thinkSMARTer, Not Harder: Understanding Executive Functions

from Brains to Behaviors

Alissa J. Ellis, PhD

   Assistant Clinical Professor, Child and Adolescent Mood Disorders Program Director,

thinkSMART Program, Semel Institute of Neuroscience,

UCLA

Parents are often puzzled by the frustrating, confusing, and worrisome situation of teens showing a more pronounced decline in grades and overall academic performance.  While difficulties may have been present earlier, more dramatic consequences on academic performance are seen during middle and high school when academic demands increase and teens transition to greater independence in the classroom and at home. Many parents are riddled by questions such as: What is going on? Is my teen just lazy?  Why can he spend hours watching YouTube or playing video games, but can’t spend 30-minutes studying for an exam?

The answer to these questions lies in a concept known as Executive Functioning.  Executive functioning is a broad term that encompasses numerous cognitive processes that are critical for accomplishing tasks and achieving goals.  Working memory (i.e., temporarily holding and manipulating information needed for a task), cognitive flexibility (i.e., ability to easily shift from one idea or rule to another), and inhibition (i.e., stopping an automatic response) are the initial foundation for more complex executive functions needed for daily skills such as those involved in time management, organization, task initiation, and planning.  Rarely, are single executive functioning processes used in isolation.  Rather, they work together to achieve the desired outcome.

Most individuals have “good” executive function days and “bad” executive function days.  This is because executive functions are highly vulnerable to decline due to common experiences such as  stress, poor sleep, or lack of exercise.  Some teens may experience more “bad” executive function days than normal because EF weaknesses are considered a ubiquitous feature of most neurodevelopmental and psychological disorders such as ADHD, Autism, mood and anxiety disorders, and substance abuse.  As teens transition into adulthood, executive functioning difficulties seem to worsen, creating more dramatic negative effects.  Further complicating the issue is the fact that medications do not demonstrate robust changes in executive functioning, despite being the first-line treatment for disorders such as ADHD. This highlights the need for interventions during the critical stage of adolescence, if not before.

Unfortunately, deploying executive functions requires effort–a lot of effort.  Let’s be honest, we would all love to throw logic, reason, and planning out the window and let our fun-seeking selves take the lead!  Why else can some teens spend hours playing video games but be unable to complete homework?  Parents often interpret this as meaning that their teen just needs to work harder and put in more effort.  While any behavioral change requires effort, telling a teen to work harder doesn’t quite achieve the desired results.  This is because these weaknesses in executive functioning are due to both a skills deficit and a motivational deficit.  Skills and strategies to help with time management, organizational skills, and planning can be taught to teens and their parents (e.g., through a program like thinkSMART®), but mere exposure to these skills does not always equate with use of the skills or improvements in executive functioning.

That’s where motivation becomes more of a key factor.  To be clear, motivation is not something that can be immediately and easily turned on.  Let’s be honest; how many parents are truly “motivated” to clean out their garage or refrigerator?  This is how your teen may feel about school work.  Adolescence is a period where all youth begin to consider more risk-taking activities and are behaviorally drawn to more rewarding, pleasurable experiences.  There becomes a clear and inherent difference between preferred and non-preferred tasks. With  this difference, some teens find the idea of non-preferred tasks nearly insurmountable.  They have little to no motivation to complete tasks that are non-preferred.  This  lack of motivation  is not just an issue of “will power,” but a complex interplay between psychological factors, brain factors, and parenting factors.  Psychological factors include disorders known to specifically affect motivational systems such as depression and ADHD and factors that affect our psychological responses to challenges or distressing tasks.  For example, in depression, motivational systems are dampened to the point of very little, if anything, seeming motivating or pleasurable.  Conversely, in ADHD, teens are more likely to impulsively engage in pleasure-seeking or enjoyable activities and require immediate gratification from these activities to remain engaged.  Neither of these lend themselves to helping a teen complete a difficult, lengthy task.  Combine this with low distress tolerance–the tendency to “give up” or not persevere on something that isn’t pleasurable or is perceived to be difficult–and the result is a teen who may be perceived as “not even trying.”

These psychological aspects are closely related to the brain processes implicated in motivation.  While  the complexity of these is too broad for this article, there are a couple important considerations to help understand teens’ motivation.  The first consideration is that of the neurotransmitters involved in motivation, such as dopamine.  Dopamine affects motivation through its effects on how an individual experiences pleasure and perceives the salience of a reward.  It helps us to determine the cost/benefit of rewarding experiences.  Dysregulations in dopamine, either too little or too much, can impair our motivation to work or act on what is important.

The next consideration are dysregulations in the specific brain areas considered to reflect aspects of the motivational system such as the anterior cingulate cortex (ACC) and the dorsolateral prefrontal cortex (DLPFC).  The ACC, in particular, is involved with cognitive control, reward valuation, and has strong connections to subcortical dopamine pathways.  Activity in the ACC contributes to waning effort on difficult tasks and facilitates the switch to more preferred activities.  The DLPFC has been shown to be related to the approach behaviors associated with the attainment of goals, but can also be linked to more difficulties inhibiting more automatic responses.  That is, if a teen’s automatic response is to disengage or do a preferred activity, this area of the brain may be making it even more difficult for them to modify that response.  This is supported by research suggesting that these same brain systems are involved in distress tolerance–the ability to persist on a task despite it being challenging or aversive.  Disruptions in this area are associated with a teen more quickly “giving up,” when a reward is not present or salient.   Combined, the dysregulations in both the dopamine system and in the functioning of critical areas of the prefrontal cortex, such as the ACC and DLPFC, can wreak havoc on a teen’s ability to recruit the necessary motivation to complete aversive tasks.

