KC Davis 0:03
Hello, you sentient balls of stardust. I'm KC Davis. And this is struggle care, the mental health podcast that promises never to tell you to journal. today. I'm in the studio with psychologist Leslie cook. And we are talking about executive functioning. So pull up a chair, use this time to do something kind for yourself and enjoy the conversation. Hello, you sentient balls of stardust, welcome. I'm so excited for this episode, because I have Dr. Leslie Cook, who is a psychologist, and she does a lot of work with ADHD and other neurodivergent sees and actually met her on Tik Tok. So Leslie, thank you for being here.
Lesley PsyD 0:42
Thank you for having me, this is really exciting for me, because I feel the same way about you and your content. So this is going to be a great talk.
KC Davis 0:51
Oh, I'm so excited. So I wanted specifically for us to talk about executive functioning, because I feel like it's a real buzzword right now. Or buzz words, sort of floating around the mental health community. And I really wanted to learn more about it, I have such sort of like a cursory knowledge of it as a therapist, but I have heard you in your content, talk about executive functioning. And I just thought, you know, this is someone who I really want to sort of pick their brain, about the way that executive functioning shows up in people's lives and the way that it relates to trying to do everyday care tasks.
Lesley PsyD 1:29
Yeah, I think that this is an area that is both extremely exciting for me that people care about, because I don't think it would have been a buzzword a year or two ago. So that makes me happy. But I also love that we're going to talk about how it applies, you know, both to people with diagnoses, but also just to folks in general, because if you have a central nervous system, you have to use these functions on a daily basis.
KC Davis 1:51
So what's interesting is that I used to run a family program for a drug rehab. And one of the things that we would talk about was about how we had this little Did y'all ever do this, it was like the hand, like made the fist to talk about like the different parts of the brain. Yep. And we'd be like, Okay, this is the brainstem by your wrist and your little thumb coming over is sort of the seat of like the instincts and the fight or flight. And then your prefrontal cortex is the front. Except when I was talking about that to clients and families, what I was focusing on was actually the fight or flight aspect of it, and talking about how when your fight or flight gets triggered, you kind of go, your frontal cortex goes offline. And since that's the part of our brain responsible for impulse control, and sort of cause and effect, it would help families and clients think about how when they're feeling really activated, whether in therapy or just in the world, how all of these amazing coping skills that they're learning in rehab might temporarily go offline. So I really focused on talking to them about that part of the brain kind of getting hijacked, focusing on the fight or flight. But now that I've been diagnosed with ADHD, and I've been doing this work around helping people who have functional barriers, deal with care tasks around their home, for the first time, I'm starting to want to learn more about that frontal lobe, that part that's going offline, like, what all is that responsible for? So I wanted to start I send you like, kind of six questions. And I would love to hear you describe executive functioning for a layperson, like someone who doesn't know any type of psychological terminology or therapeutic language.
Lesley PsyD 3:34
Yeah, this is actually something that I am continuing to hone, because it's really hard to translate. It's really complex. So hopefully, this will be easy to understand. And thank you Disney feel like I should be paying them for the movie Inside Out. The best image I can think so as I talk through this, a good visual image is that control panel inside of the main character's brain. So there is the what are the behavior that she's engaging in, which is more choice based in that movie, then there's the emotions, and they have an effect on the control panel, but they're not the control panel themselves. So executive functions are these eight core functions of that control panel that tell our body, how to do things when why, to what extent when to stop. And here's the list of them. There are abilities to inhibit, like, stop ourselves, to shift from one thing to another. Controller emotions, start a behavior, remember things as we're learning them, how to plan and organize, how to monitor what we're doing in the middle of it, and how to monitor how we're feeling about what we're doing. So you can imagine how complex this control panel is. Wow.
KC Davis 4:47
Yeah. A lot. That's like, I feel like when you describe those eight functions as a therapist, that's like everything that I'm trying to teach someone is like how do we be are aware of our emotions? How do we regulate our emotions? How do we think through things? That is such a great, great summary, it almost kind of gives me like the visual of like a dam. And you know how you can like open the dam a little or you can open the dam a lot. But like that dam is really in control of what is coming and going, and in what amount, whether it's attention, or feelings or emotions. And so I could definitely see how like if somebody's control panel is shorting out, or someone's dam isn't like letting in or out the right amounts of things. Why that would make life so complicated.
Lesley PsyD 5:37
Yeah, incredibly, so in for diagnoses, like ADHD, it's like those emotions showing up to work every day in Riley's brain. And somebody's like, a shift is down today. Oh, man. All right, Colin, task monitoring, he'll have to work an extra shift. And you really can't predict like what's going to be offline or on line on a given day. So you can imagine how that would not only make your day difficult, but also would affect emotions in the opposite direction, then you get frustrated that you can't shift when you need to.
