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Impact of Executive Functioning Disorder (EFD) on Individuals with Autism Spectrum Disorder (ASD)
Executive Functioning in the ASD Mind
The article Executive Functioning and Theory of Mind on the www.autismspeaks.org site quotes, Temple Grandin as saying "I cannot hold one piece of information in my mind while I manipulate the next step in the sequence.” As I reflect on this statement I wonder what feelings were pounding in Temple Grandin’s heart as she made the statement. The realities of the intricacies and important of the Executive Functioning of the brain really becomes relevant to day to day living.
According to the article “Understanding Executive Functioning Issues” on the www.understood.com website, Executive Functioning is the CEO of the brain. Executive Functioning allows a person to systematically complete a task that requires planning, organization, the use of a working memory, application of time management skills and the utilization of flexibility when the processes to complete a task becomes challenging. The article goes further to indicate that these Executive Functioning processes are part of day to day living.
Autism Spectrum Disorder (ASD) is intertwined with the possibility of comorbid medical disorders occurring simultaneously within an individual. According to www.merriam-webster.com, the medical definition of comorbidity is “existing simultaneously with and usually independently of another medical condition.” One such comorbid disorder is Executive Functioning Disorder (EFD). On the www.webmd.com website, EFD is defined as “a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.” According to Autism Speaks, this ability to organize and process information is referred to as Executive Functioning Disorder (EFD). As an ASD child develops, their personal characteristics also evolves. Learning who they are is a life long journey of adaption in the world around them.
It is not unusual for individual with Autism to struggle with processing and taking in large amounts of information that can be broken into meaningful pieces that produces the desired completion of a task. Persons afflicted with EFD are more likely to require assistance completing tasks, will have difficulty being successful at work or school and typically have poorer social skills. According to www.additudemag.com a person without EFD can follow through on six critical steps to successfully complete a task. The six steps of Executive Function outlined by the site www.additudemag.com are:
1. Analyze a task
2. Plan how to address the task
3. Organize the steps needed to carry out the task
4. Develop timelines for completing the task
5. Adjust or shift the steps, if needed, to complete the task
6. Complete the task in a timely way
According to www.AutismSpeaks.com, individuals with ASD are more impulsive and will have greater difficulty understanding social cues. An individual with deficits in processing large amounts of information because of EFD are likely to see deficits in the areas of sequencing, planning and self-regulation. At times, ASD individuals may come across as not being empathetic, but in reality they are processing parts of a scenario or task.
According to the Autism Speaks article titled Executive Functioning and Theory of Mind it has been shown that ASD individuals are poor readers of social cues and this can impede their Executive Functioning skills. I have found that there are “shut down” moments when my daughter in overload mode. What may be a normal amount of information for some is not for her. The EFD in the ASD child picks up on a few of the steps of the task. They face more opportunities to be shown what is wrong versus what was right. She may seem confused if told the outcome was not correct. She may show facial signs that to the keen observer indicate there is a sensory overload happening. She may feel punished for having to redo a task. The question is what strategies are put into place to negate these potential inward feelings of failure.
It is imperative that their caretakers support them by becoming knowledgeable of the unique traits that their ASD family member exhibits. With my own child, I view it as a dance with ASD and EFD. As her feet moves, my feet must be choreographed along with hers. The choreography helps me to be fluid as I learn her processes. One missed dance step can cause either of us to feel or look awkward. It helps me develop a keen ability to predict her feelings. I can help bring in other members to dance along to the routines she has created. At the same time, she is learning those around her and picking up on their moves.
The awkward “dance” can be seen when watching the interactions of ASD individuals with those who do not have the disorder. Although either party can at times feel awkward, often it is the ASD child whose skillset prevents them from moving through the world successfully. How does EFD fit in? The six steps of EFD described earlier will lead to functional independence. Less reliance of others. There is more dependence on learning from others the “right” and “wrong” way to do things.
As my daughter grows into adulthood the practicing of rituals, routines and deepening our understanding of how social cues are used by in her daily interactions continues. We have found that implementing strategies to help her and those around her cope with EFD is critical to her success. As an individual with ASD her mental checklists must be like a non-stop record player in her head.
The tasks, visuals, frequent reminders and never ending lists that may seem mundane to others is essential for her to remain in survival mode. As my husband and I see growth there are celebrations. Some may see it as “not letting go” when in reality the ASD parent is always operating in training mode. It is part of the predictability dance. Recognizing that the EFD mental checklists are like the lyrics to the song our child dances to helps use to develop patience. Through patience we develop reflection. Through reflection we develop a sense of reality. It helps us to adjust and to accept the needs of our daughter. More importantly, it is a reminder to her that she has support and establishes a platform for her success. We have found that keeping her teachers and other support persons informed of her needs is equally as important as keeping her aware of the strategies to overcome EFD challenges.