We all lose our keys or phones from time to time, run late for an appointment, or underestimate how long a task will take. But for students consistently “hitting a wall” when it comes to time management, distractibility, prioritizing tasks, or getting started with assignments (even if they’re interested in them), we can begin to group and label these frustrating patterns into cognitive difficulties known as executive function disorder or executive dysfunction.
“It often has very little to do with intelligence level,” explains Dorm Director Brittany Becker, LMHC.
“It’s about how a student takes in information, takes in all the variables surrounding the information, organizes it all, processes it, and then understands how to navigate the impulses that come up that make them say, ‘I’m not doing this,’ or, ‘I can’t do this.’”
Struggling with executive function is common for people diagnosed with ADHD. However, executive dysfunction can impact a much larger demographic of young adults who are adapting skills they’ve learned in childhood to a completely different terrain. “We also often see executive function problems co-occurring with thought and mood disorders,” explains Brittany.
Fortunately, executive functioning skills can be learned and developed, especially in young adulthood. Discovering and implementing new systems that work for your particular learning style is an endeavor that can help you get set up up for a lifetime of learning, self-acceptance, and personal growth.
In the following post, we outline the barriers many young adults with executive dysfunction often come up against. We will also explore what we, as mental health clinicians, have seen works to overcome these barriers.
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Key Article Takeaways:
Many young adults with ADHD and other co-occurring disorders struggle with executive functioning skills, often because of dramatic life changes during the transition into adulthood.
Primer: What is executive functioning?
Executive functioning refers to the neurocognitive systems that allow us to plan, prioritize, remember, focus on, and juggle tasks successfully. They are all the skills that go into achieving goals.
As Harvard University’s Center on The Developing Child describes, “Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses.”
It can help to think of executive functioning as the ‘how’ of learning. How do our brains break down tasks, switch between them, plan, and manage day-to-day activities smoothly?
This differs from person to person and also develops throughout childhood, adolescence, and adulthood. How our brain functions “is premised on the variable rate of the development of the brain – which does not reach maturity until the early 20s,” explains the ADHD Foundation.
The Eight Core Executive Functioning Skills
In therapeutic settings the brain’s executive functions are often divided into eight core pillars to address challenges more specifically. Different executive functions can be improved upon with different therapeutic modalities.
Eight Core Executive Functions
- Impulse Control
- Emotional Control
- Flexible Thinking
- Working Memory
- Self Monitoring
- Planning and Prioritizing
- Task Initiation
Each of the eight core executive functions come with a unique and complex set of cognitive systems. These systems are not innate. We must learn and develop them.
What are the key indications or symptoms of executive dysfunction?
Students or young adults struggling with executive function often find it difficult to prioritize tasks, panic when things or plans change, or consistently have trouble with short-term memory. There are several scenarios in young adulthood that can make these challenges come to the surface.
School Anxiety & Refusal
“We often identify executive dysfunction when a student goes off to college but can’t keep up with the school work for some specific reasons. These can include finding it difficult to prioritize assignments, not knowing how to seek out support in a timely fashion, or not knowing or remembering when assignments are due,” explains Brittany, director at The Dorm NYC.
“This often comes up as school anxiety or school refusal. It often has very little to do with intelligence level. It’s about how a student takes in information, takes in all the variables surrounding the information, organizes it all, processes it, and then understands how to navigate the impulses that might come up that might make them say, ‘I’m not doing this,’ or, ‘I can’t do this.’”
Managing New, Emerging Mental Health Symptoms
Even if a student is coping with schoolwork well, several other scenarios can indicate executive dysfunction. The college years are often a time when underlying mental health disorders emerge.
For students or young adults managing new diagnoses, another common scenario of executive dysfunction comes up around medication management, explains Brittany, “which involves a ton of small tasks like knowing how to seek out the care you need, making appointments, keeping appointments, and then remembering to follow up on the instructions the provider gives.”
