ADHD and Executive Function

Thinking of ADHD as a deficit of Executive Function (EF) offers a wealth of treatment possibilities. For clinicians, adults with ADHD, and parents of children with ADHD, this executive function conceptualization opens up a new way to organize thinking around deficits and strengths, and points the way to generating effective treatment plans. 

I recently read an excellent article from Dr. Thomas E. Brown of the Yale Clinic for Attention and Related Disorders, titled ADD/ADHD and Impaired Executive Function in Clinical Practice. In it, Brown defines ADHD as “a cognitive disorder, a developmental impairment of executive functions (EFs), the self-management system of the brain.” By stepping away from the behavioral aspects of ADHD and moving toward this cognitive understanding, treatment planning can be readily tailored to compensate for specific missing skills and abilities. I frequently direct my clients to create structure and systems which will shore up the weaker areas, allowing them to improve their performance.

                                       

In Brown’s article, he defines six areas of Executive Function Deficit. The first, called activation, includes activities required in beginning to work. Clearly, this deficit is familiar to anyone struggling with procrastination. Second, Brown defines focus, the difficulty in actually paying attention to the work at hand. Third would be effort, especially as needed to complete longer tasks. Fourth is emotional regulation. (Emotional regulation is not mentioned specifically in the symptom list in the DSM-IV or 5, but the inclusion of it in the DSM-5 was articulately argued for by Russ Barkley in his keynote to the CHADD conference.) Brown mentions memory as the fifth executive function, especially memory for more recent events, and problems in holding information. The sixth and final executive function is action, including impulsivity, pacing and taking in feedback from others. 

                                             

Russ Barkley offers both the Barkley Deficits in Executive Functioning Scale (BDEFS for Adults) and the Barkley Deficits in Executive Functioning Scale--Children and Adolescents (BDEFS-CA), which allow clinicians to evaluate client’s executive functioning in their daily life. The executive functions in the BDEFS are similar to Brown's, broken down to time management, organization and problem solving, self-restraint, self-motivation, and self-regulation of emotions. Because the BDEFS is a validated measure, results of the test can indicate exactly where individuals are struggling and what can be done to improve performance. 

For some clients, medication alone can have a huge impact, for others, therapy such as Cognitive Behavioral Therapy (CBT) can address problem areas. Many clients can benefit from a combination of medication and therapy. I've found this EF conceptualization to be especially effective in treatment planning for my clients. 

Book Review: Late, Lost, and Unprepared

Late, Lost, and Unprepared: A Parents' Guide to Helping Children with Executive Functioning ,by Joyce Cooper-Kahn, Ph. D. And Laurie Dietzel, Ph. D. is, yes, another book on helping kids develop executive function. But that’s not necessarily a bad thing. Different books (several of which I’ve reviewed here) on the topic offer similar ideas, but the details vary and one book may work better for your child than another.  The first part of Late Lost, and Unprepared thoroughly explains executive function, breaks executive function down into a list of specific skills, and discusses the developmental aspects of executive function. If this is the first book you’ve read about helping your child, it’s certainly worth the time to read this carefully.

 The second half of the book, “What You Can Do About It”, is of value even to those who have read a number of other books on the topic of executive function. This book’s strength is in breaking issues down methodically. As a former engineer, I know that the best way to get to a solution is to deal with a series of simple issues, rather than one overwhelming problem. This book helpfully lists very concrete, specific issues for each category of executive functioning. For example, one chapter about impulse control addresses specific problems like interrupting others, hitting others, and running off in stores.

A strength of this approach is that the authors present both short term and long term solutions. This is what every parent needs to remember, that executive skills improve with growth and maturity. While short term solutions stop disasters from happening, longer term solutions are what will be truly valuable to maturing individuals.

Another strength of the book is that it discusses how parents can advocate for their child. It’s ideal for every child if all the people dealing with him can be working toward the same solutions.   This book makes that idea straightforward and easy to figure out.

Book Review: Is It You, Me, or Adult ADD?

Marriage always involves compromise and adjusting for differences, and that’s even more true when one partner has a diagnosis, like autism, Asperger’s, or ADHD. In my therapy practice I work with many of these mixed couples, where it’s not just two different personalities, but also two different ways of experiencing and dealing with the world. These differences can bring a refreshing sense of novelty, perspective, and balance to a relationship, but they can also result in conflict, disappointment, and disconnect. Fortunately, understanding those differences between partners can be the first step in bringing a troubled relationship into one that’s supportive and satisfying for both.


