Executive challenges in autism & ADHD

A common topic of discussion in autistic and ADHD communities is executive (dys)function (better described as executive challenges), and how it impacts our daily lives.

Executive functions are cognitive processes that facilitate the achievement of our goals. For example, they help us solve problems, guide our decision-making, and control our actions. Executive functions are primarily regulated in our brain’s prefrontal cortex.^[1]Uddin L. Q. (2021). Cognitive and behavioural flexibility: neural mechanisms and clinical considerations. Nature reviews. Neuroscience, 22(3), 167–179. However, those of us who are autistic and/or ADHD have altered neural processes which impact how our prefrontal cortex manages these executive functions.^[2]Demetriou, E. A., Lampit, A., Quintana, D. S., Naismith, S. L., Song, Y., Pye, J. E., Hickie, I., & Guastella, A. J. (2018). Autism spectrum disorders: a meta-analysis of executive function. Molecular psychiatry, 23(5), 1198–1204.

In this article, we’ll explore how different executive functions come up in our day, how autism and ADHD relate to executive functioning, and how to identify our executive function strengths and weaknesses.

Executive functions

Below are 12 executive functions and how they impact our daily lives.

Keep in mind that the term “struggle” is subjective. Just because an example below describes “poor” executive functioning scenarios doesn’t mean that definition applies to you. What might be negatively impacting someone else’s life may not be affecting you!

Response inhibition

Thinking before acting

Response inhibition/inhibitory control (often referred to as self-control) allows us to take time, evaluate circumstances in our environment, and weigh the costs/benefits associated with different choices instead of acting on impulse.

• We are using response inhibition when we wait for a sale before making a purchase we can’t afford.
• We may struggle with response inhibition if we have a tendency to blurt out answers in school instead of waiting to be called on by the teacher.

Working memory

Manipulating information in our head

Working memory is a form of short-term memory which allows us to think about and work with information that has been given to us.

• We use our working memory when following a set of directions on a map.
• We may struggle with working memory if we find it difficult to follow the steps in a recipe.

Emotion regulation

Managing our emotions

Emotion regulation/emotional self-regulation allows us to control our emotional reactions so that we can continue to pursue our goals.

• We use emotion regulation when we take a deep breath instead of honking our car horn repeatedly when a pedestrian takes their time to cross the road.
• We may struggle with emotion regulation if we go into a fight/flight/freeze response or have a meltdown/shutdown in a situation that isn’t threatening.

Important note: For autistics, sensory overwhelm is a real threat to our well-being and safety. Having a meltdown or shutdown is justified!

Task initiation

Starting something when we want to

Task initiation allows us to begin projects in a timely fashion.

• We use task initiation whenever we begin a task. This could be starting something undesirable like a household chore or something we enjoy like reading a book.
• We may struggle with task initiation if we procrastinate a great deal on starting our homework. This type of intense procrastination might look like sitting at our desk with the textbook open, but our brain just won’t start reading.

Sustained attention

Maintaining our attention in the face of distractions

Sustained attention allows us to keep doing what we’re doing even when we feel bored/tired, and other thoughts/activities are trying to grab our attention.

• We are sustaining attention when waiting for a red light to turn green.
• We may struggle with sustained attention if we lose focus during a movie that isn’t about a compelling topic.

Planning/prioritizing

Creating a realistic plan that allows us to attain a goal

Planning/prioritizing allows us to determine the steps needed to complete a task and discern from things that may impede progress.

• We are planning when we make an itinerary for a family trip.
• We may struggle with prioritization if we use all our spoons replying to our friend’s text messages and then don’t have any energy left to respond to our work emails.

Organizing

Creating and maintaining logical systems and routines

Organizing/organization allows us to track information, ideas, and materials.

• We use organizational skills when we put laundry away in designated drawers.
• We may struggle with organization if we have a hard time recounting an experience coherently because our thoughts don’t flow in a logical manner.

Time management

Estimating and allocating appropriate amounts of time for a task

Time management allows us to operate within given time limits and recognize when timing is important.

• We are managing our time when we set aside 30 minutes in the evening to cook dinner.
• We may struggle with time management if we unintentionally go to bed late because we don’t consider how long a movie lasts.

Behavioural flexibility

Updating plans when conditions change

Behavioural/cognitive flexibility allows us to overcome unexpected obstacles, integrate new information, and adapt to shifting situations.

• We are being flexible when we change into warmer clothes if it suddenly starts to snow.
• We may struggle with flexibility if we have difficulty re-phrasing a sentence when a listener doesn’t understand.
• Another sign we may struggle with flexibility is if we experience distress when an appointment time is changed.

Metacognition

Reflecting on our own thoughts and actions

Metacognition allows us to take a step back and critically analyze our performance in a situation.

• We are using metacognition when we evaluate how we sounded during a piano recital.
• We may struggle with metacognition if we don’t realize that our problem-solving strategy isn’t working and we continue repeating the same method.

Persistence

Maintaining course when pursuing a goal

Persistence/perseverance allows us to reach our goal even when faced with distractions such as competing interests and unexpected changes.

• We are persisting when we complete a 10 km race even though we felt tired and our muscles were sore halfway through.
• We may struggle with persistence if we avoid hobbies we don’t think we are “good” at because it’s too discouraging to stick it out till the end.

Note that while persistence is a dedicated effort to stick with something, perseverance means showing persistence despite facing challenges and opposition.