Ongoing Frustration with Everyday Tasks
Many students struggling with executive functioning are frustrated by both the repercussions of not fulfilling the tasks at hand, as well as the emotional frustration that comes up for them surrounding planning, prioritizing, and following through.
“For some students, they’ve never been exposed to certain skills or situations. Others, they’re in a new transitional place and they need to try to transform the skills they’ve learned in childhood and adapt them for what life looks like in your twenties, which is very different from what it looks like when you’re twelve,” explains Brittany.
What therapeutic modalities can help students improve executive dysfunction?
Many students struggling with executive dysfunction have identified specific goals and desires, but have trouble putting a system into place to achieve them. Clients can remove a lot of frustration and grief from the college experience after discovering their unique learning style, explains Brittany.
“Everyone has a different learning style. What’s going to help one person will be different from somebody else. In our executive functioning therapy, we try to offer a buffet of ways to approach these skills that clients can expose themselves to. They can then try them, practice them, and see what works and what doesn’t.”
There are several ways students can improve their executive functioning, including individual therapy, group therapy, clinical coaching, and real-world practice.
Individual Therapy – The modalities that work
Behavioral or skills-based therapies work to target not only the behaviors that may be holding you back, but the beliefs or emotions surrounding those behaviors.
“We look at two parts – the new behaviors that we can use instead, but also acknowledge and understand the beliefs or thought patterns you had about a situation that triggered the behavior or avoidance patterns we’re trying to leave behind,” explains Brittany.
Additionally, doing mindfulness and grounding practices can help students cope with the frustration of navigating their learning style.
“If you’re getting overwhelmed during a task, there are several things you can do to reset,” explains Brittany. “Including positive self-talk, breaking a task down into several small steps, or even putting pen to paper and listing out an actionable to-do list like drinking a glass of water, counting to 10, or practicing a grounding technique.”
Once you’ve re-centered yourself and found solid ground, the task at hand often becomes much more manageable. Coping skills like these are a core theme of clinical coaching and skills-based therapies.
Clinical Coaching: How it improves executive functioning in young adults.
Clinical coaches differ from traditional therapists in that they practice new skills and ways of thinking in real-world settings with the client (as opposed to in the therapist’s office.) This is a cornerstone of treatment at The Dorm.
“Historically you have young people who are immersed in care but then thrown right back out into life without the support they need,” explains Dorm Founder John McGeehan, LCSW, CADC. Clients can often benefit from “a foundational treatment community that will run alongside them as they build their life, understanding that that’s when the rubber meets the road – when they’re struggling to navigate a university campus, struggling with that first job.”
A clinical coach can keep a student supported and hold them accountable for practicing the skills learned in therapy. During clinical coaching a licensed therapist works hand-in-hand with clients to identify different systems that will work for them, adds Brittany. “Planning, prioritizing, task initiation, and follow-through are huge themes within coaching that can be addressed with specific activities and resources.”
Clinical Coaching for Executive Dysfunction – A Case Example
One common example of executive dysfunction in college students or young adults is keeping up their living space independently, often for the first time in their lives. Cleaning and personal hygiene are only one example of how executive functioning comes into play in daily life, but it’s a great example because taking care of a home often takes planning, prioritization, time management with other responsibilities, task initiation, and organization.
“When we help clients move into independent living and they’re moving into their own space for the first time, cleaning and hygiene can be indicators of their overall mental health. But for those who are struggling with executive functioning, they may be emotionally stable but running into ongoing frustration at not being able to stay on top of household tasks,” explains Brittany.
We can work with clients to try out a few different methods that might work for their learning styles. One technique we introduced was to divide their apartments into quadrants, and I’d say today we’re only going to look at this one quadrant and consider what tasks we have here. Cleaning dishes is very different from doing laundry, organizing, and putting away laundry, for example.”
Just because a young adult hasn’t developed a system that worked for them in the past doesn’t mean they can’t develop these tools for lifetime success with the right coaching and encouragement. There are several tools and exercises like these that coaches introduce to clients.
