Emotional Intelligence in Neurodiversity

Happy Hearts Day! Hmm, want your heart to be happy? Have a high emotional intelligence. Eh??

It’s a happy Valentines’ Day to all. Yeah it’s kinda sweet this mushy season especially if you’re with someone special. Oh, it’s quite common in neurodiversity to find a someone special. Believe me. But, like me, am six years single since my last relationship and haven’t found another one, it’s okay. Don’t fret. Don’t be jealous. Maybe for us neurodiverse people (and all people of course) we need to learn more about emotional and social intelligence before we worry about finding that special someone.

What is emotional intelligence?

Emotional intelligence (EI) or emotional quotient (EQ) is the knowledge of awareness and dealing with emotions or feelings. It is the capability of individuals to recognize their own, and other people’s emotions, to discriminate between different feelings and label them appropriately, and to use emotional information to guide thinking and behavior.[1]

Usually most people do acquire emotional intelligence as they learn to navigate the world from their childhood ie by slowly learning to control their feelings like learning to delay gratification by not whining or throwing tantrums as they get older. Or when they become adults they try to calm down when being nagged by an angry employer or lover and not just shout back and curse them unless they cause so much harm or have an emergency situation.

Now, the problem with neurodiverse people, people with learning disabilities and developmental disorders and people with extremes in intelligence, their emotional intelligence is usually less developed than most people or the typically developing people. Why is this that so? Because these people usually has atypical or not so usual brain development ie too rapid cognitive development like giftedness, errors in brain chemicals that govern the brain and its activities like in ADHD or lack of theory of mind or the ability to read other people in cases of autism spectrum disorders, these can cause less development of the emotional intelligence.

What is the implication of the lack of EQ to neurodiverse people?

The thing here is because neurodiverse people have less developed EQs, their dealing with emotions is much harder to control. Let’s give child prodigies as example. Usually parents of child prodigies just harness their children’s area of gift (usually classical music or math) and they train these kids harshly as if they’re robots that do nothing but practice all day or study without teaching them to be more aware of themselves – their strengths and weaknesses. Now prodigies do excel in their gifts, but that cannot be sustained. Why? Because these kids tend to become their own uinverse thanks to parents who want them to be always the winner and being a loser means they’re rubbish and a loser anyway, they tend to lash out when they lose or may become withdrawn and quiet, not able to deal with their own emotions. This is not good as it can result in having emotional problems later on in life.

People in neurodiversity have more problems picking up and understanding emotions but this is not due to their laziness or sort but because of the brain structure. In children in ADHD, some brain parits are actually smaller than the brains of children without ADHD. Overall rain size is generally 5% smaller in affected children than children without ADHD.[2] This means that the part of brain dealing with emotions is somewhat less developed. This makes children with ADHD less attuned with their own feelings and just blurt out hurtful words or become too emotional that is not appropriate for their age ie a middle schooler throwing tantrums and behaving like a 2-year-old.

Image courtesy of quotesgram.com. Oh! this dog is too cranky. People with lower EQ have much more tendency to be cranky all of the time especially when they can’t get  what they want.

What are the complications of having a low EQ?

Psychological problems may arise from not being aware of their feelings. they may become more obsessed with numbing their emotions by having a vice (illegal drugs, casual sex)  or become more dependent too other people (as security blanket – hmm I’m guilty of this as I used my mom as my security blanket to hide my emotional inadequacy). Also, by not being aware of your emotions, you’ll also never to learn to be aware and support other people’s feelings. You become more selfish and childish in your ways just trying to consider only yourself not other people. That is so bad. People will get avoid and dislike you, which si the reason why a lot of neurodiverse people are single or have turbulent relationship history.

Not good right? Now, what are the characteristics of people with high emotional intelligence and how neurodiverse people can learn from them?

Daniel Goleman, an American psychologist, developed a framework of five elements that define emotional intelligence[3]:

1. Self-Awareness – People with high EI are usually very self-aware . They understand their emotions, and because of this, they don’t let their feelings rule them. They’re confident – because they trust their intuition and don’t let their emotions get out of control.[4]
2. Self-Regulation – This is the ability to control emotions and impulses. People who self-regulate typically don’t allow themselves to become too angry or jealous, and they don’t make impulsive, careless decisions. They think before they act. Characteristics of self-regulation are thoughtfulness, comfort with change,integrity , and the ability to say no.[4]
3. Motivation – People with a high degree of EI are usually motivated . They’re willing to defer immediate results for long-term success. They’re highly productive, love a challenge, and are very effective in whatever they do.[4]
4. Empathy – This is perhaps the second-most important element of EI. Empathy is the ability to identify with and understand the wants, needs, and viewpoints of those around you. People with empathy are good at recognizing the feelings of others, even when those feelings may not be obvious. As a result, empathetic people are usually excellent at managing relationships , listening , and relating to others. They avoid stereotyping and judging too quickly, and they live their lives in a very open, honest way.[4]
5. Social Skills – It’s usually easy to talk to and like people with good social skills, another sign of high EI. Those with strong social skills are typically team players. Rather than focus on their own success first, they help others develop and shine. They can manage disputes, are excellent communicators, and are masters at building and maintaining relationships.[4]

All these five are needed in order to have a high emotional intelligence. Easier read than applied, right? Especially if you have a learning disability right?

Yes. That’s only a part, but trust me, all people do have to learn how to have emotional intelligence. In short everybody. But also we need also EQ, needed it more than IQ in order to be more satisfied in life and in ourselves.

How to increase your EQ?

Awareness and acceptance are the key elements in developing your EQ. To develop your EQ you just first be aware of what are you feeling. Note your emotional reactions to events throughout the day. It’s easy to put your feelings about what you experience throughout the day on the back burner. But taking time to acknowledge how you feel about experiences is essential to improving your EQ.[5]

Pay attention to your body. Instead of ignoring the physical manifestations of your emotions, start listening to them. Our minds and bodies are not separate; they affect each other quite deeply.[5]

Wikihow gives some examples of feelings with physical signs[5]:

Stress might feel like a knot in your stomach, tight chest, or quick breathing.
Sadness might feel like waking up with slow, heavy limbs.
Joy or pleasure might feel like butterflies, your stomach, a racing heart or increased energy.

