The frontal lobes and associated neuronal networks play an important role in executive functioning i.e. the mental processes underpinning vital cognitive functions including the ability to:

  • Think, reason and solve problems.
  • Make, communicate and act upon informed judgements.
  • Plan, organise and initiate action.
  • Understand and think through consequences of actions.
  • Self monitor, adapt and modify behaviours.
  • Learn from experience and apply this learning in the future.
  • Show insight and awareness of personal circumstances.
  • Empathise with, understand and relate to others.

Executive functions affect how the person communicates, manages interpersonal relationships, exercises judgement and behaves in various social situations. functioning plays an important role in the organisation, planning, implementing, monitoring, and adapting of all day-to-day activities including . Executive functioning impairment may be characterised by:

  • Impaired social awareness and judgement.
  • Reduced ability to identify and understand the motivations of others leading to potential conflict.
  • Apathy and lack of motivation.
  • Inflexibility and rigidity of thought and action leading to difficulty modifying behaviour as necessary.
  • Impulsivity and disinhibition.
  • Poor planning and disorganisation.
  • Problem solving difficulties.
  • Impaired decision making abilities.
  • Impairments of prospective memory affecting planning, organisation and the person’s ability to implement intended action plans.
  • Impairments of the ability to regulate emotions and behaviour.

Executive functioning processes are interdependently integrated with other cognitive process i.e. attention, information processing, memory and language processing abilities. Formal psychometric assessment of executive functioning may not always provide clear evidence of impairment.  Evidence of executive functioning difficulties may however be observed in how the person functions in everyday life situations.

Executive functions are the ‘air traffic controller’ system for all other cognitive processes. They oversee, organise and initiate what we do and continuously control all our activities.  This includes self monitoring, evaluating, modifying all our actions in response to internal stimuli (thoughts, feelings, sensations etc) and external stimuli (events occurring in our environment).

Damage to the executive functioning system can result in changes in emotional and behavioural regulation as well as cognition.  Executive functioning impairment may be associated with changes in personality and behaviour.

Damage to the frontal lobes and associated networks may lead to changes in mental state including:

  • Apathy.
  • Reduced expression of emotion in relation to their circumstances, to bad or good news e.g. may not appear distressed by their condition; may not express feelings verbally or by facial expression.
  • Irritability, agitation.
  • Emotional lability (rapid changes in mood e.g. from giggling to tearful).
  • Irritability and agitation.
  • Low mood/depression.
  • Euphoric/elevated mood.

Damage to the frontal lobes and associated neuronal networks may lead to changes in behaviours, some of which may be viewed as challenging, including:

  • Distractibility.
  • Low boredom threshold.
  • Inability to occupy self and self direct activity.
  • Restlessness.
  • Pacing.
  • Impulsive behaviours.
  • Imprudent and rude behaviours including blunt communication style.
  • Verbal aggression.
  • Physical aggression.
  • Self injurious behaviours.
  • Disinhibited behaviours (including sexual disinhibition).
  • Spitting.
  • Destructive behaviours.
  • Extreme non-compliance (persistently unable to co-operate with staff in essential care, activities of daily living and medical interventions.
  • Withdrawal from social interaction.

Dysexecutive Syndrome (also known as Frontal Lobe Syndrome) is characterised by the constellation of executive functioning difficulties described above.  This syndrome is a disorder of higher cognition associated with changes in personality and behaviour.

It is important that not to attribute negative or difficult behaviours arising from executive functioning impairment as being deliberate or purely due to pre-injury personality traits. It is likely that prior to the brain injury, the person would have been perfectly able to modify and adapt their behaviour according to the social situation.

Factors Influencing the Impact of Executive Functioning Impairments

How to Help the Person with Executive Functioning Impairments