12 00:00:35,750 --> 00:00:47,139 And this is a topic we're covering because many of the strengths and challenges that go along with the autistic neurology fall within the realm of executive function.

13 00:00:48,849 --> 00:00:51,619 Before we dive into that topic for today,

14 00:00:51,759 --> 00:00:58,540 I'd like to thank Amanda who pointed out that my diagnostic terms in the first episode were imprecise.

15 00:00:58,830 --> 00:01:03,279 I use terms that are common in my day to day interactions with patients,

16 00:01:03,290 --> 00:01:04,819 families and physicians,

17 00:01:05,080 --> 00:01:07,900 which are the terms ADD and ADHD.

18 00:01:08,089 --> 00:01:09,099 However,

19 00:01:09,110 --> 00:01:16,800 the most precise and current terminology is ADHD predominantly inattentive presentation.

20 00:01:17,379 --> 00:01:21,389 ADHD predominantly hyperactive -

21 00:01:21,470 --> 00:01:26,199 impulsive presentation, or ADHD combined presentation.

22 00:01:27,379 --> 00:01:29,589 And I guess in reviewing that in my mind,

23 00:01:29,599 --> 00:01:32,720 I think it's similar with the term dementia,

24 00:01:32,730 --> 00:01:37,550 which is often still used in day to day language in clinical settings,

25 00:01:37,559 --> 00:01:42,690 even though the most recent and precise term is major neurocognitive disorder.

26 00:01:43,360 --> 00:01:43,650 So,

27 00:01:43,660 --> 00:01:44,410 thanks Amanda,

28 00:01:44,419 --> 00:01:51,279 I'll stick to being precise and specific in podcasts about the topic of ADHD

29 00:01:51,839 --> 00:01:55,230 And instead of using each of the subtypes,

30 00:01:55,239 --> 00:02:07,379 I will just use the term ADHD unless I'm speaking about specific features of one subtype. As we discussed in the first episode,

31 00:02:07,389 --> 00:02:16,580 executive function is really a broad term and it's includes multiple subfunctions or subcategories.

32 00:02:17,179 --> 00:02:33,800 And this is a series that I really encourage you to listen to the first episode before listening to subsequent episodes because it really went through a lot of layers of explaining executive function, ADHD, and autism ...

33 00:02:34,350 --> 00:02:37,160 how those relate or don't relate to each other.

34 00:02:38,539 --> 00:02:43,720 So the subcategories of executive function include things like attention,

35 00:02:43,990 --> 00:02:45,919 goal directed persistence,

36 00:02:45,929 --> 00:02:47,949 organization, response

37 00:02:47,960 --> 00:02:50,020 inhibition and several more.

38 00:02:50,440 --> 00:02:50,990 In fact,

39 00:02:51,000 --> 00:02:53,229 depending on what source you're using,

40 00:02:53,240 --> 00:02:57,669 there can be about 12 or so sub functions identified,

41 00:02:57,679 --> 00:03:06,410 even though there's really no complete agreement on how to list out the sub functions within executive function.

42 00:03:08,110 --> 00:03:17,000 There are two main developmental diagnoses with large executive function components and these include ADHD and autism,

43 00:03:18,710 --> 00:03:23,160 the ADHD criteria, as we talked about in the previous episode,

44 00:03:23,339 --> 00:03:28,899 only describe symptoms falling within about four of the subcategories.

45 00:03:29,720 --> 00:03:35,460 I would label these subcategories in the ADHD as organization,

46 00:03:35,500 --> 00:03:41,690 attention, response inhibition, and goal directed persistence. For example,

47 00:03:41,699 --> 00:03:50,500 "fails to give close attention to details or makes careless mistakes" is one of the criteria that can be met in ADHD.

48 00:03:50,919 --> 00:04:08,720 And I would say that, as a symptom, that falls within the subcategory of attention. "Blurts out answers before questions have been completed" is an ADHD symptom that falls within the executive function

49 00:04:08,729 --> 00:04:13,100 subcategory of response inhibition.

50 00:04:13,809 --> 00:04:20,420 So is somebody able to inhibit or stop a response until they think it through?

51 00:04:21,890 --> 00:04:31,679 So autism will present with core executive function features in some combination as well across the totality of the 12 categories.

52 00:04:31,959 --> 00:04:40,040 And these features are some of the strengths and gifts within the autism presentation.

53 00:04:40,049 --> 00:04:45,309 and also some of the challenges. In this episode,

54 00:04:45,320 --> 00:04:48,559 we're going to focus on the executive function

55 00:04:48,570 --> 00:04:53,600 sub features of working memory, speed, and sequencing.

