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  • Print publication year: 2007
  • Online publication date: August 2009

14 - Managing dysexecutive disorders


Executive function (EF) is a term used to refer to self-regulatory behaviors necessary to select and sustain actions and guide behavior within the context of goals or rules. In essence, EF involves developing and implementing an approach to performing a task that is not habitually performed (Mahone et al., 2002a). Initiation, planning, organization, shifting of thought or attention, inhibition of inappropriate thought or behavior, and efficiently sustained and sequenced behavior are all crucial elements of EF. As such, EF should be viewed as a multidimensional construct, comprised of sub-components that are separable from the specific cognitive (i.e. linguistic, visuospatial) domains in which they are assessed (Harris et al., 1995).

Recently, an influential model argued that inhibitory control is the core (and developmentally fundamental) component of EF (Barkley, 2000). Other researchers, however, have proposed that inhibitory control develops in parallel with other more “intentional” skills including response preparation and working memory (Rapport et al., 2001). The term “intention” is used in behavioral neurology to refer to four component processes: initiation, sustaining, inhibition, and shifting (Heilman, Watson & Valenstein, 1993). Whereas attention is considered to precede sensory detection/perception, intention is thought to occur between sensation/perception and action, and involves a state of preparedness to respond (Denckla, 1996a). Intention and working memory may be subsumed under the construct of executive function. Both are fundamental in the development of functional competence in children, and in mediating the severity of presentation of a variety of learning problems.

Anderson, V., Godber, T., Smithbert, E. & Eckert, H. (1997). Neurobehavioral sequelae following cranial irradiation and chemotherapy in children: An analysis of risk factors. Pediatric Rehabilitation, 1, 63–76.
Barkley, R. A. (2000). Genetics of childhood disorders: XVII. ADHD, Part 1: The executive functions and ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1064–8.
Barnett, R., Maruff, P., Vance, al. (2001). Abnormal executive function in attention deficit hyperactivity disorder: The effect of stimulant medication and age on spatial working memory. Psychological Medicine, 31, 1107–15.
Beebe, D. W., Ris, D. W. & Dietrich, K. N. (2000). The relationship between CVLT-C process scores and measures of executive functioning: Lack of support among community-dwelling adolescents. Journal of Clinical and Experimental Neuropsychology, 22, 779–92.
Beebe, D. W., Wells, C. T., Jeffries, al. (2004). Neuropsychological effects of pediatric obstructive sleep apnea. Journal of the International Neuropsychological Society, 10, 962–75.
Beers, S. R., Skold, A., Dixon, C. E. & Adelson, D. (2005). Neurobehavioral effects of amantadine after pediatric traumatic brain injury: A preliminary report. Journal of Head Trauma Rehabilitation, 20, 450–63.
Bernstein, J. H. (1996). Issues in the psycho-educational management of children treated for malignant disease. Ontario, Toronto, Canada: POGO News.
Bernstein, J. H. (2000). Developmental neuropsychological assessment. In Yeates, K. O., Ris, M. D. & Taylor, H. G., eds., Pediatric neuropsychology: Research, theory, and practice. New York: Guilford Publications, pp. 405–38.
Bernstein, J. & Waber, D. (1990). Developmental neuropsychological assessment: The systemic approach. In Boulton, A., Baker, G. & Hiscock, M., eds., Neuromethods: Neuropsychology. Clifton, New Jersey: Humana Press, pp. 311–71.
Brocki, K. C. & Bohlin, G. (2004). Executive functions in children aged 6 to 13: A dimensional and developmental study. Developmental Neuropsychology, 26, 571–93.
Burmeister, R., Hannay, H. J., Copeland, al. (2005). Attention problems and executive functions in children with spina bifida and hydrocephalus. Child Neuropsychology, 11, 265–83.
Butler, R. W. & Copeland, D. R. (2002). Attentional processes and their remediation in children treated for cancer: A literature review and the development of a therapeutic approach. Journal of the International Neuropsychological Society, 8, 115–24.
Canfield, R. L., Gendle, M. H. & Cory-Slechta, D. A. (2004). Impaired neuropsychological functioning in lead-exposed children. Developmental Neuropsychology, 26, 513–40.
