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They Could Do It Yesterday. Why Can’t They Do It Today?
- Wajdi Akef Fakhoury, LMFT
- Oct 14, 2025
- 12 min read
Executive functioning, stress, trauma, and fluctuating access to skills in neurodivergent people
Wajdi Akef Fakhoury, LMFT 148333
Yesterday, they completed the routine without help.
Today, they cannot begin.
Yesterday, they tolerated the change.
Today, the same change leads to panic, refusal, shutdown, or escalation.
Yesterday, they remembered the appointment, answered the email, made dinner, or arrived on time.
Today, the knowledge is still there—but access to it seems to have disappeared.
To an observer, this inconsistency can look intentional.
They know how to do this.
They have done it before.
They are capable when they want to be.
They must be avoiding, manipulating, or refusing.
But the ability to perform a task under one set of conditions does not guarantee access to that ability under every other set of conditions.
Knowing what to do is not the same as being able to initiate it.
Understanding the steps is not the same as being able to organize them.
Having completed a task before is not proof that the task will remain equally accessible when the person is tired, overwhelmed, anxious, in pain, interrupted, rushed, or managing several demands at once.
Sometimes the inconsistency is not evidence that the person does not care.
It is evidence that something about access has changed.
Executive functioning is the bridge between knowing and doing
Executive functioning refers to a group of mental processes that help us direct attention and behavior toward a goal.
These processes include:
Holding information in mind.
Starting an action.
Inhibiting an immediate response.
Shifting between tasks or ideas.
Organizing and sequencing steps.
Estimating and managing time.
Monitoring progress.
Adjusting when something changes.
Returning to a task after interruption.
Regulating emotion long enough to continue.
Working memory, inhibitory control, and cognitive flexibility are often described as core executive functions.
Together, they help a person use what they know in the moment that they need it.
This is why a person can explain a plan clearly and still struggle to carry it out.
They may know the deadline but fail to represent how close it is.
They may understand the entire assignment but be unable to identify where to begin.
They may intend to make a phone call all day and repeatedly fail to cross the invisible threshold between thinking about it and doing it.
They may agree to a change, then become overwhelmed when the change actually occurs.
The problem is not always a lack of insight.
It is often the difficulty of translating insight into coordinated action.
Executive-functioning differences are not limited to one diagnosis
Executive-functioning differences can occur across many neurodevelopmental profiles, including ADHD, autism, intellectual and developmental disabilities, learning differences, and combinations of these conditions.
Research has identified executive-functioning differences across multiple neurodevelopmental conditions, although the pattern and degree vary significantly among people and diagnoses.
Executive functioning is therefore a relevant clinical domain—not a single deficit that looks identical in every neurodivergent person.
Adults with ADHD may experience difficulties involving working memory, inhibition, sustained attention, planning, and cognitive flexibility.
But executive-functioning differences are neither universal nor sufficient to explain every feature of ADHD.
Autistic people may also experience executive-functioning differences, but considerable variation exists between individuals, situations, and methods of assessment.
The term neurodivergent therefore tells us that conventional assumptions may not fit.
It does not tell us exactly where this person struggles, what support they require, or what they can access on a particular day.
That must be understood individually.
Ability is not an on-and-off switch
People often think of ability as something stable:
Either you can do the task or you cannot.
Real-world functioning is more complicated.
A person’s access to executive functioning can be affected by:
Stress and anxiety.
Poor sleep.
Pain or illness.
Hunger.
Medication effects.
Sensory overload.
Interpersonal conflict.
Grief.
Competing demands.
Fatigue.
Uncertainty.
A change in routine.
The amount of language being processed.
The speed at which a response is expected.
The number of decisions required.
Whether the person feels watched, criticized, or rushed.
Stress is especially relevant because working memory and cognitive flexibility—the abilities needed to hold information in mind and adapt when circumstances change—can become less reliable under acute stress.
The effects are not identical for every person or every area of executive functioning.
But performance does not remain unaffected simply because the underlying knowledge is present.
Sleep, emotional well-being, physical health, social conditions, and stress can also influence executive-functioning performance.
The task may not have changed.
