Do ALL Autistic People Have Impairment with Executive Function?

Based on content of autistic writers, it seems that executive dysfunction automatically comes with ASD.

But can an autistic person have normal executive function? What exactly is executive function?

It’s what enables one to effectively navigate through the demands of living independently while maintaining impulse and emotional control, plus good focusing skills.

• A set of cognitive skills including flexible thinking, working memory and self-control.

• Think of executive function as the brain’s management headquarters.

• A person can have excellent executive function and still occasionally find themselves becoming uninhibited, over-emotional, careless, irresponsible and “stressing out.”

These glitches will occur more frequently if the individual is subjected to major recurring or chronic life stressors.

• In short, “keeping it together.”

Some autistic people are talented writers. It’s human nature, including among neurotypical writers, to have a tendency to write more about when things go wrong rather than when things go great.

If an autistic author has executive dysfunction, they may be more likely to write about this, than is the autist — who has normal executive function – to write about what it’s like to have normal EF.

The result is a flurry of online content by autistic authors describing their impairment with executive function, and very little content by autists describing their normal executive function.

This can create the illusion that executive dysfunction always comes with autism spectrum disorder.

“It wasn’t all that long ago that I thought to myself, ‘I can’t be autistic because my executive functioning skills are so strong!’” says Clarissa Harwell, LCSW, a therapist diagnosed with autism at 43.

“I’ve since learned how faulty that thinking is, and how broad a concept executive functioning really is.

“I have strong working memory, task initiation, comprehension, organization, planning and time management skills.

“But I also am quite directionally challenged and have dyscalculia [impairment in math skills].

“I struggle immensely with visual manuals and telling time on an analog clock.”

DOES poor executive function always come with autism?

“Not all individuals with autism have executive functioning challenges,” says Dr. Meghan T. Lee, clinical neuropsychologist and practice owner, Horizon Neuropsychological Services in Colorado.

Dr. Lee explains, “In the DSM-4, ADHD symptoms (one of which being executive functioning challenges) were automatically subsumed by autism.

“Now, the DSM-5 allows clinicians to not make this assumption, instead diagnosing both autism and ADHD if both sets of symptoms are present.”

ADHD is found more commonly in people with autism spectrum disorder than in non-autistic people. But not every autistic child or adult meets the criteria for ADHD.

Autism is the only diagnosis for some individuals, while there are people with only an ADHD diagnosis.

“Although research varies, it is generally believed that approximately 20 percent of individuals on the spectrum do not have executive functioning weaknesses,” says Dr. Lee.

Thus, all that online content by autistic authors describing challenges with their EF has a ring of truth: Most autistic individuals have struggles in this area.

“It is also important to note that executive functioning challenges span a wide range of diagnoses,” says Dr. Lee.

“As such, it is important to assess for potential comorbidities outside of ADHD if executive functioning challenges are present.”

Autism and Normal Executive Function

This cognitive function, like many abilities in humans, has a range.

Some autists in that 20 percent have what would be termed average or normal EF, while others may have superior or excellent EF.

By now, you should realize that having good executive function does not rule out the presence of autism spectrum disorder.

Autistic people with intact EF likely don’t have the additional diagnosis of ADHD, but there’s no hard data on how many autistic people – without ADHD – still struggle with EF.

My only diagnosis is autism spectrum disorder. My assessment revealed no impairment in executive function.

But perhaps better than that, my life skills are and have always been completely minus any evidence of executive dysfunction. One can hit all seven criteria for a diagnosis of ASD while still having excellent executive funtion.

If you know an autistic person who has a history of efficiently navigating persistent stressful situations while maintaining organization, emotional control and even coming up with clever solutions to the little problems that crop up – chances are pretty high that this individual has excellent executive function as it pertains to life skills.

But you’ll continue to hear much more about problems with executive function among autistic people, than normality of EF – simply because it’s human nature to write about things when they go wrong rather than right.

The takeaway is this: If you learn that someone is autistic, don’t assume anything.

Don’t assume they can’t keep organized or that they fall apart the moment they must conduct more than one task at a time or plan a road trip crossing several state lines with two young kids in tow.

Don’t make presumptions based on the three other autistic people you’ve known.

There’s a well-known saying among autists: “If you’ve met one autistic person, you’ve met ONE autistic person.”