Executive Dysfunction: When Knowing What to Do Isn’t Enough

Written by Sidra Koss, LPC

Feeling like you can’t do the things you used to? Answering emails and texting people back has become impossible, or no matter how hard you try, you keep missing doctor appointments. Or maybe you’ve never understood how people can just get stuff done. Friends and co-workers seem to check one thing after another off their to-do lists, while you feel like you’re struggling to make yourself dinner on a daily basis.

If you can relate, you might be struggling with executive dysfunction.

What Is Executive Function?

Before understanding executive dysfunction, it’s helpful to first define executive function.

“Executive function skills help us plan, focus our attention, switch gears, and juggle multiple tasks—much like an air traffic control system at a busy airport,” explains Harvard University’s Center on the Developing Child. They help us “send the signal to begin a task, keep us focused long enough to follow through, and allow us to manage and shift between multiple demands.” 

These are cognitive skills, separate from intelligence. Someone can be highly intelligent, knowledgeable, and capable while still struggling to consistently access and use their executive function skills.

What Is Executive Dysfunction?

Executive dysfunction, by contrast, occurs when someone has difficulty with the mental processes involved in planning, organizing, initiating, managing, and completing tasks. It can happen when these skills were never fully developed, but it can also occur when stress, mental health conditions, neurological differences, or other factors make those skills harder to use.

Common Signs of Executive Dysfunction

Executive dysfunction can look different in different people. A person might not experience all of these symptoms, or experience them in varying degrees, but it generally looks like:

• Task Paralysis: Difficulty starting or completing a task, even when the person wants to do it and may think about it repeatedly.

• Difficulty Switching Tasks: Difficulty stopping one activity and shifting attention to another, especially when the switch is unexpected or abrupt.

• Disorganization: Difficulty keeping track of belongings, information, schedules, or the steps involved in completing a task.

• Prioritization and Planning Challenges: Difficulty determining where to start or which parts of a task matter most.

• Time Mismanagement: Difficulty recognizing how much time has passed or accurately estimating how long a task will take.

• Inattention: Difficulty staying focused or keeping one’s thoughts on track while completing a task.

• Forgetfulness: Difficulty retaining information long enough to use it, which can look like missing appointments or forgetting instructions.

• Difficulty Self-Monitoring: Difficulty noticing and evaluating one’s own performance.

• Emotional Dysregulation: Difficulty managing strong emotions well enough to continue to think clearly or complete a task.

• Lack of Impulse Control: Difficulty resisting distractions or pausing to consider consequences before acting.

Possible Reasons for Executive Dysfunction

Executive dysfunction is a description of what is happening, not a diagnosis. This means there can be a few different reasons someone might struggle with it.

ADHD and/or Autism

Executive dysfunction is often associated with ADHD and autism in children and adults. Some researchers describe ADHD as an inherent condition of executive dysfunction and see the brain’s ability to self-regulate as fundamentally wired differently (although it should be noted that ADHD is far more complex than just an executive dysfunction issue). That said, people can struggle with executive functioning for many other reasons; struggling with executive functioning does not automatically mean someone has ADHD or autism.

Childhood Experiences 

Executive functioning develops throughout our lives. Skills like attention, working memory, inhibition, and cognitive flexibility start developing when we’re young and continue to grow throughout childhood and adolescence. Because of this, a person’s childhood experiences and environment can affect how these skills develop—both positively and negatively. Some of us never get the opportunity to fully develop these skills, which can leave us feeling discouraged as adults when we struggle with executive dysfunction and its frustrating impact on our lives.

Temporary Overwhelm

Executive dysfunction can also occur when a person is overwhelmed and their cognitive resources are strained (think burnout, chronic stress, depression, anxiety, sleep deprivation, or substance abuse). Someone might normally be pretty organized and capable of managing their time, but find that those same things become much harder when they are exhausted, overwhelmed, or going through a particularly difficult time.

Impairment, Learning Disorders, Intellectual Disabilities

Executive dysfunction can result from, or occur alongside, a number of neurological and medical conditions. For example, learning disabilities, traumatic brain injuries, strokes, dementia, multiple sclerosis, and Parkinson’s disease can all affect skills like planning, attention, working memory, cognitive flexibility, and self-monitoring.

How to Address Executive Dysfunction

There are multiple ways to begin treating executive dysfunction. Psychotherapy, skills training, and medication (if the cause is ADHD) are all things that can help.

Address the Emotions

Struggling with executive functioning can come with shame, feelings of failure and inadequacy, stress, low self-esteem, and anxiety. You might regularly experience thoughts like:

• “If I can’t do the whole task perfectly, there’s no point in starting.”

• “I’m always messing things up.”

• “My friends probably think I’m incompetent.”

• “Everyone does this, so I should be able to, too.”

• “If I ask for help for such a basic thing, people will think I’m stupid.”

• “I have to wait until I feel motivated.”

• “I’m lazy.”

