Mission: Organization

How to offset the Impact of Executive Dysfunction

By Sheryl K. Pruitt, M.Ed.

All children use executive functions, which are cognitive processes used to perform tasks. Some children, however, have impairment in these skills known as executive dysfunction (EDF). This learning difference, like so many others, is multi-faceted and can be a complicated disorder to define. Understanding executive functions and how they relate to success in school is paramount to understanding the learning difference called EDF.

Jenny is her parents’ pride and joy.She has always been a bright and inquisitive little girl. Her IQ led them to believe she would excel in academics, have a lot of friends and be a delight to be around. Instead, Jenny has proven to be challenging at home and at school. She frequently seems off-task and disorganized. Despite her obvious intellect, she is unable to follow directions and has trouble starting and then finishing projects. Jenny also has trouble controlling her emotions and conceptualizing future plans. Jenny is a child who proves intelligence does not always mean success in school.

All children use executive functions, which are cognitive processes used to perform tasks. Some children, however, have impairment in these skills known as executive dysfunction (EDF). Given her challenges, it is possible that Jenny has EDF. This learning difference, like so many others, is multi-faceted and can be a complicated disorder to define. Understanding executive functions and how they relate to success in school is paramount to understanding the learning difference called EDF.

Neuropsychologists and many other healthcare professionals consider EDF to be a brain dysfunction. Some consider attention deficit hyperactivity disorder and EDF to be part of the same disorder. However, there is another school of thought that views EDF as a disorder unto itself. This distinction becomes important when considering treatment options. Medication can sometimes assist inattention, distractibility and hyperactivity, but the negative impacts of EDF are remediated by cognitive strategies rather than medication.

A student can have deficits in some or all of the executive functions listed in the “Hallmarks of Executive Function (EF)” sidebar. It is important to identify where the deficits are and to remediate accordingly. Regardless of the areas of deficit, EDF affects memory, academics, behavior and social skills.

EDF and Memory
EDF affects three main areas of memory. The first is the area of procedural memory where memory for a motor sequence is stored. A second area is strategic memory that affects the ability to remember a strategy, for example how to organize a written document. The third area, the working memory, is where one has to hold the information in short-term memory long enough to use that information to assist with learning, behavior and social decisions. The ability to follow multiple oral directions is an example of a skill that requires good working memory. Therefore, many children with working memory deficits are unable to follow multi-step directions.

Think of the impact of this on basic functioning at home, at school, in social situations and at work. Do not be alarmed, however, about your child’s future ability to function and succeed. There are numerous strategies to assist your child. Learning to externalize his working memory is one such strategy. By writing directions down and using a calendar or personal digital assistant (PDA) to list important information, you can help your child offset the impact of deficits in working memory and increase the ability to collect information successfully. Another good rule of thumb: Lists! Lists! Lists!

EDF and Academics
Executive dysfunction impacts academics by holding a student back from performing at the level of his intelligence. The organization and planning deficits alone impact everything from cleaning out a bookbag or locker to keeping up with homework. Reading comprehension can also be affected because of the inability to prioritize and know what part of the chapter is important. This results in the student not knowing the answers to the questions after the chapter has been read. The strategy of first reading a summary and the questions can make a real difference in a student’s ability to answer the questions on the chapter material.

Long-term projects and term papers can cause great difficulty for students with EDF. Executive functions are used to analyze a task and break down a project into simple, achievable steps. Many children with EDF become overwhelmed when assigned a project and some do not even start the project until the night before when adrenalin kicks in. In order to alleviate the difficulties EDF brings to the child, the teacher needs to meet with the student and help the student break a project down into individual homework assignments. The teacher will need to monitor the assignments for compliance and for difficulties with the task. To edit and write at the same time requires executive function and working memory. For a child with EDF, editing should be a separate task with an editing strip made up of cues, such as, “Have I checked my work?” or “Are the decimals and dollar signs in the answer?”

An added impact of EDF on school success is the inability for a child to understand why homework should be done at all. The lack of understanding about how the present affects the future makes homework seem futile. Electronic games or other “here and now” activities seem more important than future success. Helping the child see the connection between homework and future success is very important.

