How Do I Know I Need a Psychological Evaluation: Executive Functioning (Part 1)

There are several reasons a person might need a psychological evaluation. Psychological evaluations are used to measure the current levels of functioning for a lot of different cognitive domains. In this series, we will explore some of the common domains evaluated by psychological assessments and how to recognize if you may benefit from an evaluation. The first domain we will look at is executive functioning.

What is Executive Functioning

The term executive functioning has become more prevalent in recent years. It is an essential component of people’s overall functioning. Sometimes known as Executive process or control, executive functions include the higher-order processes that make human beings more intelligent than other animals. It includes things like:

1. Decision Making
2. Problem Solving
3. Organization
4. Attention
5. Working Memory – The ability to hold and manipulate mental information
6. Mental Flexibility – The ability to switch between topics and to adapt to different situations
7. Inhibition – The ability to withhold behaviors and thoughts and not engage in them and more

These abilities are found in the brain’s frontal and prefrontal cortices and are typically not fully developed until about 25 years of age. This is partially why teenage years are associated with risky and impulsive behaviors. It is also interesting to note that the prefrontal cortex is unique among humans and other primates. However, humans’ have more gray and white matter. These functions play an important role in human beings’ lives, and having well-developed executive skills is generally associated with success.

How can I tell if I have Executive Functioning Issues? 

Difficulties with Executive Functions can present in lots of different ways. One of the most common presentations is difficulty with attention and is usually associated with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Several components make up attention, and they can all be associated with the brain’s areas responsible for Executive Functioning. Attention as an Executive Function includes:

1. Inattention – the ability to attend to the topic at hand and inhibit distraction
2. Sustained attention – the ability to maintain attention over time
3. Hyperactivity – regulating or inhibiting impulses, physically or cognitively
4. Set shifting – the ability to switch attention between two or more things

Difficulties with any one of these may be an indication that you have an Executive Functioning issue.

Difficulties with Executive Functioning are going to look different from people of different ages. Other common presentations for people with Executive Functioning difficulties include trouble with completing tasks on time if at all, frequently being late due to difficulty planning or remembering, needing frequent and constant reminders. Keep in mind that nobody is perfect, and everyone struggles with these things from time to time. If these difficulties are causing you distress in your life, then it might be time to schedule an evaluation. 

How are Executive Functions Measured?

There are many cleverly designed psychological assessments on the market that target Executive Functioning specifically. These tests look to remove other cognitive functions from the assessment. The specific process in question is the only thing being measured. Sometimes, it is impossible to do this, so two or more tests measure the same Executive Function and another skill. When these assessments are interpreted together, a skilled practitioner can determine the nature of the difficulty.

Some tests use subjective means to determine if a person has issues with Executive Functioning. These tests may be self-report forms or may be based on a single person’s perspective, like a parent or teacher. Subjective measures only give information from the person who is completing the test and are not entirely reliable when determining a diagnosis. It is crucial to make sure you are receiving objective measures as well. Objective measures compare a person’s abilities with a larger population to see if that person is performing at the expected level or not. Some common objective Executive Functioning measures include:

1. Attention Tests
2. TOVA
3. CPT
4. Inhibitory tests
5. Stroop
6. Color-Word Interference from D-KEFS
7. Working Memory
   1. Digit Span from WISC or WAIS
   2. Subtests from Woodcock Johnson
8. Organization and Planning
   1. Tower of London
   2. Tower Test from the D-KEFS
9. Concept Formation
   1. Matrix Reasoning from WISC and WAIS
10. Set Shifting
    1. Wisconsin Card Sort
    2. Sorting Test from D-KEFS
11. Idea and Word Generation
    1. Verbal Fluency from D-KEFS

If you think you have difficulty with one of these, or if you believe you have difficulties with Executive Functioning in general, make sure to ask your evaluator what measures they are going to use and how it will help determine what problems may exist.

Can I improve my Executive Functioning?

The short answer is yes, you can. The long answer is still yes, but it is going to take a lot of work. Improving Executive Functioning is a matter of practice and application of skills to areas where improvement is needed. Going through this process is a journey, and there are no concrete answers. The best way to approach this is to evaluate areas of your life, or even singular tasks that you are successful in and apply those same skills to other areas of your life or tasks. Over time, you will see what works and what does not, and your skills with increase.

Difficulties with Executive functions can be complicated and difficult to pinpoint. If you think you are having problems with your Executive Functioning, you may benefit from a psychological assessment. Speak with a mental health professional to see if this an evaluation may bring some light to some of the difficulties you have been experiencing.