56 00:04:54,100 --> 00:05:01,769 And I've chosen these abilities to highlight together because we often use them together to accomplish daily tasks.

57 00:05:02,059 --> 00:05:06,010 And I'm hoping that in explaining them and presenting them together,

58 00:05:06,049 --> 00:05:14,709 you'll be able to watch yourself or watch other people in your life to see how these executive function abilities work for them.

59 00:05:16,929 --> 00:05:18,720 Similar to the last episode,

60 00:05:18,730 --> 00:05:22,329 I'm going to walk you through various levels of information.

61 00:05:22,339 --> 00:05:24,940 So stick with me.

62 00:05:24,950 --> 00:05:34,839 First, I want to make a comparison between the center of the brain, which is called the subcortical areas, and a conveyor belt.

63 00:05:35,600 --> 00:05:36,329 You'll,

64 00:05:36,339 --> 00:05:41,320 you've probably heard that the brain has both gray matter and white matter.

65 00:05:42,929 --> 00:05:44,720 The outside of the brain and

66 00:05:45,089 --> 00:05:54,059 certain areas in the center are gray and these gray matter sections are connected by white matter tracts.

67 00:05:55,109 --> 00:06:04,440 The color white comes from the fact that there's a fatty substance called myelin covering these neuron tracks.

68 00:06:04,450 --> 00:06:13,290 And the presence of the fatty covering allows the nerve signals to travel faster than without that covering.

69 00:06:13,399 --> 00:06:19,579 So the center of the brain impacts speed of thinking and processing.

70 00:06:20,540 --> 00:06:23,829 So in conditions like multiple sclerosis,

71 00:06:23,839 --> 00:06:24,989 for example,

72 00:06:25,000 --> 00:06:27,869 where you have demyelinating,

73 00:06:28,410 --> 00:06:31,989 that is the white matter starts to degrade,

74 00:06:32,000 --> 00:06:37,029 one of the features can be a slowing of processing.

75 00:06:39,200 --> 00:06:51,100 So the first point is that speed is a function of the subcortical pathways that impact executive function and several autistic characteristics.

76 00:06:51,109 --> 00:06:55,640 So we do want to focus on this subcategory of speed.

77 00:06:57,649 --> 00:07:01,179 Another subcategory is working memory.

78 00:07:02,950 --> 00:07:05,600 What is this part of executive function?

79 00:07:05,869 --> 00:07:06,160 Well,

80 00:07:06,170 --> 00:07:08,880 even though we call it working memory,

81 00:07:09,239 --> 00:07:16,350 a neuropsychologist or a cognitive scientist might say it's actually really more attention than memory

82 00:07:16,829 --> 00:07:30,880 in that it has to do with the amount of information a person can hold within their attention without storing it by really memorizing it for later.

83 00:07:31,700 --> 00:07:35,589 So it usually doesn't end up in permanent memory.

84 00:07:35,929 --> 00:07:40,670 But we're able to hold information our in our attention.

85 00:07:41,549 --> 00:07:54,390 And some people have a really strong working memory and others really struggle with this. And you'll see different estimates probably about how large working memory generally is.

86 00:07:54,779 --> 00:08:02,779 But most times a person can hold about five plus or minus two bits of information in their attention.

87 00:08:03,679 --> 00:08:07,209 This makes sense because if you were

89 00:08:07,769 --> 00:08:12,690 using phones in the old days where we didn't have cell phones and

90 00:08:12,700 --> 00:08:14,670 phone numbers in our phone ...

91 00:08:14,970 --> 00:08:20,799 a lot of times someone would tell us their phone number or we'd look at it in a phone book and we'd have to

93 00:08:21,149 --> 00:08:26,350 kind of rehearse it in our working memory while we dialed.

94 00:08:26,359 --> 00:08:31,489 So we held seven digits ... in those days...

95 00:08:32,190 --> 00:08:38,090 in our mind while we pushed in the information to the phone.

96 00:08:40,789 --> 00:08:43,140 So let me give another illustration.

97 00:08:43,299 --> 00:08:45,469 Working memory is what we use,

98 00:08:45,479 --> 00:08:46,309 for example,

99 00:08:46,320 --> 00:08:48,609 if we hear an instruction with ...

100 00:08:48,619 --> 00:08:52,099 let's say three parts to it and we go to carry it out.

101 00:08:52,559 --> 00:08:57,010 Our boss may ask us to print the schedule for the day,

102 00:08:57,250 --> 00:09:01,809 put a copy on her desk, and check the phone messages from overnight.

