**1.2. Executive functions in childhood**

childhood and adolescence. We acquire mastery of having and using cognitive controls with maturation. However, although the system is more effective at the beginning of maturation in

The cognitive capacity of an individual increases with the executive functions being involved in many different aspects of information processing and behavior over time. The emergence of basic skills such as orientation and attention is followed by strategy determination, implementation, and then problem-solving. Executive functions change from a developmental perspective to multiple creative cognitive skills. Understanding what executive mean requires

The attention system is a basic and supporting component of the execution system. It is a tool that guards learning for the developing individual and directs interaction with the environment, especially from birth [6, 7]. Throughout childhood, the child increasingly masters in creating schemas and representations by taking information about the environment. This supports the child's adaptation and learning of the demands and challenges of the community. For this reason, attention, regulation, and maintaining attention interact neurodevelopmentally with memory processes and constitute cognitive structures necessary for executive and behavioral control. As a result, attention during infancy and crawling period emerges as targeted behavior and serves to develop

The infant begins to see the effects of his growing awareness with the events and experiences surrounding him over his perceived knowledge. This encourages cognitive and behavioral dialog through direct and indirect interactions with objects and people. The motor functions, senses, and cognitive functions interact to create the connection between the baby and the environment, which facilitates the infant's experience with the surroundings. This increases the infant's control over the interaction with the environment. This is initially a passive response to the environment but then it turns into an environment research process. Then, the quest for increased ties and interaction becomes an active process. As people, events, and experiences increase, babies carefully separate events and experiences that they find stimulating or uncomfortable and seek support through behavior or voice responses [9]. In the game period, the child begins to realize that they are influencing their environment and surroundings through mechanisms such as attention, reaching a target, and exploring. This awareness

turns into realizing goals and desires and improves early problem-solving skills.

Self-regulation develops throughout the age of infancy, walking, and primary education period. Guiding parenting initially directs this development capacity, but the baby and then the child develops his own reactions on how he behaves [7, 10]. In "real" experience, the child reacts to events through observation and imitation. By actively recalling these experiences, the child makes behavioral choices. The strategy begins to play a greater role in their behavior

parallel with increasing needs, it may provide less support afterward [4].

you to understand how each ability develops over time [5].

**1.1. Basics of executive functions**

30 Occupational Therapy - Therapeutic and Creative Use of Activity

executive function skills over time [7, 8].

*1.1.2. Behavioral and emotional regulation*

*1.1.1. Attention*

Middle childhood is one of the basic periods in which executive functions are necessary to support successful learning and the development of academic skills [8]. With executive functions in the first three grades, children can identify what's important and integrate new information with the existing information. However, from the fourth-grade onward, the learners who are expected to manage integrated academic requirements more competently and strategically have considerable demands on working memory, impulse control, self-monitoring, and intent to facilitate independent problem-solving and productivity [12]. For the typically developing middle school child while learning success proceeds in a forward line which indicates a growing capacity for independence, demands are met via variable engagement of EF skills. For example, impulse control develops completely between 10 and 12 years old [13, 14]. Similar speed in organizational skills with the speed of processing, verbal fluency, multidimensional transition, and planning usually occurs during middle childhood [14].

Middle childhood is a time period in which attention and motivation are necessary and a child should be under observation. For successful learning, behavioral regulation must increase [15]. Children who are 6 years old start to make tasks more successfully that require impulse control, and at age 9, most children can self-monitor and correct their behavior moderately [16]. Children who manage the tasks of increased attention and regulation effectively are more resistant to situations such as blocking, dissatisfaction, insistence, and self-control. Emotional regulation should be underlined with increasing daily demands and challenges, especially in terms of disappointment, anxiety, and anger. However, the difficulties associated with attention and behavior control, which are frequently seen with attention deficit and hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD), emphasize that there is a major hurdle in the development of executive functions. As difficulties arise such as inefficiency, carelessness, and poor self-control, executive dysfunction manifests itself [17].

The enhanced self-control capacity in this period is necessary to meet additional demands, especially in social areas. Young people in this age start to establish stronger ties with their peers, and the opportunities in playing and learning reinforce belonging. This social inclusion increases opportunities by providing a wider range of participation and influence across all aspects of executive control. Especially, trying to solve problems together gives children the opportunity to accept and consider the opinions of others in situations where they can develop and change their ideas and goals [18].

