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Executive skills

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  2. Tips and tricks
  3. Professional help
  4. Involving family and friends

At the end of the day, I haven't got the important stuff done

Sometimes planning and organising daily life can become difficult. You can feel busy all day or even all week, but still not get through your tasks. There are a whole range of supervisory skills that we use to manage new and challenging circumstances. These include planning, estimating, organisation, judgement, reasoning, self-monitoring, picking up errors, adapting to new things and being flexible with change.

Some people notice problems with executive function occasionally and during very difficult activities (e.g. exams), whilst for other people they can occur frequently and repetitively (folding your wheelchair to fit it into your car). Having a problem with planning skills can lead you to feel that you are not coping well, and to have trouble choosing the right thing to do.

You may find that you feel overwhelmed at particularly busy times. If these skills are more significantly affected, then everyday tasks can seem like too much. By using these tips to improve your planning skills, you can help to solve this problem.

Signs that you are struggling with executive skills include:

  • Repeating the same response or action that doesn't work.
  • Finding it hard to generate or consider alternatives in, say, managing your health.
  • Running out of time and finding that you haven't completed important tasks.
  • Misjudging social situations and saying or doing the wrong thing.
  • Taking longer to get the hang of doing something new.
  • Feeling apathetic or unable to begin a task

Tips and tricks

  • If you find it hard to stay on task, reduce distractions by finding a quiet environment and letting others know when you can and can't be disturbed.
  • Use written plans and schedules. They will help you think in advance about what you need to do , but also give you something to refer to that will help you get the task done.
  • Break a task down into smaller sections. For example, "pack suitcase" in your diary the night before going on holiday may be enough, but also make a list of the items you want to take, schedule a time to shop for extra items (e.g. sun cream) and launder the clothes you need to pack.
  • If you find making decisions hard, you might find it helpful to talk through the options and outcomes with a family member, friend, or health professional. Ask them to write out the options and implications for each choice, or write out the pros and cons yourself. Be willing to take time to make decisions and to ask for more or repeated information.
  • If you find yourself stuck in a rut and trying the same strategies without success, it may be time to get help exploring new options. Just because something is unsuccessful with your current approach doesn't mean that success isn't possible. Enlist the help of family, friends or professionals to generate options. Be open to different approaches and ideas. Consciously try to be flexible in your outlook.
  • Look for 'brain training' games or apps to help you practice your planning skills.

Professional help

A psychologist or other therapist may teach you how to break down tasks into sections and plan in a structured, step-by-step way. This is a skill that can be applied to any situation or problem that needs solving. After a few practices in real-life situations, they will leave you to apply your new skill on your own to all activities that require it.

If learning a procedure to apply to many situations is too much for you, your health professional may concentrate on the particular steps that are necessary for a specific task. An occupational therapist might help you practice these steps. They may be written down or cued in some other way (e.g. letter or number prompts).

Computer based training and rehabilitation programmes can be delivered by a health professional to counteract the specific problems you face.

Involving family and friends

Difficulties with planning, organising and prioritising can be harder to explain to other people. Usually when someone doesn't manage to plan, organise or prioritise as expected, other people may regard this as laziness, or poor motivation, or that they just couldn't be bothered. 

If you are able to explain your difficulties to those around you, they may be able to work out when a task is likely to be difficult for you. They can then prompt you to take special care, or ask for help with that task. Or they may be able to present a task to you in sections, which you can easily manage. Or they could write it down in sections, giving you a sort of "game plan".

Other resources

References

  • De Giglio L, De Luca F, Prosperini L, Borriello G, Bianchi V, Pantano P, Pozzilli C. A low-cost cognitive rehabilitation with a commercial video game improves sustained attention and executive functions in multiple sclerosis: a pilot study. Neurorehabil Neural Repair. 2015 Jun;29(5):453-61.
  • Dagenais E, Rouleau I, Tremblay A, Demers M, Roger É, Jobin C, Duquette P. Prospective memory in multiple sclerosis: The impact of cue distinctiveness and executive functioning Brain Cogn. 2016 Nov;109:66-74.
  • Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. Executive function is an important consideration for coping strategy use in people with multiple sclerosis. J Clin Exp Neuropsychol. 2017 Jan 16:1-15.
  • Raimo S, Trojano L, Spitaleri D, Petretta V, Grossi D, Santangelo G. The relationships between apathy and executive dysfunction in multiple sclerosis. Neuropsychology. 2016 Sep;30(6):767-74.

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