103 00:09:02,929 --> 00:09:07,559 So we have to keep these tasks in mind while doing them.

104 00:09:07,570 --> 00:09:11,359 We have to hold them in our mind.

105 00:09:11,500 --> 00:09:15,849 And although we may recall the sequence of requests later in the day,

106 00:09:15,859 --> 00:09:22,320 we're unlikely to remember them in a month or a year because we haven't memorized them.

107 00:09:23,299 --> 00:09:25,190 But while we're carrying them out.

108 00:09:25,200 --> 00:09:31,179 We may be able to keep them in mind because they're in our working memory.

109 00:09:31,450 --> 00:09:37,469 So the term working means that we keep things in mind while we're using them.

110 00:09:37,479 --> 00:09:44,950 I'm using this information of what the three tasks are while I'm accomplishing the tasks.

111 00:09:46,280 --> 00:09:50,619 Working memory is what we use when we walk into a room for something.

112 00:09:50,900 --> 00:09:55,950 And then sometimes if the information has left our working memory,

113 00:09:55,960 --> 00:09:58,270 we feel frustrated that oh,

114 00:09:58,280 --> 00:10:01,869 I walked into a room to get something and now it's gone.

115 00:10:02,109 --> 00:10:05,489 That's something that has slipped through our working memory.

116 00:10:07,250 --> 00:10:08,229 Similarly,

117 00:10:08,239 --> 00:10:09,299 we may say,

118 00:10:09,309 --> 00:10:09,340 oh,

119 00:10:09,349 --> 00:10:10,219 shoot,

120 00:10:10,229 --> 00:10:12,599 I was going to say something or ask something,

121 00:10:12,609 --> 00:10:14,000 but I forgot what it was.

122 00:10:14,859 --> 00:10:21,489 We were keeping it in our mind while the other person finished their sentence.

123 00:10:21,500 --> 00:10:24,179 But then by the time they were finished,

124 00:10:24,229 --> 00:10:27,229 our thought had slipped through our working memory.

125 00:10:27,239 --> 00:10:30,789 It wasn't held the way that we wanted it to be.

126 00:10:30,799 --> 00:10:36,770 And so we were unable to bring it back when the person,

128 00:10:37,960 --> 00:10:39,789 signaled that it was our turn.

129 00:10:42,080 --> 00:10:51,950 So to summarize our abilities within executive function stem anatomically from the center and the front part of the brain pathways,

130 00:10:51,960 --> 00:10:55,780 the subcortical pathways that connect with the frontal lobes.

131 00:10:55,789 --> 00:11:01,719 And these pathways include white matter which impacts how quickly someone can think,

132 00:11:01,729 --> 00:11:03,340 process and respond.

133 00:11:03,900 --> 00:11:08,130 And this part of the brain also impacts working memory,

134 00:11:08,140 --> 00:11:14,349 which is our ability to hold information in mind while we work with and use it.

135 00:11:15,409 --> 00:11:26,900 So let's tie these concepts speed and working memory with the conveyor belt image that I mentioned earlier in the talk about the third piece for today,

136 00:11:26,909 --> 00:11:36,059 which is sequencing. A sequence of something is the order in which the things occur or they're arranged.

137 00:11:36,270 --> 00:11:41,020 And when we listened to our boss ask us to do three things,

138 00:11:41,030 --> 00:11:44,210 she presented them in a certain sequence.

139 00:11:44,219 --> 00:11:46,349 And when we listen to someone,

140 00:11:46,789 --> 00:11:50,820 the words and their meanings and concepts,

141 00:11:50,830 --> 00:12:00,309 these come toward our ears and into our brains as sequences of data. Picture that conveyor belt.

142 00:12:00,320 --> 00:12:01,109 Now,

143 00:12:01,440 --> 00:12:07,289 a conveyor belt is a surface that moves and it brings items to you.

144 00:12:07,809 --> 00:12:15,039 A person in a factory may work with items coming toward them on a moving surface.

145 00:12:15,380 --> 00:12:18,630 Perhaps they're employed to sort the items.

146 00:12:18,710 --> 00:12:19,869 For example,

147 00:12:19,880 --> 00:12:23,859 here come green and red candies.

148 00:12:23,869 --> 00:12:40,484 And I'm employed to take the green candies coming toward me and put them in the green box and to take the red candies and put them in the red box. Or maybe someone's employed to assemble something. As the item comes toward you,

149 00:12:40,494 --> 00:12:42,385 you add this piece,

150 00:12:42,395 --> 00:12:50,575 then you place it back on the moving belt and the next person will add the next piece and so forth.