Gina’s Pera’s  Is It You, Me, or Adult ADD?  was written as a support group in book form, focused on the partners of adults with ADD or ADHD, and Pera uses the voices and examples of support group members throughout. But, don’t be fooled by the support group theme. This book is an extensive and well researched resource, covering not just anecdotal examples but also thoroughly detailing treatment options, historical background and professional discussions of ADHD. I always appreciate writing that’s easy to read while still being informative and professionally referenced. This book will serve as a useful long term reference as well as a book to read through.

I read some reviews criticizing Is It You, Me, or Adult ADD? for siding with the non-ADHD partner and blaming all the marital problems on ADHD and the ADHD partner. Although I think this can be a fair criticism in general, the book really isn’t directed at those couples where ADHD is bringing creativity and spontaneity to the marriage. People attend support groups because they need support with problems and they pick up a book like this because there’s something wrong in their relationship. It’s reasonable to address the problems the diagnosis brings in these cases.

Is It You, Me, or Adult ADD? is an excellent resource for couples dealing with ADHD and I recommend it highly.

Conference for Learning Differences

Ed Rev 2011 will be held on Saturday, April 16, 2011 at AT&T Park. Ed Rev 2011 is "a day of inspiration and resources for students with learning and attention difficulties, and their parents and educators." The day includes speakers, activities, and an art contest. Whether or not you can attend, it's worthwhile to check out the excellent list of exhibitors and resources. Check out the brochure.

Treatment Options: Reading Programs

Kids with special needs like ADHD, ASDs and learning differences can frequently benefit from specialized tutoring and academic programs. But there are so many options, it’s difficult to choose what’s appropriate. And for adults, it can feel too late to get the help they need.

Today, I’m interviewing Theresa Rezentes, of Dyslexia Connections. Theresa is certified in both Slingerland Reading methods and  Lindamood-Bell methods. She works in schools as well as individual students in Alameda and Western Contra Costa County.

P. R. What are the signs that a child could benefit from working with a reading program?

T. R. As a reading therapist, I tutor kids who read below grade level despite an average to above average intelligence and who exhibit signs of letter direction confusion (b and d or b and p are most common), or who transpose letters (change their order) as exhibited in writing or oral reading.  Also, the child avoids reading for pleasure despite many encouragements.

P. R. What are these different reading programs?

T. R. As these children are three dimensional, hands-on learners, many need to write letters and words in the air with their whole arm to give them meaning.  The above confusions can be so distracting that only by writing the letters in the air while saying them and pronouncing them immediately following give them the scaffolding needed to make sense of words and reading.  This physical relationship is what is needed to permanently bypass the confusions that many children see if they have trouble reading.  Also, both the Slingerland and Lindamood-Bell Methods focus on auditory processing weaknesses which the majority (80%) of these students possess.

P. R. Can this be helpful for adults? 

T. R. Yes, it is but will take longer to make progress. I compare it to learning Spanish as an adult vs. as a child. The reason is that the neuropathways are more solidified with adults compared to children.  Therefore, the letter confusions are more permanent and will take longer to correct.  However, with therapy of three or more hours a week, progress can be made.  The bottom line is that it takes a true commitment of the adult.

P. R. How does this differ from what's taught in schools? 

T. R. For years, the Slingerland Institute had trained teachers using this method with hopes it would reach the schools.  Unfortunately, because most principals are not aware of these methods they are not supported by administrators and many of these children end up in Special Education with an IEP. The Slingerland Method is available in many Catholic Schools in the Oakland Diocese.  It has widespread support of the diocese and I treat children who attend Catholic schools.

The Lindamood Bell method is available in only two schools in Oakland.  The Susan Barton Method is available in the Pleasanton USD and San Ramon USD.  Both Lindamood Bell and Susan Barton require one on one tutoring and most schools cannot afford to have one employee work with one student several hours a week.  It is really through parental efforts and pressure that enable these methods to be available in the public schools, typically through a lawsuit settlement, or through private tutors certified in these areas.  I am certified in both Lindamood-Bell and Slingerland.

P. R. Thanks Theresa.

For those interested in learning more, please visit Dyslexia Connections.

Book Review: Out of the Fog, Treatment Options and Coping Strategies for Adult Attention Deficit Disorder

So much of what’s written about ADHD is aimed at parents. But the disorder doesn’t just disappear when these kids grow up. Based on information published on Russell Barkley’s website, 65 to 80% of children with the disorder continue to have impairments as adults. This can range from school, employment, and interpersonal issues to conditions as severe as mental illness, substance abuse and legal problems.

