Tyranny of Doing-Executive Dysfunction

Previous Tyranny of Doing posts: Trauma, Activism, Home and Family

 A huge section of my practice focuses on folks with ADHD and Autism. Some clients come to me already diagnosed, and some come for a different reason and we determine over time that many of their struggles are connected to some form of neurodivergence that impacts their executive functioning. I am also a late-diagnosed ADHD. I figured it out in my 30s after a sibling was diagnosed. Understanding why my brain does what it does has been personally helpful as well as professionally helpful. I’m also solidly blaming ADHD for the long delay between newsletters this time. Sometimes the focus just isn’t there to get the work done. I apologize for the long break, and definitely plan on writing shorter essays going forward.

 A note on terminology: Neurodiversity refers to the wide variety of types of brains (or neurotypes) in the world, neurodivergent refers to those brains that differ significantly enough from neurotypical to cause some level of challenge in the world, and neurotypical refers to the most common collection of traits. Since neurodivergence is a common enough variation on normal, the mental health field tries to avoid the term “normal”, instead referring to “typical”. Neurodivergence can be genetic/organic like ADHD and Autism, or it can be acquired in the form of a traumatic brain injury or other medical event.

The vast majority of our educational, work and social expectations are based on assumed neurotypicality. Just like the world is largely designed for right-handed people, it’s also designed for neurotypicality. And people can change their neurodivergence about as well as they can change their dominant hand.

Merriam-Webster Dictionary definition:

executive function- noun the group of complex mental processes and cognitive abilities (such as working memory, impulse inhibition, and reasoning) that control the skills (such as organizing tasks, remembering details, managing time, and solving problems) required for goal-directed behavior

Executive Dysfunction is when executive function doesn’t work right. The biggest challenge most clients with executive dysfunction report is not being able to start or complete tasks that are important and that they want to do. Forgetfulness, disorganization, challenges with time, and trouble managing emotions are other common impacts of executive dysfunction.

It’s Not Laziness

The a common criticism I see from folks struggling with executive dysfunction is labeling their inability to start or finish a task as “lazy”.  This is usually because others have labeled a lack of doing as “lazy”, when viewing it from the outside. There’s a big gap between not wanting to do something, and not being able to do that same thing. Not wanting to is laziness, not being able to is either an executive function issue, or a skill issue. Feeling worried that the important task needs to be done, thinking about it over and over again and knowing that you need to start it is a far cry from brushing off the task as unimportant or not worth their time.  A task being undone is still the end result, but the level of distress about it is very different.

When a neurotypical adult, someone who’s executive function works very well, doesn’t complete a task, it very well may be laziness, or not prioritizing that task. And so, they are likely to assign laziness or lack of prioritizing to someone else not completing a task, assuming they are neurotypical. This sets folks with executive dysfunction up for distress and frustration, because they are being judged both externally and internally.

Sometimes It IS a Skills Issue

A task being undone is not always a case of lack of effort or executive function, it is sometimes not knowing how to do something. We won’t judge a 4 year old for not knowing how to tie their shoes, because they haven’t been taught it yet, but we may criticize a 10 year old, who has been successfully tying their shoes for years, for having flapping laces.

Often neurodivergent folk learn differently, and may need to be taught things in a different way. Common issues are struggling with where to begin a large task, prioritizing within a set of tasks, and breaking a large task into smaller parts. Processes that require multiple steps to be done in order can be very challenging for someone with executive dysfunction. Issues with working memory, or the ability to hold information in your head to use it in a few moments, is a  common expression of executive function. For people with ADHD especially, a task that seems relatively simple on its face could actually have 5-7 tasks that all need to be attended to. My favorite example of this that I’ve found was for making coffee in a countertop coffee maker:

Option 1: make coffee (1 step)

Option 2: pour water into machine, pour coffee grounds into machine, push start (3 steps)

Option 3: fill coffee pot with cold water, pour water into machine, empty filter basket, replace filter, open coffee container, find coffee scoop, measure coffee, place grounds in filter, press start (9 steps)

You could conceivably break the steps in option 3 down into even more sub-steps. For neurotypicals it’s often option 1 or 2, for anyone with executive dysfunction, it’s usually option 3, or beyond. There’s a reason so many people choose to buy their coffee! And considering that ADHD brains work better with some kind of stimulant in the system, many of us need coffee to make coffee! (Our household preps coffee the night before and relies on the auto-start feature of our brewer to make sure we have coffee when we get up.)