Stress tolerance

Continuing to cope during stressful circumstances

Stress tolerance allows us to deal with uncomfortable and demanding situations.

• We are tolerating stress when we agree to go along with our friend’s dinner plan, even if it’s at a new place we’ve never been to.
• We may struggle with stress tolerance if we become highly anxious and have a panic attack during a job interview.

Each of these executive functions has its own unique aspects of cognitive processing. Neuroscientists can even distinguish between brain activity and circuitry associated with distinct skills. However, whenever you set out to pursue a goal in real life, whether it be doing your laundry, going on a camping trip, or learning a song on the guitar, you are using a combination of executive function abilities to attain your goal. Can you imagine a situation you experienced and identify all the executive skills you used to manage it?

How autism & ADHD relate to executive functioning

From the descriptions above, you can see just how integral these executive functioning skills are to managing life. While everyone has varying strengths and weaknesses across these abilities, autistic and ADHD individuals tend to show consistent patterns of executive functioning struggles (sometimes called executive dysfunction). Our unique brain processes can make accomplishing our goals more difficult.

Autism

Research shows that autistic people tend to struggle with behavioural flexibility.^[3]Craig, F., Margari, F., Legrottaglie, A. R., Palumbi, R., de Giambattista, C., & Margari, L. (2016). A review of executive function deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 12, 1191–1202. This might partly explain why so many of us like to stick to routines and prefer sameness. For example, our poor behavioural flexibility means that a last-minute change in plans causes us distress. Low flexibility in autistics can also look like eating the same foods every day for breakfast or seeking comfort in rewatching our favourite movies. While low flexibility results in difficulty coping with some situations, that’s not the case for all situations. There isn’t anything “wrong” with preferring to rewatch an old movie instead of a new one. Context matters!

One interesting interaction is that autistics who also experience high levels of anxiety tend to struggle even more with behavioural flexibility.^[4]Craig, F., Margari, F., Legrottaglie, A. R., Palumbi, R., de Giambattista, C., & Margari, L. (2016). A review of executive function deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 12, 1191–1202.^[5]Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559–572. This finding is important because it offers insight into one possible reason why roughly 40% of autistics also experience anxiety disorders.^[6]Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559–572. However, research has yet to understand whether anxiety causes poorer behavioural flexibility or whether our worse behavioural flexibility causes our increased anxiety.

ADHD

In contrast, those of us with ADHD struggle with planning/prioritizing, organizing, and task initiation.^[7]Craig, F., Margari, F., Legrottaglie, A. R., Palumbi, R., de Giambattista, C., & Margari, L. (2016). A review of executive function deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 12, 1191–1202. This likely explains the struggles many of us had in managing all our classes in high school or why we tend to forget to text our friends back.

In ADHD, executive functioning weaknesses—planning and organizing in particular—are associated with depression.^[8]Craig, F., Margari, F., Legrottaglie, A. R., Palumbi, R., de Giambattista, C., & Margari, L. (2016). A review of executive function deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 12, 1191–1202. In general, individuals who struggle with planning and organizing tend to have a harder time managing daily life demands. Having ADHD seems to increase these daily struggles even more.

Part of thriving as a neurodivergent person means nurturing our strengths and ensuring that we get the support we need to help manage our weaknesses. Taking these actions may even help us feel less anxious or depressed. For example, I support my autistic + ADHD partner by adding his appointments to my own calendar so that I can help remind him when he needs to leave. This way, he can concentrate on what he is good at: hyperfocusing on the complex engineering problems he deals with at work.

Measuring executive functioning

Discovering our executive function weaknesses and strengths allows us to understand how we can develop useful coping strategies and identify areas where we might want extra support. The Executive Skills Questionnaire (ESQ) is a questionnaire designed to rate our executive functioning abilities.^[9]Dawson, P., & Guare, R. (2018). Executive skills in children and adolescents: A practical guide to assessment and intervention. Guilford Publications. We can use the ESQ to determine our strongest skills and our weakest skills. Click the link above or the image below to go to the embedded questionnaire on our website. On this page, we’ve also explained the scoring and its validity as a test.

In addition to being a helpful personal tool for discovering areas for growth, it is also helpful for clinicians diagnosing autism and ADHD. Because autistic individuals commonly struggle with behavioural flexibility and ADHD individuals struggle with planning, organizing, and task initiation, scores on the ESQ can be used in combination with other assessment tools to better understand whether an individual may be autistic and/or ADHD. At Embrace Autism, Dr. Natalie looks for a low behavioural flexibility score on the ESQ to bolster her assessment of autism.

Summary

Executive functions are cognitive processes that facilitate the achievement of our goals.

• Behavioural flexibility is an executive function that allows us to adapt our behaviour when circumstances in our environment change
  • Autistics struggle with behavioural flexibility
    • e.g., we prefer routines and sameness
    • e.g., we become distressed with sudden changes in plans
  • Low behavioural flexibility is associated with high anxiety in autistics
• Planning/prioritizing and organization are two executive functions that allow us to create the steps and routines/systems needed to pursue our goal
  • ADHDers struggle with planning and organization
    • e.g., we may struggle to manage our household chores
  • Poor planning/organization is associated with depressive symptoms and lower day-to-day functioning in ADHD
• The ESQ is a questionnaire that allows us to identify our executive function strengths and weaknesses