“You can’t just say to anyone, ‘Ok you’re just going to make sure to clean your room every Tuesday at this time,’” explains Brittany. “You have to know how to break it down for clients and introduce different methods that might work for them. These can look very different from person to person. The goal of a coach is to teach you not only what systems will stick long term, but how you come up with your own systems.”
Group Therapy – Supported, targeted programming for executive dysfunction
Group therapy for young adults is one of the cornerstones of life at The Dorm. Engaging in therapeutic support alongside peers leads to better clinical outcomes and reinforces the development of critical social and emotional skills.
Group Therapy for Emotional Control and Impulse Control
“Emotional control and impulse control are a core theme of several of our groups,” says Brittany, “including Urge Surfing, DBT, and Mindfulness Meditation.” Learn below how each of these groups helps clients expand specific executive functions:
Dialectical Behavior Therapy (DBT): This group implements the evidence-based, cognitive behavioral treatment following Marsha Linnehan’s standard DBT curriculum. Instructors introduce a step-by-step format to teach four sets of skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Mindfulness: This form of group mindfulness meditation teaches participants to be in the present moment without judgment. Clients explore a variety of techniques and principles to build resilience in real-time during the group, and are encouraged to maintain their practice outside of group meetings. Didactic by design, this group is expanded from the first module of DBT.
Meditation: This practice in mental training teaches clients how to transform their relationship with their emotions, moving from a space of reaction to response. Clients learn an assortment of stress reduction techniques through breath work and self-regulation exercises.
Urge Surfing: This unique group experience is specifically for clients overcoming addictive behaviors beyond substance use, including self harm. Clients learn to “ride out the wave” of urges and minimize them using specific techniques, including behavior chain analyses, diary cards, skills and process work.
Group Therapy for Flexible Thinking
“For clients with overcontrol, we often see a lot of “black and white thinking,” explains Brittany. “This is when we would recommend a group setting centered on Radically Open DBT, which helps clients promote flexible thinking with the support of a peer community.”
Radically Open DBT: “RO-DBT” is a cutting-edge, evidence-based therapeutic modality to treat multiple clinical diagnoses characterized by overcontrol, including but not limited to OCD, anorexia nervosa, and refractory depression. This modality strives to help clients foster openness, flexibility, and prosocial behavior through self-inquiry practiced with a clinician and in group therapy. The ultimate goal of RO DBT is to help clients become less encumbered by strict and rule-governed behaviors that may negatively impact their quality of life.
“If we can figure out how to expand how we look at the world and approach different tasks, then we can find what works best for us with our learning style and coping style,” she says. “On the flip side, rigid thinking is a symptom that often comes through our door which then impacts our task initiation, completion, and follow-through.”
Group Therapy for Working Memory
“We target working memory in Cognitive Remediation Groups, which meet twice weekly,” says Brittany. Many students whose executive functioning has been Cognitive Remediation is a huge stepping stone for clients whose executive functioning has been impacted neurologically.
Cognitive Remediation: “Cog Rem” is an evidence-based group that supports individuals who have struggled with the loss of any cognitive ability (attention, memory, processing speed, problem-solving, etc.) due to psychosis, depression, eating disorders, brain injury, personality disorder or a host of other mental health conditions. This group combines discussion sessions with an experienced group leader and interactive computer exercises.
What are the long-term mental health benefits of improving executive functioning skills?
In conclusion, young adulthood and college years are a prime time for students to explore and understand their unique learning styles and behavior patterns. This not only makes the college experience more manageable but sets them up for a lifetime of greater self-compassion and confidence in their choices.
“Executive function skills help people make more positive choices about nutrition and exercise; to resist pressure to take risks, try drugs, or have unprotected sex; and to be more conscious of safety for ourselves and our children,” explains Harvard’s Center on the Developing Child.
Through the modalities summarized above and a supportive peer community, college students can hone their executive functioning skills and find satisfaction and fulfillment in their education and vocational choices.