C : Hello everybody, we are here today in this special podcast directed to teachers and other education professionals to talk about Executive Functions and the dysexecutive syndrome in Autism Spectrum Disorder.
Executive functions ? But what are they ? You’ll ask. To answer our questions, we welcome today a special guest, a psychologist specialized in neurosciences and autism : Marie Quelven
M : Hi Cynthia, I’m glad to be here with you and excited to share information about this subject.
C : Great, so it seems to be really important to you to do these interventions, and to kind of raise awareness of findings about brain function and some specific disorders such as Autism Spectrum Disorder.
M : Yeah, in fact, autism and the dysfunctions it brings still aren’t very well known to the general public. And, something important is to understand them better, so we can try to make adjustments and keep including them as much as we can.
C : I see, well it’s true we hear talk a lot about autism these years, but if i were asked about the specifics i really couldn’t tell. What I know is only what we found in the books and manuals such as the International Classification of Diseases and
Diagnostic and Statistical Manual of Mental Disorders. What a name hein ?
In this classification, autism is considered as a neurodevelopmental disorder. Two sets of criterias are associated for the diagnosis of this disorder : social and behavioral criterias. The difficulties are found especially in social interaction, in communication and in the limited, repetitive and stereotypical nature of the interests and behaviors of the person. Counter to DSM 5, which contains all sorts of autism in one category as a spectrum, the CIM 10 distinguishes three sets : infantile autism, asperger disorder and atypical autism, each having its own specific features.
But what really mean all those complicated words ? explain us, what do we really mean when we use the term “Autism Spectrum Disorder” ?
M : As you said, ASD is a neurodevelopmental disorder which means it is present from birth and all along life. These two manuals you talked about consider autism in different ways. But the fact that autism is a spectrum is now widely accepted. Thus, what we call “Asperger” is a milder form of autism without intellectual deficiency.
About the symptoms, first of all, people with autism have difficulties talking and interacting with other people, this is the social part of the disabilities. Second, they focus on some subjects in a restrictive way and they also show motor stereotypies which are little movements constantly repeated. But, another one of the dysfunctions they have to face is the dysregulation of executive function.
C : Finally, the question we are all asking… What are those executive functions you talk about ?
M : Executive functions are a set of mental skills. They can be regarded as the control tower of thoughts and actions since they are essential to achieve many tasks in our everyday life. Indeed, they allow us to mentally play with ideas, make decisions, or plan our actions… It’s what we call “Cognitive control”. Hence, the main executive functions are :
– Working memory, to remember information
– Inhibition, to focus our attention on a task or to inhibit inapropriate behaviors
– Mental flexibility, to promote adaptation to each new situation.
– And finally, Planification, in order to predict the steps to achieve a goal
C : So, it seems to be like a real toolbox, what happens if there is any problem with those functions ? Can we still do what is needed on a daily basis ?
M : Indeed, such dysfonction is called DES : Dysexecutive Syndrome and it generally results from a brain injury or another disorder such as autism.This syndrome can be soft or severe depending on the degree of the difficulties it causes. So, actually it can have a significant impact on quality of life and academic success.
C : I didn’t know people with Autism Spectrum Disorder were concerned by such a syndrome. But how does it work concretely ? What kind of difficulties related to executive control they have to face for example ?
M : I’m not surprised Cynthia, this syndrome is not the first thing we think about. Generally, autism is associated with social handicaps but there are multitudes of other difficulties associated with ASD including the ones linked to executive dysfunction. As you probably know, we usually say that it is really problematic for people with ASD to face changes in their routine. In fact, this is directly linked to a lack of cognitive flexibility. Another big issue for them is to focus their attention on one specific stimulus inhibiting the rest. In the classroom, they can easily be disturbed by some noises, or too many posters on the walls. Even something as easy as making tea can become a real challenge. Because, planification is also affected. So for them, it is not easy to simply remember that first you have to boil water, then put tea on the teapot and finally add the hot water.
The problem is, executive function deficits present during childhood are the same in adulthood because the cognitive remediation programs existing do not seem to be based on the ASD population.
C : Oh, it sounds bad… and is there no other way ? Any treatment or something we can do to help people with this syndrome ?
M : Of course, there are strategies or habits to put in place to decrease or compensate for the difficulties related to dysexecutive syndrome. In order to compensate for working memory, it is possible to create a schedule with all things to do in the morning or night routine. To take another exemple, the lack of inhibitory control can be managed by limiting the amount of stimulus that could interfere. It means you’ll have to try to work in a space without too many things on the walls, with a soft light that will not be found aggressive and without too much surrounding noises. We can also solve the problem of planification with different methods like the decomposition of the problem in sub-steps or the creation of a numbered steps list. There is always a way to compensate for dysfunctions and to live with them.
C : I see, this is much more comforting. So as you said before, it seems really important to learn more about people with autism and the way their brain works to include them the better we can. And for us, that we aren’t specialized in the subject, it is essential to keep informed about the new findings, because the more we know, the more we can adapt to everybody’s specific needs.
So what do we have to keep in mind when we talk about autism ? Autism is a neurodevelopmental disorder, present all along the life of the person. It brings a lot of difficulties such as interacting with people. Now, we also know that some tasks linked to executive function can be really hard to achieve for people with ASD. Hence, it is essential to know the specifics about what causes these difficulties in order to find the adjustments that can be made.
Furthermore, we have seen only a few examples of what can be done to facilitate the everyday life of people with autism. But potential adjustments are widely open to your imagination and need to be adapted to every specific case. So, if you find yourself in the need to make adjustments for a student with autism or any other disorder, the best piece of advice we could give you is to observe and let new ideas arise.
M : I could not have said it better myself. Thank you for inviting me Cynthia.
C : Thank you for your answers Marie. And to our auditors, Good luck, I hope we’ll see you for our next edition !