Executive Dysfunction-A Stumbling Block

A Stumbling Block for Children of All Abilities

By Joyce Heid

For children who are not equipped with the skills to organize and prioritize, accomplishing daily tasks, not to mention long-term projects, can be a nightmare. The good news is that it’s never too late to learn and develop these skills.

If your child has good executive function skills, it does not mean he or she is proficient with a palm pilot and has a Bluetooth headset. It does mean your child has developed important skills such as the ability to manage his or her time, pay attention, and retain information—and, very important, that he or she can perform tasks in an organized, sequential manner.
Whether juggling play dates, sports practices and school functions, or preparing a presentation for one’s boss, an aptitude with such executive skills is necessary to function effectively. While your child may not have as complicated a daily itinerary as you do, he still relies upon these same skills each day. However, because he is using them to complete much simpler tasks, difficulty executing these skills may not become apparent until it causes performance issues at school.

In A Special Edition 2005-06, a Baltimore’s Child publication for families with children with special needs in Maryland, Nancy Knisley described executive function: “…when a child’s problems with executive functioning cause academic problems, trying to improve academic achievement without addressing the more global problem is unlikely to produce the desired results. A child who can’t figure out what materials to put on his desk to begin a writing assignment or who can’t put his thoughts on paper in a logical order will have problems writing effectively—until some interventions are put into place to help the child with those key management or control tasks.”
Part of brain development includes learning to engage multiple basic functions—language, motor skills, memory, and spatial skills—so they work together in harmony to solve problems and complete tasks competently. Separately these functions are unable to perform even basic problem solving—or complete a writing assignment. Together they allow students to succeed.

Dr. Lori Perez, a certified school psychologist and executive director of LearningRx, a tutoring center in Severna Park, explains, “Executive functions are often described as the “mastermind” of our cognitive skills because they are the higher-order thinking skills that control many of our lower-ordered processing abilities. They are necessary for controlling our goal-oriented behaviors. For example, attention, planning, and regulating behavior are all a part of executive functions.”

Again, if each skill performs independently—with no executive control—almost any multi-step task will prove difficult.
Dr. Thomas L. Baumgardner, a Towson psychologist specializing in pediatric and adult neuropsychology, compares executive function to cooking: “Borrowing from my beloved mentor Dr. Martha Denckla, M.D., I will suggest an analogy to cooking, where there are ingredients and recipes…and then there are those other processes that go on in bringing the meal together and that are ‘central’ to achieving the goal of getting-the-meal-on-the-table…at a particular time and place.”
“Executive processes are not the ingredients, nor the recipes,” he continues, “but rather, the timing and coordination of the actions, events, and ingredients that are folded together in the process of achieving the goal of delivering a satisfying meal…”

Lacking executive function skills is in no way a reflection of intelligence. One can possess a very high intellect and still have difficulty keeping his or her talents organized to accomplish tasks efficiently.
Baumgardner continues with his metaphor, writing that, “…intelligence and the performance of IQ tests represent the ingredients acquired [or purchased] for use in the recipe; and the recipes are but special forms of knowledge [meta-knowledge] that we may have discovered or invented or received from our mothers. But recipes still must be ‘executed.’ Therefore, we could have the finest ingredients [such as vanilla beans, sugar, fresh cream, and eggs] and cherished recipes, but we might still fail at achieving the intended goal of dinner for six at 7…cocktails and hors d’oeuvres at 6:30, salad at 7, tenderloin and Bordeaux at 7:15, and creme caramelle at 9 p.m. …For this, the shopping must be completed, the oven preheated, the meat thawed and seasoned, the ingredients combined in the proper sequence and timing, the table set, the flowers arranged. And don’t forget the dress, make-up, and matching shoes.”
In short, Baumgardner continues, “executive functions [make up] the regulatory process [or the coordination and control] that is needed to make plans, to organize knowledge, and [they are] the skills for the purpose of accomplishing a future goal.”

Early Executions
The groundwork for executive function skills begins early in life. According to Perez, the first signs of executive function—the conscious control of thought, action, or emotion to accomplish a goal—become apparent before a baby can walk or talk.
“Executive functions are present from infancy. Infants can plan and problem-solve, but their skills are limited. An infant can learn through play how to manipulate [his or her] world—for example, how to get a toy to make noise. While [infants] exhibit signs of executive function, they are largely oriented only to the present and are stimulus-bound, meaning that something must occur to get their attention right then and there in order to get a reaction.”

