My Brain Drives Without A Map: Executive Dysfunction

Introduction

Joshua came in from playing, and it was time to take a shower so that he and his family could go out to eat. He went into his room, where his Nintendo DS was lying on the bed with a game still paused. He had forgotten he was almost done with level 12 before his friend had asked him to ride bikes. It would only take him a couple of minutes to beat the level. He sat down to play. His mom poked her head through the doorway. “Josh, you’re supposed to be taking a shower. Why are you on your game?”

Joshua tossed the game back on the bed as he stood. “Sorry, Mom, I’ll go now.” He went into the bathroom and turned on the shower first. It always took a few minutes for it to get warm. While he waited, he decided to brush his teeth.

“Josh!” his dad called from down the hall. “Your mom needs you to come and take some towels to the bathroom.”

Joshua sighed and spit out the toothpaste. He took the stack of towels from his mother and started back toward the bathroom. His dad almost bumped into him. “Oh good, you got the towels. How was your day?”

“It was good, I played with Steve. My bike has a low tire.”
“I’ll fix it tonight. Hey, is that the water running?”
“Yeah, I started the shower.”
“Well don’t waste water, Josh! Hurry up with those towels.”

Josh’s face turned red with irritation as he walked down the hall. He put them in the bathroom closet and then took his shower. After drying off, he put on his underwear and then sprinted to his room for the rest of his clothes. He was pulling on his jeans when he heard his mom calling again.

“Josh! You left your shoes in the front hallway!”

Now Josh huffed in frustration. He was trying to get ready. He quickly buttoned his jeans and headed to the hallway. He picked up his shoes when his mom met him at the stairs. She looked at the shoes in his hands and his bare feet.

“You can’t go without socks. It’s too cold outside.”
“I was getting dressed,” Josh said, a little irritated.
“Watch the tone.”

Joshua went back to his room to put on socks and shoes. He was pulling on his left sock when his mom called him again.

“Josh, where’s your coat? Can you bring it down here so I can sew on that button?”
Josh brought the coat to his mom and watched while she began to sew on the button.
“I thought I told you to put your shoes on. Why are you wasting time?”

This time Josh made an annoying sound. His dad, who was watching the news, shot him a look. “Don’t get smart with your mom.”
Joshua had to control his urge to stomp back to his room. He put on his shoes as quickly as he could.
Josh’s dad walked in, his arms folded. “Why haven’t you brushed your hair? It’s sticking straight up,” he said.

Unable to contain his frustration any longer, Joshua pushed himself off the bed forcefully and huffed out, “Good grief!”

His dad caught him by the arm. “What did you just say? You better control your temper, Josh. Maybe I just need to take the air out of both those tires, and you can stay inside and help your mom clean the house tomorrow.”

As they rode to dinner in the car, Josh’s dad told his mom about the outburst.
His mom sighed and shook her head. “If only he weren’t so scattered.”
What is executive function?

Do you have a child like Josh? Are you like Josh? Maybe this story has a familiar theme. If so, it may be because you or someone you know struggles with executive functioning.
Sometimes struggling with executive function feels like walking on shifting sand or trying to navigate the changing staircases at Hogwart’s. And it’s especially frustrating when those around us are the ones shifting things!

What do I mean by executive functioning?

The executive functions are a set of processes that all have to do with managing oneself and one’s resources in order to achieve a goal. It is an umbrella term for neurologically-based skills involving mental control and self-regulation.
(www.idonline.org/article/29122 “What Is Executive Functioning?” Joyce Cooper-Kahn and Laurie Dietzel)

The writers of the above article liken difficulties with executive functioning to taking a road trip without a map.

WebMD states that executive function helps us to:
· Manage time
· Pay attention
· Switch focus
· Plan and organize
· Remember details
· Avoid saying or doing inappropriate things
· Do things based on experience
· Multitask

These skills are gathered into two groups: organization and regulation.
https://www.webmd.com/add-adhd/executive-function#1

Understood.org, an organization that researches, supports, and advocates for people with differences (like dyslexia, dyscalculia, ADHD, and more), breaks down executive functioning into three areas:
· Working Memory
· Cognitive Flexibility
· Inhibitory Control

So what does all this information mean?

Well, for those who struggle with executive dysfunction, it means the world can be a frustrating, overwhelming, and distracting place. I can attest to this because not only do I struggle with this, so does my oldest. I am one of those adults who likely would have been diagnosed with ADD or ADHD had I been a child in the 1990s or 2000s.

Both my children struggle with executive functioning. My oldest is also on the spectrum, so it can be very overwhelming for her at times. Sometimes struggling with executive function feels like walking on shifting sand or trying to navigate the changing staircases at Hogwart’s. And it’s especially frustrating when those around us are the ones shifting things!
Think about poor Joshua. They didn’t realize it, but his parents basically set him up to fail. They had tasks for him to do, but they kept interrupting one task to turn his attention to the new task. He probably felt like a bouncing ball, ricocheting from wall to wall.

