Explaining & Navigating Executive Dysfunction


child in beige hoodie leaning forward on table feeling exhausted while studying

¿Executive Dysfunction?

Executive Function

Humans have this cognitive process called executive function. This is basically how our brains go, “yep, I have a goal or task I ought to get done and I am going to do it”, and then the really neat thing about executive function, is that it is by its very nature executive, it has the power, the ability, to put those little cognitive brain cogs whirring about wanting to do the task into action in order to complete the task from start to finish without veering off course. Hence, a person has executive function in a task. So, executive function for brushing teeth would look like a person thinking, “oh I should go brush my teeth” and then they work out what steps they need to do to do it and they go do it, no issue there. Obviously, this is really simplified and executive function is not only just about this. For example, executive function also is about being able to effectively switch between tasks, generally plan activities, emotional regulation, working memory, problem solving, and so on.

Executive Dysfunction

Now, there is the flip side to executive function, the rather aptly named executive dysfunction. This is where one, in the context of task initiation issues, can understand the goal and can even know exactly what needs to be done, yet there is a disconnect in the process. This makes even the simplest of tasks seem like an impossibility. People with an executive function problem like this may lie in bed trying to will themselves to get up to brush their teeth, yet the process of actually doing it does not follow automatically from that internal command, no matter how much they tell themselves. No matter how much they command themselves, yell inside their heads to “just get up and do it!” or call themselves names and beat themselves up over it. It is exhausting and draining to even try to will oneself to do these things, and it doesn’t actually make a person feel better if it takes all of their energy for such little reward. It can actually make them feel worse, like, “oh it took you all this energy just to brush your teeth and your exhausted from it and feel awful, how pathetic are you?!”. Sometimes people need to prioritise tasks depending on how much energy it will take from them when they deal with executive dysfunction. Executive dysfunction is not a disorder but rather a set of cognitive processes and symptom common in a few different areas which I also experience personally as part of my autism, ADHD, and anxiety.

For me executive dysfunction can become an issue with quite a few things from communication to selfcare. For example, I often struggle with actually communicating what is in my head, the process of bringing thoughts into conversation is a tricky one. I struggle with selfcare, for example brushing teeth can be really hard as it is a task I genuinely dislike in terms of sensory input, so I have that layer of just not liking it on top of just struggling or not being able to actually start on going to do it. The other part of this is, and I think it is an anxiety thing, I feel bad for not doing it, I think I feel guilt for not being able to do a lot of things, so growing up I found it really hard being told to go do a task like this or being questioned about it would as that would just make it worse.

Executive dysfunction can manifest in many ways and ultimately affects goal-orientated behaviours across working memory, response inhibition, set shifting, and fluency. Some examples of how executive dysfunction may affect these four areas are:

  • Working Memory – working memory is our ability to hold information temporarily, when we have issues with executive dysfunction we may struggle more with our working memory and our ability to focus on the task at hand.
  • Response Inhibition – response inhibition is our ability to basically think before acting so as to not engage in an action that interferes with a goal-driven behaviour, when we have issues with executive dysfunction we may be more reactive to things that distract us from the task at hand and more easily distracted.
  • Set Shifting – set shifting is the ability to move back and forth between different tasks, however, when we struggle with executive dysfunction, we may get stuck thinking on just one task and really struggle to or are just unable to change our focus to the other task. We can call this very stuck and continued fixed thinking on the task perseveration.
  • Fluency – fluency is our ability to communicate efficiently with verbal or visual information, however, when we struggle with executive dysfunction many aspects of this can become affected, from the pragmatics (i.e. how we communicate the social and contextual aspects of language) to the semantics (i.e. the actual meaning of the words) of language.

How I Navigate Executive Dysfunction

Executive dysfunction affects so many things and it can be really difficult to navigate certain aspects of it. Some skills I use to help with my executive dysfunction are:

  • Breaking tasks down into individual components to make them feel more manageable.
  • I have post-it notes and pencils (important to have them both) in every room to jot things down to help navigate issues with working memory and getting distracted by or too focused in on something.
  • I often have my computer read aloud the text I am reading to help me focus in on it.
  • I use a lot of mindfulness when I am stuck in that sort of ADHD paralysis and I will think to myself “okay, I am here and I am doing this thing instead of that thing and that is okay, I will get there in a moment” and I will be really gentle with myself instead of trying to just force myself, as I ultimately end up more stuck if I try to force things.
  • I try to have glasses of water in each room when I am working because I know I will forget to drink and I know having glasses of water around makes me more likely to drink.
  • I have a massive whiteboard to plan my week, but I also use a digital calendar too so I get notifications.
  • I make a lot of lists and add easy things on to them that I know I can manage to give me a boost by having something to check off quickly.
  • Asking others for help: this is an important one and you are allowed to do this, we all need help with different things at different points.

