Cognitive Fatigue in Autism

I receive messages from adults on the autism spectrum who live all around the world. They courageously reach out with the hope that someone will be there on the other end, someone who may truly understand what they are going through, and the amount of effort they are required to exert on a daily basis to sustain the ‘magic illusion’ of normalcy when working in traditional settings. 

When individuals on the autism spectrum exert maximum effort to perform in settings that are not suited to their strengths, they often experience cognitive fatigue and emotional exhaustion. For this reason, it is fallacious to prescribe the same old ‘encouragement’ to these individuals that they should merely get a job in the traditional setting and then come home and enjoy their ‘hobby’ like the rest of the workforce. This is simply is not possible. These individuals are using every ounce of their cognitive resources to perform daily tasks, and when they do return to home to their safe haven, they often require considerable time to replenish their reserves.

Types of Attention

The ability for humans to think, to process and recall information relies on cognitive ability.  The DSM 5 includes six neurocognitive domains for diagnosis including perceptual-motor function, language, executive function, complex attention, social cognition, learning, and memory. This blog will discuss attention and its effects on adults in the workplace.

Attention is a multifaceted construct, and researchers across disciplines differ in their proposed theories, methodologies, and their use of terminology in published attentional studies. However, sustained and selective attention are two of the most widely agreed upon definitions across disciplines including cognitive psychology, neuropsychology, and behavioral analysis.

Sustained Attention
Sustained attention is the ability to focus selective attention on a specific stimulus. This is the ability to attend to a task without being distracted (e.g., playing a videogame).

Selective Attention
Selective Attention is the ability to pay attention to the salient stimulus in the midst of other distractors. Selective attention requires filtering out of the distractions while focusing on what’s important. (e.g., listening to instructions from a teacher in the classroom when other students are talking).

Other types of attention are also important in clinical settings.  Alternating attention, dividing attention, and processing speed are also critical when completing tasks.

Alternating Attention
Alternating attention requires focus to alternate, or shift, between tasks that demand different underlying mechanisms. For example, reading a hardcopy of a document and then adding data to an Excel spreadsheet.

Divided Attention
Divided attention is the ability to simultaneously process two or more tasks. For example, reading a text when you are listening to your friend talk about her weekend. Although people often use the term multitasking, it is not possible to fully attend to two tasks at the same time. Therefore, you are only focusing on a piece of each task. For example, studies have been published showing how driver’s accuracy decreases when they are speaking on their mobile phones. These same individuals are not believers until they are actually shown the videos to prove that they started swerving and/or alternating their speed.

Neuroimaging Study
In 2016, Brandon Keehn and colleagues published a neuroimaging study that measured attentional capture in children and adolescents on the autism spectrum. Sixteen children and adolescents completed a visual presentation paradigm that measured the activation of networks underlying attention. The paradigm presented the participants with relevant targets that required them to ignore the distractors that were irrelevant. The results showed that the autistic participants paid attention to the distractors that were supposed to be ignored, and did not pay attention to the target stimuli. In other words, their responses were under-reactive to the relevant stimuli suggesting that they may have experienced difficulty filtering the irrelevant information.

The authors hypothesize that non-social attention processes may play a role in the difficulties that they face in everyday life in social communication contexts.

In The Workplace

The cognitive profile of each adult on the spectrum is unique, and adaptations can be made in the workplace to compensate for the areas that may create anxiety, stress, and overall cognitive fatigue for the individual.

Many adults on the spectrum describe that they can focus on an area of interest for an extended period, and they often describe this as being “in the zone.” However, if they are required to perform tasks that are out of their area of strengths, or of increasing complexity (holding information in working memory simultaneously), it is common to see sustained attention decrease over time. Errors will increase, processing speed will decrease, and the time required to perform the task will increase as sustained attention decreases. Adults on the spectrum report that their employers tell them to “just pay attention” and to “work faster.” Processing time will increase as the cognitive load increases, so it is essential to understand the underlying processes that the project requires.  If the employee is more alert in the morning, they can tackle some of the tasks that need sustained attention in increments that are best suited to their cognitive style.

Alternating attention may be of particular challenge. If individuals are distracted and have to shift their attention to someone asking them a question or if co-workers are laughing and talking in the corridors, it may be difficult for them to refocus on the project or task at hand. Some individuals find that it is helpful for them to listen to music of their choice. Others do not find this to be beneficial and instead prefer absolute silence.

As the neuroimaging study indicates, filtering out external distractors may be difficult for individuals on the spectrum. An employer may see that their employee is seemingly paying attention, but it is impossible to fully realize how much effort this individual requires to stay focused on their work. For this reason, some adults experience cognitive fatigue if they have been working at their maximum effort for a few days at a time, or a week at a time, or a month solid. They may require downtime. This does not mean that they are weak or lazy, and many adults on the spectrum share that this is one of the most difficult aspects to deal with in a traditional setting, especially if they have not disclosed their diagnosis. Of course, calling in sick does not ingratiate them to their co-workers who may become resentful that they are required to take on more responsibility on the days that the employee is not there.

The autistic adults that I work with report that they enjoy going to a workplace setting, but that they also are incredibly productive working from home. Agile work environments are of great value when employing an adult on the spectrum. It is imperative to create an atmosphere allowing the employee to feel comfortable sharing their learning and working styles. They want to perform well, they want to contribute, and they want to be a part of your organization. Please pay attention to their processing styles.

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Heidi Ham

Heidi Ham

Social entrepreneur, CEO and Founder of Spectrum Fusion, a non-profit organization dedicated to making the world a better place for adults on the spectrum.

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