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Conduct Disorder (CD)

Overview

Higher-order control systems that plan, organize, make decisions, and inhibit impulses.

This is the mind’s conductor — the system that plans, prioritizes, organizes, and restrains impulses.

Everyday examples:
  • Planning errands efficiently (“I’ll stop at the pharmacy after the bank”).
  • Budgeting monthly expenses.
  • Avoiding a sharp retort during an argument.
If disrupted:

Life feels chaotic. You may act on impulse, mismanage time, or struggle to start or finish tasks.

Executive Function Disorders:
Main brain systems:

Dorsolateral prefrontal cortex (planning, working memory), orbitofrontal cortex (inhibition, emotion), anterior cingulate (error monitoring), basal ganglia.

Key neurotransmitters:

Dopamine and serotonin balance flexibility and impulse control, norepinephrine.

Clinical examples:
  • Frontal Lobe Injury: Poor judgement/planning, impulsivity, emotional flatness, or inappropriate behavior.
  • Schizophrenia: Disorganization of thought and difficulty filtering irrelevant stimuli — a breakdown in executive control.
  • Depression: Frontal hypoactivity leads to slowed thinking, indecision, and low motivation.
Everyday consequence:

Trouble organizing daily tasks, managing finances, or regulating emotions.

Citations:

7. Friedman & Robbins, Neuropsychopharmacology 47:72–89 (2022).
8. Dalley et al., Philosophical Transactions of the Royal Society B 368:20120404 (2013).

Bedside correlate:

Disorganized thought, poor planning, impulsivity, difficulty shifting between tasks, social disinhibition.

Rehabilitation strategies:
  • Cognitive: Goal-management training, problem-solving therapy.
  • Pharmacological: Dopaminergic modulation (amantadine in TBI, bupropion or modafinil for apathy/fatigue).
  • Behavioral: Use of planners, checklists, stepwise goal setting.
Executive Function Skills Assessment Questionnaire

 

Identification Section
Name: ___________________________
Age: _______
Gender: ☐ Male ☐ Female ☐ Other
Date: ___________________________
Completed by: ☐ Parent ☐ Teacher ☐ Clinician ☐ Self

Purpose:
To assess areas of strength and difficulty in executive functioning—mental processes that enable planning, organization, self-monitoring, flexibility, attention, and emotional regulation.

Rating scale (optional):
0 = Never  1 = Sometimes  2 = Often  3 = Very often

(Alternatively, responses may be discussed qualitatively)

Section A – Planning and Organization
  1. Does the person find it difficult to plan ahead for schoolwork, projects, or daily routines?
  2. Does the person start tasks without thinking about the steps required?
  3. Does the person lose track of what they need to complete (e.g., homework, chores)?
  4. Can the person organize their materials or workspace independently?
  5. Does the person need frequent reminders to complete multi-step activities?

Optional Notes:
Examples of difficulties (e.g., incomplete homework, messy desk, forgotten items).

Section B – Working Memory
  1. Does the person forget instructions soon after hearing them?
  2. Can the person hold information in mind while doing another task (e.g., following 2–3 step directions)?
  3. Does the person struggle to recall what they have just read or heard?
  4. Can the person keep track of several things at once (e.g., while cooking, packing, or during problem solving)?
  5. Does the person often say “I forgot” even for familiar routines?

Optional Notes:
Examples of real-life situations or compensatory strategies used.

Section C – Inhibition and Self-Control
  1. Does the person act impulsively without thinking of consequences?
  2. Does the person interrupt others during conversation or activities?
  3. Can the person stop themselves from doing something they have been told not to do?
  4. Does the person have difficulty waiting their turn?
  5. Does the person rush through work, leading to careless errors?

Optional Notes:
Describe how impulsivity affects performance or relationships.

Section D – Cognitive Flexibility (Shifting)
  1. Does the person have difficulty moving from one activity or topic to another?
  2. Does the person become upset when routines change unexpectedly?
  3. Can the person think of more than one way to solve a problem?
  4. Does the person get “stuck” on a particular idea, activity, or response?
  5. Does the person become frustrated when plans do not go as expected?

Optional Notes:
Give examples of rigidity or adaptability in daily life.

Section E – Emotional Regulation
  1. Does the person overreact to small frustrations or setbacks?
  2. Can the person calm down after getting upset or angry?
  3. Does the person express emotions appropriately for the situation?
  4. Does the person get easily discouraged when something is difficult?
  5. Can the person recover focus after an emotional event?

Optional Notes:
Describe triggers, coping strategies, or supports that help.