Finally, parenting factors must be considered.  These involve behaviors rooted in  doing things for your teen, rather than having them do them for themselves.  For example, writing in your teen’s calendar, making them lists or reminders, and not allowing them to experience any natural consequences for their behaviors. Parents often want to save their teen from these consequences which, on the surface, seems appropriate.  Yet,  this reinforces the cycle within which the teen is caught: Why be motivated to make a change in behavior, if they know that they will always be saved?

While it may seem impossible to change the psychological or neurobiological processes with which your teen was born, there are compensatory strategies and behaviors that can help to facilitate stronger executive functioning. So, how can you help  a teen with motivation to make these changes?

Start building habits as early as possible. Healthy habits and routines are critical for overall health and success.  Just like children are taught to brush their teeth or wash their hands, executive functioning strategies and behaviors must be taught and reinforced as early as possible.  Imagine trying to get a teenager to start brushing their teeth at age 12 or 13!  It would be so  challenging.  Yet, because the habit and skill was taught so early, it has become automatic and routine.  Habits such as writing assignments down, making lists, and planning can be started as early as grade school, with support.  It is never too early to start routines or use strategies that will be important as the child gets older.  As described above, teens with EF difficulties have difficulty making the “correct” choice when it comes to doing a non-preferred activity over a preferred activity.  The key here is to limit the number of choices that your teen has to make by creating clear rules and habits from a young age.  For example, homework must be completed after school (with the exception of a clearly defined “break” of a set-amount of time).  If the teen is in such a routine that no choices are involved, they are less likely to give into their brain’s urge to push them toward the preferred pleasurable activity because the habit has become the more adaptive “automatic response.”

Identify “quicksand activities” and moderate the use of these.  Quicksand activities are those activities that are likely to suck you in and are nearly impossible from which to disengage.  For many, these activities fall in the category of screens, social media, or gaming.  You’ve probably asked yourself, “Where did that hour just go? There’s no way I was lost on my phone for that long.”  But, even adults are susceptible to these quicksand activities.  Helping your teen to recognize what these activities are is the first step.  Ask yourself and your teen, “What activities cause the most fights?” “What activities are the hardest to stop doing  when  asked?” “Where does time seem to disappear?”  Once these are identified, their use must be closely monitored and avoided unless all responsibilities are accomplished.  As can be seen, engagement with quicksand activities should never occur as a “break” afterschool or otherwise until non-preferred tasks are completed.

Make the idea of behavior change relevant (to you and your teen).  One of the most important factors in a person engaging in behavioral change is making it relevant and important.  If a teen is unable to find any reasons for why trying new strategies could be useful, the change will be much more difficult to make.  Ask your teen what the “pros” of change are.  Have them clearly visualize how putting effort into a change may be good for them.  Discuss what aspects of their lives might be better if they are willing to make the change.  Your teen isn’t the only one who needs to reflect on how hard it is to change and why it might be worth it.  You, as a parent, must also commit to making changes to support your teen.  Being consistent and supporting the use of good compensatory strategies is hard.  If you can’t commit to it, then your teen won’t be motivated to either.   

Consistently use rewards.   In order to create new habits, the behavior must start.  If your teen is resistant to trying strategies, consider using a reward system.  These are typically most effective when they are salient (i.e., important/relevant) to the teen and when given in close proximity to the completed behavior.  There is no perfect reward.  This is entirely dependent on the person and what works.  Teens have earned additional time on their weekend curfew by writing in their planners each day; Other teens are not allowed to have screens unless they’ve demonstrated their use of the habits.  Other teens earn money for the use of the skills.  Whatever it is that motivates your teen, use it!

Considering the  above, parents should know that this is more than just an issue of your teen needing to work harder.  That said, is hard work needed to improve executive functioning?  Absolutely.  Do teens and parents  need to commit and put effort into change?  Absolutely.  Does this change require will-power?  Absolutely.  Is it harder for some teens than others?  Absolutely.  Parents need to recognize this and emphasize the need for consistency, concrete routines, and strategies to optimize your teen’s motivation.   Hopefully by this point, it’s more clear that your teen is not trying to be this way, but is needing your help in navigating the obstacles that they are currently facing as a result of a  larger issue such as ADHD, autism, mood or anxiety disorders.

Alissa Ellis, PhD is a Los Angeles based clinical neuropsychologist who specializes in understanding and modifying emotional and cognitive processes in teens and adults with mood, anxiety and attention disorders.  She is a Health Sciences Assistant Clinical Professor in the department of psychiatry at UCLA  and has a private-practice (www.EllisEffect.com).  Dr. Ellis is the creator and director of the thinkSMART® program, a behavioral intervention for teens and their parents targeting weaknesses in executive functioning, which is currently being offered through UCLA (semel.ucla.edu/thinksmart).  She is also an avid researcher focusing on the effects of the thinkSMART® program on executive functioning and how individual differences in motivation affect the outcome of the program.  Dr. Ellis also has grant funding from the National Institute of Mental Health to examine how adolescents’ neurobiological responses to reward and frustration impact their mood over time.