25/08/2020
What it takes to successfully execute an action
Before we start looking at strategies for supporting problems with executive functioning, let’s look at some of the executive functions that need to take place to execute daily activities. Since we complete most of these steps subconsciously and simultaneously, we are not very cognizant of what it takes to perform a simple act and where these simple acts can break down.
• First, we must be aware that action is needed. Let’s take for example, like getting dressed in the morning. Often on weekday mornings we may have a set routine that we do each morning to get us up and out to work or school in time. Somewhere in that routine your brain is cued to get dressed. Often it follows another step in you daily routine (first getting up, after shower, etc.). Whether it is a certain time or following another event, your brain must recognize that it is time to get dressed.
• Second, you must decide what is needed for that day, underwear, socks, shirt, pants, shoes, maybe a sweater if it is cold, etc. What does the event require, tie, dress pants, simple t-shirt, school uniform, etc. So, we must appraise what do I need to wear for the weather and type of activity I will be doing that day. That may require us to check outside or the weather report to see what the weather is going to be and our schedule to see what activity I will be doing. I do not want to be freezing all day because I forgot to wear a sweater or go to the important meeting with a T-shirt and jeans on.
• Next, I must appraise the options I have and make a choice. What color do I want to wear, which shirt and pants, shoes, etc. Of what I have available, what do I want to wear?
• Next, I must plan a course of action. Usually this is simple for us because we do it out of habit. The way we put our clothes on, the sequence of steps we usually do the same each day. So, now we do it out of habit, without having to think it through. However, if it is a new event or one that is not habit we would have to plan a course of action. Break it down into a sequence of steps, from start to finish. For people on the spectrum with severe executive functioning difficulties they may need a checklist of visual sequence schedule to provide that course of action.
• Next, we must organize the materials we need to complete the task. Where are my shoes at? They are not where they are supposed to be. I saw that shirt here yesterday. It must be in the wash. Damn, now I have to shift gears and get something else. I must know where each thing is at and arrange them, so I can start my course of action. This can be very difficult if I am messy and disorganized. This is me when it comes to doing a home project since I never have my tools well organized. It takes me twice as long to look for each tool I need because they are not well organized. This makes doing home chores frustrating.
• Ok, now I have the materials and my course of action, I need to start initiating the plan. Hopefully I know what to do and when to do it. Again, thankfully for dressing I do this every day and is usually out of habit. However, for someone with severe impairment they often get confused on how to start and what steps to complete. Or, it may take them three times longer than most of us to get dressed. They may not ever have established a habit of how and what sequence to get dressed. How we get dressed always changes a little based on if my pants have a zipper, are snap or button, and need a belt or not, or if it is a pullover or button-down shirt. Am I wearing the slip on or shoes with laces? Each day may present a little different strategy.
• As I am executing my plan to get dressed it is important for me to monitor how I am doing as I am doing it. Did I remember to put my underwear on before putting on my pants, is it on backwards? Did I put the right shoe on the right foot? Did I get the shirt buttoned correctly? This ability to continually monitor or think about what you are doing as you are doing it becomes even more crucial with more complex tasks that are not automatic out of habit. Especially if each step must be done successfully before moving on to the next step. One step done wrong may mean undoing a series of steps to back up to correct the error.
• To complete even a simple task like dressing I need to be able to keep my attention and focus on each step until it is completed. If I have an impairment in that area I may get distracted and lose my concentration half way, become stuck on figuring out what shirt to wear and forget where I am at in the chain of events. This is where having a checklist can help cue people back to what they have completed and where they left off.
• We also need to judge and monitor how much time it takes. What time it is, how long it is taking me to get dressed and what time I need to be dressed and ready to go. I hear parents all the time complain about their child taking an hour to get dressed, and not being reading in time to catch the bus. We all have misjudged how long it will take us to do things and not left enough time. This usually makes us frustrated and anxious, but for some autistics it can present panic, because now their schedule is off. This sense of time and passage of time can be very weak, an hour can go by without realizing it.
• Finally, once I am done getting dressed I need to check my work to make sure is neat and organized. Many with executive functioning issues forget to check their work to make sure it is competed correctly. Make sure my shirt is not inside out or on backwards, make sure my zipper is zipped and pants snapped. Make sure my shirt is tucked in and buttons in correct sequence. Is my collar straight? We all know the individuals that have trouble in this area. They dress themselves but their close are in disarray, shoes untied, collar turned up or shirt tail hanging out. They do not have a clue that they are not dressed to expectation.
As you can see, the simple actions in our daily routine can be laborious when we have problems in executive functioning. We tend to take all these steps for granted and execute them with ease. But when we have impairments in these areas, it inhibits our ability to live independently. I know very bright individuals on the spectrum that must rely on support staff for daily living because they cannot execute their daily activities without assistance.