Observe how your emotions and behavior are connected.[5] For example when you see your crush, what do you do, do you hide? Become speechless and run away? Or when you’re angry, you throw things like I used to do. This is very important especially for people who can’t fully express themselves verbally (autism, expressive language disorders and the like) as behavior can make or break in dealing with other people. Especially if a person behaves destructively. She can hurt herself as well as other people. This can cause social isolation and can lead to more severe psychological problems like depression.

And accept your feelings wholeheartedly. No judging. Even if you feel ashamed (I’m still guilty of this but am trying to fight it). Feel it. Accept your feelings as your own. But please don’t wallow on them.

Practice deciding how to behave. You can’t help what emotions you feel, but you can decide how you want to react to them. If you have an issue with lashing out in anger or shutting down when you’re hurt, think about how you’d rather react.[5] It’s actually hard. Promise, but really practice makes perfect. And when you fail to do, don’t punish yourself. Don’t also use escapist behaviors like binge eating/drinking, compulsive gambling etc.

More tips[5]:

Be open-minded and agreeable. Consider other people’s point of view. Not just me, myself and I. That’s emotional immaturity.

Improve your empathy skills. Instead of just pitying another person who has problems, imagine yourself in that situation that person has as if it’s your own. Very hard because you have Asperger’s? Yeah hard, but you must. Now when you imagine that you have that problem, it’s much easier for you to understand and support your loved one in trial.

Read people’s body language. How? Observe how people act and they say and compare them to see if there’s any discrepancy. Hard? Literally study people as if they’re academic subjects. Also you can watch your favorite television show and observe how characters behave.Here you’ll learn about body language and you can compare a sincere person or not.

Practice being emotionally honest. Don’t ever lie about your feelings like telling “I’m fine” but in fact you’re cranky. That’ll lower your EQ and you are being dishonest to yourself and other people.

See where you have room for improvement. Being intellectually capable is important in life, but being emotionally intelligent is just as essential. Having high emotional intelligence can lead to better relationships and job opportunities.

Be more light-hearted at home and at work. When you’re optimistic, it’s easier to see the beauty in life and everyday objects and spread that feeling to those around you. Practice this everyday and poof all people will be drawn to you. Be negative and people will avoid you for good.

Hope this will help all of us here, whether neurodiverse or neurotypical. Maybe that special someone will come to you and have a sweeter Valentine’s day or even if not, at least you’ll become more content with your emotions and life as well.♡

Reference:

1. https://en.wikipedia.org/wiki/Emotional_intelligence
2. http://www.additudemag.com/adhd-web/article/5008.html
3. http://www.danielgoleman.info/topics/emotional-intelligence/
4. https://www.mindtools.com/pages/article/newCDV_59.htm
5. http://m.wikihow.com/Develop-Emotional-Intelligence

Executive Function, the Brain’s Director

You hear it. You read it. Executive functioning, which is almost always broken in ADHD or autism and other developmental disorders and learning disabilities. Ever wonder what is executive functioning? What is executive functioning?

Image courtesy of Psychology Today. Executive Function in the brain.

Executive function (EF) (also known as cognitive control and supervisory attentional system) is an umbrella term for the management (regulation, control) of cognitive processes[1][2], including working memory, reasoning, task flexibility, and problem solving[1][3], as well as planning and execution.[1][4]

Executive function consists of several mental skills that help the brain organize and act on information. These skills enable people to plan, organize, remember things, prioritize, pay attention and get started on tasks. They also help people use information and experiences from the past to solve current problems.[5]

In short, executive function is comparable to a company’s CEO, a celebrity’s manager, a sport team’s coach, the film’s director, an orchestra’s conductor, or a computer’s CPU; all of them direct what a group or a person will do to make a group run smoothly.

Image courtesy of Balboa School. The brain’s executive function is comparable to a computer’s CPU.

There are 8 key executive functions in the brain according to Understood.[6] What are they?

Eight Key Executive Functions:

1. Impulse Control – helps your child think before acting.
2. Emotional Control – helps you child keep his feelings in check.
3. Flexible Thinking – allows your child to adjust to the unexpected.
4. Working Memory -helps your child keep key information in mind.
5. Self-Monitoring – allows your child to evaluate how you’re doing.
6. Planning and Prioritizing – help your child decide on a goal and a plan to meet it.
7. Task Initiation – helps your child take action and get started.
8. Organization – lets your child keep track of things physically and mentally.

Two of the major ADHD researchers involved in studying EF are Russell Barkley, PhD, and Tom Brown, PhD, have also their own version of key executive functions[7]:

Barkley breaks executive functions down into four areas[7][8]:

1. Nonverbal working memory
2. Internalization of Speech (verbal working memory)
3. Self-regulation of affect/motivation/arousal
4. Reconstitution (planning and generativity)

Brown breaks executive functions down into six different “clusters.”[7][9]

1. Organizing, prioritizing and activating for tasks
2. Focusing, sustaining and shifting attention to task
3. Regulating alertness, sustaining effort and processing speed
4. Managing frustration and modulating emotions
5. Utilizing working memory and accessing recall
6. Monitoring and self-regulating action

Hmm.. they’re like the soccer team. Each member must function and cooperate well to win a game.

(C) Cartoon Network. Key executive functions are like a soccer team.

With executive function in sync, learning is much easier for a growing child up to his adulthood.

How executive function develops?

A range of tests measuring different forms of executive function skills indicate that they begin to develop shortly after birth, with ages 3 to 5 providing an important window of opportunity for dramatic growth in these skills. Growth continues throughout adolescence and early adulthood; proficiency begins to decline later in life.[10]

Image courtesy of Harvard University/NIH Toolbox project. This graph shows executive function development and proficiency across the life span.

