The Executive Functions – Part 1

I thought I would write a blog about the Executive Functions and how Neurodiverse people can have impairments that are situational, variable and chronic and significantly interfere with functioning in many aspects of a person’s daily life.  I thought I would do this by talking about each of the domains contained within the Executive Functions, so for example, how a weak work memory can impact someone that is learning something new or studying because they have an inability to make, take and follow notes.  Which is important to know, but I have decided not to do it this way.  There is one human activity that has so many steps to it that it requires most of the Executive functions to work to be able to do it so I’m going to write about that.  What I did think though is that it might be a good idea to write and explain what the Executive Functions are.  So here goes.

Actually I’m going to be lazy because I’m still burnt-out and because Bill explains it so well I’m going to use an excerpt from Bill Nason’s book – The Autism Discussion Page: on the core challenges of Autism.

“The prefrontal cortex of the brain holds what is called the executive functioning skills. These skills allow us to attend to what is important, inhibit our impulses, think before acting, and evaluate the consequences of our behaviour. It also allows us to break a task down, evaluate options, plan and organize a course of action, monitor what we are doing as we do it, and evaluate the effectiveness of our actions. These skills also allow us hold several things in our short term memory so we multi-task several tasks at one time. The executive functions area of the brain is the “conductor” telling the rest of the brain how to work together to appraise, evaluate, and execute action. Without it we could not function effectively in our day to day living”.

He goes on to say

There are many areas in the executive functions that people on the spectrum often struggle with. Listed below are some of the common challenges they experience:

Weak Executive Functioning Skills

Poor Inhibition

Poor ability to inhibit impulses.
Often impulsive; acting without thinking; interrupting.

Attention Problems

Either difficulty focusing or hyper-focused on detail.
Problems inhibiting/filtering out distracting stimuli; picking out relevant details.
Difficulty maintaining attention, getting distracted off task.
Difficulty shifting attention; gets stuck and difficulty moving on.

Shifting Gears

Difficulty shifting from one mind-set to another.
Problems with unexpected changes.
Difficulty with transitions.
Rigidly adheres to view point.

Planning and Problem Solving

Difficulty planning: setting goals, predicting future outcomes and designing course of action.
Difficulty following sequential steps.
Problems judging how long it will take to do things, to organize a course of action.
Poor problem solving.

Organisation Skills

Has problems organising materials, meeting deadlines, bringing what is needed, and remembering to deliver messages.
Forgetful, disorganized, messy.

Working Memory

The ability to hold information in immediate memory while focusing on a task.
Difficulty shifting attention between task and active memory.
Difficulty with multi-step tasks and complex instructions.
Often forgets directions once task is started.

Self-Monitoring

Poor ability to monitor and check work.
Poor self-monitoring of behaviour.
Tends not to use past experiences to evaluate present actions.

What you might notice is poor impulse control, difficulty regulating emotions, trouble concentrating on topics of low interest, difficulty shifting gears, and little snags causing frustration are all very common for people on the spectrum. 

Even though the people may be bright, they usually have problems organising themselves, allowing enough time to do things, forgetting where they are at in the task, and problems completing assignments. These people have problems breaking things down into small parts, getting started and then sequentially completing all steps of the task.

People with Executive have difficulty multi-tasking because they have problems holding information in their short term memory and then shifting their attention from one task to the other. Also, while engaged in action they have difficulty monitoring and evaluating their own behaviour, and assessing how their actions affect others. They cannot act and think about how they are acting at the same time. This multi-tasking job of both acting and monitoring how we are acting is essential when interacting with others.

This last paragraph intrigues me.  It reminds me of a situation I was in recently where I could have landed myself in trouble.  I was at an event and I said something I shouldn’t have done.  I didn’t appreciate this at the time, it was only later when I processed the event that I realised that an invitation to criticise something was not meant literally, however, I took it literally and acted accordingly. Later still I had an epiphany, could this be the reason why it is believed that Autistic people are not self-aware?  Perhaps, because of Executive Dysfunction, it just meant we are less able to be self-aware in the moment.

So that is Executive Dysfunction in a nutshell. Bill Nason’s book is aimed at people that are involved in the lives of children and is instructive in how to teach children to overcome these problems.  It might be possible to teach children ways to overcome some of their issues, for example, how to use a diary?  I personally think it would be very difficult to teach someone to overcome all of their Executive Dysfunction.  A bit like trying to teach a paralysed man to walk or a blind woman to see.  I think once a child grows up and leaves home this becomes very apparent as everything falls apart, especially for women because we are expected to be able to look after ourselves and others.  I find it extremely difficult to live up to the societal expectations of me. It looks odd to Neurotypicals, a seemingly intelligent woman that has the knowledge, skills and capability to be able to perform, what appears to others to be, simple tasks and I’m just not able.

You know there is this trend at the moment in health, wellbeing and social care to help people to do things for themselves, it isn’t always possible.  My Dad is an ADHDer and has never in his 72 years been able to manage money, this is very common, I can’t either, I can however, manage his.  Again I have the knowledge, skills and understanding of how and why it is important to manage my finances, but I don’t always have the impulse control or the ability to plan for the future or the wherewithal to control my emotions.  I could spend weeks teaching my Dad how to manage his finances, it wouldn’t make a bit of difference because he has Executive Dysfunction.  If he was being supported by an organisation he would likely be discharged for not engaging fully with the service and he would feel like a failure and stupid for not being able to do it.  Anyway this blog is getting too long, so…

My next blog will be about specific human activity and how the executive functions have to work together to allow a person to complete a vital task and why so many of us fail.  Although, there could be a that a different blog gets written before that, I can’t plan these things!