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E12. Executive Functioning Skills



Welcome to ADHD Crash Course! Today we're going to talk about executive functioning skills. It's likely that you've heard this term used before, especially in relation to ADHD. So, what are they? What are executive functioning skills?


These are a collection of skills that are basically your "get it done skills".


They're skills that are going to move you towards your goals, skills that help you envision your goal, plan your goal, break down the steps to move towards your goal, skills that help you sustain your energy and your attention and your focus in order to move towards your goals, skills that help you think about your goals.


Now, one thing to keep in mind is that you can have problems with executive functioning skills and not have ADHD. But if you have ADHD, you're going to struggle with at least some of these skills. I think this is where a lot of the misunderstandings come about ADHD. People (understandably, because of the name) are looking at attention and hyperactivity.


Of course, those are huge factors with ADHD, but for many people, especially as they get older, older children and definitely adults, the real gaps and the real struggles that they have functionally have to do with these skills. When you're younger, your parents are these skills for you.


Let's say you're in second grade and you need to leave for the bus at eight o'clock. Your parents are going to say, "Hey, you need to make sure you're ready to walk out the door at eight o'clock. Bus comes at eight, good night." That's not going to happen.


As the parent, you're going to break down all of the steps. You're going to do the planning and the prioritizing, the time management to figure out what this child needs to do to be able to walk out the door at eight o'clock. This can be really difficult for people with ADHD and it can appear like someone with ADHD is "suddenly" struggling with these skills, when, in fact, the demand of these skills has just increased in their lives.


So, if you have a young child who's been doing fine, and they've moved up in a grade and the expectation is they're going to be a lot more independent, that they're going to be planning projects and staying organized and breaking down steps and doing a lot of these skills that we're about to talk about; It looks like they "suddenly" have executive function issues when they've actually always had the issues...they've just had the support.


Or it may not be evident until a child in elementary school moves to middle school, a really big leap for independence. Or, for others, it may not be evident until a middle schooler moves to high school or high schooler moves to college or an adult gets their first real job and has to break down their projects and their plans and communicate with a team.


For a lot of women that I work with, these struggles became really apparent when they had children and they were suddenly the executive functioning manager for another human being as well as themselves.


And it's too much, it is just too much gap to bridge when you're doing that for yourself and someone else, when it's already a weak area (for you). I wanted to mention just a couple more broad things about executive functioning skills before I go into the specific skills.


Having deficits in these skills has nothing to do with intelligence. You can have an exceptionally high IQ and have executive functioning skill deficits.


When someone struggles in this area, it can be misinterpreted as laziness or indifference, but struggles in this area are very real. They're not moral failures, they are skill deficits. The cool thing to remember is that since these are skills, we can very often strengthen them or at least strengthen some of them. It takes practice, like it does for any other skill that you improve on.


Let's get into the specific skills and talk about executive functioning skills, what they are, what they look like. I've grouped these in a way that makes sense to my brain. I've grouped these into three different categories: how we plan, how we regulate and how we think.


How We Plan


The first one, "how we plan". Here are four skills that have to do with how we plan that are executive functioning skills: sequencing, prioritizing, organizing, and time management.


Sequencing


With the first one, sequencing, we're breaking down the steps of a task in order. If your child has to write a research paper, figuring out what comes first, "Well, I guess I need to pick my topic", and then second, "I need to do some research", and third, "I need to write my outline". Breaking down this nebulous, open ended task into sequential steps is essentially sequencing.


Prioritizing

Prioritizing; this one's tricky. Deciding what's the most urgent and important task. A lot of times for people with ADHD, everything feels urgent. This is why I encourage my clients to do a brain dump; just dump out everything that they're responsible for, on their mind, weighing on them; dump it all in one place. Then from that list, try to figure out what's urgent.


Organization


Next is organization. Organization is basically having a system for keeping track of things. Maybe that's physical things or conceptual things or maybe that's time and schedule (related) things.


Time Management


The last one for how we plan is our time management. I've done a previous episode about time and our sense of time. This is judging time in using it effectively. Time management isn't just our time sense, although that's a part of it, it's leaning on other skills as well.


