Some of you mentioned that it would be nice to have a concise summary of the key elements of executive function impairment to share with family members and others. So I made a thing!
You’ll need javascript to view it. You can pause the slideshow by hovering your mouse over it and then clicking the pause button.
I also created a new Executive Function page with links to the Executive Function Primer posts plus the slideshow and some introductory text.
The first article in a 3-part series on motherhood is out today at Autism Women’s Network: Motherhood: Autistic Parenting
I kicked off the series with the social aspects of motherhood because that was one of the biggest challenges for me and for many of the women who answered the survey questions. In the article, I focused a lot on the areas of difficulty that we experience and touched on some general ideas for supports.
There is clearly a big gap when it comes to resources for autistic moms. I’m wondering if any of you have found solutions to the need for social supports. Do you know of online support groups for mothers on the spectrum? Have you found ways to communicate effectively with your children’s school or have you gotten any social supports from local social services organizations? Have you enlisted help from your own parents or family members when it comes to the social aspects of being a mom? If you’ve done things that have worked, I would love to hear about them and I think lots of people would benefit from having a pool of realistic options to draw upon.
As always, I owe a huge thank you to everyone who answered the survey questions. There were more than 70 responses, many of them incredibly detailed. I’m humbled by how honestly and openly you all share your stories. Although I couldn’t include quotes from everyone, I did my best to find the common threads of our social struggles and portray those in the article through representative quotes. There are still two more articles coming, so if you’d like to contribute, please feel free to fill out the survey in the coming days.
This is part 4 in a series about executive function. After wrapping up the discussion of regulatory functions with some thoughts about Cognitive Flexibility, it talks a bit about some models of EF and how the various pieces fit together. Looking for the other parts? Part 1 | Part 2 | Part 3
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Cognitive Flexibility
Cognitive flexibility is all about change. Changing your mind. Changing your opinion. Changing your beliefs. Coping with change. Understanding why change happens.
In a more formal sense, it’s the ability to shift your thinking or attention is in response to changes in the environment or situation (such as new rules, information, demands or goals). If you’ve ever wondered where the autistic tendency toward rigid thinking and routine comes from, this is it. Change requires cognitive flexibility. It’s not necessarily that we don’t want to do things differently. Impaired executive function makes it harder to adapt to change by forming new thought or behavior patterns.
Variation in executive function capacity can explain why one day it’s not a big deal if the bus is five minutes late or your favorite shirt is in the laundry but on another day, this kind of small disruption to routine triggers a meltdown. What appears to be a fit of irrationality is actually a failure of the prefrontal cortex to cope with change in the expected way.
Cognitive flexibility also refers to considering multiple aspects of a situation at the same time, such as seeing opposing points of view or multiple characteristics of an object. When you think about it, there is little difference between “lack of empathy” or “impaired theory of mind” and impaired cognitive flexibility. Not seeing the other person’s point of view can be as simple as having difficulty seeing multiple aspects of a situation at the same time.
Finally, cognitive flexibility includes task switching, which is sometimes listed as a separate component of executive function. Difficulties with task switching are what make it hard to stop playing World of Warcraft and start making dinner. Or to pick up where you left off on a task after being interrupted. Poor task switching is also why people will often say that autistic people are so good at doing repetitive tasks. It might be more accurate to say that we’re not very good at stopping. Continue reading Executive Function Primer (Part 4)
This is part 3 in a series about executive function. It looks at the regulation functions that are related to initiating, monitoring and inhibiting our actions and thoughts. Looking for the other parts? Part 1 | Part 2
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The second category of executive function components, regulation, includes cognitive flexibility and the initiation, monitoring and inhibition of actions. These executive functions are primarily related to how we interact with our environment.
When you think of inhibition, you probably think of the common usage which means a feeling of self-conscious restraint. The inhibition related to executive function is somewhat different. It refers to our ability to block or suppress a thought or action, either consciously or subconsciously.
Biologically, inhibition takes place in three different realms: motor inhibition, cognitive inhibition and emotional inhibition. It’s quite possible that you’ve never even thought about inhibition in this way and yet it has a huge impact on your daily life.
