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.
Well presented
ReplyDeleteThought provoking. I am going to share it with my sons teachers. Thank you.
ReplyDeleteVery interesting,I can relate this to my work as a Local Area Coordinator. Thanks for taking the time to share.
ReplyDeleteReally appreciate this, Judy. I am 55 and Dx'd with dyspraxia (2011) and adult ADHD (2015) - and my executive functioning is hugely impaired, in spite of my being highly able.
ReplyDeleteIt's the spiky profile of our condions that most people don't understand - and label us as lazy, disruptive or highly disorganised, as you say. For me, in the workplace (and I've had many of them!) my EF differences are generally viewed as unprofessionalism (because, as far as others can see, I'm perfectly capable of acting in a professional manner if only I would put my mind to it).
The years of my conditions going unrecognised have caused untold damage to my sense of self: my self-esteem is at rock bottom. And the tendency towards self-loathing cannot be underemphasised. Thank you for the great work you do in trying to educate others through your intelligent and thoughtful writing.