Help! Mum Fell In The Hot Tub

ADHD Files #5: Executive Function

Recently, in a display of poise and grace, I tumbled violently into a poolside spa that contained three people. I was on a trip to Melbourne with two of my daughters, running mental analytics as they chatted to a friend in the water: if the plane leaves at four, we need to be at the airport at two, which means we need an Uber at one-thirty, which means we need to be in the room packing up by 12.30, which means… I time-slotted a ten-minute chat and soak, no swim, because I didn’t have time to dry my hair. Then I stepped confidently into thin air where no step existed and went, as my dad would say, arse over tit, taking out a child on the way through and ending upside down, a foot underwater.

It was mostly comedic. I was grateful I hadn’t hit anything important and I laughed along with the girls. But a few hours on, I remained a bit shaken, and a large blue bruise had begun slowly blooming on my arm. It was the kind of mystery bruise that can be chalked up to the ADHD tax, which for me is almost always related to becoming overwhelmed, with too many tabs open in the brain case. The challenges of executive function, at that point, exceeded my capacity to manage them.

We hear a lot about ‘executive function’. But what it is exactly? Apart from a title that brings to mind a 70’s office vibe?

Dr Russel Barkley, one of the OG voices in ADHD, says that executive function relates to all the ways that the brain can act with a goal in mind. He breaks the brains ability to do this into three main areas: self-awareness (I’m acting with a full knowlege of what I’m doing), self-restraint (the capcity to not do the thing) and self-directed sensorimotor actions, or imagination: the ability to visualise a thing, and therefore mentally practice and predict future consequences. These three things operate in concert, and they’re all impaired to some degree in an ADHD brain. Back in the neurobiology newsletter, I described the idea of Britney the door bitch blocking ‘signal function’ between the prefrontal cortex, where ideas live, and the other parts of the brain that get stuff done. That link between knowledge and action can be the sticky place for someone with ADHD, full of pitfalls and false doors. It’s part of the reason why clinicians like Barkey like to frame ADHD as a ‘performance’ rather than an ’attention’ problem.

The ability to plan, to make thoughtful choices and decisions, to problem solve and to look ahead: these are hallmarks of an ordered life. A struggle to manage them means - well. Let’s just say you might end up suddenly underwater.

‘The thing about executive dysfunction,’ says the Hacking Your ADHD podcast, ‘is that it doesn’t really feel like a choice in the moment, but it absolutely feels like a choice in retrospect. And so, when we’re trying to look back and fix our issues, it does seem like it would have worked out - had I just buckled down and done the thing.’

The result: you feel like a ‘wilful ally in your own demise.’ It looks like choice, a conscious choice, to those around us, and it feels like it must have been to us, trying to understand things in the aftermath, but in the moment, that pesky right anterior orbital prefrontal cortex, where the Choice Machine lives, is asleep. And after the thing is done, or not done, or done badly, the moment embeds a kernel of shame deep in our sense of ourselves. Why do I do this? Why am I like this? Over time, these Shame Kernels (TM) become part of who we are; pieces of what podcaster and writer Brendan Meehan calls the Wall Of Awful.

A simple task can feel very difficult to do because we are not only dealing with the task but with the Wall of Awful: the emotional barrier to it. Every brick of the Wall is made up of a past failure: the Brick of Disappointment, the Brick of Rejection, The Brick of Shame. The emotional impact of repeated failure makes activating new tasks even more difficult. The kicker: failure doesn’t even have to be real. A Perceived Failure Brick is still a brick.

Working memory, a real challenge for those with ADHD, is a vital aspect of executive function. Robust working memory allows a person to hold an idea in place, conceptualise the steps needed to action it, and ignore things that are more compelling. It’s the ‘look, a squirrel!’ problem.

Time, too, is slippery and difficult for those with ADHD, and issues with time can make for a disrupted ability to string together complex chains of actions directed towards a distant future goal. The later the goal, the harder the task. And when you can’t conceptualise a delayed future, then you tend to operate in crisis, needing those Last-Minute Larry dopamine lozenges of panic to act like stimulant medication, washing some cortisol into the brain to lift your sluggish neurotransmitters to a functional level. And adding another little brick to the Wall of Shame.

The only way to improve executive function, says Barkley, is to improve the environment. Pills don’t teach skills. Personally I use a lot of timers. I set them on my phone constantly (thank you Siri), use a pomodoro free app online and I use a visual timer like this one:

I also try to externalise my executive function as much as possible, using a series of notebooks, my chalkboard pantry and the Notes app on my phone to keep endless, looping lists.

After many decades of seeing each failure as a kind of profound inability to manage life; each one a new brick for that Wall of Shame, I’m now learning to read these moments as useful markers of my internal state. If I notice I’m a bit all over the place like a madwomans shit, I try to ask myself: Do I need a break? A sandwich? A little lie-down? To take three things off the to-do list? Each time I operate my brain with more kindness and understanding, I get a little bit better at managing my behaviour around any given body of water.

That fall won’t have been my last comedy pratfall into a spa. In fact, like the time I did a little fart in front of a room full of participants in a training program, it might even be a little bit sad to lose that unexpected moment of comedy that surprises, and often amuses, me as much as anybody else present. I hope you are able to be kind to yourselves in these moments too, in your own journey to understand your silly old brain.

Ten Good Things

1. RIP to Andrea Gibson, glorious poet.

2. 

3. Read and loved: fantastic political thriller The Peak by Sam Guthrie:

   

   4. Jane Goodall the Rethinking pod talking chimp social tactics

   

   5. Jazz Emu, courtesy of middle child:

   

   6. This heating pad and new best friend, soothing my grumpy hips.

   

   7, 8, 9 and 10: Branden Gates ‘Trump as a gay man’ series. Too good! He’s brilliant.

   

   @bransennnI wanna feel this guy’s muscles!!!!

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   @bransennnNot NOT w/ a lot of enjoyment

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@bransennnOk size queen!!!!

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@bransennn💔

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