151 00:12:50,585 --> 00:12:54,804 So items come to you in a sequence,

152 00:12:54,815 --> 00:12:57,205 one item after another,

153 00:12:57,215 --> 00:12:58,445 after another,

154 00:13:00,450 --> 00:13:09,960 the items also come with a particular speed on this moving surface and it can be increased .. like wow,

155 00:13:09,969 --> 00:13:14,260 the items are really coming quickly now... or slowed down.

156 00:13:15,520 --> 00:13:21,830 You can see that if the speed is set for a pace that most people can keep up with,

157 00:13:21,840 --> 00:13:24,900 there will be success in completing the task.

158 00:13:25,250 --> 00:13:31,169 But maybe there would even be a pace that would be too slow for the workers.

159 00:13:31,390 --> 00:13:32,489 For example,

160 00:13:32,500 --> 00:13:34,349 a worker might get bored.

161 00:13:34,539 --> 00:13:37,330 If the items aren't coming fast enough.

162 00:13:38,270 --> 00:13:42,039 a bored worker might have distraction and restlessness.

163 00:13:42,049 --> 00:13:42,059 Oh,

164 00:13:42,070 --> 00:13:42,969 my gosh.

165 00:13:42,979 --> 00:13:44,510 This is so slow.

166 00:13:45,080 --> 00:13:47,090 If the pace were too fast,

167 00:13:47,099 --> 00:13:50,770 the worker wouldn't be able to use all the items coming toward them.

168 00:13:50,780 --> 00:13:52,400 Things would get past them,

169 00:13:52,440 --> 00:13:59,609 things would get missed and only a portion of the items could be manipulated and used for that task.

170 00:14:00,659 --> 00:14:07,349 So the speed and the number of items coming at us needs to be at a just right spot.

171 00:14:08,780 --> 00:14:12,729 My favorite image for this is a classic,

172 00:14:12,739 --> 00:14:26,489 I love Lucy clip from the Chocolate Factory television episode. This episode aired in 1952 and it's considered one of the funniest of the whole comedy series.

173 00:14:26,760 --> 00:14:38,130 I've linked a clip of the Chocolate Factory scene with the conveyor belt in the show notes for those of you who would like to view it or who haven't seen it.

174 00:14:38,140 --> 00:14:51,250 It's a great demonstration of what can go wrong if the speed of the moving belt is too slow or too fast or if too many items are being sequenced on the conveyor belt at once.

175 00:14:54,169 --> 00:14:57,700 Now let's get back to the conveyor belt in our minds.

176 00:14:57,710 --> 00:15:03,270 So if my boss is giving me instructions with multiple details or steps,

177 00:15:03,739 --> 00:15:17,219 it is as if the words or chunks of information are coming toward me from her voice into my mind ... just like the little pieces of chocolate on the conveyor belt

178 00:15:17,229 --> 00:15:18,849 in the comedy clip.

179 00:15:19,080 --> 00:15:24,369 The speed of the conveyor belt is how quickly she's speaking.

180 00:15:24,780 --> 00:15:31,669 And my perception of the speed is impacted by how quickly my brain can process and keep up.

181 00:15:31,700 --> 00:15:35,340 If my brain's conveyor belt is slower.

182 00:15:35,349 --> 00:15:37,200 If I have slower information

183 00:15:37,210 --> 00:15:44,609 processing, the speed that she's giving me information for the conveyor belt may be overwhelming to me.

184 00:15:45,400 --> 00:15:48,559 Or if I have really fast processing,

185 00:15:48,750 --> 00:15:56,630 I may get really bored and distracted while she's talking because there's just not enough that's new coming toward me.

186 00:15:58,960 --> 00:16:01,130 Let's take another example,

187 00:16:01,229 --> 00:16:04,549 this one involving a student in a class.

188 00:16:04,630 --> 00:16:08,919 So a teacher is presenting information to the class.

189 00:16:08,950 --> 00:16:18,429 The student is required to receive the bits of information at the speed they're presenting as if in the conveyor belt analogy.

190 00:16:18,440 --> 00:16:20,369 And here comes new information.

191 00:16:20,380 --> 00:16:34,260 Then the student must hold the information in mind while deciding what parts to write in their notebook or to type in their laptop.

192 00:16:34,429 --> 00:16:38,099 All of this must be done while the teacher is still speaking.

193 00:16:38,489 --> 00:16:40,849 And this is all executive function.

