Executive dysfunction

What is executive function/dysfunction?

Executive function is the name for a collection of thinking skills that we use when solving problems, making decisions, planning and completing tasks, reflecting on our activity and correcting mistakes. It involves cognitive skills such as:

• planning;

• motivation;

• multi-tasking;

• flexible thinking;

• monitoring performance;

• memory;

• self-awareness; and

• detecting and correcting mistakes.

We rely on many of these executive function skills on a daily basis, such as to cook a meal, follow a conversation, interact with others, work, study and plan our day, among other activities.

These skills are processed in a part of the brain called the prefrontal cortex. Other parts of the brain closely connected to the prefrontal cortex are also involved. Unfortunately, the prefrontal cortex’s positioning in the brain (at the front) makes it a common site of injury. People with injury to their prefrontal cortex can therefore develop difficulties with their executive function skills, and when this happens, it is described as executive dysfunction.

Executive dysfunction is also sometimes referred to as ‘frontal lobe problems’ or ‘dysexecutive syndrome’.

Executive dysfunction - impaired skills

Some of the executive functional skills that can be affected following a brain injury are as follows.

Motivation and initiation

A brain injury survivor may lose their sense of ‘get up and go’, making it difficult for them to start or complete tasks. This may be mistaken by others for laziness or disinterest. For example, a survivor may need to be frequently reminded about needing to book an appointment because, while they do intend to do it, they don’t take the initiative to make the appointment phone call and get it arranged.

Organisation

A brain injury survivor may struggle with staying organised. This can affect their ability to make plans and see these through efficiently. Thinking through the steps to get things done may be difficult for them. For example, a survivor may be unable to keep track of appointments and frequently get these muddled up.

Flexible thinking

Adapting or changing behaviour, or switching between tasks, may be difficult for the brain injury survivor. They may become ‘stuck’ or ‘fixed’ on certain information or behaviours. This is called ‘rigid thinking’. For example, a survivor may not think to lower the heat if food is cooking too quickly.

Problem-solving

Thinking through a problem and being able to form a solution may be difficult for the survivor. It may also be difficult for them to anticipate the consequences of their decisions. For example, a survivor may be unsure of what steps to take if they have lost their bank card.

Impulsivity

A brain injury survivor may act without fully thinking through the possible consequences of their actions. For example, they may spend most of their pay cheque on one item, without considering the bills that need to be paid later.

Planning

Thinking ahead and going through the various steps needed to complete an activity may be more difficult for the brain injury survivor. For example, it might be difficult for them to think through the steps needed to arrange and book a holiday.

It may be difficult to identify exactly which areas of executive function are impaired in a brain injury survivor, and often more than one skill has been affected.

The impact of executive dysfunction

Executive dysfunction can cause problems with multiple aspects of day-to-day functioning, such as:

• starting or finishing tasks, such as cooking a meal;

• interacting with others, such as socialising with friends and family;

• making decisions, such as what to wear or what activities to do;

• thinking through problems and forming solutions, such as identifying what to do if someone misses the bus;

• using alternative solutions if needed, such as using alternative ingredients in a recipe;

• behaving appropriately and controlling emotions, such as being able to control frustration if stuck in traffic;

• planning ahead, such as preparing tasks to be done across the coming week.

Social impact

Other people may identify these behavioural changes in brain injury survivors, but may not understand that they are due to brain injury. For example, colleagues of a survivor may notice that they are not meeting work deadlines in the same way as they did before the injury. Partners or spouses may feel that the survivor does not make as many social plans as they did before the injury, and misinterpret this as the survivor being disinterested. The survivor themselves may feel upset, embarrassed or frustrated about being misunderstood.

On the other hand, some survivors may themselves be unaware of their executive dysfunction. They may not have insight into the impact of their brain injury. This may cause family and friends to feel upset or concerned, especially if the survivor refuses help.

Work and education

Returning to work or education may be particularly difficult for survivors, as many executive function skills are used for working and studying. Struggling to prioritise jobs, multi-task, stay organised, initiate new tasks or figure out how to correct mistakes can all be challenging for a survivor with executive dysfunction.

Daily tasks

Daily tasks can be challenging, for example going grocery shopping, choosing what to wear, getting ready in the morning, cooking meals, completing activities through the day or engaging in hobbies. These daily challenges may affect the survivor’s quality of life, causing feelings of frustration or upset.

As well as these daily difficulties, survivors may find themselves facing challenging situations that may put them at risk of harm or danger. For example, being unable to detect and correct mistakes may cause a survivor to get into arguments or fights with others who do not understand they have had a brain injury that has affected their cognitive skills. Or a survivor may have financial problems if they have impulsively spent more money than they ought to have.

Professional support

Professionals called clinical neuropsychologists can help with identifying areas of executive dysfunction that may be causing difficulties. They can do this by asking brain injury survivors to complete specific tests designed to identify cognitive issues, as well as having conversations with the survivor and their family about the difficulties being experienced.

Once the areas of difficulty have been identified, clinical neuropsychologists can suggest methods of improving or coping with executive dysfunction.

Living with executive dysfunction, or other effects of brain injury, can cause some survivors to develop feelings of sadness, worry or frustration. In these cases it may be helpful to speak to a counsellor or other psychologist, or to contact organisations with mental health helplines such as Mind and Samaritans. The Headway helpline is also available for brain injury survivors to talk about their feelings.

For some, these feelings may develop into mental health difficulties such as depression and anxiety. In these cases, it may be necessary to get professional support. Contact your GP to discuss your concerns.

The information on this page was produced with expert support from Professor Jonathan Evans, Professor of Clinical Neuropsychology.

This information was last reviewed in 2025.