KC Davis 6:07
So what does it look like when somebody has issues with executive function like when there are disruptions? So that control panel like, how does that show up in someone's life? Like, What would someone have to tell you like in a session to make you go, I wonder if there's some executive functioning issues here.
Lesley PsyD 6:23
So a lot of the time, the first way that shows up is people expressing how bad they are at something. So I always get curious when someone says, you know, I know that my difficulty, like losing things is really impacting my life. But I'm just so terrible at that. That's usually some kind of note to me to ask more questions. Because if you were just terrible at that, you probably would never do it. Usually when that shame kicks in of like, look at this part of me that so bad, I'm not doing well, it's because you feel like you should be able to, or you feel like, you know, I can on this day. So maybe it's just my effort. So whenever I hear shame and guilt in there, I'll ask more. And there's a difference between not being great at a skill, and then having an actual executive function disturbance. So I am not great in developing physical systems to organize my stuff. But I am fantastic at developing tracking systems for my work. If I'm great at developing tracking systems from my work, then my tracking system should work every day, but they don't system. So that's the second factor is inconsistent performance, even with effort and energy,
KC Davis 7:36
which is interesting, because I think that somebody who is experiencing inconsistent performance like that, that's the reason why they assume that they must just be lazy, because they go to work. And they never miss, you know, a work call, they're on top of what they need to do at work. And then they came come home, and can't seem to motivate or activate themselves to do the dishes in the laundry. And they're confused, because they're like, it's the same skills, I'm going to work and I'm seeing what needs to be done. And I'm doing it. But then I come home, I see what needs to be done. And I can't seem to do it.
Lesley PsyD 8:11
I would add to that, that when I see clients in my office that present with that kind of concept, they're even harder on themselves, I hear, I can go to work and manage a multimillion dollar contract, but I can't do my laundry. So they also kind of push these care tasks down in important importance in their life somehow, like I should be able to do this, it's so much easier. But it's not really laundry is about 15 different tasks. And so that's another thing that I'll look for is when they say I'm good in this environment, but I'm terrible over here, that's usually a sign that there's something else going on.
KC Davis 8:46
Yeah, and I totally see that too. We especially the comments that I sometimes get off tic TOCs was just clean as you go, just put it in the dishwasher, just do your laundry, because for people whose executive functioning is firing on all cylinders, like they don't recognize that they're actually doing 12 different steps and utilizing eight different skills to do something like their brain has automated that to the degree where it feels like a simple, non complex task,
Lesley PsyD 9:15
if there was something that came up the most, that is the bit of information that's really helpful I found for family members who don't experience executive function problems is that because you don't perceive that you're doing 15 tasks, does not mean that you're not doing them, it means that your neurology showed up to support your motivation. Those are two different things. You can't motivate yourself into better executive function you can't
KC Davis 9:40
fascinating and you know, one of the questions that I had, and we'll sort of skip around just because coming up is I want to kind of talk about the difference between motivation versus task initiation. Because those things I think, get confused and I think there's a lot of people showing up to their therapists office saying, I'm just not motivated. I'm just not motivated. And I think a lot of therapists are getting curious about what does that mean? What does that look like? So they're jumping right to sort of interventions that can help with motivation, when the actual issue is task initiation. So can you talk about the difference between those two things?
Lesley PsyD 10:15
Sure, motivation is either the desire to do something or the acknowledgement that it's really something that would be good if it gets done now. So it's more of a sensation than anything else. Motivation is a feeling, look at that pile of laundry. So even though that's full of dread, that's motivation, I'm not looking at the pile of laundry going. And I really love that that is an art sculpture, I hope that never goes anywhere. Which is might be true, that's where I've reached that level in my life. But motivation can be positive, or, you know, I hate to use negative, but it can have a distressing component. But then there's the behavior of task initiation. And actually, that is even multiple tasks in itself. So the signal to the body to move for individuals who do not have ADHD, or other forms of executive function disturbance, the motivation is followed by activity to that motor cortex almost immediately, they think it they do it, they just do it, and they don't have to tell themselves to do it. Anyone who has depression or significant anxiety, or ADHD knows the feeling of staring at the task and saying, move, get, move your leg, just move a foot, just do something. So there's a disruption there, the motivation is not leading to the body moving, and then we have to fight to get up. And so task initiation goes from what should be a seamless reflex almost, to a mountain to climb. And that can be incredibly distressing in itself and make us feel real bad about ourselves. It's interesting,
KC Davis 11:43
because what you're describing sounds exactly like what I described when I first got on Vyvanse, where I said, all of the sudden, the transition from sitting in a chair, to getting up to do the laundry was seamless, like the rails had been greased, it was not a hard transition to make. Whereas before, I would sit in the chair and think about how I needed to do the laundry. But I just so badly, either didn't want to or couldn't get up. And it took a long time to almost talk myself into and create. And I had to come up with all of these methods of creating momentum, so that I could get myself to go do the laundry. The other thing that reminds me of so most of my career was an addiction. And I have totally had those conversations with clients where it was a lack of motivation. And the way that they describe it is I don't care, I don't care that the laundry is not done. And sometimes it's really frustrating because you're sometimes talking about addiction, or you're talking about something unsanitary. And the poor families are like how could you not care? How could you not care that you're dying? How could you not care that you're not taking care of yourself? How could you not care that you have dirty clothes, and you smell and they would literally say I just I don't care, I can't make myself care, I feel complete apathy, when I think about those tasks, or they say, I don't think that I deserve those things. And so I have no motivation to do them. And that, for me really helped realize, oh, so motivation, a lack of motivation. And you can correct me on this shows up more like apathy.