Castellanos, F. X., Sonuga-Barke, E. J., Milham, M. P. & Tannock, R. (2006). Characterizing cognition in ADHD: Beyond executive functions. Trends in Cognitive Sciences, 10, 117–123.
Chronis, A. M., Fabiano, G. A., Gnagy, E. al. (2001). Comprehensive, sustained behavioral and pharmacological treatment for ADHD: A case study. Cognitive and Behavioral Practice, 8, 346–59.
Chronis, A. M., Jones, H. A. & Raggi, V. L. (2006). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clinical Psychology Review, 26, 486–502.
Cicerone, K. D., Dahlberg, C., Malec, J. al. (2005). Evidence-based cognitive rehabilitation; updated review of the literature from 1998 through 2002. Archives of Physical Medicine and Rehabilitation, 86, 1681–92.
Crowley, J. A. & Miles, M. A. (1991). Cognitive remediation in pediatric head injury: A case study. Journal of Pediatric Psychology, 16, 611–27.
Cummings, D. D., Singer, H. S., Krieger, M., Miller, T. L. & Mahone, E. M. (2002). Neuropsychiatric effects of guanfacine in children with mild Tourette syndrome: A pilot study. Clinical Neuropharmacology, 25, 325–32.
Dawson, P. & Guare, R. (2004). Executive skills in children and adolescents: A practical guide to assessment and intervention. New York: The Guildford Press.
Delis, D. C., Kaplan, E. & Kramer, J. H. (2001). Delis-Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation.
Denckla, M. B. (1996 a). Biological correlates of learning and attention: What is relevant to learning disability and attention-deficit hyperactivity disorder?Developmental and Behavioral Pediatrics, 17, 114–19.
Denckla, M. B. (1996 b). Research on executive function in a neurodevelopmental context: Application of clinical measures. Developmental Neuropsychology, 12, 5–15.
Dennis, M., Barnes, M. A., Donnelly, R. W., Wilkinson, M. & Humphreys, R. P. (1996). Appraising and managing knowledge: Metacognitive skills after childhood head injury. Developmental Neuropsychology, 12, 77–103.
Dodrill, C. (1997). Myths of neuropsychology. The Clinical Neuropsychologist, 11, 1–17.
Dodrill, C. (1999). Myths of neuropsychology: Further considerations. The Clinical Neuropsychologist, 13, 562–72.
Durston, S. (2003). A review of the biological bases of ADHD: What have we learned from imaging studies?Mental Retardation and Developmental Disabilities Research Reviews, 9, 184–95.
Espy, K. A. (2004). Using developmental, cognitive, and neuroscience approaches to understand executive control in young children. Developmental Neuropsychology, 26, 379–84.
Espy, K. A., Kaufmann, P. M., Glisky, M. L. & McDiarmid, M. D. (2001). New procedures to assess executive functions in preschool children. The Clinical Neuropsychologist, 15, 46–58.
Espy, K. A., Stalets, M. M., McDiarmid, al. (2002). Executive functions in preschool children born preterm: Application of cognitive neuroscience paradigms. Child Neuropsychology, 8, 83–92.
Evans, D. W., Lewis, M. D. & Iobst, E. (2004). The role of the orbitofrontal cortex in normally developing compulsive-like behaviors and obsessive-compulsive disorder. Brain and Cognition, 55, 220–34.
Ewing-Cobbs, L., Prasad, M. R., Landry, S. H., Kramer, L. & DeLeon, R. (2004). Executive functions following traumatic brain injury in young children: A preliminary analysis. Developmental Neuropsychology, 26, 487–512.
Feeney, T. J. & Ylvisaker, M. (2003). Context-sensitive behavioral supports for young children with TBI: Short-term effects and long-term outcome. Journal of Head Trauma Rehabilitation, 18, 33–51.
Gassio, R., Artuch, R., Vilaseca, M. al. (2005). Cognitive functions in classic phenylketonuria and mild hyperphenylalaninaemia: Experience in a paediatric population. Developmental Medicine and Child Neurology, 47, 443–8.
Griffith, E. M., Pennington, B. F., Wehner, E. A. & Rogers, S. J. (1999). Executive functions in young children with autism. Child Development, 70, 817–32.
