GTD, Autism, Aspergers, ADD and Executive Function

Hello - In the topic "Getting a Technique Incorporated", we started to go off into the topic of autism and how GTD might or might not help that in adults. I think it needs to be its own thread, so I'm moving it here (see below). If there are folks out there with high functioning autism, aspergers or ADD - or those who work with them - I'd love to get your thoughts on the post below.

Guest, thanks for your reply. And I have the RDI book on reserve from the library (Gustein was on my list of autism stuff to read, so it has moved up the priority list).

And I think I see your point...you need to have a frame of reference to make inuitive decisions in the moment and for folks on the spectrum, that frame of reference isn't solid. It is really hard to "see" inside the mind of someone going through this, so I appreciate you trying to explain it. It is a complex issue and it affects people on so many levels so, yes, of course, GTD or any time management process would just help in a limited way.

A thought I'm having - or the question I'm really trying to get at -is does consistently asking yourself the question "what is the next action" - just deliberately training your brain to think that way over and over again - help with that executive function issue. As an example, my daughter seems to have a lot of trouble with remembering the sequence of things...for instance, , all the steps involved in using the potty (the obvious, then flush, get hands wet, soap on hands, rub, rinse, etc.). She has to be walked through each step even though she's done it a thousand times. I'm trying to phase out prompts and just give her a "now what?" to encourage her to remember the steps on her own. But then again, she is only three - typical kids forget this stuff all the time.

I've done very little reading on the executive function aspect of ASD, so these may be naive questions.

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>New question. out of curiosity..for guest who posted on 8/2 - or any one else who might be reading who may be dealing with high functioning autism...do you feel like GTD helps you to manage your autism? I know its been used to work with kids/adults with ADD as it helps with the "executive function" (prioritizing, decision making, organizing). Folks with autism have similar challenges - if I understand correctly, they simply have less neural pathways in this section of their brain, but this can be strengthened with practice. I'd love to know your thoughts.
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Hello. Me again. About GTD helping manage my autism .. not particularly, no, I don't think significantly more than any other time management program has helped (and I've tried countless). What I have managed to implement re GTD has helped only marginally. GTD like any other system (making lists, keeping calendars, etc) are just tools/skills. The problems with autism related to executive functioning have more to do with the root issue of the problems with episodic memory (also called emotional memory or autobiographical memory) and the autistic problem of limited motivations.

Yes, I believe it is generally accepted at the moment by researchers that the problem in autism is the wiring between the prefrontal cortex and the limbic system, but (IMHO) "practice" by rote trial has limited value in strengthening the pathway, because a lot of practice means little if the *memory* part is not there to support it. I am a big believer in Dr Gutstein's approach in building *motivations* for a skill before trying to rote-build a skill. In addition to my own personal experience, research has shown that skills without intrinsic motivations are very poorly generalized later. Also, I am a big believer in doing things at the developmentally appropriate time. Doing things "out of order" is a sure recipe for a mess later. My life is a testament to that.

About GTD and autism specifically .. where it breaks down in a huge way is the 'intuitive choice' about what to do in a given moment .. without a well-functioning episodic memory, that's an extremely difficult task for a person on the spectrum. "Managing" autism is more about addressing the deeper deficits of relative information processing, flexible thinking, past/future thinking, episodic memory, (and of course social co-regulation, referencing and declarative communication.) To a large extent, GTD "assumes" an ability in the fundamental neurotypical abilities of 'executive functioning' (defined by Dr Gustein as 'the ability to reflect on past experiences and anticipate potential future scenarios to make decisions in the present to lead to desired goals,' which goes back to the problem with episodic memory.) So in developmental terms, I would say that much of GTD is for individuals who are quite far along the developmental pathway.