The Author

This was made by @pallyallywrites who has her own personal blog, pally.ally.writes, where they write about psychology, neurodiversity, and life.



How I Keep Myself (Mostly) On Track


white printer paper on white table

Find Your Own ND System This Spooky Season

Introduction

There are so many systems offered to those under the neurodiversity umbrella to help us stay on track of things: from bullet journals to calendar apps. Usually we are recommended tools from neurotypicals who just don’t quite get how we work. So, in this post, Marina, a wonderfully kind autistic individual, shows their own personal neurodiverse ways of staying organised and on track. She also offers suggestions and a download for others to try too. They highlight the importance, of finding your own systems, things that work for you individually, ultimately noting that there isn’t a right way to do all of this and that that is okay.

My Systems

Over the years, I’ve realized that planners don’t help me because the information is inside a book. If I don’t open it, it practically doesn’t exist. If I misplace it or forget to use it one day, it’s difficult to get back in the habit of using it.

So… here are the systems that work for me!


Whiteboards

I have two whiteboards in my flat.

One is in the hallway, so my flatmate and I can put our schedules on it. It helps us remind each other about events and know when the other person will be out or busy. I use a green marker and she uses a red marker.

Image Description:
Small whiteboard with blue frame and green and red text. Split into days of week. Some text has been scribbled over. 
End of Image Description
Shared Whiteboard

The second whiteboard is the most important. It’s in my room and it keeps track of my week.

It’s split into 5 sections:

1 – Week

  • I have the days of the week with numbers listed and I write the main event of the day
  • Updates Sunday night

2 – Today

  • Day and number
  • The day’s schedule in detail
  • Daily to-do
  • Dinner ideas
  • Updates every night

3 – Weekly/Long-Term To-Do

  • Write the deadline!

4 – Morning Routine

  • Sometimes I get stuck in the mornings, and it helps to know what I’m meant to do next

5 – Notes/Reminders

  • Anything that will make me happy
  • General reminders
Image Description:
Large whiteboard with wooden frame. Split into five sections, labelled with dates and times.
End of Image Description
Personal Whiteboard

Calendar

I got this cheap calendar and have it tacked to my bookshelf. All important events are added here, and I cross off the day once it’s over.

Image Description:
Red and white calendar open on October 2021 with messy writing.
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Calendar

Daily Routine and Habit Trackers

Image Description:
Diagram, 4 rows, 3 columns all separate tables.
First column has tables labelled Morning, Study, Free, and Night with relevant icons. Second has smaller 5x7 tables with days of week. Third has 5x1 tables labelled with tasks.

End of Image Description
Weekly Habit Tracker – downloadable and editable version at the end of article

Guide to this chart:

It’s split into Morning, Study, Other, and Night. Each table is 7 days’ worth.

The idea is that I may not do every single activity every day, but throughout the week I want to do them most days and I want to keep track of it. I struggle with maintaining a strict routine but there are things that I want to make sure I do.

Morning and Night are routine trackers. I can make sure I took my medications, brushed my teeth, did all the important tasks. Sometimes I forget, or I do things in the wrong order. It’s helped me to have it written out and be able to cross it off.

Study and Other are habit trackers. I don’t need to do every activity every day, but I like to make sure I’ve done them all at least twice throughout the week.

The Other (aka free time) section also serves to give me ideas for times I am bored and need something to do. I might realize I haven’t played video games in a while, or maybe I spent the whole week playing video games and should maybe pick up a book.

I usually keep this in a poly pocket so I can use a whiteboard marker to cross it off and reuse the same sheet.

I’ve attached an editable word document of mine at the end of the post.


Final Thoughts

Whenever I notice something isn’t working, I adapt it. It takes time to figure out what you need and what works for your brain, but it’s great to have A System (or several systems). One of my close friends loves to spend a day planning her bullet journal spreads and decorating it. That overwhelms me and I can’t imagine relying on it. My whiteboards stress her out because I have my deadlines right in front of me. Some people love their computer’s calendar, there are loads of apps out there, a regular planner is fantastic for others, etc.

It takes a lot of experimentation to find your own system, so keep at it and do whatever works for you. There isn’t a right way to do it.