What most people would consider a mild side thought or insignificant interruption can derail the brain of a person who has difficulties with executive function. And if it persists, we feel so much pressure trying to decide which thing is more important, we can become downright grumpy. Like Josh. Every time his mind and body synced for one task, he was interrupted and asked to refocus on another task.

So does this mean people with executive dysfunction cannot multitask? No, not really. But it does mean, for lack of a more complex explanation, that we need to be the ones to choose. If I am reading an article and the ding on my oven says the cookies are done, and I get up to take them out of the oven, and then the phone rings, I can do all those things. If I decide I want to talk to my mom on speakerphone while cleaning, I can do that.

However, if I am folding and hanging laundry, and someone asks me to go to another room to find a particular item, especially if I have no idea where the item is, but I know that they also want me to keep the laundry going, and then they ask me after I find the item (or they find it) to make them a sandwich…yeah, a part of my brain is going to freeze and say, “which thing do you want??”

Here’s an example. I drove home from work several years ago, and I knew as soon as I walked in the door I needed to turn the oven to 375 degrees to preheat so that it would be ready by the time I needed to put in the casserole. I also knew I needed to call someone. So my mind had this file: Inside>oven>phone call>casserole prep.

However, as soon as I walked in the door, someone needed something from me. And it required the use of my hands. I dropped my stuff, hung the tote bag I had carried on a doorknob, and did whatever it was that they needed. I went on about my night.
The next day, when it was time to go to work, I couldn’t find my keys. I looked in my purse, my pockets, the car, the bedroom, the kitchen, and everywhere else I could think of. No keys. I used the spare set, but that was only a temporary fix. I would need the non-duplicated ones on my ring at some point. I ended up having a copy made of my husband’s house key. Luckily, we had touchpad access at work. However, I had to leave my work office unlocked. Replacing the key was going to cost 40 dollars.

Guess where my keys were? Three weeks or so later, I finally went through the tote bag I had brought home, and my keys were at the bottom. Since my file of thought had been interrupted, I didn’t pay attention to where I dropped my keys. Instead of dropping them into my purse as I always do, I dropped them into the bag. It’s a silly example, but it’s always what happens when my linear process of tasks gets derailed. And it’s not a “habit” I can break. It is the way my mind works.

Kids are often messy, and when we would tell our oldest “clean your room,” she would get completely overwhelmed. There were so many tasks and so many different things to put up, she didn’t know where to start. Likewise, she might find a book she had forgotten about in the midst of cleaning and start reading it. Or, if some things in her room needed to go into the living room, she might take them in the living room, get distracted by the television, and forget that she needed to go back to her room.

I have similar problems. That is why when I clean my house, I do a room at a time. If I start on the bedroom, and then in the middle stop and wash dishes, and then in the middle of that stop and get clothes out of the dryer…I will, in fact, have a nervous breakdown. It’s too many directions. Just let me clean the bedroom, then the bathroom, then the kitchen. That’s how I keep my tasking organized.

As a teacher, parent, and observer, I see so many adults who set up their children with executive function difficulties to fail. They either give them too many varying tasks and then get upset when they aren’t done, or they keep interrupting one task to ask the child about another task, and the child eventually snaps or melts down. Then the child gets in trouble for having a temper.

It’s not about intelligence

So what’s going on? Are they just dumb? Actually, it’s the opposite.
TE Brown, Reichel PC, and Quinlan of the Yale Clinic for Attention and Related Disorders studied 157 adults with ADHD who had IQ’s of 120 or higher. 73% of the adults studied were significantly impaired in the area of executive function.

These are adults who have had their lives to develop mechanisms to adapt. A child, no matter how smart, does not have these mechanisms. In “IQ and Executive Function Skills: The Engine and the Fuel,” Jackie Stachel writes:

Think of IQ as the engine in a car and Executive Function skills as the oil, fuel, belts, and hoses that make it run effectively. That perfectly restored 1969 Pontiac GTO with a 330 horsepower engine has plenty of potential to cruise down the highway on a sunny Saturday, but see how far you get with faulty spark plug wires.
(https://www.beyondbooksmart.com/executive-functioning-strategies-blog/iq-and-executive-function-skills)

In another study, done by Brown, Reichel, and Quinlan, and published by the Centre for ADHD Awareness in Canada, the charts of 117 children from ages 6–17 with IQs of greater than 120 were studied. 62% of these students were significantly impaired in 5 of 8 markers for EF.
(http://caddac.ca/adhd/wp-content/uploads/2017/06/Brown.Reichel.Quinlan_Executive-Function-Impairments-in-High-IQ-Children-and-Adolescents-with-ADHD.pdf)

So what actions can we take?

There are ways to accommodate for these struggles and ways to adapt habits and thinking to minimize the stress they cause. I joke sometimes that my almost constant leg jiggling for as long as I can remember was my own way of dealing with the “H” in ADHD as a child. That isn’t really an example of executive dysfunction, but it’s just an example of how something simple can become a mechanism. Here are some other things that you or your child can do.

For the person who struggles:
Compartmentalize your tasks. I mentioned that I get stressed if house cleaning bounces me all over the house. And yet sometimes the only way to remove clutter from one room is to put it somewhere else. I adapt to this by creating a stack of items to go in other rooms. Or, if the de-cluttering is excessive, I have a box or tote bag that I place the items in while I work in one room. Then when it’s time for the next room, the first thing I do is unpack the box or bag and put those items away before I begin cleaning.

