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Executive Function Problems – Hiding in plain sight

Posted Mar 09 2013 9:14am

Executive function issues just blend right in

Ouch. I was pretty active yesterday, for the first time in a long time, and now all the muscles that I usually don’t use (and I’m embarrassed to admit I don’t use them) are complaining. Funny, I didn’t think I pushed myself that hard, but my body says otherwise.

It’s just as well. It will start me down the road to get in shape for the spring and summer. Spring is only 2 weeks away, after all. It can’t come soon enough. Of course, I say that now… I can only imagine how in a matter of months I’ll be looking forward to summer… then fall… then winter… then spring again…

All in good time. I think it’s best if I just enjoy now for what it is.

I’ve had some hard thinking and soul-searching to do, lately. Reading about executive function — and how common it is in TBI, and how it can really screw with your ability to live your life and have “positive outcomes” (the official term for “getting your sh*t in order and just being able to live your life the way you intend”) — I’ve had to back up a little bit and really consider how much my life has been screwed up by executive function issues.

It’s weird. I haven’t even given this a whole lot of thought – I tend to think of my issues as being lower-order. Things like tinnitus (which was out of control the other day — really driving me crazy… come to think of it, it’s worse than normal and bugging me in the background, right now, too)… and light and sound sensitivity… and touch being painful, or tactile defensiveness, where I recoil if anyone touches me (that’s been happening lately, too)… and the aches and pains, headaches (those have been around, lately)… lack of coordination… trouble sleeping… a whole host of physical issues that mess with my mind, because they are so damn’ distracting and take considerable energy and focus to keep them from taking over my every waking moment.

But reading the paper on “Higher-Order Reasoning Training Years after Traumatic Brain Injury in Adults” is turning out to be a wake-up call. And I am realizing — years after starting my neuropsych rehab — that I have considerable issues with executive function. I have had these issues for a long, long time.

And I haven’t really realized it. Not fully, anyway.

Let me clarify — I do know that I have issues with:

