The complexity of executive function difficulties in autism spectrum disorders (ASD) means that each individual’s experience can vary significantly. However, by understanding these challenges, we can begin to tailor support in a way that helps autistic people navigate their world more effectively and independently.

Basic Executive Function Skills

At the core of our cognitive abilities, executive function skills play a pivotal role. They act as the command centre of the brain, directing our attention, memory, and problem solving skills. These functions are essential for performing everyday tasks, making decisions, and interacting with others, both effectively and efficiently.

Three basic, core executive functions help us to interact with our world efficiently with success: working memory, inhibitory control, and cognitive flexibility. From these, higher level cognitive abilities are built, such as motor planning and emotional regulation.

Working Memory

Working memory is a critical executive function that allows us to hold and manipulate information in our minds over short periods to guide decision-making and behaviour. It is often likened to a mental scratchpad, allowing us to work with information without losing track of tasks, even simple tasks. 

Unlike long-term memory, which stores vast amounts of information, or short-term memory, which simply refers to the storage of information, it is the ability to manipulate stored information for short-term use. This means even autistic people with incredible memories may experience challenges with their working memory.

Working memory helps with motor planning, which is a crucial cognitive ability that helps us learn motor actions by organizing and executing movements efficiently. It involves the ability to recall and perform the steps necessary to complete a task, such as brushing teeth or tying shoelaces. 

Motor planning enables us to set goals and determine the most efficient way to accomplish them. These skills are fundamental for time management, completing tasks, and organizing thoughts.

Motor planning issues go beyond motor coordination; they can affect social skills as well. Children with dyspraxia may struggle with ideation, sharing ideas, and adapting plans quickly, leading to challenges in play and interactions with peers and adults. 

Examples of working memory and motor planning in action:

• repeating someone’s name when meeting them for the first time
• retrieving different LEGO pieces to build a car
• getting ready to go to school on time in the morning
• completing the night time self-care routine before bed
• cleaning up a messy bedroom
• keeping your school desk organized
• listening to the teacher while having a question to ask
• beginning reader recalling the pronunciation of specific letter blends when encountering an unfamiliar word
• preparing for a job interview

Inhibitory Control

Inhibitory control refers to the ability to inhibit or control impulsive responses and is a crucial cognitive function that allows individuals to select appropriate behaviours aligned with their goals.

Behavioural inhibition relates to managing desired and undesired behaviours, often referred to as self-control or impulse control. It involves overriding competing urges and delaying gratification. 

Inhibitory control also plays a role in regulating our emotions: the ability to control our emotional reactions to situations and express emotions in appropriate ways.

When our emotions are heightened, such as when we’re overexcited or anxious, being able to regulate our emotions means we can bring our physiological state to a functional level, at which we can continue to behave effectively and appropriately.

Examples of inhibitory control and emotional regulation in action:

• staying off social media when you have homework to do
• staying quiet when you have something to say but shouldn’t
• resisting the urge to finish all the Halloween candy
• refraining from interrupting someone while they are talking
• continuing to do your assignment even though you hear something
• staying seated when feeling bored during circle time
• selecting your words carefully when feeling angry with someone
• waiting your turn to go down the slide
• asking for a toy instead of grabbing it out of somebody’s hand
• waiting in line to purchase an new game that you want to open immediately

Cognitive Flexibility

Cognitive flexibility, also known as set shifting, is the brain’s ability to adapt to new, changing, or unplanned events. It involves the capacity to shift attention, switch between different tasks or mental sets, and consider multiple perspectives or solutions to a problem

It contributes to the ability to overcome previously held beliefs or habits when required by new situations. This allows for the adjustment of thinking from old to new contexts. 