Lesley PsyD 13:18
Yeah, lack of motivation is the best way that I can think about it is motivation is a sensation, it's not an action. It's just something that you feel. And so there's probably 1000 different versions of motivation, you can be slightly motivated, you can be not motivated at all. But what I see a lot when I have clients with actual motivational issues, is that they can convince me all day long, why they should do something. But then when we get down to it, and I say, Do you want to do this? Is this something you want in your life? They'll kind of exhale and be like, No, and I don't understand that. Like, what does that mean about me? And it's okay, we can deal with motivational issues. There's interventions for that. But confusing, the two really leads to a shame and guilt cycle.
KC Davis 14:03
Yeah. And a lot of times, especially around care tasks, when people talk about, you know, I just struggle with the motivation to do XYZ. And maybe it's something like clean my room. And sometimes it's a task initiation sheet, right? I want it clean, I function better when it has some order. But when I look at all the things there are I get overwhelmed. I don't know where to start, I get distracted. I have overwhelming emotions. But sometimes when people say, Oh, I can't find the motivation to do it. When you get really curious, you find that it is an actual value issue. Actually, I don't value a cleanroom I only think I should value it because of the way that I was raised. But I function fine and a messy room. And so sometimes you find that the motivation is about what you value and you just, you don't actually value that thing. You just feel like you're supposed to or that's what good people are supposed to value You
Lesley PsyD 15:00
that is exactly why in all of my interventions related to this, the first question I asked someone is, if no one was watching, and no one could say anything to you about this, how would you do this? Just you and people, not only have most of them have never even allowed themselves to think about it that way. But usually, there's a big realization at that point, oh, I think if it was up to me, I would probably just leave all the laundry in the laundry room, I wouldn't be moving stuff all over the house. And so then we say, alright, so if that's what your brain wants, can't we just build a system around that? So you don't have to fight yourself?
KC Davis 15:36
Yes. And I think, you know, one of the pillars of struggle care that I talked about is that shame is the enemy of functioning, and how shame can create short term compliance or short term change, but it doesn't really create long term change, nor does it create or sustain any type of intrinsic motivation. And I think it's what you said exactly about, at some point, you're alone. And shame is always about what someone else thinks of you, or the fear that you won't be accepted. Or, you know, I'm full of shame, because I'm a piece of shit, I'm a bad person, I'm not lovable, I'm not good enough. And that all has to do with the need for belonging and acceptance in your tribe. But if your tribes not around all the time, like you're going to default to whatever motivational or initiation issues are there. And so the shame doesn't work. And as someone who went to long term residential behavior modification for 18 months, you know, I was on point I followed every rule, I did really well, like I won, I won the game. And I functioned really well, when there was constant. outside pressure outside, it was like having an external control panel, right, there was always an external pressure, and external accountability. You know, these rules, regulations, structure, peer pressure monitoring. And once I left, although I did learn lots of great things there, there were so many things that was like, Oh, I'm two days in, and I'm not getting up at the crack of dawn and doing chores and doing all these things that were so easy for me when I was in structure.
Lesley PsyD 17:17
And I think that what that in both of those examples in your example of leaving that highly structured environment and the other example of people having what they often describe to me as relapses when no one's around, what's really happening in those moments is that people are returning to what is authentic, and guilt and shame causes us to interpret authenticity as bad. So imagine what that does to our sense of self, when being who we truly are, is the bad way to be. How do you escape that?
