Executive Function... "What is this anyway?"

Chris A. Zeigler Dendy, M.S.





Executive functions are crucial for school success! Published in CHADD's ATTENTION Magazine, February 2008; updated in 2011. Five years ago, most parents and teachers of students with ADHD didn't have a clue that a child's academic success was contingent upon strong executive skills. However, today's savvy parents and educators realize that deficits in critical cognitive skills known as executive functions (EF) are slower to mature in many children with ADHD. In 2007, researchers made a startling discovery: the brains of students with ADHD mature three years more slowly than their peers. This helps explain why their executive skills are delayed. Two years later, scientists found that the part of the brain that enables students to work on "boring tasks" such as school work has a reduced number of dopamine receptors and transporters. More simply stated the reduced levels of brain chemistry in this key area explains why students can play video games for hours but struggle to complete their homework in a timely manner. Impact of ADHD and Executive Function Deficits on Learning and Behavior. Practically speaking, problems with the "brain's CEO" contribute to several problems: disorganization, difficulty getting started and finishing work, remembering homework, plus difficulty memorizing facts, writing essays or reports, working complex math problems, remembering what is read, completing long-term projects, being on time, controlling emotions, and planning for the future. Before we understood the role of executive functions, parents and teachers were often baffled when students, especially those who were intellectually gifted, teetered on the brink of school failure. Unfortunately, to the uninformed, deficits in executive skills often appeared to be a simple matter of "laziness or lack of motivation". When a student had trouble getting started and finishing an essay or math work, it was easy to assume that the student chose not to do the task. Executive Functions Defined. Although scientists have not yet agreed on the exact elements of executive function, two ADHD researchers, Dr. Russell Barkley and Dr. Tom Brown, have given us insightful working descriptions. Dr. Barkley describes executive function as those "actions we perform to ourselves and direct at ourselves so as to accomplish self-control, goal-directed behavior, and the maximization of future outcomes." Through use of a metaphor, Dr. Brown gives us a helpful visual image by comparing executive function to the conductor's role in an orchestra. The conductor organizes various instruments to begin playing singularly or in combination, integrates the music by bringing in and fading certain actions, and controls the pace and intensity of the music. Dr. Gerard Gioia and his colleagues also contributed to our knowledge of executive functions when they developed the BRIEF (Behavior Rating Scale of Executive Functions). Additional Research on Executive Functions. Researchers vary widely in reports about the frequency of these deficits in students with ADHD. However, Dr. Russell Barkley, a noted authority on ADHD, reported that 89-98 percent of children with ADHD have deficits in executive skills. Dr. Barkley believes that the scores on EF rating scales are a better predictor of real world functioning than the lower EF deficit prevalence rates reported on traditional tests of executive skills. According to Dr. Barkley, students with ADHD experience roughly a thirty percent developmental delay in some skills such as, organizational and social skills. Basically this means our children appear less mature and responsible than their peers. For example, a twelve year old's executive skills are often more like those of an eight-year-old. To ensure academic success for these students, parents and teachers must provide more supervision and monitoring than is normally expected for this age group. I refer to this as providing "developmentally appropriate supervision." Real World Impact. Although our son Alex successfully struggled through the early school years, he finally hit the proverbial "ADHD brick wall" in middle school. Belatedly I realized that the demands for executive skills increase exponentially in middle school (working independently, organizing oneself, getting started, remembering multiple assignments). As a former teacher and school psychologist, I'm also embarrassed to say I failed for many years to recognize that a high IQ score alone was not enough to make good grades. It wasn't until Dr. Barkley identified the central role executive function plays in school success, that I finally understood why school was so difficult for my son. Teachers would say, "Alex is very bright; he could make better grades if he would just try harder." In truth, our children often do try harder, but even then, cannot make good grades without proper treatment and academic supports. Bottom line--the executive function deficits were the primary cause of Alex's academic struggles, not the symptoms of his ADHD. Components of Executive Function Based upon material from Barkley, Brown, and Gioia I have outlined eight general components of executive function that impact school performance: Working memory and recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory.)

Activation, arousal, and effort (getting started; paying attention; finishing work)

Controlling emotions (ability to tolerate frustration; thinking before acting or speaking)

Internalizing language (using "self-talk" to control one's behavior and direct future actions)

Taking an issue apart, analyzing the pieces, reconstituting and organizing it into new ideas (complex problem solving).

Shifting, inhibiting (changing activities, stopping existing activity, stopping and thinking before acting or speaking)

Organizing/planning ahead (organizing time, projects, materials, and possessions)

Monitoring (self-monitoring and prompting)

Viewing the Impact of Executive Function Deficits in Two Categories. I've found it helpful to view the practical impact of executive function deficits in two general categories: specific academic challenges like writing essays, remembering what is read (comprehension), memorizing information, and completing complex math and

essential related skills like organization, getting started on and finishing work, remembering tasks and due dates, completing homework and long-term projects in a timely manner, processing information in an efficient and timely manner, having good time awareness and management, using self-talk to direct behavior, using weekly reports, and planning ahead for the future. Essential related skill deficits may be mistaken for laziness. Since these common academic challenges such as a writing disability are easily recognizable, teachers are more willing to provide necessary accommodations. However, educators may be reluctant to provide needed supports for essential related executive skill deficits such as disorganization, getting started, and failure to submit completed homework in a timely manner. Unfortunately, on the surface, failure to perform these tasks looks like a simple choice was made to be lazy and not complete the work. However, that's not the case; a neurological deficit makes these tasks extremely difficult for students with attention deficits. Consequently, parents and teachers must always keep in mind that, first and foremost, this is a neurological problem, not laziness. Let's take a more in-depth look at just one element of executive function-deficits in working memory and recall-and their impact on school work. Poor Working Memory and Recall

Contrary to conventional wisdom, researchers report that working memory skills are a better predictor of academic achievement than IQ scores. This explains why children with ADHD and high IQs may still struggle in school. Deficits in working memory and recall negatively affect these students in several areas: Affects the here and now:

a. limited working memory capacity

b. weak short-term memory (holding information in mind for roughly twenty seconds;capacity-roughly the equivalent of seven numbers)

c. forgetfulness-can't keep several things in mind

As a result, students:

- have difficulty remembering and following instructions.

