Executive Functioning and Executive Dysfunction
Executive Function
Myth or Magic
Gary Cunningham
The Functional Test
Can the person: -
1.
Understand the information relevant to the
decision
2.
Retain the information
3.
Use or weigh the information
4.
Communicate
What is
Executive Functioning?
According to Headway, it is an umbrella term that
includes: -
•
Planning and organisation
•
Self-awareness
•
Initiating appropriate behaviour
•
Inhibiting inappropriate behaviour
•
Controlling emotions
•
Concentrating and taking in information
•
Motivation
What is
Executive Functioning?
Executive
Dys
function is:
“….term for the range of cognitive, emotional
and behavioural difficulties which often occur
after injury to the frontal lobes of the brain.”
Headway.org.uk
Some Common Effects
of Executive Dysfunction
•
Loss of 'get up and go'.
•
Problems with thinking ahead and carrying out the sequence
of steps needed to complete a task.
•
Finding it hard to anticipate consequences
•
Acting too quickly and impulsively without fully thinking
through the consequences
•
Reduced ability to engage in social interactions
•
Difficulty with learning new information
SAR Re. KH
Gloucestershire SAB 2016
•
KH, male, moved to Glos in 2010. Had several
adult children, some of whom lived with KH
•
Started to have difficulty walking, eventually
leading to using a walking frame
•
GP visited – concerns about state of home
•
KH would attend hospital as inpatient for
investigation but would discharge himself
•
2015 – KH “switched off” and appeared to
have “given up”
SAR Re. KH
Gloucestershire SAB 2016
•
Visited GP early 2015 – leg oedema, skin
breakdown on buttocks and incontinence, as
well as other issues
•
Various issues around Nurses, visiting but not
gaining access; GP appointments made but
not attending – regular pattern of KH’s
behaviour
•
SW and OT did manage to visit – condition of
flat and lack of cleaning
SAR Re. KH
Gloucestershire SAB 2016
•
December 2015 – call made to emergency
services
•
Ambulance team found KH to have significant
pressure sores (Grade 4 with maggots)
•
Flies/insects flying round the room
•
Flat cluttered, full black bin-liner bags blocked
the majority of floor space
•
KH survived
SAR Re. Hannah
Gloucestershire SAB 2017
•
Hannah, was 26 in 2016
•
Described as “highly intelligent, articulate, caring
and multi-talented…”
•
She had on-going physical and mental health
‘challenges’ – increasing obesity, self-harming
behaviours and illicit drug use
•
Up to January 2015 she had been sectioned
under the MHA, had therapeutic interventions,
contact with the police and over 100 attendances
to hospital over a 12 year period
SAR Re. Hannah
Gloucestershire SAB 2017
•
Hannah was admitted to hospital Feb 2015 –
initially felt she lacked capacity to make
‘sound’(?) decisions.
•
Discharged on 3 March – re-admitted on the
6
th
March for 6 days
•
Staff thought that to some extent, Hannah
had been through so many things that she felt
she was invincible and didn’t recognise the
increasing risk she was putting herself under.
