#executive functions

With my type of executive dysfunction, often the biggest problem is just starting things. I know the floor needs to be vacuumed. I know the recycling needs to be taken out. I know I need to start cooking the stew so I can eat it later. But I just can’t seem to start it.

On the other hand, If the cat asks me for food, it’s easy to get up and feed him. If someone asks me to do something or just says “do it now”, I can usually do it. I just need that trigger. 

So here’s a strategy lifted from Dungeons and Dragons: preparing an action. During combat, a player can, instead of taking an action on their turn, prepare a specific action to be taken when a specific trigger happens (ie, the character is hiding behind a door and if an enemy walks through the door, they’ll attack).

So I know a task needs to be done, but I can’t start doing it. I choose a trigger I know will happen soon, and I prepare my action. Examples:

The next time I get up to go to the bathroom, I’ll also wash the dishes.

The next time the cat asks me to feed him, I’ll clean the kitchen floor first.

When this video I’m watching ends, I’ll start writing that article.

When the clock hits 12:30 (I can even set an alarm), I’ll start cooking lunch.

TLDR; ADHDers struggle with executive dysfunction, which is struggling with the executive functions (EFs) of the brain that help us in different areas of our lives. The core EFs are inhibition (regulating our emotions and behaviour), working memory (remember information to work with it) and cognitive flexibility (thinking flexibly enough so we don’t struggle with change or thinking differently).

There’s a plethora of symptoms for ADHDers that go beyond the typical inattention, hyperactivity and impulsivity, but they’re not commonly talked about, like how we struggle with executive dysfunction.

What are the executive functions?

They’re a group of mental processes that are essential for us to go through life, these are cognitive skills like planning, prioritising, initiating tasks and motivation. They affect how we manage work, school, our mental and physical health and even how we socialise.

Executive functions (or EFs) can be categorised in two types, organisation and regulatory abilities. The first ones are about gathering and structuring information in our brains, the second is about evaluating that information to make a response to it. This is what makes us look at something we like and think about how much we need it and set a level of priority for it.

Besides these two big categories, there are three core functions; inhibition, working memory and cognitive flexibility.

Inhibition

Inhibitory control is the ability that helps us to control our attention, behaviour, thoughts and emotions in response to an internal or external stimulus so we don’t let our instincts be in charge of everything.

Considering this, we already can see how this core EF is really impaired when it comes to ADHD. After all, the most common struggles and symptoms of it have to do with how we regulate our attention when there’s different distractions near us, our impulsivity and our issues with emotional regulation.

Working memory

This core EF involves holding information in our brains so we can mentally work with it. This is like when you cook and you have to remember the steps you followed from a recipe so you don’t accidentally go through the same step twice.

Considering the definition of working memory, it’s important we differentiate it with short-term memory, which doesn’t manipulate information, just stores it for a short period of time and it isn’t actually hit with ADHD as working memory is.

This is quite a critical skill, because it’s thanks to this one that we can make sense of what just happened so we know what to do next with that information. And it’s also a skill that’s greatly impaired for us ADHD folk, kinda like when I go grab a pot that was on the stove and burn myself, and then go for it a second time until I finally remember “wait, I’ll go get the oven mitt”.

Cognitive flexibility

The last core EF is the build up of the first two. This one is about being able to change perspectives spatially and interpersonally, changing how we think about something or thinking outside the box, adjust to priorities or demands that change, admit we’re wrong and even take advantage of sudden opportunities that present to us.

ADHDers are VERY good at being outside the box thinkers, we’re great when there’s a problem that needs a new solution to fix it, we’re fast to take risks and we usually like change. So you may wonder why are we still talking about it? Well, that’s because cognitive flexibility is also involved in task shifting which is a very common problem for ADHDers, if there’s sudden changes to our routines we can abandon them because we just can’t make ourselves go back to it, and some of us do struggle to take opportunities that are good for us.

This EF may not be as clearly impaired as the first two, but that doesn’t mean we don’t struggle with it.

Executive dysfunction

There’s something a lot of ADHDers are not aware of, including myself until a few years ago. The reason we struggle so much to do something that seems so simple to others, the reason why we can have great days that are so productive only to find it so hard the next day to just send an email and be an adult, that’s because of impaired executive function, which is called executive dysfunction.

As Dr. Russel Barkley usually says, ADHD is not a deficit of attention, but a deficit of executive functions. Not all ADHDers struggle with the same EFs, and not all of us struggle the same way, but there are six clusters of EFs that tend to be impaired in us; activation, focus, effort, emotion, memory and action.

Activation is about organising tasks and the materials we need to do something, estimating time, and actually getting started. Focus is managing our attention as needed during a task, be it sustaining it or shifting it. Effort has to do with regulating alertness, sustaining motivation and processing speed during a task. Emotion and memory are strongly linked to inhibition and working memory, so it’s just what you read before. And finally action is about monitoring and regulating physical activity.

Just as not two ADHDers are the same, not two days of one ADHDer will be the same, and this is because executive dysfunction can be linked to dopamine, a neurotransmitter that we don’t produce in the same amount as non-ADHDers. Because of this, EFs are also linked to our interests, which is why it’s SO much easier to gather snacks for game night, sustaining focus and motivation to keep on playing while being aware of what our body does to get the special moves, but we can’t do the same when it’s about writing that 10 page essay on co-property in law school (yes, I am having war flashbacks).

What can I do about it?