I’ve published several good reviews on coping with ADHD in this blog. Smart But Scattered and Late, Lost and Unprepared are two favorites. Although they tend to focus on children’s issues, many of the technique can be adapted to adults.

But it’s always best to be able to find something uniquely adapted to your own situation, which is why I was to pleased to find Out of the Fog, Treatment Options and Coping Strategies for Adult Attention Deficit Disorder, by Kevin R, Murphy, Ph.D. and Suzanne LeVert. Dr. Murphy was a researcher at the Adult ADHD Clinic at the University of Massachusetts, and is now in private practice. Out of the Fog is a book that really attempts to do it all: explain the condition of Adult ADHD, discuss treatments and strategies, and cover practical aspects such as organization and communication. With a lesser author, this approach might be too much at cover, but Murphy is so knowledgeable, he’s got good advice for all these varied aspects. Because the book was written in 1995, it doesn’t use some of the newer terminology, such as “Executive Function”, and the specific medication information is showing its age. In general though, the information in this practical guide is still useful and timely.

Now's the Time To Pay Attention!

School started a few weeks ago, the novelty is wearing off, and routines are setting in. Although it’s tempting to just settle in and let things run their course, now is really the perfect time to look closely at what’s going well and to uncover those little problems that might get bigger. This is true for all students, from kindergarteners to university students. Little, developing problems are easier to solve and there’s still plenty of time to make up for any lower grades. Habits haven’t set in too much yet and it’s easy to create new routines.

First, it’s important to think about what went well last year, and what you’d like to change this year. Did missing assignments snowball into low grades? Did you get overinvolved as a parent, not allowing your child to develop independent skills? Did you forget to factor in time for social connections with other students?

Second, look closely at how that aspect is going this year. Are you just starting to see one or two missing assignments? Are you jumping in a bit to nag, (help) your child? Are you ducking into the library at lunchtime?

Third, look for those tiny changes you can make to improve the situation. The best results often come from rules or systems. Can you start checking the school website every evening before going to bed, and make sure you’ve completed, and packed up, all your assignments? Can you set up a check list for your child, and then let her be responsible for her own work? Can you promise yourself that just once a week, you’ll take the risk and eat lunch with someone else?

Remember, the earlier in the year you try making changes, the bigger the impact of those changes.

Book Review: Late Lost, and Unprepared

Late, Lost, and Unprepared: A Parents' Guide to Helping Children with Executive Functioning , by Joyce Cooper-Kahn, Ph. D. And Laurie Dietzel, Ph. D. is, yes, another book on helping kids develop executive function. But that’s not necessarily a bad thing. Different books (several of which I’ve reviewed here) on the topic offer similar ideas, but the details vary and one book may work better for your child than another.  The first part of Late Lost, and Unprepared thoroughly explains executive function, breaks executive function down into a list of specific skills, and discusses the developmental aspects of executive function. If this is the first book you’ve read about helping your child, it’s certainly worth the time to read this carefully.

The second half of the book, “What You Can Do About It”, is of value even to those who have read a number of other books on the topic of executive function. This book’s strength is in breaking issues down methodically. As a former engineer, I know that the best way to get to a solution is to deal with a series of simple issues, rather than one overwhelming problem. This book helpfully lists very concrete, specific issues for each category of executive functioning. For example, one chapter about impulse control addresses specific problems like interrupting others, hitting others, and running off in stores.

A strength of this approach is that the authors present both short term and long term solutions. This is what every parent needs to remember, that executive skills improve with growth and maturity. While short term solutions stop disasters from happening, longer term solutions are what will be truly valuable to maturing individuals.

Another strength of the book is that it discusses how parents can advocate for their child. It’s ideal for every child if all the people dealing with him can be working toward the same solutions.   This book makes that idea straightforward and easy to figure out.

Success with a Learning Disability

We all learn differently, and we all have our own strengths and weaknesses. For both kids and adults, it’s important to remember that school success and standard academic achievement are not the same thing as intelligence, and how you do in school doesn’t determine how you’ll do in the rest of your life!

I’m always looking for examples of successful individuals who dealt with learning disabilities or a diagnosis like ADHD, Asperger’s or autism. One such list can be found in the article Ten Celebs Who Suffer From a Learning Disability.  Others lists like this can be found through Google or Yahoo searches.