Examples of cognitive flexibility in action:

• compromising with your partner about what to eat for dinner
• understanding that others don’t like that same things you do
• taking the bus in a new city
• brushing your teeth with an electric toothbrush instead of an manual toothbrush for the first time
• taking a different route when you run into a construction zone on your regular commute
• trying a different dish at a familiar restaurant
• making breakfast and seeing that there are no more eggs so you have a waffle instead
• switching between different languages as a bilingual

A Note about ADHD and ASD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that includes challenges in executive functioning skills.

It is important to note that ASD and ADHD have similar executive functioning profiles.

According to the meta-analysis literature, the comorbidity (when two or more medical conditions are present in the same individual) rate of ASD and ADHD ranges from 30-80% of individuals with ASD also having ADHD, and 20-50% of individuals with ADHD also being autistic. 

ADHD is typically diagnosed through a comprehensive evaluation by a pediatrician or primary care provider. Treatment for ADHD often involves a combination of medication, behavioural therapy, and school/educational support to help manage the symptoms and improve functioning.

The significant overlap of the two diagnoses suggests that an assessment for ADHD may be warranted if behavioural therapy is insufficient in addressing the executive functioning challenges for an individual with ASD and medication may be required as a supplementary intervention. 

In any case, consulting a primary health care provider will be beneficial for any considerations related to ADHD and medication.

Executive Dysfunction in Autism: Goals and Strategies

Executive dysfunction refers to executive functioning issues that individuals face with managing and regulating cognitive processes. These difficulties can manifest in various ways, including problems with initiating tasks, organizing our own thoughts, and controlling impulses. 

For many individuals with autism spectrum disorder (ASD), executive dysfunction challenges may exacerbate the learning challenges that already come with an ASD diagnosis.

Addressing executive functioning challenges requires tailored interventions that consider the unique needs of each individual with autism spectrum disorder. 

Some strategies are suggested here, but a full treatment package that uses a combination of supports and ways to contact positive outcomes (i.e., reinforcement) for the individual will improve the treatment efficacy. 

Improving Working Memory

Challenges in working memory can make it difficult for autistic children to follow multi-step instructions or retain information long enough to use it.

Visual reminders and visual schedules can help individuals concretely picture what needs to be done. Visuals can show the tasks of the day, or sequential steps required for a task, or merely a to-do list.

Social narratives can also enhance working memory for individuals with autism. It creates repetition from an autobiographical perspective to form mental scripts. 

These scripts may aid the individual to remember what to do in certain social situations, or understand what a new event will entail. Once rehearsed, the social narrative itself may also serve as a visual reminder.

Examples of supporting working memory

• During the Covid pandemic, our world was suddenly plastered with visual support. The Centre for Disease Control made available a variety of visual posters that showed not only when to wash your hands but also how to wash or sanitize your hands to help people follow the rules to washing their hands.
• A child going on a school field trip for the first time reads a social narrative from his perspective of what that day will look like. The story shows pictures of lining up for the bus, sitting on the bus, arriving at the destinations, and the rules at each location. 

He will read the story several times and pretend role-play with his toy figures to play out the story. His support teacher will then use the pictures from the stories to remind him of the expectations at each location on the actual day of the field trip. 

Practicing Motor Planning

Individuals with challenges in motor planning and prioritizing may struggle to see the bigger picture and decide which tasks are most important. Children who struggle with motor planning may appear clumsy, have difficulty learning basic skills, and take longer to complete physical tasks.

Developing organizational skills is crucial for individuals facing motor planning challenges. We focus on teaching strategies for sorting, categorizing, and systematizing information. 

Supporting individuals with autism in this area includes breaking tasks down into smaller, more manageable steps and using visual supports to illustrate task sequences. This can make it easier for them to understand what needs to be done and in what order, helping them to plan and prioritize more effectively.

Examples of supporting motor planning

• Get Ready, Do, Done, created by SLPs Sarah Ward and Kristen Jacobsen, is an example of a strategy to teach motor planning. In practice it might look like: 

1. prior to building a LEGO car, a child with autism is taught to brainstorm what type of car they want to build (what the “done” goal is),
2. Then decide what types of pieces they might need (what the plan is, what they have to “do”), and 
3. finally what materials they need to gather (how to “get ready”). 

