# Theories of autism: executive function

I’m going to talk about a second cognitive theory of autism, one that I identify with quite a lot.  But first, I want to show you a video game that (sort of) works as an example.  ;  )

Klax is a simple but quirky puzzle game that was released in the arcade as well as on a lot of home video game systems.   Here’s how it works:

• A whole bunch of multi-colored tiles are tumbling down a ramp toward the player.
• The player needs to catch each of these tiles on a small white paddle by moving it left and right.
• If you miss one of the tiles, it screams (!) as it falls off the ramp and one of the lights on your “drop meter” turns on.  The game is over if you miss three tiles.
• When you catch a tile on the paddle, you can drop it into the playing area by moving the paddle left or right and pressing A.
• The object is to line up three tiles that are the same color– you can make a vertical, horizontal, or diagonal line.  When you do that, you get points and the line of tiles disappears (giving you the room you need to work with as more tiles come tumbling down the ramp).  Bonus points if you make a line four or five tiles long!
• You can stack up to five tiles on top of the paddle.  Once you reach that limit, you have to drop one of them, or you won’t be able to catch any more.
• Every level has a slightly different goal.  Sometimes only horizontal or diagonal lines will count.  Sometimes you need to get a certain number of points.
• As the game goes on, the tiles come faster and faster, and the number of different colors increases too.
• As a last desperate measure, you can fling tiles back up onto the ramp by pushing the up button.  But it’s only up there for a few seconds before you have to catch it again– along with the other tiles that were coming anyway!

Got all that?  Well, here’s a video showing the game being played.  This person doesn’t have much trouble at all until level 3.

It’s a fun game that starts out easy but gets steadily more difficult.  There’s an interesting balance of things you need to keep track of– moving to catch each tile, deciding where to drop it in the playing area, keeping the playing area from getting too full, achieving the specific task the level asks for.  It’s fun to play with a friend every once in a while to see who gets overwhelmed first!

And incidentally, that’s why Klax is my 67th favorite video game.

Okay, on to the main point of my post.  ; )

As complicated as I made the game sound in my description above, I find it easier to complete 30 levels of Klax than I often found it to organize the everyday tasks in my life when I had my first experience living by myself during grad school at Texas Tech.  Why?

Part of it is that I was able to describe everything you need to know in order to play Klax in that fairly short list of rules.  You can come up with general guidelines for all the things you need to do in day-to-day life like shopping for groceries, doing laundry, paying rent and utilities, getting haircuts, keeping your car in good shape, and fitting this in around a work and school schedule.  However, I could never make enough rules to deal with the specific tasks I might be faced with each moment, and as a result, even simple things could cascade into major problems:

• I decide to stop at the supermarket on the way home, but busy traffic or construction keeps me from getting into the turning lane I need to get there.  I wasn’t prepared to have to take a route I’ve never taken before, so I just bypass the supermarket and go home; I finish the last of my canned pasta, leaving me with just cereal.
• My clothes need to be ironed because I ran out of time to do that when I first took them out of the dryer.  But now it takes longer, and I worry that I’m running out of time to get my work done.
• I sit frozen for a while because I know that I need to do some reading, write a short online post, and do an entire assignment for class tomorrow, but I lack the energy to decide which one to do first.
• I finally decide to work on the big assignment; it takes me all night, so I never do the short online post or the reading.  I realize that my printer is out of paper.
• I’m able to find a printer on the way to class, but I realize I left my stapler back in my room.
• I do my best to stay awake in class by drawing in the margin of my page; I try to participate in the discussion, but it’s hard to do when I didn’t do the reading.
• That evening would be a good time to do something like go to the supermarket/get a haircut, but I’m too exhausted to even consider going out.  I eat cereal for dinner.

And so it would go.  At the beginning of a new semester, I’d be able to start fresh, but as the semester went on, things would pile up and I’d have to start juggling them, a lot like a person who’s about to lose in Klax– which class would it hurt me the least to fall behind in?  Should I deal with the class I’m the farthest behind in first, or should I at least keep up the pace in the one class I’m still keeping up in?

Forget about longer term goals like making friends, building career contacts, or planning for after graduation.  It was all I could do to keep my head above water.  I couldn’t understand why I was having so much trouble when I knew many of my classmates had even busier lives– let alone my teachers.  It was also pretty discouraging because I thought I had always been a pretty good student.  Why was I so overwhelmed?

Well, one of the proposed theories of autism seems to describe the sorts of difficulties I was experiencing pretty well.  This theory describes the effects of autism as a difficulty or failure of executive function.  Executive function is a bit of a nebulous concept; psychologist Uta Frith describes it as “an umbrella term for a range of higher-order control processes needed in order to perform non-routine actions.”  It’s called “executive” because it describes the sorts of decisions the CEO of a company needs to be good at.

It’s probably easier to give examples of executive function than to define it.  Here are some of Frith’s examples of  tasks that require executive function:

• Deciding when you have reached your goal.
• Holding in mind several things at once.
• Stopping behavior that is no longer useful.
• Responding flexibly in the face of change.

This list makes me laugh, because it’s a very good way to describe the opposite of me.  I think I’ll save more specific examples for other (hopefully shorter) posts, but I think the CEO in my brain is hoping for a government bailout.  I think another way to put it is that I may be smart about some things, but I lack “common sense.”  As a result, it can be a lot of work to do something simple like organizing my day.  (And that’s before I even start doing anything!)

Even though the term “executive function” is kind of sketchy, it does seem to be linked to a specific part of the brain, the frontal lobe.  The reason we know that is that people who sustain brain damage to the frontal lobe experience difficulty with the tasks in the list above.  So the hypothesis is that maybe autism affects the frontal lobe somehow.  But there’s certainly a lot we still have to learn about that.

Frith also provides a list of ways to cope with poor executive functioning skills (or to help someone else who is):

• Use clear structure.  (Definitely; it really helps to have a process to follow.)
• Give constant prompts and reminders.  (My Mom did this long distance by phone.  I love you, Mom!)
• Give outside support.  (I have a strong tendency to ask for feedback; I always want to know if I’m “doing it right.”)
• Routinise behavior.
• Cope with novelty.  (I don’t know if there’s any way to get used to new experiences besides having them, but it does help if you can go into them gradually.  That’s not always a choice, but if it is, it’s OK to try to make adjustments slowly.)
• Cope with anxiety.  (This is a major reason for my anxiety.  I can get tired out mentally before I even start doing anything.)

I am really thankful for the people God placed around me at Texas Tech.  In addition to the long-distance encouragement I got from my family, I had a church family and an on-campus Bible study group that I could share my prayer requests.  I had a friend who would talk about football with me any day of the week (which was one of the few ways I could relax.)  I had a roommate who loved to cook and would sometimes make actual dinner with meat and vegetables when all I had to eat was cereal.  I had professors who were amazingly understanding (even though I didn’t know any of this Asperger’s or executive functioning stuff back then); they would give me intermediate goals and meet with me to help me make it through some of the toughest assignments.

And I had a Savior who loved me, was with me, and supplied all of my needs.