news_12_20

Jerusalem Post, 12/20/03

THE "BOSS" DISORDER

by Judy Siegel-Itzkovich

Executive function disorder is the scientific term for a neurological condition in which children, teenagers and adults have difficulty with all or some of the following processes: initiating, planning, organizing, working memory (the ability to hold information in one's mind while processing and manipulating it), selective attention, sustaining a mental set, inhibitory control and separating emotion from fact.

Shaare Zedek Medical Center in Jerusalem will soon open a new unit to screen for, assess and treat attention deficit hyperactivity disorder (ADHD) in adolescents and adults.

Dr. Judith Guedalia, head of the hospital's neuropsychological unit, recently announced that the service will be launched on January 1. She notes that researchers consider these functions to be controlled by the prefrontal regions of the brain, which operates like the conductor of an orchestra.

Over the past two decades, Guedalia notes, there has been considerable progress in understanding the functions of the prefrontal cortex, and its regulation of mental activities that allow for self-control and goal-directed behaviors which come under the umbrella of "executive functions." Until recently, the terms executive function and dysfunction were mainly confined to textbooks and used by neuropsychologists.

"But today, parents and educators are seeing those same terms in evaluations of under-performing children and adolescents with learning disabilities and conditions like ADHD. The functions may, in addition, be seen in people of any age who are markedly disorganized, inefficient and failing in their careers," says the Jerusalem neuropsychologist.

Adolescent brains continue to change physically: The frontal lobe continues to develop late in adolescence, and in fact myelination (the coating of the neurons to make them mature) is not complete until the fourth or fifth decade of life. Some aspects of executive functioning, such as the ability to move from one activity to another, develop at an early age. However, the more notable difficulties such as organizational problems emerge as children move into intermediate school and enter adolescence and even adulthood.

"Professionals see a strong relationship between executive function and ADHD, and in fact, there is a high degree of overlap: Many pupils with ADHD demonstrate executive functioning difficulties. However, these symptoms are often not evident in the initial diagnosis of attention problems, since one of the defining characteristics of ADHD is onset in early childhood. Since the symptoms appear in adolescent and adult development, the patient often goes undiagnosed."

So far, there is no single test that measures the strength of executive functions.

Neuropsychologists, whose area of expertise is the brain-behavior relationship, use a series of tests to evaluate performance in a number of areas to make possible a more comprehensive evaluation. The executive-function/ADHD battery used at Shaare Zedek includes the newly developed computer-driven Neuro Trax (ordinarily used for early detection of dementia) and other neuropsychological tests.

Printed results of the tests and recommendations for treatment are given to the patient not only to increase awareness of the problems but also to suggest means of dealing with them.