Neurodiversity and executive functioning

Neurodiversity and executive functioning

What did you do this morning?

???????Thought about what to make for your evening meal?

???????Packed your bag for work?

???????Wrote a shopping list for your weekend shop?

???????Got out clothes ready for the gym this evening?

???????Remembered the dog must go to the vet tomorrow and he needs to not be fed this evening?

???????Thought about what to wear in case it rains later?

???????Planned what time to leave the house to catch the train?

???????Got annoyed as you are waiting in a queue?

All these things need planning. We need to decide what's important/urgent/or can wait till later. We need to decide what not to do as well as what we need to really do straight away...

In order to operate effectively in education, home or employment we need to think and plan both for the short term and over long periods of time. These skills allow us to prioritize our lives.

When life is ordered and we know what is happening to us and it can make us feel calm and in control. But when things don’t go our way even when it is not intentional to be disorganized it can make us feel a lot of things.. chaotic, anxious, shameful, exhausting, and hugely irritated.

This is especially true if plans don't work or you lose possession, miss an appointment, or do not finish work you had planned to do by a certain time. This is especially hard when this happens to you repeatedly. We can all genuinely mean to remember but still not remember to remember!

It can also be so frustrating to start out with great intentions. We want to try out strategies such as using a to-do list or placing reminders around the house but we can fall after the first hurdle. The Post-it notes begin to blend in with the wallpaper and the alarm to remind us can be switched off and we go back to sleep.

Others around you can reinforce your negative feelings and lower self-esteem. They may also make statements such as “ she’s always late”…. “don’t give her the keys she’ll lose them” which just makes you feel even worse.

**WARNING** to those who are super organized if you don't know what it is like to find it hard to prioritize and plan you can come across as quite condescending!!

So what is this all about?

Executive functioning skills (EF)

EF is involved in handling novel situations outside the domain of some of our 'automatic' psychological processes that could be explained by the reproduction of learned schemas or set behaviors. We also have skills like doing our teeth in the morning that we can do this on 'automatic pilot' and can manage to think of other things at the same time. We have done them again and again and again and so they require little of our focus or attention.

EF is:" A cluster of skills that are necessary for efficient and effective future-orientated behaviour"

(Welsh, cited in Diamantopoulou et al,2007).

I think it's funny that we use metaphors to describe this part of the brain such as it being our controller or...

???????Conductor

???????Cook

???????Driver

???????Chief

???????Pilot

Without executive functioning skills it is hard to be an executive unless you have a Personal Assistant to help you. In reality, we don't all have a PA(but would love to!) and it doesn't happen until you have got to a position of authority. This is why for some people the opportunity for coaching support and help with planning and prioritization can make a HUGE difference to our success (or our failures).

We have an area of the brain that particularly is important for EF skills and this is our prefrontal cortex.

This controls:

???????planning

???????setting priorities

???????organizing thoughts

???????suppressing impulses

???????weighing the consequences of one's actions

Interestingly our brains change greatly in our teen years. The main change is that unused connections in the thinking and processing part of your child's brain (called the grey matter) are 'pruned' away. At the same time, other connections are strengthened. This is the brain's way of becoming more efficient, based on the 'use it or lose it' principle. If you have teenagers, you will probably recognize this and see them reverting to toddler behavior – and acting without thinking!

What’s the relevance of EF to neurodiversity?

We see that people who are neurodivergent often have challenges with EF that impact day-to-day. There is extensive research such as:

???????ADHD (Barkley, 2001) - there are extensive studies showing the big impact on EF in people with ADHD. Nearly everyone with ADHD will have some challenges with executive functioning to some extent. Medication for ADHD can help with this to some extent.

???????ASD/C– Pennington and Ozonoff (1996) found children performed 1 SD below the control group on EF tasks.

???????Developmental Coordination Disorder (also known as Dyspraxia) – children challenges on tests of working memory (Alloway and Temple, 2007)

???????Dyslexia – studies have found working memory challenges that impact their phonological (spelling) problems (Wolf 2010)

???????Dyscalculia – Askenazi and Henik (2010) found evidence of specific EF challenges in university students with ‘pure’ dyscalculia

What are EF challenges?

People may have some of the following. Each person will be different in the pattern of their strengths and challenges. You can have cognitive overload when you have competing demands to do and remember all at the same time.

