Executive Functioning Disorders – not just kid stuff
Thursday, April 30, 2015 55 Comments
by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
Part 4 in a Series (click HERE for Part 3)
EFD – the gift that keeps on giving
“The more you know about EFD challenges, the better you’ll be able
to help your child build her executive skills
and manage the difficulties.”
~ from a fairly comprehensive – albeit misleading article:
Understanding EFDs – Executive Functioning Disorders.
In fact, MUCH of what you will read about EFD is misleading — UNLESS it makes it clearer than clear that difficulties with Executive Functions are NOT exclusively – or even primarily – a childhood problem.
NOR are the problems rare
In my [25-year] experience with ADD and it’s “sibling” disorders (including TBI, anxiety and depression – among many others), the number of people struggling with EFDs is grossly under-estimated and under-reported.
EVEN an excellent article in a published in the well-respected Journal of Attention Disorders, “Executive Dysfunction in School-Age Children With ADHD” reports that “An estimated 30 percent of people with ADHD have executive functioning issues.” ~ Lambek, R., et al.
AND YET, many ADD experts like Dr. Thomas E. Brown from Yale, who has spent his entire career studying ADD/ADHD, position it AS a condition of Impaired Executive Functions.
[A New Understanding of Attention Deficit Hyperactivity Disorder (ADD/ADHD)]
So, wouldn’t that place the best estimate of
the percentage of ADD/ADHDers
challenged with impaired executive functioning
at 100 percent?
But wait! There’s more
MORE folks on Team EFD than folks with ADD/ADHD
For the most part, the executive functions are mediated through a particular region of the brain called the prefrontal cortex [PFC].
Implication: any individual with a disorder, stroke or other brain damage affecting the prefrontal cortex is highly likely to experience brain-based executive functioning challenges of one sort or another.
That includes individuals OF ANY AGE with mood disorders, autistic spectrum disorders, TBI/ABI, and more than a few neurological conditions such as sensory integration disorders, Parkinson’s, dyslexia — in fact, almost all of what I refer to as the alphabet disorders.
BY THE WAY . . . if you already suspect that YOU are probably a member of Club EFD, unless your reading skills are EXCELLENT and you are already a voracious reader, enroll a friend, loved one or coach to help you work through the EFD articles.
Don’t forget that you can always scroll up the sidebar
for a reminder of how links work on this site, they’re subtle ==>
A Review of a few EF Basics:
While, unfortunately, impaired executive functions are not yet fully accepted as an “official” disability, most scientists, doctors, therapists understand what Executive Functions ARE (along with a comparatively small subset of life coaches who received comprehensive brain-based training).
- Some of those professionals know enough to understand how EF’s operate and the implications of impaired executive functioning skills: that they impact life success negatively.
- Some are able to recognize problems stemming from impaired executive functions through observation of a patient in his or her individual practice.
- Only a few know how to help you effectively overcome what they identify.
Executive Functioning Self Defense
If you’ve read the three articles above, by the time you finish this article YOU will know more about executive functions and executive functioning than most of the helping professionals you are likely to encounter.
If you’ve also read the articles linked throughout this article, you will be well on your way to knowing how to work around kludgy executive functioning.
Your final task will be to develop the the systems and standardize the habits you will need to be able to systematize as many repeatedly challenging tasks as possible. You want to put them on autopilot, bypassing PFC involvement for the most part.
(You can also hire me to make sure you work on that – but I’ve made the information available on ADDandSoMuchMore.com for anyone who is ready-willing-and-able to do whatever it takes to be able to benefit from it).
It’s quite possible to learn to defend your life from what you do!
Understanding what’s going on – and what you need to put in place to accomplish your goals and run your life – makes ALL the difference.
So let’s get started. Don’t short-change yourself or your loved ones.
Many Executive Functions – probably more than you realized
As you reviewed above, “Executive Functions” are what we call the integrated set of mental skills that make effective management of the cognitive tasks of daily living possible — including, among others:
- tasks with intensive working and short-term memory requirements
- anything that necessitates an inner awareness of the passage of TIME
- activities where a reliable sense of direction is important
- ALL tasks requiring adequate attentional skills, which means a relatively strong ability to:
1-focus on the intended object,
2-sustain the focus, and/or
3-shift focus at will
They are all brain-based abilities that allow one to be ABLE to do things like:
- ride herd on impulse control and emotional regulation
- plan, sequence, prioritize, schedule, and activate to task-completion
- estimate time to completion and monitor time elapsed
- retain cognitive focus despite everyday distractions
- switch gears and get back on track when interrupted
- analyze ideas and think through concepts, especially as they apply to life-management
- keep track to evaluate performance on everyday tasks
Which are foundational abilities to be able to do things like:
- participate appropriately in conversations
(without blurting, interrupting or changing the subject, or “drifting off”)
- apply previously learned information and strategies toward new problems
(lifelong learning, as well as getting through educational or workplace training)
- organize – an environment or a schedule – and maintain it
- follow directions & jump through multi-step tasks
- understand when more information or assistance is needed
(relatively clear when, why or how to ask for help, with few difficulties accepting help when offered)
- keep track of and follow through on promises
(including work and school assignments as well as personal promises made to loved ones)
- many of the Challenges listed in a prior article on ADDandSoMuchMore.com, Variations on ADD-ADHD
In other words, the brain’s Executive Functions consist of a collection of mental abilities that help our brains organize information in a manner that we can act on it.