Gioia, G. A., Isquith, P. K., Guy, S. C. & Kenworthy, L. (2000). Behavior rating inventory of executive function. Odessa, FL: Psychological Assessment Resources.
Goldberg, M. C., Mostofsky, S. H., Cutting, L. al. (2005). Subtle executive impairment in children with autism and in children with ADHD. Journal of Autism and Developmental Disorders, 35, 279–93.
Gureasko-Moore, S., DuPaul, G. J. & White, G. P. (2006). The effects of self-management in general education classrooms on organizational skills of adolescents with ADHD. Behavior Modification, 30, 159–83.
Habboushe, D. F., Daniel-Crotty, S., Karustis, J. al. (2001). A family–school program for children with attention-deficit/hyperactivity disorder. Cognitive and Behavioral Practice, 8, 123–36.
Harris, E. L., Singer, H. S., Reader, M. al. (1995). Executive function in children with Tourette syndrome and/or attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society, 1, 511–16.
Heilman, K. M., Voeller, K. K. S. & Nadeau, S. E. (1991). A possible pathophysiologic substrate of attention deficit hyperactivity disorder. Journal of Child Neurology, 6 (Suppl.), S76–S81.
Heilman, K. M., Watson, R. T. & Valenstein, E. (1993). Neglect and related disorders. In Heilman, K. M. & Valenstein, E., eds., Clinical neuropsychology, 3rd edn. New York: Oxford University Press, pp. 279–36.
Heilman, K. M. (1994, January). Praxis. Paper presented at the NIH Conference on Attention, Memory, and Executive Function. Bethesda, Maryland.
Holmbeck, G. N., Greenley, R. N. & Franks, E. A. (2003). Developmental issues and considerations in research and practice. In Kazdin, A. & Weisz, J., eds., Evidence-based psychotherapies for children and adolescents. New York: Guilford Press, pp. 21–40.
Holmes, J. M. (1987). Natural histories in learning disabilities: Neuropsychological difference/environmental demand. In Ceci, S. J., ed., Handbook of cognitive, social and neuropsychological aspects of learning disabilities. Hillsdale, NJ: Lawrence Erlbaum Associates, pp. 303–19.
Jung, R. E., Yeo, R. A., Chiulli, S. J., Sibbitt, W. L. & Brooks, W. M. (2000). Myths of neuropsychology: Intelligence, neurometabolism, and cognitive ability. The Clinical Neuropsychologist, 14, 535–45.
Klingberg, T., Fernell, E., Olesen, P. al. (2005). Computerized training of working memory in children with ADHD: A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 177–86.
Klingberg, T., Forssberg, H. & Westerberg, H. (2002). Training of working memory in children with ADHD. Journal of Clinical and Experimental Neuropsychology, 24, 781–91.
Konrad, K., Gauggel, S., Manz, A. & School, M. (2000). Lack of inhibition: A motivational deficit in children with attention deficit/hyperactivity disorder and children with traumatic brain injury. Child Neuropsychology, 6, 286–96.
Krause, K. H., Dresel, S. H., Krause, J., Kung, H. F. & Tatsch, K. (2000). Increased striatal dopamine transporter in adult patients with attention deficit hyperactivity disorder: Effects of methylphenidate as measured by single photon emission computed tomography. Neuroscience Letters, 285, 107–10.
Lichter, J. B. & Cummings, J. L. (2001). Introduction and overview. In Lichter, D. G. & Cummings, J. L., eds., Frontal-subcortical circuits in psychiatric and neurological disorders. New York: Guilford Press, pp. 1–43.
Mahone, E. M., Koth, C. W., Cutting, L., Singer, H. S. & Denckla, M. B. (2001). Executive function in fluency and recall measures among children with Tourette Syndrome and ADHD. Journal of the International Neuropsychological Society, 7, 102–11.
Mahone, E. M., Cirino, P. T., Cutting, L. al. (2002 a). Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette Syndrome. Archives of Clinical Neuropsychology, 17, 643–62.
Mahone, E. M., Hagelthorn, K. M., Cutting, L. al. (2002 b). Effects of IQ on executive function measures in children with ADHD. Child Neuropsychology, 8, 41–51.