Where in the brain is executive function?

Historically, the executive functions have been seen as regulated by the prefrontal regions of the frontal lobes,[1] but a review found indications for the sensitivity but not for the specificity of executive function measures to frontal lobe functioning. This means that both frontal and non-frontal brain regions are necessary for intact executive functions.[1]

Neuroimaging and lesion studies have identified the functions which are most often associated with the particular regions of the prefrontal cortex.[1][11]

The prefrontal cortex has its parts where specific executive functions are:

• The dorsolateral prefrontal cortex (DLPFC) is involved with “on-line” processing of information such as integrating different dimensions of cognition and behaviour.^[12] As such, this area has been found to be associated with verbal and design fluency, ability to maintain and shift set (mental ability to switch between thinking about two different concepts, and to think about multiple concepts simultaneously), planning, response inhibition, working memory, organisational skills, reasoning, problem solving and abstract thinking.^[11][13]
• The anterior cingulate cortex (ACC) is involved in emotional drives, experience and integration.^[12] Associated cognitive functions include inhibition of inappropriate responses, decision making and motivated behaviours. Lesions in this area can lead to low drive states such as apathy (absence of feelings), abulia (lack of will or initiative) or akinetic mutism (patients tending neither to move (akinesia) nor speak (mutism)) and may also result in low drive states for such basic needs as food or drink and possibly decreased interest in social or vocational activities and sex.^[12][14]
• The orbitofrontal cortex (OFC) plays a key role in impulse control, maintenance of set, monitoring ongoing behaviour and socially appropriate behaviours.^[12] The orbitofrontal cortex also has roles in representing the value of rewards based on sensory stimuli and evaluating subjective emotional experiences.^[15] Lesions can cause disinhibition, impulsivity, aggressive outbursts, sexual promiscuity and antisocial behaviour.^[11]

Image courtesy of Wikipedia/Natalie M. Zahr, Ph.D., and Edith V. Sullivan, Ph.D. Preforntal cortex in the brain’s frontal lobe.

When children have opportunities to develop executive function and self-regulation skills, individuals and society experience lifelong benefits. These skills are crucial for learning and development. They also enable positive behavior and allow us to make healthy choices for ourselves and our families.[10]

When children have opportunities to develop executive function and self-regulation skills, individuals and society experience lifelong benefits.

We usually have this executive function taken for granted. But for people in neurodiversity, their executive function is broken or impaired, inhibiting their normal functioning.

What happens if executive function is impaired?

If executive functioning is working well and the task is fairly simple, the brain may go through these steps in a matter of seconds. If your child has weak executive skills, though, performing even a simple task can be challenging. Remembering a specific word may be as big a struggle as planning tomorrow’s schedule.[5]

When executive functioning is impaired, all of its functions cannot be done or sustained. Hence, this is called executive function disorder (EFD) or executive dysfunction.

If your child has executive functioning issues, any task requiring these skills could be a challenge. That could include doing a load of laundry or completing a school project. Having issues with executive functioning makes it difficult to:

• Keep track of time
• Make plans
• Make sure work is finished on time
• Multitask
• Apply previously learned information to solve problems
• Analyze ideas
• Look for help or more information when it is needed[5]

To explain this further, let’s include the 8 key executive functions and how they become impaired when executive function is broken:

1. Impulse Control – Kids with weak impulse control might blurt out inappropriate things. They’re more also likely to engage in risky behavior.[6]
2. Emotional Control – Kids with weak emotional control often overreact. They can have trouble dealing with criticism and regrouping when something goes wrong.[6]
3. Flexible Thinking – Kids with “rigid” thinking don’t roll with the punches. They might get frustrated if asked about something from a different angle.[6]
4. Working Memory – Kids with weak working memory have trouble remembering directions – even if they’ve taken notes or you’ve repeated them several times.[6]
5. Self-Monitoring -Kids with weak self-monitoring may be surprised by a bad grade or negative feedback.[6]
6. Planning and Prioritizing – Kids with weak planning and prioritizing skills may not know which parts of a project are most important.[6]
7. Task Initiation – Kids who have weak task initiation skills may freeze up because they have no idea where to begin.[6]
8. Organization -Kids with weak organization skills can lose their train of thought – as well as their cell phone or homework.[6]

EFD is relatively common in neurodiversity and less so in neurotypical people and can affect people of any degree of intelligence and capability.[16] Unfortunately, EFD is often mistaken as ADHD or LD (learning disabilities) by doctors (ADHD can have no EFD, just their hyperactive and inattentive problems). But despite giving learning therapies, children with EFD do not respond to them, thus mistaking them as lazy, unmotivated, stubborn or uncooperative. Usually, nothing could be further from the truth. They are working as hard as they can to keep pace with the demands in their lives.[16]

Very bad. Not only they will suffer in school and cause educational underachievement –  suspension, dropping out of school, repeating a grade, but also they will have a high risk of becoming unemployed and socially isolated, increasing risk for mental disorders.

What causes EFD?

In most cases of executive dysfunction, deficits are attributed to either frontal lobe damage or dysfunction, or to disruption in fronto-subcortical connectivity. Neuroimaging with PET and fMRI has confirmed the relationship between executive function and functional frontal pathology.[2][17] Certain genes have been identified with a clear correlation to executive dysfunction and related psychopathologies.[17] Not surprisingly, plaques and tangles in the frontal cortex can cause disruption in functions as well as damage to the connections between prefrontal cortex and the hippocampus.[17][18] Another important point is in the finding that structural MRI images link the severity of white matter lesions to deficits in cognition.[17][19]

The heritability of executive functions is among the highest of any psychological trait.[17][20] The dopamine receptor D4 gene (DRD4) with 7′-repeating polymorphism (7R) has been repeatedly shown to correlate strongly with impulsive response style on psychological tests of executive dysfunction.[17][21]

Image courtesy of http://www.des-livres-pour-changer-de-vie.fr./all-gifted.com. Einstein’s desk shortly after his death. Disorganized work areas don’t necessarily mean sloppy. This is one manifestation of executive function disorder (EFD).

