Saturday, March 19, 2011

The Roadtrip Without A Map (no GPS either...)

Finding this last summer was an "A ha!" moment that clarified some of the confusion I've had, and where it comes from. I always though this was just attention deficit disorder going back over 10 years, but it turn out there's a bit more to it than that.

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One day in May, Robin gets a phone call from her Aunt Sue in Merryville, Missouri. Aunt Sue is planning a family reunion in July, and she wants to know if Robin 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. Robin is excited at the prospect and eagerly says, "Of course we'll be there! We wouldn't miss it!"

Aunt Sue gives Robin all the particulars, including the dates of the reunion and places to stay. Robin 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, Robin 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?" Robin's daughter practically shouts, "I'm going to Ocean City with Julie and her family sometime in July." Robin blows up at them all, yelling, "Why are you all being so negative? This is supposed to be fun!"

About once a week, Robin's husband reminds her to get the information about the reunion. She promises to do so. (And she really means to get around to it!) Finally, in June, Robin's husband gets very annoyed and says, "Do it now! I'm going to stay right here in the kitchen until you call!" Robin 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 Robin'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 to 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 cats while we're gone?" Robin 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 Aunt Sue?" 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 cats will be fine.

So, they're off. Robin'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?" Robin answers, "Missouri is west, so I know we have to go west." He looks at Robin 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, Robin says, "What map? I don't have a map." Robin's husband sighs and shakes his head. "Oh no! Another road trip without a map! Why didn't you tell me you were having trouble getting it all organized? I could have helped." Robin 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?"

Do you think Robin had made reservations for where to stay along the way? Do you think she had planned out how much cash they would need for the trip or made it to the bank ahead of time? These and many other details, of course, had escaped planning.

A List of Executive Functions

With this example as a base, let's turn back to the question of what specific abilities are covered under the umbrella term of executive functioning. Below is the list of executive functions from Dr. Gioia and his colleagues. We've included a specific illustration of each executive function from our case study of Robin in parentheses after each definition.
  • Inhibition
  • The ability to stop one's own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; if you have weak ability to stop yourself from acting on your impulses, then you are "impulsive." (When Aunt Sue 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.")
  • Shift
  • The ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation. (When the question emerged regarding who would watch the cats, Robin was stymied. Her husband, on the other hand, began generating possible solutions and was able to solve the problem relatively easily.)
  • Emotional Control
  • The ability to modulate emotional responses by bringing rational thought to bear on feelings. (The example here is Robin'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?")
  • Initiation
  • The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies. (Robin 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.)
  • Working memory
  • The capacity to hold information in mind for the purpose of completing a task. (Robin 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.)
  • Planning/Organization
  • The ability to manage current and future- oriented task demands. (In this case, Robin 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.)
  • Organization of Materials
  • The ability to impose order on work, play, and storage spaces. (It was Robin'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.)
  • Self-Monitoring
  • The ability to monitor one's own performance and to measure it against some standard of what is needed or expected. (Despite the fact that they're off to Missouri without knowing how to get there, with almost no planning for what will happen along the way, and without a map, Robin does not understand why her husband is so upset.)

The executive functions are a diverse, but related and overlapping, set of skills. In order to understand a person, it is important to look at which executive skills are problematic for her and to what degree.

That's me to a T. I have a problem getting myself into things without proper planning nor with regard to whether or not it's too much to take on (I have a hard time standing up for myself and saying no to people). Then you have the organizational skills aspect, which in some areas I just completely fail at. Maybe fail isn't the proper word, as I just have a different way of organizing that efficient for me, but might not be for other people.

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