Hi, I'm Dr. Tracey Marks, a psychiatrist and I make mental health education videos. Today, I'm talking about
executive functioning. What it is and what it looks like when it's not working optimally. This is part one in a
series of videos talking about managing ADHD
symptoms without medication. ADHD can be thought of as a disorder of executive functioning, so understanding this
is an important lead-in to making behavioral changes. Executive function is a set of
cognitive or thinking skills that are responsible for the following, planning, organization and prioritizing, initiating actions, self-inhibition, self-monitoring your behavior, being able to shift your
attention between tasks and working memory. That's a lot of stuff,
so let's break it down. First, planning organizing
and prioritizing. This involves any planning
on a global level, it's not just planning a party. It's the ability to anticipate
how long things will take or how much effort things will require or thinking through multiple steps to see something that you wanna do all the way through to the end. Problems in this area can
look like being unprepared for something even though
you had adequate time or resources to do it. You may have trouble
managing your time properly because you can't look at
various pieces of information and easily tell what's
the most important thing to pay attention to, so instead you may spend
your time frittering away at something that doesn't matter much while leaving the most
important thing incomplete. Next, initiating actions. This involves taking action
to get started with something. Anyone can put things off
that they don't wanna do but trouble with initiation is at the root of procrastinating. It's like there's a block
to being able to just do it. So if you have trouble in this area, you may need lots of pressure and prodding to get things done. So let's say you have a
big project to complete and that project is
gonna take a lot of work and a lot of planning. The person without trouble
initiating will be motivated to get it out of the way so that they don't have
to think about it anymore. The person who has trouble with initiation, doesn't use
the same kind of reasoning, they don't factor in the stress
that it will cause having to do things at the last
minute with not enough time. They can just still sit
there and be immobilized and unable to start the
project and put it off until the last minute. Self-inhibition. This can be thought of as impulse control. It's the ability to hold
back from automatic responses because you're able to anticipate what impact your action will have. Trouble in this area can
look like interrupting people or even making quick
decisions or snap judgements. Self-monitoring. This skill is the ability
to look at your behavior and measure your progress
against what others expect of you or what's needed of you. If you have trouble in this area, you may tend to have no
idea of what you're doing and how it impacts others. You may have trouble
accepting feedback from people because you don't see what the problem is. You don't see that you're consistently turning things in late or being late has a negative impact. In fact, you may forget
that you're always late and it's not that you don't
remember that you were late, you don't remember that you
have a pattern of being late or a pattern of being unreliable. Ability to shift between tasks. Some people refer to this
skill as cognitive flexibility. This is a skill that involves
being able to shift attention from one thing to another and also involves being able
to respond and adapt to change. If you have trouble in this area, you may be considered to
be rigid in your thinking and you may be unable to
deal with any kind of change from the way you think things should be or from what you were told. Or you could have serious
trouble multitasking. The last skill is working memory and this is the ability to
keep things top of mind, to be able to retrieve and process recently learned information. And this skill is important for problem-solving and decision-making, because with those mental processes you need to be able to
take the information that's in front of you
and manipulate it in a way that helps you make a
decision or solve a problem. So if you have trouble in this area, you can have trouble with problem-solving and analytical thinking. Also if you have
inadequate working memory, you could have trouble making
appropriate adjustments to your behavior because you're not taking into
consideration factors that should affect your current decisions. For example, going back to the example of always being late, inadequate
working memory plays a role in your inability to remember your pattern of always being late. It's like yesterday is forgotten and everyday is just a new day. The control for your
executive functions is located in the front part of your brain that includes the frontal lobes and other structures such
as the basal ganglia, which are further down from the lobes. Executive function is also controlled by your prefrontal cortex and this matters because that's where the stimulant
medications work. There's many conditions that could impair your executive functioning and some of these are depression and a traumatic brain injury. A traumatic brain injury occurs when you have an injury to your head that disrupts your brain tissue. Alcohol can also temporarily impair your executive functioning and if you have a stroke that occurs in the frontal part of your brain, you can have trouble with
some of these functions. I mentioned earlier that ADHD
causes a lot of impairments in executive functioning. The stimulant medications, like Ritalin and Adderall,
work to increase dopamine in the prefrontal cortex but even with medication,
many people are still left with difficulties managing
some of these functions and cognitive-behavior
therapy focuses on managing some of these executive skills. I'll talk in another
video on tips to manage some of the executive
dysfunction that comes with ADHD but first, I wanted you
to understand the nature of the problems that
is the executive skills and how the dysfunction
falls into certain domains. Stay tuned, see you next time.