Image courtesy of The Telegraph. This is a messy table. Can be an EFD or just simply lazy.

What needs to be done for EFD?

Early assessment needs to be done to avoid problems in school, work, and social relationships that could affect a person with EFD.

According to a local expert on EFD, Sarah Ward, M.S.,CCCSLP, of Lincoln, Massachusetts, one of the biggest complaints about children with EFD is, “They did it yesterday, why can’t they do it today?” For such children, however, the organizing pattern is not established in one pass; pathways must be developed through repeated practice. An important method of helping these kids is by teaching processing skills. Ward believes that this can be done most effectively through[16]:

1. Segmentation: Teaching (not telling) students how to break down a task into smaller, manageable parts.
2. Verbal approach: Using declarative language, instead of imperative language
3. Mental picturing: Teaching students to think through a situation in order to envision how a goal can be accomplished
4. Using visuals as a reinforcement.

Now, there is an application of these strategies in the following quotation from aane.org[16]:

Ward gives an example that uses these four techniques. A child was asked to set the table for dinner. She got stuck and overwhelmed in her attempts to do the task.

1. The child was helped to break down the task to a manageable level, in this case putting out four plates.
2. Once this was accomplished, the use of declarative language helped determine the next step. Rather than saying, “Okay, now put out the forks and knives” (imperative), the statement Ward made was, “Great, the plates are out. Now we’ll need something to eat the food with” (declarative).
3. In this one brief statement, the child was given specific positive feedback for what she had done (“Great, the plates are out” as opposed to the generic “Good job”), and was asked to assess the situation and figure out what came next.
4. Ward often uses photos or drawings to reinforce the concept being taught. In this case she used a photo of a correctly set table. It “conjured up the whole” and showed what it would look like if the table were set properly. Ward often uses stock images such as those found in Google Images (Ward even Googled Hamlet to show whatever images there were to help a student write an essay about the character!)

These concepts work equally well in school situations. As teachers we often say something like, “Take out your ruler and calculator and get ready for math.” Ward suggests that a better way to help students develop skills that will generalize to future situations is to say, “We’re going to do graphing now. How would your desk look? What is involved in graphing?” This teaches the student to become more self-directed by encouraging the development of self-talk, which Ward calls “notes to self.” The development of this kind of self monitoring is essential to effective, independent thinking and functioning.

Another crucial concept children need to learn, Ward says, is the “sweep and passage of time.” She explains that we teach kids to read the clock, but this has little to do with monitoring the passage of time. Ward uses a wall clock with a glass cover and actually draws on its surface with erasable markers to block off the amount of time that will be allowed for a task. In Ward’s estimation this concrete visual “pie shape” method of demonstrating the passage of time gives a sense of control and improves motivation, because “They can see they are succeeding.”

There are tests to diagnose EFD in people. Here they are:

Clock Drawing Test (CDT) – The Clock drawing test (CDT) is a brief cognitive task that can be used by physicians who suspect neurological dysfunction based on history and physical examination.[17]

The procedure of the CDT begins with the instruction to the participant to draw a clock reading a specific time (generally 11:10). After the task is complete, the test administrator draws a clock with the hands set at the same specific time. Then the patient is asked to copy the image.[17][22] Errors in clock drawing are classified according to the following categories: omissions, perseverations, rotations, misplacements, distortions, substitutions and additions.[17][23] Memory, concentration, initiation, energy, mental clarity and indecision are all measures that are scored during this activity.[17][24] Those with deficits in executive functioning will often make errors on the first clock but not the second.[17][23]

Stroop task – The Stroop task requires the participant to engage in and allows assessment of processes such as attention management, speed and accuracy of reading words and colours and of inhibition of competing stimuli.[17][25] The stimulus is a colour word that is printed in a different colour than what the written word reads. For example, the word “red” is written in a blue font. One must verbally classify the colour that the word is displayed/printed in, while ignoring the information provided by the written word. In the aforementioned example, this would require the participant to say “blue” when presented with the stimulus. Although the majority of people will show some slowing when given incompatible text versus font colour, this is more severe in individuals with deficits in inhibition. The Stroop task takes advantage of the fact that most humans are so proficient at reading colour words that it is extremely difficult to ignore this information, and instead acknowledge, recognize and say the colour the word is printed in.[17][26]

Wisconsin card sorting test (WCST) – The WCST utilizes a deck of 128 cards that contains four stimulus cards.[17][25] The figures on the cards differ with respect to color, quantity, and shape. The participants are then given a pile of additional cards and are asked to match each one to one of the previous cards. Typically, children between ages 9 and 11 are able to show the cognitive flexibility that is needed for this test.[17][27][28]

Trail-making test – This test is composed of two main parts (Part A & Part B).[17] The participant’s objective for this test is to connect the circles in order, alternating between number and letter (e.g. 1-A-2-B) from start to finish.[17][29] The participant is required not to lift their pencil from the page. The task is also timed as a means of assessing speed of processing.[17][30] Set-switching tasks in Part B have low motor and perceptual selection demands, and therefore provide a clearer index of executive function.[17][31] Throughout this task, some of the executive function skills that are being measured include impulsivity, visual attention and motor speed.[17][30]

What about the adult with EFD?

Just like the child/student with EFD, an adult who has it certainly has problems in working memory, task completion, and emotional regulation. An adult with EFD will struggle to sustain a regular job, run a household, and control her emotions as well as maintaining relationships.

The adult with EFD experiences the following struggles in an excerpt from the Yellow Brick Program:

For those emerging adults who are not competent in these life skills, their self-image and self-esteem suffer tremendously. They feel debilitating shame and self-recrimination. They try to hide their incompetence, not asking for help, soon they are overwhelmed with dirty laundry, broken appliances, messy refrigerators, and unpaid bills. For example, one young man is fully capable of showering, dressing himself, and making it to appointments, but he has never experienced independent living. He has not learned how to do laundry, budget his money, or set up utilities in a new apartment.