A part of the healing process could be learning how to approach yourself with more compassion. That doesn’t mean giving up or deciding you never have to change. It means accepting where you are while learning to move forward and grow through therapy.

Work With a Mental Health Professional

Again, executive dysfunction is a description of what is happening, not a diagnosis. Everyone’s situation is different, so it’s important to work with a licensed mental health professional to figure out the complexities of your own experiences and how to care for yourself through them. Treatment will depend on the underlying cause. If you are in Chicago, and looking for a therapist to work with on your executive dysfunction please reach out.

Develop Executive Functioning Skills

A trained professional can also help you build and practice skills that support executive functioning. Some helpful skills may include:

• Learn to Address the Underlying Emotion: View “laziness” as a symptom instead of a cause, and find the actual emotional blockage. When you attempt the task, what emotions come up? Address and process those first, then do your task.

• Break Tasks Down Into Smaller Steps: Tasks are often more complicated than we make them out to be. Take them one at a time. And try to tackle the most difficult task first.

• Leverage Interests: Connect the task to personal passions, like listening to your favorite music while you clean.

• Make Tasks and Things You Need to Remember Visible and Tangible: Use post-Its, white boards, stickers, accessories (e.g. watch put on the other hand, reminder rings), to give yourself visual reminders.

• Use Time-Based Techniques: Work in intervals or block out dedicated time in a quiet, distraction-free environment.

• Try Body-Doubling: Work in the presence of a friend or coworker who is also working on a task.

• Give Yourself Permission to Be Imperfect: If you have a task to do, let yourself do it while upset, sad, tired, uninspired, imperfect, but do it.

Use Self-Management Tools

There are tools that can be helpful for developing better executive functioning.

• Organizational Apps: Trello, Actimate, Lunatask, Goblin Tools, Google Keep.

• Gamified Focus Timer Apps: Focus Friend, Flora, Habitica

• Virtual Body-Doubling Apps: Focus Mate, Flow Club, Flown, Discord focus groups.

• Pomodoro Technique: Break work into a series of 25-minute focused intervals, each separated by a five-minute break. After four intervals, take a longer break.

• Text / Email Scheduling: Write the message when you remember it and then schedule it for later.

Consider Medication When Appropriate

Finally, medication might be the option you want to pursue. A mental health provider can help you find a testing center and psychiatrist to treat your ADHD.

Remember That You Are Capable

At the end of the day, executive dysfunction is not a sign that you’re lazy, unintelligent, or incapable. You can be successful, motivated, hardworking, and genuinely want to do something while still struggling to get yourself to start it.

The most important thing is figuring out what is actually getting in your way. Understanding why you are struggling is often the first step toward figuring out what might actually help. Instead of continuing to ask, “Why can’t I just do this?” Perhaps it’s better to ask, “What is making this difficult for me right now?”

The answer will not be the same for everyone. But with the right support, strategies, and sometimes treatment for an underlying condition, executive functioning can become easier to manage.

Ready to address your executive dysfunction? Click here to find a provider through Cultivate Counseling Group a counseling practice in Chicago serving all of Illinois via telehealth. We are located in North Center and hopefully soon in Avondale.

Sources:

Center on the Developing Child at Harvard University. “A Guide to Executive Function: What Is It, and How Is It Developed?” Center on the Developing Child at Harvard University, 22 Nov. 2024,

https://developingchild.harvard.edu/resource-guides/guide-executive-function/Diamond, Adele. “Executive functions.” Annual review of psychology vol. 64 (2013): 135-68. doi:10.1146/annurev-psych-113011-143750Girotti, Milena et al. “Prefrontal cortex executive processes affected by stress in health and disease.” Progress in neuro-psychopharmacology & biological psychiatry vol. 85 (2018): 161-179. doi:10.1016/j.pnpbp.2017.07.004

Willcutt, Erik G et al. “Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review.” Biological psychiatry vol. 57,11 (2005): 1336-46. doi:10.1016/j.biopsych.2005.02.006

Zainal, Nur Hani, and Michelle G Newman. “Executive Functioning Constructs in Anxiety, Obsessive-Compulsive, Post-Traumatic Stress, and Related Disorders.” Current psychiatry reports vol. 24,12 (2022): 871-880. doi:10.1007/s11920-022-01390-9

Written by Sidra Koss. She specializes with adolescents, and adults specializing in high-stress, high-anxiety, chronic over-functioners struggling with perfectionism and low self-esteem, suffering from burnout. She also works with ADHD, executive dysfunction, PTSD and anxiety. Reach out if you’d like to work with Sidra.

Cultivate Counseling Group is a therapy practice in Lincoln Square/North Center Chicago (and virtually all over Illinois, Florida and Wisconsin). If you’re looking to have your or your child work with a therapist, contact us to ask questions, inquire about availability, or schedule an appointment. You can also reach out directly to hello@cultivatecounselinggroup.com.