I have mixed feelings about the term ‘executive dysfunction’. My main problem is that it seems to refer to a whole grab-bag of difficulties, with a range of underlying causes and manifestations. Even so, for all its woolliness, it’s a useful concept. It helps us to talk about aspects of autism which have historically been absent from the way we talk about and diagnose it, but which are often central to what makes autism disabling. It also draws attention to the similarities between autism and other neurological differences, like ADHD, which can be useful to think about.
In the short autistic glossary I recently put together, I ended up defining ‘executive function’ as ‘the psychological ability to get things done’. Wikipedia expands on this a little, defining ‘executive functions’ (note the plural) as ‘a set of cognitive processes that are necessary for the cognitive control of behaviour: selecting and successfully monitoring behaviours that facilitate the attainment of chosen goals.’
So why is this a problem for autistic people? Several factors come into play — which is why I have misgivings about the term. On its own it doesn’t explain much, but once you recognise it’s an umbrella term, you can start to look at what’s under the umbrella.
A big one is autistic inertia. Getting going, stopping, changing plans or switching tasks are all a bit like steering a large truck when you’ve got an autistic brain — or, as Erin Human puts it, like sending out and retracting a million tendrils of thought.
Another factor is the enormous difficulty we have devoting attention to tasks that are not interesting to us. It’s hard to get across how serious this is, because of course nobody likes doing boring things. It’s a lot more than that, though, partly because of the previous point. Stopping ourselves from doing or thinking about something we’re really into is really hard at the best of times. Stopping in order to do something we have no interest in is much harder still. Getting going with things we actively dislike is genuinely a huge challenge.
This is related to the ‘spiky profile’ of autistic people — the way we often have islands of high capability, but lots of things we struggle with. Our processing resources tend to be highly concentrated, and hard to redistribute (this is monotropism). Trying to shift them at will can be exhausting, and sometimes it’s just futile.
Speaking of exhaustion, it’s much harder for anyone to actively redirect their attention if they’re tired, and everyday life is often very, very tiring for autistic people. We’re expected to navigate a sensory world not designed for us, to maintain social relations based on arcane rules that nobody ever explains and to constantly adapt to other people’s priorities. Often, a lifetime of dealing with these things leaves us with additional anxieties and neuroses which make life even more exhausting. On top of that, most autistic people have trouble getting enough sleep, at least some of the time.
Another factor that’s relevant to executive functions is difficulty with interoception — the perception of what’s going on inside our own bodies. As with all the senses, autistic people have a way of failing to spot signals we’re not tuned in to, while we’re incapable of tuning out other signals. That can mean that we don’t recognise when we’re hungry, tired or need to pee, registering instead just a vague distress that makes it even harder to direct our attention where it needs to go. Alternatively, what might be a minor signal for someone else can instead become an impossible-to-tune-out distraction. This probably also relates to the way we can find it difficult to keep track of time, especially when we’re deeply focused on something — yet another thing that comes under the heading of ‘executive functions’. It’s harder to plan your time effectively if you keep losing track of how much of it has passed.
It’s important to recognise that these things are not wholly negative. The inertia is closely related to our ability to hyperfocus, and sometimes tuning out signals from our bodies adds to that too. The latter can also allow us to keep going when other people would give up. Still, recognising the difficulties grouped under the heading of ‘executive function’ is key to getting to grips with autism and identifying useful strategies and accommodations.
So, how do you deal with executive functions not working the way people want them to? Reminders are a good start, whether from people, technology or old-fashioned diaries and calendars, which can be a great way of maintaining a general sense of what’s coming up — as long as you’re in the habit of looking at them (I’ve only really got to grips with using a physical diary in the last few months; I first had to admit to myself that it was too easy for me to tune out electronic reminders).
Schedules and well-structured days can be really helpful, but can sometimes backfire if the autistic person doesn’t feel fully in control. Likewise lists of tasks, and sometimes these work best if they’re very detailed — partly because it’s so much easier to get started with small tasks, rather than trying to grapple with a big job in its entirety. Don’t underestimate the importance of getting enough rest, both in terms of sleep and downtime, in order to conserve the energy needed to manage tasks. Be aware that sensory overload, and even background filtering of excessive stimuli, can be draining, and take steps to minimise that. Remember that it can take a while to gear up to something. If you have other ideas, do let me know what’s worked for you.
Perhaps most importantly, accept that problems collectively labelled ‘executive dysfunction’ can make a lot of things very difficult for autistic people. Don’t treat it as a moral failing when this causes problems — it’s no use pretending that sheer force of will is enough to fix it. Try out different strategies; what works for one person might not work for another. The better you understand the root causes, the better equipped you’ll be to deal with them.