He feels great shame and self-contempt, as if he’s “supposed to know how” to do these things, even though he has not had a chance to learn. Instead of reaching out to those around him who can show him the way, he denies his needs out of humiliation and self-condemnation. Instead of asking for assistance, he laughs at the thought, stating he doesn’t need the help. At these moments, he feels utterly alone in the world, unable to request the help he needs because he thinks he should already know how to do everything. Even when those around him offer support, he brushes it off, later resenting that no one is there to support him. The idea of successfully living an independent life seems hopeless.

To a parent, teacher, or boss, what looks like laziness or irresponsibility may actually be executive functioning deficits, which are neurological mechanisms tied to specific brain functions key to development at this age. The parent sees the son who isn’t showering and is distressed, concludes that he is lazy or doesn’t care about his appearance, when it is really a deficit in the executive function of “initiation.” A teacher observes a student who forgets to turn in homework all the time and concludes that student is irresponsible when, really, it is a deficit in “planning.” A boss sees an employee who gets stuck on simple tasks as “dumb” when, in reality, it is a deficit in “problem-solving.”[32]

Very embarrassing, isn’t it?

That’s why identification of a executive function disorder is important in order to manage its problems so the person affected will have less problems in his everyday life. Managing EFD in adults is similar to therapies done on children, but on an adult level.

If you are a person with EFD or suspected EFD, follow the given intervention above of segmentation of tasks to avoid confusion. Also, try to choose a job with less “procedural” tasks, i.e., musician versus nurse (where a nurse has a lot of “procedural” tasks that needs very intact executive function; musicians do not need to have that as they are only require to repeatedly play a musical instrument plus memorize a particular piece).

Remember, next time you encounter a”lazy” child or “disorganized person,” maybe you can suspect that he has impaired executive function, which most of us would normally take it for granted.

To conclude this, let’s take an excerpt from all-gifted.com:

Before that goes away, we as parents must work hard so that our children at least keep up with the work required of them.  We must chip in to help, teach time management and organization skills, and look out for tools to phase them into self-reliance.[33]

That’s right. The earlier the identification and assessment, the better.

So if you have a child who is so gifted in other areas that his executive function falls behind and into judgmental eyes, would you crucify him for what he lacks, or would you patiently work and put things in place for him until he finds his next champion or develop his own planning methodologies and coping strategies?[33]

References:

1. https://en.wikipedia.org/wiki/Executive_functions
2. Elliott R (2003). Executive functions and their disorders. British Medical Bulletin. (65); 49–59
3. Monsell S (2003). “Task switching”. TRENDS in Cognitive Sciences 7 (3): 134–140.doi:10.1016/S1364-6613(03)00028-7. PMID 12639695.
4. Chan, R. C. K., Shum, D., Toulopoulou, T. & Chen, E. Y. H., R; Shum, D; Toulopoulou, T; Chen, E (2008). “Assessment of executive functions: Review of instruments and identification of critical issues”. Archives of Clinical Neuropsychology. 2 23 (2): 201–216.doi:10.1016/j.acn.2007.08.010. PMID 18096360.
5. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/understanding-executive-functioning-issues
6. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/key-executive-functioning-skills-explained
7. http://www.help4adhd.org/faq.cfm?fid=40tid=9varLang=en
8. Barkley, Russell A., Murphy, Kevin R., Fischer, Mariellen (2008). ADHD in Adults: What the Science Says (pp 171 – 175). New York, Guilford Press.
9. Brown, Thomas E. (2005). Attention Deficit Disorder: The Unfocused Mind in Children and Adults (pp 20 – 58). New Haven, CT, Yale University Press Health and Wellness.
10. http://developingchild.harvard.edu/key_concepts/executive_function/
11. Alvarez, J. A. & Emory, E., Julie A.; Emory, Eugene (2006). “Executive function and the frontal lobes: A meta-analytic review”. Neuropsychology Review 16 (1): 17–42. doi:10.1007/s11065-006-9002-x.PMID 16794878.
12. Lezak, M. D., Howieson, D. B. & Loring, D. W. (2004). Neuropsychological Assessment (4th ed.). New York: Oxford University Press. ISBN 0-19-511121-4.
13. Clark, L., Bechara, A., Damasio, H., Aitken, M. R. F., Sahakian, B. J. & Robbins, T. W., L.; Bechara, A.; Damasio, H.; Aitken, M. R. F.; Sahakian, B. J.; Robbins, T. W. (2008). “Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision making”. Brain 131 (5): 1311–1322.doi:10.1093/brain/awn066. PMC 2367692.PMID 18390562.
14. Allman, J. M., Hakeem, A., Erwin, J.M., Nimchinsky E. & Hof, P., John M.; Hakeem, Atiya; Erwin, Joseph M.; Nimchinsky, Esther; Hof, Patrick (2001). “The anterior cingulate cortex: the evolution of an interface between emotion and cognition”. Annals of the New York Academy of Sciences 935 (1): 107–117.Bibcode:2001NYASA.935..107A. doi:10.1111/j.1749-6632.2001.tb03476.x. PMID 11411161.
15. Rolls, E. T. & Grabenhorst, F., Edmund T.; Grabenhorst, Fabian (2008). “The orbitofrontal cortex and beyond: From affect to decision-making”.Progress in Neurobiology 86 (3): 216–244.doi:10.1016/j.pneurobio.2008.09.001. PMID 18824074.
16. http://www.aane.org/asperger_resources/articles/education/executive_function_disorder.html
17. https://en.wikipedia.org/wiki/Executive_dysfunction
18. Clark C, Gallo J, Glosser G, Grossman M (2002). Memory encoding and retrieval in frontotemporal dementia and Alzheimer’s disease. Neuropsychology. 16(2); 190–96
19. Buckner, R. (2004). Memory and executive function in aging and AD: multiple factors that cause decline and reserve factors that compensate” Neuron 44;195–208
20. Friedman, et al (2008). Individual differences in executive functions are almost entirely genetic in origin. Journal of experimental psychology, 137(2), 201–10.
21. Langley K, Marshall L, Bree M van den, Thomas H, Owen M, O’Donovan M, Thapar A (2004). Association of the dopamine D4 receptor gene 7-repeat allele with neuropsychological test performance of children with ADHD” American Journal of Psychiatry161(1),133–38.
22. Jeste DV, Legendre SA, Rice VA, et al (2004). “The clock drawing test as a measure of executive dysfunction in elderly depressed patients.” Journal of Geriatric Psychiatry and Neurology. 17(190)
23. Shulman, K (2000). Clock drawing: Is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry. 15(6); 548–61
24. Damasio H, Rudrauf D, Tranel D, Vianna E (2008). Does the clock drawing test have focal neuroanatomical correlates? Neuropsychology. 22(5); 553–62
25. Biederam J, Faraone S, Monutaeux M, et al (2000). Neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder” Journal of Abnormal Psychology 109(2); 252–65
26. MacLeod C (1991). Half a century of research on the Stroop effect: An integrative review”Psychological Bulletin 109(20); 163–203
27. Kirkham, N. Z.; Cruess, L.; Diamond, A. (2003). “Helping children apply their knowledge to their behavior on a dimension-switching task”. Developmental Science 6: 449–476. doi:10.1111/1467-7687.00300.
28. Chelune, G. J.; Baer, R. A. (1986). “Developmental norms for the Wisconsin Card Sorting Test”. Journal of Clinical and Experimental Neuropsychology 8: 219–228. doi:10.1080/01688638608401314.
29. Gaudino E, Geisler M, Squires N (1995). Construct validity in the trail making test: What makes part B harder? Journal of Clinical and Experimental Neuropsychology. 17(4); 529–35
30. Conn H (1977). Trail-making and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Digestive Diseases. 22(6); 541–50
31. Arbuthnott K, Frank J (2000). Trail making test, Part B as a measure of executive control: validation using a set-switching paradigm. Journal of Clinical and Experimental Neuropsychology. 22(4); 518–28
32. http://www.yellowbrickprogram.com/Papers_By_Yellowbrick/ExecutiveFunctionEmergingAdult_P1.html
33. http://www.all-gifted.com/executive-dysfunction.html

