Day 58 of 99 Days to FASDay: FASD and Executive Functions

Updated 2022

I’m not certain if the Know FASD website was around when I first began this series, but it has great information and links; so information for Day 58 has changed.

From one of the links on the site, executive function is described like a bicycle wheel. The many skills that comprise it, are the spokes. It is possible that only 1 or 2 spokes are damaged; however, the wheel is affected. Individuals with FASD may have only 1 or 2 of these skills affected, or they may have many skills affected.

The frontal lobe of the brain is responsible for many tasks related to executive function. Part of the reason why executive function deficits are more pronounced in adolescence is that the frontal lobe continues to develop during adolescence and during this time, the individual is faced with more behavioural regulation expectations along with greater opportunity to take risks. The inability to properly inhibit responses and learn from consequences may lead to impulsivity and risky behaviour.

Executive functioning comprises of many cognitive skills involved in goal oriented behaviour. It includes mental processes that require controlling of thought processes, usually in order to problem solve and achieve a goal as efficiently as possible. Executive functions are a prominent area of difficulty for people with FASD.

People with FASD may have problems in these areas of executive functioning:

  • Planning (“What do I do first, second third…”)
  • Problem solving (“What are my options? Which is best?)
  • Monitoring their own thought processes (“I think I did that wrong? I should not say that out loud.”)
  • Cognitive Flexibility (“This requires subtraction, this one addition.”  “Stir the pot on the stove, and then turn the kitchen tap off … then back to the stove.”)
  • Rapidly producing responses(“nonverbal and verbal fluency” Keeping up with a conversation)
  • Stopping themselves from providing particular responses in a given situation (Applying a “brain brake pedal”)
  • Working Memory
  • Use of feedback (“I heard it, and I remember it, but I don’t know how to act on it”)

Executive function problems increase as a task becomes more complex and more abstract. This means it has more components involved and is less applied (You can’t see it or work with it)

Much of this “higher level” thinking or abstract thinking develops in late childhood in typically developing children. But other aspects of executive function continue to develop into adolescence and adulthood. These developments are delayed and/or lacking in individuals with FASD. Executive functioning problems may become more pronounced in adolescence and adulthood as expectations for independence grow.

From the Original series:

From Teresa Kellerman at Come Over To

Individuals with FASD often have symptoms or behaviors that are a direct result of damage to the prefrontal cortex, which is the part of the brain that controls “executive functions.”

These are examples of executive functions of the prefrontal cortex and the effects of alcohol exposure on behaviors related to them:

  • inhibition:  behavior perceived as socially inappropriate
  • problem solving: inability to spontaneously figure out solutions
  • sexual urges: inability or difficulty controlling sexual impulses
  • planning: inability to apply consequences from past actions
  • time perception: difficulty with abstract concepts or time and money
  • internal ordering: like files out of order, difficulty processing information
  • working memory: storing and/or retrieving information
  • selfmonitoring: needs cues, supervision and support from others
  • verbal selfregulation: needs to talk to self out loud, needs feedback
  • empathy: diminished sense of remorse, inability to understand others
  • regulation of emotion: moody roller-coaster emotions, exaggerated
  • motivation: need external motivators to complete menial tasks
  • judgment: inability to weigh pros and cons when making decisions

For a great chart showing skill areas and descriptions at different levels check out Tri-Level Man, John Kellerman’s Levels of Ability For Self-Care and Daily Living Skills. Thank you to Teresa and John Kellerman for sharing their story and experiences.

Research on Executive Functioning in FASD

Uploaded to Policy Wise

Executive function (EF) has been defined as higher-order cognitive processes involved in goal-oriented behavior under conscious control.

EF is an umbrella term for many cognitive processes including planning, inhibition, working memory, set shifting, flexible thinking, strategy, employment, organized search, abstract thinking, concept formation and fluency.

EF emerges around one year of age and important developments in EF occur between 2 and 5 years. Adult-level abilities are reached on some EF tasks by 12 years, whereas other EF abilities develop until adulthood.

One common finding in the research on EF in FASD is that these EF deficits persist regardless of whether the individual has facial characteristics of FAS. This finding indicates that alcohol damage on some cognitive functions may be just as severe for those with and without full FAS, and it highlights the importance of understanding the CNS deficits that these individuals display.

It is also important to note that in some studies the EF deficits were lower than what would be predicted based on the participants IQ. Thus, the EF deficits found in FASD cannot be solely attributed to a low IQ.

One aspect of EF that appears to be particularly important in FASD is working memory.

Researchers at the University of Alberta (Rasmussen & Bisanz) completed a study examining EF in children and adolescents with FASD.

The goals of this study were to examine

1) The pattern of EF deficits in FASD, and

2) Age differences in EF abilities in FASD.

Twenty-seven children with FASD aged 8 to 16 years participated in this study, in which they completed many different tests of executive functioning. The scores of the children with FASD were compared to the average scores for a sample of children without FASD.

Children with FASD performed poorly on most tests of executive functioning, and a distinctive profile emerged. Children with FASD performed poorest on the test that involved problem solving, flexible thinking, and concept formation.

The children did not have difficulty on executive functioning tests that involved nonverbal fluency, planning, and spatial reasoning.

Compared to children without FASD, older children with FASD showed more difficulty on some verbal tests of EF than younger children with FASD.

Difficulty on verbal EF appears to be more pronounced with age.

Some researchers (Watson & Westby) have suggested various strategies for addressing EF deficits in children prenatally exposed to alcohol and other drugs.

For example, for difficulties with nonverbal working memory (remembering events, information, and behaviors etc.) they suggest using visualization techniques including self-awareness training, consistent and structured environments and routines, as well as visual aides and checklists.

For difficulties with self- directed speech and verbal working memory they suggest language intervention, cognitive- behavioral intervention, and linking visual cues to verbal prompts.

The authors further recommend social skills training, role-playing, social stories, and teaching the vocabulary of emotions, to deal with problems with self-regulation.

Lastly, for difficulties with problem solving they suggest cognitive modeling, coaching, and self-determination curricula.

A Day in the Life

Here is a great graphic from Understood to illustrate a day in the life of a child with executive functioning issues.

Ready to explore more? Find out from an expert whether kids outgrow executive functioning issues. Get tips on how color-coding can help. And learn about classroom accommodations for executive functioning issues

Executive Function & Self-Regulation

While not an article specific to FASD, there is some interesting information and ideas on the Centre for the Developing Child website you may be able to adapt.

Executive function and self-regulation skills are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses.

Executive function and self-regulation skills depend on three types of brain function: working memory, mental flexibility, and self-control. These functions are highly interrelated, and the successful application of executive function skills requires them to operate in coordination with each other.

Each type of executive function skill draws on elements of the others.

    • Working memory governs our ability to retain and manipulate distinct pieces of information over short periods of time.
    • Mental flexibility helps us to sustain or shift attention in response to different demands or to apply different rules in different settings.
    • Self control enables us to set priorities and resist impulsive actions or responses.

For more information: Center on the Developing Child (Harvard University)


Check back tomorrow for Day 59 as we continue looking at primary characteristics of FASD!

One thought on “Day 58 of 99 Days to FASDay: FASD and Executive Functions