Ask the Doc October 2019

Answered by Dr. Josh Turknett, Neurologist, TLG Principal Consultant

Executive Function Skills: “What could a parent or supervisor do to assist or train someone who does not seem to have “executive function” skills? Are there courses? Coaching? Or is this the way it always will be?”

In September of 1848, railroad worker Phineas Gage became arguably the most famous neurological case in history after receiving an accidental frontal lobotomy. While supervising a work gang blasting rock for the Rutland and Burlington Railroad, an explosion propelled a three and a half foot long, 1-inch diameter tamping rod through Gage’s head, straight through the left frontal lobe of his brain.

Miraculously, Gage lived. But after the accident, he was not the same.

Since Gage’s infamous accident, we’ve learned much more about the specialized functions of our frontal lobes. They are perhaps the most distinguishing feature of the human brain, supporting the most unique features of our cognition.

Those features include our ability to imagine possible futures and to balance the needs of today with those of tomorrow (or the needs of this moment with the needs of the next one).

Put in sterile clinical terms, the frontal lobes support our planning and goal-directed behaviors. They do so both by helping us think about the world in the abstract, and by suppressing our more primitive impulses that are only concerned with the here and now. Without the frontal lobes, we are dominated by the motivations and drives that arise from the most ancient and primitive parts of our brain.

And the frontal lobes are the mediators of our executive functions. Like a CEO or President, they perform that role via top-down control over much of the brain. The waking brain is a buzzing hive of continuous activity, with countless functionally specific neural networks processing sensory data at all times. The frontal lobes help decide which of those networks influence our thoughts and behavior at any given moment, ideally to achieve the aforementioned balance between our present and future needs.

But as with most everything, when it comes to executive function, it’s possible to have too much or too little of it.

Too little executive function and, like Gage, we can’t sustain our attention on anything long enough to survive on our own. In Freudian terms, we are all Id and no Superego.

Too much executive function, on the other hand, and our lives are ruled by rigidity and inflexibility.

In between those two pathological extremes is a continuum where most of us reside. But our executive function isn’t some fixed and unchanging trait, as where any of us falls on that continuum at any point in time depends on a wide variety of factors.

For example, you’ve likely witnessed your own dramatic slide to the impulsive end of the spectrum after just a few adult beverages.

In addition to the familiar effects of frontal-lobe-suppressing neurotoxins like alcohol, there are many other ways in which the foods we consume and the lives we lead impact our frontal lobe function.

Many of the frontal lobes’ biggest challenges stem from the unprecedented demands of the modern world. We still possess brains that were optimized for the life and habitat of a tribal hunter-gather, but that now find themselves in an altogether foreign land.

Some would argue that the disruption in sleep quality and quantity caused by our modern lifestyles has the most significant frontal lobe suppressing effects. Optimizing sleep is certainly low hanging fruit for improving our executive function (and all aspects of brain function, for that matter), yielding an excellent return for a relatively minimal investment. Many sleep experts argue that simply attending to our sleep needs would reduce the number of child and adult Attention Deficit Disorder diagnoses to a tiny fraction of their current numbers.

Others may argue that the standard Western diet is the frontal lobes’ Public Enemy Number 1, with added sugars and other refined carbohydrates exacting the highest toll. Just a single spike in blood sugar has been shown to impair cognitive function across the board. When sustained over time, those impairments in cognition, including compromises in executive function, become permanent.

And when it comes to the unique challenges of our modern environments, let’s not discount the impact of smartphones, the single most effective distraction device ever invented. Try to wrestle one out of the

hands of a screaming 3-year-old, whose frontal lobes have barely begun to come online, and you’ll see just what we’re up against.

The research indicates that information technology has taken a collective toll on our capacity to sustain attention. Recent studies show that the average person now switches their computer screen every 40 seconds. From the perspective of someone living just 20 years ago, we all look like we’re suffering from a pathological deficit of attention.

For all of these reasons, the frontal lobes find themselves presented with more challenges than ever in this age of distraction. But the silver lining is how much of our executive function is modifiable.

For those that struggle most, structure, routine, and a minimum of environmental distractions are the keys to success.

Those who score high on conscientiousness in the Big 5 personality traits seem to be able to get back on task relatively quickly, and so are better able to cope with distraction-riddled environments. On the other hand, those who score low tend to pay a much higher productivity cost after their attention is diverted.

The conclusion of Phineas Gage’s story offers hope to anyone who struggles with these issues. Just five years after his brain injury, Gage was not only living independently but was successfully operating a long-distance stagecoach in Chile, a living testament to the remarkable plasticity of the human brain.

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