Executive function — the term for critical mental skills like organization, focus, time management and emotional regulation — help all of us navigate our daily lives.
People with ADHD are much more prone to executive dysfunction. And the number of people with attention-deficit/hyperactivity disorder is expected to rise. In 2022, the Centers for Disease Control and Prevention reported that over 11% of children in the United States were diagnosed with ADHD — an increase of about one million since 2016. And it’s not a disorder you age out of. Already, over 15 million U.S. adults have ADHD.
So what happens when executive function skills don’t develop as they should or when life’s demands overwhelm them? Some are turning to executive function coaches for help.
Dr. Ellen Braaten, Harvard Medical School professor and executive director of Mass General’s Learning and Emotional Assessment Program, joined GBH’s All Things Considered host Arun Rath to shed light on executive functioning and how the once-obscure practice of executive function coaches is gaining mainstream attention. What follows is a lightly edited transcript.
Arun Rath: I gave a brief definition in the introduction, but could you tell us in more detail what exactly executive function is and why it’s so important for us?
Ellen Braaten: Yeah. It’s great to think of executive functioning as a collection of skills. It’s not just one thing. They’re really the cognitive processes that allow us to attend to events in our environment, to plan, initiate actions and control our emotions. It’s the ability to use our intelligence both fluently and fluidly — meaning we can use it quickly when it needs to happen quickly, we can stop our behavior when we need to stop it, and we can shift our attention from one thing to the next.
It’s a lot of different things that are under the umbrella of executive function skills. It’s nice to think of it like a good executive secretary, or a good executive assistant, who helps you prepare, plan and execute a task in a timely manner.
Rath: It’s not surprising that with ADHD diagnoses on the rise, demand for executive function coaches would also be on the rise. But I wonder if there are other factors at play as well. In particular, I’m thinking about modern technology, modern challenges that are making these difficulties worse.
Braaten: There definitely are issues that are in our society right now making this worse. It’s good to keep in mind, too, that at one time, executive function issues and problems were thought of completely in the domain of ADHD — that if you had problems with executive function skills, you most likely had ADHD, either inattentive or hyperactive subtype, or some combination of either one.
Now, the demands in our society — in our classrooms, in our business environments, in our lifestyles — are so much and demand so much concentration, planning and organization. We have to keep so many bits of information at our fingertips at any one time that this really puts pressure on our executive function processes, even when we have pretty good executive function skills.
All of us can struggle with executive function skills. We have too much to manage when we have a job that we can’t quite do, or haven’t learned the skills yet to do, so we are overwhelmed. … [We are] constantly bombarded with information, and our brain has to sort through all of that. We live in a society where the demand is so high that we really tax our executive function skills even when they’re quite good.
Rath: I also feel like, with young people in particular, we expect a lot more executive functioning from them. When I was a kid, my schedule was: school [and] home. It’s not like that now.
Braaten: No, it’s not. ... Now, think about what we ask even first-, second- and third-graders to do. Not just all the things that are in their backpack — they have to remember their water bottle and all these demands on their attention. We have real expectations that even young children — I hear about this a lot — that the curriculum for kindergartners includes executive function tutoring.
That’s not necessarily a bad thing to think about; we want kids who are well organized and remember what they’re supposed to do. But it might be good to just think about making environments that allow us to be in line developmentally with what we’re being asked to do. We don’t necessarily do that right now for a lot of our students.
Rath: For older kids and adults who are turning to executive function coaches, what are the kind of tactics that coaches employ? How do they help?
Braaten: So, we should keep in mind that the research really shows that executive function coaching is really only effective for people who have trouble with that.
Now, there is another thing that might be worth mentioning, and that is executive coaching for executives. That’s been around for a long time. It’s a certain kind of cross between coaching and therapy that helps people realize their goals, but it’s mostly for executives. But we’re talking about executive function coaching to help deficiencies.
The tutoring — or the coaching — really should be primarily focused on exactly that person’s issues. Not everyone with executive function weaknesses has the exact same issues, so someone might struggle with working memory, another with organization. Other people might struggle with being able to inhibit their responses or organize their stuff or organize their time.
Any one of those issues, or more, should be focused on very individually by the executive function tutor. So the first part of that coaching or tutoring process should be a good assessment as to what are the underlying challenges for that particular person, and then a curriculum develops from their challenges. It’s very individualized.
Rath: What are the kinds of things that parents should look out for that might be a case where an executive function coach could be beneficial for their child?
Braaten: Things you want to do as a parent is look at the environment. First of all, is your child being asked to do anything that is really inappropriate for their developmental stage? That’s the number one thing you want to do: Look at the match between your child and what they’re being asked to do. Because the more you can change the environment, the easier it’s going to be.
In terms of the tutoring itself, what you want to look for is somebody who has some experience. It’s always good to look for someone who you’ve heard about through a personal reference or direct referral. It’s good to choose a company with a track record.
One of the things to be really wary of is this is a wide-open field, and you’re probably listening and thinking, “Gosh, I could use help with that.” Well, everybody could these days! You want to make sure you’re going to somebody who has a proven track record, who has a lot of experience and knowledge about executive function skills, and also the other issues that can impact executive function skills, like ADHD and other learning disabilities.
But you want to make sure that what you’re doing — or what your child is doing in their coaching sessions — is actually making a difference. This is an expensive treatment, and you want to make sure you are getting bang for your buck.