Section F – Initiation and Task Completion
  1. Does the person need frequent prompting to begin tasks?
  2. Does the person procrastinate even for activities they understand?
  3. Once started, does the person stay engaged until the task is done?
  4. Does the person abandon tasks halfway through without reason?
  5. Can the person manage to resume a task after being interrupted?

Optional Notes:
Identify typical settings (school, home, work) where initiation is hardest.

Section G – Self-Monitoring and Awareness
  1. Does the person recognize when they’ve made a mistake?
  2. Can the person check their own work for accuracy or completeness?
  3. Does the person overestimate or underestimate how well they did on tasks?
  4. Does the person ask for help appropriately when stuck?
  5. Can the person describe what strategies help them do better?

Optional Notes:
Examples of insight, self-correction, or lack of awareness.

Section H – Time Management
  1. Does the person understand how long tasks will take to complete?
  2. Does the person often run late or misjudge time?
  3. Can the person use tools (clocks, timers, schedules) to manage time?
  4. Does the person get distracted from the main task by less important ones?
  5. Does the person complete work only at the last minute?

Optional Notes:
Describe strategies (alarms, planners, visual schedules) used.

Section I – Goal-Directed Persistence
  1. Does the person give up easily when faced with challenges?
  2. Can the person work toward a long-term goal over several days or weeks?
  3. Does the person stay motivated when progress is slow?
  4. Does the person balance short-term pleasure against long-term goals?
  5. Does the person take pride in finishing what they start?

Optional Notes:
Include examples of perseverance or avoidance patterns.

Interpretation (for Clinician/Teacher Use)
  • Quantitative: Add section scores to identify weak domains (higher scores = more difficulty).
  • Qualitative: Discuss observed patterns, triggers, and support strategies.
  • Summary: Note areas of strength, emerging skills, and domains requiring intervention or scaffolding.
Executive Function Skills Scoring & Interpretation Sheet

Name: ____________________  Age: _______  Date: __________
Assessor: ___________________________  Context: □ Clinical □ Educational □ Other __________

Rating Scale (for each item):
0 = Never  1 = Sometimes  2 = Often  3 = Very Often

Section Scores

Domain

Item Count

Raw Score

Average (Score ÷ Item Count)

Interpretation

A. Planning & Organization

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

B. Working Memory

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

C. Inhibition & Self-Control

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

D. Cognitive Flexibility

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

E. Emotional Regulation

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

F. Initiation & Task Completion

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

G. Self-Monitoring & Awareness

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

H. Time Management

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

I. Goal-Directed Persistence

5

____

____

☐ Normal ☐ Mild ☐ Moderate ☐ Severe

Interpretation Guidelines

Average Score (0–3)

Level of Difficulty

Interpretation and Suggested Action

0.0–0.5

Normal Range

Executive skills in this domain appear age-appropriate. Continue with current supports.

0.6–1.2

Mild Difficulty

Occasional lapses. Monitor, encourage strategy use, or classroom accommodations.

1.3–2.0

Moderate Difficulty

Persistent problems interfering with learning or self-management. Recommend structured interventions or cognitive-behavioural strategies.

2.1–3.0

Severe Difficulty

Marked impairment. May require individualized education plan (IEP), therapeutic input, or neuropsychological evaluation.

Profile Summary (for Qualitative Notes)

Strengths Identified:
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

Areas of Concern:
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

Observed Triggers or Contexts:
(e.g., transitions, unstructured time, group settings)
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

Compensatory Strategies or Supports in Place:
(e.g., visual schedules, verbal cues, breaks, planners, timers)
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

Summary Interpretation Template

The assessment of executive function skills indicates that [Name] demonstrates relative strengths in [strong domains] and difficulties in [weak domains].

Areas of concern include [describe behaviour patterns such as poor planning, impulsivity, or emotional reactivity], which appear to affect [school performance / daily living / relationships].

These findings suggest that targeted interventions (e.g., explicit strategy teaching, structured routines, visual organization aids, self-monitoring checklists) may enhance performance in the identified domains.

Follow-up with [psychologist / occupational therapist / educator / clinician] is recommended if executive function difficulties persist or impact daily functioning significantly.

Optional Composite Scores
  • Global Executive Function Score (GEFS):
    Sum of all 9 domain raw scores ÷ 45 (total possible).
    Interpretation:
    • 0.0–0.5 = Normal
    • 0.6–1.2 = Mild
    • 1.3–2.0 = Moderate
    • 2.1–3.0 = Severe
Note for Interpretation

While quantitative scoring aids comparison, qualitative context is crucial. Executive functions are context-dependent and develop with age, environment, and motivation. Patterns across domains—rather than absolute numbers—often yield the most insight.