Think about the game of hide and seek. When you hide from a baby and he “finds” you, on a basic level, the baby has a question in mind—“Where is Mommy?”
He develops a plan—“I’ll look under this blanket.”
Finally, once you’ve been discovered, the baby delights in realizing that he has accomplished the goal—the baby’s found Mommy! Using the most basic executive function skills he has accomplished his goal.
As development continues, it is accepted that young children still have limited attention spans and ability to reach goals in multiple steps. The work a child performs from preschool through early grade school is usually very structured, with instruction planned accordingly. Even so, executive function skills continue to expand.
Perez explains, “Great developments in executive function occur throughout early childhood. Many preschoolers can think about the past and plan for the future. They may be able to make a choice, given one or two options. However, being given many options is often overwhelming and frustrating. Preschoolers may learn from the consequences of their behavior, but their ability to regulate and control their behavior is still limited. They demonstrate an interesting disassociation between ‘knowing’ and ‘doing.’”

Each age group displays different behaviors demonstrating executive skill development. Perez illustrates, “You may find that an early elementary-age child may engage in self-talk much more often than an older elementary-age child. This self-talk is the child’s way of thinking through a problem. The self-talk continues through adulthood; however, it becomes internalized.”
When a child approaches middle school, he or she is expected to exhibit control over emotions and behaviors and discipline him- or herself, thus allowing him or her to pay attention and retain more complex information as well as be able to complete schoolwork independently. It is at this time that problems with executive function may become evident.

According to Baumgardner, “Because executive functions are the control processes that permit an individual to organize knowledge and behavior for the purpose of meeting immediate environmental demands and to engage in future-oriented actions, problems with these control processes often appear at that point in development when increasing the levels of independent behavior is expected…when the ability to self-regulate, to manage time, to plan, organize, and complete complex or multiple tasks, become the norm.”
“Problems are often recognized when children enter school, at the transitions in middle school and high school and then college, and perhaps with job promotions that involve increasing levels of responsibility and independence,” he notes.

Function vs. Dysfunction
Indicators of problems with executive function, known as executive dysfunction, may include the inability to finish work on time, not asking for help when needed, struggling to communicate information in a sequential manner, such as telling a story, and difficulty performing tasks independently.
Perez encourages parents to be aware of what to expect as their child grows.
“When looking for signs that a child is in trouble, it is important to note what the appropriate developmental milestones are for a particular age group. For example, preschoolers often demonstrate short attention spans and impulsivity. They may also struggle with transition times because they are not yet developmentally ready to self-regulate their behavior.”

“As a child enters school,” continues Perez, “he or she makes great strides in many areas of executive function such as the ability to self-regulate behavior, the ability to sustain attention and delay gratification, and the ability to plan and problem-solve. While making these strides, it is important to remember that brain development in this area is not yet complete. So, while he or she is able to self-regulate behavior, a young child may still require feedback and reminders from the outside world to judge how well he or she is meeting expectations.”
Describing key periods in skill development Perez states, “We see ‘spurts’ of growth in executive functions between ages 7 to 9, 11 to 12, and late adolescence/early adulthood. While older children often appear to be intellectually mature because their logic and reasoning skills increase dramatically and they become more adept at abstract thought, it is important to remember that their decision-making is still often ruled by emotion.”
When a child is having trouble completing schoolwork, according to Perez, there are signs or traits which in conjunction with a disorganized room or desk or notebook that may indicate he or she is having problems with executive functions. They include:
Concrete thinkers: Difficulties with perception of social cues. Poor cause-consequence understanding and limited self-insight.

Rigid or difficulties with change: Can be perceived as uncooperative due to rigidity/being rule-bound.
“Forgetfulness” or inattention: Can be perceived as apathetic or lazy due to poor initiation.
Disorganized, poor motor planning and control: Can be perceived as inefficiency or incapable planners.
Poor frustration tolerance: Difficulties waiting turn. Difficulty following rules, or violating rules despite knowing them.
Emotionally reactive/inappropriate degree of reaction: Difficulties with social skills, aggression. Can be perceived as lacking in empathy.
Perseveration difficulties: Continuing to behave in a way that is no longer appropriate, often despite knowing what they are supposed to do. Perseverative errors (or repeatedly making these errors) are classic examples of failures of executive function.

Addressing the Dysfunction
Because the adverse effects of executive dysfunction can have disastrous consequences, problems should be addressed early. Not only can executive dysfunction lead to poor school performance, it can also lead to depression and other behavior problems.
Perez encourages parents not to get discouraged and think there is little that can be done for their child.
She says, “…the biggest misconception is that there is nothing a parent can do to assist in executive dysfunction. Parents can assist in the development of executive functions by providing feedback so that a child becomes actively engaged in identifying what is difficult and easy for [him or her] and in identifying clever ways to accomplish difficult tasks.”
Fortunately, there are strategies to help combat executive dysfunction, though some interventions can present their own challenges.