SAR Re. Hannah
Gloucestershire SAB 2017
•
November 2015 – Hannah had taken an
overdose, but refused to go to hospital
•
January 2016 – broken needle in her arm
•
Discussed potential risks, amputation of arm
and death due to health problems and
Hannah understood
•
May 2016 – Hannah underwent surgery and
discharged (10
th
May) with community
support
SAR Re. Hannah
Gloucestershire SAB 2017
•
May 26
th
– wound necrotic and urged Hannah
to seek urgent medical attention. She declined
to go to hospital
•
Nurse explained risk of dying and Hannah was
taken to a different hospital by a friend
•
May 27
th
– Hannah died
SCR Re. Mr C
Bristol SAB 2016
•
Mr C, aged 61 in 2014, suffered mental health
problems since approx. 1985
•
He had a history of being sectioned under the
MHA and was being supported in his BCC rented
flat by various health care professionals
•
2012 – Mr C’s son advised AWP that he couldn’t
support his father any longer due to his use of
cocaine and increased threat of violence by his
father
SCR Re. Mr C
Bristol SAB 2016
•
June 2013 – report smoke was coming from
Mr C’s balcony – “having a BBQ”
•
September 2013 – twice fire brigade called to
deal with more ‘BBQ’s’ – told no more BBQ’s
due to fire risk
•
March 2014 – smoke from the balcony –
warned again about burning items
•
May 2014 – 2 further visits by fire brigade
SCR Re. Mr C
Bristol SAB 2016
•
30 May – injunction issued prohibiting Mr C
lighting fires in his flat. Mr C said he
understood why the injunction was needed
•
Early July – visit noted “charred and burnt
furniture”. Identified risks in the continued use
of candles and fires for cooking – he did not
see as a fire hazard
•
6 September – A fire broke out in the flat and
Mr C died
TB v KB and LH [2019]
EWCOP 14
•
KB, a 75 year old man, divorced in 2010 and
has 2 adult children
•
Has long standing issues with alcohol
consumption and various medical conditions
•
Through alcohol he urinates in public,
inappropriate and anti-social behaviour
•
Physically – minor cardiac event several years
ago, diagnosed with prostrate cancer,
secondary in lungs and bones
TB v KB and LH [2019]
EWCOP 14
•
Hospital notes
–
2012 – KB’s cognitive state was fair, although
evidence of some short-term memory loss
–
2016 – very significant cognitive
problems….marked deficits in short term
memory….consistent degree of unawareness of
his problem are consistent with a dementing
illness
TB v KB and LH [2019]
EWCOP 14
•
“…the deficits identified in P’s (KB) memory
and executive function mean that he not be
able to retrieve relevant information and not
be able to use and weigh….” Macdonald J
•
“People with executive functioning and
deficits in their short-term memory may be
okay, but may have difficulty in electing the
right bits and using them in context…”
Professor Kapur
Myth or Magic?
•
It’s real!
•
However, deficits in Executive Functioning is
part of the diagnosis
•
The magic comes from how you use the skills
that you have in questioning -
–
Is the person really
using
the information?
–
Are they really
weighing
up the information?
Questions!
Executive Functioning is a key aspect of cognitive function, encompassing various abilities such as planning, self-awareness, and emotion regulation. Executive Dysfunction, often resulting from frontal lobe injuries, can lead to difficulties in decision-making, social interactions, and learning. This content explores the concept of Executive Functioning, its common effects, and a real-life case study highlighting the challenges faced by individuals with Executive Dysfunction.
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Presentation Transcript
Executive Function Myth or Magic Gary Cunningham
The Functional Test Can the person: - 1. Understand the information relevant to the decision 2. Retain the information 3. Use or weigh the information 4. Communicate
What is Executive Functioning? According to Headway, it is an umbrella term that includes: - Planning and organisation Self-awareness Initiating appropriate behaviour Inhibiting inappropriate behaviour Controlling emotions Concentrating and taking in information Motivation
What is Executive Functioning? Executive Dysfunction is: .term for the range of cognitive, emotional and behavioural difficulties which often occur after injury to the frontal lobes of the brain. Headway.org.uk
Some Common Effects of Executive Dysfunction Loss of 'get up and go'. Problems with thinking ahead and carrying out the sequence of steps needed to complete a task. Finding it hard to anticipate consequences Acting too quickly and impulsively without fully thinking through the consequences Reduced ability to engage in social interactions Difficulty with learning new information
