Monday, August 25, 2014

Executive Function Deficit: Why Brains Make Bad Decisions

Executive Function Deficit (or EFD) is probably a brain dysfunction few have heard about. I confess I didn't either until encountering the article 'The EFD Gap"  in the August, 2014 Mensa Bulletin (pp. 22-25). According to author, Lisa Van Gemert:

"Executive function deficit is more than just being easily distracted by shiny thoughts of leaving random person items around like Ellery Queen. EF includes the ability to stop yourself from thinking or behaving in way undesired by you (and often the people around you), planning, organization of time and materials, and much more. In short, executive function is what allows people to problem solve in order to achieve a goal, including effectively making the myriad decisions involved in successful management of day to life."

One such decision entails a place to live so that often, say when we see or hear people wail that they've "lived in a 620 sq; foot dump the past 12 years" we wonder whether their EF decisions were sound.  Did they save money - say by eating at home instead of going out or getting take out - or just blow it? Did they keep a bank savings account or CD or another vehicle to save?   Did they look for best interest rates even in a down environment (thanks to the Fed)? Or just blow money on every kind of item, including DVDs, new cars etc.?  This is what executive decision making is all about: assigning goal priorities in a manner which achieves your most desired long term goals while forgoing the short term gratifications, desires.

According to Muriel Lezak, an emeritus professor of neuropsychology quoted in the article:

"The executive functions consist of those capacities that enable a person to successfully engage in independent, purposive, self-serving behavior."

She also argues that EF differ from general cognition, noting:

"Questions about executive functions ask how and whether a person goes about doing something e.g. Will you do it? And if so, how? Questions about cognitive functions are generally phrased in terms of what or how much, i.e. how much do you know?"

The author, Gelmert, does admit that "if there is a fad in neuropsychology, EF is it. Yet it would be a mistake to dismiss its impact because of faddishness."

Gelmert observes that executive function  runs along a continuum rather than a dichotomy, so there is no 'black and white'. It's not a case that your EF exists or doesn't. It is the level to which it exists and manifested in the quality of your decisions.  The downside (p. 24):

"Unfortunately, the nebulous nature of definition, diagnosis and treatment make EF problems harder to cope with for parents, practitioners, educators and the person with the issue."

Because of this ambiguity, discussions tend to focus on extreme manifestations of EF deficits, such as ADHD. According to Paul Beljan, a neuropsychologist and past President of the American Board of Pediatric Psychiatry, "just because something is commonly diagnosed doesn't mean it's exploding."

Indeed, but minus a common definition any specific diagnosis is problematic. For example, consider one facet of EF, processing speed - which "works at hundreds of milliseconds yet we're measuring it with a stop watch" - according to Dr. Beljan.  Effective evaluation of EF deficit then, must look at multiple factors: attention, inhibition, planning, adaptation, flexibility, speed, cognitive shift and sustained attention to a performance task..

Interestingly, EF deficit also has a genetic component. Twin studies disclose if one has it the other is likely to as well.  There is also an "evolutionary holdover" and those brain functions that served us 200,000 years ago have become obstacles to social cohesion now. Back then, if you didn't jump when a twig snapped you might get eaten by a saber tooth tiger. Also, if you didn't hoard food you'd starve.  As Beljan observes: (ibid.):

"Our lives are changing so fast that our brains can't keep up and this becomes profoundly obvious when someone really has a deficit. They're incredibly bright, but just can't achieve."

Where is EF housed? The observation above implies the "executive" prefrontal cortex, but as the author notes, that's "too simplistic". Other areas of the brain are involved as well. Beljan cites "working memory" which has a motor component, as not only using the prefrontal cortex but the basal ganglia with additional input from the cerebellum and the rest of the frontal lobe.

Beljan sums up deviations from proper EF functioning as a "disorder" and notes (p..25):

"Essentially what is at the core of this deficit is a failure of the brain to consolidate behavior into routines- procedural memory."

Given the multidimensionality of the problem and the fact there likely will be no pill for a "miracle cure" the most people can do - for themselves and their children - is work toward better EF outcomes. Some of the advice given in the article includes:

- Build think time into routines. If kids act before they think they can't process the activity all the way through. (A key is bearing in mind that kids have to cognate what adults find automatic.)

- There is no one right way, so don't become discouraged when you hear a solution that worked for some person but which fails in your situation.

- Use trial and error to find out what works, then live or die by that process. It's always detrimental to change up the routine.

- Don't be persuaded that an expensive organizing system will solve the problems.

- Spend time identifying all the steps of a process (e.g. such as a child getting ready for school, or a high school senior getting ready for college admission). Awareness of the process helps to force a level of consciousness.

- Higher quality decisions and executive functioning must constantly be worked on. It's like going to the gym and exercising the same muscle sets.

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