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Living With Executive Dysfunction

Executive dysfunction involves problems with planning and executing tasks. Sometimes the "simplest" tasks, such as grooming, are very difficult for autistics due to executive dysfunction. Since each person with executive function problems will exhibit different strengths and weaknesses, the methods for dealing with these problems vary quite a bit. The methods presented below work well for myself - they enable me to live independently in much the same way as a neurotypical. Without these methods, I would be unable to do this. I do believe they can be helpful to many other autistics, although any method chosen needs to be accepted fully by the autistic for it to provide help - and no single strategy will work with all autistics. In fact, some strategies, including some of mine, won't work with most autistics.

Of course these strategies aren't perfect. Even with them, I often find I'm having trouble with maintaining my living space, for instance. But certainly they are better then the alternative of trying to do these things in the same ways that neurotypicals do them!

General Strategies

Eliminate Clutter

Go through your stuff. Show no mercy. Dispose of anything you don't need. For instance, is there something in your closet you haven't worn in a while? Get rid of it. Do you have boxes from your last move still unpacked, months later? Throw them away (don't even open them - it'll make you want to keep the stuff in them!). The less stuff you have, the easier it will be to keep it all organized! Don't hang onto things just because they might "someday" be useful. Yes, you may end up spending some money later, but you probably wouldn't have been able to find it anyhow (and, thus, spent the money still!).

Simplify

Do you really need to do it? You should ask yourself this question before you even consider strategies to overcome difficulty performing a task. Some tasks can simply stay undone. For your actual strategies, keep them as simple as possible. Don't try to do everything perfectly - try to do what is needed.

Use Routines

Train yourself to follow a routine, with few deviations. The closer you follow a standard routine, the more likely you are to remember it (this is true for both autistic and non-autistic individuals). The more frequently you use a routine, the more likely it is to become a habit.

Small Jobs

Don't attempt big jobs. Only do small jobs. Instead of "cleaning your house", "clean the corner of the living room." Cleaning the corner of the living room is part of cleaning your house. But, by breaking the task into small pieces and only doing one small piece at a time, you will be attempting jobs which can be achieved in a very short amount of time and in one setting. This will also reduce the possibility of getting interrupted in a task, which can be very bothersome to some of us. This technique is used by professional project managers in the corporate world - it is recognized that major tasks can not be scheduled or performed satisfactory, but small jobs can.

Be Realistic

You won't be able to do things the same way an NT will. You may have to be content with doing less and taking more time to do it. That's okay, though. Figure out what you want to do, and then think hard about it. Ask yourself, "Will I be able to do this with just a little prompting or help?" If not, then solving the executive function difficulties probably won't solve the problem without you first solving the other underlying problems. In addition, your strategies will not motivate you to do a task you don't want to do. These strategies will only help you perform tasks that you want to do.

Be Pragmatic

Get rid of strategies that don't work. If, after a week you aren't able to establish the strategy, it probably won't ever actually work. If, after a month, you are still doing the strategy, you will probably be able to keep doing it, as a month is usually long enough to get over the initial enthusiasm that often makes doing a new strategy much easier initially. No matter how wonderful a strategy is, if you can't or won't follow it, it is no good for you.

Get Help

Sggab (amanda at autistics.org) finds that having someone else to watch over her helps her to complete tasks and overcome the problems with starting a task. Some people find that having others call and remind helps get a task done. However, others claim that such reminders only reinforce inertia, so this may be very individual specific.

Kalen (news at paradox.freeserve.co.uk) says that an externally imposed schedule, such as the kind of schedule a student in formal education must follow, helps her start all her other routines, and also improves her overall functioning. However, she cautions that even this won't help when she is overloaded.

Set Aside a Workspace

A friend of Sggab finds having a specific area to do a specific task to be helpful. I, too, use this strategy. For instance, I have a certain desk that is only used when I'm working from home. By putting myself at that desk, I have a spatial cue that I'm supposed to be working. This helps me stay focused.

Checklists

I use checklists for many of my routine tasks, such as getting dressed and getting ready for bed. I also use them to remind myself of certain tasks. Please visit my Using Reminders & Checklists page.

Personal Digital Assistant (PDA)

I use a Palm Pilot to help organize my time. Even the cheapest Palms, such as the will help some who have executive function difficulties.

The most useful features of the Palm are the to-do lists and calendar. One of the advantages of some of the newer models is the "silent alarm" feature. Reminders can be set to alarm by vibrating instead of beeping, which allows you to get your reminders discreetly and without disturbing others in a class or event.

I also use an enhanced version of the Palm ToDo list, called "ToDo+". The main feature that is "missing" from the standard to-do application is a reminder function. ToDo+ adds the reminder functionality. I use the reminders for tasks that take a short amount of time, but that I don't want to show up on my calendar. ToDo+ is available for download at a low price from Handshigh Software. A demo version is also available.

Finally, I also use a belt-case for my Palm. A PDA is useless unless you have some way of carrying it with you all the time. I clip the belt case to the front pocket on my jeans. The belt case keeps it out of the way and provides limited protection for the Palm. However, it appears the exact model I use is currently unavailable from Palm, although other vendors make "universal" belt cases for PDAs.

A possible alternative, suggested by Matt (matt1234 at hvc.rr.com) is to use the Casio Databank 150 watch. This watch can have 100 alarms, each of which can be set up to a year in advance. This is probably a very good alternative to the Palm, especially for people who don't want to carry a full-sized PDA.

