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.