My problem, as a programmer, is that I can’t easily express what I’m thinking on screen/paper. I already do draw out a lot of it, when I can, but its not enough. I already try to document what’s in my mind before I commit it to code, but the “house of cards” mental aspects don’t go away, so there’s really not much difference between distracting me from documenting my thoughts and distracting me from writing code, both are equally as detrimental.

It depends on what I’m working on, of course, so I think its essentially when problems become too abstract, then I can’t easily translate my in-my-mind understanding to paper/screen.

I did, however, enjoy my time playing with Max/MSP (a visual programming language) for the exact reasons you mentioned: I could think “out loud” so to speak, at least to a larger degree than I can in text. Pseudocode helps, a bit, but I’ve always found boxes-and-lines better to focus my thoughts. Incidentally, whiteboards are one of my favourite programming tools :)