  • Planning and organization – I usually consider myself a good planner, and I’m very systematic in my approach, mostly because I have to be. Sometimes I get confused when I least expect it, so I have to have an ironclad plan in place… or I become intensely anxious, and then everything goes to hell. I can plan work-related things, and projects on large scales, but when it comes to little things in my life, I run into issues. Looking around at my house at all the projects that need to be done, it’s evident that I haven’t been able to plan appropriately to deal with them.
  • Flexible thinking – In some cases, I am very flexible and I can adjust quickly and with great ease. Other times, I get stuck in one rigid mindset, such as morning and evening routines or how to do things at work, and if I deviate one iota from my prescribed process, I freak out. It’s really weird… lately, I’ve noticed that my thinking about my morning workouts has been very inflexible, to the point of me not doing anything if I don’t have the time to do my whole workout in exactly the same order… and it doesn’t need to be that way at all. I tend to find a process that works for me, and then I do that over and over and over again, regardless of whether I would benefit from changing it up. I’ve recently changed up my workouts, and now I’m sore. But I also feel this sudden breath of fresh air, and even though I’m sore, it actually feels really good to have some variety. I tend to make people around me nuts, too, because I have such rigid ideas about how things should be done. When I give instructions, I am generally way too specific and way too micro-managing for anybody’s comfort level. The thought often doesn’t occur to me that there might be other perfectly fine ways of doing things that I’ve figured out myself.
  • Monitoring performance – I have to really work at this. My monitoring is very spotty, and there are big gaping holes in my perception of “how I’m doing”. I tend to be extremely focused on specific details about my life, rather than my overall performance. And to tell the truth, at work my performance has suffered because I have not monitored it and corrected things that were amiss.
  • Multi-tasking – Yeah… well…  I like to think I can multi-task, but the truth of the matter is, I’m not multi-tasking and getting things done. I’m going off on tangents to distract myself at regular intervals… and in the end, stuff just doesn’t get done.
  • Solving unusual problems – This is actually an okay area for me — provided that the problems are intriguing and don’t represent a threat to me and my safety and my sense of self. If the unusual problems seem to threaten my well-being and my perception of who I am, I tend to avoid them like the plague. I’ll do anything, besides deal with them. Kind of like Nero fiddling while Rome burned.
  • Self-awareness – I’m getting better at this, I think, with the help of my neuropsych, who is the only person I know who has a tolerance for my version of crazy. For years, I thought I was extremely self-aware, when in fact, I was aware of this “self” I had invented according to what and how I thought I should be. The “self I used to be” was based more on fantasy than reality, and in some ways I suspect I was quite deluded. Most of us are, to some extent, but the degree to which I’d come up with a slew of cockamamie explanations of why I was the way I was… well, it was pretty remarkable, when I think back.
  • Learning rules – This is actually a strong suit with me… at least, I think it is, to some extent. I tend to be very rules-based. However — and this is a big issue — it’s very spotty and irregular, and I never know for sure which rules I will learn, and which I’m just picking up in part. And then remembering them… it can get interesting, because I could swear I have them down cold, then I find out I’m completely off base.
  • Social behavior – I’ve gotten a whole lot better at this, in the past years, largely because I’ve learned how to talk to people, which I never really did before. I still freeze up at times, but nobody knows I’m freezing up, because I know how to present in a calm and relaxed manner. On the outside, I’m chill and engaging. On the inside, I’m freaking out because I haven’t the faintest idea what’s going on. Interacting with people takes a lot of skills and cognitive ability, from processing what they’re saying to you, to remembering what they said earlier in the conversation. And being able to read and react to their signals… I swear, sometimes I just don’t have the energy for all that activity. It’s exhausting for me.
  • Making decisions – Yeah, well. In some ways I am extremely decisive, because I know all too well the consequences of not making decisions. A lot of times, my decisions are not that great, but at least making a decision gives me a chance to see if it was smart or not — and then adjust… and hopefully learn for the next time.
  • Motivation – This is one of the big challenges I face. When I am feeling tired and overwhelmed, which is much of the time, I just don’t feel like doing anything. At all. And the fact that I can get up and go out into the day and get on with my life, says more about the habits I’ve formed, than any eagerness on my part. Motivation is a double-edged sword for me. Too little of it, and I feel like crap and can’t see the point in doing anything. Too much of it — especially over an extended period of time — and I get overwhelmed and exhausted, and I end up de-motivated again.
  • Initiating appropriate behavior – Often doesn’t happen. Especially when I’m uncertain about how to proceed, and I have a history of bad experiences with a situation. Take for example a conversation I had with a neighbor yesterday — their spouse had done me a huge favor while I was away on my business trip, and I was deeply indebted to them. But the neighbor I was talking to has gone a little nutty on me in the past, flipping out over things I did with my house that they didn’t like (it was a stupid thing and they were so not in their rights, but never mind). It’s really been ugly with this person before. But their spouse and I are on good terms. So, when I saw this (formerly nutty) person, I just chatted about this and that, not mentioning my gratitude to them and their spouse for helping me out, even though they hinted at the favor in the course of our brief conversation. I literally couldn’t figure out how and when and where to insert the “thank you” that I wanted to tell them. So, I didn’t. And I felt like an idiot the rest of the day. Still do, in fact. It’s one of my things — I guess I’m pretty honor-bound in these matters (not to mention a bit inflexible in my thinking – see above) — to always be respectful and express gratitude, but I couldn’t manage it yesterday.
  • Inhibiting inappropriate behavior – Like not talking trash about upper management at work when you’re within earshot of other upper management. Like not making references to color and class and religion, when around people who are from a different ethnic or economic or religious background than myself. Like not jumping out of my car and running over to the cop who just pulled me over, to give them a piece of my mind for pulling me over. Like not going on and on and on about something, talking and talking and talking even after people have told me to shut the hell up, and I’m digging myself deeper into a hole. These sorts of inhibitions don’t seem to come easy to me — and it’s always at the worst possible time, usually when I’m stressed and on edge.
  • Controlling emotions – Yeah, talk to my spouse and my co-workers about this. They’ve seen me go off on the stupidest little things. Some of them have seen me weep uncontrollably over who-knows-what, others have seen me go OFF over some dumb sh*t, others have seen me laugh hysterically over something that was funny three days ago. In all cases, I’ve done a really great impression of a crazy person. I try to laugh or shrug it off, but sometimes it’s pretty alarming for people, and it makes them wonder about me.
  • Concentrating and taking in information – I’ve gotten better with this over time. Of course, it works best if I’m rested, and it works worst if I’m exhausted and overwhelmed. And it’s really bad if I’m having a lot of physical issues that are sucking up my energy, just keeping myself focused on what’s in front of me. Sometimes it just doesn’t work for me at all, and I have to either stop altogether, or rely on the people around me for clues about what I should do next. It can be subtle and irregular, but it’s worst when I’m tired and dealing with a lot of physical issues.

