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Executive-Function Deficits in Children

Posted by | May 5, 2012

Improving executive-function skills can help your ADHD child overcome frustrating academic obstacles and succeed in school.

by Marcia Eckerd, Stephen Rudin

"It’s raining kids in my office,” says Roy Boorady, Ph.D., assistant professor of child and adult psychiatry at New York University’s School of Medicine and Child Study Center. Every spring, psychologists who do neuropsychological testing are inundated with middle- and high-school students who are floundering. And the reasons for their visits are usually the same: They find it hard to navigate the swift currents of their educational environments.

Such children are often diagnosed as having learning disabilities or attention deficit hyperactivity disorder (ADD/ADHD), and interventions are prescribed. Many improve, sometimes dramatically. But others, despite educational services and medical help, continue to have problems. Some fall further behind; others burn out and give up trying. The vexing question is “Why?”

Signs of Executive-Function Deficit

In addition to the learning or attention deficit problems such children exhibit, many also display executive-function (EF) deficits. They lack the abilities to handle frustration, start and complete tasks, recall and follow multi-step directions, stay on track, plan, organize, and self-monitor. ADD/ADHD therapists and other professionals who can evaluate and diagnose ADD/ADHD typically point out executive-function problems, but many families dismiss them as less critical than other learning challenges. However, it is clear that effective executive functioning is a key factor in remedying academic difficulties.

Executive functions are the skills that an individual of any age must master to deal with everyday life. Self-monitoring is particularly important for students, because it governs their ability to evaluate their work and behavior in real time. It separates successful students from the failures.

“Executive functions include learning to balance sports, music, and other social activities with academic demands,” says Susan Micari, M.S. Ed., past president of the New York Chapter of the Association of Educational Therapists. “It often requires the student to recognize that he or she needs extra support from teachers, and to be able to ask for it.” Micari notes that executive-function deficits are thought to play a significant role in the severity of ADD/ADHD and dyslexia.

When Executive Function Problems Start

The transitions to sixth and ninth grades are critical for students. Over the span of one short summer, two things happen. For sixth-graders, the structure found in elementary school disappears. For ninth-graders, the level of academic expectation rises dramatically. Students with strong verbal abilities, who would have been expected to perform at a high level, stumble if they have executive-function problems.

It is crucial for parents, educators, and therapists to address executive-function problems, as well as learning problems, in order to serve struggling students. Often, though, learning difficulties are treated while executive functions are ignored. This approach is akin to repairing a car’s transmission but ignoring its faulty steering.

Parents usually understand a diagnosis of ADD/ADHD or learning disabilities. They’ve heard about these disorders and about the range of treatments for them, starting with medication. Unfortunately, the message about executive function often gets lost.

“Parents don’t understand why their children aren’t able to work independently on homework or in the classroom or be better organized,” says Marianne Findler, Ph.D., assistant professor of psychology in psychiatry at Weill Cornell Medical Center. “They assume that their child will ‘pick up’ executive-function skills, once he has been shown what to do. Their quick fix is to purchase a new planner or electronic organizer.”

Where to Get Help for Executive Function and ADD/ADHD

Who can provide executive-function remediation? Most parents don’t have the knowledge or skills to address EF deficits. What’s more, preteens and teens dislike being nagged by their parents, who, in turn, don’t want to be the “homework police.” Schools usually don’t have special-ed teachers equipped to deal with EF challenges either. Students need coaching from professionals who specialize in EF problems and how to teach the skills to improve them. Talking with your doctor, psychologist, or psychiatrist is usually the best place to start.

Good executive-function skills are not a guarantee of school success, but their absence is a predictor of difficulty at some point, and of the loss of self-esteem that follows. We need to help our children early on, so they can succeed in school and life.