Prefrontal Executive Function Syndromes in Children
Abstract
"Executive function" is a term describing the processes required for conscious control of thought, emotion, and action that are central to the management of one's day-to-day life. Executive function is subserved by the prefrontal cortex and related subcortical structures. Disorders affecting the prefrontal cortex-subcortical system are numerous and heterogeneous, but contemporary research has begun to elucidate the mechanisms and consequences of dysfunction in various subsystems with increasing specificity. Prefrontal executive dysfunction results in impaired regulation of cognition, attention, behaviors, arousal, and emotion, all of which have serious and pervasive consequences for functioning across the life span. These executive function deficits are typically difficult to treat, ameliorate, or remediate and require sensitive handling by caretakers. Executive dysfunction can arise as a consequence of many different factors (metabolic, genetic, certain types of epilepsy, cerebral dysgenesis, prematurity, traumatic brain injury, hypoxia, and toxic exposure). The present review delineates the features of prefrontal executive function deficits in children and proposes a roadmap for their diagnosis, treatment, and management.
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Children may perform within expected levels on executive functioning tasks in the clinic but perform poorly in daily activities that require executive functioning abilities.
“children may perform within the expected levels on EF tasks in the clinic setting but perform poorly in daily activities that require EF abilities (Powell and Voeller 2004).”
From Characterizing the Factor Structure of Parent Reported Executive Function in Autism Spectrum Disorders: The Impact of Cognitive Inflexibility (2014) · cites this paper as Powell and Voeller 2004
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“EF depends on prefrontal cortices which have a protracted maturation (Powell and Voeller, 2004; Sowell et al., 2004), making EF susceptible to developmental disturbances.”
BackgroundDiagnostic Group Differences in Parent and Teacher Ratings on the BRIEF and Conners' Scales
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“Executive function represents a complex construct that includes multiple abilities such as working memory, planning, emotional self-regulation, attention, organization, motivation, motor control, and goal-directed behaviors (Barkley, 1997; Powell & Voeller, 2004).”
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“This task assesses cognitive control processes that are particularly affected in TBI patients (Cicerone et al., 2005; Powell and Voeller, 2004; Rees et al., 2007).”
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“The highly structured situation of office-based testing may serve as the child’s executive control and preclude assessment of the full spectrum of real-world executive dysfunction, such as the ability to multi-task [29, 31, 53, 62, 63].”
BackgroundVogan, V. M., Morgan, B. R., Lee, W., Powell, T. L., Smith, M. L., & Taylor, M. J. (2014) · Journal of Neurodevelopmental Disorders · doi:10.1186/1866-1955-6-19 · Cited by 70 · see citing works
“The DLPFC is believed to play a critical role in holding information ‘online’ [26] and mediating strategic organization and data compression processes [68,69], hence its sensitivity to increasing cognitive demand in ours and other studies [68-71].”
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“Verbal fluency, inhibition of inappropriate behaviors, attentional control, and speed or efficiency of processing [35,36]”
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Vogan, V. M., Morgan, B. R., Powell, T. L., Smith, M. L., & Taylor, M. J. (2015) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2015.10.008 · Cited by 56 · see citing works
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Metacognição e funções executivas: relações entre os conceitos e implicações para a aprendizagem
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“These regions of the brain are known to be critical for a number of higher-order cognitive processes such as working memory, response inhibition, and cognitive flexibility (Powell and Voeller 2004).”
BackgroundLoad matters: neural correlates of verbal working memory in children with autism spectrum disorder
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“The protracted frontal lobe maturation means that the functions relying on the frontal lobes are particularly vulnerable to developmental disturbances [13, 14].”
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“Such cases continue to be encountered in occasional striking clinical presentations, as we have seen recently in 2 new cases (see Figure 1 for examples), but also in more mixed and subtle forms in acquired and neurodevelopmental disorders involving frontal pathophysiology ( Powell & Voeller, 2004 ).”
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“Regulatory functions that can be foundational for cognitive development do not newly emerge in childhood, but evolve from birth [68], [42],[43].”
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“It mediates attention and controls distractibility, maintains focus but also provides flexible shifts of cognitive set, and is also involved in generating fluent verbal and nonverbal activity (Powell and Voeller, 2004).”
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“The coexistence of EFD in children with ADHD has clinical significance: Children with ADHD and EF are at greater risk for significant academic, behavioral, and social problems than children with ADHD only ( Biederman et al, 2004 ; Powell & Voeller, 2004 ).”
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“Dysfunction of the frontal lobes and frontal-subcortical circuits is often associated with impulsivity and aggression, and poor decision making (e.g., Dyer, Bell, McCann et al. 2006; Powell & Voeller, 2004).”
BackgroundTraumatic Brain Injury and Suicidal Behavior: A Review
Wadhawan, A., Stiller, J. W., Potocki, E., Okusaga, O. O., Dagdag, A., Lowry, C. A., Benros, M. E., & Postolache, T. T. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-181055 · Cited by 32 · see citing works
“TBI also has been related to higher scores on measures of cognitive and personality traits, such as aggression and impulsivity [148, 224, 244–246], impaired decision-making [148, 224–226], and increased sense of hopelessness [137], all of which have been linked to death by suicide.”
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“It is the last cognitive function to mature [60] and evolves over a prolonged period of time through brain maturation and life experiences in childhood and adolescence.”
BackgroundAltered Functional Connectivity in Patients With Sloping Sensorineural Hearing Loss
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Executive Function in Nephropathic Cystinosis
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The Long-term Impact and Rehabilitation of Pediatric Traumatic Brain Injury
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“In our study, the neuropsychological tests sometimes lacked sensitivity as previously described [10,48].”