Cooperation and reconciliation-related activities help the child struggle on his/her own and master on these skills. A child who is weak about understanding society and solving problems in society also faces difficulties in social participation. A child who is not able to observe the wide range of perspectives, or a wide range of options offered during a group event, is usually incomplete in executive functions, and it is possible to observe that a child with faults on executive functions is affected by more than one area of socialization and academic skills [18, 19].

**2. Executive functions and its neurology**

Executive functions are interdependent and progressively acquired; high-level cognitive skills that occur in conjunction with the expansion and integration of cerebellar, subcortical, and prefrontal nerve networks during early childhood and adolescence until early adulthood. Because the development of nervous systems that support executive functions lasts too long, they are vulnerable to changes that occur during development, which can lead to multiple

Executive Functions and Neurology in Children and Adolescents

http://dx.doi.org/10.5772/intechopen.78312

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The prefrontal cortex has an important role in the development of executive functions. The prefrontal cortex is located in the anterior part of the premotor cortex and constitutes approximately one-third of the cortex (**Figure 1**). The neural connections between the prefrontal cortex, motor and sensory cortices, and the brain's subcortical structures are carefully regulated and are responsible for controlling, influencing, and regulating behavioral goals and behaviors. As the individuals mature, large neural networks that are responsible for learning and behavior become increasingly integrated and coordinated with prefrontal cortex-related networks. As a result, the regulation of high skill levels that lead to many behaviors is related to the neurodevelopmental processes of the mature brain. This contributes to the enhancement of coordination of communication and behavioral regulation related to executive functions [21]. At the beginning of life, subcortically managed neural processing is the primary ability to interact and understand sensory input, to interact more extensively with the environment, and to reinforce and remember these experiences over time. These experiences reinforce the link between more integrated sources of knowledge that are better understood by the ongoing myelination of the more integrated and mature brain (**Figure 2**). As the connections between the subcortical structures and the prefrontal cortex increase, attention and memory control increases. In infants and children who begun to walk, growth episodes are associated with increases in attention control and working memory capacity. Subsequent brain growth episodes occur at 6–8, 10–12, and 14–16 years of age. Coordination between the prefrontal cortex and regulatory and executive networks improves the communication

**2.1. Executive functions and prefrontal cortex**

executive dysfunctions [20].

further [22].

**Figure 1.** Prefrontal cortex.

## **1.3. Executive functions in adolescents**

Adolescence, in other words, upper cognitive access, is an important period in which an individual is able to make a strategic choice to increase learning capacity, evaluate options, and meet that demand. Ongoing development of the executive neural network (frontal lobe) explains the inconsistencies of high-level skills of adolescence [20]. Frontal functions, especially the dorsolateral prefrontal cortex and the orbitofrontal cortex areas, gradually begin to engage. In addition, there is a marked decrease in the gray matter of the cortex and an increase in white matter during this period [21]. While these important changes in brain structure change social awareness and expectations in this period, hormonal and physical changes improve the interaction between the individual and the environment [22]. For this reason, adolescents' capacities of awareness, decision-making, and problem-solving, which are highly affected by cognitive skills and emotional, social, and physical situations, also vary [23]. As a result, it is theorized that the development of executive functions in adolescence may be modulated in an emotional or social context. Luna and Sweeney also described adolescence as a "transition to an effective working relationship with the brain." During the adult period, executive networks become more consolidated and refined. Actions are more in sync with behaviors and interact more with others with better behavioral and emotional control [24].

Increasing independence and its capacity and managing multidimensional learning and behavioral demands develop during this period. This is a reflection of progress in the areas of attention control, flexibility and processing speed, capacity and working memory, planning, and problem-solving in conjunction with the increase in frontal cortex pruning and myelinization that occurs during adolescence [25].

While Anderson believes that cognitive flexibility and target-setting capacity mature up to the age of 12, some researchers later argue that executive functioning, memory, impulse control, and planning continue to evolve considerably in adolescence and early adulthood [26]. This theory was more widely accepted because of the proliferation of synapses at the beginning of adolescence. These developments turn into emotional decision-making and less responsive reactions to the will of the environment, and this is an appropriate response to the theory of self-control and social rules [27].

Disorder in the development of executive control during adolescence is present in psychopathology. The capacity to think before moving, to assess the appropriateness of one's answer, and to determine the most effective action that gives the desired result often varies in adolescence. However, in a typically developing young person, these skills become increasingly more effective over time [27]. Young people with impaired executive functions cannot make effective choices and cannot reach the result. In fact, while adolescents are more conscious at the beginning of pubertal maturation, they then enter into risky and sometimes reckless behavior and become more sensitive to others' views and assessments. This can make their relationships difficult with peers and adults [20].
