prioritization Archives - Executive Dysfunction Research & Advocacy

POST SUMMARY

This article is about how “time-based prospective memory” (TBPM- which, when impaired, is often referred to as “time blindness” or “time numbness”) is at least in part reduced in autistics (and we here at EDRA think the same would go if ADHDers, and perhaps other folks with prioritization difficulty) due to not encoding tasks with the same level of importance that neurotypicals do. When explicitly instructed to prioritize the TBPM tasks, autistics’ performance increased significantly, almost matching those of the NT controls. So, this paper suggests that for some, impaired TBPM can improve by being explicitly told what time-related tasks should be prioritized.

“Time blindness” or “time numbness” is a common experience for many people with executive dysfunction, especially autistics and ADHDers. This paper adds to the amount of evidence supporting the role that the executive function of prioritization plays in our ability to manage our time efficiently, which will hopefully lead to more interventions to help folks improve these skills.

Increasing Extrinsic Motivation Improves Time-Based Prospective Memory in Adults with Autism: Relations with Executive Functioning and Mentalizing

2019; Julia Landsiedel and David M. Williams; Journal of Autism and Developmental Disorders

ABSTRACT

Time-based prospective memory (PM) is diminished under various task demands in individuals with autism spectrum disorder (ASD). However, it is still unclear what underpins their impairment or how it could be remediated. This study explored whether instructions to prioritise one element of a PM task over another improved performance in adults with ASD (compared to a group of matched neurotypical adults), and how that is related to cognitive abilities. Results indicated that importance instructions significantly improved the PM performance of participants with ASD. Moreover, the extent of the benefit was associated significantly with objectively-measured executive set-shifting ability and self-reported inhibitory control ability (the poorer the set-shifting/inhibitory control, the greater the benefit). Implications for future research and clinical practice are discussed.

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Article Highlights:

Prospective memory (PM) is “the ability to remember to carry out a delayed intention or plan at the appropriate moment in the future“
Time-based prospective memory (TBPM) is when that delayed intention or plan must “be carried out at a particular future time point.” This includes both
- “remembering to carry out an action after a certain time delay (e.g., taking medication 30 min after eating),”
- “or at a specific time point (e.g., taking medication at 7 pm).”

TBPM & Executive Function

“It is thought that several elements of executive functioning (EF) work together to support this process.”
- “Working memory supports the maintenance of the time-based intention while participants complete the ongoing task and track the passage of time…”
- “Inhibitory control, as well as cognitive flexibility, are required to interrupt attention to the ongoing task… and either initiate a time-check… or to execute the PM intention…”

Intention Importance

When we create an intention to do something, our brains encode the activity’s importance along with it. So, “an intention’s importance will be a crucial determinant of successful PM performance in everyday life.”
- “For example, collecting lifesaving medication for one’s child is likely to be undertaken regardless of the costs to one’s ongoing activities (e.g., even if it makes one late for work),
- whereas collecting one’s dry-cleaned clothes may not be important enough to disrupt one’s ongoing daily activities for.”
The relative importance of an intention (i.e., how important one intention is relative to other intentions to do other actions) “affects PM performance by increasing extrinsic motivation (doing something for external incentives/driving factors).”
- “This leads to changes in the strategic allocation of attentional resources towards the completion of the intended action, even if it is at the expense of other ongoing activities”

Importance in TBPM for Autistics

When researchers emphasized the TBPM task over the ongoing task before the autistic participants started (“PM high importance”), their overall PM performance increased significantly, with only a “small to medium” score difference from controls
- When the task was “PM low importance,” autistics had a statistically large difference (lower performance) than the neurotypical (NT) controls.
So, the autistics had a much larger benefit (increase in performance) than the NTs when they were explicitly told when the PM task was more important than the ongoing task.
- It appears that it helped them “remember to carry out the planned action at the appropriate time…while they were successfully completing the ongoing task.”
It appeared that “the more difficulties the participants had with cognitive flexibility and shifting mindset, the more they benefitted from the emphasised instructions”

“Overall, then, the results imply that supporting executive control processes by giving explicit instructions can positively support TBPM among people with ASD.”

“This could be particularly useful in employment settings to alleviate communication and interactional difficulties…when individuals with ASD are required to manage multi-tasking demands (e.g., finishing a work report and being on time for a work meeting).”

Future Research:

“Finally, it would be important to explore whether the execution of self-generated compared to other-generated (family, work colleague, experimenter) intentions differs in ASD. Related to this, future research should also explore how self-rated (personal) importance of intentions… affects PM performance.”
“Exploration of these factors would provide further important insight into how to tailor task instructions in order to maximally benefit task performance of individuals with ASD.”