Speed Reading and Study Skills Classes and Too Much Homework

A few local notes of interest to those here in the San Francisco Bay Area’s East Bay. California State University, East Bay is offering a variety of reading skills, reading comprehension, study skills and speed reading classes this summer in Danville and Walnut Creek. These classes include programs for ages 4 up through adults and college students. For more information, call them at (800) 979-9151.

Some of my regular readers may be aware of my concern about the vast quantity and  poor quality of homework that fills our children’s time, not to mention the tremendous pressure kids are under these days. For a moving and thought provoking look at this topic, please make an effort to see the locally produced documentary Race to Nowhere. The film will be shown in Danville, California, on June 1st, 2010 at Monte Vista High. For information, and other screening times and locations, visit the Race to Nowhere website.

Getting the Job Done: Creating a Visual Plan

As I discussed in my previous post on managing procrastination and distraction, getting lost in the details can make it very difficult for anyone to finish, or even start, a project. For those with ASDs or ADHD, this can be even more troublesome. One technique I’ve found to be useful for many clients is to create some sort of visual plan of the project. Taking time to think about the goal, organizing the details, and jotting it down on paper will give you something to refer back to while working.

Here’s an example of a simple outline you might use to stay on track while completing a project. I’ve chosen the topic I’m working on right now: writing this post. (I’m typing this for the blog, but I’d only scribble it down in real life.)

Goal: Writing a Blog Post on Procrastination and Distraction

                    1. Reread previous post on this topic
                    2. Consider steps involved
                    3. Create examples:

                    A. Detailed list
                    B. Detail cloud

                     4. Find appropriate pictures to illustrate

                    A. Dog
                    B. Snack

                     5. Copy and paste document into blogging software
                     6. Create links and finalize details on blog
                     7. Publish
Here’s an example of a less structured detail list. You can make the more important steps larger and bolder.

Goal: Writing a Blog Post on Procrastination and Distraction

                    Find Pictures                                     Reread previous post
                                          Create examples   
                                                Publish                 Create links
                    Copy and paste into blogging software           Plan steps involved
               
That’s it! These are both pretty straightforward and it only took a minute or two to put them together. Now, while you’re working you’ve got a very clear idea of what you should be doing to accomplish the job.
If you decide to pet the dog:

or get a snack:

it’s pretty clear that you’re off topic. But, I think it’s more frequent that people get pulled into the details, and then wander around off topic. Finding a picture of an apple can turn into sorting through all the pictures in the photo library, or wandering from topic to topic in an internet search. That’s where the list helps. You’ve determined the goal: writing a post, and browsing internet photos has nothing to do with that. It’s a clear example of when you need to pull yourself back to work.

If you’re more auditory than visual, recording a list can be helpful. Whatever works for you is fine, just take a few moments to plan, set a goal, and then check back with your plan frequently.

Getting the Job Done

Many of my clients on the autism/Asperger’s spectrum really struggle with productivity and distraction and the seemingly simple matter of getting things done. Although this is an issue for neurotypicals as well, I find that distraction and procrastination can be a lot more challenging for those on the spectrum.

Frequently, procrastination and distraction can occur when people get caught up in details and lose sight of the big picture.That’s not surprising really, because one of the key traits of both autism and Asperger’s can be, as stated in the DSM IV, a “persistent preoccupation with parts of objects.” Uta Frith refers to this “detail focus” as Weak Central Coherence. While a detail focus can result in amazing achievement and the ability to work creatively and deeply, at the same time, it can lead to lots of activity with little output. Generally, work output does require the leap from detailed focus to a more general viewpoint. Sometimes individuals can afford to take the time to study, learn, delve deeply into an idea and see where the material leads them. But often, this drifting, detailed investigation can be nothing but a waste of time.

So, how do you move from the details to the big picture? With many of my clients I try to take advantage of their strength in visual processing. Create a graphic image of the project, listing all the details. Headline this image of details with a title explaining how all these terms relate. That headline is usually the big picture.The details can be organized in different ways, depending on how you think. If you’re logical and structured try creating a numbered, indented outline, with small details organized into bigger topics. If you’re more artistic than mathematical, a “detail cloud” may be more meaningful. This is similar to those keyword clouds that sometimes appear on the sidebar of blogs.

