A.R. Luria believed that the functional maturity of the prefrontal cortex is reached around adolescence. Children are not born with fully developed executive functions rather, they are born with the potential to develop them. Executive functions are “critical for organizing and carrying out complex actions over extended periods of time.” They represent central cognitive processes that are closely involved in the organization of behavior and goal-directed actions and, together with attention and memory, form the foundation of learning.The developmental trajectory of mental processes is heterogeneous and asynchronous. However, at certain stages of development, these asynchronous processes become integrated into coordinated mental activity that can respond effectively to the demands of the environment and society. In other words, executive functions are a set of capacities that reach their full development in adulthood.

The frontal lobes serve as the regulatory center of complex mental functioning. They govern thinking, voluntary movements, creative problem-solving, emotional regulation, and the development of personality.Executive functions begin to develop in early childhood, and this process progresses in parallel with the development of the frontal lobes and other brain structures. Behavioral and emotional regulation are an extension of the fundamental capacity for emotional control. In early ontogeny, the ability to actively maintain an abstract goal in working memory is one of the most important aspects of executive functioning.

Different brain structures and mental functions mature at different rates and reach full maturity at different stages of ontogenetic development. A sensory filter refers to the effective processing of multiple stimuli from both the external and internal environment, that is, the development of the ability to inhibit responses to these signals.Behavioral patterns are identified as externalizing and internalizing. Externalizing behaviors are directed outward and manifest as aggression, impulsivity, violence, and defiance. Internalizing behaviors are directed inward and are demonstrated through withdrawal, loneliness, depression, and anxiety.

Executive functions play a decisive role in the early stages of acquiring new skills. Their involvement is greatest when new knowledge is being established. As the acquisition of new skills becomes automated, the role of executive functions decreases.The development of executive functions can be divided into three stages:

• 0–2 years of age – the foundation of executive functions is established.
• 6–9 years of age – development of inhibitory control.
• From adolescence to early adulthood – development of the coordination between working memory and inhibitory control, comprehensive planning, visuospatial working memory, processing speed, self-monitoring, self-regulation, and metacognition.

The primary form of self-regulation is control, defined as the ability to inhibit a dominant response. Changes in self-regulation are associated with the development of the executive control system, cognitive and behavioral flexibility, the ability to shift strategies following failure, and related processes. The central executive function is also associated with the episodic buffer, which represents short-term episodic memory. The central executive is a system with limited capacity that controls the phonological loop and the visuospatial sketchpad, and it is closely linked to long-term memory.

Executive functions in childhood include:

1. Impulse control – the ability to stop and think before acting.
2. Emotional control – the ability to regulate emotions while maintaining focus on a goal or its solution.
3. Cognitive flexibility – the ability to apply new approaches when a plan fails and to shift effectively from one activity to another.
4. Working memory – the ability to retain, integrate, and use information to complete an ongoing task.
5. Self-monitoring – the ability to observe and evaluate one’s own performance.
6. Planning and prioritization – the ability to identify the information and steps necessary to achieve a goal.
7. Task initiation – the ability to begin a task independently.
8. Organization – the ability to manage information, organize oneself, and structure one’s environment.

Assessment of Executive Functions

The assessment of executive functions should begin with observation of the child’s everyday functioning. The effectiveness of interventions for executive dysfunction depends on three key competencies:

• Identifying the problem.
• Clarifying the nature of the difficulties.
• Establishing a prognosis.

During the diagnostic process, the following questions should be addressed:

1. What are the child’s and the family’s primary concerns?
2. How do these difficulties affect the daily lives of the child and the family?
3. What goals has the family established, and what expectations do they have for the child?
4. What strategies have already been used to improve the child’s functioning? .

Stages of Executive Function Assessment

• Semi-structured interview with the parents.
• Collection of information regarding the child’s functioning in real-life situations.
• Behavioral reports provided by teachers and peers.
• Assessment of intellectual development and basic cognitive processes.
• Neuropsychological evaluation of the child.
• Formulation of diagnostic hypotheses.
• Development of a therapeutic strategy.

A comprehensive assessment of executive functions predicts academic achievement more reliably than tests of academic performance, intellectual functioning, or general cognitive ability.

The following conditions should be considered in the differential diagnosis:

1. Attention-Deficit/Hyperactivity Disorder (ADHD) – ADHD is one of the most common neurodevelopmental disorders of childhood. Its symptoms involve deficits in attention, impulse control, and activity level, all of which can significantly affect learning and academic performance. Difficulties in executive functioning are considered a core feature of ADHD. Children diagnosed with attention deficits and hyperactivity are at increased risk of pronounced executive dysfunction.
2. Developmental Dyslexia (Reading Disorder) – Executive dysfunction may predict difficulties in acquiring fundamental academic skills such as reading, writing, and mathematics. Research indicates that children and adolescents with learning difficulties exhibit executive dysfunction more frequently than their typically developing peers.
3. Graphomotor Control Difficulties (Fine Motor Impairments) – These difficulties are characterized by impaired fine motor skills, reduced ability to utilize previous experiences, and challenges in automating motor actions.
4. Affective Disorders (Depression, Anxiety, etc.) – Affective disorders may negatively influence executive functioning. Common manifestations include difficulty initiating and engaging in tasks, as well as reduced cognitive efficiency.
5. Fetal Alcohol Syndrome (Prenatal Alcohol Exposure) – Fetal Alcohol Syndrome (FAS) develops in children who were exposed to alcohol before birth. Many children with FAS experience learning difficulties, impairments in working memory, and deficits in other executive functions.
6. Brain Injury – Conditions such as traumatic brain injury, concussion, stroke, and other forms of neurological damage, particularly those affecting the prefrontal cortex, can significantly impair executive functioning. The initial assessment following brain injury is typically conducted by a clinical neuropsychologist. This evaluation provides detailed information regarding the child’s cognitive, emotional, and behavioral deficits and serves as an essential basis for planning rehabilitation and therapeutic interventions.
7. Cancer Treatment – Executive functions may also be affected by chemotherapy and/or radiation therapy used in the treatment of childhood cancers, including leukemia and brain tumors.