Executive dysfunction and its relation to AS

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Hello,

In registering for this forum, one of my primary goals has been to shed some light on my overall situation and how it relates to my probable AS. I am 26 years old, and have accomplished little in life despite being one of the most intelligent people I know. I didn't graduate from high school (I did get a GED, however), don't have a driver's license, and have only had a job for about 2 or 3 months of the last 9 years since high school ended. Whenever there is anything in which it is necessary to devise a multi step plan and executive those steps to achieve a goal, I am at a complete loss as to how to proceed.

My mind works in such a way that it is almost as if the external world is irrelevant. My mind will simply return to my obsessions and there doesn't seem to be much that I can do about it. I've had friends in the past, but I tend to lose them because I don't keep in touch. I am terrible at remembering names, and worse at remembering how to get somewhere. If you were to drive me a few miles away and drop me off, I wouldn't even know how to get home. I tend not to accomplish things most days, because even when I intend to do something, a short moment later I am distracted by my incorrigible mind. And completely forget about those aforementioned multi step plans! If something doesn't involve my immediate vicinity, my thoughts, or people that I come in contact with on a regular basis, it is truly "out of sight, out of mind!"

So in addition to having lifelong social difficulties and obsessional interests, the classic signs of AS, it appears that I also have severe executive dysfunction. From what I have gleaned from lurking on the WP forums, people with AS seem to run the gamut from almost normal EF to the sorry situation that I'm in. In any case, despite the apparent paucity of research on how EF relates to AS, there is little doubt that it does. It seems likely that the social and obsessional aspects of AS and executive dysfunction have the same root causes in the brain. At least for me, I feel that I might as well have gotten a traumatic brain injury at some point in my past (I didn't), because it is really that bad.

As this problem results from the structure of my brain that I have presumably had my entire life, is it fair to surmise that therapy or drugs are not likely to make much of a difference? It occurs to me that therapy would be best in a situation where it is attempting to coax an individual back to functioning that they previously had. But I have never had executive functioning any better than it is now.

Given the apparent permanence and severity of my cognitive deficits, is is fair to say that I'm disabled? And is there anything that could possibly change the situation in the future? I'm just sick and tired of people accusing me of being lazy, as I know that there is nothing that I could've done differently. I know that they can't get into my head, but I also know that my mind functions in a fashion entirely dissimilar from theirs, and never the twain shall meet, as they say.

Thanks for any thoughts on this matter!

I'm not able to properly read your post at the moment, but here is a thread with some research that I could find related to EF and AS:

http://www.wrongplanet.net/postt166483.html

Hey there! Just happened to stumble onto this one on my very first time visiting Wrongplanet...

I guess I am a pretty high-functioning Aspie or have found the right coping mechanisms... but I have definitely always struggled with executive functioning. For me, having medication has been very helpful as a PART of becoming more successful in areas I have struggled with. For me, having an anti-depressant and a mild stimulant really seems to have lifted a "Fog" and I'm finding organization and executive functioning to work a lot better.

I'm not saying medication is for everyone, and it's never the WHOLE solution. But there are plenty of reasons to shed some of your pessimism. There are plenty of "ADD-Friendly" strategies out there... I don't really care one way or another about ADD as a diagnosis, but these books are "strategies for people who have struggled with executive functioning"...

Also... you have a real, real lot of negative self-talk going on "sorry state, incorrigible."... It sounds like you are beating yourself up pretty badly even though what you are saying is obviously based on facts. Learning to be a little gentler with yourself will go a long way in helping you believe you can find the right strategies for you. You ABSOLUTELY can find ways to get along much better here on Earth.

Since you didn't have a traumatic brain injury, your brain functions perfectly fine. You probably learned voraciously about __________ (insert your specialty interest(s) here... and it is "specialty interest" not "obsession" by the way). It's just a question of channeling energy.

I'd be more than happy to talk and share more with you here or by PM... and look forward to learning more about your story if you're up for sharing!

-AB

Impaired Executive Function is so common in AS, it should be listed as one of the primary symptoms. I consider it to be far more serious a handicap than any social impairment or 'lack of empathy'. Social skills can to some extent be learned and developed over time, at least to a minimally functional level, and I think in similar fashion, empathy is an acquired skill that while we may learn it more slowly, eventually becomes a matter of mere pragmatism - you learn to make assumptions about the thoughts and emotional states of others based on previous experience.

