How Do Executive Function Deficits Relate to Behavior Problems in Children and Teens?

What you need to know

• Children and teens with disruptive behavior disorders tend to show deficits in executive functions like working memory, inhibition, and cognitive flexibility.
• These executive function deficits may contribute to difficulties controlling behavior and following rules.
• Executive function problems appear to be worse when ADHD is also present along with behavior disorders.
• Interventions targeting executive function skills may help improve behavior in youth with disruptive disorders.

Executive functions and behavior problems

Executive functions are mental skills that help us plan, focus attention, remember instructions, and juggle multiple tasks successfully. They are like the brain’s air traffic control system. In children and teens with behavior problems like oppositional defiant disorder (ODD) or conduct disorder (CD), this air traffic control system often doesn’t work as well.

This review looked at 50 studies examining executive functions in youth with disruptive behavior disorders. Overall, the studies show that children and teens with these disorders tend to perform worse on tasks measuring executive functions compared to typically developing youth.

Specifically, they often struggle with:

• Working memory (holding information in mind and working with it)
• Inhibition (stopping impulsive responses)
• Cognitive flexibility (switching between tasks or mental sets)

These difficulties with executive functions may help explain why youth with behavior disorders have trouble controlling their actions, following rules, and adapting their behavior to different situations. If a child has poor working memory, for instance, they may struggle to remember and follow multi-step instructions. Weak inhibition could make it hard to stop and think before acting aggressively.

Impact of ADHD

Many of the studies also looked at how attention-deficit/hyperactivity disorder (ADHD) impacts executive functioning in youth with behavior problems. ADHD and disruptive behavior disorders often occur together.

The findings suggest that when ADHD is present along with ODD or CD, executive function deficits tend to be more severe. Children with both ADHD and a behavior disorder showed greater impairment on executive function tasks compared to those with just ODD/CD.

This indicates that ADHD may compound executive function weaknesses in youth with behavior problems. The combination of poor attention/hyperactivity and weak behavior regulation skills likely makes it even harder for these children to control their actions.

Factors influencing executive function

The review also examined factors that might influence the relationship between executive functions and behavior problems. Some key findings:

• Age: As children got older, differences in executive function between those with and without behavior disorders tended to increase for some skills.

• Sex: Boys with behavior disorders showed more severe deficits in behavioral inhibition compared to girls.

• Sample type: Executive function differences were sometimes larger when comparing community samples rather than clinical samples.

This suggests that executive function deficits associated with behavior problems may become more pronounced with age. They also seem to manifest differently in boys versus girls in some cases.

Implications for intervention

Understanding the executive function weaknesses present in youth with disruptive behavior disorders has important implications for intervention. Some potential applications of this research include:

• Targeting executive function skills directly through cognitive training programs
• Teaching compensatory strategies to work around executive function deficits
• Modifying environments to reduce executive function demands
• Combining executive function training with behavioral interventions

For example, a child with weak working memory may benefit from written checklists or visual schedules to compensate for difficulty holding information in mind. Or inhibition training could be incorporated into a behavioral therapy program for a teen with conduct problems.

Conclusions

• Executive function deficits appear to be a key feature of disruptive behavior disorders in children and teens.
• These deficits likely contribute to the behavioral and emotional regulation difficulties seen in youth with ODD and CD.
• ADHD seems to exacerbate executive function weaknesses when it co-occurs with behavior disorders.
• Interventions targeting executive functions may be a promising avenue for improving outcomes in youth with disruptive behavior.

While executive function deficits are not the only factor involved in behavior disorders, this research suggests they play an important role. Continued study of how executive functions relate to disruptive behavior can inform the development of more effective assessment and treatment approaches.