Further Reading:

1. http://www.additudemag.com/adhd/article/8392.html
2. https://www.psychologytoday.com/blog/aristotles-child/201107/executive-functioning-and-the-troubled-brain
3. http://www.rainbowrehab.com/executive-functioning/

Neurodivergent Sexuality, Part 2

In my Neurodivergent Sexuality post, I discussed how sexuality is presented to neurodiverse people particularly for people with autism spectrum disorders (ASD), including strategies in addressing sexual behavior and sex education. Of all conditions in neurodiversity, ASD has the most issues regarding sexuality as ASD people can’t intuitively read sexual cues causing them to struggle to find satisfying sexual relationships and becoming prone to sexual harrassment, unwanted pregnancies, and sexually transmitted diseases. But aside from ASD, people with learning disabilities (LD), ADHD, Tourette Syndrome (TS), language disorders, and sensory processing disorder do also have issues regarding sexuality.

What are the specific issues in sexuality that are presented to each neurodiverse condition?

I enumerated the following problems below:

ADHD – impulsive sexual advances without could make someone be mistaken as a pervert. Not good for romantic relationships. Impulsiveness can be a high risk for promiscuity too and can contract an STD. Inattention, which may be mistaken as being rude or never caring at all may cause strain in a sexual relationship.

According to a Psychology Today article, sex problems in neurotypicals are doubled in people with ADHD: People with ADHD have the same difficulties with sex as people without ADHD, but perhaps more often or more intensely. I call this the ADHD multiplier: the ADHD multiplies the difficulties, but doesn’t really create unique problems that others aren’t also experiencing. Many of the sexual problems for these folks isn’t about sex per se, but about the relationship struggles that undermine a satisfying sex life.[1] This can include making impulsive sexual choices, with all the consequences that that can bring. People who are thrill-seekers (such as some people with the hyperactive and impulsive symptoms of ADHD) are more likely to engage in problematic sexual behaviors, including over-using pornography.[1]

Image courtesy of feministezine.com. Does this husband has a learning disability? He seemed to pick up the wrong condom. ^_^

Other problems include:

• Losing focus during sex can cause men to lose some or all of their erection or for women to lose some of their lubrication and can delay orgasm for both.[1]
• People with ADHD will often get bored more easily than others or will more quickly get used to something. Therefore they will seek novelty to re-engage their attention and cause their brain to light up again. Just as it can happen in the classroom, it can also happen in the bedroom.[1] In short, they become easily bored to “vanilla” sex (no, not the 50 Shades stuff). What I mean is they become bored right away with a few repertoire of activities, positions, and/or locations.[1]
• Because of boredom, people with ADHD are more likely to have sexually transmitted diseases and have more sexual partners.[1][2] People with ADHD may be more likely to cheat.[1][3]

(C) Focus Features/Universal. Do ADHD people want a “50 Shades of Grey” type of sex?

Tourette Syndrome – strong involuntary tics may interfere with sex causing sexual frustration. Also, some tics may be mistaken as sexual abuse cue, which makes a person with TS mistaken as a sex offender.

Learning disabilities – People with learning disabilities are not much given sex education. It can be difficult to strike a balance between protecting people with learning disabilities from risks and allowing them to explore and develop wider personal and social relationships.[4] Young people and adults with learning disabilities are much less likely to have access to this kind of information because of attitudes towards disability and sexuality, lack of resources and lack of professionals qualified to provide the right kind of information and appropriate support.[4] Like in other conditions in neurodiversity, people with LDs do also find it hard to comprehend appropriate sexual behaviors, i.e. finding a private place for masturbation, reading sexual cues, etc.

