This post was originally published in February 2017. It is being revisited as part of the Adulting With ADHD series.
Executive dysfunction. It’s one of the trademarks of developmental disabilities such as autism and ADHD along with many other possible sources such as depression or schizophrenia. For those of us who went undiagnosed for a long time or who never learned about executive dysfunction, we often view ourselves as lazy, worthless, or many other terrible things. Things that others seem to find so easy can seem incredibly difficult or even impossible to those of us with executive dysfunction. So what exactly is executive dysfunction and what can you do about it? Today we’re going to talk about what it is and in the next post we’ll delve into strategies for dealing with it.
Executive dysfunction is when a person struggles with aspects of executive functioning. (I’m sure some of you are rolling your eyes at the statement of the obvious). However, what exactly is executive function? That can be tricky to define as executive function refers to a wide collection of functions the brain performs. The term is a nod to the executive of a company who oversees everything and keeps things running smoothly. When executive functioning is impaired, everyday tasks can become incredibly difficult or even impossible depending on the type and degree of impairment.
But what exactly does executive function entail? I’m sure you’re wondering. Executive function is often broken up into two categories: organization and regulation. Organization functions include the following:
- Abstract Thinking
- Cognitive Flexibility
- Problem Solving
- Rule Acquisition
- Selecting Relevant Sensory Information
- Working Memory
On the other hand, regulation includes the following:
- Decision Making
- Emotional Regulation
- Initiating and Inhibiting Context-Specific Behavior
- Initiation of Action
- Monitoring Internal and External Stimuli
- Moral Reasoning
As you can see, there are a lot of things that fall under the umbrella of executive function. As such, an impairment to executive functioning can have a wide range of effects. While there are many functions included in executive functioning, people with executive dysfunction typically are not impaired in every aspect. Most people with executive dysfunction are affected in only a few areas and it varies from person to person. It’s like a grab bag of executive dysfunction.
- Difficulty in planning and initiation (getting started)
- Difficulty processing, storing, and/or retrieving information
- Difficulty with abstract concepts (the inability to make the leap from the symbolic to the real world)
- Difficulty with completing tasks
- Difficulty with verbal fluency
- Inability to apply consequences from past actions
- Inability to multitask
- Loss of interest in activities
- Loss of fine motor skills like grabbing something with your thumb and forefinger more than gross motor skills like running and jumping
- Moody or “roller coaster” emotions
- Socially inappropriate behavior
- Trouble planning for the future
- Unawareness that behavior is a problem
But what does executive function actually look like in real life? While I can’t speak for everyone as each person with executive dysfunction will have a different mix of impairments, I’m going to offer up some of my own experiences in the hopes that it may help someone who is also struggling with executive dysfunction.
For example, I drop a glass of water that spills across the floor, glass breaking in the process. I am likely to stand frozen unless prompted on what to do. Why? I can see that there is broken glass and water everywhere. Why don’t I just clean it up? Because I often have difficulty breaking tasks down into steps. You may be wondering how many steps there could possibly be in cleaning this up, but it’s actually quite complex. I would need to:
- Determine that there is a problem
- Realize that I need a broom, dustpan, and a cloth to clean the water
- Figure out how to move without stepping on broken glass
- Find the broom
- Find the dustpan
- Find a cloth
- Sweep the broken glass into the dustpan
- Wipe up the water
- Throw away the broken glass
- Put away the broom
- Put away the dustpan
- Put the cloth wherever it needs to go
Twelve steps. Twelve steps for an “easy” every day task. And honestly, some of those steps could actually be broken down into smaller steps. Now, my brain doesn’t always like to process all of this. Sometimes I can’t figure out the steps involved in what I need to do. Sometimes I know the steps but can’t figure out what order to do them in. Sometimes I get lost part way through and can’t remember what I need to be doing. Sometimes as much as I want to clean up the mess, I can’t make myself move to do it (trouble with initiation). There are a lot of possibilities why someone with executive dysfunction would struggle to take care of an “easy” task that others are not likely to think about. For those with good executive function, your brain does all of this processing with you being none the wiser. However, for many with executive dysfunction, these steps must be actively thought out and remembered.
Executive Dysfunction can present in so many other ways. As many people as there are with executive dysfunction there are that many ways that it can present. Executive dysfunction can be very difficult to live with depending on the degree to which executive functioning is impaired. For many who struggle with this, everyday tasks such as cooking or cleaning are inaccessible.
That’s all for now. Tune in next time for tips on how to deal with executive dysfunction.