#prioritizing

Executive dysfunction is a core component of ADHD and often involved in autism, depression, bipolar, and OCD. It's a big barrier with widely ranging impacts, from struggles getting started to being unable to stop, from memory issues to indecision. But, what exactly is executive dysfunction?

Well, first things first, executive function isn't just one skill or ability; It is a series of skills and abilities that all intersect, interact, and play off one another. Struggles with any one of these skills could be called executive dysfunction, but usually experiencing 'executive dysfunction' means struggles with many or all of these skills, often as a barrier to doing things we want or need to do. The exact number of skills that make up executive function isn't entirely agreed upon, but for our purposes here, let's talk about four general categories:

inhibition,

attention regulation,

working memory, and

cognitive flexibility.

Inhibition

When inhibition goes wrong, the results are impulsivity.

Everyone has urges, desires, or temptations and these pop up based on environmental cues or just random chance. When they do pop up, inhibition is meant to fire up to stop us from acting rashly. That… isn't what happens for ADHD'ers (or bipolar folks in mania) a lot of the time.

For ADHD'ers, urges are faster and more frequent, and inhibition is slower to get in the way of our urges. This slowed inhibition (which is measured in milliseconds) is just long enough for us to commit to an action before inhibition kicks in. Once we're committed to action though, even if we haven't done anything yet, it's much harder to stop the ball a'rolling. This slowed inhibition directly impacts small things, like starting to talk before it's our turn, fidgeting, or agreeing to something before we've actually thought about it. But once we've started, we can develop momentum and it can lead us to much bigger impulsive moves, like impulsive buying, eating, or sex.

This slowed inhibition response impacts a lot of ADHD experiences, including ADHD flash emotions. Emotions respond to environmental cues, so we experience an impulsive emotion and then before our inhibition shuts it down, we're already in our feels.

Inhibition also tag teams us, ganging up with Working Memory dysfunction to make us more prone to forgetting things and collaborating with Attention Regulation dysfunction to wind us up neck deep in rabbit hole after rabbit hole. Speaking of which…

Attention Regulation

Getting knocked off course by distractions (or "interference") is a major issue for ADHD'ers, and attention regulation is the executive function that's gone wrong to cause that.

No matter the situation, there's always some level of distraction and attention regulation is our ability to choose which distractions we attend to. Distractions can be external, such as sights, sounds, and smells, but they can also be internal, such as thoughts, memories, emotions, or bodily needs. In fact, these internal distractions can be harder for ADHD'ers to ignore or manage, because ADHD'ers tend to experience these internal distractions more often.

For autistic folks, attention regulation is involved with sensory sensitivities. These can capture our attention, making sensory distractions harder to ignore and manage. For OCD folks, when attention regulation goes wrong, obsessions end up turning into thought loops that we can't seem to shake. While for people with ADHD, this struggle with attention regulation is obviously the reason we struggle to focus, but it also impacts how we decide which information is relevant to making a decision (i.e., decision making), to our struggles to choose what to do next (i.e., planning or task initiation), to our struggles reading and retaining information (i.e., skipping or missing words/sentences), and to how things just pop out of our heads sometimes…

Working Memory

When things pop out of our head, it is generally working memory that's going wrong.

Working memory is basically the memory specifically to hold things we're working on at this very moment. We can fill it with instructions (sensory input), information we want to store for later, or memories we already have that we need for the current thing we're working on. Things we put into working memory won't stay there forever. In fact, they only last about 30 seconds, unless we repeat them or put them in there again. This makes it really easy for things to drop out of working memory.

Things dropping out of working memory like this happens to everyone to some degree, but for ADHD'ers it's so frequent and so impactful that it can cause real havoc in our lives. If we change location, if the context shifts, if we swap devices, or if change what we're focusing on, working memory is often wiped. …and that's why ADHD'ers struggle with it so much.

Because people with ADHD shift focus, context, and topic more often, our working memory tends to get wiped more often too. Then, on top of that, ADHD'ers often have a smaller working memory to start with, because thoughts and impulses are also taking up some of those slots.

For autistic folks, working memory can be impacted as well because sensory sensitivities cause a mess. Sensory issues can overwhelm our working memory, pushing everything else out and leading us to forget what we were working on or the information we needed to work with. Because of the way sensory issues can wipe our working memory, it can be really hard for autistic people to function in sensory dense environments. Fighting this to continue to function anyways can lead to exhaustion or even shutdowns and meltdowns if we aren't careful.

Ultimately, having a fragile working memory helps to explain why we forget pieces of instructions, for example, or misplace our phone/keys. It also explains why we might struggle with people's names or faces, or even why we might have trouble creating long-term memories (because it has to pass through working memory to get there).

