Executive Function and the Exceptional Child

B Executive Function

My daughter, now in her 20s, was diagnosed with attention deficit hyperactivity disorder at the age of 15. She was not hyperactive, a component of ADHD more common in boys, but instead was “dreamy” and “spacy” at times. Identified as gifted in elementary school, she had been placed in her school’s gifted and talented program and excelled at academics.

But after she began attending boarding school in 10th grade, her academic advisor called us to report that she was not paying attention in class. She turned her work in late or not at all, and had regular emotional meltdowns under the pressure of trying to keep up with schoolwork.

Soon afterwards, a psychologist who specialized in learning difficulties tested her. Based on teachers’ written observations, our responses to questionnaires and an interview, she was diagnosed with ADHD, without hyperactivity.

ADHD, LD and Executive Function

Our daughter’s experience is not unique. In the U.S., 5.9 million children ages 3-17 have been diagnosed with ADHD. Learning disability (also called learning difference or LD), another condition that impacts academic performance, affects at least 2.4 million children. ADHD and LD may be diagnosed as early as preschool age or much later in life. Some children and adults are diagnosed with both.

Whether experienced separately or together, these conditions often create challenges in the skill set known as “executive function,” defined by the National Center for Learning Disabilities as “a set of mental processes that helps connect past experience with present action.”

Executive function is used in planning, organizing, strategizing, paying attention to and remembering details, and managing time and space. And if you are a parent, teacher or close friend of a child or young adult with LD or ADHD, you’ve likely witnessed firsthand the difficulty these individuals face in completing daily tasks that others master without a second thought.

Sequencing Tasks

In young children, difficulties with executive function may be manifested in struggles with what are called “sequencing” activities.

“Some children with learning disabilities have difficulty with sequencing, or completing a series of motor tasks,” says Linda King-Thomas, an occupational therapist at Developmental Therapy Associates, which has offices in Durham and Cary. “The term ‘dyspraxia’ refers to difficulty with organizing motor skills. Kids may not understand what they need to do in terms of using their body in the physical world – what is the sequencing of the motor component of an activity and then how do you actually do it. This often shows up in learning new physical skills, such as pumping your feet on a swing, riding a bike or learning to use a pencil.”

Children experiencing these kinds of challenges may be referred for occupational therapy. In some cases, both occupational therapists and physical therapists work with children on motor skills, depending on the specific diagnosis.

Another common challenge of sequencing is following a routine, such as getting ready for school in the morning. “With younger children, we use a visual schedule, with pictures that show what needs to be done next, such as getting dressed, eating breakfast and brushing your teeth. This helps young children see what needs to happen next,” King-Thomas says.

She recommends that parents whose children are difficult to arouse from sleep – common in kids with LD – experiment with “deep pressure” techniques, including grasping the arm or massaging a child’s neck and shoulders to help them wake up.

“This is particularly helpful for kids with sensory challenges,” she says. “Some kids also respond well to a slightly cool washcloth being applied to the neck or the forehead, while others respond to visual or auditory cues, such as turning the lights on or playing music to help them wake up.”

Getting Organized

LD and ADHD also present challenges in developing skills needed to plan for and complete work at school.

“The four core issues of ADHD are inattention, lack of organization, impulsivity and hyperactivity,” says Andrew Short, a psychologist in Chapel Hill who specializes in ADHD and learning issues. “The first three interfere most with school performance, but hyperactivity, if present, can cause problems when students move too quickly to complete their work and make careless errors or overlook details.”

Parents and experts agree that providing organizational support can help children stay on track with schoolwork.

Jennifer T. of Durham, whose 12-year-old son has dyslexia, a learning disability characterized by difficulty reading, says structure and support have been invaluable in helping him.

“He hates being confined to a desk and being indoors,” she says. “But we have found if tasks are broken down into small segments and his school and study time is structured so that breaks or outdoor play are included, he is much more successful in school and a much happier kid in general.”

Practical strategies such as color-coded folders for different tasks or types of work, a special homework folder or notebook to be reviewed at home each day, and a large calendar or white board to chart activities and deadlines are helpful for many children and teens who have LD or ADHD.

Improving Focus

Finding alternative strategies for challenging tasks and eliminating distractions are also helpful for children who find it difficult to focus for extended periods.

“One of my children, who was diagnosed in elementary school, continues to use lots of external things to help her manage her distractions,” says Sally S. of her daughter, who is now in her early 20s. “She’s an audible learner, so looking at what’s on the board or reading words on a page does not register well with her. Books on tape, reading aloud and some software programs have been very helpful for her.”

Some students find success in dictating papers, rather than writing them on paper or on a computer. Many children diagnosed with ADHD also benefit from prescribed medication, extra time on tests and external factors such as plenty of sleep and exercise, both of which contribute to improved attentiveness.

“Don’t overlook the basics,” Short says. “Good nutrition, good sleep and regular exercise have all been shown to improve concentration in kids with ADHD.”

Building on Successes

In retrospect, we realized our daughter’s earlier academic success was in part a result of our close supervision of her homework, which she was expected to do independently once she was at boarding school. After her diagnosis, strategies such as a mandatory supervised study hall, the use of a daily planner to record assignments and test dates, and other interventions resulted in improved academic performance and a much happier teenager.

Short points out that it’s important for parents to help their children with LD or ADHD find a path that leads to some measure of success and a sense of accomplishment. “Success is the best motivator,” he says. “Particularly with teenagers, you need to ask your child what strategies he or she thinks are most helpful, rather than imposing the systems that you think might work.”

“Modify your strategies until your child is on track,” he adds. “Then continue to provide whatever structure works best for them. If you communicate effectively and listen to your child’s input, he or she is more likely to buy in to the process and do what needs to be done to be more successful in school and in life.”

Managing life in a household with a family member with LD or ADHD – or both – is challenging and often frustrating for parents and children. But with careful observation, appropriate interventions and a big dose of patience and love, children and teens with LD or ADHD can learn to work with their limitations, develop their many talents and skills, and improve their executive function and ability to succeed in life and the larger world.

Resources for Families:
American Occupational Therapy Association, Inc., aota.org
National Center for Learning Disabilities, ncld.org
LDOnline, ldonline.org Children and Adults With Attention Deficit and Hyperactivity Disorder, chadd.org

Find additional category-specific resources in our Exceptional Child directory listings.

Apps That Support Executive Function:
Writing and Note Taking
Dragon Dictation
Organization and Homework
iStudiezPro Calendar and Reminders
TextMinder VoCal

Katherine Kopp is a freelance writer and editor in Chapel Hill.

Categories: Exceptional Child