A theory of dysexecutive syndromes: variations in the effectiveness of prefrontal control of behavior

Abstract

Executive dysfunction can result in impairments in the ability to regulate behavior in a goal-directed manner, such that individuals may have difficulty making decisions, planning and organizing tasks, difficulty adapting to new situations, impulsivity, and emotional dysregulation. The resulting dysexecutive syndromes can have a significant impact on an individual's life, leading to impairments in work, social interactions, and various aspects of daily functioning. A neuropsychological theory of dysexecutive syndromes is particularly relevant for understanding conditions such as traumatic brain injury, frontal lobe lesions (e.g., stroke), neurodegenerative disorders (e.g., frontotemporal dementia), and certain psychological and developmental disorders. This theory should specify how damage or dysfunction of the prefrontal cortex (PFC) leads to executive dysfunction and dysexecutive syndromes. In this article, I propose a novel theory of adaptive behavioral control (ABC theory), which suggests that variations in the effectiveness of prefrontal behavioral control contribute to executive dysfunction and thus to the range of dysexecutive syndromes observed in individuals with relevant neurological and psychological conditions. Key elements of ABC theory include that the PFC is a critical brain region involved in executive functions, and that executive functions are essential for goal-directed behavior and adaptation to changing environments. ABC theory suggests that variations in the effectiveness of prefrontal control may result from damage, dysfunction, or developmental differences in the PFC. The severity of executive dysfunction and the specific dysexecutive manifestations may vary depending on the location and extent of PFC involvement. Understanding variations in prefrontal control and their specific impact on behavior is essential for the development of targeted treatments.