Whatever you create to explain your project, put it clearly on a piece of paper where you can see it at a glance. Ask yourself frequently, “How does what I'm doing relate to what I'm trying to produce?” and “What am I trying to produce here?” Confused? An example can mean a lot more than an explanation, so please check back for the next blog posting where I'll show some examples of these techniques.

Book Review: ADD-Friendly Ways to Organize Your Life

Adults with ADHD really struggle with managing the daily aspects of their lives. Those with Asperger’s and ASDs often have issues with ADHD or executive functioning as well. For all these individuals, the tips and strategies in ADD-Friendly Ways To Organize Your Life, by Judith Kolberg and Kathleen Nadeau, Ph.D. (Taylor & Francis Group, 2002) may be useful.

The book attempts to provide strategies, accompanied by what the authors term support and structures, to manage various organizational issues every adult faces. The premise of this book is that those with ADHD may not do well with the intense, detailed organizing ideas presented in many other organizing books, but that simple structures, accompanied by support from friends, family and professionals, can result in effective changes.

The book is broken down into chapters for those who are troubled with different aspects of disorganization, such as overcommitment, waiting until the last minute, dealing with clutter, and managing bills and money. For each area, a simple plan of organization is offered, although it’s probably not a lot different than that of many other systems. The ADHD twist of this book is then in adding support in the form of assistance from friends, family or professionals. Although this could be useful, it may be unrealistic to expect a friend to sit by supportively watching as an adult sorts through monthly paperwork. I wish the book had focused more on helping adults grow and shift from using the support of others to developing independent ways of functioning in the long term.

Still, in spite of these shortcomings, the book does offer many useful tips. I especially like the limit setting tips, such as for every item or activity you add to your life, first you need to subtract one item or activity that you already have. In the chapter on prioritizing, the advice calls for limiting the to do list to 5 items only, and each should be done today.

The authors also are quite clever in utilizing the creative strengths of those with ADHD. Their “muttering” filing system uses file labels such as “Why can’t I find this when I need it?” and “I have got to call these people!” They suggest cleaning the garage to organize it in the same way a hardware store would be organized.

Like most organizing systems, adults with ADHD will not find all the solutions in one place, but they may find a number of useful tips.

Book Review: The Organized Student

Disorganization is one of the hallmarks of Attention Deficit/Hyperactivity Disorder and it’s often a key feature of autism, Asperger’s and Autistic Spectrum Disorders (ASDs). But, the good news is that disorganization is one of those issues that can be managed with relative ease. The goal isn’t to turn your child into a filing, cleaning, organizing wunderkind, but instead to teach some systems to help your student develop a level of organization that allows for school success. A great resource for this is The Organized Student: Teaching Children the Skills for Success in School and Beyond, by Donna Goldberg with Jennifer Zwiebel. (Simon and Schuster, 2005)
Although individuals with ASDs may be terribly disorganized, this weakness is frequently offset by strengths in analyzing and what Simon Baron-Cohen terms “systemizing”. The Organized Student is set up in a way that takes advantage of your child’s innate abilities and problem solving skills to develop customized, personal systems for organizing at home and at school. Goldberg runs through the specifics of organizing lockers, backpacks, desktops and all those papers that come home. The strength of the book is the immense detail Goldberg goes into, while at the same time not setting up “one size fits all” solutions. She respects her students needs to have a system that works with their own abilities and that feels appropriate to each individual.
Many of the students I’ve worked with intend to start each new school year off right, organized and structured. But without a strong yet flexible system, the best intentions don’t work, and the students are lost in a sea of papers by October. If this describes your child, it might make sense to pick up this book now. Pay attention to each new teacher’s organizing requirements, adapt the book’s suggestions to fit your child’s own needs, and start the new school year off right.