The person’s available capacity has.
Imagine capacity as a budget
Suppose getting ready for work ordinarily requires 40 units of executive-functioning capacity.
On a relatively regulated morning, the person may have 70 units available.
They can wake up, sequence the routine, locate what they need, tolerate minor interruptions, and leave the house.
Now consider a different morning.
They slept poorly.
Their usual support person is absent.
A clothing texture feels unusually painful.
Someone changed the transportation time.
Their phone is missing.
They are still thinking about an argument from the previous evening.
The routine still requires 40 units.
But the person may only have 25 available.
From the outside, the expectation seems unchanged.
Inside, the task has become inaccessible.
This does not mean the person should never be expected to get ready independently.
It means that successful support requires understanding what the task costs, what capacity is currently available, and which parts of the demand can be made more accessible.
Trauma may affect access—but trauma should not explain everything
Trauma can affect attention, trust, threat perception, working memory, emotional regulation, and the ability to remain flexible when something feels unsafe.
Research involving trauma-exposed young people has found associations between trauma exposure and lower performance in working memory, inhibition, and cognitive flexibility.
These findings are meaningful, but they are group-level associations.
They do not allow us to determine that a specific executive-functioning difficulty is caused by trauma simply because the person has a trauma history.
A transition may be difficult because earlier transitions involved sudden separation, coercion, or loss.
A direction may become harder to process when it is delivered in a setting, tone, or manner associated with fear.
A person may become highly controlling about routines because unpredictability has repeatedly preceded something painful.
But similar difficulties can also arise from ADHD, autism, intellectual disability, anxiety, depression, sensory overload, language-processing demands, fatigue, pain, or an environment that has not made expectations sufficiently clear.
Trauma-informed care should deepen the assessment.
It should not create another automatic explanation.
The question is not: Is this executive dysfunction or trauma?
The more useful question is: How are the person’s neurodevelopmental profile, current stress, history, environment, health, and support system interacting right now?
Ordinary tasks contain hidden architecture
Many tasks that appear simple are actually sequences of smaller executive demands.
Consider the instruction: “Get ready to leave.”
That may require the person to:
Stop the current activity.
Shift attention toward the future.
Represent the departure time.
Identify everything that must happen first.
Decide which step comes first.
Locate clothing and belongings.
Tolerate the sensory experience of getting dressed.
Remember medication, keys, phone, wallet, or communication device.
Monitor time while completing the sequence.
Recover if something is missing.
Manage another person’s increasing urgency.
Transition out of the home.
The instruction contains four words.
The task may contain twelve separate demands.
When someone says, “They know how to get ready,” they may be describing knowledge of the overall routine.
The point of failure may be task initiation, sequencing, time awareness, working memory, shifting, sensory tolerance, decision-making, or recovery after interruption.
Without identifying the point of failure, the support often becomes more pressure.
More prompting can create more load
When a person does not begin, supporters frequently add language:
“Come on.”
“You need to get moving.”
“We have already discussed this.”
“Why are you still sitting there?”
“First get dressed, brush your teeth, find your shoes, get your bag, and meet me downstairs.”
The supporter is trying to help.
But the person may now have to manage:
The original task.
Several additional instructions.
Another person’s urgency.
The emotional impact of perceived criticism.
The fear of being late.
The awareness that they are disappointing someone.
The need to answer questions about why they have not begun.
What looks like increasing opposition may actually be increasing cognitive and emotional load.
Repeating the entire expectation more loudly does not necessarily make the starting point more visible.
The first step must be small enough to start
“Clean the kitchen” is a category of work.
It is not a starting action.
“Finish the report” describes an outcome.
It does not identify how to begin.
“Get your life organized” is not a task at all.
An accessible starting point should be concrete and behaviorally specific:
Put both feet on the floor.
Open the document.
Write the date.
Place the dishes beside the sink.
Find the medication bottle.
Put one item into the bag.
Type the recipient’s name into the email.
Set a timer for five minutes.
The purpose is not to infantilize the person or complete the task for them.
It is to reduce the activation energy required to enter the task.
Once a person has begun, additional steps may become easier to access.
