A Day in the Life of Executive Processing Difficulties

Executive function can be described as the "boss" functions in our brain; what stands between our thoughts and our actions.  Executive function is divided into 8 major categories, which include areas like knowing how to start a project, having the follow-through to finish a project, working memory, knowing how to control impulsiveness, imagining potential cause and effect from actions, generalizing specific incidents, and understanding when other people are no longer interested in what you are talking about.  The simple definition of executive function is: "not acting like a two year old."

Children with complex backgrounds, such as children who wind up needing to be adopted, often have executive function difficulties.  Their disorganized lives have not taught them the skills they need, and the stress they experience interferes with normal brain development that would, say, help you learn how to not act like you're two.  In the category of "executive function disintegration," Hibiscus came out with gold stars leaping out all over the place.  In fact, after reading a book on the subject, I realized that Hibiscus is basically a walking demonstration of executive disfunction: she has it ALL.  Except a couple of the potential behaviors are conflicting; not knowing how to make decisions can either paralyze a child with confusion and indecision, or result in impulsive and random behavior.  Hibiscus is never paralyzed with anything.

I wrote that this is a day, but come to think of it, there is no way I could record an entire day of executive function difficulties.  So I'll go through some highlights, but I want to clarify that this is not selecting out the dramatic stories of a bad day -- this is her (our) life.  Executive function is so very universal, that it colors everything that happens, and every decision that we make about ourselves.  Also, I hope it is clear that I am not writing this to complain about Hibiscus or describe how "bad" she is, but the exact opposite.  I am writing to explain how these little skips in her brain are affecting her large and small decisions throughout the day, and thus her entire life and family interactions.

MORNING, GETTING READY FOR SCHOOL:
The children are doing their chores of taking care of the chicks in the garage.  Emerson pours them more food, and Hibiscus goes to clean out and refill the waterer.  By the time something is a routine, we don't need to use our executive function as much, because we can go through what is a normal habit without making new decisions; therefore, it is fairly easy for the children to get started working peacefully on the baby-chick chores.

But this morning Hibiscus decides to clean out the waterer in the bathroom sink.  The chicks get the water cavity filled with their coconut-coir bedding, which needs to be pulled out before the waterer is cleaned and refilled.  I have instructed them several times to do this in the trash can with a plastic bag in it, not in the sink.  I don't know if Emerson usually does this part, or Hibiscus just decided to try something new, but habit slipped through this morning.
-poor working memory (that I have instructed them how to do this)
-inability to imagine cause and effect of actions (filling the drain with coconut coir)
Emerson comes in to get me because Hibiscus is flooding the sink, as she watches with confusion as the water gets higher and higher.  However, she figures out that if she pushes the mass to the side, the water goes down, and she smiles at me with success.  I am not so impressed and tell her that she has to get ALL the coconut coir out of the sink.  She starts grabbing at it (it's possible she even skipped the step about fussing and whining; she's getting kind of used to my rule that she has to clean up her own messes), and I remind her to get the trash basket with the plastic bag from the kitchen.  I have to repeat this and hold her hands still so she can listen.
-difficulty planning steps to complete a project successfully

After a while she comes back in and reports that everything is clean.  However, I suspect her very first step was pushing things down the sink, so I go and take out the U-joint under the sink to make her make sure it isn't full of coconut coir.  I put a towel under to catch the drips, and show her the pipe she needs to clean out.  As she reaches for the sink, I tell her not to touch it.

"NO-OOO!!  I don't know how to do da-AAAT!" she whines and wails (the gist of which is probably not related to executive disfunction, although the second sentence can describe difficulty understanding how to start projects).  I start to explain, but she jumps to show me that the sink is actually clear and running smoothly.
-when an idea is in her head, it's hard to stop and think about something else
She turns the water on full blast to prove that it is running.
-poor working memory, that I just told her not to touch it.  Or, perhaps:
-inability to generalize; I hadn't told her not to touch that PART of the sink
Water enthusiastically flies out the open pipe into the cabinet under the sink.
-low ability to imagine consequences of actions

SCHOOL:
I was not there to see how she did in her classroom and her after-school nature program.  There were probably small difficulties, but in many ways these settings are easier.  The routine is stronger and more clear, which allows her to rely on habit instead of decision-making.  There is a tidal wave of other students moving along, so if she pauses for a millisecond and follows along she is likely to make the right choices.

Furthermore, in her particular case, there is less desire to prove herself independent (or smart, or powerful, or who-knows-what) by doing things a little bit differently than how her parents ask.  Plenty of children do this, but some of them are able to use their reasoning to figure out a way to do things creatively without totally ruining the point of the activity.

For instance, when asked to clear things off the table, Emerson might sulk about it, but then pretend that he is a train.  He needs to add "whoo-whoo!" noises to each item that he picks up, and walk in a particularly train-ish manner, but he delivers the proper things from the table to the counter.

In contrast, when I asked Hibiscus to put the milk in the refrigerator, she put it in the freezer.  Which ruins the point of putting milk in the refrigerator.  Actually, it just plain ruins the milk.