Our brains are constantly inhibiting–or failing to inhibit–thoughts and actions. To focus attention on one thing, we have to inhibit countless other distracting inputs (remember the top-down and bottom-up attention systems as well as selective attention). To call up a desired piece of information from memory, we have to inhibit the retrieval of millions of irrelevant bits of information. To change a behavior we have to inhibit habitual actions. And sometimes, to get through a difficult situation, we have to inhibit our emotional reactions (or, if you’re alexithymic, consider the opposite case–your emotions are involuntarily inhibited, perhaps in part because of dysfunctional inhibition).
When you think about it, a lot of autistic traits could be traced back to poor inhibition. Infodumping, even when we know the other person has lost interest. Catastrophizing long past the point where it’s logical. Blurting out what we’re thinking only to regret it a split second later. Spending the day lost in a special interest when we really did mean to get all those chores done. Even stimming could be viewed as poor motor inhibition. What if all people have a natural tendency to stim, but neurotypical people are just better at naturally inhibiting their motor function?
Extreme difficulty with inhibition can lead to impulsivity, which is more characteristic of ADHD than autism, but can be present in both. Often, impulsivity is mistaken for problem behavior and met with punishment as a means to extinguish the problem. Like other aspects of dysfunctional EF, poor inhibition isn’t something that can be fixed by simply trying harder or having more self-discipline. Support can help. Accommodations can help. Understanding can help. Practice can help. Punishment and shaming only hurt. Continue reading Executive Function Primer (Part 3)
This part 2 in a series about executive function. It looks at the remainder of the organizational functions that were introduced in part 1 : problem solving, verbal reasoning, working memory and attention.
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Problem solving is another umbrella term, encompassing the activities related to identifying and overcoming obstacles to reach a predefined goal. Probably the most complex cognitive process that we engage in, it draws on nearly all of the other aspects of executive function.
Here is the traditional problem solving cycle, with related EF components in parentheses:
Identify the Problem (attention, initiation of action, monitoring of actions, working memory)
Define the Problem (cognitive flexibility, reasoning, working memory)
Form a Strategy (planning, reasoning, cognitive flexibility)
Organize Information (working memory, attention, reasoning)
Allocate Resources (planning, initiation of actions, inhibition, cognitive flexibility)
Monitor Progress (attention, working memory, monitoring of actions, inhibition)
Evaluate Results (working memory, reasoning, planning)
For me, that list is missing a very critical step: Recognize That a Problem Exists. Because this is where I often run into trouble with problem solving. I’m pretty good at reasoning out solutions to a defined problem. Not so good at actually recognizing the presence of a problem. And that’s executive function too.
And again there is an ironic twist lurking under the surface here: when someone else is having a problem, what is the default autistic response? Fix it! Come up with a plan! Whether they want us to or not.
We are instinctive problems solvers, but only when it comes to other people’s problems, it seems. Maybe because we wish other people would do this for us? Executive function is such a strange beast. Continue reading Executive Function Primer (Part 2)
I’ve written a lot about executive function, but I realized recently that I don’t have a post that explains what EF is. I set to write one post and 4000 words later, I have a short series. This is part one. The three remaining parts will be posted over the next two weeks.
So what the heck is executive function, anyhow?
Executive function is a broad term that refers to the cognitive processes that help us regulate, control and manage our thoughts and actions. It includes planning, working memory, attention, problem solving, verbal reasoning, inhibition, cognitive flexibility, initiation of actions and monitoring of actions.
That’s a nice concise definition, in theory, but what does EF look like in real life?
In practice, executive function is a slippery concept. Sometimes it looks like responsibility. Sometimes it looks like self-discipline. Sometimes it looks like being a competent adult.
If you have poor EF, people might mistake you for being disorganized, lazy, incompetent, sloppy, or just plain not very bright. Why? Because executive function encompasses so many essential areas of daily living. Nearly everything we do calls on areas of executive function. Cooking. Cleaning. Parenting. Work. School. Self-care. Continue reading Executive Function Primer (Part 1)
Happy 2014! I hope you’re all staying warm. This is the first in an occasional series of reflection posts about Silent Monday.
Intentional silence–silence by choice on Mondays–is forcing me to think hard about involuntary silence. It’s also raised the question of when do I need to speak and why?
Passing someone on the street? That seems like an obvious don’t need to speak situation. A nod, smile, wave or some other gesture passes for acknowledgement of the other person’s greeting or existence.
Impromptu question from a stranger at the gym? Might be able to take care of that with a nod or gesture. Might have to speak.
