Executive Functioning in Autism

Executive function is the set of cognitive skills that include concentration, memory, planning, organizing, self-control, and planning, among other things. Autistic people—particularly autistic kids —are more likely to need help with tasks that require using executive function.

Despite this, there are many tools that autistic people can use to build executive function or find ways to work around it.

This article will discuss executive functioning, why people with autism have higher support needs, and strategies for building executive functioning skills.

Executive Functioning and Autism

Executive function includes higher-order functions, such as:

• Planning
• Organizing
• Self-regulation
• Attention maintenance
• Emotion regulation
• Prioritizing
• Staying on task

For example, when teachers ask students to work collaboratively on a school project to present at some point in the future or work with a team to sell cookies to raise money for a school trip, it makes a lot of demands on executive function.

By the time they're in middle school, most kids are capable of managing such complex, multi-faceted, time-sensitive, collaborative projects. They may not be perfect, but they understand what's needed to be successful.

At a simpler level, younger children are capable of managing the complex process of cleaning up the playroom and getting ready for dinner. They can respond to the big-picture goal by thinking through the steps required to straighten up the room, wash hands, dry hands, and help set the table—and then by putting those steps into action.

They have developed (or are in the process of developing) the set of skills known as executive functioning.

Why Is Executive Functioning So Tough for Autistic People?

Autistic people often need some assistance learning to complete tasks that demand a higher level of executive function. Researchers are still working to understand exactly why that is. Executive function skills are largely controlled by the frontal cortex of the brain. Studies suggest that there is reduced activation of the frontal cortex of autistic people. This can explain why autistic people might need to find other tools to help executive functioning skills.

In addition, social and communication differences associated with autism may contribute to executive function struggles. Effective planning and organization often require a nuanced understanding of social situations.

There are three main categories of executive functioning: working memory, cognitive flexibility, and inhibitory control.

Working Memory

This helps us control what we can remember in the short term to help accomplish a task. An example might be remembering a phone number you were just told.

Studies show that, in general, working memory is a challenge for many autistic people despite some autistic people having an increased ability to remember facts.

Cognitive Flexibility

This skill helps when switching from one task to another. A person's degree of cognitive flexibility will determine how well they can respond to change.

Decreased cognitive flexibility can be associated with certain mental health conditions, specifically anxiety and depression, as well as behavioral problems in autistic children. Working to improve cognitive flexibility improves autistic people's ability to engage with treatments to improve these mental health conditions.

Inhibitory Control

Inhibitory control refers to a person's ability to ignore distractions and resist impulsive behavior. Autistic people with difficulty with inhibitory control may have behavioral traits like repetitive behaviors.

What Do Executive Functioning Problems Look Like in Autism?

Autism spectrum disorder is characterized by certain traits and challenges. They are unique to the individual, but many autistic people have the following traits:

• Are great at seeing details clearly but have a hard time seeing the big picture and understanding which details are most relevant to that big picture
• Are good at following schedules and routines, but have a difficult time flexibly changing those schedules or routines
• Can understand and follow rules, but get upset when rules are broken or bent
• May have difficulty sustaining focus and motivation when engaged in something that isn't intrinsically interesting to them
• Have a hard time switching from one activity to the next
• Have a difficult time effectively communicating wants and needs to others
• May not imitate others' behaviors without being directly instructed to do so (for example, unlikely to look around, notice that everyone else is getting ready to go, and do the same)
• Have challenges with "working memory" (the ability to conceptualize and manipulate multiple pieces of information and expectations at the same time)
• Can work with concrete objects and expectations more readily than with abstract ideas
• Have difficulty with "theory of mind" (understanding that others do not know, share, feel, or understand what's inside your own mind)

Looking at this list, you'll probably notice that most of these qualities are in direct conflict with the qualities required for good executive functioning. If you don't see the big picture, are not a flexible problem solver, and have poor "people skills," you'll have a hard time planning for and executing multiple steps at the same time—especially if those steps are abstract (e.g., thinking about time as opposed to building a model).

Screening for Executive Function

Healthcare professionals can use a variety of tools to help an autistic person determine whether they need support with executive functioning. One of the most ubiquitous tools is the Executive Skills Questionnaire (ESQ). It is designed for people age 14 and up with a normal IQ level.

