Executive Functioning: A Personal Perspective
Finn Gardiner is a community educator, researcher, advocate, and designer, currently working with the Lurie Institute for Disability Policy at Brandeis University and the Autistic Self Advocacy Network. In this article, he explains how executive functioning problems impact on his life and work, and shares some solutions that work for him.
I dont actually like messes. Its just that my executive functioning problems cause me to generate them to my ownand othersconsternation.
I consider my executive functioning difficulties one of the most disabling aspects of my being autistic. These struggles manifest themselves in a number of different ways, all of which are extremely frustrating. Ive struggled with executive functioning since childhood, but I didnt have the words to describe my experiences with it until I was an adult in my mid-twenties.
I have the hardest time with daily life tasks. For example, cleaning my room without direction or prompting is really difficult. Its hard to turn the whole into parts, and once Ive taken care of one part, I run out of energy to deal with the rest of the room. Trash bags accumulate in corners of my room because I keep forgetting to carry them down with me when I go downstairs. Plates, cups, and kitchen utensils lie on my dresser and bookshelves because I forget to put them in the dishwasher. It doesnt help that I tend to perceive messes as part of the environment if theyve been there too long.
The Autism Quotient Scale
The AQ is a brief, self-administered instrument for measuring the degree to which an adult with normal intelligence has traits associated with autism . The scale provides a score of 0 to 50 across five behavioral subscales: attention to detail, deficits in social skill, attention switching, communication, and imagination. The developers view the AQ as a valuable instrument for rapidly quantifying where any given individual is situated on the continuum from autism to normality. Its utility rests on the assumption that autism lies on a continuum of social-communication disability and that effective treatments and interventions may derive from thinking of autism quantitatively rather than as a categorical diagnosis. As Gökçen et al. put it: Theory and research suggests that features of autism are not restricted to individuals diagnosed with autism spectrum disorders, and that autism-like traits vary throughout the general population at lower severities p. 187. However, see Gregory and Plaisted-Grant for an impassioned plea against accepting the continuum assumption uncritically.
In Disease Or Disorder
The study of executive function in Parkinson’s disease suggests subcortical areas such as the amygdala, hippocampus and basal ganglia are important in these processes. Dopamine modulation of the prefrontal cortex is responsible for the efficacy of dopaminergic drugs on executive function, and gives rise to the Yerkes Dodson Curve. The inverted U represents decreased executive functioning with excessive arousal , and decreased executive functioning with insufficient arousal. The low activity polymorphism of Catechol-O-methyltransferase is associated with slight increase in performance on executive function tasks in healthy persons. Executive functions are impaired in multiple disorders including anxiety disorder, major depressive disorder, bipolar disorder, attention deficit hyperactivity disorder, schizophrenia and autism. Lesions to the prefrontal cortex, such as in the case of Phineas Gage, may also result in deficits of executive function. Damage to these areas may also manifest in deficits of other areas of function, such as motivation, and social functioning.
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Do You Have Aspergers
Perhaps you are a spouse wondering if your partner has Aspergers, a friend, acquaintance or colleague of someone you suspect has it, or perhaps you wonder if you might have it yourself. How would you know?
In this chapter, I will explain how the process of diagnosing someone for Aspergers is usually carried out, both in general terms and the specific way I undertake a diagnosis. I will describe the types of information that is sought in an assessment for Aspergers and how that information is collected. I will answer the question of how accurate a diagnosis is, the confidence one can have in a diagnosis of Aspergers and I will discuss the advantages and disadvantages of having a diagnosis.
How Autism Affects Executive Functioning
Some sources report that up to 80% of people on the autism spectrum have some form of executive function disorder. At the core, executive functioning utilizes the ability to link past experiences with in-the-moment decision making, which is an area that children with autism often struggle with but can learn to achieve and continue developing.
Individuals with executive dysfunction typically lack acquired motivation to achieve goals and prepare for normal events in day to day to life, and they often have difficulty picking up on skills such as organization, planning, and reasoning without guided and focused learning experiences.
Our objective is to teach parents how to guide their autistic child while being aware of and addressing executive dysfunction.
Executive functioning can look distinctly different from child to child on the autism spectrum. Some autistic children may have the ability to notice and remember particular small details, while they struggle with sequencing their thoughts and appear to have a short attention span.
Others have trouble shifting from one thought to another. This may appear as stubbornness, as the child struggles with letting go of a thought or concept that they are still processing which can prevent them from moving on and thinking about something new.
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Autism And Executive Function
While many individuals with autism have incredible memories, especially for facts and minor details, they can struggle with executive functioning skills. These skills include the ability to manage emotions, organize and plan, pay attention, start tasks and remain focused on them, verbal reasoning, and inhibition.
As an adult with autism, its important to consider the latest evidence-based methods in terms of executive dysfunction. The goal of treatment centers, such as the Adult Autism Center, is to help adults with autism reach their potential so that they can experience the highest possible quality of life.