Dealing with Time Management

Running late? Many people struggle with time management, and they’re always running late. Missing appointments, late for work, racing to get to the meeting on time. Time management is a part of executive function, something that many people struggle with. It can be especially troublesome for individuals with Autistic Spectrum Disorders (ASDs) like autism or Asperger’s, or ADHD.
How can you improve your time management and be on time? Here are some simple tips, tailored especially for individuals with ASDs or ADHD, but anyone can use them.
1. What time is it?
It may seem obvious, but many people don’t know what time it is. If you’re always late, you’ve got to wear a watch, carry a cell phone with a clock, carry a pocket watch, have clocks in your home and office and get an alarm clock. And they have to be accurate, so go online and check to make sure every clock shows an accurate time.
2. What specific problem are you working on?
It’s always best to solve one problem at a time. When is being late most troublesome? Let’s focus on that one situation. I’ll use getting to work on time as an example.
3. A routine can be quicker.
Time management is easiest if you do the same things every day, in the same order. I know that I’m most efficient if I make espresso first, then cut up a bowl of fruit, then heat the milk for my morning latte. If I do the steps out of order I have to think about them more, I’m less efficient and it takes me more time.
4. Step by step
Think about all the steps involved in your morning routine. Waking up, getting dressed, eating breakfast, your commute. You may need to be more specific. Waking up may include the alarm going off, hitting the snooze button, dozing for just nine more minutes, and then getting up for real. The more detailed your steps, the better your results, so think about this in detail.
5. Create a timed list.
Take all these steps in your morning routine and list them in order. Then estimate how long each step will take. Many individuals with time management issues have a real problem here. Some people just don’t have a strong internal clock. What seems like five minutes turns out to be 20, something that should take half an hour seems to drag on all afternoon. This timed list will help you calibrate your internal ideas of time, and discover the truth about your actual morning routine. So don’t worry too much about accuracy at this point, just make your best guess of how long each step takes.
6. Test it out.
Tomorrow, see how accurate your list really is. Carry it with you throughout the morning. Carry a watch as well. Keep checking with your list, noting which step you’re on, and the time. Are there any steps you missed? Don’t spend time analyzing your list right now, just try to record what you doing and what time it is.
7. Fine tune your routine.
The morning rush is over, you completed the day’s work and you have some free time. Now is the time to analyze how accurate your time estimates were. Did it take as long to get dressed as you expected? You might want to repeat this exercise several to improve your accuracy.
8. Work backwards.
What time do you have to be at work? Start there, at the end of your list. Working backward, and using the amounts of time it take to accomplish each task, you can figure out what time you need to start your morning routine.
9. Leave some room for error.
The truth is, there’s a lot of unpredictability in some schedules, especially when you’re not in control, like during your morning commute. Most prompt people are actually a bit early much of the time. You need to consider if you absolutely need to be on time, or if it’s OK to be a bit late on those days the traffic is especially heavy, or if your dog is sick, or you knock over the carton of juice. The more trouble it is to be late, the more you’re going to have to accept getting there early most of the time.
That’s it. Give your new routine a bit of time to fine tune it and see how it’s working and then move on to your next time related issue. The more you work in this way, the better you’ll get at estimating how long things take, and the better you’ll be at being on time.

Are You Struggling with Executive Functioning?

In my last blog post, I introduced the term executive functioning, and now I want to take the idea to a more practical level. Many of the kids I work with as a therapist struggle in the area of executive functioning, and they’ve frequently been diagnosed with specific deficits in this area. This might have been done at their school, by a psychologist or medical doctor, or at a learning center. Diagnosis can be a very helpful tool in setting up a plan to make up for any deficits, so every individual can function at the peak of their abilities.
But for adults with Autistic Spectrum Disorders (ASDs) like autism or Asperger’s, deficits in executive functioning are seldom diagnosed. Many of my adult clients don’t even have a formal ASD diagnosis, much less a specific analysis of their strengths and weaknesses. This isn’t because the deficits aren’t there, just because the diagnostic process is less rigorous and available to adults. So, if you’re an adult diagnosed or suspecting that you have an ASD, you might want to do some research into executive functioning as well.
A good place to start is by carefully defining any problems you might be having. A step by step, methodical approach can work wonders. And, by taking tiny steps, the problem, which was vague and huge, becomes more manageable and the solution intuitively obvious.
As an example, let’s look at a hypothetical engineer named Ed. Ed was never diagnosed with an ASD, but is pretty sure he fits the criteria for Asperger’s based on his problems with social interaction, unusual communication style, and strong interest in computer technology. Ed is very intelligent and has been quite successful professionally. More recently however, Ed has started to struggle with more work related problems and his boss never seems to be satisfied.
Imagine that you’re in a situation like Ed’s. How would you deal with this problem? The first step is to consider specifically what the boss has complained about. Replay the conversations in your head and list the issues if you can. Reread your performance reviews, or any other written comments you’ve gotten. Ask a trusted colleague for input. In Ed’s case, he realized that his boss has complained repeatedly because reports have not been completed on time, he’s missed numerous line item deadlines for his main project at work, and he’s often getting to work too late.
Clearly, all these issues fall under the category of deficits in time management. By redefining the problem from, “My boss hates me.” to, “I need the work on time management.” Ed can come up with specific, concrete solutions, and so can you.
What can you do if you’re dealing with a similar issue? Lots of things:

1. Since people on the autism spectrum are frequently visual, lists, timelines and charts can be the best resource.


2. Make a detailed list of the milestones in your work assignments.


3. Figure out the order in which the steps need to be carried out, analyze how long they take, consider roadblocks and items that are out of your control.


