How do you know if you have Executive Dysfunction?

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Following on from a PM ragtime sent me:

There wasn't a diagnosis when we were children. In fact it is kind of rare to get a separate diagnosis of Executive dysfunction, as from understand it. I actually got one around 2004. It came before my Asperger's/ASD diagnosis and was pivotal (still is).

I think part of the reason it is not given the attention it deserves is the different disciplines involved in this clinical area. Behaviourists (typical psychologists and psychiatrists) acknowledge the presence of Executive dysfunction, and even believe it is part of other conditions they regularly diagnose, but show little interest in measuring or investigating it, and won’t “diagnose” it separately because it is not a behaviour or pathology. Behaviourists are by and large the predominant force in diagnosis pretty much any condition of the mind, and they are interested (unsurprisingly) in how a person behaves. The reason for this is simple: In the past it was easy to observe peoples behaviour, they knew very little of the functional side of the brain and how that would affect how you do things. Now there are professionals who are more interested in how a person’s brain functions and less so in behaviour, they then to have the prefix ‘Nuero’ to their job such as nueropsychologist / nueopsychiatrist, etc.

I think there is still quite bit of rivalry between behaviourists and functional based professionals. Really much of traditional psychiatry is pseudo science. It is not all useless they have made some good observations, but their approach isn’t a rigorous one and they can be quite resistant to change that in my experience.

In response people saying executive dysfunction is just a part of ASD or pre-existing conditions. Yes this is true however, executive is a huge area. People mean different things when talking about it. It includes areas such as judgment and emotions. Technically Autism itself meets the requirement for an executive dysfunction. Believe it or not so does savantism. Savantism may have its advantages but is considered a dysfunction of the typical executive function, not that they will offer treatment for it, but scientifically they often will use that term to describe these types of conditions. Usually when you are diagnosed with it, or just in general usage, they are referring much more to the planning an organisation side of things.

When I talk about my executive dysfunction I’m talking about a clinically significant dysfunction. Many people will have subclinical cases, or have other ways of compensating that are enough to negate a problem. I do think that all ASD people do have it, but I don’t think that everyone with ASD has it in the same severity.

What is interesting about my diagnosis is the examiner did not simply put “Executive dysfunction”, but rather “a Frontal/Executive dysfunction”. Notice the ‘a’. It is a dysfunction in the frontal executive area. The frontal lobe is where much of executive function is said to take place. It is the part of the brain the pulls all the other parts together as the brains main processor, hence the word “executive”. However the executive is not a physical location, but frontal obviously is.

The way they test for it is a day long aptitude test. There wasn’t much in the way of an interview or behaviour assessment, because they are not interested in how people feel or behave just how their brains function given tasks.

There are many components to ASD it is multidimensional, so it is not accurate to call it a exclusively social condition in this day. Yes social is important, but depending on where you are in life and what you have managed to deal with, it might not be your only priority.

Much of what we know about how the brain function comes from people with brain injuries. Using elimination they are able to figure out which parts of the brain are concerned with different things. When someone has a brain injury, especially a frontal one, they will typically have the more severe executive dysfunction sometime called ‘dysexecutive syndrome’ amongst many other names that mean the same basically the same thing.

My gripe is that professional focus much of their work either on people who are a little more than subclinical i.e. a bit messy and disorganised OR the most severe. There isn't much inbetween. Behaviourists typically don’t measure ED, so much ask you to do silly things, that a two year old could do, that are designed to detect the very worst of executive dysfunction and dementia type symptoms.

There are some interventions, to help with planning and organisation. They never work with me because they are dependent on how good your executive is in the first place. Every task especially menial tasks relies on your executive. As with anything it is about having something that is useful to you, it doesn’t actually matter how you brains function so long as it does that.

It's like the joke about the guy who wants to join the Procrastinator's Society, but keeps putting it off.

Or, like when a pharmacist gave my father a child-proof cap for his arthritis medication.



Or, of course:
Patient: "I need some talcom powder."
Nurse, walking away: "Walk this way."
Patient, observing: "If I could walk that way, I wouldn't need the talcom powder!"

Yes exactly catch-22.

I have a dream to organize better too..., but It seems to me like it's either to stay unorganized or live the life as described on a sheat of paper, i.e. become a robot. I have a deep fear of becoming like a robot. I get things done and can organize but I got to have the right spirit to do it properly. So it's on and off.