Mahone, E. M., Pillion, J. P., Hoffman, J., Hiemenz, J. R. & Denckla, M. B. (2005). Construct validity of the auditory continuous performance test for preschoolers. Developmental Neuropsychology, 27, 11–33.
Mahone, E. M. & Slomine, B. S. (in press). Neurodevelopmental disorders. In Morgan, J. & Ricker, J., eds., Textbook of Clinical Neuropsychology. The Netherlands: Psychology Press.
Mahone, E. M. & Zabel, T. A. (2001). Challenges to executive function. Insights into Spina Bifida, 7, 1A–8A.
Mahone, E. M., Zabel, T. A., Levey, E., Verda, M. & Kinsman, S. (2002). Parent and self-report of executive function in adolescents with myelomeningocele and hydrocephalus. Child Neuropsychology, 8, 258–70.
Marlowe, W. B. (2000). An intervention for children with disorders of executive functions. Developmental Neuropsychology, 18, 445–54.
Martinussen, R., Hayden, J., Hogg-Johnson, S. & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 377–84.
Mash, E. J. (1998). Treatment of child and family disturbance: A behavioral-systems perspective. In Mash, E. J. & Barkley, R. A., eds., Treatment of childhood disorders. New York: Guilford Press, pp. 3–51.
Mateer, C. A., Kerns, K. A. & Eso, K. L. (1996). Management of attention and memory disorders following traumatic brain injury. Journal of Learning Disabilities, 29, 618–32.
McEvoy, R. E., Rogers, S. J. & Pennington, B. F. (1993). Executive function and social communication in young autistic children. Journal of Child Psychology and Psychiatry, 34, 563–78.
MTA Cooperative Group (1999). A 14-month randomized clinical trail of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–86.
Michel, J., Kerns, K. & Mateer, C. (2005). The effect of reinforcement variables on inhibition in children with ADHD. Child Neuropsychology, 11, 295–302.
Mostofsky, S. H., Newschaffer, C. J. & Denckla, M. B. (2003). Overflow movements predict impaired response inhibition in children with ADHD. Perceptual and Motor Skills, 97, 1315–31.
Nyden, A., Hjelmquist, E. & Gillberg, C. (2000). Autism spectrum and attention-deficit disorders in girls. Some neuropsychological aspects. European Journal of Child and Adolescent Psychiatry, 9, 180–5.
O'Connell, M. E., Mateer, C. A. & Kerns, K. A. (2003). Prosthetic systems for addressing problems with initiation: Guidelines for selection, training, and measuring efficacy. NeuroRehabilitation, 18, 9–20.
O'Driscoll, G. A., Depatie, L., Holahan, A. al. (2005). Executive functions and methylphenidate response in subtypes of attention-deficit/hyperactivity disorder. Biological Psychology, 57, 1452–60.
Ozonoff, S. & Jensen, J. (1999). Brief report: Specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders, 29, 171–7.
Pelham, W. E., Gnagy, E. M., Greiner, A. al. (2000). Behavioral versus behavioral and pharmacological treatment in ADHD children attending a summer treatment program. Journal of Abnormal Child Psychology, 28, 507–25.
Pelham, W. E., Fabiano, G. A., Gnagy, E. M., Greiner, A. R. & Hoza, B. (2004). Intensive treatment: Summer treatment program for children with ADHD. In Hibbs, E. D. & Jensen, P. S., eds., Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice, 2nd edn. Washington, DC: American Psychological Association Press, pp. 311–40.
Rapport, M. D., Chung, K. M., Shore, G. & Isaacs, P. (2001). A conceptual model of child psychopathology: Implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child Psychology, 30, 48–58.
Reiter, A., Tucha, O. & Lange, K. W. (2005). Executive functions in children with dyslexia. Dyslexia, 11, 116–31.
Riva, D., Avanzini, G., Franceschetti, al. (2005). Unilateral frontal lobe epilepsy affects executive functions in children. Neurological Science, 26, 263–70.
Royall, D. R., Lauterbach, E. C., Cummings, J. al. (2002). Executive control function: A review of its promise and challenges for clinical research. Journal of Neuropsychiatry and Clinical Neurosciences, 14, 377–405.
Rudel, R. G. (1981). Residual effects of childhood reading disabilities. Bulletin of the Orton Society, 31, 89–102.
