This project is supported by an EA Infrastructure Fund grant.
 

tl;dr: Executive dysfunction is common and can make uni intolerable.  The successor to this project is open to all. Sign up to be an accountability partner now, or tell us in the comments what's needed.

I (Gavin) keep meeting young people who struggle enormously with university. I now personally know 9 EAs who suffered lasting mental health problems they associate with uni, or who are currently thinking of dropping out. (This is about 5% of all EAs I have spoken to intimately.) 4% of EAs taking the 2019 Survey reported “Some college, no degree”. 3% of EAs in the 2020 SSC survey reported having less than an associate degree as their completed education.

There's nothing inherently wrong with dropping out: uni isn't for everyone. But we (Damon and Gavin) think this implies a few problems:

1. Some EAs are on suboptimal trajectories because of poor fit with uni / other mental health problems.
    
2. There's a shortage of in-community coaching and mentorship, particularly for people with these problems / less obvious potential.
    
3. Dropping out entails shame or trauma - even though dropping out isn’t a strong disqualifier in many careers, including EA careers. Prospective suffering makes (1) much worse.
    
4. The above, and lack of attention to the above, harm community morale, even among those who don’t themselves have these problems.
    

Some people aren’t constituted to sit through college, or doubt the emotional cost-benefit ratio in their case. Some could make it through with less trauma, given a bit of help. So we’re doing something for people who struggle in these ways. 

Gavin’s hunch was that executive dysfunction was the major neglected factor (distinct from well-known conditions like anxiety, depression, or scrupulosity). Damon (a professional therapist) came on board to dig into what that actually means, and we designed a survey to test the hunch. We did some small things on our small exploratory grant and have ideas for how to scale up.

What is executive dysfunction?

First things first; “executive dysfunction” is not a diagnosis. Executive functions are what govern our ability to plan actions, take those actions, maintain focus on them, adapt to changes, and more subtle steps between.

ADHD is a diagnosis that points to a cluster of common struggles with executive function: working memory, impulse control, and self monitoring. But there are plenty of other diagnoses that can impact one or more of those eight, and of course even things like lack of sleep, hunger, being irritated, disruptive environments, and other stressors can affect them.

So in general when we talk about executive dysfunction what we’re really pointing at is a symptom we witness when someone isn’t able to act on their desires, or on things they think they should do, or on things they think they should desire.

Which brings up the more philosophical question; what does it mean to “fail to act” on a desire? Does someone “have executive dysfunction” if they struggle to complete something they don’t want to do, but feel they have to? What about what they “want to want” to do, but don’t find interesting, even while they can still work on passion projects without issue? Or is it only executive dysfunction if they can’t bring themselves to work on something they feel a strong desire to do, in which case what does “strong desire” mean?

All this makes the question of whether someone struggles with executive dysfunction ill-posed. The better question is “in what domains or in what types of circumstances does someone struggle with executive dysfunction,” followed by narrowing down to which of their executive functions are the chokepoint. Organization? Task initiation? Emotional control?

(I’m also not a fan of “emotional control” as a phrase, as it implies something like stifling or dampening or wrestling with your emotions. This might accurately describe the feeling for some people, but integrating emotions in a healthy way doesn’t have to feel like any of that)

With this more precise understanding, the possible interventions also become more clear. Organization and planning skills can be learned, as can self-awareness and emotional integration. Multitasking and working memory, meanwhile, are harder to improve, and so reducing distractions by adjusting the environment might be more effective.

But most importantly, the question of whether the task is tied to a “want” or a “want to want” or a “should” can itself guide people to better understanding whether their struggle is one that is worth resolving at all, as compared to one that isn’t worth the costs compared to other actions or paths. Many people have pushed through some difficult job or university degree and were glad they did; others regret time wasted and emotional suffering endured for a goal that didn’t end up mattering to them.

Which is why executive dysfunction should not be treated by default as a difficulty that needs to be overcome. Instead it can also be a signal from one or more of your parts that the path you’re on is not the right one for you, and that you might benefit from searching for other, better roads, or even goals.

Along with depression and anxiety, additional factors can exacerbate executive dysfunction, such as perfectionism. The idea that anything tried must succeed, or be done perfectly, often leads to a feeling of dread or hopelessness at the prospect of even starting a task. This is particularly exacerbated by OCD.

Which leads to a general theory of treatment that includes things like exploring motivations and dissolving “shoulds” as a first step before taking for granted that failure to do something is about the person rather than the thing they’re trying to do.

[The above refers to the parts model of the self, and to the therapeutic idea of systematically replacing the concept "should" with less normative framings. A lot of people find these helpful, but they're not consensus views and they don't work for everyone.]

Once that’s done, only then is it useful to focus on strategies for breaking tasks down into simpler versions of themselves, finding tools and contexts for improving focus and accountability, and generally working around that colorful circle up there as much as possible to improve whatever might be the rate limiter. For example, since past difficulties can exacerbate this sense of predicted suffering or failure, it’s also important to focus on small, achievable steps that are more likely to succeed and thus increase predictability of success.