194 00:16:40,859 --> 00:16:43,630 So we'll touch on this in a different episode,

195 00:16:43,640 --> 00:16:49,349 but the student must use another piece of executive function in this task as well ...

196 00:16:49,409 --> 00:16:50,909 prioritization.

197 00:16:51,440 --> 00:16:57,010 So I'm receiving a lot of information on this conveyor belt from the teacher.

198 00:16:57,020 --> 00:17:08,349 But what information is important for my notes and what is not important. To what do I give priority when there's a lot on the conveyor belt.

199 00:17:08,729 --> 00:17:09,668 For example,

200 00:17:09,678 --> 00:17:13,348 it's not necessary to write down every word

201 00:17:13,359 --> 00:17:16,668 the teacher is saying. What the efficient,

202 00:17:16,678 --> 00:17:22,529 just-right thing to do would be to pick out these most important things,

203 00:17:22,538 --> 00:17:23,409 these themes,

204 00:17:23,418 --> 00:17:25,529 these categories, definitions,

205 00:17:25,538 --> 00:17:26,188 dates,

206 00:17:26,239 --> 00:17:30,308 these are the things we need to jot down in our notes.

207 00:17:30,359 --> 00:17:35,668 And our executive function is what helps us with this whole process.

208 00:17:36,069 --> 00:17:36,520 Now,

209 00:17:36,530 --> 00:17:38,319 if it's working well,

210 00:17:38,449 --> 00:17:40,900 the student just does this automatically.

211 00:17:42,060 --> 00:17:45,949 If things are hard in that area of executive function,

212 00:17:46,329 --> 00:17:48,099 the person may feel like,

213 00:17:48,109 --> 00:17:48,540 gosh,

214 00:17:48,550 --> 00:17:48,560 I,

215 00:17:48,569 --> 00:17:49,760 I cannot,

216 00:17:50,729 --> 00:17:51,140 you know...

217 00:17:51,150 --> 00:17:53,500 note taking is very difficult for me.

218 00:17:53,510 --> 00:17:55,229 I just can't keep up.

219 00:17:55,239 --> 00:18:07,400 I can't keep the things in my mind while I'm writing because I either lose them because the teacher is still speaking or I lose what the teacher is now saying.

220 00:18:07,680 --> 00:18:15,839 So it either is something that happens smoothly and automatically or it really becomes a very difficult thing.

221 00:18:17,900 --> 00:18:20,290 Let me give you a social example.

222 00:18:20,579 --> 00:18:27,829 Imagine a person at a social event where a group of people are speaking about a funny experience.

223 00:18:28,300 --> 00:18:35,770 An individual in the group will need to be taking in what multiple people are saying...

224 00:18:35,890 --> 00:18:44,390 So there are multiple conveyor belts and speeds all while holding parts of the conversation in mind.

225 00:18:45,390 --> 00:18:59,500 And this person also then has to think about what they might say or contribute to the conversation and how to time what they're going to contribute and still keep up with the speed of the exchange.

226 00:19:01,930 --> 00:19:11,260 This example also involves those executive function abilities of working memory and speed and sequencing.

227 00:19:13,219 --> 00:19:15,989 Let me give you a life activity example,

228 00:19:16,770 --> 00:19:25,459 driving is a good example of a life activity that requires a person to take in multiple streams of information.

229 00:19:25,469 --> 00:19:26,040 In this case

230 00:19:26,050 --> 00:19:29,300 visual ... at varying speeds.

231 00:19:29,579 --> 00:19:36,520 Oh, this visual information is coming at me as I'm driving through the visual space.

232 00:19:36,920 --> 00:19:59,699 So the individual must first notice incoming visual details, adapt to unpredictable changes in the visual field (like, oh now I have less space in this lane than I did because the car is coming over toward me), and make quick safe decisions about how to respond.

233 00:20:00,310 --> 00:20:06,989 So one individual may feel like this all comes very automatically and at a speed that really works for them,

234 00:20:07,750 --> 00:20:15,699 another individual may feel overwhelmed by the amount of visual information coming at them in such a quick time...

235 00:20:15,839 --> 00:20:21,800 particularly because it's unpredictable and it involves safety issues.

236 00:20:21,810 --> 00:20:26,040 So if I can't keep on top of this visual information,

237 00:20:26,689 --> 00:20:31,400 I really might get in a situation that's really pretty dangerous.

238 00:20:32,479 --> 00:20:37,500 Other people while they're driving may feel concerned because they get bored.