I'm not quite sure I have put my finger on the "dissonance" I feel in terms of your question .. GTD may help me manage my life as well as any other time management system I've tried over the years .. but I would not say that it helps me manage my autism, no, because the problem with autism is a lot deeper than any "tricks" or tools. Let me see if I can explain this better .. if you couldn't remember how much you loved doing something (or hated doing something).. how easy would it be for you to know if you wanted to do it again and whether to make it a priority? If you never experienced feeling happy about interacting with someone else, how easy would it be for you to decide you wanted to see them again despite it being a next action on your to-do list? GTD may help manage 'stuff' and 'activities' but it does not really help "manage" these more fundamental difficulties of autism, no.

Hope this helps explain it a bit. Thanks for asking. )

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>does consistently asking yourself the question "what is the next action" - just deliberately training your brain to think that way over and over again - help with that executive function issue.

Hello again. I would say no, simply asking that question has not helped me in terms of the deeper issues re executive functioning.

[Interestingly (and this just may be a personal quirk and have nothing to do with my autism) the David Allen question which has been more beneficial to me has been "where does this need to be?" He covered that in one of his newsletters - the "what does being organized really mean" some months back - and I found that VERY helpful.]

In terms of your specific issue however..
> As an example, my daughter seems to have a lot of trouble with remembering the sequence of things.

The part of the "executive functioning" you are speaking of here, ( ie a static, step-by-step procedure) is not really what is considered a "core deficit" of autism actually. For an issue such as this, have you tried a visual "schedule" on the wall, showing each step of the procedure? That is an approach which might help her. You would probably find many of the ideas in the book, "Asperger's What Does it Mean to Me?" by Catherine Faherty quite helpful. (There are many sections for parents and teachers in that book.)

(An aside: the most recent information on RDI is availalble from the web site.. I think there is still a 32-page intro booklet for parents you can download for free.)
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Hi Belaisa,

I have ADHD and a non verbal learning disability, which includes XF issues. GTD has helped somewhat but it hasn't been the total answer.

For me, asking what the next action helps with projects like cleaning the condo since for me, it is simply an issue of deciding on where I want to start first. But for complex issues like career planning, it really doesn't help.

It is hard for me to explain but let me take a shot. Unlike cleaning my condo, with career planning, it seems there are so many issues I need to consider at the same time.

Of course, if I could visualize what I was trying to accomplish, this would make things easier but unfortunately, it is hard for me to do that. Inspiration, the software program, helps but again, isn't the total answer.

Guest was right on the money with this comment:

<<o a large extent, GTD "assumes" an ability in the fundamental neurotypical abilities of 'executive functioning' (defined by Dr Gustein as 'the ability to reflect on past experiences and anticipate potential future scenarios to make decisions in the present to lead to desired goals,' which goes back to the problem with episodic memory.)>>

For me, sometimes, the next day, I can't remember what I was striving to do the day before. I may record the information somewhere in my computer but forget that I did that.

Also, executive function includes an ability to monitor yourself and make sure you are on the right track. Yeah, right:))

Please understand that I am not saying it is hopeless and I might as well give up trying to do any of the things that GTD suggests. But it is quite clear to me that those of us with XF issues have some unique challenges that aren't going to always be solved by various time management techniques.

Hope this helps.

Guest and PT - thanks for your response and for the time you took to explain where you are coming from. I think phrasing my question as "do you feel like GTD helps you to manage your autism?" wasn't the right direction. Austism/ADHD, etc. are very complex issues and obviously a time management system of any kind is only going to help so much as far as "managing austism" goes - that takes a very wholistic approach.

Let me rephrase...neurologically typical or not, we all vary in our ability to organize and breakdown tasks. This isn't a strength for me like it is for some people, so GTD has really helped me in that regard once I developed the habit of thinking in terms of NA's. But it took practice. Folks with real executive function issues are going to struggle even more, but I'm wondering if they'll benefit even more with practice.

So I guess a better way to say my question is more like....for folks with executive function issues - austism, adhd - with PRACTICE, does the habit of thinking through outcomes and next actions help strengthen the executive function (rather than deal with autism or adhd itself)? It would seem that people in that situation would need a ton of support....someone to really coach them and remind them for awhile until things became a habit.