I am no expert, but I do like to read what experts have to say when it comes to ADHD, and for some problems taking our medicine is all we need, for others the best strategy is working with a psychologist and occupational therapist, or going for Cognitive Behavioural Therapy, commonly known as CBT. There’s not a one-shoe-fits-all solution even in the professionals’ opinion, especially when there’s comorbidities like depression or anxiety that also impair our EFs.

Besides that, we can always tackle these issues with some external help, like making calendars in a very obvious place so we don’t lose track of time, use organisational apps like Todoist in synch with Google Calendar so we can add tasks fast and have it all synched in our devices. Something that helps a lot is having accountability, talk with someone you trust and tell them about your struggles and your plans, sometimes having someone else to talk to really makes a difference. If you want a lighter method of accountability, you could also try body-doubling, a passive way of accountability.

Hope you enjoyed reading this far! For more information, check the sources, the first one has more in depth strategies. And remember, I’m not a medical professional, I just have ADHD and love to read about it.

Sources:

- https://www.psychologytoday.com/us/blog/the-best-strategies-managing-adult-adhd/201601/adult-adhd-and-work-improving-executive-function

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861/

- https://www.additudemag.com/what-is-executive-function-disorder/

- https://memory.ucsf.edu/symptoms/executive-functions

- https://www.sciencedirect.com/science/article/abs/pii/S0165178119310376#

- https://www.additudemag.com/what-is-executive-function-disorder/

TW: This post contains depiction of blood and gore. Haha, kidding, but i’ll be talking about how ADHD effects humans throughout their menstrual cycle. Am I allowed to joke when making trigger warnings? Apologies in advance if that was inappropriate. Or if anyone is offended by the title. RSD kicking in. Hormonal fluctuations throughout the menstrual cycle had been shown to effect ADHD symptoms…

(brainyquote.com ; 31.10.2020)

- written in 50 minutes instead of 30. -

Let us begin with animism, a very ancient way to view the world, found at the roots of most religions. Objects and phenomena of nature such as the weather, climate, single mountains, trees, rivers, accidents or catastrophes are interpreted as actions of living beings motivated by specific intentions, that sometimes one had to find out. In Shintoism in ancient Japan for instance, local deities were present everywhere and had to be included in everyday decisions. They were said to have a good and a bad side, only one of them meaning well, and humans had to be careful to favour the nice one. Earthquakes could be the expression of the deity of the mountain, but so could rain, or being able to take a path safely, „under their protection“. Thus, the current state of mind of the deity, whether it expressed itself as angry or happy or calm, was directly, and almost exclusively, related to the consequences it had on humans. Assuming that those deities existed, they would have been perceived „as we (humans) are“, which might not always have been concordant with how they actually were.

Furthermore, the questions of animism leads to another aspect of human perception and interpretation, which is a tendency to seek sense everywhere, and more easily in ways that put ourselves in the center of the explanation. In shintoism, a mountain couldn’t just be a mountain, it had to be alive, like us, think, like us, and have emotions, sometimes irrationally so, like us. And not only that, but most of the time, all of this revolved entirely around human behaviour. It was angry? The village had done something wrong. Climate was very good for agriculture this year? The prayers and rituals had worked. If the explanation wasn’t about humans, the people wouldn’t have even known what to do with the information.

What’s interesting is, a similar thing happens for all humans during development. For very small children whose parents get a divorce, even if the latter explain the reasons to their child, the child is very likely to interpret all bad things that happen to it as its own fault. In psychology, we call it egocentrical reasoning (which has nothing to do with egoism) : at first, it cannot understand things otherwise, and it takes a long development to be able to inhibit this first intuitive reasoning style. So, a divorce might make the child see its own past actions in a suddenly very dramatic way („I didn’t always listen; I didn’t go to bed when they told me; I kept playing with the curtains when they told me not to; I wasn’t good enough at school“, …). This can of course be prevented through repeated explanations from part of the parents, and the child’s maturation processes will make it understand the situation in a new light later. But these thoughts can still be traumatizing, in the sense where if they were believed for a long period of time, they will have shaped the child’s personality in some way.

Later, we become able to interpret other people’s actions by identification with them. In psychology, this is called Theory of Mind. If I were you, why would I do that? Whereas the child under six years old wasn’t naturally able yet to put itself in other people’s shoes (thus putting itself at the center of everything), those over seven will gradually develop the ability to abstract their own perception and imagine what it would be like from another person’s point of view. I know the gloves are drying on the heater, but that doesn’t make the other child stupid for looking for them in the drawer : they didn’t see the adult put them on the heater to dry. If I were them, I wouldn’t have been able to know either. This ability is less intuitive than the egocentrism, but in most adults in becomes automatical too. Some neurological differences, like autism for instance, can complicate it though.

In a similar way, „I would never hurt someone on purpose“ can turn into „he didn’t do it on purpose“. But in fact, we have very little access to what other people think : maybe he did and maybe not. It is our own responsibility to evaluate what we think we know, and how we think we know it.

Last but not least, what we know and feel will always keep influencing our perception. If we are already anxious we are more likely to perceive someone as potentially dangerous – if it expresses as social anxiety for example, we might perceive a comment as being mockery, although a person was actually just trying to help. Anxiety levels are influenced by basic things such as food, working out, socializing, whether one got good sleep, etc. But also past experiences, our own personality, shaping our expectations… So yes, another time, „what we are“ makes up a very important part of how we see the world!