GETTING READY FOR DINNER:
Clearing the table took the children 45 minutes tonight, with one adult in almost constant guidance.  How it is even possible to take 45 minutes to clear and set a table is completely beyond me; you will have to ask someone with executive disfunction, I guess.  However, here are a few elements:
-difficulty understanding how to start a task
We actually have lists on the wall, breaking down setting the table into very small jobs, for just this reason.  However, tonight they were:
-easily overwhelmed
and unable to even use the lists as a tool.  (Emerson doesn't have executive disfunction, but he has extreme anxiety over being able to do things the right way, which looks similar when it comes to task completion.)  And furthermore
-lack of being able to generalize
probably meant that they couldn't see that ALL THE STUFF covering the table was actually on a couple of categories: crayons and paper, dishes from lunch, and a few books.  Instead, it looked like a million totally random things.  So, when faced with a million things to do, why not
-distractibility
read every book you encounter, and color with every crayon?

DINNER CONVERSATION:
We spent a while figuring out how to count by 5's, which Hibiscus's class is also working on.  It's difficult for her to figure out, because as soon as she hears something that gives her an idea, she's saying and acting upon her idea.  But since an idea usually comes to her by the third word of the first sentence, this means that she misses most of the explanation.

Then the conversation took a turn like this:
Hibiscus: I am taking some more potatoes.  I like potatoes.  Look, this is a little potato!  What a cute potato, I want to eat this potato.  Now I am cutting it.  I am cut, cut, cutting it, and now the potato is cut.  I'm going to put butter on my potato.  I like butter!

At this point I said her name in a warning tone.  We have had many discussions about what constitutes a conversation; how, for instance, people take turns talking, and the thing that you talk about is the thing that the previous person was talking about.  No one else had been having an in-depth discussion about Hibiscus's potato, surprisingly enough.  In fact, I am trying to add to our understanding of conversation, that monologues about what you are eating are actually not interesting at all to the other conversationalists.  But even though she clearly hasn't grasped that, this fell under the previous rules of other people not getting turns, and not being germane to the conversation that everyone else was having.

Hibiscus apparently didn't remember those concepts about conversation.
-poor working memory needs lots and lots and lots and LOTS of repetition
"What?!" she protested.  "What's the matter with butter?"
I tried to say something succinct about that being enough talk about her potato, and then model moving on in conversation.  Hibiscus was not moving on.
"I wasn't talking about my potato!" she protested.  "I was talking about butter!"
-inability to generalize, since her last phrase was indeed about the butter
"Can't I have butter?  I like butter!  I like butter on my potato!  Butter is really nummy on my potato!  My potato is good with butter --"
-extreme difficulty in realizing when other people are no longer interested in what she is talking about

GETTING READY FOR BED:
After dinner, Daddy was dealing with washing hair and getting kids in and out of the bath, and I was doing their physical therapy routine with each of them in turn in the bedroom.  (Wilbarger brushing and joint compressions, plus some reflex-integration exercises.)  While each child was not being either bathed or brushed, he or she was expected to be cleaning up the bedroom.

We have even made a song about it.  Before leaving the table, we sing:
"Clear your plate,
Potty and wash-hands,
Pa-ja-mas,
Clothes in hamper,
Clean your room, till the grown-ups come."  
Each line repeats one note of the scale, until by the last line it's reached the dominant and does a simple arpeggio up and down, which is the most musically compelling part so the kids love to sing that line.  Now whenever I remind them to tidy, someone always sings "clean your room, till the grown-ups come!"

Having a song aims to help poor working memory, and general mental disorganization.  The tune gives the memory a boost, and if we repeat the song and tick steps off on our fingers every time a child says "what do I do now?" (or goes scooting past at 60 mph with a naked bum), they can usually figure out what step they're on.

First of all, as for actually tidying the room, there was a lot of similar behavior as I described about the table, with discussions like "I don't know what to DOOO-oooo.  I don't know HOOO-oooow to clean my room" said in the most whiney voice possible, to which I would reply "pick up that kleenex right there and put it in the trash," or something along those lines.  This is an outside influence providing some executive function.  However, they were gradually getting to the point where we could vacuum.

I finished Buttercup and took her to brush teeth.  Daddy was getting the vacuum.  Emerson started screaming at Hibiscus to stop something, and ran desperately away.  She was laughing; he was not.
-gets carried away with emotion and misses social cues

Most of the time, I try not to get involved in their little altercations, but sometimes something is pretty clear.  In this case, they hadn't been upset and there wasn't time for an altercation.  However, there was a dead fly waiting to be vacuumed up, and upon seeing it, it had clearly popped into Hibiscus's mind that it would be interesting to put it on Emerson's chin.  When he startled and shrieked, she responded to the heightened emotion by chasing him.
-lack of impulse control
-difficulty to imagine consequences to actions

The words burst out of him so spontaneously the story seemed clear.  I looked at Hibiscus is surprise and asked "wait a minute, did you put a DEAD FLY on his FACE??!!"  Just to make sure I had both sides of the story.  Hibiscus looked even more horrified than I did, and then she made a miserable sound, flung her arms over her head and crept out of the room.  Obviously, that's exactly what she DID do (or she would have denied it), and obviously, as soon as she thought about the situation for 1.2 seconds, she realized that it was a REALLY BAD IDEA.
-no pause between thinking of something and just doing it.