Executive function, however, is what it is and IME never seems to get much better than whatever level you have reached by the age of 20. Personally, I feel I have the Executive skills of someone aged 17-25 and I'm actually twice that old. Its not about organizing my immediate environment, or even about being able to plan and carry out somewhat complex tasks. For me its about 'big picture' problems, like financial planning for the future, comprehending contracts and insurance policies, completing and filing paperwork - oy! I HATE paperwork - stuff like that. As a for instance, I'm a writer and I love to create novel-length fiction, but couldn't create an outline if you put a gun to my head.



You are correct, drugs are not effective for any form of autism. Some people take them for anxiety, but I recommend Chamomile gelcaps instead. No side effects, no danger of dependence and they're very effective at calming without any 'stoned' feeling.

Some parents of autistic children resort to 'Behavioral Therapy', but all that does is force the autistic person to deny their own true personality and adapt to neurotypical behaviors even when their own brain tells them they should do otherwise. I consider that a form of psychological torture and just living in the real world will do enough of that to an autistic over a lifetime without putting them through some sort of Nazi 'social conditioning' program.

As to the real question: Are You Disabled?

If you have AS, of course you are, autism is classified as a disability. It is a set of handicaps that will impair you for your entire life. The degree of that impairment will vary depending on your personal ability to create coping mechanisms that help you fake your way through this NT world. If you refer to qualifying for assistance, that will depend on just how dysfunctional you are and for that, you need an official diagnosis and evaluation over time by a qualified mental health professional.

Please note, 'qualified' and 'professional' are NOT synonymous. There are a great many 'professionals' in the mental health care field who have no personal experience with autism, or perhaps some experience with autistic children, but have never even MET an autistic adult and there is a HUGE difference in the methods of diagnosis. Someone who can spot an Aspie child in a few minutes, may swear that an Aspie adult is not autistic at all, because they don't take into account all the years they've spent painfully learning to HIDE their handicaps.

Once diagnosed, qualification for disability assistance will depend on several factors, not the least of which will be recommendations made by your diagnosing mental health counselors and even your age. If your coping mechanisms seem high functioning enough, you may be considered capable of managing in the workplace, at least until you pass middle age. I've seen some on WP claim that you can't get disability for AS, but don't you believe it, because more than a couple of us here do. A tip: If your disability is 'manageable with medication', you will not qualify for assistance. Another reason to avoid the pharmaceuticals unless you really need them.

But diagnosis comes first and that can be a hurdle all by itself, then after diagnosis you will go through a period, even though you're already virtually certain that you have it, during which your psyche will gradually adjust to understanding your AS and incorporating it into your identity. Its one thing to THINK you've discovered something about yourself, its a whole different ballgame once you KNOW. Trust me, it changes you. Some of those changes are cathartic, some are painful. Its an adjustment process, but its bigger than you realize until you've experienced it. Good luck.

Me too. Except I haven't yet successfully created novel-length fiction. But I have never created anything resembling a good outline.

I have MAJOR executive dysfunction problems too by the way. Mailing stuff, writing back to people, filling out forms, getting places on time, remembering recipe steps I've JUST read, figuring out how to attack a seemingly simple problem like cleaning a room - anything that requires more then one step, FORGET IT!

One thing that DOES help I've learned is breaking things into steps and only doing one step at a time. For example, cleaning my room - I pick up all the fabric and put it in a pile. Take a break. Sometime later pick up all the paper and put it in a pile. Getting dressed - put on a shirt. Stay in pajama pants while I eat. put on pants at some later point when I don't feel confused and frazzled by my shirt-putting-on feat.

Also - like I said I am not one to be talking, I too have only held a few months' worth of jobs since high school and I'm 25 - I've applied for disability money now - but I have found that putting a task in context of the big picture - the meaning of life - is the only thing that motivates me to get it done. For instance: why should I write back to my friend? I want to but I can't make myself. But then eventually I think about everything the friend means to me, and where I would be without the kindness and care and love of other humans who aren't even related to me but who have somehow found in themselves affection for mem this creature who might as well be an alien for all they know my origins and I write back to them. Or not even though I want to. So yes I struggle with this.

Verdandi,

Thanks for the link, I'll be sure to check it out.