Again, forgive me if these are naive questions :oops: . The reaon I'm asking isn't for my daughter so much since she is so little, but for the adults and parents of older kids and adults I run across. I'm wondering if this could be a resource.

Hi again.

Oh, I think it could be a resource of course .. just like any other system I've tried over the years could be a resource.

>does the habit of thinking through outcomes and next actions help strengthen the executive function (rather than deal with autism or adhd itself)?

From my perspective, the problem with just thinking through outcomes and next actions alone is just a skill. I believe without working on the episodic memory part for those with autism, you would be *sorely* (and actually unforgivably) shortchanging that person .. you would be attempting to give someone a skill without the "motivation" or the real payoff. I suppose one could do "discrete trials" of GTD principles (aba style) but I think somehow that would be missing the point.

Any reasonably intelligent person on the spectrum could pick up GTD by themselves.. If you wanted to "help" someone by reminding them all the time or getting a coach to remind them all the time I suppose you could do that .. but once you stopped reminding them, would it "stick" or generalize? Perhaps. But that is really missing the point. It is more like giving someone the fish instead of teaching them HOW to fish or WHY to fish!

Dr Gutstein (he has been a mentor to me so that is why I keep bringing him up and I think the world of him) has this funny/poignant story he tells in his workshop about "Roger" (who is also in his book .. when you read it, you'll see him there). Anyway, Roger (who has AS) calls him at midnight one night because he is distressed, and has just moved into a new dorm room at U. Dr Gutstein starts guessing the reasons for the distress .. new room, new semester, changes, etc .. no, no, no. Finally he asks him what the matter is! Well apparently the movers packed up all of Roger's stuff from his old room and moved them into his new room, and put all his boxes in a pile on one side of the room.. Roger has been staring at the boxes since the afternoon, paralyzed because he does not know which box to open first. Roger .. with an extremely high IQ, who got perfect scores on his SAT's has not been able to figure out which box to unpack first!

Now is this something GTD may have helped with? Oh, I don't know. Perhaps. But if it did, only very superficially .. maybe a little more help to "get by." But you can see.. the problem is deeper than that.

My vision for others on the spectrum is much higher than just getting by. That is why I am lukewarm about trying to use GTD to "help" people on the spectrum as a starting place. EVERYONE needs "executive functioning" skills to get by in life .. and GTD comes with some great tools .. but starting the discussion from that place seems to me like it is at the wrong (ie developmentally inappropriate) place.

> does the habit of thinking through outcomes and next actions help strengthen the executive function (rather than deal with autism

The thing is that Executive Function IS a core deficit of autism, so anytime you are trying to help strengthen the executive function you ARE dealing with the autism itself. I DO think GTD offers excellent tools so I am not knocking it at all, but without working on the episodic memory part of the executive functioning which I would consider a *foundational* skill, you would be trying to layer GTD skills on top of a very weak foundation. That is why you would have to keep "reminding" a person. It is like the issue of "eye contact" .. why keep *reminding* a person on the spectrum, when they can learn/experience the REASONS for "eye contact" (facial referencing) and in the end, just do it for themselves? (ie without having to "practice" it as a rote skill?)

I hope this has made some sense! I am afraid I have not been as clear as I might ... Maybe I will try again later... I am having trouble putting my finger on what is not quite sitting right, here .. something to do with trying to use a behavioral approach/solution to a problem which is not fundamentally behavioral .. it may LOOK that way from the outside, (ie that is where the "symptom" is visible) but the problems and solutions are deeper .. I think the problem I have with this idea is that I think GTD is a good system of tools, but only when used at the developmentally appropriate time .. for example, would GTD help someone with Alzheimer's ? See what I mean? (??) Even with a lot of "practice" ??