Specific LDs:

• Dyslexia – because they have poor reading comprehension, reading about sex education materials (I didn’t say porn) is an issue; they’ll not learn the very basics of sexuality like orientation, sexual behavior, contraception, and how to’s on building a healthy sexual relationship. Intimacy may be an issue too. Writing (is that still in??)) romantic letters can be daunting as well. Can be a turn-off to a partner.
• Dyscalculia – dyscalculics have problems in distances and timing, which makes him or her find some difficulty in performing certain acrobatic-like sex positions.
• Dyspraxia – like dyscalculia, he or she may also have problems in sex positions thanks to uncoordinated movements. Clumsy hygiene practices are a major turn-off in a potential sexual partner.

Language disorders – Communication is the main issue here. People with language disorders find it hard to express their sexual needs, which may lead also to sexual frustration. Sometimes these people are also vulnerable to sexual abuse because of their language comprehension and expression difficulties.

Sensory processing disorder (SPD) – for people with tactile defensiveness (very sensitive to touch, gets irritated) type of SPD, sex is especially difficult. Since sex involves a lot of touching (yeah I mean a LOT, including kissing, cuddling, fondling…and touching all the way and I have to stop mentioning the obvious details), some people with tactile SPD are averse to sexual activities.

To better illustrate the sensitivity of SPD in the bedroom, I’ll quote an excerpt from YourTango[5]:

Now imagine that you’re a person who is “weird,” “geeky” or “overly sensitive,” but you’re lucky enough to have a long-term relationship. Chances are your partner started out as loving and understanding, thinking that once you started to relax and feel secure in the relationship, you’d be less likely to react to the “little things” that seem to drive you nuts. But it’s been years now, and you haven’t changed. All sorts of things set you off. You’re still so nervous! Your partner has a hard time coaxing you into intimacy too, which she thinks would be helpful for both of you – but she doesn’t know that it’s because you can’t get an erection when your teeth hurt, and the reason your teeth are hurting is because that fresh coat of yellow paint on your bedroom walls puts you so much on edge that you’re grinding your teeth just to stay in the room! She’d think you were just making excuses and over-reacting again. She’d think you don’t really love her if something like a color would keep you from feeling aroused.

The marriage counselor or sex therapist you both saw said that you had to make an effort to be “less selfish” and your partner agreed. You’ve had too many fights about sex over the years, and you’re very afraid of that kind of fight, so you don’t say anything when your partner begins to stroke you, and nothing much happens, so you just pretend you’re tired, and you shut your eyes against that yellow, which still bruises your nerves even though it’s dark, and so both of you go to sleep unhappy and hurt.[5]

Very frustrating, right? And usually the non-SPD partner feels abandoned or unloved or becomes insecure because he or she is ‘not attractive’ to his/her partner.

Image courtesy of Huffington Post. Sex can be a very big issue in sensory processing disorder.

What to do to solve or minimize problems with sexuality in neurodiversity?

By addressing the specific issues per individual with a learning disability or neurodevelopmental disorder, you will know what strategies to be used to have a better sex life and better understanding of his or her sexuality.

Here are some strategies used per neurodiverse condition:

ADHD – People with ADHD have hypersexuality, meaning an unusually high sex drive. People who are hypersexual want to engage in sexual behavior frequently, often to the point that daily activities are left uncompleted. It is not unusual for people with hyper-sexuality to spend a great deal of time watching pornography, masturbating, or fantasizing because of an increased need for sexual stimulation or to combat boredom.[6] Some people may also have its opposite, hyposexuality (a person’s sex drive plummets and they often have no interest in sexual activity at all). This can be caused by the ADHD itself or as a side effect of medication, particularly antidepressants that are often prescribed for ADHD patients.[6]

Some strategies included from Healthline[6]:

• Mix it Up – Don’t be afraid to try new things in the bedroom to decrease boredom. Discuss ways to spice things up before sex to ensure that both parties are comfortable. Seek a variety of positions, locations, and techniques whenever possible.[6]
• Communicate and Compromise – Discuss ADHD and how it may affect your intimacy and sexual expression. If you know that your partner with ADHD is sensitive to light or sweet smells, for example, turn off the lights and refrain from using lotions or perfumes. Do not be afraid to seek the help of a qualified sex therapist. Many couples coping with ADHD benefit greatly from couples counseling and sex therapy.[6]
• Prioritize – Make it a goal to work on being in the moment. Get rid of distractions and try doing calming exercises together, such as yoga or meditation, so you can learn to be in the now. Make dates for sex and commit to them. Making sex a priority will ensure that you don’t get sidetracked.[6]

Tourette Syndrome – since most people with TS only have mild tic symptoms, most of them are somewhat good with their sex lives. But for those with severe TS symptoms, usually management of TS is included also (for more information about TS management, click the article here).

Learning Disabilities – this is specific for each learning disability.

• Dyslexia – As they struggle with reading comprehension, they usually have intuitive verbal abilities, which makes verbal instruction easier for them. While reading sex education manuals may be difficult, providing pictures, watching a video (not porn) about sexuality and sex education, or talking to a sexologist regarding sexuality may be more okay than reading. For dating gestures, verbal expressions are preferred over written letters. Or just express love to a partner by giving his partner’s favorite objects, flowers/chocolates, or be physically intimate with his partner.
• Dyscalculia – performing acrobatic sex positions is discouraged. Stick with the easier types. This is to avoid miscalculation of distance, which can be a disaster for her and her partner (imagine injuries and sexual frustrations).
• Dyspraxia – never also try hard sex positions because these involve motor skills, which is not good for dyspraxics.

Language Disorders – Instead of telling partners verbally their sexual desires, write them instead to better understand what they want in bed. Or point out to a picture or illustration of an erotic scene so that to avoid conflict. As with language disorders, speech and communication therapy is also important like teaching about sarcasm and nonverbal language so that people with language disorders can distinguish people who want a relationship and to avoid a sexual predator. When reading about sexuality topics, make sure to read and comprehend them slowly to completely understand sexuality. (To know more about language disorders, read my specific language impairment and stuttering posts).