ABecker755,

I'm flattered that you considered my thread worthy of your first post. Thanks for taking the time to reply to me.

I think that my post is rather negative, but how else could I view my situation? I should say that I don't have any intrinsic problem with my situation or the way my brain works; it feels normal to me, as I'm sure it does for most people on the autistic spectrum. It's just that I feel that I'll let a lot of people down. Life is hard enough, without having to worry about me. And I do crave respect and a place in this world just like everyone else. But as it is, my virtues do not earn me many plaudits, and I've no doubt that my vices attract plenty of scorn (though kindly, I'm mostly spared hearing about it at this point).

My brain feels like it functions perfectly fine to me, but most people probably wouldn't feel that it is very adaptive. It's coming down to a matter of survival. Irrespective of any emotions that I might have about all of it, it really is just about survival. How am I going to survive? Because at the end of the day, nobody in the world will give a darn about my situation or deign to accommodate me in any way, and it has always been like this. I've always been treated like I am capable of being just like everyone else, but time and experience has demonstrated otherwise.

My intention in writing this post, as I said, was to find out more information about executive dysfunction in AS. Feel free to write anything you think might be of benefit to me.

Avengilante,

What you're writing is describing my experience of life quite exquisitely. Yes, I was about as awkward as you can imagine when I was a child. Somehow, I've progressed to the point where people generally consider me to be completely normal and are shocked to find out that I think that I have some sort of cognitive deficiency. My social skills seem to be just fine. As I wrote, that doesn't mean that I'm making tons of friends, but nobody acts like I'm some kind of "weirdo", which is definitely how I felt in Middle and High School. Just within the last couple of weeks, I was at a doctor's office and chatted with some random lady about a medical condition that I've had for the past year, and we must have talked for more than a half hour. Then after that, some other fellow started talking to me. When I was about to leave the hospital someone else approached me and told me that they had heard my story and were sympathetic. I don't think any of this could have happened years ago. So I have come a long way. And when I am in intelligent company, I understand that I can be quite engaging. Because my interests are fairly wide ranging, I can usually find something that the person I'm talking to is interested in.

I was writing about this in another post, and a good point was made that most of the research being done on AS is related to difficulties experienced by children. As children don't tend to have many responsibilities that they must attend to, executive functioning naturally gets short shrift. But for me, this is unquestionably my biggest problem. While my social skills aren't perfect, I can blend in well enough, I think. And I don't want to give up my interests! I wouldn't want the "cure" if it entailed that. The fact is that my executive functioning is at the level of, perhaps a 12 year old. Or even younger. I envy your 17-25 year range.

I fear getting involved with the medical system. For the past year, I have had significant medical problems, and I've found dealing with the medical system to be an absolute nightmare. Any sort of bureaucracy scares me, and especially when it involves something as sensitive as this. Unless I was certain that the psychiatrist I was going to was really prepared for me, I don't think that I'd be inclined to go. I'm certain that I don't want to be subjected to some sort of fascist reconditioning program.

I've often thought that in all around simpler, less complicated world, I might fare better. From my own experience, and reading the experiences of others, I'm beginning to see that people on the autistic spectrum are just spat upon and unceremoniously tossed into a ditch by society. It's too bad that we aren't better at organizing things, because we really ought to fight for our rights. I think that this is the next civil rights issue in America. What we have to go through in the world is just horrific. Isn't it possible, that if there was some level of accommodation, that most of us could do alright in the world? Even those who fare better are still mistreated to a shocking degree. Why do we just take it lying down in a fetal position?

purchase,

Thanks for writing. Your life sounds almost exactly like mine. It's good to know that I'm not alone, I guess.

What you're describing has been known as "baby steps" since the movie What About Bob? came out. Believe me, people have suggested this to me my whole life. It does help a lot with getting things like making appointments and basic stuff around the house done. But as for the big "life steps", there doesn't seem to be any substitute for whatever area of the brain is suppose to do its thing but isn't. I do agree that the giving and receiving of affection and love to and from others is probably, at the end of the day, the most important thing in life. I do like people, but sometimes I find that I have a hard time relating. My life isn't much like anyone else that I know. Still, being completely isolated would probably be the worse thing that could happen to a human, so I do the best that I can to take the opportunities that I have for social contact, even if that usually just means family.