Areas of executive functioning can be related to:

Initiation:

???????Getting going.. (especially when doing the boring stuff)

???????Procrastination .... (hard getting off the starting blocks )

???????Poor time estimation- (not being able to tell how long a task will take to complete)

Working memory:

???????You can think of this as the brain's RAM (using it as a metaphor). It allows you to hold information in your mind while making links.

??????? Challenges with short term memory-what has just been said or remembering a sequence

???????Juggling and processing different information such as listening to someone talking to you while remembering you need to turn out the light before going out.

Emotional/Self-control:

???????Not having internal prompts such as having an internal voice saying ‘…after I have finished this I need to do that...’

???????Problems lead to a sense of frustration forgetting important things especially when others see you as lazy/can’t be bothered and it is not true.

???????Difficulties regulating alertness such as being hard to complete tasks when the interesting parts have been done.

• Difficulties with your sleep pattern and finding it hard to shut off- I call this ‘my busy brain’.

???????Feel a lot/reflecting and feelings of rejection

?Remembering to remember:

???????Thinking you need to do something but not remembering to do it – this is very frustrating.

???????Difficulty taking others' perspectives into account.

???????Impulsive, not considering the context

• Difficulty adjusting and graduating your pace... being in one gear....all or nothing..

Focusing:

???????Challenges sustaining focus

???????Difficulties shifting to another task

???????Slower gaining information and losing focus

???????Difficulty moving to another topic or task in class

Hindsight and foresight:

???????Harder learning from past experiences and then repeating the same actions again and again

???????Difficulties with predicting future challenges

Time awareness:

????This has been called “time blindness” by Psychiatrist Russell Barkley

???????Remembering to put appointments into your diary

???????Allocating appropriate time to a task

???????Splitting a task into parts and recognizing how long each will take

What are the implications for the workplace?

People with neurodivergent traits may have spiky profiles with some key strengths in some areas but may have challenges with some specific executive functioning skills. This may impact on:

???????Jobs and tasks that involve planning or decision-making.

???????Tasks that involve error correction or troubleshooting.

???????Situations where responses are not well-learned or contain novel sequences of actions.

???????Dangerous or technically difficult tasks with multiple parts to them.

What can you do if you have EF challenges?

The good news we can do a lot to make a real difference when we understand what specific aspects are challenging.

·?????Check your barometer - how are you coping – is everything too much? Do you need to take time out/space/rest? When you are overloaded it can make it harder for you to manage new information or juggle multiple tasks.

·?????Anticipate when challenges may occur so you can build in additional time and ensure you have time to care for yourself.

·?????Have a place to go/time out create spaces mentally or physically where you can go to take time out if you feel overloaded. Using counting, listening to a familiar song or sound, going for a 5-minute walk, making a cup of tea for yourself.

·?????Reflect on experiences that have happened to see what can be pre-empted?next time in a similar situation.

• Minimize clutter and separate similar items into groups. ?Use color coding/visual prompts to help.
• Try to visualize what you want to do (such as using daily checklists) and where you want to be. Break the steps into small parts and recognize as you move forward however small it is.
• Create a list of actions at the beginning and end of each day and mark priorities. Carryover lists to the following day.

·?????If studying or focusing on work tasks, try the Pomodoro method of working – 25 minutes+ 5 minute breaks.

·?????Try to automate ‘boring’ tasks and choose some pleasure stuff?after more tedious tasks.

• Choose some music that helps you to focus.
• Use timers and set alarms to remind you when deadlines are set. Put all tasks into an electronic diary as soon as you know the task/appointment. Set reminders before the deadlines rather than at the deadline itself.
• Try and gain an understanding of how different aspects of work link together such as a project/assignment. If you work as part of a team understand how your work links with others.

I think executive functioning support is like someone having a good recipe book. The book tells you the tools you need, the order of the tasks, how long they will take, and what the end goal will look like when it is finished.

Finally, some people with ADHD who have EF challenges find that specific medication can help them with focusing and attending and help with short-term working memory. Professional guidance needs to be given choosing the right one for you if this is appropriate.

Professor Amanda Kirby is CEO of Do-IT Solutions an honorary professor at Cardiff University and an emeritus professor at the University of South Wales. She has written 9 books in the field of neurodiversity including the latest with @theosmith Neurodiversity at Work: Drive Innovation, Performance and Productivity with a Neurodiverse Workforce

Further reading:

• Executive Functions: What They Are, How They Work, and Why They Evolved (Barkley)
• Guare R, Dawson P, Guare C.?Smart but scattered teens.?Guilford Press; New York: 2013.