Take the example of trying to get out the door at a certain time. You need to be able to sequence in your mind and think "Well, what's my normal routine? What order does that go in?" and you need to be able to prioritize how you're going to spend your time in order to get out the door; judge, of course, how much time each thing in the sequence takes you.


You're going to have to move backwards knowing you want to get out the door at a certain time to enable you to do that. Something like time management is a pretty complicated executive functioning skill that's using several at the same time. Several of our skills that we're going to talk about today are like that. They may be classified as their own thing, but they're actually leaning on other skills.


How We Regulate


Our next group of executive functioning skills are how we regulate. Skills included in here are emotional and attentional regulation, response inhibition (also known as impulse control) and task initiation, which I've put in this category for reasons that I'll tell you in a second.


Attention Regulation


With attention regulation, this is not just a lack of attention. It's a regulation problem. So, it's not just "I don't have attention" across the board, it's that I can't rely on my attention, I have a hard time shifting my attention. Sometimes I can attend to something exceptionally well, but I can't always count on that. That is attention regulation.


Emotional Regulation


Now, emotional regulation, actually used to be one of the diagnostic criteria, I think it was back in the 70s, for ADHD, and no longer is, but people very often have difficulties with emotional regulation with ADHD. That's your ability to experience really intense emotions and work through them without being carried away with them.


I want to point out here that just because you don't see that someone's dysregulated emotionally, does not mean that they're regulating well. There are a myriad of coping strategies that people use to deal with this dysregulation emotionally, and these become secondary problems, things like addictions, things like disordered eating, various kind of coping strategies. And they very often have this underpinning of problems with emotional regulation, response inhibition, or impulse control.


Impulse Control


I've done an episode specifically on impulse control. Impulse control or response inhibition is more about stretching out the pause that you have between the impulse and your action. Our focus is not on having less impulses, because that portion is out of our control.


Our focus is more on stretching the pause and working on how we're interpreting and thinking about the impulses. So if you want to dive deeper on that one, I have that episode on impulse control as an earlier episode.


Task Initiation


Now, the last one in this category is task initiation. Why did I put it in with regulation? Because one thing I've noticed in the people who I work with (and in my own life) is that often when starting a task, self-activating gets blocked more because of other regulation issues.


Maybe we experience overwhelm and we're not able to get started because it's just a daunting task or a boring task! Being able to regulate and tolerate those emotions and move forward is tricky. Also, attention regulation is a factor here with task initiation, being able to sustain our attention to move us through those initial steps is often a real challenge. So, I put it here in the "how we regulate" section.


How We Think


The third category is "how we think" and there are three skills that I'm going to talk about here: metacognition, cognitive flexibility, and working memory.


Metacognition


Metacognition is thinking about our thinking. It's this awareness of how we think, this awareness of our internal experience. An example of metacognition in my life is judging that working memory is an issue for me and being realistic and aware about that as I move about a task.


Another example of metacognition is recognizing what you've learned and what you understand. I think all of us have had the experience where you've sat and read the same thing multiple times, or maybe you've read something and you've had very little understanding or retention.


Metacognition lets you realize it. "Yeah, I sat there with that book for an hour, but I've got nothing. I did not get anything out of that experience." And that is an advanced level of thinking, thinking about our thinking.


Cognitive Flexibility


The next one's cognitive flexibility. This one's a toughy. Cognitive flexibility is our ability to adjust and see things from more than one point of view or to adjust our thinking in response to the demand of an environment. What does this look like functionally?


Rolling with Murphy's Law. If something can go wrong, it's going to go wrong. So, can I adjust? We had plans to go hiking, it's raining, can I switch gears and not melt down and choose something else to do? It lets us view things from other people's perspective. It helps us stay creative and problem solve.


Working Memory


The third one is working memory; this is holding information in our minds in order to complete a task. This is a short, the shortest, memory. If you've ever been preparing something with a box mix and you have to keep taking the box out of the garbage because you forget the steps, then you might be my people.


So...how do we apply this to our lives?


So far, I've talked about executive functioning skills. I've defined them. I've talked about the concepts. But if you're like me, you're probably wondering, so what?


If this is a hard area for you, you may want to know, what am I supposed to do with this information? A lot of the work that I do with my clients is supporting these skills and helping my clients develop these skills and compensate for areas where these skills are not strong.