Once the plan is laid out, the individual can gather the materials efficiently, work through their plan, and achieve the task goal.

• When teaching children with autism to use an augmented alternative communication (AAC) device, we can minimize motor planning challenges by keeping the pathways consistent, so that the individual can learn the motor plans to access that vocabulary more easily.
• Visual support such as a creating shopping list and the store of the map may be helpful for adults with autism to have a successful grocery shopping trip.
• To teach a child with autism how to put on a shirt, we may break the dressing task down into smaller chunks and teach one component at a time. We can show them a video or present the steps in a visual strip for them to reference.
• A visual timer may be used as a visual reminder to keep an autistic individual on task if they experience difficulties managing time.

Practicing Inhibitory Control 

For autistic individuals, difficulties with inhibitory controls can lead to impulsive behaviours and challenges with focusing on tasks. Strategies to support inhibitory processes include creating distraction-free environments and using tools that encourage focus and concentration.

Teaching young children with autism the skill to wait for preferred items, activities, and attention may be the first step in teaching impulse control. Depending on the child, we may have to start from a very short time to wait (1-3 seconds) and build up from there. 

Playing turn-taking games to practice waiting for their turn is also a great way to build the foundation for learning impulse control.

When supporting individuals with autism who have low self control, it may be beneficial to first examine their sleep health. Sleep quality has been shown to positively influence impulse control. Simply put, when people sleep better, their ability to control their impulses improves.

Examples of supporting inhibitory control

• Headphones, particularly noise-canceling headphones, can help block out overwhelming noise and sensory stimuli for people with autism, especially those with sensory issues.
• Teaching the individual to minimize distractions in their workspace before starting a task can promote independence in changing their own environment as needed. 
  For example, find a quiet spot or put on your headphones, clear your work surface, close the curtains, etc.
• Post visual supports as reminders of what they’re supposed to be doing to promote staying on task until completion.

Teaching Emotion Regulation Tools

Challenges with emotion regulation for individuals with ASD can lead to difficulties in social interactions and cause stress and anxiety, often manifesting in what may stereotypically be described as temper tantrums or meltdowns, or other maladaptive behaviours that aim to escape or avoid the stressful situation, such as overeating, aggression, running away, shutting down, self-injurious behaviours, or substance abuse.

Strategies to support emotion regulation in autism include teaching and finding coping skills that will work for the individual, such as deep breathing, counting, finding soothing objects or repetitive movements that would effectively calm their nervous system.

Coping skills are best taught when a person is not in distress to proactively equip them with effective strategies to manage their emotions and reactions before they escalate. Teaching coping skills during calm moments allows individuals to build a repertoire of techniques that they can readily access when faced with challenging situations.

Examples of supporting emotional regulation

• If we want to teach children with autism to take three deep breaths as a coping strategy, we would practice the skill in isolation while they are playing with us calmly.
  
  We could show them a visual depicting the coping strategy, model what to do, and use any materials to help them engage in the strategy, such as using a pinwheel to blow three times. 
  
  This way, when they are in distress and we show him the visual of taking three deep breaths, they would have already learned what that visual means and thereby increases the chance that he will use the coping strategy.
• Teaching one to manage emotions prior to solving problems is important to teach any problem-resolution skills.

Practicing Cognitive Flexibility

Challenges with cognitive flexibility impact an individual’s ability to switch between tasks, understand different viewpoints, and adjust to changes in routines or environments. 

Supporting cognitive flexibility involves creating structured environments that gradually introduce changes, allowing individuals with autism to adapt at their own pace. When using visual schedules to lay out the shape of the day, small planned disruptions may be inserted, or the order of events may be changed.

Emphasizing routines while preparing them for potential changes can also alleviate stress and improve their ability to cope with new situations.