Ah, getting out of pajamas and into your day clothes. I can't tell you how many times I driven people absolutely nuts with this. I guess NTs just tend to get up in the morning, take a shower, and get dressed. More recently, I've taken to showering upon first getting up in the morning, but it's often the case that I just put back on most of the same clothes! At least I've had some improvement in that area over the last few years.

platocrat isn't asking about autism symptoms though, they're asking about co-morbid AD/HD symptoms, sometimes characterised as 'executive dysfunction', but AD/HD by current definition nonetheless. The drugs for which have among the highest success rates and lowest side effects rates of any psychiatric drugs. They're most definitely worth a try under supervision of a doctor.

Not all executive dysfunction is ADHD and per the study I linked above differences were found between autistic executive dysfunction and ADHD executive dysfunction, even though many autistic people also have ADHD.

Is that paper referring to studies of AD/HD in all its forms, or only the Hyperactive and Combined Types? The wording in the parts I read gives the impression that the writers were ignoring or ignorant of the existence of Primarily Inattentive Type AD/HD, and the lethargic, 'foggy' subtype of this known unofficially as 'sluggish cognitive tempo'. The lethargic types are known to present some different cognitive deficits than the hyperactive and subclinically hyperactive types (they're more likely to show processing and working memory deficits, as with autism), so any study comparing autism to AD/HD should separate the hyperactive types from the non-hyperactive types and compare all three to each other. Most studies into AD/HD focus on one or the other, usually the hyperactive types.

Primarily Inattentive Type AD/HD does respond to medication, although Russell Barkley claims to have found that 'SCT' children have an inferior response and respond differently to the various dosages, usually. Still, some benefit. I'm diagnosed with Primarily Inattentive AD/HD, and I'm not sure whether to classify myself SCT or not due to my stimming looking hyperactive sometimes and my dyspraxia, asthma and obsessive interests making me look lazy and lethargic the rest of the time, but I know I've benefited from stimulants, not so much in the form of concentration but in the form of gaining for the first time an 'inner nag' that makes me feel a need to find something to do that isn't merely for entertainment purposes and to stick with a task until it's done.

This had me fooled for a while. In fact one family member thought the same.

I can experience "object blindness" in this muddle of my processing visual information..... It appears some with AS have the same issue; at this point it could be comorbid SCT with this; IDK.

Roseblood, there is a "twin thread" in members only, and from what you posted here we may be

How do you like it? There nothing like knowing you have talents but you're stranded in Dysecutive backwardness, as your thoughts are twisted or, to say it better: the overall sequencing is wrong ; information is a random string and if you have enough time you can disentangle it....

Last edited by Mdyar on 17 Jul 2011, 4:46 am, edited 1 time in total.

Most people who have ADHD-PI still have subclinical hyperactive/impulsive symptoms - there's not a huge gap between combined types (who have six or more inattentive symptoms and six or more hyperactive/impulsive symptoms) and inattentive types (who have six or more inattentive symptoms and can have as many as five clinically severe hyperactive/impulsive symptoms and still be inattentive).

But numerous conditions cause executive dysfunction, of which autism is one. PTSD causes executive dysfunction very similar to ADHD, for example. Depression can cause symptoms very similar to ADHD's inattentive symptoms. There's a lot of overlap.

The thing I found most interesting about that study was the conclusion that autistic people seem to have more severe executive function deficits than people with ADHD.

I looked at the DSM criteria for ADHD, including the Predominantly Inattentive sub-type, and I'm not sure that I'd meet the criteria. It's possible that when I was in school that I might have met the criteria, although it is hard to remember. As far as I'm aware, though, I was never diagnosed with it, even though it was something that was fairly well documented at the time I was going through school.

The problems described seem more related to keeping focused on a task at hand. I have some issues with that, but the bigger problem is simply initiating things in the first place, particularly if they are things that are "stretched out" in time and space. If it is something immediately present in front of me, it doesn't cause too many issues. It's trying to think about, and comprehend, what I need to do when the things are separated by many miles and many days or weeks or months or years and how to piece it all together into a cohesive whole that results in the fulfillment of some goal.

