This is the second part of a three part blog series on executive functioning. Part one explained what executive functioning is and why it matters. This blog will build upon that explaining how deficits in executive function can look.
What executive function deficits look like
Executive function deficits can vary in their appearance. In order to provide a broad framework to utilize to understand executive functioning, deficits are described below in regards to how they may appear in children with ADHD and autism, since both often involve executive dysfunction.
ADHD and executive functioning
There are many ways in which individuals with ADHD may exhibit deficits in executive function. Below are some of the more common areas of difficulty.
Inattention
A hallmark of ADHD is inattention and the ability to focus/pay attention is an executive function. The child may become distracted easily. They may also struggle to shift their attention from one task to another. Oftentimes, they can focus for long periods of time when doing things they enjoy, which confuses people, because their attention is short in other situations. In addition, people with ADHD often lose track of time and have poor time management skills. They struggle to estimate the amount of time a task will take, resulting in allowing themselves significantly less time than they need, causing a need to rush to complete the task.
Forgetfulness
Children with ADHD are often forgetful because they struggle to hold information in mind. This can manifest as difficulty following directions because they cannot remember all of the steps. The more lengthy the directions are, the harder they are to remember. It is not uncommon for children to be paying close attention but walk out of the room after receiving a direction, become sidetracked, and completely forget what they were asked to do. This can also result in children completing their work but never turning it in or taking home something to be signed but never getting it actually signed.
Forgetfulness causes additional difficulties for children with ADHD because not only do they often forget what they heard but also what they read. This leads to them reading the same page and/or line in a book repeatedly and still not knowing what they read. Children with ADHD may be able to read fluently but often struggle with comprehension. It is also possible that they struggle to read fluently due to difficulty ignoring the lines on the page other than the one they are currently reading.
Impulsivity and inhibition
Individuals with ADHD often struggle to regulate their behavior, think before acting, and inhibit a response (i.e., refrain from responding to certain information). This can result in behavior problems, interrupting, initiating tasks before directions have been given, and answering before questions have been completed.
Planning and organization
Many people with ADHD struggle to know where to start a task. They become overwhelmed at the list of things they have to do and freeze. For example, if a child with ADHD is told to clean their closet, they may not know the best place to start so they begin by pulling every item out of their closet. What they end up with is their room looking like their closet did with stuff everywhere. Now they are presented with the same problem they had originally, what to do now. This often leads them to shoving everything back into their closet or leaving it all over their room and moving on.
These difficulties translate to trouble finding things they need at home and school. Furthermore, when presented with assignments, particularly larger projects, children often become overwhelmed and unsure of where to even start. They struggle to break the assignment into manageable chunks. Furthermore, children with ADHD struggle to prioritize.
Trouble with organization can impact a child’s writing. They may struggle to plan ahead and outline what direction they want to go with their writing. This can result in a stream of consciousness rather than a well thought out paper. Furthermore, they may unintentionally insert or omit words without realizing it.
All of this is further impacted if a child is impulsive and acts before making a plan, as they then have to adjust as they go and try to get back on track.
Initiation
All of the difficulties listed above, especially trouble planning and organizing tasks, lead children with ADHD to have trouble initiating tasks. Take the example listed above where a child is asked to clean out their closet, many children would open their closet door and freeze due to an inability to determine where to start. This can cause them to need to be explicitly told what to do before ever initiating a task.
Emotional dysregulation
Given the difficulties listed above as well as the others not highlighted in this article that are often faced by children with ADHD, it is not unexpected that they often have trouble regulating their emotions. Their reactions may seem more extreme and they may struggle to calm themselves down. People with ADHD often exert such significant effort to complete tasks that others can do with ease that it wears them down, whether they realize it or not. In other words, their threshold or capacity to take on additional difficulties is limited due to the toll everything else has taken on them. This propensity to become upset easier has been referred to by Dan Siegel as “flipping your lid.”
