Understanding Executive Functions by Looking at Life without them
 

Our story is about Patti, who lives life without the benefit of strong Executive Functioning (EF). Patti is a composite of many individuals that struggle with weaknesses in executive skills. She is well-intentioned but her lack of EF skills is a source of constant struggle and heartache.

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One day, Patti gets a phone call from her mother in California. She is planning a family reunion in July, and she wants to know if Patti and her family can come. All of the extended family will be there. The little town will be overrun with relatives and it is going to be a great corralling of the family from all across the United States. Patti is excited at the prospect and eagerly says, "Of course we'll be there! We wouldn't miss it!"

Patti's mother gives her all the particulars, including the dates of the reunion and places to stay. Patti  rummages around in the kitchen junk drawer for a pencil while her aunt talks, but she never does find one with a point on it. She promises to herself to find a pencil and write down all the details just as soon as she gets off the phone. But by the time she hangs up, she can't remember the specifics. She makes a mental note to call back soon to get the dates.

That evening, Patti excitedly tells her husband and two children about the reunion. Her husband asks when it will take place. "Some time in July. I don't remember exactly." He says, "Well, please find out this week because I have to request vacation time at work." Their fifteen-year-old son exclaims, "Hey, I thought July was when I was supposed to go to Band Camp!" "Didn't you remember?" Patti's daughter practically shouts, "I'm going to New York City with Julie and her family sometime in July." Patti blows up at them all, yelling, "Why are you all being so negative? This is supposed to be fun!"

About once a week, Patti's husband calmly reminds her to get the information about the reunion. She promises to do so but is resentful that he keeps asking (And she really means to get around to it!).  Finally, in June, her husband gets very annoyed and says, "Do it now! I'm going to stay right here in the kitchen until you call!" Patti makes the call and gets the dates as well as the other particulars. Her husband harrumphs around the house the rest of the evening because now he has only three weeks left before the requested time-off. Luck is on their side, though, because he manages to arrange the vacation around work, and the reunion dates do not conflict with the kids' activities.

Over the next three weeks, thoughts about the trip float through Patti's head from time to time. She thinks about how the kids will need to have things to do in the car since it's a long trip. She thinks about taking food and snacks for the ride. She thinks about getting her work at the office cleared up in advance so she can be free of commitments for the vacation. She thinks, "I really should take care of that stuff."

A few days before it is time to leave for the two-day drive from Missouri, she starts piling stuff into the van, including clothes and other supplies. (You can only imagine what the inside of this van looks like!)

Finally, it's time to pile the people into the van, too. On the way out of the house, one of the kids asks, "Who will be taking care of the dogs while we're gone?" Patti moans, "Oh no! I forgot about that. We can't just leave them here to die and there's no one to take care of them! Now we can't go. What will we tell Grandma?" Her husband takes over, and starts calling around the neighborhood until he finds a teenager who can do the pet sitting. The crisis passes. The dogs will be fine.

So, they're off. Patti's husband drives the first shift. He pulls out of the neighborhood, gets onto the main highway, and then asks, "So, what's the game plan? What's the route?" Patti answers, "California is west, so I know we have to go west." He looks at Patti incredulously and says, "You don't know any more details than that? Well, get out the map. We can't just head west with no more information that that!" And, of course, Patti says, "What map? I don't have a map." Her husband sighs and knowingly shakes his head. "Oh no! Another road trip without a map! Why didn't you tell me you need help getting it all organized? I could have helped." Patti replied, "I didn't have any trouble. Everything is fine. We're in the car, aren't we? We'll get there. What are you so upset about?"

  -adapted from Dawson & Guare, 2010 

 

 Ask Yourself:

  • Do you think Patti had made reservations for where to stay along the way? 
  • Do you think she planned out how much cash they would need, or where they would stay, or made it to the bank ahead of time?  
  • Can you sense how resentful she is, when asked about whether she made plans or organized for the family (food, money, reservations)?  
     
  • Can you imagine the negative reinforcement she is receiving from people because she is deemed undependable, flakey, disorganized... 
  • Do you think she is even aware of her deficits or why people are angry with her?
  • How will she understand these problems and remedy them?

Let's Review the Executive Functioning Categories:

  1. Inhibition - When her mother called, it would have made sense to tell her, "Let me check the calendar first. It sounds great, but I just need to look at everybody's schedules before I commit the whole family."
  2. Shift - When the question emerged regarding who would watch the dogs, Patti was stymied and defensive. Her husband, on the other hand, began generating possible solutions and was able to solve the problem relatively easily.
  3. Emotional Control / Self-Regulation - The example here is Patti's anger when confronted with her own impulsive behavior in committing the family before checking out the dates: "Why are you all being so negative?"
  4. Initiation - Patti thought about calling to check on the date of the reunion, but she just didn't get around to it until her husband initiated the process.
  5. Working memory - Patti could not keep the dates of the reunion in her head long enough to put them on the calendar after her initial phone call from Aunt Sue.
  6. Planning/Organization - Patti lacked the ability to systematically think about what the family would need to be ready for the trip and to get to the intended place at the intended time with their needs cared for along the way. Although she may blame her husband, she has always been designated with delegating responsibilities for the family. 
  7. Organization of Materials - It was Patti's 's job to organize the things needed for the trip. However, she just piled things into the car rather than systematically making checklists and organizing things so important items would be easily accessible, so the space would be used efficiently, and so that people and "stuff" would be orderly and comfortable in the car.
  8. Self-Monitoring - Despite the fact that they're off to Cali without knowing how to get there, with almost no planning for what will happen along the way, and without a map, Patti does not understand why her husband is so upset. This scenario has likely happened many times through their relationship, but she has been unable to use the negative feedback to correct her behavior.
  9. Communication - Patti failed to communicate with her family before and during the Trip. She did not dole out responsibilities. She did not create or manage the expectations or responsibilities.   
  10. Accountability - Patti did not take Responsibility for planning the trip, for scheduling or anticipating the needs of others, or the problems that arose.  She showed almost no awareness of the needs of others and likely blamed others for their expectation that she would have planned the trip. Further, she was unable to hold herself accountabile for the many tragic errors that likely led to confusion, chaos, and frustration.

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