Abstract

Abstract: Disorders of executive functioning associated with frontal lobe damage have long been recognised as causing significant disability in people with brain injury and other neurological and psychiatric conditions. While the last half-century has seen significant advances in modelling the functional anatomy of the frontal lobes, there has been, with one or two notable exceptions, rather less focus on the development of treatment interventions aimed at the rehabilitation of executive dysfunction. In this presentation a series of treatment interventions driven by a theoretical model of executive functioning will be described and results from studies to evaluate the impact of these interventions will be presented. The interventions are related to (i) the use of autobiographical memory to support problem solving, (ii) improving the ability to initiate action and (iii) increasing the ability to self-monitor task performance and improve goal maintenance. A group based intervention which draws upon these interventions and incorporates them within a broad-based attention and problem-solving group format will be described and evidence for the effectiveness of this format presented (Evans, 2009)1. In the clinical context there are many factors that will influence the selection of approach to intervention with people who present with dysexecutive symptoms, including levels of insight and awareness, severity of the executive impairment, the extent of other cognitive deficits and the nature of rehabilitation goals. A framework summarising the process of intervention selection taking account of these factors will be discussed. Within this framework a distinction is made between interventions that are characterised as “self-instructional” approaches and interventions focused on specific tasks or behaviours. The self-instructional approaches, aimed at those with more mild-moderate impairments include techniques designed to train cognitive skills/strategies for managing impairments in executive functioning across a range of tasks/situations. The more functional approaches, for those with more severe impairments, include external aids or environmental modifications designed to compensate for dysexecutive symptoms and support/prompt appropriate behaviours.