Russell, E. W. (2001). Toward an explanation of Dodrill's observation: High neuropsychological test performance does not accompany high IQs. The Clinical Neuropsychologist, 15, 423–8.
Slomine, B. S., Salorio, C. F., Grados, M. al. (2005). Differences in attention, executive functioning, and memory in children with and without ADHD after severe traumatic brain injury. Journal of the International Neuropsychological Society, 11, 645–53.
Slusarek, M., Velling, S., Bunk, D. & Eggers, C. (2001). Motivational effects on inhbitiory control in children with ADHD. Journal of the American Academy of Child and Adolscent Psychiatry, 40, 355–63.
Snyder, M. C. & Bambara, L. M. (1997). Teaching secondary students with learning disabilities to self-manage classroom survival skills. Journal of Learning Disabilities, 30, 534–43.
Suzman, K. B., Morris, R. D., Morris, M. K. & Milan, M. A. (1997). Cognitive-behavioral remediation of problem solving deficits in children with acquired brain injury. Journal of Behavioral Therapy and Experimental Psychiatry, 28, 203–12.
Thompson, P. M., Sowell, E. R., Gogtay, al. (2005). Structural MRI and brain development. International Review of Neurobiology, 67, 285–323.
Turner, G. R. & Levine, B. (2004). Disorders of executive functioning and self-awareness. In Ponsford, J., ed., Cognitive and behavioral rehabilitation: From neurobiology to clinical practice. New York: The Guilford Press, pp. 224–68.
Vance, A. L., Maruff, P. & Barnett, R. (2003). Attention deficit hyperactivity disorder, combined type: Better executive function performance with longer-term psychostimulant medication. Australian and New Zealand Journal of Psychiatry, 37, 570–6.
Vygotsky, L. S. (1962). Thought and language. In Hanfmann, E. & Vakar, G. (Eds. & Trans.), Cambridge, MA: MIT Press. (Original work published 1934).
Weber, P. & Lutschg, J. (2002). Methylphenidate treatment. Pediatric Neurology, 26, 261–6.
Willcutt, E. G., Pennington, B. F., Olson, R. K., Chhabildas, N. & Hulslander, J. (2005). Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: In search of the common deficit. Developmental Neuropsychology, 27, 35–78.
Wilson, B. A., Emslie, H. C., Quirk, K. & Evans, J. J. (2001). Reducing everyday memory and planning problems by means of a paging system: A randomized control crossover study. Journal of Neurology, Neurosurgery, and Psychiatry, 70, 477–82.
Wodka, E. L., Mahone, E. M., Blankner, J. al. (2007). Evidence that response inhibition is a primary deficit in ADHD. Journal of Clinical and Experimental Neuropsychology. Published online December 19, 2006. DOI: 10.1080/13803390600678056.
Wodka, E. L., Mostofsky, S. H., Prahme, M. al. (2007). Discriminant value of executive function measures in children with ADHD. Abstract. Journal of the International Neuropsychological Society, 12(S1), 40.
Yerys, B., White, D. A., Salorio, C. al. (2003). Memory strategy training in children with cerebral infarcts related to sickle cell disease. Journal of Pediatric Hematology/Oncology, 25, 495–8.
Ylvisaker, M. Szekeres, S. F. & Haarbauer-Krupa, J. (1998). Cognitive rehabilitation: Organization, memory and language. In Ylvisaker, M., ed., Traumatic brain injury rehabilitation: Children and adolescents, 2nd edn. Boston, MA: Butterworth-Heinimann, pp. 159–79.
Ylvisaker, M., Adelson, D., Braga, L. al. (2005). Rehabilitation and ongoing support after pediatric TBI: Twenty years of progress. Journal of Head Trauma Rehabilitation, 20, 95–109.
Zabel, T. A., Kirk, J. K., Mahone, E. al. (2004). The use of electronic devices to cue self-catheterization for adolescents with spina bifida. Abstract. Cerebrospinal Fluid Research, 1 (Suppl 1), S57.
Zelazo, P. D., Muller, U., Frye, al. (2003). The development of executive function in early childhood. Monographs of the Society for Research in Child Development, 68(3), vii–137.