Read about the impact we have on supporting people with brain injuries and other neurological conditions
Our team across our services are here to answer your queries and questions
Take a look at our different services across the UK, and how they can support you
Read about how our services are having an impact on people’s lives
Learn about brain injuries, the rehabilitation journey, from diagnosis and treatment to the ongoing support and independence.
The Brain Injury Linkworker Service is based on the belief in equal and fair access to neurorehabilitation for all. Learn how we can support your organisation.
Read the latest insights about brain injury rehabilitation from the Brainkind research team
View our research teams published book chapters and articles in peer reviewed publications.
Too Many to Count is the first study in the United Kingdom to explore the prevalence of brain injury in domestic abuse survivors accessing community-based services.
Do you support homeless people and prisoners and ex-offenders who have experienced an acquired brain injury? Our training is designed to give you the tools you need to support people in your service.
Login to view and download our BINI and BISI tools
View our careers page for jobs across all our services.
There are many ways to donate to Brainkind. Your donations will help support people with brain injuries and neurological conditions.
Home / What are executive functions and how do they shape behaviour?
Some days it can feel like the world has turned upside down. Bad news, followed by more bad news, the media providing a steady stream of coverage of depressing, frightening, and alarming events. Much of this relates to human behaviour, what we do, and its results. We hear about conflict, humanitarian crises, crime, and overflowing prisons. Are humans’ behaviours deteriorating? Or are we just more aware of what is happening in the world than before? What drives our behaviours, how do behaviours ‘work’ at a brain level?
Executive functions (EFs) refer to a group of higher-level cognitive skills that are essential for human behaviours such as pursuing goals and adapting to novel situations. These include abilities for our everyday survival, such as working memory, inhibitory control, cognitive flexibility, planning, reasoning, and problem solving [1]. When these functions are impaired, people may struggle to manage their thoughts, emotions and behaviours, potentially resulting in behaviours considered challenging, out of line with social norms, or even criminal.
Research has consistently shown that damage to the frontal lobes is associated with impairments in executive functions, indicating that EFs are primarily located in networks involving the frontal lobes and prefrontal cortex or key connections to these areas of the brain [2], which are large, late developing and particularly vulnerable to injuries to the head [3], also known as traumatic brain injuries (TBI), such as falls, car accidents, and assaults.
For example, a study by Epstein and colleagues [4] of 55 patients with TBI found that damage to the frontal cortex disinhibited subcortical generators, which are neural pathways essential for functioning, including emotional processing, and that this, in turn, could lead to increased clinical symptoms such as aggression, anxiety, and depression. Although participants all had ‘mild’ traumatic brain injuries, the researchers concluded that the cumulative number of TBIs and whether these had led to loss of consciousness could influence symptoms long after injury, as participants had sustained their injuries nine years prior, on average.
While some studies may have cast a degree of doubt with regards to the exact nature of the link between the frontal lobes and executive functions [5], the body of evidence, including some very interesting, high profile case reports [6, 7], indicating that those with damage to the frontal networks of the brain are more likely to have EF difficulties, is now quite large. But how do these difficulties impact on behaviour?
There are many different ways in which difficulties with executive function can affect our behaviour. For example, impairments in cognitive flexibility may lead to rigid thinking and difficulty adapting to rules. These difficulties may contribute to so called oppositional or non-compliant behaviour, emotional outbursts and lowered tolerance to frustration – especially when people are unable to read others’ emotional cues or respond appropriately to them.
In one of the first studies to use behavioural assessment of aggression in response to provocation, Tonnaer and colleagues [8] found that the ability to inhibit responses, or put differently, the ability to ‘count to ten before responding’, was a key factor, as their study showed this to be a stronger predictor of reactive aggressive behaviour than other executive functions, such as working memory, flexibility, and divided attention.
More recent studies have investigated the specific contribution of focal prefrontal cortex damage and executive dysfunction to our ability to recognise emotions. Ouerchefani and colleagues [9] examined 30 patients with focal prefrontal cortex damage and 30 controls. They asked both groups to complete inhibition, flexibility, planning, and emotion recognition tasks. The patients demonstrated impairments in recognising fear, sadness, and anger, alongside deficits on all executive measures. Poorer emotion recognition was associated with deficits in inhibition and cognitive flexibility, highlighting the interplay between executive dysfunction and emotional dysregulation.
In a second study, the same research group [10] reported that over 50% of people with focal prefrontal damage presented both cognitive and behavioural dysexecutive syndromes, displaying difficulties with initiation, inhibition, as well as behavioural dysregulation. These deficits were associated with decreased autonomy in day-to-day activities and increased behavioural issues, such as hypo- or hyper-activity, distractibility, irritability and aggressiveness. This further demonstrates the role that the frontal networks of the brain are likely to play on integrating cognitive processing and behavioural control.
Understanding a bit more about the role of executive functions in the human brain can helps us to consider some additional, or alternative perspectives or explanations for some of the seemingly constant stream of ‘bad news’ we are exposed to in the media and our everyday lives. While executive functions certainly do not explain each and every behaviour or event, it is always useful to know more about the science behind some of our human behaviours.
To recap, executive functions, which are primarily controlled by the frontal lobes and prefrontal cortex, are vital for effective cognitive, emotional, and behavioural regulation. Damage to these areas can result in significant impairments, which in turn may lead to emotional dysregulation, difficulties in social functioning, behaviours that challenge, and, in some situations, even contribute to violence, criminal offences.
Understanding this relationship has critical implications for education, prevention, and practice by health and social care professionals as well as that of those working within the criminal justice system, such as police, prison and probation officers. Without this understanding, it is difficult to effectively support people with such impairments and work with them to reduce behaviours of concern. The evidence we have to date, highlights how some behaviours often reflect neurological deficits, including the cognitive and emotional regulatory aspects of executive functions. However, there is more work to do to further explore how these changes in executive function after a brain injury evolve over time, and how different people respond to different intervention strategies.