Picking up a package at the apartment office? One (but not both) of us will have to speak. The Scientist and I divide up the responsibility, taking turns doing the necessary interacting with strangers.
Replying to a stranger who stops me on the street to ask for directions? Obviously requires speaking.
A set of rules forms and like most rules, they work until I run up against the unforeseen exception. Continue reading Scenes from Silent Monday (I)
I had jury duty recently. For those of you who aren’t familiar with the US jury service system, US citizens are periodically required to fulfill our civic duty by reporting to a local courthouse and making ourselves available to sit on a jury panel for a criminal or civil trial. The processes vary quite a bit from place to place but often you show up for a day at the courthouse and get sent home without actually sitting on a jury.
Unless you’re really lucky. Like me. Then, somehow, you get put on a jury 2 out of the 3 times you’ve ever been called to serve.
Together with seven other people, I got assigned to a jury panel for a 3-day civil trial. The case was strange. The testimony was at times fascinating, at times mind-numbingly boring. None of that is especially what I want to talk about.
Like so much else in life these days, I approached jury duty as an experiment. A socializing experiment. I decided it was the perfect opportunity to reboot my approach to interacting with strangers. It was a relatively safe, time-limited interaction–if things went poorly, I knew that I would only have to spend three days with these people and then I’d never see them again.
In the past, I would have done my best to pass, hoping that my fellow jurors would like me and more importantly, not think I was too weird. This time around, I made a conscious decision not to worry about that. Continue reading Socializing: Reboot
In my last post, I talked about my recent language difficulties and mentioned autistic regression. Sometimes called autistic burnout, autistic regression is a loss of skills or coping mechanisms.
Regression can refer to a specific set of skills or abilities:
progressively losing the ability to speak
deteriorating executive function
reduced memory capacity
loss of self-care capabilities
loss of social skills
reduced ability to tolerate sensory or social overload
It can also refer to a general loss of the ability to cope with life or to accomplish all of the necessary daily tasks of living.
Sometimes the loss is temporary–a period of a few weeks or months–after which a person regains the lost abilities. Other times the deterioration in skills or coping mechanisms takes place over years. It may be come permanent or semi-permanent, with skills being regained but not to the level at which they previously existed.
Often a period of autistic regression begins during or after puberty or during the transition to adulthood (late teens to early twenties). Mid-life is also a common time for autistic people to experience burnout or regression. In fact, many people (including me) list a noticeable change in their ability to cope with daily life as one of the reasons for seeking a diagnosis. However, autistic regression can happen at any age and is often preceded by a major life change or a period of increased stress. Continue reading Autistic Regression and Fluid Adaptation
There’s a new article today at Autism Women’s Network: Autistic Women: Misdiagnosis and the Importance of Getting it Right
The rate of being diagnosed with a co-occuring condition if you’re autistic is very high. In fact, I’m curious if there’s anyone here whose sole diagnosis is autism or Asperger’s. I have a comorbid diagnosis of an anxiety disorder and probably have mild undiagnosed OCD. The really interesting thing is that so many of us don’t feel that all of our comorbid diagnoses are a good fit. I wrote about how my anxiety doesn’t feel disordered to me and so I don’t think the diagnosis fits.
I also think it’s interesting that we’re often given diagnoses for conditions that have many overlapping traits with autism. For example, dyspraxia and sensory processing disorder share nearly all of their traits in common with autism. How do clinicians decide that one autistic person should also get a dyspraxia or SPD diagnosis while another person with a very similar profile doesn’t? I would love to hear your thoughts on this or anything related to the article in the comments here.
Also, I owe a huge thank you to the people who filled out the survey about comorbid conditions and patiently worked with me on sharing their stories for this article. My next article for AWN will be about motherhood and the challenges that being on the spectrum can present as well as how it might affect our choices regarding childbearing. Okay, so that’s likely more than one article.
If you’d like to share your thoughts and experiences, I’ve created a short 5-question survey at Questions about Autistic Motherhood. It’s open to both women with children and women who do not have children. As long as you identify as being on the spectrum and would use the term mother to refer to yourself if you had a child, then you’re welcome to take the survey. I’m especially interested in the question about what supports autistic moms would benefit from–if there are enough responses, that will be its own article, because I think its a subject that doesn’t get nearly enough attention.
Musings of an Aspie 