Actually, Hibiscus really hates bugs herself, and was probably at least as upset about the idea of a bug on someone's face as anyone else.  It just hadn't occurred to her that that was what she was doing.  Because she didn't take that 1.2 seconds to think before she acted, nor did the social cues indicate to her that something was wrong.

I told her that I could see that she felt bad, and that she didn't mean to do it, and now she just needed to make her brother feel better.  After wailing that she didn't know what to do (this has been a theme lately, apparently), she stomped back into the room, said "SOR-REE, Em'son" in her most affronted voice, and stomped out.
-human nature does not like apologies, I am hypothesizing

In our family, we are not required to say sorry.  We are required to make the other person feel better, and not move on with fun things in our own lives until we are ready to do that.  Hibiscus said she didn't know how, but Emerson and I agreed that for an offense like this, she could help him with a chore.  His laundry needed folding, and I suggested she could help him with that.
"She has to do the whole thing!" he demanded.  I was going to say that that was a little out of proportion to something that wasn't actually mean-hearted, but he had reconsidered himself.  "Maybe she can do part of it," he reasoned. "We can sit and fold it together." Upon further contemplation, he agreed that that would make him feel better, like she was helping him and not hurting him.

Hibiscus had been horrified about the fly, but she was even more horrified that she was going to get another chore.
-difficulty imagining consequences to actions
-poor working memory for household rules
She had been asked but hadn't chosen to participate in the discussion about what chore it would be, but since Emerson himself had argued her point and offered to help her, I felt like it was pretty reasonable.

For the entire rest of bedtime she kept forgetting that she needed to fold laundry for Emerson.
-poor working memory, or possibly just finagling to get out of something moderately unpleasant

FALLING ASLEEP:
So, she ended up having to fold laundry while the rest of us started books, but even though it took us more time to get into bed with the pillows in order than it would have taken her to just fold the clothes (Emerson moved clothes into two piles and made sure that his pile, for the morning, was bigger, so it wasn't unfair), she was so busy throwing a giant fit that she didn't have a chance to fold.  To make a long story short, when she finally came back from the other room where she and the laundry had been placed, she complained of a headache.  I said it was probably from screaming so much.  She wailed and wailed that her head hurt, which was more crying.
-inability to see past the immediate moment

I suggested that she get a drink of water.  She yelled "NO," and resumed complaining and crying.  I said that when I have a headache I get a drink of water, and got another "NO."  Then "it hurts, it hurts, it hurts!" as she bangs her head against the floor.  (Really?)  I finally told her to go get a drink of water, and to stop crying so her head could have a rest.  She went into the bathroom, but came back saying she didn't want a drink.  She kept complaining that her head hurt, and really the only solution that I could think of was having some water -- and I knew she would be thirsty after all that screaming -- so I kept gently insisting.  Besides, when you are drinking water, by definition you can't be screaming and banging your head against things.  She skulked back from the bathroom a minute later, trying to explain that something was in the cup, and she wasn't thirsty anyways.  I explained how she could remove the object from the cup and then drink, but she wasn't having any of it.  Since she calmed down and climbed into bed to listen to the rest of the story, I left it alone.

Fast forward ten or fifteen minutes.  I have finished books and blessings and left the room.  Emerson gets out of bed and asks politely for some water, so I fill a sippy cup and give it to him.  As I do that, he politely tells me that Buttercup wants some too, can I get her one?  From the upper bunk, Hibiscus demands sulkily that I get her water too.  First of all, she has a shelf by her bed that always has a water cup on it, and when I glanced up it was there.
-poor working memory
-inability to put details in context/generalize: i.e., it was reasonable for Emerson and Buttercup to ask for water, because they didn't have a shelf with a cup on it.  She thought it wasn't nice that I didn't bring her water, without realizing that the detail that she already HAD a water cup changed the situation.

But furthermore, I told her with some exasperation that I wasn't getting water for her, when she had refused over and over to get water for herself, and protested over and over that she wasn't thirsty and wouldn't drink.
"You didn't tell me to get water!" she complained.
I did, I said, I had told her to get water over and over, and she wouldn't do it.
"You never told me to get water!" she yelled.
We repeated this a couple of times.  I finally appealed to Emerson, and he agreed with me, obviously completely confused about how someone who had just refused to drink water 17 times in a row could say that she had never been invited to drink water.  Finally one of us said some kind of word that cued Hibiscus in to the conversation we were talking about.
"Ooooh, THAT telling me to get a drink," she replied.  She was equally confused about how being asked to take a drink from the sink had anything to do with the current issue of filling her water cup.
-inability to generalize.  Generalization is a really useful skill, isn't it?


And those are some small but very typical incidents, in the day of a life with very few executive function skill.