Specific Strategies

Watering Plants

To make sure I water my plants, I added an item to my Before You Leave checklist. I follow this checklist every day, before I leave the house the first time. The item asks me to water my plants on Monday, Wednesday, and Friday - this ensures that I don't either water too frequently or infrequently.

Taking Medication

I also use two checklists (Morning Routine and Good Night) to remind me to take the pills (I don't have any medication which needs to be taken more frequently then this). To prevent me from taking too much medication (a problem that has affected me in the past), I use a pill-box that is divided into one section for each day of the week. I refill it during my bedtime ritual (covered by the "Good Night" checklist).

Keeping Track of Keys

Currently, I use a checklist when I arrive back home. This checklist has me leave my keys on a desk by the front door. In the past, I used a different strategy - I would always place my keys on a table next to the door. I trained myself to perform this routine every time I arrived home.

Remembering to Take Things to Work

This is part of my Before You Leave checklist. It reminds me to take my sunglasses, wallet, PDA, keys, etc, with me before I leave. It also asks me to check my Palm Pilot for anything "special" I need to bring to work that day, although I also find that it helps if I write the "special items" on my checklist as well (using the dry-erase marker I attach to every checklist).

Chris (natureloverchris at aol.com) has a different, but interesting, strategy. She puts her keys next to everything else she has to take to work. For instance, if her lunch is in her refrigerator, she also puts her keys in the fridge, next to her lunch. Since she has to grab her car keys before going to work, she is visually reminded to take the things next to them.

Others may pile up the things they need to take in front of the door, or even leaning against the door, so that the chances of noticing them are much higher as one would have to climb over them to leave the house!

Taking Out Trash

This is also part of my Before You Leave checklist. It reminds me to check my garbage and take it to a dumpster (bin) if needed.

Washing Dishes

Before I developed these strategies, dishes with rotting food would sit in my sink for months. Today, my sink is empty. My first strategy is to use disposable dishes whenever possible. For instance, I eat cereal in a plastic bowl with a plastic spoon. I throw both away after breakfast.

Another strategy is to wash the dishes as soon as they are put into the sink. Rather then walking away, force yourself to wash the dishes right then. In this scheme, you wouldn't soak your dishes, since that would result in them simply remaining in the sink, with food rotting in them. It may be better to take more time and scrub them harder then for me to leave them soaking for months!

A modification to this that seems to be working best for me is to do dishes while waiting for food to cook. This also keeps me in the kitchen near my cooking food - which helps me to not burn or forget about it! Often, there is time during cooking where there is nothing to do but wait. This is a great time to do whatever dishes are in your sink.

The final strategy is to get rid of dishes that aren't used in a single meal setting. This ensures that you have to do the dishes frequently, since you won't have anything to eat with if you don't do this!

Remembering to Eat

I use a reminder on my living room and bathroom walls. When I see these, I ask myself if I've eaten.

I've also started trying to force myself to eat 3 times a day, not paying attention to whether I feel hungry (since I often don't). Enforcing this routine helps ensure that I actually manage to eat.

Choosing Clothes

Without this strategy, I often find myself wearing the same clothes far more often than neurotypicals (NTs) find acceptable. After I wash some item of clothing, I hang it on the left side of my closet. I hang everything, even T-Shirts and jeans. When I get dressed, I pick the first appropriate thing from the right of the closet that I find (appropriate means short or long sleeves depending on weather, and the appropriate level of formality). I don't separate clothing by type of clothing, since too many categories are confusing and hard to maintain. My system only requires me to know "left" or "right" depending on if I'm putting clothes in or taking clothes out of the closet. Of course this strategy depends on keeping up with the laundry and hanging clothes after they are done drying. I use a checklist to do ensure these get done.

Preventing Over-spending

Spend cash, not checks or credit, for small purchases. Cash is easier to track, and it is obvious when you are out. It doesn't require you to keep any records at all. One strategy I've seen applied successfully is to separate money into multiple envelopes after cashing a check. There should be some envelopes for things like rent and other bills that must be paid. Then take the remainder of the cash and put it into individual envelopes marked for given dates. Don't spend money out of future envelopes, although it is acceptable to carry money over into future envelopes. Big purchases will require you to save first and then purchase, but this will keep you out of debt.

If you have budgeting problems, do not use credit cards, or even own credit cards. While credit cards do have a convenience factor, it isn't worth the trouble they cause for people who have difficulty budgeting and planning. Debit cards can perform most of the same functions. As for the other reason commonly given for credit cards, emergencies, use a savings account instead. This prevents over-spending.

Paying Bills On-Time

I have problems paying bills on-time. To solve this problem, I use an online bill paying service (www.PayTrust.com). It costs me a few dollars per month (although many banks provide this service for less or even free), but I can schedule payments such as rent to automatically be paid. Bills that may vary in amount, such as a telephone bill, are sent automatically to my bill paying service. That service then uses some rules I set to determine if it can automatically pay my bills (I usually set rules that say things like "if telephone bill is less then $100, then pay the balance). If it can't automatically pay the bill, I get an email. I also get an email a few days before the payment is sent so that I can verify the bill before my money is sent. It also allows me to mail someone a check without having to find an envelope and stamp. I can't recommend this kind of service enough!