To “teach” a child executive functioning skills and thus improve academics and eventual life skills, the child must learn how to set goals, how to decide what steps to take to achieve those goals, and how to perform the tasks independently. Telling a child the answer to a problem does not teach him or her how to answer a problem.
For example, if your child constantly forgets what his homework assignments are or is confused about how to complete them, calling his friends each night may get him the information, but it doesn’t solve the real problem.
A more efficient strategy is to speak to his teacher about helping him use a homework organizer each night to write down what he needs to do. It can also help to write due dates on top of assignments and to break long assignments into smaller sections so they do not seem as overwhelming.
It is also important to communicate with the teacher on a regular basis to review how the student is progressing and if his or her skills are improving.

For some children, however, parents and educators may have to go a few steps further. Psychological testing may be needed to determine the proper interventions, and the child may need to have these interventions outlined in an Individualized Education Program (IEP) or 504 plan and be reviewed regularly.
Finally, Baumgardner explains that, although the formation of executive function skills may begin in early childhood, honing these skills continues for years.
“The processes involved in self-regulation that lead to the ability to organize goal-directed behaviors start early in childhood and continue to develop into the 30s,” he notes, adding that our brains mature and develop well into adulthood.
And, while early intervention is best, it is never too late to work on executive skills. This is great news. BC

Build Executive Function Skills at Home
Dr. Lori Perez offers suggestions for parents on how to build their child’s executive function skills. She says that, when working with children at home, parents should focus on the following areas:
• Make sure children develop self-awareness of their strengths and needs and that they receive informative feedback when necessary.
• Make sure children are involved in goal-setting so that they are routinely asked to predict how well they are doing with activities and to compare predictions with actual outcomes.
• Make sure children are participating in planning activities such as larger projects for homework and that they are involved in breaking down large projects into smaller, more manageable tasks.
• Give children opportunities to delay gratification (such as saving an allowance for a large gift).
• Encourage children to “talk though a problem” to inhibit mistakes that may be made by engaging in impulsive decisions.
• Ensure that their life is adequately organized on a regular basis and that they participate in organizational strategies. Go through their book bag once a week and have them get organized the night before for the next day. Have them pull out the clothes they will wear for school and make a list and check off what they’ve done.
• Help children to memorize and to make links between visual or auditory clues to help with memorization.

Additional Resources and Activities
Dr. Lori Perez recommends the following resources for finding additional help with addressing executive functioning skills
Websites: www.ldonline.org, www.nasponline.org, and www.learningrx.com.
Books: The Organized Student: Teaching Children the Skills for Success in School and Beyond, by Donna Goldberg and Jennifer Zwiebel (Fireside, 2005); and No Mind Left Behind: Understanding and Fostering Executive Control—The Eight Essential Brain Skills Every Child Needs to Thrive, by Adam J. Cox (Perigee Trade, 2007).
Perez also recommends a list of games to play for building executive functioning skills. These games are appropriate for a variety of ages.
Apples to Apples – for Logic and Reasoning, Executive Processing, Planning.
Battleship – for Logic and Reasoning, Planning, Working Memory.
Blokus – for Logic and Reasoning, Planning.
Chess – for Logic and Reasoning, Attention, Executive Processing, Planning.
Connect 4 – for Logic and Reasoning, Attention, Executive Processing, Planning.
Cribbage – for Logic and Reasoning, Attention.
Gobblet – for Logic and Reasoning, Executive Processing, Planning.
Blink – for Working Memory, Processing Speed.
Legos – for Planning, Problem-Solving, Executive Processing.
Mancala – for Logic and Reasoning, Planning.
Perfection – for Memory, Planning, Attention.
Rummy – for Logic and Reasoning, Planning, Attention.
Rook – for Logic and Reasoning, Planning, Attention, Working Memory.
Sequence – for Logic and Reasoning, Planning, Working Memory.
Set – for Logic and Reasoning, Planning, Working Memory.
Stratego – for Logic and Reasoning, Planning, Memory.
Sudoku – for Logic and Reasoning, Planning, Memory.
Tetris – for Logic and Reasoning, Memory, Planning, Processing Speed, Attention, Memory.
Uno – for Logic and Reasoning, Memory, Attention.
Skip-Bo – for Attention, Processing Speed, Planning, Memory.
Squint – for Logic and Reasoning, Planning, Processing Speed, Memory, Attention.

© Baltimore’s Child Inc. August 2008

Leave a Reply

Your email address will not be published. Required fields are marked *