Sensory processing disorder – Because SPD is a very complicated disorder[7], a complete assessment of SPD must be made. From there, specific strategies are made for a person with SPD to have a better sex life. Consulting a sexologist with knowledge about SPD may be helpful too. Adjusting the external stimuli that can interfere with sexual activity (lighting, room temperature, fabric, type of sex, foreplay, etc.) can also help. More importantly, the sexual partner of an SPD person must be educated about SPD so that he or she can understand and accept SPD as a whole. Alternate forms of sexual activities (like bondage-discipline fetishes for the hypostimulated) can be tried also.

The bottomline here is education about how neurodiversity affects sexuality and strategies used to fulfill sexual needs of the neurodivergent.

Other general tips:

• Having casual sex is discouraged but not prohibited. No, not because of morals or whatsoever religion but because of disclosing neurodiversity. Since casual sex involves people that barely know each other, trust is hard to build and a sexual partner may become agitated when having sex with a stranger with neurodiverse condition. This may be somewhat hard for the neurodivergent as he is at risk of being rejected later (or right away) because the sexual partner, especially if uneducated about neurodiversity, may suspect that the neurodivergent partner is either rude, weird, or conscious, or even crazy. Not good because in the long run, this will make the neurodivergent feel hurt or rejected. A neurodivergent may have casual sex if he or she has milder forms like dyslexia alone but I highly discourage people with TS, dyspraxia, ASD, and SPD from having casual sex.
• Admitting your sexual and developmental history to a partner. This is important to see whether a partner is willing to accept a neurodivergent to be intimate with her or not. Neurodivergent people usually become sexually active later than most people (usually in their late 20s and later; the neurotypical average age of sexual debut is 17) or sometimes never have sex at all. This is frightening but it is better to admit your sexual history as well as your condition to a partner so that she will understand you and be become a better lover to you. Who knows? Some people prefer lovers with fewer sexual partners.
• Do not force yourself to have sex if you do not want to. Sex is one of the human basic needs[8] but is also a preference. Some people are born asexual (meaning no sexual preference or not interested in sexual relationships or activities) and prefer not to have sex. Also if a neurodivergent has a relationship, she should be ready before having sex and her partner must be informed and must respect her decision. If a partner forces her to have sex, that’s already a sexual harassment and should end the relationship and report it to authorities.
  

  Image courtesy of Wikipedia. Maslow’s hierarchy of needs. Sex is on the basic/physiological level, but can be also optional for neurodiversity especially if tactile sensitive. She may opt not to have sex at all.

• Admitting your sexual orientation – like all human beings, all of us have sexual orientations and preferences. Neurodivergent people also have sexual orientations and preferences.  neurodivergent can be heterosexual, gay, lesbian, transgender, bisexual. It is possible to be heterosexual (preferring persons of opposite sex), homosexual (preferring persons of same sex), bisexual (attracted to both sexes), or asexual (doesn’t have any sexual preference). It is important also to admit your sexual orientation to better understand your sexuality and your neurodiversity.
• Express your sexual needs appropriately. Yes a neurodivergent can express his sexual needs, but sometimes not appropriately, like offering an indecent proposal to a potential date (stranger not yet a lover or acquaintance except if you want casual sex). He can be branded as a maniac. For those who want a romantic relationship but do not know how to flirt or attract potential partners, do not rely on pornography or romance movies to attract a potential partner because it will make you branded as a sexual predator for imitating porn or you may come off as needy for imitating romance movies and you may attract the wrong partner. Instead, seek help with friends and family and social coaches who are aware of your condition on how to behave and act in dating scene.
• Educate about sexuality and sex education. Don’t worry if you come from a religious, prudish background. Since school is not enough about giving sex education and peers have limited knowledge, search for yourself on the internet regarding sexuality and sex ed. Get from any medical websites and some magazines. A teenage neurodivergent can also get info about sex ed from university websites like Scarleteen and Sexetc. There, you can be educated about sexuality and be prepared to have sexual relationships and activites without much anxiety.
• Use birth control if you’re not ready yet to have a baby. Also, since some States and most of non-Western (actually a strong Catholic or Muslim) countries don’t give access to contraception and you, a neurodivergent, wants to have sex but is not ready yet to have a baby, use birth control. This is also used to avoid sexually transmitted diseases.
  

  Image courtesy of Discovery Channel. Use birth control to avoid unwanted babies or STDs. Use it or be sorry unless you want a child.

I hope that this 2-part blog about sexuality is helpful especially to all neurodivergent people. Again, neurodiversity is part of humanity. Therefore, neurodivergent people also have rights to know and enjoy their sexuality.

Reference:

1. https://www.psychologytoday.com/blog/here-there-and-everywhere/201403/adhd-and-sex-interview-ari-tuckman
2. Barkley, Russell, et al (2010). ADHD in Adults: What the Science Says. The Guilford Press. ISBN: 1609180755
3. Garcia JR, MacKillop J, Aller EL, Merriwether AM, Wilson DS, Lum JK (2010) Associations between Dopamine D4 Receptor Gene Variation with Both Infidelity and Sexual Promiscuity. PLoS ONE 5(11): e14162. doi:10.1371/journal.pone.0014162
4. http://www.scope.org.uk/Support/Families/Parents-and-Carers/Landing/Learning-disability/Sex
5. http://www.yourtango.com/experts/dr–amy-marsh/sex-and-sensory-dysfunction
6. http://www.healthline.com/health/adhd/adult-adhd-sex-life
7. http://hubpages.com/hub/Adult-Sensory-Processing-Disorder
8. http://www.simplypsychology.org/maslow.html

Further reading:

1. http://www.thelearningdisabilitieself.net/tag/sexuality/
2. http://www.thinkingautismguide.com/2011/07/autism-and-orgasm.html
3. http://www.goodtherapy.org/blog/sensory-integration-clues-behind-sexual-dysfunction