KC Davis 17:47
Yeah, well, and then you carry it into every relationship, because no matter how much someone says, they love you, no matter how much praise or validation, you get, there's always this voice inside your head that says, if you only knew, and what's interesting, you know, kind of going back to talking about the way we show up at work, the hardest job I ever had, was working at a restaurant, I worked at a really high end restaurant for Hillstone Restaurant Group, and they ran their waitstaff, like a boot camp. I mean, I can't even describe to you like everything was very regimented. Everything from like, you had to memorize certain abbreviations, you could only walk into the kitchen and one door, you had to have things in your hand, as you left the door, you had to put drinks on the table, within 30 seconds food on the table, within 10 minutes. Everything was highly, highly regimented. And so as you're going through your shift, you're having to multitask, prioritize, work with your working memory. And I was excellent at that job. But there was this structure there, there was this external structure, and there were all of these other people. They're doing it with me. And I think it's so fascinating how there are environments in which my executive functioning can fire on all cylinders. And then I can go home and look around my home and not be able to sort of turn everything back on. And I will assume it must be because I'm not trying hard enough. It must be because I'm not good enough, as opposed to, there is an obvious environmental difference between work and home.
Lesley PsyD 19:23
Absolutely. And that's what we talk about as, as clinicians who work with people with executive function disturbance, and in this case, especially ADHD is that if our internal structure is inconsistent, and we know that then we need to build external supports. So if we do that, right, that's not good. And then we shift that if we do that, effectively, that in a way that works for us, we do it so that it enhances our view of ourselves because if we notice that our control panel shift button is down that day, we can complement it with other external support. So we can utilize that concept or really well, I think what happens is, we don't teach people about this, when they're well, we're not teaching children and teens about executive function. So we have all of these assumptions, I can do it at work, but not at home. That must mean I don't care as much about my home, well, no work is set up perfectly for you, you've got all these external supports that help you so that no matter what function is down, you've got a compensatory strategy. And I find that that's a lot of your work that I witnessed and have on a daily basis, is you're really helping people figure out where you know what system is down for them, and how not just individual solutions, but how to think about yourself and your environment, to provide your own external support that goes with you from place to place well,
KC Davis 20:43
and I find that so many of the resources that talk about like running your home, and setting up systems and routines are very intimidating, because there's like, you know, 9000 checklists for the day, and it's really all consuming. And I think that we can write those things off as if no, no, no, those things are for people who have their shit together. Those are for healthy people that are on top of it, that are using those kinds of strategies, as opposed to I mean, and you see this too, with like, when you watch the TIC TOCs, about people like restocking their pantry, like when you look at the all the clear containers, and that like that gets written off as Oh, that's something Pinterest moms do. But in reality, there's some real functionality to having clear canisters where you can see things and having a time of the week where you restock everything. It's just that we sometimes I think need help making those systems accessible. And so it reminds me of when I started having a cleaning schedule, I always said no, I'm not going to do that. And then I started one and I really call it a care tasks at schedule. And it's literally one thing a day just one like I do laundry every Monday. On Tuesdays, I restock bathrooms. On Wednesdays I clean one thing in my kitchen. On Thursdays I do the sheets and on Fridays, I do the floors. And then on Saturdays, I do the groceries. And so it's really simple. It's nothing that anybody would like all over Pinterest in but setting up that system mirrored some of the more structured environments I've succeeded in in the past and circumvents ways in which my control panel short circuit so because my working memory is unhelpful to me at times, I found that when I do laundry on Mondays, it took about a month but now the idea that laundry is supposed to be done on Mondays is not something being handled by my working memory. It has been filed away in short term memory and contextualize. So that Monday and laundry are inextricably linked in my mind and my associations. So from the moment I wake up on a Monday, it's like it gets flagged it goes it's a laundry day. And before when I was just waiting to do laundry for when we ran out of clothes, it had no associations. So I'm either procrastinating it not doing it getting into the wash and forgetting about it, getting into the washer, the dryer, but then putting it on the floor. And it totally changed my ability. I mean, I literally can't tell you, Leslie, I have never been able to do laundry in a timely manner and have clean clothes put away until eight months ago. And what else is funny, I was looking at it tic toc that I did recently where I talked about how I used to try to be on the house's schedule. Like oh, I noticed that the clean sheets are dirty time to clean the sheets. And when we run out of food or grocery shopping, we run out of clothes, all laundry, and I never could keep on top of anything. And so when I started washing sheets every Thursday, all of a sudden, the sheets were getting washed. And it was for some reason it kind of went to like an enjoyable activity because I felt like I was participating in the routine. And I was doing it and that felt really good. So it even changed my like reward system relationship with the task. And I think it's really funny how for Casey Davis, the only two options for the frequency of how often I wash sheets is every week, which I recognize is too often or literally once a year. Like that's it.
Lesley PsyD 24:20
But I love the idea that that's based on trying things and then honoring yourself. And when you find that thing that starts to work really leaning in and not worrying about is this what I'm supposed to do isn't weekly too much. I don't think I have to do that. It doesn't matter if you are finding a rhythm and I think rhythm is a really important word. For people with executive function issues. Rhythm is better than routine for a lot of people routine is like you said it and then I have to do it that way. That's how I do it. Rhythm is paying attention to how it feels and leaning in when it feels right.
