1. Executive Functions in Daily Life Living Independently
Nancy Perry, Ph.D.
Autism Spectrum Advocate

2. “You can’t make a dead horse drink water.”
Tracy H.

3. Executive Functions Initiation Planning, sequencing, and organizing
Abstract reasoning, as opposed to concrete thinking
Mental flexibility and response to novelty
Control of attention and concentration
Working memory
Regulation of emotions and behavior
Judgment and self-monitoring

4. Initiation
Initiation is the ability to start. The alternative to initiation is the need to wait for cues to start an activity, and then again to switch from one activity to another. People with this deficit may be described as depressed, unmotivated, lazy, and dull. They can be easily coerced to do things they would not do on their own. They are not aware that their ability to direct themselves is impaired compared to others.

5. Planning, sequencing, and organizing
The brain, not the personality, is disorganized. Imagine not being able to sort out the steps to a plan. With this deficit, individuals often cannot report the sequence in which various events occurred, even on the same day, thus it can appear to be a memory problem.

6. More on planning, sequencing, and organizing
Planning has characteristics that include judgment. Scheming is my word for poor planning typified by individuals with Executive Funciton deficits. Scheming does not include an evaluation of consequences.

7. Abstract reasoning, as opposed to concrete thinking
This deficit makes individuals seem child-like in their thinking. Concrete thoughts are about tangible things, people, and events that can easily be pictured. This deficit is related to the failure to grasp sarcasm, innuendo, and other features of colloquial speech, as seen in ASD.

8. Mental flexibility and response to novelty
Related to control of attention, mental flexibility is required for responses to new demands. Individuals with deficits can be perseverative, or sticky, slow to react, and without choices to fit a sudden, novel demand. Driving is a situation in which this deficit can be life threatening.

9. More on Mental Flexibility
The other side of mental flexibility is being too flexible, or runaway impulsivity. Under conditions of impulsivity, it is difficult to stop and think, and make a choice about what action best fits the situation.

10. Attention and concentration
Attention and concentration must be directed, both consciously and unconsciously in normal functioning. An individual who cannot control the direction, intensity, and ability to divide attention can appear to have personality problems, as well as organicity.

11. Working memory
Problems with working memory exist in connection with impaired ability to control one’s attention. Memory consists of immediate use, storage, and retrieval. If material is not attended to, it fades quickly. And for storage to be robust we have “tricks” like rehearsal, generalizing, mnemonics and so on. Retrieval also relies on an organized brain.

12. Regulation of emotions and behavior
All regulation issues happen largely out of awareness until we need to be conscious of them. We make fluid changes in interpersonal behavior constantly. The ability to inhibit behaviors overrides impulsivity. Emotional behavior is perhaps the most culture-bound aspect of behavior. But non-disabled individuals know the “rules” within a culture without being taught them specifically. Control of behavior is related to moral judgments and self-monitoring.

13. Judgment and self-monitoring
This is the pinnacle of human functioning, according to a pioneer in the study of executive functions.* It is impossible to present as a normal adult if unable to self-monitor behavior. Judgment is intertwined with all the other executive functions as well.
* Donald Stuss, 1986, The Frontal Lobes

14. Judgment and self-monitoring require the brain to do more than one mental operation at the same time.

15. Specific issues related to Executive Functions in independent living
Hygiene and manners
Controlling anxiety and rigidity
Moral behaviors
Lying
Stealing
Physical Aggression
Exploitation

16. Issues – Continued Chores and obligations
Television, computer, video games
Money
Food
Interaction of food, money, and health
School and employment

17. MOST IMPORTANT TIP
The best way to work with all the Executive Function impairments is to instill habits at the earliest possible age. Hygiene, manners, cooking and eating, exercising, managing laundry and appearance, completing obligations, making appointments, planning daily life – all are accomplished better by habit.

18. Provide behavioral options
When discouraging one behavior, be prepared to suggest a better one
Be prepared to encounter initiation deficits and ways to overcome them
Be prepared for emotional dysregulation and have techniques for management
Emotions played out are not necessarily integrated – don’t expect insight!

19. Reasons for young adults to leave home
Because leaving the parental home is the major hallmark of adulthood and brings the achievements of adulthood: primary relationships with peers, work, separation from the previous generation
Because if children remain at home, they will likely confront their parents’ deaths, and then have to change their lives at the most difficult time

20. Cultural Caveat
It would be unthinkable in some cultures to have an adult child with disabilities leave the parental home. There is little to be gained by opposing such a cultural imperative, but plans should be made that are realistic if the family lives in this culture. For example, siblings may be “Americanized” and unwilling to care for the adult sibling with disabilities in the same way the parents have done.

21. Thank you for having me here today
Thank you for having me here today. The client who appeared in video did so with the utmost enthusiasm and excitement.