You know, it’s funny – when I write all this down, I can see that there are areas where I would really like to improve. But when I’m going about my daily life, they don’t just pop up in plain view when I need to see them. Now, I know that there are plenty of other people walking around out there with similar issues, and not all of them are related to TBI. The thing with me is that no matter what the cause, I still want to get a better handle on these things and not have them disrupt my life the way they have been. In so many small, seemingly insignificant ways, they get me down… and then they snowball, till I have no idea how to handle any of them, aside from leave and go on to the next thing.

The issues aren’t just small things, here and there. There are some significant ways that my life is disrupted by these things — and I believe a lot of my issues can be traced back to concussions/TBIs I sustained as a kid. Over the years, I just got in the habit of doing things a certain way — or NOT doing things at all. And as a result, I just haven’t developed the “muscle” for the kind of executive functioning I (and others) expect of myself.

Seriously, I’m a smart cookie, and I have my moments, but my life and my career and my financial state do not reflect even a portion of what I’m truly capable of — and what I have tried — with all my might — to be capable of. I want to change this. More than just about anything.

So, yeah — executive functioning. Frontal lobe stuff. I have a pretty good understanding of my physical issues, and I have my ways of coping with them. Now I need to look at the higher-order issues I have, and actively participate in them.

Yes, actively participate. Because I’ve been seeing a neuropsych for a number of years, now, but to be perfectly honest — and I feel like an idiot saying so — I haven’t really understood what the hell we were doing each week, just talking about my life. Seriously, how interesting can it be to hear about my stupid projects at my stupid job? But that’s been the (somewhat tiring) topic of conversation — in great and thorough detail — for some time, now.

But in all honesty, I haven’t given it all I had. I’ve glossed over things. I’ve covered up problems I’ve had with my reading and writing and comprehension and planning and follow-through… to the point where my neuropsych never realized how much I was struggling with my reading and comprehension and planning and follow-through, and didn’t realize that I switched those several jobs when I did because I got so friggin’ confused that I just couldn’t do it anymore.  It wasn’t just about “seeking new opportunity” which is a great way to describe “get me the hell out of here” — it was about avoiding dealing with the difficulties I was having and just couldn’t deal with, before everyone found out how much I’d let things slide and ended up pissed off at me — which is what’s been going on in my current job for over a year, now.

Thinking honestly about a lot of things in my life, I instinctively avoid certain things I really need to deal with. Things like fixing a leaning lamp post in front of my house that I can’t figure out how to shore up. Things like paying bills. Things like financial planning in general. Things like getting my chores done. Things like sorting all the papers I’ve thrown on my desk. Things like planning and completing project tasks that confuse and frustrate me and I can’t figure out how to handle. I don’t waste my time sitting around feeling insecure and anxious — I just avoid them completely and think about other things.

Which is great in the moment… but later on it’s a big problem.

It’s cumulative. So, here I am, with a seeming ton of little things I need to sort out, all sitting around in the wings, as I go merrily on my way, paying attention to other things that seem much more interesting to me and give me some relief from my overwhelm. Eventually it does catch up with me, and I have to dig myself out from under… which is kind of where I am now. And where I am now, is realizing that I can’t just run away from things, I can’t just avoid them. I have issues that are hiding in plain sight — the only reason I don’t see them, is I’m not looking. And I’m not admitting to them, to the person(s) who can help me.

I really need to stop and stand my ground and just deal — with the things I’ve put off, as well as my own executive function issues. I need to stop looking at all the tasks and to-do items as hindrances and problems, and see them as ways to improve my executive functioning overall.

‘Cause I need to address it. Before it gets the better of me. Again.

I’m changing jobs. I’m changing my life. If I don’t address these executive function issues, I’m just going to make a tough job harder — if not impossible.

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