Here Is An Example Of How Executive Dysfunction May Affect A Child On The Autism Spectrum:
-Imagine that you are a child. Your parent asks you to pick up the toys that are scattered around your bedroom.
-You forget what you are supposed to do as you head to your bedroom.
-You cannot remember where your toys belong as you pick them up .
-Your brother volunteers to team up with you, but you have difficulty following his instructions. He is not guiding you. He is not showing you what to do step by step. He is not saying, Here, watch what I do. Follow after me. Instead, he is telling you what to do and each directive piles up, one on top of the otherjumbling in your head.
-You begin to feel upset or frustrated. You have trouble controlling your impulses and regulating your behavior. The room does not get cleaned. You are confused. You head into what looks like a tantrum and it goes into a full meltdown because you see no way to regulate otherwise.
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How To Improve Flexibility
- Timers to pre-warn when to finish.
- Routines/Schedules Understand their need to know what is happening when.
- Pre-warn about changes ExplainWHY changing and WHAT replacement i.e. Mum is picking you up today as Grandma is at the Doctor
- Use Social Scripts that give clear descriptions of what is going to change/new and what I need to do.
Bilingualism And Executive Functions
A growing body of research demonstrates that bilinguals might show advantages in executive functions, specifically inhibitory control and task switching. A possible explanation for this is that speaking two languages requires controlling one’s attention and choosing the correct language to speak. Across development, bilingual infants, children, and elderly show a bilingual advantage when it comes to executive functioning. The advantage does not seem to manifest in younger adults. Bimodal bilinguals, or people who speak one oral language and one sign language, do not demonstrate this bilingual advantage in executive functioning tasks. This may be because one is not required to actively inhibit one language in order to speak the other.Bilingual individuals also seem to have an advantage in an area known as conflict processing, which occurs when there are multiple representations of one particular response . Specifically, the lateral prefrontal cortex has been shown to be involved with conflict processing. However, there are still some doubts. In a meta-analytic review, researchers concluded that bilingualism did not enhance executive functioning in adults.
What Is Executive Function
The technical definition of executive function is: the cognitive processes that help us regulate, control and manage our thoughts and actions. It includes planning, working memory, attention, problem solving, verbal reasoning, inhibition, cognitive flexibility, initiation of actions and monitoring of actions. But what does that look like in real life?
Cynthia Kim, in her blog Musings of an Aspie says:
In practice, executive function is a slippery concept. Sometimes it looks like responsibility. Sometimes it looks like self-discipline. Sometimes it looks like being a competent adult.
If you have poor EF, people might mistake you for being disorganized, lazy, incompetent, sloppy, or just plain not very bright. Why? Because executive function encompasses so many essential areas of daily living. Nearly everything we do calls on areas of executive function. Cooking. Cleaning. Parenting. Work. School. Self-care.
One of our contributors, Rebecca Moyes, described executive function this way:
can be likened to an employee who works for a company where the supervisor is unorganized and inefficient. Nothing seems to go right, things get misplaced, and general chaos seems to be the operational rule. Its a lot like that for children with autism spectrum disorders. The executive in charge of their brain is not effective, and because of this, planning processes suffer.
Medical Issues That Impact Executive Function
Executive functions are housed in the frontal lobe and prefrontal cortex of the brain. Consequently, medical issues that impact these areas of the brain, can cause or contribute to problems with executive function.
The good news is that many of these issues are treatable! Because of this, you will want to find and work with an experienced doctor to evaluate if your child’s executive functioning issues can be attributed to a treatable medical cause, such as:
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What Are Executive Functions
Executive functions refer to a broad range of cognitive processes aimed at achieving goal-directed behavior, from cognitive flexibility and problem-solving to working memory and processing speed. Executive functioning issues are implicated in several neurodevelopmental disorders and learning disorders, including Autism Spectrum Disorder and ADHD. Understanding executive functioning offers neuropsychologists a brain map to work with that gives them insight into how students brains are wired and connected.
At Seven Stars, we utilize two kinds of assessments, Formal and Functional to better understand how executive functioning issues affect an individuals daily life. Successful treatment of these intimately interconnected problems is only accomplished through a sophisticated and coordinated understanding of the whole person, taking into account all mental, social and behavioral factors, rather than just a particular disorder, behavior, or symptom.
Our formal assessments include psychological and neuropsychological evaluations, pragmatic language assessments with a Speech and Language Pathologist, auditory processing assessments with an Audiologist, and sensory processing assessments with an Occupational Therapist. Functional assessments evaluate how these executive functioning issues affect ones academic performance, social skills, and understanding of emotional and therapeutic needs and response to individual, group, and milieu interventions.
Executive Dysfunction In Children With Autism
Executive dysfunction in children with autism is a key issue. Executive function itself refers to planning, working memory, impulse control, inhibition, initiation, and monitoring of tasks or actions. All of these elements can be impacted by autism spectrum disorder .