239 00:20:37,729 --> 00:20:51,510 There's just not enough new information in the visual field to keep their mind on the road and they may find their mind wandering in a way that kind of makes them nervous and and leads them feeling like...

240 00:20:51,810 --> 00:20:54,469 they just can't focus very well while they're driving.

241 00:20:56,550 --> 00:21:00,859 What is often the case is that for many on the autism spectrum,

242 00:21:01,079 --> 00:21:18,439 they'll take longer to adjust to driving than their non autistic peers ... most often because they feel like things are really happening quickly and they can feel overwhelmed by the amount the speed and the unpredictability of information on that conveyor belt.

243 00:21:20,229 --> 00:21:22,069 So going back to our episode,

244 00:21:22,079 --> 00:21:25,569 topics of speed, working memory, and sequencing,

245 00:21:25,810 --> 00:21:31,199 we've reviewed that an individual must adapt to the speed of incoming information,

246 00:21:32,060 --> 00:21:35,949 then sequence through the items coming toward them.

247 00:21:36,479 --> 00:21:46,319 Hold enough of the information in mind that is important while then doing something with or responding to the information.

248 00:21:47,660 --> 00:21:57,680 And this is all part of the subcortical frontal pathways of the brain and the ability that globally we call executive function.

249 00:21:59,540 --> 00:22:00,479 So far,

250 00:22:00,489 --> 00:22:05,479 we've emphasized information coming toward us on the conveyor belt.

251 00:22:05,489 --> 00:22:15,589 But we can also think of executive function abilities for the information that we send out on conveyor belts to other people or to the environment.

252 00:22:16,900 --> 00:22:18,229 For example,

253 00:22:18,239 --> 00:22:25,199 how quickly do we produce a product or a response to questions from others?

254 00:22:26,219 --> 00:22:29,920 One person may be quick and efficient with tasks,

255 00:22:30,150 --> 00:22:37,920 but maybe they make a few errors on the way. Another person may finish the task more slowly,

256 00:22:37,930 --> 00:22:39,099 but to them,

257 00:22:39,109 --> 00:22:43,699 accuracy is really important and they notice a lot of detail.

258 00:22:45,390 --> 00:22:51,369 Neither of these executive function styles is inherently better than the other

259 00:22:51,380 --> 00:22:52,390 all the time.

260 00:22:52,630 --> 00:23:01,430 But the person whose executive function is more methodical and detail oriented in producing output may struggle in a job where the boss says,

261 00:23:01,439 --> 00:23:02,089 hey,

262 00:23:02,150 --> 00:23:05,020 the priority on this project is speed.

263 00:23:05,030 --> 00:23:08,130 I need this quickly. And vice versa.

264 00:23:08,140 --> 00:23:17,930 The individual who works quickly and decisively may really struggle at jobs where the smallest detail can make or break a project.

265 00:23:19,800 --> 00:23:27,930 Individuals who make decisions more slowly may show resistance when pressed for an answer or an action.

266 00:23:29,319 --> 00:23:37,910 Other people may almost feel this psychological opposition when they try to encourage the person to decide or to move on.

267 00:23:39,000 --> 00:23:40,500 Let's take an action.

268 00:23:40,510 --> 00:23:42,359 Let's stop thinking about it.

269 00:23:43,430 --> 00:23:52,579 One example could be adult children trying to press their dad to get his roof fixed. If he has executive function

270 00:23:52,589 --> 00:23:56,030 that's significant for being very slow,

271 00:23:56,040 --> 00:23:57,530 methodical...

272 00:23:57,680 --> 00:24:04,130 He may forever be saying things like "I'll think about that" or "I'll know when the time is right,"

273 00:24:04,400 --> 00:24:07,439 but there's never any real movement toward action.

274 00:24:07,449 --> 00:24:09,099 There's this stickiness,

275 00:24:09,109 --> 00:24:15,680 the conveyor belt toward decisiveness kind of gets stuck. Again,

276 00:24:15,689 --> 00:24:19,260 this approach to action is not right or wrong,

277 00:24:19,270 --> 00:24:25,800 but it's about whether it works for him in certain instances and against him and others.

278 00:24:26,030 --> 00:24:28,219 And when the roof is falling in,

279 00:24:28,229 --> 00:24:31,219 it's really likely working against him.

280 00:24:32,000 --> 00:24:43,489 Another factor that impacts whether something helps a situation or not is how extreme or inflexible the executive function reaction is in that situation.

281 00:24:44,079 --> 00:24:45,949 So for example,

282 00:24:46,239 --> 00:24:51,810 if we have this situation with the dad and his roof...