When they do not, that is further information about where support is needed.
External support is not cheating
Many people are expected to hold plans, deadlines, routines, and instructions entirely in their minds.
When that fails, they are told to try harder.
But human beings routinely externalize executive functioning.
We use calendars because memory is imperfect.
We use alarms because time is not always felt accurately.
We use written directions because spoken information disappears.
We use checklists because completed steps are easier to track when they are visible.
We place objects near the door because the environment can cue an action more reliably than intention alone.
For a neurodivergent person, external supports may be central to independent functioning.
Useful supports can include:
Written or visual sequences.
Calendars and reminders.
Timers and countdowns.
Objects placed where the action occurs.
A consistent location for essential belongings.
Templates.
Body doubling or parallel work.
Scheduled check-ins.
Automated payments or refills.
Written summaries after conversations.
A clear plan for what to do when the routine breaks.
Independence does not mean completing every task without tools or support.
It means having enough control, access, and reliable structure to participate in one’s own life.
Plan for interruption—not only ideal performance
Many strategies work when everything proceeds exactly as expected.
Then an appointment runs late.
A support person cancels.
An item is missing.
A child becomes sick.
The internet stops working.
The person misses one step and concludes that the entire plan is ruined.
A neurodevelopmentally responsive strategy includes a restart plan:
What happens when the routine is interrupted?
How does the person identify where to resume?
Which steps can be skipped?
Who can help without taking over?
What is the minimum viable version of the task?
How will the plan be revised without turning one disruption into abandonment of the entire goal?
Starting is an executive function.
Restarting is one too.
A plan that only works under perfect conditions is not yet a reliable plan.
Transitions require more than a warning
Countdowns and advance notice can help, but they are not sufficient for everyone.
A transition may require the person to understand:
What is ending.
When it will end.
What happens next.
Where they are going.
Who will be there.
What will be expected.
What will remain the same.
What choices are available.
Whether and when they can return to the preferred activity.
What will happen if the plan changes again.
For some people, “five more minutes” provides useful preparation.
For others, it announces an approaching loss without providing enough information to organize the next step.
Support should address the actual uncertainty.
Regulation and executive functioning are connected
Problem-solving requires access to attention, language, memory, flexibility, and inhibition.
When a person is highly distressed, those abilities may be less available.
This is why a detailed lecture about planning, responsibility, or consequences often fails during overload.
The person may first need:
Less language.
Reduced sensory demand.
More physical space.
A pause in nonessential expectations.
A familiar support person.
Time to recover.
A clear and immediate next step.
Help identifying what has changed.
Regulation should not be treated as a demand to become calm enough for other people’s convenience.
The purpose is to restore access—not merely improve appearance.
Examine where the difficulty occurs—and where it does not
A person who struggles with a task in one setting may complete it elsewhere.
That difference is clinically useful.
Ask:
Is the expectation clearer in one environment?
Are fewer steps held in working memory?
Is the pace slower?
Is the task connected to a strong interest or immediate outcome?
Is there less sensory strain?
Is help available earlier?
Does one person communicate more directly?
Is there less fear of criticism?
Are the materials already organized?
Does the routine occur at a better time of day?
Is the person given more control over how the task is completed?
The goal is not to prove that the person could do it if they really wanted to.
It is to identify the conditions under which access improves.
Those conditions can then inform support elsewhere.
Accommodation and accountability are not opposites
Understanding executive functioning does not mean that every missed task, hurtful interaction, or broken agreement should be ignored.
Neurodivergent people remain responsible for the impact of their behavior to the extent that responsibility is developmentally and contextually appropriate.
But accountability becomes meaningful only when the expectation is accessible.
A person cannot repair what they do not understand.
They cannot follow a plan they cannot retrieve.
They cannot consistently use a strategy that requires the same executive abilities that are failing in the first place.
Supportive accountability may involve:
Making the expectation explicit.
Separating intention from impact.
Identifying the point at which the plan broke down.
Creating a realistic repair step.
Practicing the strategy outside the moment of crisis.
Building reminders into the environment.
Revising an expectation that repeatedly exceeds available capacity.
