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.