Last edited by mosez on 05 Jan 2009, 2:55 pm, edited 1 time in total.

With all due resepct, from what i have read, this is not the case. Some people with AS show no evidence of ED, while others do. In some diagnostic criteria it is not included as part of the diagnostic process. However, it is rather common in people with AS.

regarding your detailed posts above ....i am learning a lot. thank you. good to read your info. :wink.

my executuve dysfunction also extends into the areas of study and note taking. at uni i was head down and scrawl - as i could not glean main points in lectures, and so i tired to get the whole lecture down on paper. i would note others taking a note here and there. I also often had to READ all the topic before tutes, because i could not organise the verbal information from the tutor. without some attempt at prior familiarisation i could not grasp key points easily.

i also had a great deal of diffiuclty organising my time. the easiest way for me to cope nowadays, is to pare back my life to its simplest form to reduce the complexities of the information and things i have to sort through mentally.
My clutter tenedencies are tied in with this ED too i beleive. Although i also think it links in with my emotional attachment to objects which can indeed be stronger than my attachment to people.

starting and finishing projects? following things through? i can do this in my special interest to some degree- everywhere else basically SUCKS. I can leave the washing i the washing machine for two days after it has gone through the cycle. i struggle with day to day things like paying bills, shopping, etc.

I have been told it is related to poor working memory

I have been told it is related to poor working memory

double post deleted

I don't know whether I have ED or not. It's something I discussed with my therapist on several occasions.

I'm very impulsive, have a very low concentration/attention ability, cannot spontaneously organise or make any decisions, cannot spontaneously structure, cannot keep a check on time, cannot adapt to change, have trouble spontaneously taking future and past into account and so on and so forth... guess I could just say 'I'm autistic and ADHD.'

Yet while the above deficits/symptoms are 'severe', I manage exceptionally well because from earliest childhood I always worked on strategies to cover up these. And there I read about those with separately diagnosed ED they just can't manage what I can. So I can't have ED like them, can I. I have a few but big strengths that allow me to handle the few but severe deficits.

Back on the subject of school / classroom difficulties...
If I ever try college again, I'm going to hire a full-time private tutor.
I did this for a couple classes in high school, and, despite being a bit humiliating having
someone explain everything to you, it was actually a big help to my grade,
so I highly recommend private tutors for those who are struggling in school / college.

Their job is to sit there and explain to you however many things you want them to about your course work,
for as long as it takes for you to understand everything you want to.
See, unlike a teacher, they can't escape from your questions; it's an interrogation.
They're NOT LEAVING until you have the answers!
How I wanted to do that with most of my teachers who explained lessons lazily and quite poorly: I wished
I could just put them in a room, and say, "Look, you're not leaving this room until I understand today's lesson. GOT IT?!?"
Ya, I'd be a b***h, but I need to be in order to learn!
I have SOME learning disability that was never diagnosed, and that has hurt me in all levels of my schooling.

What I have most is, when someone (like a teacher) says something to me, a multiple-choice list pops up in my head
of all the things they could be meaning by what they just said. But on their end, they're completely sure that they've
been perfectly clear, and I that I simply must know what they mean unless I'm completely stupid. That kind of attitude is very hurtful to my learning process. It's clear where I got this problem from: My mom has exactly the same deficiency. You can be talking to her in casual conversation, and she'll stop you over and over to ask about the multiple-choice lists popping up in her head about the things you are telling her. She needs a clarification every two sentences or so. (Pronouns are a biggie. If you say "he", "she", "him", or her", chances are pretty good that she'll ask you who you mean, even if you've already said.) Is there a specific name for this kind of communication confusion?
That's what I have most of all that inhibits my classroom understanding.
Here's how it goes in school:
1. Teacher says something during a lecture.
2. Those multiple-choice lists pop up in my head contain all the possible meanings of what she said.
2. I raise my hand to get clarification.
3. The teacher ignores me 90% of the time.
4. Hence, I never learn 90% of the information I'm confused about, even though I want to.
Also, often enough, the teacher's answer only causes yet more mental multiple-choice lists to present themselves,
and so the confusion can spiral out of control. (The teacher is always past caring about this, and just gives me a look of disgust in the vain hope that I'll just "get with it" or something. )

When learning something brand new, I need the person teaching me to talk until my brain correctly synthesizes the information in its own language, period -- no matter how long that takes. A lot of times, I hear an instructive sentence they say, and I just end up thinking about the sentence and how well it was structured, while no thought is occuring about the actual information the sentence contains. Lists of accurate definitions of each word in the sentence will unfold in my mind, while the meaning of the sentence isn't even being processed yet. So, there's that palpable mental gap. This usually happens when I'm nervous, and is very dependent on the degree of nervousness.