<<I hope this has made some sense! I am afraid I have not been as clear as I might ... Maybe I will try again later... I am having trouble putting my finger on what is not quite sitting right, here .. something to do with trying to use a behavioral approach/solution to a problem which is not fundamentally behavioral .. it may LOOK that way from the outside, (ie that is where the "symptom" is visible) but the problems and solutions are deeper .. I think the problem I have with this idea is that I think GTD is a good system of tools, but only when used at the developmentally appropriate time .. for example, would GTD help someone with Alzheimer's ? See what I mean? (??) Even with a lot of "practice" ??>>

Bellaisa and Guest,

Bellaisa,

You have asked some good questions and I appreciate your attempt to understand what having an XF deficit is like for people like guest and me.

In addition to Guest's excellent comments, I wanted to make some additional points regarding additional practice. I realize this isn't because of bad intentions but this society erroneously think that all someone has to do to remediate their weaknesses is just practice constantly and improvement will automatically take place. For people like Guest and I, we may practice a skill until h-ll freezes over and only advance from a failing level to a D level due to our neurological deficiencies. I am not saying this would happen with GTD but as guest pointed out, using a behavorial approach to a problem that is neurological instead is usually a recipe for utter frustration.

I also agree completely with guest that episodic memory is an issue for those of us who have XF deficiencies. As a result, if I am working on complex projects like trying to find a new job, unless I constantly review things every day what I am trying to accomplish (and even then, I still might lose focus and forget everything.), simply focusing on the next action means nothing to me. Ironically, it feels like that endless blob of To Dos that GTD supposedly gets away from.

I know that GTD stresses the importance of envisioning the outcome. Well, if I have a deficiency that affects my ability to do that, even if I improve, I will never be as good as someone without my problems. Again, extensive practice, may not help the situation.

As I previously mentioned, GTD works fine for simple projects like upgrading my antivirus software. Since I have only used Norton and like it alot, all I have to do is some comparison shopping and find the lowest price. It is a series of single NAs unlike the job hunting process in which it branches out into a web of subprojects and NAs.

Again, I am not giving up and it sounds like Guest isn't doing that either. I still think GTD is the best system for me. But as far as strengthening executive function, I would agree with Guest and say no.

PT

Hello Bellaisa and PT,

Me again. OK I want to try again to answer this question.

>with PRACTICE, does the habit of thinking through outcomes and next actions help strengthen the executive function

Now that I've had longer to think about this .. I would say, actually, that yes, thinking through outcomes and next actions would help strengthen the executive function. HOWEVER, I think it is a developmentally inappropriate place to start for someone on the spectrum. Now I think I have a better way to explain this.. for example, you have said you were thinking more in terms of adults than for your 3 year old child because clearly GTD would not be at her level. But what about for an adult who is still at a 3 year old child age in terms of some parts of the executive functioning development?

I can't speak for those with ADD as I don't know anything about ADD, but for those with autism, the cognitive problems are more than just breaking things down into smaller steps and choosing an order. (Actually, the many tools of GTD are about a lot more than that, too.) The problems with autism are also with relational thinking and flexible thinking (ie being able to discern gradations .. is this better than that? what does "enough" mean? what to do when something is not clearly black and white but is some shade of grey? what happens when things don't go as planned? is there really more than one way to do things? etc.) Procedural memory and executive functioning related to static procedures is not really a core deficit of autism; rather it is these other aspects of thinking (for "dynamic systems" like finding a job, as PT has given as an example) which need to be addressed. And "getting things done" also includes actually taking action ... even neurotypical people have problems with this, if the threads on the board are any indication .. one of the core problems with autism is limited motivations .. added to a difficulty with transitions, so even if one CAN break things down into steps, what then?

I don't want to harp on RDI, but it is the only program I have found which addresses the problems of executive functioning in autism and addresses them with a step-by-step developmental approach. For example, one of the first "lessons" is about "what is enough?" Flexible thinking and relationship thinking are basic parts of living in dynamic systems, (like working on a team, finding a job, holding a job, being in a relationship, etc) which of course GTD does not address. GTD assumes an adult or at least a young adult ability in the basics of these types of cognitive tasks for best results.