Executive functioning is mediated by the frontal lobe, meaning any developmental delay that implicates the frontal lobe typically results in executive dysfunction. Executive dysfunction is observed in conditions such as attention deficit hyperactivity disorder , obsessive compulsive disorder , Tourette syndrome, schizophrenia, and, of course, ASD. This article will look at the cognitive theory of executive dysfunction in ASD.
Autism spectrum disorder is characterized by difficulties in social interaction and social communication, restricted interests, and repetitive behaviors. These autism traits make general functioning much more challenging, and many scientists argue that executive dysfunction explains these traits.
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Executive Functioning In Adults With Autism Spectrum Disorder
It is a little-known fact about adults on the Autism spectrum, including those with Aspergers syndrome, that problem-solving and behavioral regulation are often more significant challenges than the social difficulties commonly associated with these conditions.
Problem-solving and regulation of behavior are controlled by several higher-order cognitive abilities, known together by the global term, Executive Functioning . Ever since autism, Aspergers syndrome and the more recent classification, Autism Spectrum Disorder, were first described, EF difficulties have been considered a prominent feature of these disorders.
It may be true that not everyone with Autism Spectrum Disorder has difficulty with executive functioning, but without a doubt the vast majority are significantly impacted by limitations in executive functioning. Yet, what these limitations actually look like in adults on the spectrum is not widely known.
Here is a list of the main executive functioning skills and the impairments in those skills that are most often seen in adults with Autism Spectrum Disorder.
The impairments are described in italics for each EF category.
Attention Deficit Hyperactivity Disorder
People with ADHD typically have difficulty paying attention to whats going on around them, they are easily distracted, they tend to do things without thinking about the results, they are often forgetful, have trouble finishing what they intended to do, are disorganized, jump from one activity to another, are restless and have poor social skills.
Many of these symptoms overlap with those of Aspergers. Research has shown growing evidence for a connection between Aspergers and ADHD. Genetic studies suggest the two disorders share genetic risk factors, and studies of the incidence and distribution of both conditions confirm that many people with Aspergers have symptoms of ADHD and vice versa. Brain imaging and studies of the brain structure show similarities between the two disorders.
Having said that, there are important differences between the two. People with ADHD often try to do multiple activities at the same time. They get distracted easily and jump from one interest or activity to another. Focusing on one thing for a long time is hard for them. On the other hand, people with Aspergers tend to focus on only one activity at a time, and they focus on that activity intensely with little regard for anything else going on around them. They are hyper-focused rather than unfocused.
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Executive Function And Asd: Evidence
If you are an educator, currently working in todays school settings, chances are you interact with learners with autism spectrum disorder . Many of them exhibit strengths that allow them to memorize facts, attend to detail, focus on academic content, share information with others on a topic of interest to them, and follow clearly stated behavioral expectations. But for many learners on the spectrum, a lack of appropriate executive function skillswhich includes the ability to switch between topics and activities, initiate action, cope with change, make choices, plan and organize, inhibit impulses, manage emotions, and solve problemsmake reaching high expectations in todays classrooms difficult.
Potential evidence-based practices that teachers may want to consider to address difficulties in EF include visual supports, social narratives, and video modeling. Effective visual supports include environmental modifications to a students environment that support engagement in a desired behavior or skill . For a student who just cant seem to get started on an activity or assignment, or who has difficulty making the switch between activities, using a visual support in the form of a first-then board may useful. The function of a first-then board is to show the order of two activities by specifying what activity must be completed first . Depending on the age and the developmental level of the student, the activities can be visually represented using images or text.
How Do We Help Individuals With Autism Overcome Executive Function Challenges
Executive function is something that most of us take for granted. We might have challenging areas here and there, maybe we arent as organized as we would like, or maybe we lack some initiative, or self-control, but for those with executive function disorder even the basics can be hard. So how can he help? We will go over some ideas for how to help in our next blog post.
For further reading:
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From Visual Reminds To Rewards
Therapy can help autistic people develop some executive functioning skills, but in all likelihood, many people on the spectrum will have to learn to live without the full range of skills.
Still, solutions are available to help autistic people overcome these limitations. For example, many smartphone apps can help them to manage time and stay on track. Visual reminders, like charts or infographics, can remind people of the step-by-step tasks needed to finish a project or accomplish a goal.
Some of these tools help to break a process down as much as possible. The key is to simplify the steps and make the connections between each step explicitly clear. The big picture then becomes clearer as the person is able to see the individual steps to get there.
While neurotypical children may respond to discipline when they fail in a task, autistic children will often not be able to understand why they are being punished. Instead, small, tangible rewards are often recommended when they get a step in the process correct. This can help them internalize the process as much as they can, so they repeat the steps in the future.
People with autism can compensate for a lack of executive functioning. With therapy, they can learn vital skills to help them work with others, and set and accomplish goals. While they may always struggle somewhat in this area, it doesnt have to hold them back from a robust, successful life.