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Executive Functioning and the Emerging Adult:

The Dissonance Between Intelligence and Competence

Paule Verdier MOT, OTR/L

 

CASE EXAMPLES:

BRILLIANT BOY WHO CAN’T FUNCTION WHEN EMOTIONALLY DYSREGULATED

Charles had completed his degree before entering treatment. He is in the highest one percentile in Verbal and Performance scores on IQ testing. Yet, after college, Charles fell apart, unable to get out of bed and go to work. The PASS provided several opportunities for the assessor to determine in detail the nature of his difficulties in executive functioning. During the assessment his awareness decreased, to the point that physical gesturing had to be used to point out a home storage problem and that he had been given too much change during the shopping exercise. His problem-solving skills proved to be limited, as he chose to mail bills using two 27-cent stamps instead of one 42cent stamp.

He was unable to follow the verbal directions given to him regarding the radio broadcast and newspaper article subtasks, instead adding information he had previously learned. Rather than checking to see if the batteries were dead in the flashlight, Charles chose to take the entire flashlight apart to examine the bulb and determine whether it was in working order before attending to the batteries.

Throughout the assessment, Charles made comments on the tasks being “out-dated.” Even when he made only a slight mistake, he had a hard time admitting to being wrong, instead trying to blame someone or something else for the problem. He was extremely confident throughout the assessment, to the point of being patronizing. His inability to be open to making mistakes stops him from seeking out help in learning life skills.

THE EFFECTS OF ATTENTION DEFICIT DISORDER ON A BRIGHT YOUNG WOMAN

Angie is a very bright young woman with severe Attention Deficit Disorder (ADD). Prior to Yellowbrick Angie had been in a series of treatment centers for substance abuse and mood disorder. Her ADD made performance on the PASS very difficult, many of her executive functions were impaired, leading to dangerous situations. Young adults with ADD can begin a task, but are not capable of seeing it through to the end, and are often prone to making a multitude of mistakes. Angie had difficulty attending to the radio broadcast, she was unable to identify the underlying subject matter, and was not able to provide a reasonable solution to the problem. Home tasks were helpful in identifying Angie’s difficulties.

During the cooking activities, Angie was haphazard, unable to pay attention to detail, and created several unsafe situations, and incured a slight burn to her hand. She almost walked into a pair of scissors that were poking out of a drawer. She seemed unaware of messes on countertops and did not clean them when instructed to clean up after herself.

In emerging adulthood when independent living skills are developed, it is alarming how many highly intelligent young adults experiencing severe mood dysregulation do not know how to do simple tasks such as turning on a gas oven, know whether or not canned goods should be refrigerated, or how to write a check. They may have been able to do these things in the past, but experiencing extreme emotions can cause severe dysregulation of behavior. The effect on self-esteem is severe, and many young people state they felt ashamed of not being knowledgeable or experienced in some life tasks. This can be true even if they complete them correctly. The effect on those around them is also significant. Parents, in particular, may become very distressed and feel like the future for their child is hopeless. Whether it is lack of experience, poor executive functioning, or ADD, these emerging adults are unable to perform in the basic areas of life skills. When their selfesteem is adversely affected, they may not reach out for help, therefore never learning adequately. What this means for the life trajectory for emerging adults is that they will not be prepared to live independently without a greater appreciation and attention to building these skills.