Injury to the frontal lobes of the brain and associated neuronal networks may result in emotional and behavioural dysregulation, thereby resulting in behavioural difficulties. Individuals may present with irritability, emotional lability, anxiety, agitation and occasionally aggression.
The person with executive functioning difficulties may present with significant changes in personality and behaviour. Typical clinical features of executive functioning impairment include apathy, reduced motivation, lack of impulse control, reduced empathy, reduced insight, emotional lability, irritability, aggressive outbursts, socially inappropriate behaviour and sexually disinhibited behaviour. This constellation of clinical features is referred to as Dysexecutive Syndrome (also known as Frontal Lobe Syndrome).
Specific executive functioning difficulties which may have an impact on behaviour include:
- Difficulties weighing up information in the social environment and then making appropriate social judgements based on this.
- Planning a response (e.g. what the person does/says etc) in the light of these judgements.
- Evaluating and caring about the likely consequences of the response either for themselves or other people, being able to demonstrate empathy.
- Difficulties in the person’s ability to apply an ongoing process of continuous monitoring of their behaviour and its consequences, monitoring the behaviour of others and, in the light of this monitoring, be able to evaluate and modify behaviour/responses.
- Awareness of one’s own situation, abilities, needs etc (i.e insight).
In order to make appropriate social judgements, the person needs other skills which underpin executive functioning processes including:
- Cognitive skills including attention, information processing and memory.
- Communication skills including the ability to interpret other people’s communication e.g. other people’s speech, language, non-verbal communication and their communicative intent.
- The ability to recall events from the past which may share some similarities with the current situation.
- Knowledge of the other people involved in the situation.
A reduction in the ability to apply the above cognitive processes to everyday situations may result in the person utilising challenging behaviour as opposed to more constructive communication strategies and appropriately assertive behaviour.
Specific Executive Functioning Impairments Impacting on Behaviour