4. Factor in some cushion in case everything doesn’t run smoothly.


5. Talk to your boss about his expectations and requirements for specific deadlines.


6. List these items on a calendar and check it daily.


7. It may help to create little checkboxes where you can physically mark your progress.


8. If you’ve missed a deadline, deal with it immediately. Ignoring the problem does not make it go away.

And, most important, check back on this blog for more posts on managing executive functioning.

Executive Functioning and Autistic Spectrum Disorders

How can you solve the problems you’re having at work or in your relationships? One solution might be to consider the concept of executive functioning.
Executive functioning is a term that comes up frequently in discussions of the characteristics of autism, Autistic Spectrum Disorders (ASDs) and Asperger’s Syndrome. In general, many individuals with an ASD struggle with specific deficits in executive functioning as well. I don’t want to go into the details of measurement of executive functions or review the research on correlations between autism or Asperger’s and executive functioning in this posting, but I do want to introduce the basics.
A good definition of “executive function” can be found in Simon Baron-Cohen’s The Essential Difference (Basic Books, 2003, p. 176). Baron-Cohen defines executive function as “shorthand for the control centers of the brain that allow not just planning but also attention-switching and the inhibition of impulsive action.”
Tony Attwood discusses executive functioning in The Complete Guide to Asperger’s Syndrome (Jessica Kingsley Publishers, 2007, p. 234) and lists “organizational and planning abilities, working memory, inhibition and impulse control, self reflection and self-monitoring, time management and prioritizing, understanding complex or abstract concepts, using new strategies.” Other researchers may classify executive functions differently, but the general concept is the same.
The research on the correlation of executive functioning deficits and autism or Asperger’s can get very complex, due to the difference of ability levels along the autism spectrum, as well as the many measures of specific types of executive functions. It’s not surprising that different studies measuring executive function in individuals with autism get different results. What is clear is that individuals, both those with autism and neurotypicals, can vary in their abilities in each of the different executive functions.
What’s probably of more immediate value to those with ASDs, is to individually consider the specific executive functions as Attwood lists them. For individuals who are struggling professionally or in relationships, this can be helpful as a first step in problem solving.
Check back on this blog over the next few weeks. Further posts will give some examples and specific suggestions for managing problems with executive functioning.

Autism and Strengths in Problem Solving

It’s exciting to find researchers focusing on all the strengths that go along with autism and Asperger’s, the enhanced abilities and skills, and not just studying deficits and difficulties. On that topic just this month, there was an interesting study published in the journal Human Brain Mapping.
The study compares autistic and non-autistic individuals’ performance on a standard assessment tool called Raven's Standard Progressive Matrices (RSPM). What’s perhaps most interesting about the study is that the autistic subjects performed better than would have been predicted by the results of their IQ tests, and that the autistic subjects, while as accurate as their non-autistic counterparts, performed the test more rapidly. There were also differences in which areas of the brain were active, indicating that the autistic subjects used more visual processing in their reasoning.
Lead author Isabelle Soulières, a post-doctoral fellow at Harvard University who completed the experiment at the Université de Montréal, commented, "Some critics argued that autistics would be unable to complete the RSPM because of its complexity, yet our study shows autistics complete it as efficiently and have a more highly developed perception than non-autistics."
Per the test publisher, “Raven’s SPM is a nonverbal assessment tool designed to measure an individual’s ability to perceive and think clearly, make meaning out of confusion, and formulate new concepts when faced with novel information. It has been used world-wide for more than 70 years.” The article, Enhanced visual processing contributes to matrix reasoning in autism, by Isabelle Soulières, Michelle Dawson, Fabienne Samson, Elise B. Barbeau, Chérif P. Sahyoun, Gary E. Strangman, Thomas A. Zeffiro, Laurent Mottron, was published online on 15 Jun 2009. You can find a review at Autism News or read the abstract for the study online.