KC Davis 24:54
Wow, that gave me goosebumps rhythm is more important than routine. And I think that that must be What I'm feeling because rhythm is so satisfying to me. Rhythm is even if it's, it could be the most monotonous task. But if it's on a rhythm, if it's in the flow, all of a sudden, I feel a sense of reward when it's accomplished only if it's in the rhythm and in the flow.
Lesley PsyD 25:17
Exactly. It's funny because I think we're both going to say things like in the last year in the last eight months, because the pandemic really created this opportunity to really look inward. In all the time we have with ourselves. I really found in the last year that I enjoyed the fact that my family all slept in later, because they weren't going to school, both of my kids stayed home and fully homeschooled. And so I don't sleep in past seven, I never have, it works for me, I like it. And all of a sudden, I had an hour, from seven to eight of this pristine quiet. And what I found is that I was starting to get a cup of coffee and sit in the same chair and do my notes, my notes for work for if anyone who's not a psychotherapist, it's kind of the bane of our existence. Usually, we need to do it. And it's important, but it's not fun. We like the people, right? We like working with our people. And so I hate notes, and I would often get behind. But what I found is I started getting up at seven, no one's awake, sitting in my chair with my cup of coffee, doing my notes, and then all of a sudden, that became a really joyful time for me a peaceful time. And if I heard footsteps, I very kindly reminded a child not until eight, you have to, like stay in your zone. And so I agree with you, I think when we find our rhythms, and we lean in, we really are honoring ourselves. I think it's just hard in our modern society to feel like we're allowed to do that. Well, I
KC Davis 26:40
love that you came to that rhythm gently. Because that's been my experience with all the rhythms that work in my house. Now I came to them gently, I wasn't forcing them. And so what I mean by that is like you didn't say one time, like, you know what, I'm gonna start waking up an hour earlier, so that I have some time to myself, and then you know, you wake up and you snooze, you don't it was like it kind of accidentally happened, and then you realize you liked it. And so all of the things, the rhythms for me that stick are the ones that I sort of happen upon gently, they're not the ones where I'm trying to force myself into a routine or force myself into a schedule. And that's kind of what I'm hearing about your rhythm too.
Lesley PsyD 27:19
Yeah, I'll give you an example of how two people can utilize the same compensatory strategies in opposite ways. In my house, we don't have a set day for any task, because that didn't feel rhythmic. To me, it didn't feel authentic to me, what I do is in my brain is surfing. So I have a rhythm of the things that need to be done, not on a daily basis, but more and more like monitoring the house. And I do what feels right that day. And I just don't repeat the same thing two days in a row. And so that's another way to utilize the same skills to get the same result, but in a completely different manner. And that really, I think, speaks to why it's so important not to just look at someone else's strategy and say, I'm going to copy that exactly. And if it doesn't work, that's my fault.
KC Davis 28:06
Yeah. And that's why I try really hard not to make it sound like when I'm talking about what works in my home, that I'm not handing it out as a prescriptive routine, like, oh, everyone should do this. This is the answer. Because people are so different. This is just what works in my house. And maybe it'll work for three weeks, and I'll try a new system, maybe it'll work for three months, and then I'll try a new system. One thing I know about me now is that the challenge and the novelty is really important. And so if I use a system for a rhythm for three months, and then I stop using it, I don't have to, I can either just kind of go with the flow and naturally get back on it. Or I can go maybe it's time for a new rhythm, a new system, it doesn't mean that I failed, or that I've done something wrong, or I've relapsed, I can't keep on a system for the life of me. Maybe it's just my natural need for novelty and challenge. And so instead of sort of beating myself up and trying to force myself back onto something I can go, so what's a way that I can do it now what feels right now that will still get those same functioning goals done. And I think it's okay to change your rhythms as they change.
Lesley PsyD 29:16
Absolutely. And I think that's what I really enjoy about your content is the strategies that you provide are kind of like a bouquet of flowers, you might pick these flowers to hold and smell today. And maybe later, you'll be like, I want to go back to closing duties. And we've implemented your concept of closing duties in our house. And what I noticed is that we do them for a while, and then they become pretty easy to do. And we don't look at the list anymore. And then all of a sudden we'll kind of notice and noticing is by the way, just as a pause. It's a really helpful concept with executive function disturbance. Because noticing is different than criticism. So Oh no, I'm not using my planner can become. Oh, that's interesting. I haven't used my planner in a week. So when we noticed that in the evenings, we're feeling more stressed. Faster, there's more mess, we'll just recenter ourselves and be like, Oh, time to go back to closing duties. And if you do it that way, it's really a way to think about having this variety of tools in the same toolbox.
