From the desk of Melanie Whetzel, M.A., CBIS, Lead Consultant – Cognitive/Neurological Team
Executive functions are high-level mental processes or abilities that influence and direct more basic abilities like attention and memory. The term executive function describes a set of cognitive abilities that include the ability to plan, organize, and strategize; pay attention to and remember details; start and stop actions; and form concepts and think abstractly. Executive functions also keep us from behaving in inappropriate ways.
Executive functions are important for successful adaptation and performance in the daily situations in our lives. They allow us to begin and complete tasks, and to persist when we are faced with challenges. We need to be able to recognize unexpected situations and adjust our plans quickly when unusual or sudden events crop up and interfere with our regular routines.
Disabilities that may occur or be exacerbated and limit the ability to fully use higher level thinking skills include but aren’t limited to Alzheimer’s and other forms of dementia, brain injury, mental health impairments, epilepsy, multiple sclerosis, and learning disabilities.
Naturally, employees with deficits in executive functions who work in higher level positions that require more frequent or sustained use of these higher level thinking skills are likely to run into situations where they will need accommodations to complete the tasks and duties of their positions. Let’s look at a several higher level positions and a just few of the myriad thinking skills that are required.
A Look at Higher Level Positions
- Advise and represent clients in court, before government agencies, and in private legal matters
- Conduct research and analysis of legal problems
- Interpret laws, rulings, and regulations for individuals and businesses
- Prepare and file legal documents, such as lawsuits, appeals, wills, contracts, and deeds
- Manage school activities and staff, including teachers and support personnel
- Develop, implement, and maintain curriculum standards
- Evaluate teachers’ performances
- Manage the school’s budget, order school supplies, and schedule maintenance
- Give preliminary estimates on cost and construction time
- Prepare structure specifications
- Prepare contract documents for building contractors
- Manage construction contracts
- Computer Engineers:
- Design new computer hardware, creating schematics of computer equipment to be built
- Test the completed models of the computer hardware they design
- Analyze the test results and modify the design as needed
- Oversee the manufacturing process for computer hardware
- Direct and oversee an organization’s financial and budgetary activities
- Manage general activities related to making products and providing services
- Negotiate or approve contracts and agreements
- Analyze financial statements, sales reports, and other performance indicators
As you can see from the short list above, these higher level positions require some very specific and advanced cognitive processing skills. When a cognitive disability develops or is exacerbated, daily tasks and duties may become difficult. Employees who never have had performance issues in the past may now find tasks problematic. And because these positions are higher ranking ones, often at the management level, the process of providing accommodations may be difficult, awkward, and unfamiliar.
Helpful Hints for the Accommodation Process
- Before your condition significantly affects your ability to effectively do your job, talk to your employer. A full conversation with your employer is vital for success.
- Explore your rights under the ADA. Contact JAN for assistance.
- Encourage a support person or team, possibly a family member familiar with the effects of the disability, to be part of the process.
- A full conversation with the employee is vital for success. Keep an open mind about possible accommodations.
- With assistance from the employee’s doctor, determine if the disability may progress and how quickly that is apt to happen. This will help in ascertaining the long-term accommodations that may need to be made. If the disability does progress, job-related tasks will likely become more difficult to perform. Providing accommodations so that the employee is able to continue working as long as possible may help to preserve an income and independence, as well as increase self-esteem.
- Explore your rights and responsibilities under the ADA. Contact JAN for assistance.
- Encourage a support person or team, possibly a family member familiar with the disability, to be part of the process.
- Monitor the employee’s performance to ensure the accommodations are effective. Some adjustments or changes in accommodations may be necessary. Keep in mind that a reassignment may become necessary in some situations.
A Brief Look at Accommodation Ideas for Executive Functioning Deficits
- Memory: Individuals may experience memory deficits, which can affect their ability to complete tasks, remember job duties, or recall daily actions or activities.
- Provide written instructions and checklists
- Allow use of a recorder
- Offer training refreshers
- Provide minutes of meetings and trainings
- Use flow-chart to indicate steps in a task
- Use a color coding scheme to prioritize tasks
- Organization and Prioritization: Individuals may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work.
- Develop color-code system for files, projects, or activities, and to prioritize tasks
- Use weekly chart to identify daily work activities
- Use electronic organizers, mobile devices, and e-mail reminders
- Provide a "cheat sheet" of high-priority activities, projects, people, etc.
- Organize work space to reduce clutter
- Take time at the end of each day to organize and set up for the next day
- Multi-tasking: Individuals may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks or the frequency of performing the tasks.
- Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order
- Identify tasks that must be performed simultaneously and tasks that can be performed individually
- Provide specific feedback to help the employee target areas of improvement
- Remove or reduce distractions from work area
- Managing Mental Fatigue: Individuals may have more difficulty with cognitive functioning when experiencing fatigue.
- Permit flexible scheduling, which may include longer or more frequent work breaks
- Provide additional time to learn new responsibilities
- Allow the employee to do mentally difficult tasks when he has the most focus and stamina
For a more complete list of accommodations. Also see JAN's A to Z: Executive Functioning Deficits for a more extensive list of accommodations.