Once sufficient motivation is identified, STRONG executive functioning skills enable us to plan, organize, remember things, prioritize, pay attention and get started on tasks relatively quickly and easily.
With WEAK executive functioning skills, and without help developing strategies and work-arounds, handling even the simplest of tasks can be stoppers. Recalling a specific term, name or date, for example, could be as big a challenge as recalling an assignment or adhering to a schedule!
Everything is fuzzy when the PFC is doing a sub-par job!
Manifestations of executive functioning struggles
Executive functioning challenges can produce a wide range of symptoms in wide variety of individuals – as well as in the same individual in various environments, at various times, or as they age.
REMEMBER as you read, very few individuals exhibit everything on the lists above and below, and almost all of them struggle with a variety of things that aren’t listed at all.
Depending on which skills are the weakest (as well as how important they are to the initiation or completion of any particular task), you might see any number of the problems below, to varying degrees of struggle. (CLICK HERE for a prior list by type of task)
- Difficulty making decisions (ex., stuck in the “research” phase or avoiding/delaying decision-intensive tasks, etc.)
- Struggles getting started, or figuring out WHERE to begin
(trouble seeing the main idea or the task objective; easily overwhelmed attempting to chunk tasks into smaller, more manageable sub-tasks and/or figure out which to do first, needlessly over-complicating,etc.)
- Trouble with transitions of all types
(sleep/wake, work/home, chores/leisure time, etc. — switching gears from one activity to another)
- Inability to stick to a plan or activity – OR – inability to abandon it,
(even with the awareness of potential penalties for getting off schedule)
- Micro/Macro issues: moderate ability to focus on small details OR on the overall picture, with low ability to track both in tandem
(or to switch between them in response to task demands)
- Task pacing fluctuations – troubles maintaining timing-appropriate attention to detail
(rushing through tasks that require more detailed attention, or obsessing over details so that deadlines are missed and other projects ignored)
- Limited self-awareness and low ability to self-evaluate. (Impaired self-monitoring abilities: may believe they are doing poorly when they are on-track, or doing well when they are not; consciously unaware that they’ve wandered off-task, lack of understanding about the need to check their level of engagement or their work)
- Difficulties incorporating feedback
(lack of understanding about what they are supposed to DO with the feedback, frequently defensive, sometimes oppositional, often troubles with accepting what they believe is negative feedback, overreacting to perceived injustices or problems getting started on a task – or finishing it when something upsets them.)
- Inflexibility and black and white thinking (Seeming inability to change course when a specific strategy or plan doesn’t work – lack of awareness of alternate possibilities)
- Trouble sustaining attention on tasks, instructions, feedback,
or even everyday conversations
(ex., easily distracted, loses train of thought or thread of conversation with interruptions, or registers only the first or last thing said – missing modifiers like “don’t” or “never;” needs to be told task or locational directions many times before they “stick”)
- Isn’t always able to find the words to explain something
(needs help processing what something feels/sounds/looks like – or describing what it is they need help understanding)
- Isn’t able to think about or do more than one thing at a time effectively
(yet frequently resistant to doing only one thing at a time, chronically multi-tasking with little to no awareness of the impact on the ability to focus)
- Problems organizing or keeping track of things (including information)
- Remembers or recalls information better in a specific manner (with cues like acronyms or mnemonics, or when they have repeated it aloud or written it down),
- Or when delivered in a certain way (spoken, written, etc.)
- Insistent on or picky about seemingly “extraneous” things as necessary to task initiation or completion (typed instructions vs. neatly hand-written, fountain pen vs. ballpoint, college-ruled paper only – or never, etc.)
Things get WORSE as time goes by . . .
because each new skill must build on the ones before it.
If you never learned to add or subtract, multiplication and division would remain a mystery.
If you hadn’t mastered basic arithmetic, how could anyone expect you to do well as you moved through school? Exactly!
Similar to moving from basic arithmetic to higher math, learning how to manage one’s life is also an incremental, multi-stepped process.
Early skills development is possible only if a child’s parents and teachers are aware of what’s really going on. Otherwise, getting through the day remains a frustration for everyone.
For example, children with task management problems can come across as chronic procrastinators, or as if they are deliberately disobeying, when that’s not what’s really going on.
Perhaps, for example, they’re so overwhelmed that they shut down, doing nothing in an attempt to back away from their increased anxiety over not being able to do what seems easy for others.