SAR Re. KH Gloucestershire SAB 2016 KH, male, moved to Glos in 2010. Had several adult children, some of whom lived with KH Started to have difficulty walking, eventually leading to using a walking frame GP visited concerns about state of home KH would attend hospital as inpatient for investigation but would discharge himself 2015 KH switched off and appeared to have given up
SAR Re. KH Gloucestershire SAB 2016 Visited GP early 2015 leg oedema, skin breakdown on buttocks and incontinence, as well as other issues Various issues around Nurses, visiting but not gaining access; GP appointments made but not attending regular pattern of KH s behaviour SW and OT did manage to visit condition of flat and lack of cleaning
SAR Re. KH Gloucestershire SAB 2016 December 2015 call made to emergency services Ambulance team found KH to have significant pressure sores (Grade 4 with maggots) Flies/insects flying round the room Flat cluttered, full black bin-liner bags blocked the majority of floor space KH survived
SAR Re. Hannah Gloucestershire SAB 2017 Hannah, was 26 in 2016 Described as highly intelligent, articulate, caring and multi-talented She had on-going physical and mental health challenges increasing obesity, self-harming behaviours and illicit drug use Up to January 2015 she had been sectioned under the MHA, had therapeutic interventions, contact with the police and over 100 attendances to hospital over a 12 year period
SAR Re. Hannah Gloucestershire SAB 2017 Hannah was admitted to hospital Feb 2015 initially felt she lacked capacity to make sound (?) decisions. Discharged on 3 March re-admitted on the 6thMarch for 6 days Staff thought that to some extent, Hannah had been through so many things that she felt she was invincible and didn t recognise the increasing risk she was putting herself under.
SAR Re. Hannah Gloucestershire SAB 2017 November 2015 Hannah had taken an overdose, but refused to go to hospital January 2016 broken needle in her arm Discussed potential risks, amputation of arm and death due to health problems and Hannah understood May 2016 Hannah underwent surgery and discharged (10thMay) with community support
SAR Re. Hannah Gloucestershire SAB 2017 May 26th wound necrotic and urged Hannah to seek urgent medical attention. She declined to go to hospital Nurse explained risk of dying and Hannah was taken to a different hospital by a friend May 27th Hannah died
SCR Re. Mr C Bristol SAB 2016 Mr C, aged 61 in 2014, suffered mental health problems since approx. 1985 He had a history of being sectioned under the MHA and was being supported in his BCC rented flat by various health care professionals 2012 Mr C s son advised AWP that he couldn t support his father any longer due to his use of cocaine and increased threat of violence by his father
SCR Re. Mr C Bristol SAB 2016 June 2013 report smoke was coming from Mr C s balcony having a BBQ September 2013 twice fire brigade called to deal with more BBQ s told no more BBQ s due to fire risk March 2014 smoke from the balcony warned again about burning items May 2014 2 further visits by fire brigade
SCR Re. Mr C Bristol SAB 2016 30 May injunction issued prohibiting Mr C lighting fires in his flat. Mr C said he understood why the injunction was needed Early July visit noted charred and burnt furniture . Identified risks in the continued use of candles and fires for cooking he did not see as a fire hazard 6 September A fire broke out in the flat and Mr C died
TB v KB and LH [2019] EWCOP 14 KB, a 75 year old man, divorced in 2010 and has 2 adult children Has long standing issues with alcohol consumption and various medical conditions Through alcohol he urinates in public, inappropriate and anti-social behaviour Physically minor cardiac event several years ago, diagnosed with prostrate cancer, secondary in lungs and bones
TB v KB and LH [2019] EWCOP 14 Hospital notes 2012 KB s cognitive state was fair, although evidence of some short-term memory loss 2016 very significant cognitive problems .marked deficits in short term memory .consistent degree of unawareness of his problem are consistent with a dementing illness
TB v KB and LH [2019] EWCOP 14 the deficits identified in P s (KB) memory and executive function mean that he not be able to retrieve relevant information and not be able to use and weigh . Macdonald J People with executive functioning and deficits in their short-term memory may be okay, but may have difficulty in electing the right bits and using them in context Professor Kapur
Myth or Magic? It s real! However, deficits in Executive Functioning is part of the diagnosis The magic comes from how you use the skills that you have in questioning - Is the person really using the information? Are they really weighing up the information?