Finally, Cognitive Flexibility

When things go sideways, cognitive flexibility is the executive function that allows us to adapt and carry on. At its core, cognitive flexibility is essentially being able to think about things in different ways, often at the same time, and make connections.

People with ADHD tend to be extremely cognitively flexible in some ways, but extremely rigid in other ways. For example, ADHD'ers tend to be really good at creative problem solving, a skill that requires cognitive flexibility. At the same time however, black-and-white thinking, a sign of cognitive rigidity, is also really common for ADHD'ers.

For autistic folks, struggles with cognitive flexibility are incredibly common. We often struggle to adapt to unexpected changes, to take different perspectives (especially when stressed), to decode complex or ambiguous communications or social cues, or to move from one context or environment to another.

It should also be said that depression, anxiety, and OCD also impact cognitive flexibility. These mostly making it harder to think flexibly due to the emotional upheaval going on below the surface. It's harder to think flexibly when you're panicking, for example, when the world feels like it's out to get you, or if you're in the middle of an obsession spiral.

Beyond these four core executive functions, there are a couple other skills and abilities that are often included:

Task Initiation, or getting started with a task,

Self-awareness, or being aware of our thoughts, bodily sensations, and emotions, and

Planning and Prioritizing.

Since I've rambled on enough already, I won't go into these right now, but these additional executive functions can be thought of as combinations of the four categories above. For example, struggles with bodily awareness, can arise from dysfunction in attention regulation, working memory, and inhibition all at the same time.

The Takeaway

Executive functions are a bunch of different skills and abilities that interact, team up, and play off each other. Any time that any one of these goes wrong, it could be called executive dysfunction, and they can go wrong for everyone from time to time; however, for certain people, such as those of us with ADHD, autism, anxiety, OCD, or depression, executive dysfunction comes in more flavours, happens more often, and has much larger impacts on our lives when it does show up.

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Prioritizing mental health applies to each and every one of us. If you’re looking for tips to modify your thinking, better understand mental health conditions, where to get help or find additional resources – you’ve come to the right place.

I didn't get great sleep last night, and yesterday was a very busy and stressful day. My body and brain are both bundled up cozily in Recovery Mode, but I still have to push myself to do the basics just like every day. I just woke up from a nap, I'm sleepy, and although my daily basic tasks are all written out and organized on my menu, picking where to start is proving a hurdle. For many with ADHD, prioritizing and acting on even our daily hygiene routines are things that don't come naturally to us, so in order to function, sometimes it can help to talk/walk through the process "manually". As an example of what this can look like, I'm going to write down the "manual prioritization" process I'm using today to push through my post-nap funk.

Ok. Let's walk it back a few steps. Pick these scattered tasks up off the floor and arrange them in a neat line. First, which of my menu items for today could I realistically do as I am right now?

I mark some of the tasks on my Appetizers and Mains sections with blue arrows, to indicate the things I could do with minimal energy. This narrows it down to "eat lunch, drink water, make tea, brush teeth, get dressed" and a couple tasks related to medical stuff.

That's still kind of messy. I CAN do all this now, but I don't WANT to do any of them. Can I narrow it down more? .... Actually, yes. What basic needs does my body have to meet at this moment? Which of these will make me more comfy in general?

Good question. I mark immediate basic needs with pink dots. These are all on the appetizers, of course, and narrows things down to "eat, get water, brush teeth, and make tea". Actually.... Scratch the tea. It would be inconvenient to delay brushing teeth and drinking water for that right now. Ok, 3 things left, and they're all super easy and logical. What do I want to do first?

Water. My mouth is dry and tastes like ass, but I don't want to brush my teeth until I eat something. I'll start with filling my waterbottle, and think about food while I'm in the kitchen.

how it worked out just now was that I went to the kitchen for water ✅, realized I had some soylents in the fridge (technically a complete meal's worth of nutrition, easy to grab and finish fast, but only to use in a pinch. I keep a couple around to fend off Ritalin jitters) and grabbed one for lunch ✅, and decided after I finish it to get dressed ✅, brush teeth ✅, and make tea if I'm still lagging ✅. Then I'll be ready to do more complicated thinking and accomplish the medical tasks ✅✅.

The basic gist is to just focus on finding step 1, and after that the rest falls into place. I can string my tasks together more intuitively once I've actually initiated something and got moving, so once I have priority 1 decided, I can usually kick back into gear from there. If dealing with the first thing doesn't work, I can just go back to the list and do the process again until my motor's running.