284 00:24:51,839 --> 00:25:00,250 a really extreme slow and resistant response to the need for action in that circumstance...

285 00:25:00,260 --> 00:25:00,540 well,

286 00:25:00,550 --> 00:25:01,880 that's creating safety,

287 00:25:01,890 --> 00:25:02,530 health,

288 00:25:02,540 --> 00:25:05,930 financial issues ... that it really could hurt the person.

289 00:25:07,520 --> 00:25:08,349 Ideally,

290 00:25:08,359 --> 00:25:13,770 our brain is supposed to help us have the just right amount of speed,

291 00:25:14,359 --> 00:25:14,650 (you know,

292 00:25:14,660 --> 00:25:16,300 not too quickly,

293 00:25:16,310 --> 00:25:19,439 not too slowly) and sequencing.

294 00:25:19,790 --> 00:25:27,349 I see details that are important but I can let other things go so that I can get to the best outcome.

295 00:25:27,770 --> 00:25:30,199 And when it's important to, you

296 00:25:30,209 --> 00:25:33,510 can adjust to the situation itself.

297 00:25:33,520 --> 00:25:33,900 Wow,

298 00:25:33,910 --> 00:25:37,540 I didn't expect this situation but I can adjust to that.

299 00:25:39,459 --> 00:25:48,989 But sometimes the struggle that a person is having is really that it's hard to get to that just right spot for ... for anything,

300 00:25:49,000 --> 00:25:51,880 whether it's speed or executive function or,

301 00:25:51,890 --> 00:26:00,180 or anything else in life ... rather than sometimes swinging to that too much extreme.

302 00:26:02,329 --> 00:26:13,569 One more example of the sequencing of output could be seen when multiple smaller actions are needed to complete a larger task.

303 00:26:14,099 --> 00:26:20,699 So a classic example of this would be the parental request that their child clean his room.

304 00:26:21,680 --> 00:26:32,449 So the child has to think through all of the pieces of action that will need to be engaged with in order to get this finished product.

305 00:26:32,849 --> 00:26:37,989 It's almost like saying what are all the pieces I need to put on this conveyor belt,

306 00:26:38,020 --> 00:26:46,030 all the pieces that I need to to bring together for the whole action of having a clean room or the whole outcome.

307 00:26:47,310 --> 00:26:48,500 There's a first step,

308 00:26:48,510 --> 00:26:49,400 a second step,

309 00:26:49,410 --> 00:27:01,109 a third step ... all on the conveyor belt until a finished product is reached. Some ways in which this executive function task can get stuck would include...

310 00:27:01,400 --> 00:27:01,930 "Wow,

311 00:27:01,939 --> 00:27:06,599 there are so many actions or pieces to the task.

312 00:27:07,040 --> 00:27:10,829 I just don't know where to start.

313 00:27:11,949 --> 00:27:12,930 I'm stuck.

314 00:27:12,939 --> 00:27:16,599 I'm overwhelmed by the amount of possibility.

315 00:27:16,880 --> 00:27:23,709 I can't get my direction to navigate the task even though I could do all of these little pieces,

316 00:27:23,760 --> 00:27:25,310 where should I start?"

317 00:27:25,930 --> 00:27:28,400 And this is often the situation.

318 00:27:29,089 --> 00:27:31,959 And the parent may say,

319 00:27:31,969 --> 00:27:32,170 "Hey,

320 00:27:32,180 --> 00:27:33,369 start wherever you want,

321 00:27:33,380 --> 00:27:34,449 it doesn't matter."

322 00:27:35,349 --> 00:27:41,739 But that's not likely to help the child who actually needs someone to sequence the task with them.

323 00:27:42,089 --> 00:27:43,810 Tell me where to start.

324 00:27:43,829 --> 00:27:46,319 How can I get going with this task?

325 00:27:46,709 --> 00:27:49,630 And then after I do the task,

326 00:27:50,239 --> 00:27:51,619 ... the first task,

328 00:27:51,849 --> 00:27:53,739 what's the second task I should do?

329 00:27:53,750 --> 00:27:59,199 How should I string things along without getting overwhelmed or stuck or lost?

330 00:28:00,739 --> 00:28:11,000 The child knows how to do each little part of the task but doesn't have the sequencing ability to navigate this larger task without assistance.

331 00:28:11,010 --> 00:28:22,510 And so the parent who realizes this might take a picture representing each smaller task ... like a photo of clothes in the laundry basket,

332 00:28:23,010 --> 00:28:25,750 a photo of books on the bookshelf,

333 00:28:25,760 --> 00:28:34,650 a photo of the bed made ... whatever the five or seven steps to having a clean room might be.

