How accommodations can help workers with executive function issues thrive at work

I have a friend from whom I love to borrow quotes. She speaks and thinks in great sound bites and I try to borrow from her as often as possible. One of the statements she frequently repeats is, “saying ‘focus’ to a person with ADHD is like saying, ‘oh, just cheer up’ to a person with depression.”
If only it were that easy.

Focusing is an “executive function,” described by psychologist Hadley Koltun in an interview with the author as “the ability to initiate, plan, conduct and monitor the progress of complex tasks,” as well as regulate one’s emotional state while performing those tasks.

While executive function (EF) issues are often discussed in the context of ADHD – up to 90% of all kids with ADHD struggle with this – health-care professionals are increasingly recognizing the presence of EF behaviours in a variety of invisible conditions, including epilepsy, learning disabilities, mental health and dementia, among others.

Two decades ago EF was virtually unheard of. Psychologists diagnosing a worker with learning disabilities in specific areas of information processing, for example, may have missed the mark by failing to acknowledge the presence of ADHD or EF behaviours. As diagnostic theories and tools have evolved, psychologists are now able to earlier identify symptoms and behaviours in clients that may indicate the presence of EF deficits.

While supporting employees struggling on the job, employment professionals should consider the possibility of EF as being a possible variable in a client’s poor work performance, especially if the worker has been previously diagnosed with a learning disability or another cognitive disorder. Employees struggling with planning or organization issues may benefit from accommodations suggested by the employment professional.
What is it like to deal with EF issues in school and at work?

Executive functions are the logic and problem-solving centres of the brain. Time, stress and emotional management, priority-setting, organizing, multitasking, personal censorship, working memory and just plain getting started are commonly affected areas for those with EF challenges.
People living with Executive Function Disorder (EFD) or EF issues related to other conditions may struggle to “analyze, plan, organize and complete tasks with or without deadline,” writes Janice Rodden on additudemag.com. “Children and adults with executive functioning problems struggle to organize materials and set schedules. They misplace papers, reports and other school materials.”

These are lifelong issues that people like my client Kathy, who lives with epilepsy and borderline personality disorder, have to deal with. Kathy, 33, notes that prioritizing, memory and organization have always been significant challenges for her. For instance, when she worked for an office manager for a gold-mining company, part of her job was recruiting volunteers from post-secondary campuses for an annual fundraising run. “I had to give a speech and was terrified. I have problems with verbal working memory and forgot everything,” she says.
Another problem area for her is trying to stay organized on the job: “I try really hard to keep my space organized, but it’s a challenge. My brain feels like spaghetti.”

Workplace accommodations

In her Additude Mag article, Rodden identifies seven types of self-regulation:
• Self-awareness
• Self-restraint
• Non-verbal working memory
• Verbal working memory
• Emotional
• Self-motivation
• Planning and problem solving

Organizing principles like this can help employees start to identify accommodations for themselves. The good news is that these solutions are usually relatively inexpensive items that are used every day.
For instance, Kathy uses Post-It notes as memory prompts and to help her prioritize. She has also learned to recognize the types of roles in which she works best. “I’m actually okay with boring jobs that have lots of repetition. It’s great for my brain,” she says.

It’s important for workers to give themselves time and encouragement to adapt to accommodations they are trying to implement. Some accommodations may not be successful the first time. In other cases, job descriptions may change so the accommodation needed to successfully complete a task may change with it. Job coaches and mentors can play valuable roles in supporting workers with EFD by helping them identify and integrate various strategies to contribute to workplace success.
Here are some suggested accommodations for people with different executive function challenges:

Reducing distractibility
• Removing distractions
• Providing quiet workspaces (or ear plugs, white noise machines)
• Taking frequent breaks

Sustaining attention
• Gauge attention span – how long can you maintain focused on a particular task before getting distracted/tired?
• Identify the time of day you function best and plan the most important tasks for that period
• Try to block access to “short term temptations” like social media which distract from task completion
• Allowing “distraction time” half-way through a large task or at the end of a smaller one in a series of tasks

Organization

Many people with EFD suffer from “overwhelm” by accumulating unnecessary files, papers and other assorted clutter in their workspace. To combat this, try developing a sorting system
• Only focus on the most important things – Anything not critical should be discarded
• Determine:
– a location
- categories and subcategories including a colour coding system to identify levels of task priority and ease of access
– time frame for sorting
- “rules for sorting” (What not to keep/keep); think Marie Kondo… if it doesn’t bring you joy, dump it!

Prioritizing
• Evaluate tasks to determine which are high priority and schedule them into a calendar accordingly
• Graded task assignment is useful here:
- Break down tasks into manageable chunks
- Create “cheat sheets” to prioritize activities
- Overestimate time needed to complete them
- Record estimated vs actual time to improve prediction

You can see that the majority of these accommodations are inexpensive to implement. Workers with EF issues should also take some time to think about disclosing at least some of their challenges to employers if they feel aspects of their disability will prevent them from performing essential duties of the job. Community agencies like Epilepsy Toronto and other disability employment programs also offer services like coaching that can help employees perform effectively on the job while also educating employers about their employee’s disability.

As awareness grows about the role executive functions play in determining workplace success, employment counsellors can facilitate positive outcomes for their clients by taking a strengths-based approach that capitalizes on pre-existing skills. They can also make substantial contributions to their clients’ self-awareness and growth by helping them understand that the deficits they perceive in themselves are in fact gifts and unique ways of contributing to a world that’s slowly but surely embracing neurodiversity.

Carter Hammett is the employment services manager at Epilepsy Toronto. He can be reached at carter@epilepsytoronto.org