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“Powell and Voeller (2004) also argue that childhood executive functioning is subserved by the prefrontal cortex–subcortical system, with dysfunction at least partially caused by biological insults (e.g., hypoxia or toxic exposure) or abnormalities (e.g., genetic or metabolic).”
BackgroundEfectos de la actividad física sobre las funciones ejecutivas en una muestra de adolescentes
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“…Attention; Children; Adolescents Executive function represents a complex construct that includes multiple abilities, such as working memory, planning, emotional self-regulation, attention, organization, motivation, motor control and goal-directed behaviors (Barkley, 1997; Powell & Voeller, 2004).”
BackgroundPremature Infants: The Behavioral Phenotype of the Preterm Survivor
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“…traumatic insult in children (Mendelsohn et al. 1992; Wilde et al. 2012) and right frontal regions are vital in supporting executive functioning such as cognitive flexibility, judgment, and self-monitoring (Jacobs et al. 2007), which may contribute to social functioning (Powell and Voeller 2004).”
BackgroundInfluentialNeuromagnetic Vistas into Typical and Atypical Development of Frontal Lobe Functions
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“Disturbances of frontal lobe development can have severe consequences for the maturation of executive functions (Powell and Voeller, 2004).”
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Efectos de la actividad física sobre las funciones ejecutivas en una muestra de adolescentes
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“Results of this study support prior research findings of impaired EF associated with frontal-lobe involvement more so than temporal-lobe involvement, and particularly with problem solving (Hernandez et al., 2003; Powell et al., 2004).”
ResultHennessy, A., Nichols, E. S., Al‐Saoud, S., Brossard‐Racine, M., & Duerden, E. G. (2024) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045241228889 · Cited by 16 · see citing works
“…hyperactivity disorder (ADHD), often face academic challenges due to dif fi culties with executive functioning (EF) skills, which are essential for adaptive behavior and learning (e.g., working memory, planning, inhibition, attention) (Dajani et al., 2016; Powell & Voeller, 2004; Sun & Buys, 2012).”
BackgroundDisfunção executiva como uma medida de funcionalidade em adultos com TDAH
Saboya, E., Saraiva, D., Palmini, A., Lima, P., & Coutinho, G. (2007) · Jornal Brasileiro de Psiquiatria · doi:10.1590/s0047-20852007000500007 · Cited by 14 · see citing works
Wilderness adventure therapy and cognitive rehabilitation: Joining forces for youth with TBI
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“in mental health, juvenile justice and behavioural interventions, with rigorous evaluation, it could prove a most useful tool in the rehabilitation of young people with TBI [10, 51, 76].”
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“But there are other studies which found a relationship between empathy, social skills, and the proposed cognitive dimension of prefrontal cortex functions, the executive functions (Taiwo et al. 2021; Powell and Voeller 2004).”
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“…most evidence for TPJ ’ s involvement in mentalizing pertains to the right TPJ (Koster-Hale et al., 2017; Lombardo et al., 2011; Van et al., 2015) (although in certain mentali-zation tasks the TPJ appears to be activated bilaterally (Santiesteban et al., 2015; Ye et al., 2015; Young et al., 2010)).”
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“Furthermore, a multiple cases design was chosen to allow the examination of contrasting patterns along different dimensions; gender, type of CP, motor impairment, class arrangement, social participation in class, cognitive impairments, social impairments.”
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“…cortex (Collins et al., 2012; Nowrangi et al., 2014), evidence indicates that this region does not act alone in the performance of executive functions, but rather in conjunction with more subcortical and posterior, such as the thalamus and cerebellum (Elliott, 2003; Powell & Voeller, 2004).”
Measures of General Cognitive Functioning
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“syndrome (18), and executive dysfunction (19), and differential diagnoses, such as Landau-Kleffner syndrome (20), early-onset schizophrenia (21), early-onset catatonias (22), and attachment disorders (23).”
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“…develop significantly throughout childhood and adolescence (Best & Miller, 2010; Korkman et al., 2013) and depend on extensive brain regions and networks (e.g frontal, parietal, and cerebellar lobes) (Collette et al., 2006; Nowrangi et al., 2014; Powell & Voeller, 2004; Salehinejad et al., 2021).”
Influence of executive functions on quality of life in Pediatric Epilepsy: A cross-sectional study
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- Authors
- Powell, K. B., & Voeller, K. K. S.
- Affiliations
- Western Institute for Neurodevelopmental Studies and Interventions Western Institute for Neurodevelopmental Studies and Interventions, Boulder, CO,
- Western Institute for Neurodevelopmental Studies and Interventions Western Institute for Neurodevelopmental Studies and Interventions, Boulder, CO
- Corresponding author
- Powell, Kristin B.
- Venue
- Journal of Child Neurology
- Publisher
- SAGE Publications
- Published
- 2004-10
- Volume
- 19
- Issue
- 10
- Pages
- 785-797
- ISSN
- 0883-0738 (ISSN-L)
- 1708-8283
- OpenAlex
- W1585151500
- Cited by
- 137
- References
- 92
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 2 · 2020: 4 · 2019: 6 · 2018: 6 · 2017: 7 · 2016: 9 · 2015: 10 · 2014: 10 · 2013: 7 · 2012: 11
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- executive function, prefrontal cortex, executive dysfunction, children, attention, emotion regulation, arousal, diagnosis, treatment, preterm birth, traumatic brain injury, hypoxia, toxic exposure, cerebral dysgenesis, epilepsy, genetic disorders
- MeSH terms
- Adolescent, Adult, Child, Child Behavior Disorders, Cognition Disorders, Female, Humans, Male, Medical Illustration, Neuropsychological Tests, Syndrome, Prefrontal Cortex
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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