But if you don't have a coach and you're not working with someone, what can you do? I'm going to go through each of these categories and pick one of the skills and tell you what it might look like to work with that executive functioning skill.


Let's look at prioritizing...


Okay, for how we plan, let's look at prioritizing because that tends to be tricky for many of us. If you're trying to prioritize your day, where do you start? I usually start with a brain dump; getting everything out of my head into one place, one master list.


Then once we have that list, we can go through and decide "Hmm, what has urgency? What is time specific? What is really important in this list?" and where a lot of us struggle with this prioritization is that everything feels important. Everything feels urgent! So we can't go by the feeling, we've got to think ahead a few steps and think, "Hmm, if this doesn't get done, what is that going to look like for me?"


Another factor that's pretty relevant here, is judging our time. It's hard to prioritize when you don't know how much time each thing is taking and how much time you have. Another piece of working on this prioritizing will be deciding what's the priority and deciding how long those things are going to take you. Because it's really, really common for us to misjudge our time and add too many options to our day and have this feeling of scrambling without recognizing too many things made it on to our priority list for that day.


Let's look at initiation...


Okay, for the second category, "how we regulate", let's pick the executive functioning skill of task initiation. If I'm struggling here, what can I do about that? First off, I'm going to notice and acknowledge that I don't feel like doing this thing, I don't feel like starting it. If I'm noticing, there might be a couple of reasons it's hard for me to get started.


Maybe I'm feeling overwhelmed. If that's the case, I'm going to use a different set of strategies to help calm myself down and help break down this task, step by step, so I am not looking at this whole picture of what I have to do. Instead, I'll look at one really doable step.


Or maybe I just don't like the task, I'm just avoiding it because it's a dreaded, boring, not fun task. I'll use a different strategy here. I'll use my knowledge about what helps increase motivation. I know that some really common ways to increase motivation for my kind of brain is either adding some intensity or some interest.


If I can add some fun, play my favorite music, make it a competition; if I can add some intensity by texting my best friend and say, "Hey, I need to get this thing started, I'll text you when I finished it", if I use one of those little hacks for increasing my motivation, I might be able to help myself get going on that first step.


But, maybe I'm having a hard time getting going on that first step because I haven't been able to break down the steps. That's another reason why task initiation can be tricky for us sometimes. And so if that's why I'm struggling with this, I'm going to think about that end product, whatever it is, I'm needing to get done, and I'm going to go backwards from there to figure out what my most reasonable first step is going to be.


You can see that there's no cookbook here, there's no "this is the strategy that works for ADHD with this executive functioning skill" because even if you're having a problem with the skill, there are many reasons that could be underlying that.


Really understanding yourself, understanding your brain, and breaking down where the breakdown is, will be helpful when coming up with the next strategy you use for any executive functioning skills that you're working on.


Let's look at working memory...


Our final category is "how we think" and the executive functioning skill that I'm going to tackle here is working memory. Now, there are some skills that you're going to improve in and there's some skills that you're going to improve by compensating for the skill.


On a whole, I would say working memory is a skill that we just compensate for. I can tell you, for me, compensating for this executive functioning skill is twofold. Number one, pretty much everything in my life gets written down, and number two, I have habits and systems for checking the things that are written down, because otherwise I'm going to grab an envelope while I'm talking to somebody and jot a really important note, and I'll have no idea where that is.


Or, I'm going to make this grocery list, polling everybody in my family, planning out the meals, and forget the list. For me, having not only the knowledge, the understanding that I've got to write all this down, but also, habits about how I check that, how I reference it, where it gets written down, is really important for me.


It won't be flawless, but can be functional!


Do things still fall through the cracks? Absolutely. Do I find things like "check the rag blue" in my planner and wonder what on earth I meant by that? Sure. It happens. Seriously, I still have no idea what that meant. So, flawless? no. Functional? Definitely. And that's my goal.


That brings us to the end of this episode on executive functioning skills. I know that this was a lot of material to cover and because of time we couldn't get nearly as in depth as the subject warrants, but hopefully this overview can be a foundation for you for the subject, because it is a complicated one and it is one that comes up an awful lot when it comes to managing life with ADHD.



 

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