Downloads



Making A Communication Guide For Appointments


As someone who struggles a lot with certain aspects of communication, especially when the ways in which I communicate are not understood by those I am interacting with and are not met with patience, I often rely upon many different tools to navigate the world, one of which is a guide which quite literally communicates my ways of communicating.

This guide is a really useful thing to have, especially for giving to people I am going to meet for appointments as they can have some understanding and preparation in place on their part for how they are going to facilitate communication with me. It means I am not always expected to try my very best to align to a neuronormative expectation of how I am meant to be, because they know to meet me at my level. It also means they see beyond a label: they do not just read that I will be nonverbal there and assume I have nothing to say, they know I am funny and smart and opinionated and have my own ways of communicating with them.

In this post I will break down the kind of things I put in each section of my communication guide and then leave a blank copy for you to download and fill in if you want to.


Title

Firstly, I start with the title, I personally do not title mine with anything beyond my name and NHS number as the document has the title, but if you make your own you can come up with all sorts of titles. I do quite like the idea of calling it: Communicating Communication.

Breaking Down Communication Generally

The first page is focused generally on how I communicate and what helps me to be understood and understand others.

What Facilitates Communication

In this section I put what kind of things help me with communication generally. It is the first section so it is kind of like an overview of some of the most important things someone would need to know to help ensure good communication between me and them. Some examples of things I have in here include:

  • Having regularity to day and time of appointments.
  • Having face to face appointments if possible.
  • It is really helpful if I feel understood, and that my specific experiences are recognised.
  • I like to clarify details – having patience and time to do this is really useful.
  • Having a little bit of time to get to know the person I’m speaking to is helpful, and being introduced to new people I will work with.

How I Communicate

In this section I give an overview of the ways in which I communicate to help the person better understand me and how to communicate with me. Some examples of things I have in here include:

  • I am unable to verbally communicate in appointments, but can communicate using text/writing.
  • I can struggle with literal statements, and misinterpret some humour (I personally think I have a fantastic sense of humour myself!).
  • I take people’s word choices seriously and am quite pedantic about language.
  • I find it helpful to clarify meaning to ensure I have understood.

Other Information About Me That Is Useful To Know

In this section I just give a broad overview of anything else I think might be useful to know for others meeting me. As I often use this for health professionals, I tend to focus here about how I may express things like pain or emotions, as they are important parts of communication too. Some examples of things I have in here include:

  • I can find it difficult to know what it is I am feeling emotionally.
  • I struggle to express distress and pain.
  • I have a poor concept of time.
  • I need to move about, this is not me being rude or being bored, it is self-stimulator behaviour and something I need to do.

Breaking Down Communication Appointments

This is the second page and focuses on how to best support me through an appointment in terms of communication and is a really useful tool to send out to people before I meet them.

Things To Consider Before Appointments

In this section I include things, such as how to contact me in terms of arranging the appointment and what can be done beforehand to ensure I feel comfortable attending. Some examples of things I have in here include:

  • The best means for arranging appointments is by mail or email.
  • It is really helpful to know the purpose of the appointment in advance.

Things To Consider At The Start Of Appointments

In this section I advise on what is best to do when we meet, how we introduce ourselves, and how we start the appointment. Some examples of things I have in here include:

  • It is helpful to revisit the purpose of the appointment.
  • It is a good time to check in with how I am feeling, as this might impact on my ability to engage in the session.

Things To Consider During Appointments

This section focuses on what is important to communication throughout the appointment, both in terms of being understood, but more importantly here (since I have covered a lot of how I communicate), in terms of understanding the other person. Some examples of things I have in here include:

  • If there are distracting noises, I will struggle to process what is being said.
  • If you are giving me the choice of something it is best to only have two options (listing things can be tricky for me).
  • I can find it hard to express when I am struggling – it is helpful if you check with how I am managing during the appointment.

Things To Consider At The End Of Appointments

This is the last section where I relay how to best end appointments with me in a way that works with my styles of communication. Some examples of things I have in here include:

  • I find it useful if we can recap on any action points discussed / agreed.
  • It is helpful to have some time for me to ask any questions or clarify anything I’m not sure about.
  • If the purpose of the appointment has not been met, it is useful to have some reassurance about this.
  • I find it helpful if we can schedule any future appointment(s) together at the end.


The Author

This is Practical Neurodiversity’s first blog post. It was made by @pallyallywrites who created this space and who has her own personal blog, pally.ally.writes, where they write about psychology, neurodiversity, and life.