Health Magazine

Executive Functioning Issues and Older Teens

By Gbollard @gbollard

This post follows on from my earlier post "How a Lack of Executive Functioning May Appear in Young Adults" which actually ended up looking at children rather than young adults. (Thanks Sharon for pointing that out.) Hopefully I won't get sidetracked again.  If you haven't read that post, you might want to read it before continuing here as it provides a useful introduction to the topic.
In my earlier post I defined lack of executive function and talked about the problems it can cause in day-to-day scenarios involving simple tasks, like getting dressed.  As children get older however, executive functioning difficulties become more pronounced because they're expected to be able to take responsibility for more far-reaching decisions.
The decisions made by teens can affect lives and can result in legal action, injury and even death.
An Example;
Take, as an example, the problem of driving home after a night out.
The simplified executive functioning would probably flow as follows but each component would have a myriad of ordered sub-tasks as well;
  1. Decide - Am I ok to drive home?  
    This would require both a knowledge of the drink-driving laws as well as a reasonably accurate count of one's own consumption.  Of course, if there's a tester machine handy, this simplifies things but someone with defective executive functioning could easily miss this step and not even consider their own suitability to drive. Of course, if they're well over the limit, then their executive functioning is probably even more impaired than usual and the decision will not be made without outside involvement.
  2. Decide - Are my friends ok
    Chances are, this decision would probably not even occur to an individual with Aspergers syndrome. It's not that they don't care but simply that it takes work to put themselves in someone else's shoes and they won't pick up on subtleties. If someone's speech is slurred or if they're a little unsteady on their feet, it probably won't register but of course, if they fall over - or better still, ask directly for a lift home, they'll be helped.  Even without executive functioning difficulties, this step will probably be missed.
  3. Drive Home
    Driving is an executive functioning nightmare. There are so many sequenced tasks to perform that little things, like putting a seat belt on may be missed.  There's also the constant distraction of one's driving surroundings.  Headlights from oncoming traffic, noise from the radio or passengers, street lights, traffic lights etc. You'd be surprised at how these things can further impair executive functioning.
So far, I've hardly mentioned the worst parts of executive functioning difficulties, distractions and unexpected change but both of these can be deadly..  Driving aged teens rarely seem to drive alone and the distraction of their passengers can be enough to have serious consequences.
Change is just as bad.  You might be wondering what exactly constitutes change on the road since since everything there is in motion but I can tell you that both of my worst teenage driving accidents were the result of cars being in "unexpected places".  Simply driving at different times of the day can put parked vehicles in previously moving lanes.
In the days before mobile phones, street-side telephone boxes used to be a big issue too because cars would be unexpectedly parked there when their owners were on the phone. Although these are less of a worry now, a car turning at a rarely used intersection is enough change to cause an accident.
Beyond Driving
The problems of teenagers with executive functioning difficulties don't end with cars.  Unless they have extremely strong personalities, it's hard for them to make appropriate choices when peer pressure is applied. It's also more likely that they will react incorrectly under pressure.
For example, a person involved in a low-level crime, such as underage smoking, drinking or loitering, may not realize that the crime isn't serious enough for them to be hauled off to jail.  Instead of standing their ground and accepting a lecture from the law, they may try to run or even worse, may react violently.
This is one of the reasons why so there are so many stories about people with aspergers being assaulted by police. It's not police brutality, it's simply that these young adults react inappropriately by either becoming overly defensive or by fleeing.
Finally, the problems are not limited to legal and driving issues. They also have social consequences.  For example. a female with impaired executive functioning may go too far in flirting with someone.  In particular, flirting without a clear plan or intentions.  This can lead to unsavory and dangerous responses.  It would be wrong to suggest that a female is responsible for an aggressive reaction but at the same time, an inability to read warning signals and a failure to plan for safety significantly increases her risk.
What can be done?
It's hard to know exactly what can be done to improve executive functioning skills in young adults and the problem is twofold;
  1. How to recognize a lack of executive functioning?
    If this has been picked up in a young child, and taught constantly, then there's an easy answer.  Unfortunately however most doctors talk about autism, adhd or aspergers in general terms rather than the specifics of executive functioning.
  2. How to teach a young adult to plan more effectively
    If it wasn't difficult enough to pass on the skills of successful planning and awareness to young adults, there is also the problem that young adults are not interested in this sort of "training" from their parents. While role-playing these scenarios could be helpful, it's unlikely that it could be accomplished at home. It really needs to be done as part of their formal education.
What these young adults really need is to have role-playing (and social stories) about real-life teen situations included as part of the school curriculum.  I know that it sounds a bit "sleazy" suggesting that we teach our teenagers to flirt or to prepare to depart a drunken party but role-playing these scenarios is probably the most effective means of combating the problem.  There is also the suggestion that teens with aspergers syndrome should be registered with their local police station (or at least wear a medical band) in case their condition leads to police action.
I'll be very interested to hear what my readers feel could be appropriate solutions.

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