No promise of reward or threat of punishment will change things — any more than a child who needs glasses could squint her way into visual focus to improve her reading ability. Failures multiply, self-esteem is decimated, and behavior problems tend to result.
What’s needed, like getting glasses for a child who can’t see clearly enough to read, is an awareness of the source of the struggle and the development of interventions that will help work around EF weaknesses – the sooner the better.
- Early intervention helps develop ways to use strengths to support weaknesses before failure expectations take hold.
- Early awareness of the need for intervention will allow most EF-challenged children learn to compensate for those challenges well enough to learn effectively and complete age-appropriate tasks successfully.
- Success builds on success.
Thanks to the miracle of neuroplasticity, appropriate intervention can be helpful at any age. Things can change, even into adulthood – but only once you’re aware of the reason behind the need for change.
Most of us who were undiagnosed as children put together coping skills of some type, but perhaps not the ones that that we really need. At best we are underfunctioning, swimming upstream.
Turning yourself around to swim WITH the current
It’s a very simple process – not to be confused with easy:
- Learn about Executive Functions & how they work: expose yourself to the information in the articles linked above – in whatever manner will work for you now.
- Identify the areas where your brain is not neurotypical. (Hint: where are you struggling? Check out Optimal Functioning (Challenges) Series of articles to help you get specific – start with those that match the areas that are most challenging for you.)
- Accept the reality that things have seemed harder for you because they ARE harder for you – and stop beating yourself up! (Don’t let anyone else do it either. “Tough” and “love” make lousy companions.)
- Embrace the idea that you haven’t been handed a life sentence – just because you always have doesn’t mean you always will! You can develop work-arounds that will allow you to manage what you’re currently avoiding or struggling to do.
- Systematize. Set new habits in place. Decide how you are going to attempt one task on your “difficult” list and do it that way every single time – until it becomes a habit. Habits are patterns – the human brain has evolved to be a pattern-recognition machine. For inspiration and understanding, read through the entire Habits, Decisions, Attention Series as you begin to systematize your life.
- Enroll support. Find someone to serve as a sounding board and accountability partner. You can work with an understanding friend or loved one as long as they are willing to do some reading to understand Executive Functioning struggles so that they don’t inadvertently make things more difficult. If you can afford it, hire a comprehensively trained brain-based coach – or locate a therapist who is EFD-knowledgeable, willing and able to work in a coach-like fashion.
Stay tuned — future articles in the Executive Functioning series will continue to take a look at the implications of Executive Functioning struggles on the way to helping you figure out how to drive the very brain you you were born with.
As always, if you want notification of new articles in the Habit Series – or any new posts on this blog – give your email address to the nice form on the top of the skinny column to the right. (You only have to do this once, so if you’ve already asked for notification about a prior series, you’re covered for this one too). STRICT No Spam Policy.
Want to work directly with me? If you’d like some coaching help with anything that came up while you were reading this Series (one-on-one couples or group), click HERE for Brain-based Coaching with mgh, with a contact form at its end (or click the E-me link on the menubar at the top of every page). Fill out the form, submit, and an email SOS is on its way to me; we’ll schedule a call to talk about what you need. I’ll get back to you ASAP (accent on the “P”ossible!).
You might also be interested in some of the following articles
available right now – on this site and elsewhere.
For additional links in context: run your cursor over the article above and the dark grey links will turn dark red;
(subtle, so they don’t pull focus while you read, but you can find them to click when you’re ready for them)
— and check out the links to other Related Content in each of the articles themselves —
Related Content on ADDandSoMuchMore.com
- Like Life on the High Seas (reblog from TBI advocate)
- ABOUT Black and White Thinking
- ABOUT Distractions
- ABOUT Alphabet Disorders
- TYPES of Attentional Deficits
- Symptoms of Attentional Struggles
- Expectations shape experience
Related Articles ’round the ‘net
- A poignant first person description of EF struggles from a blog about healing from ptsd
- Executive Functions and Their Disorders – Oxford Journals, British Medical Bulletin (full article, free access)
- Individual Differences in Executive Functions Are Almost Entirely Genetic in Origin (full article, free access)
- Executive Function – Web MD
- Executive Function Impairment = ADD/ADHD
- Coping with Executive Function Impairment
- Understood.org – Understanding Executive Functioning Disorders
- Executive Function – revisited (TBI advocate)
- Executive Function Skills
- Getting Organized – Executive Functioning Tips
Exercise, Sports & Executive Functioning
- Why Pumping Iron Aids the Brain (theglobeandmail.com)
- Executive function as a predictor of soccer success (withyourcuppa.wordpress.com)
- Executive Functions may predict success in football (Karolinska Institute)
- Dumb Jocks? Not if They’re Good at the Game (webmd.com)
- Weight training helps older women stave off dementia (cbc.ca)