Executive Dysfunction Thread from @sayitslp Jana O’Connor

12:21 AM · Oct 25, 2019·Twitter Web App

Original Thread here.

1/ (Thread) #NeurodiverseSquad no one has ever explained #ADHD or #executivedysfunction to me quite like Sarah Ward (@swardtherapy) and I need to share the awesome. (I’m a speech therapist with an 8yo son with ADHD, for background.)

2/ First, memory. You have two broad types of memory: Long-Term Memory (LTM) and Short-Term Memory (STM). STM is often used interchangeably with Working Memory (WM), which refers to a sort of mental “scratch pad” where you can hold information in mind and use it.

3/ Now, WM also has subtypes: The 1st is Verbal Working Memory. Verbal Working Memory is what allows you to hold someone’s phone number in mind, rehearse it, and write it down when you find a pen. It lets you remember a set of words someone said, or something short you read.

4/ The 2nd kind of WM is Nonverbal Working Memory (NWM). This refers to your ability to hold images in mind. To see scenes from the past, pictures you saw, where you left your keys, etc. It also helps you imagine the future.

5/ Not words about the future, but what the future LOOKS LIKE. Now, it’s the ability to see what the future looks like that is impaired in those with poor executive functioning skills, like those with #ADHD, #ASD, and #executivedysfunction.

6/ I will talk about ADHD because my son has ADHD. NVWM impairment is exactly why it’s hard for someone with ADHD to just… do the thing.

7/ Because #neurotypicals just imagine what “done” looks like, and work backwards from there to figure out what steps to take. Then backwards again to figure out what they need to get started. Then they know how to start.

8/ Folks, if you can’t easily imagine the end product, you can’t identify the steps that get the end product complete. And if you can’t identify the steps, you can’t collect what you need to start. And you… can’t start.

9/ So WHY is it so hard for people with ADHD to just… do the thing? It’s because starting on a task is completely overwhelming when you can’t see what you’re working towards.

10/ If a neurotypical person is going to make a peanut butter and jelly sandwich, they’re gonna think about what a peanut butter and jelly sandwich looks like as a FIRST STEP. Practically instantaneously. What does done look like? Then they plan backwards from there.

[peanut better and jelly sandwhich]

11/ What are the steps to achieve the “done” image? Well, laying out the bread, spreading the peanut butter, spreading the jelly, putting the two sides together. BAM. What will I need to prepare to do those steps? Bread, peanut butter, jelly, knife. BAM.

12/ You plan backwards, and execute that plan forwards. Or: you “plan the work, then work the plan.” This is incredibly hard for those with executive dysfunction.

13/ Learning this has helped me immensely. Once I could understand that this failure to see the “done” was what was holding my son back, all I had to do was make the “done” visible and visual for him.

14/ What does “ready for school” look like? We took a photo of him ready with all his things. Now each morning I show him that and say “match the picture” and he’s ON IT. The photo helps him see the wholeness of what HE looks like in the future. He can see the done.

15/ What’s more, this helps with his anxiety. He is always anxious about birthday parties. Why? I now know he can’t visualize what it will be like. Uncertainty = anxiety. What does the place/crowd/food look like? No idea. Stress.

16/ Now we reduce birthday party anxiety by making the uncertain/unknown into something he can see. We google photos of the venue. Of kids eating cake and pizza. We look at several photos of what it might look like and anxiety is reduced. Hugely. This is wizardry, guys.

17/ I shared this strategy with his gr 3 teacher and she (bless her) immediately put it into practice. He was unable to start on his journal writing one morning. She said “here is what done looks like” and flipped to a previous, complete journal entry.

18/ She went through it with him and helped him identify the steps/parts (a topic, sentences, capital letters, spaces, etc.). That’s what done looks like. And he immediately got to work writing a new one.

19/ This is so fundamentally different than giving a kid a checklist you made. You are _teaching_ the kid the skill of visualizing the “done”, and of _creating_ their own checklist from that “done” image. They are thinking through all the steps of planning themselves.

20/ Building these skills is crucial for kids with executive dysfunction. I love this strategy, which Sarah Ward calls “Get Ready – Do – Done.” because it makes planning (as well as the thing you’re planning) VISUAL. This is building nonverbal working memory.

/end! Tagging @HowtoADHD, @ErynnBrook, @danidonovan to see if they’ll be able to share this around. I hope it helps and would love to see discussion about this from any #neurodiversesquad folks!

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PS: wow! Thank you for so many thoughtful and wonderful replies! I’m trying to read them all and like/respond when I can. I’m so grateful this small effort on my part has helped some of you understand yourselves (or others) better.

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PS2: I am hearing from some folks saying they don’t identify with this or that it doesn’t accurately describe their executive functioning issues/experiences. Thank you for reaching out and teaching me about your brains! I really love learning more about this.

PS3: to further clarify, I fully acknowledge this type of difficulty is not everyone’s experience of ADHD. I’m hearing that sometimes you can see the done but the steps are a mystery. Or prioritizing them is hard. Or distraction happens along the way. Brains are complex!

PS4: there are many pieces to the executive functioning puzzle and the ball can be dropped anywhere along the way. Individuals vary. I am learning so much about this from your replies and stories. Thank you!

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One response to “Executive Dysfunction Thread from @sayitslp Jana O’Connor”

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