For something a complex as cleaning a room or a while house, a research project, or searching for a job, while the actual action will be somewhat challenging for most folks, it can feel overwhelmingly complex for anyone with executive dysfunction. This why advice to “just do it” and “it’s simple, just pick a place to start” is so damaging for those with executive dysfunction. If they could, they would, and they’re struggling with the “could”. When everything feels the same level of important, it’s extremely difficult to know what is the “most” important thing to complete, and so jumping from task to task, or spending lots of time on a relatively unimportant task are equally as likely.

A challenge specific to ADHD is “galaxy brain”, when someone can see all of the possibilities, and all of the things they “could” do. This is great for creativity and generating ideas. It tends to run headlong into limitations of time, energy and attention. The tension between the two can often make it feel like someone with ADHD is failing, because they aren’t doing all of the things they “could” be doing.

A challenge specific to Autism is often rigidity in how they approach the steps of a problem, and then struggling if they’re asked to start on step 3, or if step 4 is somehow impossible, but can be skipped for now. Being flexible in the order of things is very challenging for many autistic folk.

Task inertia is a super common challenge. It’s the inability to start moving on a task, or the inability to stop once you’ve gotten going. This is often where people label themselves “lazy”. Going from a resting state to motion is very challenging and can be very frustrating. The flip side of this is hyperfixation, where all the focus is on the task, and outside demands and information are unable to break the focus. A perfect example of this is getting started on a big project like a school paper (Or a long newsletter!) It takes tremendous effort to get started, but once you’re into it, it’s hard to stop. And if something breaks the concentration, then getting it back again is nearly impossible.

Learning To Work With The Brain

One of the hardest things for many neurodivergent folk to accept is that their brain is different, and that they need to do things differently than neurotypical people. Just like buying left handed scissors, finding or creating ways of working with executive dysfunction is incredibly important. It’s also likely that the standard strategies for remembering things, task initiation or task completion will be insufficient for most people with executive dysfunction. Different does not equal bad! It’s just different.

Structure and routine are often very helpful for ADHD people, even if they struggle with them. Routine is usually comforting and necessary for Autistic people. Having an appointment at the same day or time means it’s more likely to be remembered and attended. Other examples of routine and structure can be eating the same thing for breakfast every day, wearing a “uniform” of similar mix-and-match clothing, and having a dedicated spot for important objects. Frustratingly, there is no universal advice, and each person and family will find the routine and structure that works for them.

Borrowing other people’s executive function can be helpful, whether it’s asking a loved one for reminders of what needs to get done, or if there are plans for the weekend, or asking for body doubling support. Body doubling is when someone sits with you while you work on something. They can be doing their own thing, not necessarily interacting, but their presence can help keep you on task. This is why studying or working at a library or coffee shop can be so helpful!

You Are Not Alone

Ok, that feels trite, but it’s true! Loads of people are functioning with executive dysfunction.

It can sometimes feel like “everyone” has it together and can do the things that you struggle with. It’s an annoyingly universal feeling. You are far from alone. Executive dysfunction can show up as a result of many different mental health issues, not just ADHD and Autism. It’s also hard to feel like we’re getting enough done in our 24-hour news cycle, chronically online, performance is everything kind of world. When everything feels like it’s equally important making the choice to focus on one thing can feel super hard. There is a movement of creators, therapists and others that is pushing for a more neuroaffirming world.

There are many, many creators online, and scores of books and podcasts that can be helpful for managing executive dysfunction, and also for reminding you that you’re not alone. Catie Osborn, Matt Raekelboom, Alex Hogg, How to ADHD, Holderness Family are some of my favorite creators.

Take good care of yourselves.