Adults with Congenital Heart Disease: Do You Struggle with Executive Functioning?

Have you ever wondered how it is possible that you can solve problems around the house, achieve goals at work, or finish a challenging task?

This is due to something called executive function (EF). EF is a group of thinking processes controlled by the brain. What’s interesting is that the part of the brain that manages EF is not fully developed until about age 25! This is one reason many teenagers and young adults have a hard time planning ahead, staying organized, and being calm!

Some people, including those born with congenital heart disease (CHD), are more likely to have difficulties with EF. In this post, I’d like to discuss how EF may affect your daily life and offer some ideas for what to do if you feel like you are having trouble with EF.

When Executive Functioning Isn’t Working Properly

When EF isn’t working properly, it’s noticeable. People who have difficulties in this area may observe that they’re struggling with certain things, like paying bills on time, keeping track of their schedule, or making simple mistakes, but they may not be able to pinpoint why.

People with certain health conditions, including adults with CHD, are more likely to have EF difficulties compared to people without these conditions. If you happen to have more severe CHD or had multiple operations and/or complications, your risk of having EF problems appears to be greater. People with CHD who were born prematurely are also more at risk for having problems with EF.

Brain and heart specialists are starting to recognize that complications of CHD in adolescence and adulthood, such as heart failure and high blood pressure, may add to EF difficulties.

When you have EF problems, daily life may be more difficult for you in multiple areas, like taking care of your health or managing school or work responsibilities.  Here are some questions to help you assess your risk for EF difficulties:

Questions To Assess Risk for Executive Functioning Issues

  1. Do you frequently forget to take your medication? Or do you wait until the last minute to start a project or task? Planning can be difficult for patients with EF issues. This can include remembering appointments and medications, keeping track of schedules, and completing tasks by due dates.
  2. Is your home, desk, or car cluttered or messy? When patients have EF problems, they often have a hard time keeping things organized, like class notes or maintaining a clean bedroom or desk.
  3. Do you often feel like you do or say things without thinking? Patients with EF issues may have problems controlling their inhibitions. Your inhibitions keep you from doing or saying something you know you shouldn’t do, like interrupt a conversation.
  4. Do you say or do things that make you wish you had handled your emotions differently? Emotion regulation can be difficult for patients with EF problems. They may get angry, sad, or excited more easily than others.
  5. Do you find yourself forgetting or losing important things, such as your wallet, keys, or glasses? Working memory helps us hold information in our minds for short periods of time to solve problems, such as remembering where we’ve left something, following directions, or doing mental math.
  6. Do you have problems finding solutions when things don’t go your way? We call this shifting – looking for other solutions when things don’t work out the first time you try. Patients with EF deficits may feel stuck and have a hard time finding different ways to solve problems.

It’s important to note that everyone has problems with these things from time to time. But when these kind of problems start interfering with your life, EF may be an issue, especially if you have a more severe form of CHD. Consider discussing this with your CHD specialist or your primary care doctor.

Your doctor may recommend working with a psychologist or counselor who is trained to help you find strategies to overcome EF difficulties. There are also many practical tools available to make life easier, such as medication and organization mobile apps, books, and online programs.

Here Are A Few Tips to Help with Executive Functioning:

  • Use your phone to help with planning and organizing. Add appointments, due dates, and reminders into your phone’s calendar. Set alarms or use an app for medications or other things you need to remember. Take a photograph of important information (phone numbers, health insurance information) that you want to keep.
  • Get support from friends and family. A friend, family member, or significant other may be able to give you reminders for things you need to do. Try sharing a calendar with them so they can be a back-up in case you forget.
  • Manage your surroundings. Important items, like medications, wallets, or keys, can be placed at the dining table, next to the coffee machine, or other visible places. Keep a small supply of extra medications at work or in your bag in case you forget to take them before you leave home.

To learn more about our Adult Congenital Heart Disease Program, please call 513-803-2243 or fill out this form for more information.

Christina Holbein, PhD

About the Author: Christina Holbein, PhD

Christina Holbein, PhD, is a research fellow working with Kevin Hommel, PhD, in the Center for Adherence and Self-Management within the Division of Behavioral Medicine and Clinical Psychology. A pediatric psychologist by training, she has enjoyed partnering with Dr. Gruschen Veldtman and the Adult Congenital Heart Disease Program at Cincinnati Children's to study how young adults with CHD take care of their health and adjust to life. She is an avid sports fan and especially loves cheering on the Ohio State Buckeyes and Buffalo Bills.

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Comments

  1. Roxy October 27, 10:57
    Your ef explanation fits me to a t, but mine was diagnosed after a stroke at the age of 58. Turned my world into a mixed up life.