To further explore this, I plan to write a series of posts on how to procedurally explore executive function within ourselves so that we can identify the places where we get stuck when we have trouble doing stuff we want to do, and have a better idea of what can help.

To learn more, feel free to check out the rest of Damon's research on what he calls Procedural Executive Function:

Part 1: Planning & Prioritizing, Task Initiation

Part 2: Emotional Control, Self Monitoring, Impulse Control

Part 3: Working Memory, Organization, Flexible Thinking

Survey

Here’s the survey we sent out. We sent it to the EA Corner Discord and to a few other places students go.

Survey results

Since it selects for people struggling, the survey can’t answer how large the problem is. But we got 74 responses, which is more than enough of a constituency anyway. 

We really should have separated out procrastination from executive dysfunction. But a (suitably weakened) version of the hunch is confirmed. 

Themes in "What has helped before?"

Accountability: Deadlines, Accountability Partner/Group, Academic mentorship, rapid feedback loops, Bets with friends, Friends/partner, studying in the library, housemates, coworking

Productivity: Boss as a service, Beeminder, Focusmate, website blockers (Freedom), productivity gamification apps, habit trackers, Apple watch, tracking work time, Pomodoros, Routines/structure/weekly planning

Psychology: Therapy, finding purpose, following personal interest, social support (friends), self-care/love/acceptance, accepting own difficulties, EA Mindset, journalling, Meditation, anxiety reduction techniques, gamifying tasks, gap year, CBT techniques

Medication: Ritalin, Caffeine, Antidepressants, ADHD medication, Adrafinil, SSRIs, Adderall

Themes in "What do you need?"

After asking them a freetext question about what would help, we also asked:

Since a large minority of people mentioned this without being primed, and a large majority thought it could work for them after being prompted, we decided to go ahead and pair people up. (No particular evidence base for this, it just makes sense.)

Accountability partners

You can sign up to be paired with an accountability partner here. (If you already filled out the survey, check your email.)
 

What we’re doing about it

• DONE: Survey of people struggling (n=74)
• DONE: Interviews with excellent dropouts (3 out of 5 done, posts forthcoming)
• DONE: Invited survey respondents to be accountability partners
• TODO: pilot of executive dysfunction coaching
• TODO: evaluate the peer accountability pilot
• TODO: work out what other help to provide (see below)

Possible larger programmes

1. Free Support Booking: we book external support for people we identify 

We use the survey to identify people, then contact them and find out what kind of
support they need (e.g. therapy; a tutor for their subject; life coach; career coach). Then we book a few sessions for them - say 10 and so ~$600 per mentee.
(Booking for them sidesteps the executive dysfunction.)

After that, recruitment via word of mouth.

Pros: no adverse selection, minimal coaching iatrogenics, low time investment
Cons: unfair, small-scale / money intensive, no community signalling or belief correction

2. Identify a few great EA coach candidates and pay for their training

We’ve met 3 people interested in becoming a part-time EA coach. With help from our advisors, we should be able to identify more and test them out. Then pay them to take proper courses. Let them reach out to people who opted in on the survey, at subsidised rates.

Pros: useful for everyone, not just the struggling. Low iatrogenics.
Cons: Not as targeted
 

Thoughts welcome.

Concerns

• Iatrogenics. It would be bad to nudge people into dropping out if that’s not actually what’s best for them. And it’s incredibly hard to know what’s best for them.
  Mitigation: mental health professionals and other people who know how to back off.
   
• Adverse selection. An earlier version of this aimed for unconditional support, but this would quickly get swamped.
   
• Perverse expansion of EA into a mini society. Do we even want to replace general mental health professionals / student support with community stuff?
  Mitigation: We’re not replacing anything, we’re supplementing.
   
• Perverse retention. Part of the problem is about retention: not losing people from the community just because they’re unlucky. But there should be graceful routes for people to decide EA isn’t for them too. A non-EA mental health worker is one of these routes.
  Mitigation: But EA support people can easily do it too, by just not being naive fanatics.
   
• Scope creep. No single project can take on all of community mental health. Even “student health” is too big. But the temptation will be to include more things as time goes on.
  Mitigation: we just handle people struggling with uni, and just the executive function bit
   
• I’ve mostly been focussing on undergrads, but others think PhDs are a good shout. We're not going to exclude them.
   

How do I get involved?

• If you’re struggling at uni, the survey is still open or you can sign up for accountability now.
• If you have ideas, comment below!
• If you want to fund this, get in touch. (The only cost currently is Damon’s time, which Gavin views as a bargain for the sanity checking and risk mitigation alone.)

Thanks to Carolin Basilowski for analysis and Howie Lempel, Aaron Gertler, Nora Ammann, Linh Chi Nguyen, Quinn Dougherty, and Chana Messinger for comments.