Book Review: Executive Functions by Russell Barkley

“The real scholars were left in almost total freedom to ply their studies and their Games, and no one objected that a good many of their works seemed to bring no immediate benefits to the people or the community and, inevitably, seemed to nonscholars merely luxurious frivolities.” – Herman Hesse, Magister Ludi: The Glass Bead Game

Two summers ago, my family and I went on our annual trip to Acadia National Park and Downeast Maine. One of the highlights was a boat ride on Frenchman’s Bay called Diver Ed’s Dive-In Theater. Anyone planning a trip with their kids to Acadia is well-advised to take this tour. Diver Ed, a marine biologist, and his very engaging, multi-degreed wife (nicknamed Captain Evil) take their boat out to a different, randomly chosen spot on the bay each tour. Once they reach their destination, Diver Ed dons his deep sea diving suit and descends to the ocean floor armed with a sophisticated video camera and a collecting bag. He transmits his video feed to a big  screen on deck and Captain Evil describes the images.

The North Atlantic is lousy with starfish (or, more accurately according to Captain Evil, sea stars) and Diver Ed brought a few back up to the boat. Captain Evil mentioned that sea stars have small eyes at the end of each arm. While it was long thought that all they saw were vague, blurry, monochromatic images, Captain Evil reported that new research has proven that they’re also capable of seeing different colors and that when this was discovered, “the two scientists in the world who study this topic were very excited!”

It is with that last thought in mind that I turn to Russell Barkley’s book from 2012 entitled Executive Functions: What They Are, How They Work, and Why They Evolved. For those readers unfamiliar with Russell Barkley, he’s a rock star within the world of ADHD and is one of the preeminent thinkers and researchers on that topic. A few years back, I read another book of his, Taking Charge of ADHD  and it greatly expanded my understanding of the disorder. I’ve seen him speak a couple of times and if you can manage to battle through his occasional pomposity, he’s a good speaker. So, it was with a good deal of anticipation that I began reading Executive Functions. Unfortunately, I found the book pretty disappointing.

In the world of human services, executive function has been a decidedly hot topic for the past few years. Delays in executive function are being implicated in more and more negative outcomes. They’re part of the package of symptoms in people with ADHD, Autism Spectrum Disorders, Anxiety Disorders, and other issues that play a big role in social, academic, and occupational struggles. I’ve got some understanding of the subject but, like many other clinicians, I’ve struggled to put my finger on a good definition and develop a comprehensive understanding. My goal in reading the book was to fill in the gaps with some practical, concrete knowledge. It took over a year for me to read this relatively short (209 pages) book and although it’s provided me with some food for thought, there’s not  enough of what I was looking for to justify the slog.

Dr. Barkley states that his book aims to solve a number of problems related to the “definition, conceptualization, and measurement of EF, including the lack of an evolutionary stance toward its existence.” He goes on to write that “…these problems can be addressed by viewing EF as an extended phenotype – a suite of neuropsychological abilities that create profound effects at a considerable distance and across lengthy time spans from the genotype that initially forms them.” Starting with the idea that EF and Self-Regulation are more or less the same concept, Dr. Barkley describes five levels of the EF Phenotype, starting with the “least evolved” level (Instrumental-Self-Directed) and finishing with the “most evolved” (Strategic-Cooperative Level). With the unfolding of each level, new self-regulation skills emerge, each of which, in turn, lead to the development of different individual abilities, cultural phenomena, and institutions necessary for their maintenance. I found the book’s emphasis on the esoteric topic of the evolutionary view of EF to be largely unsatisfying and unhelpful. To paraphrase Captain Evil, maybe the two other scientists studying this topic are very excited about this book but I can’t imagine who else would be. My dissatisfaction was compounded by Barkley’s dry, technical, and dense writing style. Consider the following passage about  the executive function processes involved in remembering to set an alarm clock:

“Telling yourself to in your own mind using self-speech to set the alarm clock at night is EC (Executive Cognition). Actually setting the alarm clock is an EA (Executive Action). In other words, EF can be bifurcated into EC that involve covert forms of SR (Self-Regulation) and into EA that involve overt forms of SR. The latter is praxeological – that is, concerned with human action. EA may arise from having been chosen, initiated, and sustained by the covert mental level of EC. Henceforth I refer to EF in this broad sense of including both executive cognition and executive actions (EF=EC + EA).” 

Got that? There’s going to be a short quiz in the morning.

To be fair, the further I delved into Executive Functions, the more I began to gain some grudging appreciation for the insights contained in the pages. In particular, I found the descriptions of the distinctions between the Tactical-Reciprocal level of EF and the Strategic-Cooperative level, two of the more “evolved” levels of functioning, to be both insightful and helpful. Both levels  reflect an individual’s appreciation of the idea that pursuing goals with other individuals is a valuable way of advancing everybody’s self-interest. However, the jump from the Tactical-Reciprocal level to the Strategic-Cooperative level, which requires a step up the ladder in terms of self-awareness and foresight, entails an understanding that working with others does not merely constitute an effective way for each person to meet their individual goals. The act of working cooperatively also creates greater total value for everyone. To function at that level requires a high level of self-regulation, foresight, and an awareness that maximizing an outcome for a group will, at times, necessitate some short-term roadblocks to each individual’s self-interest.

In the end, I’d gladly trade the highfalutin’, theoretical approach to EF found in this book for a more engaging, concrete, pragmatic approach. Clearly, I am not the audience that Dr. Barkley was writing for. Somewhere, 2 scientists have found a new favorite book.