Monday, October 20, 2014

ACC, ASD and Executive Function

While Executive Function issues are considered a disability in their own right, they are almost always found in people with callosul issues, autism and ADHD.  Executive functions consist of several mental skills that help the brain organize and act on information. These skills enable people to plan, organize, remember things, prioritize, pay attention and get started on tasks. They also help people use information and experiences from the past to solve current problems.

If someone has Executive Function issues (EF), they find it difficult to make and execute plans, complete things on a time schedule, keep track of time.  They find it hard to generalize using formerly learned material to solve new problems, or look for more information when needed to solve the problem.

Those with EF issues have a great deal of difficulty multitasking.  Contrary to belief, no one actually does/thinks more than one thing in any given time, this is not what multitasking is.  Rather thing of multitasking like juggling balls; the ability to quickly switch back and forth between several tasks. This is a primary reason why those with ACC and ASD have extreme difficulty when we are knocked off track from something we may be doing or trying to accomplish.  We (innately) realize that "if it is not done now, it may never be" and we might even become angry or belligerent if you interfere with our completion of the task.

There are six discreet tasks or operations that make up EF. They are:

  1. Analysis, or discovering just what needs to be done.
  2. Planning on how to handle the task.
  3. Organizing and breaking down the task into a series of steps.
  4. Deciding just how much time is needed to complete the task, and setting that time aside.
  5. Making adjustments when unforeseen things complicate the task
  6. Completing the task in the allotted period of time.

In a neurotypical individual, these steps may happen in barely a few seconds, but with someone with EF issues they can take far longer or not even complete at all.  Deciding what words to use in a conversation, for example, can be as difficult with someone that has EF issues as it would be to plan a trip in the coming days.

There are many signs and symptoms of EF issues...

A child (or adult) can find it difficult to figure out how to begin a given task, or focus so much on the details or the overall task, but cannot do both simultaneously.

We can have difficulty deciding just how much time is needed to perform a task, performing the task too quickly, without attention to detail or slowly with missing steps.

We can find it difficult when others give us feedback on our task, and we will stick with our plan, even when it is obvious it isn't really working.

We can have trouble paying attention, are distracted easily, and loose our train of thought when our task or communication is interrupted.

We need to have the directions repeated many times, being prompted constantly in order to fully complete the task.  If we are concentrated enough to perform the task, we have incredible difficulty switching from that task to another, as needed.

May not have the words to express the task in detail, and need prompting and help conceptualizing what something feels like, sounds like or looks like.  We remember information and steps better using cues, abbreviations or acronyms.

Now, in what ways does EF issues affect an individual?
  • Impulse Control
  • Emotional Control
  • Working Memory
  • Self Monitoring
  • Planning and prioritizing 
  • Task Initiation
  • and Organization

There are other "non-mental" related areas that are affected by executive function.  Some of those are regulating hand pressure (hand writing); bodily coordination, tending to over or under compensate movements to adapt to surroundings (clumsiness), teeth brushing ( I will tend to either brush too hard and damage my teeth and gums or not have enough pressure and don't get the job done.)

With all of these issues unless an EF problem is identified parents or peers may harshly judge the individual.  We might be told we just aren't trying 'hard' enough.  Or that we are lazy, or stubborn.  Without recognizing EF issues it can be extremely frustrating to the child or adult having them.

I personally relate, especially to the lack of ability to begin a task, even after planning said task.  I have trouble regularly brushing my teeth and other hygiene issues, because it is much like navigating a complicated maze.  If I have someone prompting me at ever step I function really well, but sans that prompting I wander around the house/around life like a three year old never getting anything done.

I carried a tremendous amount of shame around on my back for years regarding this.  The constant battering refrain from my father was "you just aren't trying hard enough," or "you're lazy, why can't you be like 'everybody else? ' "  Even today as an adult, while my conceptual understanding of these issues is strong, I can't simply relate them to everyone I come in contact with, so I am called "retarded" or "stupid", "bullheaded" or "lazy" by those who do not understand.

With EF issues, it takes more brainpower for us to get through one single day, than it would comparatively take an NT to get through a 7 day week.  Just communicating, just functioning for one day can be patently exhausting.  

There are many methods that can assist in EF, they don't all work, and not all the time, but they can improve quality of life.  My own EF issues are complicated by intrusive thoughts, something common to all with ACC, a constant dialogue going on in my brain, overthinking every tiny small thing into an intricate web of thoughts and ideas.  I take a low dose anti-psychotic called Respiradal that helps slow down these intrusive thoughts, and that does help my executive function.  The catch 22 is that too much of this can also interfere with EF.

So, this post is really "a day in the life of" me, what I go through daily, and what likely or ACC or ASD or ADHD child or adult friend or family member goes through in every moment of their lives.

Thanks for listening, I hope this has been helpful.  It is important for educators and doctors to take these things into account, for parents to take them into account, especially at IEP meetings and other times they need to advocate for their little one(s). 

God Bless,

Joseph

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