Executive Functioning in Autism and ADHD
Functioning Executively, what does this mean, and why is it so hard for Autistic & ADHD people?
‘Executive dysfunction makes me feel like a car that’s stalling, and everyone around me is telling me to just drive. They don’t realise my car works differently from theirs. For a long time, neither did I’ – Hats Darley Neurodiverse Training
Being able to function executively is something most people take for granted. They can go about everyday tasks, like travelling, showering, cleaning, and cooking, on autopilot. But for people with cognitive differences, this isn’t always the case.
When we talk about executive functioning differences, we are usually referring to differences in certain mental skills such as (1):
Working Memory
Organisation
Self-monitoring
Planning
Mental Flexibility
For some individuals, their executive functioning differences can have a profound effect on their ability to do day-to-day tasks. In these cases, they might say they have “executive function difficulties” whereas others relate to the term “executive dysfunction”.
These skills are often used together. For example, if someone is trying to do a load of laundry, they need to use different functions. Firstly, they need to notice their clothes are dirty, remember they will need to clean them before wearing them again, organise a load of washing, plan when they will do the wash and hang it out, and remember it is in the machine. On top of this, they are going to have to be flexible about when the clothes will be dry, potentially being unable to wear them when they intend to.
If we think about how this task, which is often thought of as a simple one, uses the majority of the executive functioning skills it begins to make sense how executive functioning difficulties are quite overwhelming for an Autistic and/or ADHD person. Arguably, this task might be impossible to complete without just one of these skills.
Furthermore, Autistic adults may be seen to be coping with some tasks. Their homes might be tidy, and they might be punctual and well-presented. However, they are sacrificing functioning elsewhere to meet these standards, such as neglecting to shower or eat (2).
As a natural consequence, we often see Autistic & ADHD people becoming overwhelmed, distressed or unwell when trying to function executively. Unfortunately, they might not even know why they are struggling and instead can develop low self-esteem. For people with ADHD, it has been noted that executive functioning difficulties increase their risk of depression (3). For Autistic people, these difficulties exist alongside other parts of their profile, like issues interpreting social queues, and sensory overwhelm.
How can we help Autistic & ADHD people who struggle with executive functioning?
‘Learning that my set-up is different has been a game changer for me. I drive a manual transmission and others have an automatic, I have a clutch to contend with, and they don’t. I can’t treat my car the same way otherwise I won’t go anywhere.’ – Hats Darley Neurodiverse Training
The answer to this question is that it will be different for everyone, this is because the reason why someone struggles with executive functioning will be different, fluctuating based on their environment and surroundings.
One Autistic person’s sensory profile might make them easily distracted, meaning they struggle to focus while carrying out tasks. This could mean they have to stop what they were doing when a noise or sensation becomes frustrating, and this lack of focus on the task means they cannot recall what they were trying to complete.
To support this person, a sensory assessment might help them find ways to reduce overwhelming sensory input in their home, enabling them to better focus on the task at hand.
For another, their ability to sequence a task might be impaired. For instance, when following a new journey by bus, they might not be able to mentally juggle the demands of preparation, undertaking the journey, and remembering a route. This may mean they arrive unprepared, get on the wrong bus, or become highly anxious and cannot go at all.
To help this person, they may need someone to assist them on the journeys so they can complete them safely. More often than not, the solution is likely to be supporting a person with executive functioning difficulties, rather than trying to change how they operate. For many Autistic & ADHD people, this is not possible as these difficulties exist because our brains work differently. Working out the ways that make things easier for them can help, but sometimes, higher levels of support may be required on an ongoing basis.
Takeaways about Executive Functionig
‘Although my car is tricker to drive, it takes more thought and requires different maintenance, I can drive more now knowing I need to use the clutch as well. Even if I still stall sometimes, rev my engine in place, or it won’t start, I know why and can stop and try again or get someone to help me.’ – Hats Darley Neurodiverse Training
Executive functioning difficulties are often very disabling for some although it’s common in Autism and ADHD, it’s not exclusive to it, being seen in many other conditions, like dementia, brain injuries and depression. Due to this, not all executive functioning differences have the same mechanisms for each person, so it is vital to communicate with individuals and those around them about how they are affected.
Executive functioning difficulties are not a choice, nor is it simply being lazy or a lack of trying. It doesn’t constitute a moral failure on the suffers part and it very likely causes them distress. Many people who cannot always function executively can live well as long as they are accommodated and supported to do so. Many Autistic & ADHD people may need help at work or in school for their executive functioning difficulties, but it doesn’t mean they are not able to complete their job or education. Learning the right accommodations for the person is key to helping them succeed personally and professionally, as well as maintain a good quality of life.
Unfortunately, executive functioning differences are not very well studied or understood for Autistic & ADHD folks. Hopefully, this is something that will be addressed as our understanding increases and we listen to more people with lived experience.
References:
(1)Devon County Council 2017 ‘Executive functioning’ Available at: https://www.devon.gov.uk/support-schools-settings/send/educational-psychology/resources/devon-psychology-in-action/executive-functioning/#:~:text=Executive%20function%20(EF)%20describes%20a,a%20conductor%20within%20an%20orchestra.
(2)NHS England (2024) ‘Meeting the needs of autistic adults in mental health services’ Available at:
(3) Craig et al, Bercovici (2022) ‘Executive challenges in autism & ADHD’, Embrace Autism, Available at: https://embrace-autism.com/executive-challenges-in-autism-and-adhd/