KC Davis 30:11
And it's totally fine. It's funny, because last night, I had my three year old do her closing duties, and then I did my foreclosing duties. But I honestly hadn't done either one of them fully in a week. And I had that same noticing of just non judgment. It's not Oh, I haven't done this, I need to do it. It was, you know what it would feel good to do them tonight, it would feel good to have these done for the morning. And that's totally fine. Because I get that question all the time. I feel like I start out strong, and then I fall off, what do you do to get back on the horse? And I think the answer is there is no horse. Yeah, there is no horse, there is no falling, there is no horse, it's just meandering through the woods. And sometimes, you know, you start to walk off path because it's interesting, and it meets your needs. And then, you know, when you get a little disoriented, and it serves your needs to get back on the sort of beaten path, then you do that there's no moral judgment on either side. So let me ask you this. One thing that all of this sort of came to head for me was, although I now know, looking back that I've had ADHD my whole life, when I had my second daughter, and I was postpartum, in a pandemic, that's when the majority of the executive functioning came to a head where I couldn't function anymore, right, I look back on my life, and I see where ADHD has been. And and then at the same page, I see all these compensatory behaviors. But when I was postpartum, in a pandemic, it was as though the control panel broke down even more, and the compensatory sort of tools I had didn't work anymore. And one question I wanted to talk about, because we've been talking about ADHD, and depression and sort of these diagnoses that cause executive dysfunction. But certainly there are instances or circumstances or seasons when even someone who's neurotypical can experience interruptions with their executive functioning. And I wonder if you could talk about that.
Lesley PsyD 32:03
Yeah, not only can that happen, it happens for everyone, at some extent, probably every few days. So one of the things that's challenging to really cover in full on a short format, social media, like tick tock is all the nuance that's involved in this. So I like to kind of make the quip that you know, if you have a central nervous system, you have executive functions. And if you have executive functions, then you're gonna have days with executive dysfunction, it's just how we were we're homeostatic. So you know, we deplete ourselves of calories, we get hungry, we eat. And that's the same for all of these self monitoring strategies. The biggest thing that impacts executive function, the two biggest things are overload, and anxiety, any kind of anxiety, not even clinical anxiety, just that pressure and nervousness, predominantly impacts things like working memory, and focus for every human being. So if all of a sudden, you are home with your kids all day, and you still have to work or take care of your home, and that is your primary work, and they are having a tantrum, there's a lot going on. So you could be overloaded on two counts, which is going to decrease some of these executive functions. So you might be in the middle of, I was just gonna say, Well, everyone who listens to this, maybe find this to be familiar with, let's say, you are cleaning up a mess that a child has created. And then you have another child who's on the bathroom, you know, on the potty and needs to be wiped, and then someone else who's crying because they're hungry, that's too much for a human being to process in the moment, you're going to have to sacrifice something, it's very likely that if you had another task, you're going to either let it to the side on purpose, or you're going to forget completely. We also know that because just because you mentioned being postpartum, we do know and there's emerging data that shows that estrogen fluctuation, and to some extent other hormones as well impact executive function for all people, especially so for ADHD. But even for neurotypicals, it's not unheard of that folks would have all of a sudden more difficulty with their attention and focus, you know, Miss An appointment, misplace their keys when their estrogen is particularly high or low. Problem is we don't have concrete evidence, whether it's the high or the low. And we don't know why it affects some people and not others. Interesting.
KC Davis 34:23
And when you say that, like worry and anxiety can affect executive function, even for neurotypicals. What came to mind for me was I think everyone's had the experience of being at work. And you know, you're in the groove, you're being productive, and then you get the email from your boss says, hey, I want to talk to you at 430. Right? And then all of a sudden, it's like, it's impossible to go back to work and be productive again, like you can't focus you can't think you just have this worry and anxiety. And so that totally makes sense to me. You know why that can happen if someone is experiencing stress or anxiety or just overload?
Lesley PsyD 34:56
Yeah, and those things can compound each other. So I think one of the things As the pandemic did is not only did it remove a lot of people's external coping, it compounded our anxiety in a way that we've never experienced. So gonna be anxiety provoking to teach your children at home. But when you have the extra worry of making sure that they're safe and early in the pandemic, we were, you know, washing the grocery bags and leaving are outside. I imagine for a whole lot of people, they found themselves experiencing a whole lot more disruption in these areas than typical and that may last for quite a long time.
KC Davis 35:31
Yeah, I wonder if you would say, you know, when you were talking about how there are people who have these kind of long term diagnoses, who will experience executive functioning barriers, but then a neurotypical person experiences them every once in a while, or even once every couple of days. And to me, you know, because there is a real difference between the way that someone who has a diagnoses whether it's the degree is different, or the frequency is different. And it almost reminded me of, you know, when somebody is chronically ill, their experience of medical problems and medical issues and barriers in their life is completely different from someone who's not chronically ill, who's not chronically ill, and but even someone who's not chronically ill get sick sometimes. Right? And so there's some way in which they think they can relate, you know, someone who has had the flu might look at someone who is chronically ill talking about being fatigued and having a fever and think, Oh, I know what that's like. But contextually, you know, the degree to which someone experiences executive dysfunction can really make a quality of life difference between someone who is just sort of on the normal course of life experiencing little blips here and there.
