Human babies are amongst the least developed, in terms of their ability to manage independently, of all mammals. They are born with only the primitive parts of their brain fully functioning, with the majority of brain development taking place throughout childhood (hence the soft spot or fontanelle at the top of a baby’s head which allows its brain to grow significantly during the first year of life). The parts of the brain known as the ‘frontal lobes’ are the final part of the brain to fully develop. This does not happen in typically developing children until late adolescence, although the process starts at around 12 years of age. The frontal lobes are responsible for ‘executive function’. Executive function has a number of component parts and all of these functions tend to be impaired in children with Autism and ADHD. It was thought that this ability tended to improve in individuals with Autism and ADHD some time between the age of 18 and 25. However, this appears to have been an over-estimation and some people can continue to experience difficulties throughout their life. The different aspects of executive function are outlined below:
Inhibit – This is the ability to resist impulses or not act upon them, or to stop certain behaviour at an appropriate time.
Self-monitoring – this is the awareness of the impact of an individual’s actions and behaviour upon others and the ability to observe and evaluate their own behaviour.
Shift – this describes the ability to move freely from one situation to another, including the ability to make transitions, tolerate change, problem solve flexibly, switch or alternate attention between tasks, and change focus from one topic to another.
Emotional control – this is the ability to modulate or regulate emotional response to events.
Initiate – this is the ability to begin a task or activity, and independently generate ideas on possible problem-solving strategies.
Working Memory – is the ability to hold information in mind for the purpose of completing a task, generating goals or plans and working out the next steps necessary to achieve them.
Plan/Organise – this is the ability to plan and organise task demands, anticipate likely outcomes, and set goals.
Task Monitor – this relates to how well an individual can reliably check their own work for accuracy and ensure a task is complete.
Organisation of materials – this is the individual’s ability to organise their desk, workspace, home environment, school bag etc., to know what materials are needed for lessons or homework and to keep track of their belongings.
If a person has difficulties in all of these areas, it is not hard to appreciate why they experience so many challenges in day-to-day life.
The secondary school environment (and certainly the average workplace) works on the basis that most people acquire these abilities at some level. Of course, there are many people who may not have Autism or ADHD who can also identify some of these features in themselves at times. Alcohol in particular is not helpful for good executive function! How many people have failed to adequately resist impulses, self-monitor or make good choices when they have had a drink? However, imagine how challenging this must be to experience this level of difficulty all the time? For many children (and adults) living with Autism and ADHD the impairment they have in their executive function means that they live their whole life in a five minute bubble – unable to make good choices, unable to see the consequences (for themselves and others) for the decisions they make; unable to learn from past mistakes and apply lessons learned to a new (and novel) problem.
This can (and does) lead to children in school being labelled as ‘lazy’, ‘disruptive’ or ‘badly organised’. It can lead to adults losing jobs, failing to achieve academic potential, getting into debt or even ending up in the criminal justice system as a result of poor choices and failing to appreciate consequences.
This remains a hidden and poorly understood disability for many people with Autism and ADHD. It is not always apparent upon first meeting someone. There are some extremely intelligent and gifted individuals who have very poor executive function which impacts upon their ability to manage daily living tasks and live independently. The current benefit system (which include Disability Living Allowance for children and Personal Independence Payments for adults) does not fully understand the huge impact that poor executive function can have on an individual and also how variable this can be – stress and anxiety (which are also common in individuals with Autism and ADHD) can negatively impact upon executive function.
It is vital that awareness of this is raised amongst professionals and parents. If a child (or adult) has this difficulty there are things that can be done to support them and improve their abilities in this area. This can include classroom and workplace support and modifications and, in some cases, medication prescribed by an appropriately qualified medical professional.
The main thing though is to remember that ‘five minute bubble’, and to realise that this is not a choice.