Breaking things down of course is an important skill, but not the FIRST skill one should learn. I believe starting there would do someone with autism a dis-service. So to answer your question I would say that yes, you are right that thinking through actions and next outcomes is a good idea, but it is quite an advanced thing and I think a "best practice" would be to put a proper foundation in first.

PT is right that I have not given up. Indeed, I have held a variety of professional positions in my life and professionally I have a reputation for being very well organized. So in some ways GTD and all the other "time management" things I have practiced have helped .. but has that been enough? I would say emphatically no, which is why I kept looking for better answers.

I do believe that neurological problems can be addressed and even remediated to a large extent, but not by programs developed for neurotypical people. I have used an enormous amount of self-development material designed for neurotypical people..while I believe I derived some benefit, I do feel I was tremendously "gypped" out of proper tools. I actually quite like many of the tools of GTD so don't want to sound at all down on GTD, but as a place to *start* on working on executive functioning, I believe would be a dis-service to a person on the spectrum looking for real help in this area.

Just my .02.
thanks again for asking. :o)

Guest and PT - thanks so much for taking the time to respond. My experience with adults with any form of autism or ADHD (that I'm aware of) it really limited, so I appreciate your sharing your experiences. And I so admire your tenacity in both explainng yourself to me and in working on using GTD and learning to work through challenges you are experiening.

I wouldn't think of GTD as a way to TREAT any of those conditions - I agree that would be a very superficial way of helping someone. And, yes, how severe their issue is would be a key factor. I can see where working on trying to keep in mind the big picture while looking at all those NA's would be a particular challenge - that is a challenge for typical people! :) If fact, there have been plenty of times right after I've moved where I just sat there standing in front of a pile of boxes wondering what to do next. :wink:

I think you answered my question - is this a tool that could be useful? I think you said basically - perhaps, as long as it is regarded as just a tool and is used with someone who has enough of a developmental foundation to use it.

I keep thinking back to something our developmental pediatrician said when he diagnosed my daughter.....he said something like "we all vary in our neurological makeup and it is really a question of does she need support - and we all need support from time to time." I think all of us are stronger or weaker in our exectuive funtion depending on how our brains are wired and our experiences growing up. I think there are people who would never receive a diagnosis of autism/adhd, but they have more challenges than other people in their ability to breakdown tasks and need more support and need to realize that they have a bigger challenge to face than others. Other people are just naturally great at this. It is a matter of degree. I little side note.

Hi Guest,

Wow, you have explained very well why for folks like us, GTD is not the total answer. I have always known intuitively it wasn't but could never really explain why. Now I can, thanks to this post.

I apologize to the rest of the board for this next portion, which is off topic but I want to hear about Dr. Gutstein's method because it sounds like that is something that would benefit me. But I am inferring from his website that he only practices in certain areas that I am not hear. Is that correct?

If I am correct, has he written anything about the method? Thanks in advance for your help.

PT

Hi Bellaisa,

You're very welcome and thank you for asking the questions. Many people do not understand our struggles for various reasons and usually, they are not due to bad intentions. So I greatly appreciate the opportunity to explain what XF impairments are like for folks like me. Also, your questions caused Guest to respond and I feel he/she did a fantastic job in explaining the issues.

PT

Hi PT and Bellaisa,

>Wow, you have explained very well why for folks like us, GTD is not the total answer. I have always known intuitively it wasn't but could never really explain why. Now I can, thanks to this post.

You're welcome, PT, I couldn't really understand it, either, before I learned about RDI, so I'm glad you found the ideas helpful, too.

>I apologize to the rest of the board for this next portion, which is off topic but I want to hear about Dr. Gutstein's method because it sounds like that is something that would benefit me. But I am inferring from his website that he only practices in certain areas that I am not hear. Is that correct?