Make and organize lists. I used to think I didn’t need lists. I do. The problem was, I was only using one list. One long list with all sorts of different types of tasks on it is no help to me. If what I need to do at work, what I need to do at home, and who I need to call are all on the same list, I might as well not have one. It’s too jumbled and too much information. I have a work-list, a home-list, and a contact-task list. Well, I say they are lists. I add them to my calendar with alert reminders. And I have the important ones happen several times in 30-minute increments. For example, when it was time to set up the house payment, I set a reminder for 9:00, 9:30, and 10:00. That way, If I was in the thick of something at 9:00, I had two more chances, and I couldn’t forget.

Think geographically. This is how I clean my house. It’s also how I spend my focus. If I am at work, I am at work. Unless there is something non-work that has to be done during working hours, I don’t mix genres (smile). Don’t ask me to check on something having to do with so-and-so’s birthday party or the back yard while my focus is on creating forecaster training. I’m all work at work. Similarly, if my boss sent me a text at 7:00 in the evening about something he wanted to discuss the next day, I would immediately send myself an email about it at work. I won’t remember his text because it was sent to my home environment.

Communicate. With those close to me, I just ask what they want. Or I let them know I’m overloaded. For example, last night I was preparing meatloaf and rolls and the rest of dinner. My husband, who is learning to play guitar, was asking me about string names. I tried to just shout a noncommittal answer, but he was trying to tune the guitar, so he asked again. I walked into the room where he was tuning, and I just asked him, “Does dinner need to be ready when we agreed, or do I need to help with the guitar because I can’t focus on both.” He asked me to look something up on my phone (which I had in my hand), and then I sent it to his phone. Then I resumed cooking. Had I continued to try to go back and forth across the house, I would have gotten stressed and frustrated, and that doesn’t help anybody.

Use technology. My oldest just told me about Google Keep Notes. It’s a listing and organizational app with all sorts of options. You can even drag the items up and down the list. This means I can make my grocery list and then drag the items around to organize by aisle. I was excited! There are all sorts of apps to help us organize and prioritize. Make use of them.

For those who love us strugglers
Let us finish. I think that is probably the single biggest request I’d make. If I am right in the middle of something, unless it’s a dire emergency, let me finish. If I am folding clothes, wait that few extra minutes before showing me a cool video. If I am shopping for my niece, let me finish looking before we go to the kids’ department. If I am on the phone, please, please don’t try to talk to me while I am talking to or listening to someone else. I can’t.

Watch the tone. When there are competing tasks, it immediately ups the anxiety. If it also gets confrontational, it ups it even more. I remember growing up in a house with an upstairs. If I was doing something upstairs, and my mom yelled loudly for me to do something, I always jumped, and I usually had an exasperated initial reaction. Imagine you are napping and someone suddenly bounces on the bed and says, “HEY!” Yeah, that’s how it feels. Every time.

Please don’t set us up to fail. If you know your child has ADD or ADHD, please don’t constantly interrupt one task to ask about another. If you know they are getting dressed, don’t ask them about brushing their teeth. If you just told them to do their math homework, don’t interrupt them to tell them to put up their clothing away that minute. I know…if you aren’t a person who faces this, it doesn’t make sense. But trust me when I say a lot of meltdowns can be averted if we can just do things in order.

Don’t yell. I don’t have an article to cite here. But growing up inside myself, raising my oldest, and teaching for 15 years has convinced me that kids who struggle with this are sensitive to yelling. They are very stressed when they are subjected to out of proportion outbursts. Guess what? Highly intelligent kids with ADHD lose things. If you are going to bring out the big guns every time we misplace something, we are going to be walking wads of anxiety. So it took me ten minutes to find my other shoe. If we aren’t running late, just shake your head and let it go. So an 11-year-old lost his locker combination. Yes, it’s annoying. He doesn’t deserve World War III. Not to mention children learn anger and have anger management problems when their parents can’t contain their own.

Enjoy the benefits. There are benefits to have an intelligent, creative, slightly scattered person in your life. We can be spontaneous when we want to be. If you let us focus, you’ll get excellent work. We tend to forgive pretty easily.

If you’ve read this far, thank you. I’ll go ahead and say I was interrupted about five times while writing this, and I thought I’d need a Xanax before it was all said and done. But I think this is important. I’ve seen how it hurt my own child when a teacher or other adult (or peer) didn’t understand how anxious the piling on makes her. I’ve seen parents and teachers reduce kids to tears over something that really isn’t the end of the world. I’ve seen a kid get in trouble when he simply finally expressed the frustration of being pulled into all sorts of different tasks simultaneously.

And no, the old school, “in my day there was no ADD; we used the belt!” doesn’t fly. You don’t spank a child for the way his brain works. So no. Full stop on that one.
I hope someone with a child who has EF issues or someone with EF issues themselves finds this helpful. There’s nothing wrong with our brains. We just have to learn the best way for us to use them.