Returning responsibility gradually as access improves.
The choice is not between blame and no expectations.
It is between moral judgment and useful problem-solving.
Therapy must address the point of failure
A person can spend years in therapy discussing why they procrastinate while receiving little help with the moment between intention and action.
They may understand perfectionism, fear of failure, family dynamics, and previous criticism.
Those insights may be important.
But therapy must also ask:
What exactly happens when you attempt to start?
Which part of the task becomes inaccessible?
What information are you trying to hold in mind?
What discomfort appears?
What do you do instead?
What environmental cues are missing?
What makes the task easier on other days?
What is the smallest useful entry point?
What support can be moved outside your head?
What will the restart plan be?
Neurodivergent-responsive therapy does not abandon emotional meaning for productivity strategies.
It integrates them.
The person may need to understand the shame associated with the task and create a visible first step.
They may need to process trauma associated with failure and reduce the number of decisions required.
They may need greater self-acceptance and a practical system for remembering appointments.
Insight and access belong in the same treatment.
Do not confuse fluctuating access with fluctuating character
When a person succeeds one day and struggles the next, it is easy to assume that motivation changed.
Sometimes it did.
People avoid tasks.
People become oppositional.
People make choices that affect others.
But motivation should not become the default explanation whenever access fluctuates.
The inconsistency may tell us that:
The person was better rested.
The task was externally structured.
Someone helped them begin.
The environment was less overwhelming.
The deadline created temporary urgency.
The steps were already visible.
The emotional cost was lower.
The person had more recovery time.
Fewer demands were competing for the same capacity.
That is not an excuse.
It is a formulation.
And a good formulation gives us something more useful to do than repeat:
But you did it yesterday.
The inconsistency is the clue
A person’s hardest day does not define their maximum capacity.
Their best day does not define what they can access without support every day.
Both matter.
The best day shows what may be possible under the right conditions.
The hardest day shows where the person’s internal resources, the task, the environment, or the system around them become strained.
The work is not to decide which version is the “real” person.
The work is to understand what changes between them.
Before interpreting a missed task as laziness, refusal, manipulation, or lack of concern, ask:
What is this task actually requiring?
Where is the point of failure?
What changed today?
What is competing for capacity?
What information is being held internally that could be made visible?
What support would preserve agency without taking over?
What does this person need to begin, continue, and restart?
Are we measuring what they know—or what they can access under these conditions?
They may still need to complete the task.
They may still need to repair the impact.
They may still need to build skills.
But shame is not an executive-functioning intervention.
Pressure is not a starting point.
And inconsistency is not proof that the difficulty is invented.
Sometimes the person does know exactly what to do.
What they need is a workable bridge between knowing and doing.
About Samar Neurodivergent Therapy Center
Samar Neurodivergent Therapy Center provides adapted outpatient psychotherapy and clinical consultation for neurodivergent adolescents and adults, couples, families, caregivers, and systems of support.
Our work considers neurodevelopment, executive functioning, communication, sensory processing, mental health, trauma, relationships, and the environments in which people are expected to function.
Services are available in person in Pasadena and by secure telehealth throughout California.
References
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Demetriou, E. A., et al. (2018). Autism spectrum disorders: A meta-analysis of executive function. Molecular Psychiatry, 23, 1198–1204.
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Op den Kelder, R., Van den Akker, A. L., Geurts, H. M., Lindauer, R. J. L., & Overbeek, G. (2018). Executive functions in trauma-exposed youth: A meta-analysis. European Journal of Psychotraumatology, 9(1), 1450595.
Sadozai, A. K., Sun, C., Demetriou, E. A., Lampit, A., Munro, M., Perry, N., Boulton, K. A., & Guastella, A. J. (2024). Executive function in children with neurodevelopmental conditions: A systematic review and meta-analysis. Nature Human Behaviour, 8, 2357–2366.
Shields, G. S., Sazma, M. A., & Yonelinas, A. P. (2016). The effects of acute stress on core executive functions: A meta-analysis and comparison with cortisol. Neuroscience & Biobehavioral Reviews, 68, 651–668.