(I'm having a meltdown now, due to ongoing training on a new project at work. I'm beyond the "it's difficult" stage, and the "it's impossible" stage. Now, I've reached the madness stage. And there's no way out -- no way away from this stimulus; I have to be trained more, right after lunch, until I understand how to do the project, which at the rate it's going will be about 2 mintues before Jesus returns. And I have to be embarassed and stressed-out the whole time, because I'm obviously performing sub-par in my supervisor's and another employee's eyes. And my sense of responsibility keeps nagging me to do that which I cannot do -- this new project that's really hard -- and that just ups my stress more. It's a vicious cycle. I'm staring off into space without even realizing it, and I'm having trouble doing very basic things. As if my whole brain is freaking out from the difficulties of this one insignificant project.)

Certainly been there. One of the problems is not being able to foresee or play how long something is going to take, as well as not knowing where you are in a project. I could be very close to the end and for all I know I've only just begun. vice versa.

I also harbour a lot of shame about my ExD and over compensate by trying to be a perfectionist, which usually makes things worse.

EDIT: This is Ragtime. I'm on my wife's login.

Yep, I'm that way too. About the not being able to sense the length of projects, it was funny, in hindsight that is, that my trainer kept extending our training time, while I kept expecting it to be over any second. The more I approached AS social overstim, the more determined she seemed to do more and more of the files we were working on. She earlier asked me if I needed "a break to clear your head", but at that time I didn't really. (Or maybe I was just trying to save face about my autism.) But after her lone offer of a break, she was relentless, when I really needed one! That wasn't too bad though, because by that time, something in my executive area had started correctly catagorizing and assimilating the information she was telling me. It happened right after I prayed for help, too. So, I felt only socially overstimulated by that time, not verbally/instructionally/proceedurally.

Something like this definitely runs in the family.
Our house is a mess.
My handwriting has always been bad.

Definitely had severe problems with organisation skills when I was younger, but because everyone else was so determined to "make me normal" I ended up overcompensating for my difficulties at High School to such a degree that I was far better organised and meticulous than everyone else.

I became almost neurotic about being organised and getting things right because I was afraid that I would be "found out" as "stupid" by others.

The reason why I was so organised at school was because I would have thrown a fit if I wasn't. I actually agonised over losing odd unimportant pieces of equipment or getting spellings slightly wrong because I was so petrified that I'd be carted off to some "special school" away from all my friends. I was afraid that the teachers would get angry with me too if I didn't do exactly what they said "to the letter".

Sometimes I copied stuff from the board back to front or missed out questions. I became so paranoid about this that I had to check everything and reread stuff a zillion times.
I'm sure that other people could just check stuff like this once and not have a problem.

I had to plan assignments and draw diagrams in my spare time while everyone else was socialising to make sure that I stayed on track.

I had to frequently correct myself if I pronounced or spelled words wrong. I looked up stuff a dozen times to make sure that I was right. I had to put in lots of extra hours studying because I seemed to grasp concepts and spellings slower than everyone else. I looked up the syllabus and even did relevant reading before the lesson: I was that scared that I was going to be "left behind".

As a result, I became pathologically well organised. I meditated on my organisation and checked and rechecked my pencil case every lesson to check that I had a spare pen if one pen ran out of ink. I arranged equipment on my desk with almost military precision because I was so afraid that I'd be "found out" as disorganised. The other kids must have thought I was neurotic. No wonder why they wanted to borrow all my shiny surplus equipment and tried to copy all my notes.

When I become incredibly stressed or am in an informal situation, however, my erratic tendencies and disorganisation shine through because my brain simply doesn't have the energy to construct coping mechanisms.