By Professor Tony Attwood and Dr Michell Garnett
In this second part of our two-part article we discuss executive function, what it is and how to help your child with executive functioning difficulties.
What is Executive Function?
The psychological term executive function includes:
- 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.
In the early school years, the main signs of impaired executive function are difficulties with inhibiting a response (i.e., being impulsive), working memory, and using new strategies. An autistic child who also has ADHD can be notorious for being impulsive in schoolwork and social situations, appearing to respond without considering the context, consequences, and previous experience. By the age of eight years, a child who does not have ADHDcan typically ‘switch on’ and use their frontal lobes to inhibit a response and think of the consequences and circumstances before deciding what to do or say. This is a skill that needs to be learned over considerable time for the child with ADHD. It is important to encourage the child to learn to stop before responding and for the adult to recognize that being impulsive is due to a different neurology rather than naughtiness or oppositional defiance.
Working memory is maintaining or holding information ‘online’ when solving a problem. An autistic child with ADHD may have an exceptional long-term memory and may be able to recite the credits or dialogue of their favourite film but have difficulty recalling and manipulating information relevant to an academic task. The child’s working memory capacity may be less than that of their peers. Other children have a ‘bucket’ capacity for remembering and using relevant information, but an autistic child with ADHD has a memory ‘cup,’ which affects the amount of information they can retrieve from the memory ‘well.’
Another problem with working memory is a tendency to quickly forget a thought. One of the reasons children with ADHD are notorious for interrupting others was explained by a childwho said he had to say what was on his mind because if he waited, he would forget what he was going to say.
Impaired executive function can include difficulty considering alternative problem-solving strategies and a problem with flexible thinking. Non-autistic children can react quickly to feedback and are prepared to change strategies or directions.
Our clinical experience has indicated that autistic children with ADHD tend to continue using incorrect strategies and are less likely to learn from their mistakes, even when they know their strategy is not working. They appear to be ‘locked in’ to one strategy only. An autistic adolescent with ADHD explained that when solving a problem, he assumed that his solution was correct and did not need to be changed. His thoughts were, ‘This is the right way to solve the problem; why isn’t it working?’ which caused considerable frustration and agitation to the child and their teacher and parents. Rigidity of thinking is particularly a part of being autistic, but we have found can be accentuated when the person also has ADHD.
In high school years, problems with executive function can become more apparent as the school curriculum becomes more complex and self-directed, and teachers and parents have age-appropriate expectations based on the maturing cognitive abilities of peers. In the primary school years, success in subjects such as History can be measured by the ability to recall facts such as dates. By the high school years, assessment in history has changed and requires that an adolescent shows ability in writing essays with a clear organizational structure and that they can recognize, compare and evaluate different perspectives and interpretations. Adolescents with ADHD have problems with the organizing and planning aspects of class work, assignments, and homework.
Teachers may complain that the autistic adolescent with ADHD cannot seem to ‘get their act together’ and are critical of the person for being disorganized. This is a sign of impaired executive function and is not necessarily due to the child’s laziness or lack of commitment to schoolwork. The teenager also is likely to become distressed in school situations that do not allow mental rehearsal or preparation for change. An unexpected change in the classroom schedule or surprise test can create considerable confusion and anxiety.
I Autistic teenagers who also have ADHD are likely to have difficulties with abstract reasoning, prioritizing which task to concentrate on first, and time management, especially how long to spend on a designated activity and how long it will take to complete a project. This can be exasperating for parents and teachers, who know that the teenager has the intellectual capacity to complete the work to a high standard and on time, but impaired executive function will contribute to a delay in the submission of the work and therefore may incur penalties.
There can also be problems with self-reflection and self-monitoring. By the high school years, adolescents have developed the capacity to have a mental ‘conversation’ to solve a problem. The internal thinking process can include dialogue and discussing the merits of various options and solutions. This process may not be as efficient in the thinking of an autistic teenager with ADHD, who may need the teacher’s or parent’s voice to guide their thoughts to solve a problem.
Some teenagers facilitate problem-solving by having a spoken (rather than mental) conversation, and as they are thinking and problem-solving, they find that it helps to talk their thoughts aloud. This adaptive way of problem-solving and learning has advantages and disadvantages: while peers may be distracted by the self-talk and consider the person to be weird, teachers can listen to the student’s reasoning, understand their problem-solving and enourage or guide as needed.
The Value of an “Executive Secretary”
One strategy to reduce the problems associated with impaired executive functioning is to have someone act as an ‘executive secretary.’ The child’s parent or carer may have realized that they have already become an executive secretary, providing guidance with organizing and planning, especially about completing homework assignments. The executive secretary (a parent or teacher) may also need to determine a time schedule, proofread draft reports, colour code subject books, encourage alternative strategies and ‘to do’ checklists, and establish a clear schedule and duration of school-based activities.
A parent who provides support as an executive secretary may be labelled as overprotective by school agencies and family members, but that parent has learned that without such support, the autistic person with ADHD would not achieve the grades that reflect their actual abilities. We encourage a parent or teacher to take on this very important role of executive secretary. We hope that this will be a temporary appointment as they gradually achieve greater independence with organizational skills.
Where to Now?
If you are interested in learning more, our online course Autism and ADHD covers the latest research on autism and ADHD, the additional strengths and challenges of being autistic and having ADHD, and strategies to cope at school, work, and home.
Angell et al (2021). Journal of Autism and Developmental Disorders 51, 3759-3765
Antshel et al (2011). Journal of Developmental and Behavioral Pediatrics 32, 439-446
Butwicka et al (2017). Journal of Autism and Developmental Disorders 47, 80-89
Casseus, Kim, and Horton (2023). Autism Research
Centers for Disease Control (CDC)
Grandin, T. (1995). Thinking in Pictures and other reports from my life with autism. New York: Doubleday.
Kenworthy et al (2014). Journal of Child Psychology and Psychiatry 55, The Unstuck on Target (UOT) programme
Kerns, Rast and Shattuck (2021). Journal of Clinical Psychiatry 82
King et al (2020). The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions 371- 386. Oxford University Press.
Kolves et al (2021). JAMA Network Open January 2021
Krakowski et al (2022). Journal of Child Psychology and Psychiatry 63, 1534-1543
Kutscher, M. (2014). Kids in the Syndrome Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar and More. London: Jessica Kingsley Publishers.
Oerbeck et al (2021). Scandinavian Journal of Child and Adolescent Psychiatry and Psychology 9, 30-40
Pan et al (2015). Journal of Attention Disorders 23
Pearson et al (2020). Journal of Child and Adolescent Psychopharmacology 30
Polanczyk et al (2014) International Journal of Epidemiology 43
Ressel et al (2020). Autism 24, 899-918
Rosello et al (2022). Autism 26, 743-760
Tanksale et al (2021). Autism 25, 995-1008
Unitt (2022). Good Autism Practice 23
Moraine Autism and Everyday Executive Function London, Jessica Kingsley Publishers