Executive function capacity ebbs and flows within different contexts.

There are chronic and temporary causes of executive dysfunction.

We can restore our executive function skills through better-quality sleep, physical activity, and more.

Most of my experience with executive function comes from the classroom or daily living, so I jump at the chance to hear others’ perspectives. My friend, Shahrzad Rafiee, an emergency medicine doctor and marriage and family therapist, shared her experience with executive function’s ebbs and flows.

How does the emergency department challenge executive functioning?

Shahrzad Rafiee: In many ways, working a shift in the emergency department is like putting the brain’s executive functioning system through a stress test. If there is any environment that demands constant multi-tasking, rapid prioritization, emotional regulation, suppression of distractions, and adaptation to ever-changing conditions, it is the emergency department (ED). At times, shifts can feel like American Ninja Warrior for executive functioning.

There’s a running joke in medicine that every specialty has a personality: pediatricians are the nice ones, surgeons are the type A ones, and emergency physicians? We’re the ones with ADHD.

What does executive dysfunction look like from your perspective?

SR: Sometimes it’s hard to see what executive dysfunction looks like in our daily lives. Many people can still perform, compensate, and push through professionally while carrying an enormous cognitive burden internally. The collapse often comes later—at home, after the performance is over.

I notice this most on the days after a stretch of night shifts,........

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