Noah worked on his oral all weekend, but forgot to pack it in his school bag, so he got detention for lack of preparation. Mandisi mostly makes it out of bed on time, yet he’s late every morning because it takes him forever to brush his teeth, eat breakfast and pack his bag, and he’s easily distracted by a toy on the floor, so it’s a battle of wills with his parents to make sure all the necessary tasks are accomplished before they leave home. Sarah is very organised, but her sister Kate’s room looks like it’s just been hit by a hurricane and asking her to tidy up is an even taller order than asking her to control her temper when asked to do so.
Does any of this sound familiar? These are some parents’ experiences of children suffering from executive functioning (EF) deficits. While you may be surprised that parents are so familiar with what sounds more like a psychologist’s assessment than a description of your child, EF is becoming as common a discussion point as ADHD and related attention disorders.
“Executive functions are the cognitive skills that help us manage our lives and be successful,” say Joyce Cooper-Kahn and Laurie Dietzel, the authors of Late, Lost and Unprepared: A Parents’ Guide to Helping Children with Executive Functioning.“Children with weak executive skills, despite their best intentions, often do their homework, but forget to hand it in, wait until the last minute to start a project, lose things, or have a room that looks like a dump.”
Poor EF makes everyday tasks (planning, organising and scheduling) a challenge. Children struggle to switch gears, especially when learning a new skill or task, and they find it nearly impossible to keep things organised, which is why their desks are often a mess, pencil cases are empty and desks and school bags are filled with an assortment of sweet papers, long-forgotten school notices and leftover lunch.
According to the Center on the Developing Child at Harvard University, executive function and impulse control depend on three types of brain function: working memory, mental flexibility, and self-control, and these skills or functions are significantly related. Each function draws on elements of the others, and overall success requires them to operate in co-ordination with each other.
- Working memory controls our ability to retain and manipulate distinct pieces of information over short periods of time.
- Mental flexibility helps us to sustain or shift attention in response to different demands or to apply different rules in different settings.
- Self-control enables us to set priorities and resist impulsive actions or responses. “Executive function skills have a profound impact on a learner’s school performance, so it is absolutely critical to assess whether or not the student with an attention deficit also has deficits in this area,” says Chris A Zeigler Dendy, who has over 40 years’ experience as a teacher, school psychologist, and as an author on ADHD. “Some researchers believe that students with ADHD, primarily inattentive type, are more likely to have executive function deficits. However, not all students with ADHD have poor executive functioning. The converse is also true; all students with executive function deficits don’t have an attention deficit,” adds Zeigler Dendy.
Seven skills make up executive functioning
Though executive function and its link to ADHD is a relatively new phenomenon, Dr Russell Barkley, writing for ADDitude magazine, says that executive function is judged by the strength of these seven skills:
- Self-awareness: Simply put, this is self-directed attention.
- Inhibition: Also known as self-restraint.
- Non-verbal working memory: The ability to hold things in your mind. Essentially, visual imagery – how well you can picture things mentally.
- Verbal working memory: Self-speech, or internal speech. Most people think of this as their “inner monologue”.
- Emotional self-regulation: The ability to take the previous four executive functions and use them to manipulate your own emotional state. This means learning to use words, images, and your own self-awareness to process and alter how we feel about things.
- Self-motivation: How well you can motivate yourself to complete a task when there is no immediate external consequence.
- Planning and problem-solving: Experts sometimes like to think of this as “self-play” – how we play with information in our minds to come up with new ways of doing something. By taking things apart and then combining them in different ways, we’re planning solutions to our problems.
Barkley adds that anyone who exhibits the classic symptoms of ADHD will have difficulty with all or most of these executive functions.
Help is at hand
While there is a great deal of negativity around executive functioning disorders in children, there is good news – from learning specialists and doctors who have devised methods to boost organisational skills that don’t come naturally to a child with poor executive functioning, and a mix of strategies that complement or enhance the child’s abilities, to parents and teachers who have committed to employing practical strategies instead of medication to address functioning deficits.
Dr Thomas Dannhauser, honorary senior lecturer in psychiatry, and research and development lead at Brain Gain Neurofeedback Training, comments: “EF crucially depends on brain activity in the front parts of the brain known as the frontal cortex. Children with ADHD and EF problems commonly have decreased activity in the frontal cortex. Brain Gain uses neurofeedback training that specifically exercises these areas. The training also incorporates specific techniques that allow us to exercise the frontal areas and EF simultaneously. Children can, therefore, learn how to concentrate more selectively and for longer, and they are taught how to complete tasks.” He also notes: “Some recent evidence suggests that around 20% of children who present with significant attention problems (ADHD and, therefore, executive function dysfunction) spontaneously recover in their late teens.”
While it’s tempting to list practical strategies, which could help your child cope with organising and planning challenges – like making checklists to tick off, breaking projects down into small, manageable parts or enforcing strict routines at home and in the classroom – researchers mostly agree that there is no one-size-fits-all solution to dealing with EF dysfunction. This is why an educational assessment is vital and the best place to start remediation.
Once you know exactly where your child’s deficits are, you can get professional advice about how to address each challenge with carefully structured tasks so as to always maintain positivity, build confidence and turn their challenges into learning opportunities.