I'm not quite sure what you're asking .. Dr Gutstein gives workshops all over North America (actually he will also be going to Australia next year.
He has written a number of books, including "Autism/AS, Solving the Relationship Puzzle" (which explains a lot of his theories and gives case studies) and two books of Activities (one for younger children, and one for older children, adolescents and adults) which gives some earlier ideas for implementing the program. All are available from his web site (along with some other resources). Actually, there is quite a lot of information on his web site alone.

Also .. he does regular on-line chats, so if you had a question, anyone can join in and ask questions! (Although those new to the program, generally go to the "Beginner's Chat" as he does the "Advanced" Chat which is more for people already familiar with the concepts or implementing programs.)

If you want to continue this discussion, it might be more appropriate if we moved it to the RDI discussion board, at http://www.rdiconnect.com/forums/dis...pics.asp?FID=2. Just use "Executive Functioning" or "Adult" in your subject header and I'll know to reply! :o)

>he said something like "we all vary in our neurological makeup and it is really a question of does she need support - and we all need support from time to time."

Ah. He sounds like a very nice neurologist. :o)
Yes, we all need various forms of support from time to time and it is quite a large spectrum.

A few things that might help--I do tons of works with LD and variously challenged (and often gifted) people.

1. Teach anything new to strengths.
2. Use cues that match the person's strongest sensory modality.
Choose from pictures, colors, songs, and be creative--a kinesthetic person may like cues on beds that are moved across a string.
3. Make any cues, lists, etc. as inviting as possible. Verify this by asking and observing. Assume nothing.
4. Changing contexts is most likely to be a mine-field of challenges to people that take in too much info and cannot determine the relevancy.
5. Comprehension checks are invaluable but no matter how politely done, are a little demeaning. So, if any one can figure out to do them in a non-demeaning way, I would love to know.
6. Some people are such Gestalt learners that breaking things down as almost toxic. With them, teach them a mini-version and once they have that, make it more and moe complex.
7. As you know, if you process info. differently from others, you may be frightened by things that are really benign or even reinforcing to others. E.g., flushing a toilet can be downright scary (often is even to regular kids)., a loud exclamation of praise can sound like an earth quake.

Jamie, thanks! Great list !!

I'd also like to add something .. that what might be a "reward" for one (NT) person, might feel aversive for an autistic person, and what might be aversive to an NT person (like a time-out) might feel like a welcome relief/reward to a person on the spectrum.

Also.. re "next actions," Bellaisa ... an ABA person once told me there was something like 32 action steps in teaching her son (aba style) to make popcorn. If I was to create REAL next actions for everything on my list, just getting ready for work would probably be HUNDREDS of next actions.

Hi, Bellaisa and Anonymous,

I'm an attorney (and graduate of New College of Florida, David Allen's alma mater -- hence the username) who was diagnosed with Asperger's after graduating from law school. I read this thread (which I found via Google, even though I was already registered at davidco.com -- I'm a GTD white belt) and I definitely have some thoughts about AS and executive function. I'm still mulling this over -- the connection between my AS and my problems with what has seemed like procrastination is something I've only recently come to understand. I've just started discussing the wiring of my executive center with my psychiatrist, who diagnosed me with Asperger's, and after doing some Internet and Medline research my problem with procrastination now seems less to be that and more the product of my (extremely) nonlinear thinking process. In retrospect, the connection seems blindingly obvious.

In Thinking in Pictures, Temple Grandin talks about how associational thinking is characteristic of autism. It certainly is characteristic of my thinking, and probably explains why I'm so distractible. I'm usually distracted by shiny things, as it were -- A will make me think of F, which will remind me of Q, when what I need to do -- when the chain of next actions -- is A to B to C, Tinker to Evers to Chance. (This last is an example of what I'm talking about.)

More thoughts as the bubble to the surface.

Dear NC Lawyer - Hello! I apologize that I did not reply to your post sooner. I haven't been to the forum much lately - am trying to get back into the habit of visting every now and then.

If you've had further thoughts on the topic since then, please I'd love to hear them.