Clinicians

Executive Functions and Competent Self-Managers by Jay Dennis Tarnow, M.D.

Executive functions are necessary for competent Self-Managers. The new buzzword for 2003 has been, "executive functioning." I am amazed how old concepts seem to circle around again. When the National Institute of Health declared the 90's as the "Decade of the Brain," a great deal of research was finally focused on this complicated organ. Technological advancements now allow us to see the brain in action, giving us a deeper understanding of how the brain functions. This new information about the brain has led neuropsychiatrists, neuropsyschologists, and neurophysiologists to be in awe of this complicated organ. There are no easy answers in the brain.

The past ten years have defined the location of executive functions in the Prefrontal Cortex. This is in the very front of the brain, behind the forehead. It is the most recent evolutionary development of the brain, only appearing in the "great apes" and highly developed in Homo sapiens (man). Because most major parts of the brain report to the prefrontal cortex, it has been called the "CEO" of our brains, or the "control center."

The prefrontal lobes are truly " the origin of civilization." It is this area in which the sense of self derives focus-the ability to observe ourselves and contemplate our choices and actions. The executive functions are critical to the development of a competent, creative human being.

Human thinking is proactive, forward looking, not stuck in the past or reactive. Human cognition is driven by goals, plans, aspirations, ambitions and dreams. It is in the prefrontal cortex that goals and objectives and plans of action are formed. The process begins with neural models created in the prefrontal cortex as a pre-requisite for making plans to bring that creation into existence. As the seat of executive functioning, the prefrontal cortex holds the key to what makes humans unique. It defines our humanity and makes us social beings.

There is a long history of research about what makes us truly human. In the eighteenth century "Age of Enlightenment," Prussian King Frederick the Great sponsored an experiment on language acquisition using babies who were confined without human interaction and speech. He found that social interaction was essential for not only normal development, but life itself. The babies died.

In 1807, the French scientist Jean-Marc Gaspard Itard studied a young male who was found in a primitive state, having spent most of his boyhood in the woods among wolves, surviving on whatever he could find or catch. Itard's account in Reports on the Wild Boy of Aveyrton, concluded that what makes us able to fully self -manage in society is dependent upon human social interaction during one's early years.

So the concept of who we are as humans is a broader one than just executive functioning skills. It must include the concept of "self-versus-other" and the necessity of the "other" for the development of these skills. It is a fabric woven of biopsychosocial fibers.

In medical school I became fascinated with executive functioning and its development and was lucky enough to work with scientists who were involved with defining these skills from infancy through adulthood. While conducting research in this area, I came to the conclusion that "self-managementSM" was a more apropos term. Self-managementSM is a broader concept that defines the development of executive functioning to include social competence.

Competence is the ability to consistently perform a skill. Competence is not doing something one time as many immature children think. Consistency is the key and it requires practice. Competence is having influence over one's own life. It is marked by acquisition and effective management of developmentally appropriate skills. At each new developmental stage, the individual must acquire and manage new and more challenging executive functioning skills. Each new skill is based on the one that comes before it. Therefore, if an earlier skill is not fully developed, future competence and management of one's life will be shaky.

An essential component to self-managementSM competence is the ability to self-monitor, self-evaluate and self-connect. Without these abilities, it is impossible to fully mature to competence and personal effectiveness. Basic self-managementSM competencies are the foundations for successful functioning in all areas of the child's life - school, emotions, relationship with family, peers and all others. They are expected to be in place by the time the child enters first grade.

Sometimes a child does not develop consistent self-managementSM competencies essential for school readiness. Sometimes a child is born with a biological temperament so different from their parents that a mismatch occurs. This mismatch can interfere with the parents' ability to appropriately respond to the temperamental child. In order to help children with dysfunction of the biology of the prefrontal cortex, we need to develop treatment that addresses the interaction of all levels, the biopyschosocial.

In working with children for thirty years, I have realized that it is impossible to take human functioning and its development out of context. We can replace a heart, lung, or kidney, and the person is the same being. But the brain, especially the prefrontal cortex, is "the person."

So in my theory of self-managementSM, development of the whole is greater than the sum of the parts. We need to understand all three contexts in which children develop: their biology, i.e. genetic and physiological functioning; their personality and cognitive skills; and their social context, i.e. parents, family and social history. Each of these "parts" is addressed by each of the following articles.

In the first article, Dr. Havasy connects the biological elements of the developing brain to executive functions. Linda Narun's article describes working memory as a critical cognitive skill in successful executive functions and its impact on academic success. Finally, Dr. Roche describes a third aspect of executive functioning skills, social and interpersonal competence.

In future issues of our newsletter, we will go into more detail about what parents can do to facilitate Self-ManagmentSM development.