Remedies for Executive Dysfunction in Autism

By December 31, 2015Articles

Dr. Karina Poirier explains how Executive Function (mental abilities) contributes to our understanding of the world, helping us study problems, make and carry out plans, assess how well our plans are working, and take corrective action when necessary.

The ability to think is often taken for granted; however, the capability to do so plays an integral role in our development and enables us to recognize that we are social beings. To paraphrase a popular saying, we think, therefore, we are.

In a way, life is a series of little challenges, one after another, and most of us depend on a mental framework of executive functions (EFs) to carry us through. EF is defined as the mental system that organizes high-level thought processes, such as memory, multi-step tasks, planning, initiation, mental flexibility, and inhibition. When a child’s EF isn’t working like it should, he or she can become confused or overwhelmed easily.

Usually, all this goes off without a hitch … but sometimes we experience minor executive dysfunctions. Suppose you decide to go shopping, but can’t find your keys. You saw you needed something, decided to buy it, and headed for the door—all the result of applying various EFs. But one, working memory, didn’t function as well as the rest. Now, you’ve got to find your keys before you can go.

Little executive dysfunctions like this are mildly embarrassing at worst. But long-term EF problems, like those resulting from brain trauma or neurological disorders like autism, can impact a person’s quality of life. Communication, social skills, school and career, and behavior can all be compromised. Clearly, we must treat their executive dysfunction before such people can reach their full potential.

Important EFs include:

  • Memory: Remembering similar situations, and how you reacted to them in the past. Working memory is short-term memory you use to support current activities.
  • Inhibitory control: Suppression of thoughts or fears that might keep you from reaching a goal.
  • Planning: The ability to create a mental picture of how to reach your goal.
  • Organization: Arranging your thoughts to better understand and complete a task.
  • Time management: Evaluating the time restraints on any given situation.
  • Metacognition: The ability to evaluate your progress at a glance.
  • Self-regulation of affect: Managing your emotions to control your behavior.
  • Task initiation: The ability to start a task with enough time to finish it.
  • Goal-directed persistence: Tightly visualizing a goal so that you can ignore distractions and keep working until the goal is met.

Most of us find some EFs easy, some more difficult. For example, you might be easily distracted, but talented at metacognition. A co-worker might be bad at time management, but have perfect focus.

Now: imagine what life might be like if you couldn’t use one or more of these EFs at all, which is what children with autism and related disorders regularly encounter.

For most of us, executive functions (EFs) are automatic and require little thought. For example, we rarely think twice about crossing the road. We make our decision, remember to check both ways, and suppress our fears so we can get it done. For a child with executive dysfunction—a failure of one or more EFs—a simple task can be very difficult.

Typical school tasks assume that EFs are already in place and well developed by the time a child enters kindergarten. But since this often isn’t true for children with autism and similar disorders, it’s common for them to struggle academically in the general classroom setting.

The best place to implement EF training is in the home, through the use of everyday activities. When the child is given a task, start by having her tell you how hard she thinks it will be and why, in her own words. This encourages her to think about the possible outcomes of the task, and also helps her to identify any potential obstacles. As she performs the task, ask her how she’s doing. This self-monitoring encourages her to put more thought into how to successfully complete the task. When she’s finished with the task, ask her how she thinks she did. This helps her to reflect on and evaluate her performance.

Let’s say you ask her to put away her toys. You’ve presented a goal, and now you can guide her along the logical steps toward that goal. You have to make sure she takes the right steps in the right order, and understands why she’s made the decision to follow those steps.

  • Goal: What am I trying to do?
  • Plan: How will I do it? What materials will I need to use to complete it?
  • Prediction: Is this task easy or difficult? How will it turn out?
  • Do: What problems might I run into, and how will I solve them?
  • Review: How did I do? What can I do differently next time? Is there a better way to do it?

According to Lev Vygotsky, a renowned researcher, children are more successful with completing tasks when they receive adult help (scaffolding), rather than when they complete the tasks on their own. This led to the idea of the adult as a mediator for cognitive skills, not just someone who tells the child what to do. The adult acts as the child’s consciousness rather than as a human instruction manual.

The truly responsive parent provides the emotional, physical, and emotional assistance a child requires until she can handle specific tasks independently. The adult shows the child the task that can be done and how to do it. Once the child has reached an appropriate level of physical, mental, or emotional development, she can try the task herself. And after some practice with the task, she can eventually stop relying on the adult to do that particular task for her. These shared experiences provide the framework for her to develop self-regulation.

Taking it Further

The topic of executive functions is expanded in detail, in my book, Unlocking Social Potential in Autism. In this book, I help you understand what autism is, where it comes from, how to treat it—and why it doesn’t have to mean a lifetime of loneliness for your child.

Check out Dr. Karina Poirier’s social skills therapy clinic.

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