Executive Skills Questionnaire, Revised (ESQ-R)

The Executive Skills Questionnaire, Revised (ESQ-R) is a 25-question assessment that can help healthcare professionals screen for executive dysfunction. For each question, the person taking the assessment answers whether the problem presented occurs never or rarely (0 points), sometimes (1 point), often (2 points), or very often (3 points).

It measures five different areas:

1. Plan Management: This is the ability to make and execute a plan in order to accomplish a task.
2. Time Management: Time management questions measure the individual's ability to work within time constraints, decide how to use a given length of time, and ability to estimate how much time an activity will take to complete.
3. Materials Organization: This refers to how well an individual can keep track of physical items like keys or a phone.
4. Emotional Regulation: Emotional regulation refers to how well an individual can manage emotions, particularly when things don't go as planned or become difficult.
5. Behavioral Regulation: These questions measure a person's ability to think about the consequences of their actions. It asks, for example, whether the person says things without thinking or acts on impulse.

The higher the score on the ESQ-R, the more profound the person's difficulty with executive function is likely to be. While the ESQ-R is available online, it is best to have results interpreted by a trained mental health or medical professional.

Supporting Executive Functioning

Some autistic people will always need more support with executive functioning skills. That said, it is possible to build and work around the need for such skills—in some cases, making it possible to manage complex situations without much difficulty.

Building Executive Functioning Skills

Here are a few techniques that can help to increase and strengthen executive functioning:

• Direct Instruction: Certain aspects of executive function can be taught through ordinary instruction and drilling. For example, it is possible to teach the skills of thinking through the steps required for an outcome; to complete certain tasks before others; to use time management tools such as calendars; to complete the same tasks at the same time each day or week, etc. While most people seem to internalize these skills without direct instruction, there are plenty of people —autistic or not—who can benefit from ordinary time management instruction.
• Role Play: What should you do when presented with a multi-step challenge? By role-playing and talking through such challenges, many autistic people can practice and become more skilled at planning and taking logical action.
• Setting Up Practice Challenges: At home or in the classroom, it's possible to set up low-stress situations that require executive functioning skills. Ordinary tasks like washing, drying, folding, and putting away clothes require multi-step planning, time management, and tenacity. 
• Developing Social Stories for Flexibility: Social stories are narratives written to help autistic kids go through the steps for accomplishing a task in the context of a story that they can relate to their own lives. Some data suggest these are useful tools, but more research needs to be done.
• Physical Activity: Studies show that increasing physical activity can help improve executive function in autistic children.
  

Workarounds

While it's possible to build some executive functioning skills, chances are that autistic people will find such skills tough to master. However, there are workarounds like these:

• Use apps to manage time. Alarms, visual timekeepers, and other tools can keep autistic people on track, even when they are not thinking about time.
• Use visual reminders and schedules. What are the steps required to get that laundry done? A laminated photo-based step-by-step poster in the laundry room can keep you on task.
• Break down tasks into manageable parts. Instead of "get ready for school," consider breaking tasks into smaller chunks such as "brush teeth," "get dressed," and so forth.
• Offer rewards. Failing to complete a task can result in intended or natural consequences: feeling cold when you go outside and are underdressed, for example. But when the job is done right, no one notices. Consider offering small, tangible rewards for a job done well and completely.
• Use a buddy system. It can be hard to stay on track when you're easily distracted or not especially focused on the task. With a buddy—especially one who is focused on the process—you may be more successful.
• Simplify the process. Yes, you probably should separate before you wash, and fold after you dry. However, if you wash everything together and just keep your clean undies in the laundry basket, you can cut two steps out of the process and still arrive at the same goal (clean, dry undies).

Summary

Executive function includes higher-order thinking grouped into working memory, cognitive flexibility, and inhibitory control. Some executive functions include planning, managing time and tasks, prioritizing, regulating emotions, and maintaining attention.

Autistic people are more likely to have higher support needs for executive function. Supportive measures include visualizing how a task can be accomplished, direct instruction, visual cues and reminders, rewards, simplifying processes, and more. Although executive function might require more assistance, executive function struggles do not reflect diminished intelligence.