When I think about all of the things that most external observers would declare that I have trouble with, they all could fall under the category of "life goals". At some point in adolescence, it seems as if most people start to realize that they are fully independent individuals, and that they need to think about what they want to do with the rest of their lives and figure out how to achieve it. They might make a list of things that they want to do. Many, if not most people would probably have a core list of life goals including getting a driver's licence, graduating from high school, graduating from college, getting established in a career, getting married, and having kids. Most people would say that if you've done all of these things, you're pretty "successful". If you haven't done any of them, you're certainly not.

The problem is, for whatever reason, that it doesn't work that way for me. I'm familiar with the list, for as you can see, I wrote it down above. I just don't feel any inner drive to go for any of it. I live my life in the present, and that is it. Any thought of how to process those amorphous "life goals", so stretched out in time and space as they are, just doesn't compute for me. I'm really incapable of understanding how it is that people consider these things, and how those thoughts lead to actions that ultimately lead to any of the set goals being fulfilled. As a result of not being able to understand this, I generally don't think about it very often. The fact that I can't seem to do any of those things has lead me to simply reject them as even being possible. I no longer even care about that now, but because some of them are central to survival (namely having a career) in the modern world, I fear that I may be digging myself a hole that will be impossible to extricate myself from in the future. That is my main concern.

It's possible that I do have some variant of ADHD, but I don't feel like it adequately describes what I'm facing. It's as if there is some kind of foundational drive or core yearning to achieve mastery over the external world that other humans have and I simply don't. I know that there are natural variations in people's personality, and that some people are more driven to succeed than others. But what I'm describing here is not really that. It's more that I'm unable to change even though I know that there might be pretty dire consequences at some time in the future. Even that knowledge doesn't change my motivation. I don't think that this is a normal or desirable trait in an individual, and though in and of itself it doesn't cause me much distress, I know that I will suffer for it someday.

What I'm trying to understand, is if this is something that is as a result of my probable autism, or if it is something else entirely.

How many symptoms do you think you actually fit at this age?



You should watch the videos here: http://www.youtube.com/user/A9Kam#g/u

All of the videos of Russell Barkley. He explains things that might help clarify your understanding.

Also, some text:

http://www.russellbarkley.org/adhd-facts.htm



ADHD does a huge number on one's ability to achieve life goals. Of course, so can autistic spectrum disorders, and so can many other conditions. The point is that the stuff you are saying does not necessarily rule ADHD out.

Another element of ADHD is a lack of time sense and a "myopia to the future." Basically, a lack of understanding the passage of time, and thus a lack of ability to sustain and organize plans into the future. I think autism may also interfere with time sense, so it's not necessarily a differential thing. It's just the stuff you're saying in the post doesn't really contradict ADHD at all, and sounds like a lot of the problems people with ADHD often have.

Anyway, I'm not saying whether or not you have it, but it does seem that there's not a lot of good information about what ADHD is available and people aren't aware of all or even most of the impairments ADHD causes.

"How many symptoms do you think you actually fit at this age?"

I'm not sure exactly how many, but I do think that I probably should have been diagnosed with it. It might have been useful if the school had been aware of some of my limitations even if AS wasn't an available diagnosis at the time. I don't know how I fell through the cracks. I didn't go to some underfunded, impoverished school. The town I grew up in was pretty average, I think. How did they miss it? The troubles I had were about as extreme as anyone could have.

Thanks for posting the link to Dr. Barkley's lectures. I have just taken a cursory glance at them, but I should be able to more thoroughly review them tomorrow. I suppose that I have some misconceptions about what ADHD is, then. It sounds a lot like what I am facing, but I wasn't under the impression that it affects functioning as severely as it does for me. Maybe it is just a particularly severe case of ADHD? In the diagnostic criteria this one thing stands out for me:

"Often has trouble organizing activities."

In that one symptom they have encapsulated my life's troubles. It sounds pretty innocuous too, but anything in the extreme can cause terrible troubles. I'm off to catch some shuteye, but it should be interesting to review more of those videos tomorrow.

I went through this same problem - I had obvious problems and very few noticed they were problems other than assuming I was lazy and unmotivated. I fell through the cracks and went through some bitterness about it. I am also bitter in that my parents actually resisted suggestions to have me tested for anything, even though teachers and family friends pointed out I might have learning disabilities or autism etc.



ADHD can affect functioning quite severely, although research I think I linked earlier in this thread says autistic spectrum disorders can be more severe, and the combination is not particularly fun.



I hope they help, either way.