...
Dec 1, 2020 · Long-term academic functioning following Cogmed Working Memory Training for children born extremely preterm: a randomized controlled trial.
[133]
The Effects of Mindfulness-based Cognitive Therapy on Executive ...
Aug 21, 2025 · This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) in reducing impulsivity and improving executive functions ...Missing: dysfunction | Show results with:dysfunction
[134]
The Relationship Between Mindfulness and Impulsivity: The Role of ...
May 9, 2024 · The aim of this research was to investigate the relationship between impulsivity and mindfulness, taking into account the impact of mindfulness meditation ...Missing: dysfunction | Show results with:dysfunction
[135]
Evaluation of the Effectiveness of Assistive Technology for Executive ...
Aug 29, 2023 · Executive dysfunction necessitates the use of compensatory cognitive strategies and, in more severe cases, human support over time. To ...
[136]
Assistive technologies designed to support executive function ...
Aug 1, 2024 · Assistive technologies for cognition (ATC) can help alleviate some of the impacts of executive dysfunction and support independence.
[137]
Effectiveness of Interventions to Address Cognitive Impairments and ...
Apr 1, 2016 · The third systematic review concluded that the evidence for compensatory, restorative, and adaptive approaches to executive dysfunction was ...
[138]
Identifying exercise and cognitive intervention parameters to ...
Aug 30, 2024 · Overall, our meta-analyses support the role of physical exercise in enhancing executive function in older adults with MCI or dementia. It is ...
[139]
The influence of n-3 polyunsaturated fatty acids on cognitive function ...
Mar 12, 2024 · Conclusions: Supplementation of n-3 PUFA may confer potential benefits to executive function among the middle-aged and elderly demographic, ...
[140]
Poor Sleep Hygiene is Associated with Decreased Discrimination ...
Reduced sleep quality impairs learning, memory formation, attention, and executive function ability. Poor sleep quality or sleep hygiene has been shown to ...
[141]
[PDF] Errorless Learning - OccupationalTherapy.com
Dec 21, 2015 · ▷ Errorless learning and structured teaching strategies can improve occupational performance outcomes for individuals with cognitive.
[142]
Cognitive Rehabilitation for Executive Dysfunction in Parkinson's ...
Sep 13, 2011 · Cognitive rehabilitation, a behavioral approach to improve cognitive skills, has potential as a treatment option to improve and maintain cognitive skills.Missing: errorless | Show results with:errorless
[143]
[PDF] Parkinson's disease cognitive rehabilitation for executive
The goal of PD-CoRE is to teach compensa- tory skills that address daily struggles secondary to executive dysfunction and to break the cycle of cognitive ...<|control11|><|separator|>
[144]
Caregiver training: Evidence of its effectiveness for cognitive and ...
Mar 24, 2022 · A caregiver training programme based on cognitive stimulation produces cognitive, functional and health‐related quality‐of‐life benefits in older adults.
[145]
Executive Functions after Age 5: Changes and Correlates - PMC
Much of the development of EF, especially working memory, shifting, and planning, occurs after age 5.
[146]
A Developmental Perspective on Executive Function - PMC
This review paper examines theoretical and methodological issues in the construction of a developmental perspective on executive function (EF) in childhood ...Missing: historical | Show results with:historical
[147]
ADHD, Executive Function - ADDA-SR.org
Researchers report, that 30-50 percent of children with ADHD also experience these deficits. Practically speaking, problems with the “brain's CEO” contribute to ...Missing: underachievement | Show results with:underachievement
[148]
Academic and Educational Outcomes of Children With ADHD
Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention.
[149]
Short playful interactions improve executive functions in children
Jul 2, 2025 · This study examined the effect of a short playful interaction compared to a physical control activity on children's EF performance and mood.
[150]
Adolescent Risk Taking, Impulsivity, and Brain Development - NIH
One form of impulsivity, sensation seeking, rises dramatically during adolescence and increases risks to healthy development.Missing: dysfunction | Show results with:dysfunction
[151]
The Adolescent Brain - PMC - PubMed Central - NIH
This general pattern, of improved cognitive control and emotion regulation with maturation of the prefrontal cortex, suggests a linear increase in development ...Missing: dysfunction pressure
[152]
The Longitudinal Contributions of Preschool Executive Functions ...
We found that preschool EFs and math abilities each were uniquely predictive of children's accuracy on arithmetic problems in first grade, with cascading ...Missing: screening | Show results with:screening
[153]
Longitudinal analysis of the ABCD® study - ScienceDirect.com
This review provides an examination of key concepts and techniques related to longitudinal analyses of the ABCD Study data.
