Executive Function

The area of executive function is one that is commonly affected, even in children who have experienced a mild TBI. It also is one in which the full effect of the injury may not be manifest until the child has matured to the point when one would expect him or her to demonstrate these particular skills.

Working memory is one of the first executive function areas to develop, emerging between 7 and 12 months of age. It involves being able to temporarily store some information while concurrently process­ing and retrieving other data (157). It has been shown to be impaired after TBI, and the degree of impair­ment relates to the severity of injury (5,154,157). Other areas commonly affected by TBI include the ability to inhibit, shifting set, planning, self-monitoring and control, decision making, social cognition, and behav­ioral self-regulation. The Behavior Rating Inventory of Executive Function (BRIEF) is a tool that uses parent and teacher ratings to evaluate the impact of execu­tive dysfunction on everyday life (5). Interventions for executive dysfunction have not been rigorously studied. Some have suggested using an approach that breaks tasks into problem-solving steps. Also, the pro­vision of a structured environment and expectations is important. Incentives for progress toward a goal can be helpful. It is imperative that parents develop an effec­tive working relationship with their child's school pro­gram providers to have open communication around the issues of executive dysfunction and its impact on school programming (5,156,158).