Executive Function Disorder

It’s Easy to Hover Over a Child with Executive Function Deficits. Don’t.

Executive functioning might be a key part of human behavior, but ADHD can make it tricky for kids to execute. Learn how to use memory, organization and self-regulation to nurture your child’s EF skills.

Mom helps boy with homework to help with executive function disorder.
Mom helps boy with homework to help with executive function disorder.

Efficient executive functioning is critical to all human behaviors. Thousands of articles and books have been written about this set of brain-based skills. Noted EF/ADHD expert Thomas Brown, Ph.D., likens executive functioning to being the conductor of an orchestra. Researchers at the Center on the Developing Child at Harvard University have compared EF to the air-traffic control system in a busy airport. Brain scientists agree that strong working memory, self-control, or self-regulation, and the ability to maintain and shift attention are the foundation upon which academic and social success is built. Well-developed executive functioning skills unlock human potential; deficits in EF prevent us from living up to our personal best.

Nature or Nurture?

A baby’s brain development begins to happen before it is born, shaped by his parents’ genes, by the physical and mental health and nutrition of its mother, and by exposure to neurotoxic chemicals and loud noises. Children are not born with EF skills — the ability to control impulses, make plans, and stay focused. But they are born with the potential to develop these abilities. Some young children are genetically wired in a way that makes learning EF skills more challenging, and kids with ADHD tend to be in that group.

Regardless of the amount of EF potential a child has (and this is not something that we know how to measure yet), the degree to which all children develop these abilities depends on the nature and quality of the experiences they have during infancy, throughout childhood, and into adolescence.

Children who grow up in home and school environments that nurture their ability to control impulses, make plans, remember things, and stay focused tend to enjoy healthier, happier lives. Children who are born into chaotic, unsafe, unpredictable environments, or are exposed to traumatic events that impact the development of neural circuitry early in life, may develop brains with inefficient executive function centers. Their brains become wired for self-protection, and they are always on high alert for danger. They are poor planners and problem-solvers who lack the confidence that comes from successful interactions with books, ideas, tasks, and people.

In humans, the brain regions and circuits that control executive functions have connections to the parts of the brain that determine how humans respond to fearful events and to stress. It’s impossible to think about the development of executive functions without considering the emotional responses of a child who is faced with tasks that require these skills. Emotions and cognition are inexorably linked.

What Weak EF Looks Like

Researchers acknowledge that there is no commonly used, single definition of EF. But if you’re reading this article, you probably know and love a kid whose potential is thwarted by poor executive functioning. Do you recognize that child in the following paragraphs?

Children who have weak EF find it hard to carry out tasks that have multiple steps or complex rules. Have you ever been frustrated by seeing your son or daughter look like you spoke to him or her in a foreign tongue? “You need to clean up your room, do your English homework, and take a shower before you go to bed.” If you are a teacher, are you surprised that some kids can’t follow through when you say: “Before you close your notebook, write down tonight’s homework in the section with the green tab.”

Kids with weak EF have a hard time focusing their attention or “shifting attentional gears.” They find it hard to “stop what you’re doing for a minute, and look up here at the board.” They can’t pay attention to one thing while not paying attention to other things (sights and sounds) around them. (“Hey, the furnace just kicked in! Math? What math?”) Kids with inefficient EF systems find it hard to hold a rule or different rules in mind while they carry out several tasks. (“Compute all the functions within the parentheses, and then carry out the operations indicated in this math equation.”) They can’t take something learned in one situation and apply it to another.

The good news is that executive functioning skills can be improved, and many of the programs designed to enhance these skills in kids have shown impressive results. I am convinced that efforts to improve the executive functioning of students with ADHD are likely to meet with success if the following conditions are met:

  • There is a concerted effort to identify weaknesses in EF-related skills very early in a child’s life.
  • There is a school- or program-wide commitment to making sure that specific EF instruction is embedded in all classroom instruction. When this happens, the emphasis is placed on engaging students to learn “how” they learn. Content-based instruction (“what” to learn) will follow naturally, and more effectively, in such an environment.
  • Schools use targeted, intensive interventions designed to have an impact on weak neural systems involved in EF.
  • Students are given opportunities to use EF-related skills through formal instruction and in guided and unstructured play.
  • Students are expected to take more responsibility for predicting the need for EF-enhancing strategies that eliminate or reduce roadblocks to learning. After completing work successfully, students should be able to state the relation between the strategy they employed and the positive outcome. (“This is great! How did you accomplish it?”)
  • Using developmentally appropriate strategies, students are taught about the negative impact of stress on brain function, and they are taught ways to reduce stress, like self-calming, meditation, and mindfulness activities.

Professionals who work with kids with weak EF recommend two types of interventions — environmental modifications and EF training. The first approach requires the creation of environments that are well organized, have lots of structure, minimize distractions, provide pre-transition cues, and use consistent, clear language to deliver instruction or give directions. They offer systems, forms, and roadmaps that give concrete structures for thinking. It’s like putting up bumpers on bowling alleys.

I like this method, but it’s not enough. Kids reared in this kind of environment learn to rely on mom- or teacher-made structures, and they function pretty well as long as the bumpers are up. When structures are reduced or removed, deficient EF is still deficient.

The other type of intervention involves teaching a student EF skills until he masters them. Students with poor memory might be taught to follow several approaches to improve their ability to retain new material. In her book Promoting Executive Function in the Classroom, Lynn Meltzer, Ph.D., recommends: attending to detail; repetition, rehearsal, and review; attaching meaning; and grouping bits of information.

There is abundant research to confirm that these strategies work for a lot of kids. Creating organized classrooms and providing scaffolding for learning EF skills can enhance a student’s ability to attend and improve memory, organization, and self-regulation. But some kids do not fully develop their executive function capabilities, even with these approaches.

Lost in Translation

A primary reason that EF training does not “take” or transfer to other learning is the impact stress has on the parts of the brain that are involved in executive functioning. If a student believes that he can’t do the task he is assigned — if he has an “I can’t do it” mindset — a couple of things happen: If a kid feels under threat or has stress because he feels he will look stupid if he tries to do something he thinks he can’t do, the survival-oriented midbrain goes into full fight-or-flight mode. This, unfortunately, leads to the thinking, organizing parts of his brain (the prefrontal cortex) shutting down in the service of survival.

We have to teach kids what EF skills are, and we have to give them the chance to practice these skills. Unless we ask kids to apply these skills in learning to get a feel for what it’s like when EF is working, their brains will go into fight-or-flight mode. No one learns anything when that escape alarm goes off. It’s survival biology. Kids have to believe they will be successful for the EF training to become internalized and automatic. Think of it this way: You wouldn’t teach a kid to play piano in a concert hall filled with music critics.

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