[154]
Childhood Executive Function Continues to Predict Outcomes ... - NIH
The present study, along with our previous work, reveals that lower EF scores in childhood are predictive of a range of negative outcomes in adolescence and ...Method · Wisc-Iii Digit Span... · Results
[155]
Occupational Burnout Is Linked with Inefficient Executive ... - NIH
Dec 16, 2022 · Burnout is linked with compromised EFs along with alterations in cardiac physiology and PA in daily life. Such alterations may be easily detected with wearable ...Missing: midlife | Show results with:midlife
[156]
Midlife perceived stress is associated with cognitive decline across ...
Mar 4, 2023 · The present study examined the association of midlife perceived stress with cognitive decline from young adulthood to late midlife.Missing: burnout | Show results with:burnout
[157]
Association of Changes in C-Reactive Protein Level Trajectories ...
Jul 3, 2024 · Consistently higher or moderate/increasing inflammation starting in early adulthood may lead to worse midlife executive function and processing speed.
[158]
Peripheral vascular dysfunction and the aging brain - PubMed Central
Robust evidence indicates that CVD are a strong determinant for reduced brain health and all-cause dementia with advancing age.
[159]
New onset executive function difficulties at menopause
Jun 11, 2015 · Reports of cognitive decline, particularly in the domains of executive functions (EFs), are common among menopausal women.Missing: andropause | Show results with:andropause
[160]
Testosterone, cognitive decline and dementia in ageing men - PMC
Abstract. As men grow older, circulating testosterone concentrations decline, while prevalence of cognitive impairment and dementia increase.
[161]
Midlife occupational cognitive requirements protect ... - Frontiers
Midlife occupational cognitive requirements protect cognitive function in old age by increasing cognitive reserve.
[162]
Ten-Year Effects of the ACTIVE Cognitive Training Trial on ... - NIH
Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.
[163]
Executive Dysfunctions in Different Learning Disabilities: A Review
Aug 23, 2023 · Executive dysfunction, common among neurodivergent students, involves impairments in planning, organization, task initiation, and time ...Missing: occurrence | Show results with:occurrence
[164]
Supporting K-12 Learners: The Importance of Executive Functioning ...
Apr 18, 2023 · 20% of learners have a diagnosed learning difference · Nearly 45% of learners have executive dysfunction.<|separator|>
[165]
Executive Dysfunction and Anxiety in Adolescent Females with ADHD
By highlighting the ways in which anxiety may intersect with executive dysfunction, the study aims to contribute to a more comprehensive, culturally sensitive ...Missing: tracking | Show results with:tracking
[166]
The Effect of Emotion Regulation on Executive Function - PMC - NIH
Emotion regulation and executive function are associated: adaptive regulatory strategies are linked to better executive functioning while maladaptive strategies ...
[167]
https://learnfully.com/state-of-neurodiversity-2023-report/
[168]
Association of executive function, craving and precipitants of relapse ...
Conclusion: There is a close association of craving, and relapse with deficits of EF, in AUD. Craving and relapse in AUD may be the result of deficits in EF.
[169]
Cognitive function, sleep characteristics and their relationship ... - NIH
Aug 19, 2025 · Cognitive function and polysomnography sleep were worse in older adults with insomnia and anxiety. ... dysfunction, and the decline of cognitive ...
[170]
Executive dysfunction, negative pre-sleep cognitions, and ... - NIH
Jun 19, 2024 · These impairments are associated with prefrontal cortex dysfunction, which can result from chronic sleep deprivation [5]. A recent study [6] ...
[171]
Executive Functioning in Subtypes of Attention Deficit Hyperactivity ...
According to neuropsychological theories, ADHD is postulated to arise from a deficit in executive functioning because it is the main characteristic of the ...
[172]
Dysexecutive versus amnesic phenotypes of very mild Alzheimer's ...
To investigate whether some patients with very mild Alzheimer's disease (AD) demonstrate disproportionate executive dysfunction relative to amnesia and how this ...
[173]
Prospective Memory Impairment and Executive Dysfunction in ... - NIH
The assumption that a PM impairment results from dysfunction of the prospective and/or retrospective component predicts that a patient with poor performance on ...
[174]
Apathy, but not depression, is associated with executive dysfunction ...
May 11, 2017 · Apathy is a common feature of SVD and is associated with impaired executive functioning/processing speed suggesting the two may share biological mechanisms.
[175]
The neurobiology of apathy in depression and neurocognitive ...
Dec 26, 2022 · Apathy is a common feature of depression and cognitive disorders and is associated with impairment in executive function.
