What is Executive Function?
Executive function is your brain's control centre — the set of cognitive processes that help you plan, prioritise, start tasks, stay focused, and manage your time and emotions. It includes:
- Working memory — holding information while you use it
- Task initiation — actually starting things
- Planning and prioritising — figuring out what to do and in what order
- Cognitive flexibility — switching between tasks or adapting when plans change
- Emotional regulation — managing feelings so they don't derail you
For autistic and ADHD brains, executive function is often already harder. The prefrontal cortex — where much of this processing happens — works differently. This isn't a character flaw. It's neurology.
The Overlap: Why These Conditions Travel Together
If you're autistic or have ADHD and also have one or more of POTS, hEDS, MCAS, or ME/CFS, you're not imagining the connection. Research is increasingly showing that these conditions cluster together at rates far higher than chance.
hEDS — Hypermobile Ehlers-Danlos Syndrome
A connective tissue disorder causing joint hypermobility, chronic pain, and fatigue. Studies show significantly higher rates of autism and ADHD in people with hEDS. The connective tissue differences may affect how the nervous system develops and functions.
POTS — Postural Orthostatic Tachycardia Syndrome
A form of dysautonomia where your heart rate increases abnormally when you stand. This causes dizziness, brain fog, fatigue, and difficulty concentrating. POTS and autism share links through the autonomic nervous system — the same system involved in sensory processing differences.
MCAS — Mast Cell Activation Syndrome
A condition where mast cells release too many chemical mediators, causing inflammation throughout the body. Symptoms include brain fog, fatigue, pain, and cognitive difficulties. The inflammation directly affects brain function and executive capacity.
ME/CFS — Myalgic Encephalomyelitis / Chronic Fatigue Syndrome
A complex, chronic illness characterised by profound fatigue, post-exertional malaise (PEM), and cognitive dysfunction. ME/CFS doesn't just make you tired — it fundamentally limits how much cognitive and physical energy you have available.
The common thread? These conditions all affect the resources your brain needs to function — whether through dysautonomia, inflammation, energy production, or connective tissue differences. When you add neurodivergence to the mix, you're working with a system that was already running on different parameters.
What This Actually Looks Like Day-to-Day
Knowing what to do but not being able to start
The task is clear. The steps are clear. Your body won't move. This isn't laziness — it's a disconnect between intention and initiation that's compounded by physical symptoms. When your heart rate spikes just from standing, starting anything feels like climbing a mountain.
Decision fatigue before you've made a single decision
When your baseline is already depleted by managing symptoms, monitoring how your body feels, and compensating for brain fog, there's nothing left for choosing what to eat or which email to answer first.
The "good day" trap
You feel better, so you do more. Then you crash. Then you rest. Then you feel better, so you do more. This boom-bust cycle is exhausting and demoralising — especially when people around you see your "good days" and assume that's your real capacity.
Medical admin as a part-time job
Managing multiple conditions means managing multiple specialists, medications, appointments, and endless forms. This coordination load uses up executive function that you don't have spare — often before you've even started on the things you actually want to do.
Why "Just Use a Planner" Doesn't Work
Most productivity advice is built for healthy neurotypical brains with consistent energy. When you have fluctuating capacity, the standard tools often make things worse:
- →Planners assume consistent capacity. They don't account for the day your POTS is flaring and you can't sit upright, or the MCAS reaction that wipes out your afternoon.
- →To-do lists can become shame lists. When you can't complete what you planned, the list becomes evidence of failure rather than a helpful tool.
- →Time management doesn't address the real problem. The issue isn't usually managing time — it's managing energy, symptoms, and the gap between intention and action.
The graveyard of abandoned planners, apps, and systems isn't evidence that you're failing. It's evidence that those tools weren't built for your situation.
What Actually Helps
Energy Accounting (Not Time Management)
Instead of planning by time, plan by energy. What do you have available today — not in an ideal world, but right now? This might mean categorising tasks by energy cost (low, medium, high) rather than by time required.
Some people find spoon theory helpful. Others prefer thinking in terms of "energy budget" or "capacity units." The framework matters less than the principle: your energy is finite and fluctuating, and acknowledging that isn't giving up — it's being strategic.
Externalising Executive Function
If your brain can't hold onto things, don't ask it to. Move executive function outside your head:
- Body doubling — having another person present (even virtually) while you work
- Visual cues — putting things where you'll see them, not where they "belong"
- Automation — recurring orders, automatic payments, scheduled reminders
- Resistance Breaker support — someone to help bridge the gap between knowing and doing
Pacing Strategies That Respect PEM
Post-exertional malaise (PEM) means that overdoing it today creates a crash tomorrow — or in two days, or three. This delayed consequence makes it hard to learn pacing intuitively.
Effective pacing often means stopping before you feel you need to. It means building in rest as a scheduled, non-negotiable part of your day — not as a reward for productivity. This is counterintuitive for most people, and especially hard when you've spent your life pushing through.
Reducing Decisions, Not Adding Tools
Every decision costs energy. The goal isn't to optimise decision-making — it's to make fewer decisions:
- →Same breakfast every day (or rotating between 2-3 options)
- →Clothes laid out the night before (or a capsule wardrobe)
- →Default answers for common requests ("I'll get back to you" buys time)
- →Pre-made decisions for bad days (what to eat, what to watch, who to text)
How We Support Executive Function at Estus Health
Our approach starts with understanding your whole picture — not just the neurodivergence, but the conditions that travel with it. We don't treat executive function in isolation.
Functional Capacity Assessment
We assess what you can actually do — on good days, bad days, and everything in between. This isn't about diagnosis. It's about understanding your real capacity so we can build systems that work.
Systems Built Around Fluctuating Capacity
We help you design routines, environments, and supports that flex with your energy. Not rigid systems that break when you have a flare — adaptable ones that have "bad day" modes built in.
Coordination With Your Other Providers
Managing multiple conditions often means managing multiple practitioners. We communicate clearly with your other providers so everyone's working from the same page — and you're not stuck being the messenger.