334 00:28:34,920 --> 00:28:39,849 You can put these photos up in a place where the child can see them.

335 00:28:41,369 --> 00:28:45,739 The child then can look at the photos independently and see...

336 00:28:45,750 --> 00:28:50,199 Oh the first photo is clothes in the the clothes hamper.

337 00:28:50,209 --> 00:28:56,800 So I'm gonna do that first... and sometimes the child likes to take the photo down when the task is done.

338 00:28:57,099 --> 00:28:58,959 And so "I know that's done."

339 00:29:01,010 --> 00:29:10,609 That's just one way to help teach an executive function skill for someone who is overwhelmed and trying to do that independently.

340 00:29:13,040 --> 00:29:21,750 Knowing that the full anatomical maturity of executive function isn't complete until the age of 20 or 21 or so.

341 00:29:21,959 --> 00:29:29,050 The parent realizes that part of their role is to help the child learn strategies for approaching tasks

342 00:29:29,060 --> 00:29:37,170 requiring executive function ... and to assist in areas where the child is still really developing that ability.

343 00:29:38,719 --> 00:29:39,479 Additionally,

344 00:29:39,489 --> 00:29:42,089 as we noted in the previous episode,

345 00:29:42,170 --> 00:29:47,069 everyone will have individual strengths and struggles in executive function.

346 00:29:47,880 --> 00:29:52,810 If this is a child who grows up and continues to have a weakness

347 00:29:52,819 --> 00:29:56,369 organizing a sequence to complete a task,

348 00:29:56,410 --> 00:30:02,300 they can really benefit from a strategy approach to give their brain some assistance.

349 00:30:02,780 --> 00:30:04,729 So their strategy might be...

350 00:30:04,739 --> 00:30:09,880 What if I think about this task as seven smaller tasks?

351 00:30:09,890 --> 00:30:10,979 What would those be?

352 00:30:12,170 --> 00:30:24,239 I would invite you to notice tasks in your everyday life that are easy or difficult for you and consider if they have executive function components like speed,

353 00:30:24,349 --> 00:30:26,500 working memory, or sequencing.

354 00:30:27,219 --> 00:30:29,000 Notice what's easy for you,

355 00:30:29,010 --> 00:30:31,890 what's difficult for you in these situations.

356 00:30:32,449 --> 00:30:40,930 This increased self-awareness can be a first step toward getting the best outcome in a variety of situations.

357 00:30:41,349 --> 00:30:48,170 You may realize "my nervous system default is to process information slowly.

358 00:30:48,719 --> 00:30:54,170 But this new job that I have requires speed in these areas.

359 00:30:54,380 --> 00:30:56,650 And how can I get a better outcome?"

360 00:30:57,750 --> 00:30:58,130 Well,

361 00:30:58,140 --> 00:31:03,170 the basic neurology of speed that your nervous system is set toward,

362 00:31:03,410 --> 00:31:03,890 you know,

363 00:31:03,900 --> 00:31:06,890 you may not be able to adjust that piece.

364 00:31:06,959 --> 00:31:16,819 But perhaps you could focus on strategies to reduce anything that would take away from the speed you're capable of neurologically.

365 00:31:17,160 --> 00:31:20,589 So perhaps you want to reduce distractions,

366 00:31:20,920 --> 00:31:32,089 maybe ask someone for input about what the most important thing to focus on is and really make sure that you're accountable to someone who can see the big picture a little better.

367 00:31:33,599 --> 00:31:36,140 As I noted in the previous episode,

368 00:31:36,189 --> 00:31:43,150 I like the book series Smart but Scattered when it comes to strategies for executive function,

369 00:31:43,160 --> 00:31:47,949 but you can choose whatever resources best fit your needs.

370 00:31:48,119 --> 00:31:52,010 And if you want to dive into more about executive function,

371 00:31:52,170 --> 00:31:58,609 learn about more strategies for success in areas that are causing you difficulty... by all means,

372 00:31:58,619 --> 00:32:01,969 reach out and find things that work well for you.

373 00:32:04,079 --> 00:32:08,390 I wanna thank you for joining me to learn about the executive function

374 00:32:08,400 --> 00:32:12,560 sub features of speed, sequencing, and working memory.

375 00:32:12,849 --> 00:32:21,650 And I hope it increases your understanding of what makes you tick. We'll be continuing our series on executive function next time.

376 00:32:21,660 --> 00:32:24,810 So I invite you to join me for that third episode.