[176]
The Apathy Evaluation Scale (AES-C): Psychometric Properties and ...
Sep 12, 2021 · The Apathy Evaluation Scale is a validated tool composed of 18 items that assess and quantify emotional, behavioural and cognitive aspects of apathy.
[177]
Distinguishing apathy from depression: A review differentiating ... - NIH
Distinguishing apathy from depression: A review differentiating ... Executive dysfunction and apathy predict functional impairment in Alzheimer disease.
[178]
Cultural variation in cognitive flexibility reveals diversity in the ...
Nov 5, 2018 · A number of potential explanations for cultural variation in executive functioning have been proposed, including experiences in children's home ...
[179]
Principles for Adapting Assessments of Executive Function across ...
Some cultural preferences are likely to affect performance across a range of tasks. All tasks involve the assumption that children will be motivated to comply ...
[180]
The cultural construction of “executive function” - PMC
Yet, almost all results described as measuring EF may actually reflect culturally specific cognitive capacities.Missing: diagnosis | Show results with:diagnosis
[181]
Differences between DSM-5-TR and ICD-11 revisions of attention ...
May 19, 2023 · Three major differences between DSM-5-TR and ICD-11 are: (1) The number of diagnostic criteria for inattention, hyperactivity (HY) and impulsivity (IM) ...Missing: executive nuances
[182]
ADHD and Long-Term Outcomes - CHADD
Educational Outcomes 32.2% of students with the combined type of ADHD drop out of high school, compared to 15% of teens with no psychiatric disorder (Breslau ...
[183]
ADHD symptoms, diagnostic status, and work-related functioning
Feb 2, 2021 · This study emphasizes the susceptibility of individuals' functioning at work to ADHD symptoms and impairments associated with ADHD.Missing: productivity | Show results with:productivity
[184]
Mental Health Challenges In The Workplace Demand Action
May 1, 2025 · Executive dysfunction is one of the most common workplace hurdles reported by individuals with conditions such as anxiety, depression ...
[185]
Classroom accommodations for executive function challenges
Post schedules, directions, class rules, and expectations; make sure the student sees them. · Have a daily routine that changes as little as possible. · Provide ...
[186]
Strengths and challenges to embrace attention-deficit/hyperactivity ...
Nov 8, 2024 · Our results demonstrate that workers with ADHD can adapt and thrive in employment with the right person-environment fit, and accommodations and support.
[187]
[PDF] Executive Function: Implications for Education
Intervention for Executive Dysfunction. ... The Potential for School-Based Interventions That Target. Executive Function to Improve Academic Achievement:A Review.
[188]
ADHD in The Workplace - Akili Interactive
The survey covered the impact of impairment, disclosure to employers, experiences of stigma, manager misconceptions, treatment options, and more. The research ...Missing: discrimination | Show results with:discrimination
[189]
Executive Function Deficits, Higher Level Employees, and ...
A Brief Look at Accommodation Ideas for Executive Functioning Deficits · Permit flexible scheduling, which may include longer or more frequent work breaks ...
[190]
Guide to Disability Rights Laws - ADA.gov
The ADA prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, ...
[191]
Neuroscience and Sentencing: Diminished culpability and capacity ...
Dec 14, 2009 · As a result, the defense argued, Dugan is less culpable for his criminal behavior, and his disorder should be considered a mitigating factor.<|separator|>
[192]
Ethical Concerns Raised by Neuroscience, Labeling, and ...
The ethics of ADHD. Considering ethical questions that arise when an individual is labeled ADHD is important because five million children (most of whom are ...
[193]
(PDF) Attention deficit hyperactivity disorder: Legal and ethical aspects
Aug 6, 2025 · It is characterized by executive dysfunction leading to excessive ... overdiagnosis and overtreatment of millions of children.
[194]
Executive Function, Equity, and Intersectionality - ResearchILD
Mar 13, 2024 · Executive function strategies are essential for academic and personal success, yet disparities exist in access to the support needed to develop ...Missing: interventions | Show results with:interventions
[195]
The Neurodiversity Approach(es): What Are They and What Do They ...
Under the medical model, neurodivergent individuals are described using stigmatizing terms: “deficit,” “disorder,” “restricted,” and so forth. One of the key ...
[196]
Why Companies Need a Neuro-inclusive Approach for 2025
Jan 8, 2025 · By incorporating executive function resources into the workplace, organizations can create environments where everyone can thrive.
[197]
https://www.rethinkcare.com/resources/future-of-work-neuro-inclusive-approach-2025/