School Organization Tips for Students with Asperger’s, Autism and ADHD

Organization can be a big problem for kids with Asperger’s, autism and ADHD. Executive functioning difficulties can be a factor in all of these diagnoses, making it difficult for children to plan, pay attention, organize details, and manage their time.
I sat down recently with Nancy Chin of Step By Step. Nancy Chin is the developer of the Step By Step program for academic coaching. Nancy works with school age children who are typically very bright, but still struggling in school. Many of her clients have diagnoses of Asperger’s, autism and ADHD. I asked Nancy for her tips on helping kids succeed in the classroom.
Nancy described how she often works with young students, those from kindergarten through third grade, directly in the classroom. After consulting with the parents and teachers, and observing her students in class, Nancy works to create detailed instructions for these children. Typically, she would start working only on one goal at a time, for example, dealing with transitions during the school day. With the student, she works to create a check list with all the steps necessary. She also explains that the routine will be the same everyday, something that these students may not realize.  An example might be: When the bell rings, put your books back on the shelf, put your pencils in your backpack and get in line with the other children, trying to be in the first half of the line. Although her students are very bright, executive functioning issues mean that it can be difficult for them to figure this out without instruction. She’s found that, too often, the teacher can misunderstand and view the child as being defiant or distracted, when actually they’re just unsure what to do next. Often, with younger students she’ll create a sticker chart, sometimes using tiny prizes to help reward successes.
Nancy said that her plan is to set the goals so that the students can be successful, and then to focus on the successes. She stressed that learning these skills can take time, and she likes to start working with children when they’re very young, when it can be easier for them to learn these new skills. Each small success can lead to success in other areas, for example successful transitioning from the playground gets the student to the classroom on time, which can then lead to more time for learning, and greater academic success.
After achieving this first goal, Nancy said they’ll move on to another, small goal, for example, completing classroom work. This doesn’t mean that the work is all correct, but just that the student is actually doing it. By setting small goals, and focusing on the successes, the student starts to feel successful, learns how to organize and plan, and often academic performance improves.
I think many children could benefit from an approach like this. It’s straightforward and simple, creates a visual plan, which is ideal for many individuals on the Autism Spectrum, and most importantly, allows the student to succeed.
Nancy and I also discussed her tips for organizing homework, which I’ll be talking about in a later post.

Book Review: Life and Love: Positive Strategies for Autistic Adults, by Zosia Zaks

Zosia Zaks has written a number of insightful and informative pieces on the topics of autism and Asperger’s, and you can find some of her work on the GRASP website, as well as in Autism Asperger’s Digest magazine. Recently, I wrote about her essay on empathy in my blog Social Skills for Kids, which I write to parents of children on the autism spectrum. Her most comprehensive work to date is the book Life and Love: Positive Strategies for Autistic Adults (2006, Autism Asperger Publishing Co.).



Life and Love: Positive Strategies for Autistic Adults is an insider’s guide to many aspects of life on the autism spectrum. Zosia Zaks has a master’s degree in Technical Journalism, and, like many adults with Asperger’s Syndrome, was not diagnosed with Asperger’s until the age of 31. In the first half of the book, entitled, "Life", Zaks takes on concrete and straightforward topics such as the practicalities of managing sensory issues, household chores, shopping, travel and healthcare. From her insider perspective, the author gives step by step instructions and detailed tips for a number of situations, like putting together a sensory emergency kit of items such as sunglasses and headphones, or sample schedules for managing clutter and organizing the home. This is the kind of practical, step-by-step information that will be useful for those who are struggling with the details of daily life. There’s also some brief but concrete and specific advice for attaining career success, including choosing an appropriate job and managing social issues at the office.

The second half of the book, entitled, "Love", is where Zaks shows her full range as a writer and the book really comes to life. The "Love" section of the book focuses on relationships, from friendship, to dating, to committed partnerships. Zaks skillfully shifts back and forth from abstract concepts, such as falling in love, to concrete tools like defining acceptable and unacceptable behaviors. The author continues to write in a practical and useful manner, but she discusses more emotional topics, like dealing with conflict, social isolation and the very real differences of life for males and females on the autistic spectrum.

There are also sections on internet dating, relationships with non-spectrum partners, and the different levels of friendships. This section also includes extensive materials on how individuals can keep safe while interacting with others, and a discussion of the pros and cons of disclosing an autism diagnosis.

I recommend this book to those on the autism spectrum and to those who care about someone on the spectrum. The first half of the book can function as an ongoing, practical reference, almost like an instruction book for adult living. The second half is much more, something to read and consider, and a way to deepen your understanding of relationships, whether you’re on or off the autism spectrum.