Lesley PsyD 36:44
Yeah, absolutely. And the way that I explained this to folks is that for someone who does not have ADHD, but is having a particularly stressful moment, and finding that they have some executive function challenges, maybe they just feel overloaded, or they forgot a bunch of things. Their challenges with executive function are two things, they're more predictable. So it makes sense when they happen, oh, I can see why, gosh, it's been a crazy week at work. And my kids are yelling, so they're more predictable, and they respond to intervention. So in the middle of it, if an individual who does not have an actual diagnosis does not qualify for that says, whoa, slow down. All right, you know what, I'm going to take some things off my plate, I'm going to take a minute for myself, their executive function skills will probably return right back to typical because they're more bound by the environmental stress. The core feature of something like ADHD is that the symptoms are fundamentally unpredictable. And don't make sense with the environment. People with ADHD can have incredible deficits and executive function on a day where everything is going their way, there is nothing wrong, they feel great. And conversely, they could be having the worst day of their life and remember everything and they don't respond to typical interventions. So things like just slow down and focus, just use a planner, right? Just use a planner, don't you think you should get more rest, stop drinking so much coffee Wanderlei have done all of these things today. They don't respond reliably, they may respond sometimes, but they don't respond reliably. And that's why ADHD can be hard to diagnose, especially in very young children, because we need that pattern and the severity, to understand it. So for folks who don't have ADHD, try to imagine yourself on your worst day where you were the most disorganized. And imagine that that worst day could happen at any moment, with no warning and didn't respond to anything you did. That's what it feels
KC Davis 38:36
like. And I think that's probably also you know, what we're talking about the shame and beating ourselves up. Because, you know, if you get a phone call in the middle of the day, and you get some sort of scary health news about a family member, and then shortly after that, you suddenly kind of lose all motivation to do anything else with your day, you're gonna go well, that makes sense, right? I've had this big stressful conversation, I'm, well, I'm worried. And there, it's easier to be kind to yourself in that mess. Maybe I do need to just take it easy today. But if you have ADHD, or really any of these diagnoses that can create executive functioning issues, and you wake up one day, and you're going about your day, and then randomly at 12, you don't have a phone call, but just randomly everything goes through and just powers down. And you don't want to do anything else with the rest of your day. We don't tend to give ourselves the same kind of kindness of Oh, well. Let me just you know, that makes sense. That seems valid. Let me just take it easy today. And I think the biggest difference that I have been able to experience since getting my diagnosis. Was it being easier to be kind to myself, and I'm incredibly privileged, that the stuff that I work on in terms of my struggle care platform is very flexible, and I control my own dates and goals. because to some extent, because I will wake up going, I'm gonna get this and this and this and this done. And then all of a sudden, everything just powers down at 1030. And I get to go, Well, I guess it's not getting done today, or I guess it's only kind of going to get done or I guess, let me see if there's some other sort of flow that I can jump into, and maybe just switch projects completely. Now, we don't always have that option in life, there are things that have to get done at certain times. But even when we have to sort of trudge through the ability to sort of be kind to ourselves, and I think that's been my experience is trusting myself and honoring myself that if I feel that power down, that is something that really just happened. I don't know why maybe there was no triggering point, but it did happen. It was not a moral failing. It's not laziness, and it's okay to just kind of go with it.
Lesley PsyD 40:50
Yeah, absolutely. There's a model that I use with clients that's so similar to this. And it's been expanded upon by my friend, Abby on Tiktok. She's at Proactiv busy body of the stoplight model. So those of us with these challenges, we typically have red, yellow, and green days. And a Green Day is where for some reason, we're just firing on all cylinders, we're doing really well. And on those days, we don't need as many supports as we usually would need. And we can kind of raise our expectations for ourselves. So if we wake up, and we're feeling great, that's the day to say, Alright, I'm gonna get some extra stuff done, we have our yellow days where you're feeling a little uneasy, you're doing okay, but you could really use maybe some extra supports. And then we have red days where we wake up, and anyone with ADHD typically will will resonate with this. And by half an hour after waking up, we know what they were about to have, we've already lost our keys three times and then found them in the freezer. And on those days, we need to lower expectations and increase supports. And moving through those lights is a way to both hold ourselves accountable, right? We're not that's why it's not laziness, we're not saying it's a red day, I'm doing nothing. No, we need to increase our supports, and really decrease our expectations to focus only on the most important things, which always, by the way, includes self care.
