My Executive Dysfunction

Hello my Zebras and Spoonies! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I am going to be talking about my experiences with executive dysfunction as another installment in the “My Diagnosis” Series.

What is executive dysfunction? It’s one of those things that has a vague, not very helpful definition: “when a person’s brain has difficulty performing assorted important functions.” What does that even mean? In this case, I find that a picture is more helpful.

When you have problems in any of these areas, it is lumped under the heading of executive dysfunction. The thing is that there are many things that can effect this. My ADHD and autism are the two that most people think of, but there are numerous diagnoses that I have that are associated with having executive dysfunction. Those include connective tissue disorder (hEDS), POTS, OCD and IBS. There are many other diagnoses that are related to executive dysfunction. Thus, this is another area of grey for me. There is no way to tell what’s causing this. There is even research to suggest that “brain fog” is a type of executive dysfunction. This means that things like chronic pain can also contribute. So, it’s complicated.

What’s clear, is that having impaired executive dysfunction is part of the diagnostic criteria for ADHD. That means that there is no way to have ADHD and not have executive dysfunction. Let’s take a closer look at that. Here’s the DSM5 criteria for ADHD:

Now, let’s look at how they over lap. Poor working memory often exhibits as poor listening skills because you cannot keep the pieces that you need floating in your head. Lacking organization can look like loosing your things, forgetting stuff and not being able to complete tasks. Difficulty with planning can also look like not completing tasks. Impaired task initiation looks like not starting on that homework. Alright, so the point that I am making here is that the entire inattentive type set of criteria are symptoms of executive dysfunction. Yes, every one of them. Then if you look at the hyperactive type, these are all symptoms of having impaired impulse control. So, yeah. ADHD is executive dysfunction and I think that important. Because of this, I personally think of my executive dysfunction being my ADHD. But it really it’s that clear cut.

When it comes to being impulsive, my symptoms mostly fall into the hyperactivity category. I have a really hard time sitting still for more then 2 or 3 minutes even when I am making an effort to do so. I talk. All the time. When no one is there. When I’m sleeping. I have a hard time waiting my turn when it comes to talking. I will jump into other people’s conversations. In general, I don’t like waiting, but I can do it. Otherwise, I’m not an impulsive person. When making decisions, I tend to think about things a long time before acting on them. I like to weigh out the pros and cons of all my options. Planning is strongly preferred over spur of the moment. Surprises aren’t to my taste. Structure and rules are followed. Doing things impulsively is very uncomfortable and feels messy. I think the OCD mitigates a lot of the impulsiveness. The autism need for structure and sameness may as well.

Emotional control is something that I have spent a life time working on. I feel big emotions. Whatever I am feeling, I’m all in. When I compare my emotional responses to other people, I feel that my responses are more exaggerated. Most people think of this as a negative thing, but I don’t and it’s because of these big feelings that I refuse to use stimulants. Using stimulants made all those feelings almost nothing. It was like being dead inside. I couldn’t live that way. When I’m angry, it’s likely to be a storm. But when it passes, it’s gone forever. There are no grudges here. That anger is intense and some people find it scary. But I will ask you to consider the love that I feel. When I love someone, it is with everything that I am. There is no a little bit or kinda. It’s a head first dive into the deep end. Life with me is intensely emotional. It’s been a long struggle to learn how to manage those feelings in a way that is still true to the wild spirit that I am, but also respectful to those around me. The balance can be precarious and one that I haven’t mastered, but better then it was.

I have struggled a lot with flexible thinking. Sameness and planning are safe. Please, don’t disrupt that. This is more likely the autism speaking than the ADHD. But I want things to be predictable. There are rules and those rules need to be followed. There are routines and those routines need to be followed. This is something that I have struggled with all my life and has caused me a ton of employment grief. Recently, I have done better about being more comfortable with uncertainty and with the unplanned.

My working memory is terrible. Give me your phone number and I will likely have forgotten half the digits before I could write them down even though I had pen and paper at the ready. Have never been able to do math in my head. It takes me forever to copy information down from a board into notes. I cannot hold a bunch of steps for directions in my head unless it is something I have done a bunch of times. If you give me a blob of verbal information, that’s all it will be for me: a blob. Reading means re-reading. At least twice. When I’m writing, I often have to go back and read what I’ve written because I’ve lost my train of thought.

Self monitoring is a funny thing. There are just times that my body ceases to exist and I become completely unaware of my body’s needs. I also struggle with time blindness. I will not be able to properly gage how long that task will take me until I have done it about 8 million times. This is why having a schedule and staying on time is so important to me. Everything has its time box and moving those boxes around requires a mental skill that I really don’t have. If I ran out of time for a task I won’t know if there will be time later in my day to catch it up. I will know where I have gaps or down time in my schedule, but I won’t know if that task will fit in that time box. Because of this, it can be hard for me to tell if I am on time or not.

I feel like I do pretty well with planning and prioritizing. There are times that I have a hard time breaking a larger task up into smaller tasks. Often times, my planning looks like chaos to some one else, but I promise there is a system and a logic to what I am doing. When it comes to the planning of things, I feel like I can keep things pretty organized. But not at all with my physical stuff. I live out of boom boxes and piles. I won’t even pretend there is a system to any of that.

Task initiation is another strange one for me. There are times that I really struggle with this. If I am doing something, chances are that I’d just as soon keep on doing what ever that something is. Even if I’m not having a great time doing it. Once I get into the rhythm of doing that thing, it is comfortable and changing to something else is like a grinding of my brain’s gears.

The thing about all of this is that my brain doesn’t always behave the way that I want it to. There are times that I can get amazing amounts of things done and there are times that I feel about like a slug. All my life I have had people accuse me of being lazy, rude and uncaring. People assumed that I wasn’t trying or wasn’t paying attention because I was struggling. For a long time, I believed that I wasn’t trying hard enough. I believed that I was just a lazy person. I cannot express how hurtful that is to one’s self esteem. My best was never good enough. On top of that, people often didn’t believe that it was my best.

Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like what you read, click on that like button. It really does help! Until we talk again, you take care of yourselves!

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