EDF and Behavior
Behavior is probably the most frustrating part of EDF for parents. The child can be demanding and hard to raise. When a child has EDF, he does not comprehend what he is missing or how his deficits affect his life. This means that he will not necessarily agree that something is wrong or that the parent or other adults can help him succeed with intervention. The effect of this is that the child understands and learns behavior at a slower pace and is less mature in some common sense decisions necessary on a daily basis. A child with EDF may not be able to process the instruction or may not see the future consequences of repeating the act.

Additional Strategies

Teach routines until mastered, one at a time (packing book bag, turning in work).
Provide checklists (cleaning room, bathroom routine).
Teach, “Do it now, not later!”
Have child estimate time to do homework and then write down estimate and actual time.
Teach the child to allow more time than he thinks is needed.
Ask for a syllabus for any class to assist with communication and planning homework.
Use color to organize notebooks, books, folders in files (math is red-every year).
Give advanced warning for transitions.
Check for comprehension (following and understanding directions).
Use graphic organizers (Mindmap, webbing).
Provide outlines with essential points and space to take notes.

While some children may appreciate what their parents are doing for them, kids with EDF might not understand that their parents’ actions are done for their benefit. They can be argumentative, unappreciative and uncooperative. They can develop poor ways of dealing with authority figures and act with disrespect and arrogance.

These negative behaviors can be offset with direct instruction, including cooperative problem solving. Parents and teachers need to teach negotiation skills. A behavior plan that involves family meetings, which include skill development, is necessary. The behavior plan must be based on an understanding of skill deficits and the need to teach cognitive strategies for behavior changes to be successful. While “normal” behavior plans assume that the child understands what to do and is just not doing it, this is not so with a child who has deficits in executive functions. The EDF child needs behavior modification that is more immediate, concrete and directive.

EDF and Social Skills
Social skills are important in order to become a successful adult. These skills determine whether a person has success in work and relationships. A leading cause of social impairments is executive dysfunction. Social skills groups that teach a social curriculum are needed to offset the negative social impact of EDF on the child. Any time a child makes a social mistake, an adult should gently and clearly explain what to do in the future to replace the inappropriate behavior. The intervention techniques need to be taught to all the important adults in a child’s life. The lessons will be helpful as long as there is no judgment, punitive attitude or embarrassing actions. Remember, this is a problem that is due to a cognitive dysfunction, not stemming from inappropriate, willful behavior or lower intellect.

EDF is an underestimated destroyer of the ability to use a person’s IQ points for one’s own success. If executive dysfunction is not remediated, it can have a significant effect on making friends as well as obtaining and keeping a job. The good news is that there is help and hope. There are EDF coaches who can assist parents and their children with EDF to be successful. Sometimes EDF coaches are needed to teach organizational and other strategies to offset the impact of EDF on the child. Most parents and teachers can simply look at the bookbag
or the desk or closet of a child for clues, but a thorough, knowledgeable interview by a trained specialist such as a reputable neuropsychologist can determine if a child indeed has executive dysfunction. Once professionally diagnosed, the child can be given the tools he needs to offset the impact of EDF.

Although there is no “cure” for EDF and success can be hard won, with constant work and the proper training, a person with EDF can learn to manage their life and find success.

Sheryl K. Pruitt, M.Ed. is an internationally recognized author and speaker as well as clinical director of Parkaire Consultants. Sheryl has worked with children and adults with executive dysfunction and other neurological and behavioral disorders for 30 years. She has sons with neurological disorders and understands the problem from a personal and professional point of view. Ms. Pruitt is a co-author of the book Teaching the Tiger and TSFC’s Understanding Tourette Syndrome. She can be reached at www.parkaireconsultants.com or 770-578-1519.

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September 1, 2006 | In Feature Articles | 1 Comment

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Fantastic article! Thanks for publishing an article on Executive Dysfunction that me and my husband can understand. Great explanation and tips for us to use with our son. We love your website!

Comment by Laurie Smith — October 25, 2010 #

Mission: Organization

How to offset the Impact of Executive Dysfunction

Hallmarks of Executive Function (EF)

TRANSITION CHECKLIST

Additional Strategies

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