KC Davis 42:09
It also reminds me of why you know, when I did sort of build myself this care tasks schedule over the week. And when I did my closing duties, I tried to build into each one of my routines, differing levels of acceptable outcomes. So like, I have a list of things that I do for my closing duties when I closed on my house, and it's like six things. And then I have a another list that I call survival day closing duties. That is just two things that absolutely need to be and I have full permission to choose whichever list fits my needs and my abilities in that moment. And the same thing with when i This is always my suggestion when someone says I want to try a cleaning schedule, what do you suggest. So I suggest, you know, if picking a room or a task a day, but when you say Tuesdays as bathrooms, it doesn't mean on Tuesdays, I clean every single bathroom, it just means on Tuesdays, I clean something in a bathroom. And that allows you to stay within the rhythm that feels good while still honoring sort of your needs of that day. Because it might be a day where you go in and you wipe the countertop off, and then you walk out. Or it might be a day where you go in and clean the whole bathroom top to bottom or every thing in between. And so that we don't feel like when we have a day where we can't accomplish the whole thing that we failed, because any of those options within one thing, or all the things is acceptable, and frankly, no things is acceptable to I have things on my little cleaning schedule that auto like almost week to week, barely ever get done. And sometimes they do. So as we sort of land the plane here. I want to kind of talk about, you know, if someone's listening to this podcast, and they're really relating, and they're thinking, oh my god, I think maybe some of my struggles might be related to executive functioning issues. Where would you suggest someone start? I want to ask this in two parts. Where do you suggest they start in terms of who is the right maybe person or provider to look for? Because I don't think all providers are really knowledgeable about executive functioning issues. And then for people who maybe don't have access to one on one providers, any resources that you would suggest to them?
Lesley PsyD 44:28
Sure, yeah, we have in psychology right now in particular the area of support for Neuro divergence, we have an issue, clients and community members not being able to reliably tell if we are going to be helpful to them and we are working on this. So the biggest suggestion that I make is if you have access if you have a mental health benefits through insurance going to a licensed clinician making sure that they have a credential of some kind and make sure when you make contact with them if you're looking for supports that you interview them, ask them questions, ask them Do you know what executive function is this is what I'm specifically looking for. This is one of the things that I find that people don't realize they're allowed to do. And any good clinician would welcome. So if you have access to those kinds of benefits, a psychologist or a therapist, really just starting with even psychology today.com, which is a little bit limited, or just Googling your zip code, and executive function, and therapists, it will give you a nice fat list of a lot of people more than you could contact. But working with a licensed clinician, if you have access to that is really helpful. If you don't have access, or if you want to do something to start dipping your toe in this pond and figuring out if this sounds like you, I absolutely love understood.org. It is a wonderful website, I do not make any money from understood.org. Just so everyone knows, I'm not sponsored by them. I'm just a patron, they have a wealth of articles, they have a simulator so that if you have this disturbance, and you'd like someone in your family to know what it feels like, you can have them do a simulator for executive function challenges. And there are also articles about what concretely to do to start helping yourself and also how to reach out for support. Those are my favorite two suggestions.
KC Davis 46:10
Awesome. Yeah, and I will say, as a licensed professional counselor, I have a Master's in Counseling. And I can honestly say that my education did not provide that much information. In fact, I don't remember hardly any information about executive functioning. Certainly, my education and counseling gave me the tools to understand what I was learning when I went out to learn about executive functioning. But I just wanted to sort of echo it's definitely something to ask of a therapist, because not all therapists are going to have experience in that area.
Lesley PsyD 46:43
Yeah, absolutely. And they're even if you don't have ADHD, Chad, CH A D is.org is another resource. Sometimes individuals forget that. If you don't have a diagnosis, that doesn't mean you might not benefit from the information. So it's really okay. You don't have to feel like I have to have the diagnosis to even look at this. There's probably a wealth of information that can be helpful to you.
KC Davis 47:05
Awesome. Well, thank you so so much for all of this do you want to go ahead and plug your socials and where you are and how people can watch you and contact you if they want to?
Lesley PsyD 47:16
Sure I am predominantly on Tik Tok. It is my favorite social media platform that's ever been invented because it's everything is one minute, which works for me. I'm also on Instagram. My Tiktok is Lesley Psy d l es el EYPSY. De my Instagram is actually Lesley underscore Saudi. And that'll be more of the professional information. I'm not on Instagram as much so Tiktok is the best way to peruse my contents.
KC Davis 47:42
Awesome. Well, thank you so much.
Lesley PsyD 47:45
Thank you for having me. This
KC Davis 47:45
is wonderful. This has been an incredible talk. And so if you are listening, I hope you guys check Lesley out and thank you for tuning in.
