Wednesday, September 10, 2014

The Triad of Behavioral Flexibility

Something I have always had tremendous difficult with is behavioral flexibility; something common to both ASD and ACC.  The most successful people in society have the most behavioral flexibility.  While I have compensated and adapted many things over many, many years, I still remain rigid in regards flexibility.
What makes the situation even more untenable is the thought by others that I'm "just stubborn" or recalcitrant.  To be fair, I can be stubborn at times, like anyone else, but this lack of flexibility has more to do with executive function, or the lack thereof. 

Behavioral flexibility is like a camera tripod...if one of the legs is off, then the whole thing is unusable and out of balance.  Those three "legs" are attentional shifting, rule switching and response reversal.  At any given time, one or two legs of the tripod may be working, but the other(s) are not.  While I can't speak for anyone else, in me this produces brain lock, or causes me to freeze, to be confused, and emotionally raw.

Attentional shifting is the process of directing attention to a task to increase the efficiency of performing said task, and includes inhibition to decrease attentional resources towards unwanted or irrelevant inputs.  In the real world this most often has to do with task switching.  This is one reason I always had great difficulty when I would try to work in a job.  In any given job, circumstances come up that one might have to change their activity, adapt and focus on a new activity, then perhaps go back and finish the original task.  This is not something I can do easily at all.

"Multi-tasking" is a myth, not even NTs can focus on more than one thing at a time.  What an NT is good at is task switching, and the rapid movement of attention from one task to another then back again.  Nevertheless attentional shifting remains very difficult for me.  I've learned some ways around it in life, but even then they are not a consistent part of my life.

I'm often so invested in where my attention is, that any attempt to redirect it is met with anger, aggression, and confusion. 

Rule switching is similar...The way we do things, "use this rule for division, not this one", "I'm late for the appointment, so I have to drive on the freeway today, not the side roads."  I can think of the example of when I used to drive for morning coffee, I would always take the exact same route, and if I couldn't I simply would not go to coffee, because it went "against the rules."

Again, response reversal is also closely related to rule switching.  An example of impaired response reversal would be doing the same action over and over expecting different results.  "This didn't get me what I wanted, so let me try this other thing."

And related to this tripod is the general concept of cognitive control; the ability to recognize and understand the context in which an event is taking place and select the right response(s), to alert us to any contingencies in our planning of our task or conflict between two different sets of information. 

For example; driving in a residential area should lead to a change in behavior; the driver should slow down and become more careful, the light turns yellow, we have to either get out of the intersection or stop.  Cognitive control is the first thing to go out the window when the tripod is ineffective.

In all these areas these are common experiences to many ACC and ASD folk.  The overwhelming attitude we get from NTs is that we are "doing" this, we are willful, stubborn, recalcitrant.  It simply is not true.

This is so much a part of my normal process that when I moved to my new home a few months ago, I could not brush my teeth.  Because it was a different surroundings, different arrangement, my schedule had changed.  While I've always had trouble with my ADLs, and particularly brushing my teeth, the six years I spent in my previous home I was able to keep a semi-regular habit going, but just because I changed location I "lost" that habit.  Even when I would go away from home overnight, I could not brush my teeth.

That may be a gross example, but I want people to know how real this is and how it effects us.  This goes for any sort of daily activity, unless prompted I will rarely do it, and regardless won't do it consistently...all this is typed up with cognitive control.

On an average day (making the number up) a person might have 10 thousand thoughts in their head, multiply this times one hundred and that just begins to approach my mental processing.  When I am overwhelmed with stimulus and with cognitive pressure I can only back away, or shut down, or react negatively.

Cognitive therapy (talk therapy) has limited success with ACC and ASD folk, but some years ago I came across Dialectical Behavior Therapy.  DBT is a therapy designed to help change behavior patterns that are not effective, such as self-harm, suicidal thinking and substance abuse. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings and behaviors that lead to the undesired behavior. DBT assumes that people are doing the best that they can, but either are lacking the skills or are influenced by positive or negative reinforcement that interfere with one’s functioning.

DBT has by far been the most helpful of all the tools in my kit.  DBT can be learned in therapy, in groups, or by individuals.  In fact there is an outstanding book, and The Dialectical Behavior Therapy Diary, to help make these skills a (more) consistent part of daily life.  For adults with ACC and/or ASD I recommend this above any other book(s), the skills you can learn are priceless.  When these skills are mastered behavioral flexibility can come a wee bit easier (at least in my experience.)

I hope this post has helped you peek for a bit inside my head, inside my life.  Hopefully my experience can direct you to find your own answers in life.



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