A Clinician's Guide to Neurodivergence; Supporting a Neuro-Affirmative Form of Practice by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9781040402825
Publisher: Taylor & Francis Group
Published: 2025-09-02T00:00:00+00:00

Heterogeneity associated with executive function

As we have learned, executive function disorder is not a diagnosis in or of itself, but rather it can be considered a symptom that occurs with conditions that disrupt the brain’s ability to control thoughts, emotions, and behaviour. However, many conditions can impact a person’s executive functions, and the profile may present differently depending on the condition that the person is experiencing.

Executive functioning deficits are common in mental health conditions such as depression, anxiety, bipolar disorder [1] and schizophrenia [2]. Specific domains of initiation, difficulties maintaining a goal, and cognitive inflexibility have been identified.

Many people with neurodevelopmental differences, such as autism, and Attention Deficit Hyperactivity Disorder (ADHD), also have differences in their thinking and learning, which may make some aspects of executive function easier and others harder. In autism, the domains of planning and flexibility have been found to be particularly difficult [3], whereas in ADHD the difficulties are often complex and combined with distractibility and working memory alterations [4].

Finally, people who have sustained an acquired brain injury, specifically those affecting the prefrontal cortex (PFC, the front part of the frontal lobe; see Chapter 4 on acquired brain injury for more detail) may find that their executive functions are impacted upon.

An individual’s executive functioning skill may also vary dependent on context. For example, an individual might be able to get started 94(initiate) and focus for long periods on an activity that interests them (hyper-focus). However, if they find a task boring, or they are fatigued, they may find it more difficult to both get started and to pay or sustain attention. Executive functions can also change based on the environment that the individual is in. For example, if an individual is in a loud, busy environment it might be more difficult for them to manage their emotions, impulses, and/or attention (e.g. if a child’s attention was captured by something that excited them, they may impulsively run away from their caregiver towards the item of interest without considering risk or other factors).

Further complicating the picture is a group of individuals with damage to their PFC, some of whom have been found to present as skilful within clinical interviews and to perform typically on traditional office-based assessments whilst simultaneously demonstrating limitations within the domain of adaptive functioning. Such impairments to skills of everyday life may include problems with decision-making, multitasking, and goal setting, and these may be masked by preserved language and communication skills and/or lack of insight. This is referred to as the Frontal Lobe Paradox [5] or the ‘knowing–doing dissociation’ [6]. For further information please see [7] and [8] for an overview and clinical considerations.

In summary, although executive dysfunction is not a formal diagnosis in and of itself, it is important that any deficits within this domain are assessed and included in an individual’s executive functioning profile and formulation, as these functions are implicated in, and therefore can be impactful upon, a broad range of skills.

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