"Executive Control” is a term that refers to the capacity to reflect on ones situation and life, to evaluate what is working and what is not, to formulate plans of action, and to carry out such plans successfully. Executive Control includes the capacity to learn from our mistakes so that we don’t make the same ones over and over again. Executive Control is what separates those that "get ahead," and can get along with others, from those who cannot.

Executive Control is an ability that is most closely associated with the frontal lobes of the brain. The frontal areas of the brain-just behind the forehead area of the skull--are particularly vulnerable when there is trauma to the head. This explains why Executive Control problems are so common in head injury. Executive Control includes a number of separate skills such as:
 

Self-Evaluation. The ability to take stock of ones strengths, weaknesses, resources, and opportunities. Planning. The ability to set a realistic goal and to create steps for attaining it. Initiation. The ability to get started. Time-Awareness. The ability to note the passing of time, to stay on schedule, to keep appointments and to meet deadlines. Self-Correction. The ability to evaluate ones performance and to make needed corrections in the midst of a task or project. Problem Solving. The ability to recognize when the actions you are taking are ineffective, to stop, re-evaluate, and to formulate or re-formulate a plan.

Executive Control problems and communication problems go hand in hand. Executive Control difficulties typically result in one or more of the following communication disorders: Disorganized, tangential, wandering conversations; imprecise language; word finding problems; socially inappropriate language; wordiness and resistance to interruption, or, restricted output and lack of verbal initiation; ineffective use of social cues; difficulty comprehending longer and more complex statements (spoken or written); difficulty detecting main ideas; difficulty following rapidly spoken language; difficulty communicating in distracting or stressful circumstances, and inefficient verbal learning.

Individuals with Executive Control deficits may be perceived by loved ones as having undergone a fundamental personality change. The individual may demonstrate erratic behavior and may be unusually dependent upon family members and helpers. They may have reduced ability to participate meaningfully in rehabilitation and support programs. The individual may lack an understanding that their functioning is impaired; deny having deficits, and resist help. Such a person may represent a significant danger to self or others due to placing themselves in situations they are unable to handle.

Executive Control deficits can be addressed in a variety of ways including therapies, use of strategies such as a daily planner, modifying the environment and daily habits of the individual and family, and more. Neurologists, psychiatrists, neuropsychologists, and therapists trained in brain injury may all be able to contribute treatments and strategies for success. With proper evaluation, professional guidance, and support, Executive Control deficits need not stand in the way of meaningful return to family and community living.

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