It is tempting to keep routines unchanged to help an individual stay emotionally regulated. However, it does not teach flexibility and unfortunately, real life will not always be unchanging.

It is more important to teach them that changes are ok, sometimes even for the better, and even when it’s for the worse, they can use regulation tools to cope with the changes.

Other teaching goals in flexibility may include changing play ideas, compromising, following the flow of conversation topics, and contextual problem solving, 

Modelling flexibility in daily activities, reading stories that emphasize flexible thinking, and encouraging the exploration of different problem solving strategies are effective ways to enhance cognitive flexibility in children

Examples of supporting cognitive flexibility

• Intentionally introducing minor inconvenient and fun disruptions to a regular school schedule may promote flexibility when actual disruptions occur (e.g., fire drill, a special presentation, concert rehearsal, or arrival of a substitute teacher). 
• Contingency maps can be used to illustrate different solutions to a problem and their potential outcomes. 
• While playing restaurant, we should introduce changes and alternative ideas. Instead of accepting the child’s insistence that only noodles are being served and you have to order ice cream for dessert, we can say “I don’t want any noodles, I want to order some rice” and, “wow i’m so full, no ice cream for me today.”
• Combining play themes is another way to teach flexibility. A child can learn that while we play with cars, we can race them or wash them, but we can also incorporate mechanics, police chases, going to drive-thru restaurants, driving to the farm to visit animals, etc.

Using Reinforcement: Bridging the Skills and the Why

Using executive functioning skills requires effort. It is easier to stick with what you know than to try something new. It is easier to give in to temptations than trying to fight it. It is easier to act habitually rather than thinking about what to do next. 

Executive functions are advanced cognitive skills that we can teach and that one can acquire. But even then, why bother choosing the more effortful strategy?

Reinforcement for a behaviour involves consequences that strengthen the behaviour, increasing the likelihood of that behaviour occurring again in the future. It is a fundamental principle in Applied Behaviour Analysis, shaping how individuals behave daily. 

Reinforcement can be positive or negative, with positive reinforcement involving the addition of a stimulus to strengthen behaviour, while negative reinforcement entails the removal or avoidance of an aversive stimulus to strengthen behaviour. 

For example, we want to teach a student to not run but to walk slowly through the classroom to get her pencil (positive reinforcement), but also to avoid hurting herself and others (negative reinforcement). Both consequences (i.e., getting the pencil and avoiding pain and social reprimands) should increase the likelihood that she will walk in the classroom next time to get her pencil.

But when natural consequences don’t improve behaviour, we may introduce “contrived” consequences, providing praise and “points” toward earning items or activities  that the individual likes to do when they use their executive functioning strategies.

Once skills are established, there are many ways to fading out the contrived reinforcers. 

The Importance of Tailored Support and Intervention

All learners have different skills they need to learn, and different reinforcers that can motivate them to practice and exhibit those skills. Not everyone will learn the same skills, nor in the same way.

Individualization of treatment packages is key.

Tailored interventions can significantly improve everyday executive functioning. By prioritizing individual needs, we can make meaningful progress in supporting individuals with autism and executive dysfunction.

Conclusion: When “Independence” Looks Different

Many strategies are laid out above to teach skills and manage challenges in executive dysfunction. In our teachings, we strive towards independence for the individual. 

Independence typically means an individual can successfully navigate their world without support. Independence may mean successfully fading out all the visual aids so that they can mentally organize and complete tasks efficiently and effectively without those supports. 

However, for an individual with executive functioning difficulties, the ultimate goal of being “independent” may need to look different. 

For example, visual support can promote independence as it can remove the verbal reminder from the caregiver, support staff, or teachers.

The reminders that we build into teaching autistic people the executive function skills can be transferred to the individuals themselves. 

Promoting independence thus means ultimately teaching the individual to set up their own visual supports and then reference it, to change their environment to set themselves up for success in completing a task, and to practice these skills before having to perform them.