In his recent book, “Fire and Fury,” Michael Wolff asserts that President Donald Trump is “wholly lacking” in what neuroscientists would call Executive Functions. Mr. Wolff defines Executive Functions as the brain’s ability to see cause and effect, to be flexible in your thinking, and to think in an orderly and organized manner.
This assertion regarding our president has surely sparked a lively debate in the media and around the dinner table, but does the general public really understand what “executive functioning” means? Is this term going to be the next buzzword as our country debates Trump’s fitness to serve as commander-in-chief? If so, then the public would benefit from some added insight into this nebulous term.
Executive functioning (EF) is no passing fad and has been studied by neuroscientists and neuropsychologists for decades. It is actually a broad term used to capture many types of higher-level cognition. Yes, planning, organization and flexible thinking are included under that umbrella. But executive functions are much more than these individual skills. This domain of our cognition consists of problem solving, dealing with novelty, planning, mental flexibility, discriminating between relevant and irrelevant information, and anticipating cause-effect relationships. EF has been conceptualized as “meta” cognitive activity, which overarches other cognitive functions. EF in the brain is like the business executive who is not a specialist in any particular area, but who is in charge of supervising and managing multiple domains. EF allows us to initiate and organize a large project, plan a trip or write a research paper. EF also allows us to adapt to changes in our environment and figure out new approaches when solving a problem.
Unfortunately, this important part of the cognitive world is particularly vulnerable to the effects of age. Older adults tend to perform more poorly than younger adults on tasks of concept formation, mental flexibility and planning. In general, older persons tend to think in more concrete terms than young adults and the mental flexibility needed to form new links between concepts diminishes with age, with the steepest declines occurring after age 70.
To illustrate this point, consider this age-related performance discrepancy on a commonly-used cognitive test of EF. On this test, the average high-school educated, young adult is expected to generate five or six solutions to the problem at hand; however, an individual in their 60’s is expected to generate only three solutions. And an individual in their 80’s may generate only one solution and still be considered “average for their age.” This dramatic difference in performance between young and old adults illustrates how less able an older adult may be at formulating problem solving techniques when confronted with a novel task, even in the absence of any pathology or dementing condition.
But, is it possible to have a perfectly healthy brain, even a somewhat older brain, and STILL have trouble making good decisions, solving problems or organizing your desk? I’m sure you all know someone who seems to make one bad, impulsive decision after the next or who tells the same meandering, pointless story over and over. Does this person have brain damage? Are they wholly lacking in executive functions? Maybe… but maybe not. There are many variables which affect our behavior and thinking. Cognitive skills supported by an intact brain are one set of variables. But other variables include our emotions, our motivations, our egos and our situational demands. All of these factors can lead a perfectly healthy brain to make very bad decisions. How do we know what is causing the problem in someone’s behavior and judgement?
A neuropsychologist is a type of psychologist who is specifically trained to sort out problems due to cognitive deficits versus problems due to emotional or personality factors. They are uniquely equipped with standardized measures to assess cognitive skills like executive functioning and objectively ascertain whether someone’s brain is functioning properly. A neuropsychologist is also able to evaluate the non-cognitive factors contributing to behavior, such as emotions and personality.
Whether or not Trump has intact Executive Functioning skills is unknown to me and most likely to many of you. Either way, I hope that as this term gains more attention in the media, trained professionals will be consulted in order to educate the public on this fascinating part of our cognitive world.