Think about a day you had where you woke up and nothing seemed to go your way. Your children were not awake on time, they struggled to get out the door for school, and ended up being tardy. You thought you packed your lunch the night before but realized on your way out the door you had not. You get into your car and find out you do not have enough gas to make it to the office but stopping for gas will cause you to be late to your first meeting of the day, which just so happens to be with your boss. All of this happens within the first couple of hours of you being awake and you have not even made it into work yet. Your work day plays out similarly, feeling like one thing piles on top of another repeatedly. You walk in the door after work and your child immediately asks you for help and you raise your voice about not having even set your stuff down yet. Shortly thereafter, you realize what you did and that you did not mean to snap at your child, but your capacity to handle one more thing was gone. The tiniest thing was going to set you off (i.e., make you flip your lid) and unfortunately, that tiny thing was your child. That is what your child with executive dysfunction experiences daily.
Children with ADHD or other disorders commonly associated with executive functioning deficits do not intend to lose control of their emotions. They do not mean to become overly emotional over seemingly minor things. However, they exert such significant effort throughout the day that they struggle to regulate their emotions. They “flip their lid” over things you likely would not flip yours about. Then, they often beat themselves up over it because they did not want or mean to do it.
Autism and executive functioning
There is significant overlap between symptoms and executive functioning deficits of ADHD and autism. Below are some of the highlights of executive functioning deficits commonly reported for individuals with autism.
Inattention
Individuals with autism often appear distracted or as though they are not paying attention. They may become consumed by their thoughts that seem more interesting than what is going on around them. They may also fixate on small details or things they need to be a specific way and be unable to move on. In addition, children with autism often struggle to focus on things that they are not interested in and to switch from a preferred activity to an unpreferred activity. People with autism struggle to be aware of, much less attend to, their actions and monitor their behavior and its impact on others.
Theory of mind
People diagnosed with autism often exhibit deficits in theory of mind. Theory of mind is the ability to think about thinking as it relates to your thoughts and the thoughts of others. In other words, it is what allows us to understand that others may have different perspectives than us. There are many differing opinions as to how theory of mind is related to executive functioning but most often they are linked by cognitive flexibility.
Cognitive flexibility
Individuals with autism often have inflexible ways of thinking. This relates to theory of mind due to difficulty even considering the possibility that someone else may view a situation different than you. Difficulty accepting views different from yours, actions that do not meet your expectations, and different ways of doing things can be very difficult for people with autism. This can make them appear rigid and can lead to behavior struggles. Many children act out due to difficulty adjusting to things not going according to their plan.
Children with autism usually follow routines and schedules very well. They struggle to adjust when those routines are not followed. This also applies to rules. It is not uncommon for children with autism to be rule-bound, or to even want to create the rules themselves, which can cause them to become upset when other people break the rules. When children with autism become upset when rules are broken, they may act as “rules police” trying to point out and correct others’ missteps.
Planning, problem-solving, and organization
Inflexibility in thinking carries over into problem-solving. It can be hard for children with autism to come up with new ways to solve problems. This may cause them to repeatedly use ineffective strategies because they are familiar with those strategies. People with autism often appear disorganized to others but may have their own organization system (e.g., sorting by similar characteristics). They can have difficulty formulating an organized plan or strategy to complete tasks as well as communicating that to others.
Memory
Children with autism often remember things that others do not, even things that others never noticed. However, they may only recall specific details but not the overall idea. Their inattention may cause them to miss directions. Their difficulty understanding the perspectives of others may lead to misinterpretation, and therefore misremembering, of information.
Emotional dysregulation
The ability to regulate emotion is influenced by all of the aforementioned variables and others for children with autism. Similar to children with ADHD, they can struggle to regulate their emotions and behaviors and to recover from setbacks.
Summary
Part one of this blog series outlined what executive functions are and why they matter. This blog was part two in the series and outlined what executive function deficits look like, particularly in children with ADHD and/or autism. It is important to note the list is not exhaustive and that there are many other conditions that cooccur with executive dysregulation. Every child is different.