- have difficulty memorizing math facts, spelling words, and dates.

- have difficulty performing mental computation such as math in one's head.

- forget one part of a problem while working on another segment.

- have difficulty paraphrasing or summarizing.

- have difficulty organizing and writing essays.

Affects their sense of past events:

a. difficulty recalling the past

As a result, students:

- do not learn easily from past behavior (limited hindsight).

- repeat misbehavior.

Affects their sense of time:

a. difficulty holding events in mind

b. difficulty using their sense of time to prepare for upcoming events and the future

As a result, students:

- have difficulty judging the passage of time accurately.

- do not accurately estimate how much time it will take to finish a task; consequently, they may not allow enough time to complete work.

Affects their sense of self-awareness:

a. diminished sense of self-awareness

As a result, students:

- do not easily examine or change their own behavior. Affects their sense of the future:

a. students live in the present-focus on the here and now

b. less likely to talk about time or plan for the future

As a result, students:

- have difficulty projecting lessons learned in the past, forward into the future (limited foresight).

- have difficulty preparing for the future.



Common Academic Problems Linked to ADHD and Executive Function Deficits Many students with ADD or ADHD have impaired working memory and slow processing speed, which are important elements of executive function. Not surprisingly, these skills are critical for writing essays and working math problems. Research studies by Mayes and Calhoun and more recently by Katusic have identified written expression as a major learning problem among students with ADHD (65-67 percent). Consequently, writing essays, drafting book reports or answering questions on tests or homework is often very challenging for these students. For example, when writing essays, students often have difficulty holding ideas in mind, acting upon and organizing ideas, quickly retrieving grammar, spelling and punctuation rules from long-term memory, manipulating all this information, remembering ideas to write down, organizing the material in a logical sequence, and then reviewing and correcting errors. Since learning is relatively easy for most of us, sometimes we forget just how complex seemingly simple tasks really are, for example memorizing multiplication tables or working a math problem. For example, when a student works on a math problem, he must fluidly move back and forth between analytical skills and several levels of memory (working, short-term, and long-term memory). With word problems, he must hold several numbers and questions in mind while he decides how to work a problem. Next he must delve into long-term memory to find the correct math rule to use for the problem. Then he must hold important facts in mind while he applies the rules and shifts information back and forth between working and short-term memory to work the problem and determine the answer. To further complicate matters, other serious conditions may co-occur with ADD and ADHD. According to the recent landmark National Institute of Mental Health MTA study on ADHD, two thirds of children with ADHD have at least one other coexisting problem, such as depression or anxiety. Accommodating students with complex cases of attention deficit disorder is critical! These children are at greater risk than their peers for a multitude of school problems, for example, failing a grade, skipping school, suspension, expulsion, and sometimes, dropping out of school and not going to college. Favorite School Success Strategies Over the years I have collected several favorite teaching strategies and accommodations that work well for students with ADD or ADHD. So here are just a few of my favorite tips: General Teaching Strategies

Make the learning process as concrete and visual as possible.

Written expression

a. Dictate information to a "scribe" or parents.

b. Use graphic organizers to provide visual prompts.

c. Use Post-it notes to brainstorm essay ideas.

Math

a. Use paired learning (teacher explains problem, students make up their own examples, swap problems, and discuss and correct answers).

b. Use a peer tutor.

(After barely passing high school and college algebra, my son made an A in calculus plus had a 100 average on tests when the professor used this strategy. At the same time, he also tutored a friend.)

Memory

a Use mnemonics (memory tricks), such as acronyms or acrostics, e.g., HOMES to remember names of the Great Lakes, Huron, Ontario, Michigan, Erie, and Superior.

b. Use "visual posting" of key information on strips of poster board.

c. Consider "Times Alive", an educational CD, to assist withmemorizing multiplication tables.

Modify teaching methods.

a. Use an overhead projector to demonstrate how to write an essay. (Parents may simply write on paper or a computer to model this skill.)

b. Use color to highlight important information.

c. Use graphic organizers to help students organize their thoughts.

Modify assignments-reduce written work.

a. Shorten assignments.

b. Check time spent on homework, and reduce it if appropriate (when total homework takes longer than roughly 10 minutes per grade level as recommended in a PTA/NEA Policy, e.g. 7th grader = 70 minutes).

c. Write answers only, not the questions (photocopy questions).

Modify testing and grading.

a. Give extended time on tests.

b. Divide long-term projects into segments with separate due dates and grades.

c. Average two grades on essays- one for content and one for grammar.

Modify level of support and supervision.

a. Appoint "row captains" to check to see that homework assignments are written down and later turned in to the teacher.

b. Increase the amount of supervision and monitoring for these students, if they're struggling.

Use technology.

a. Use a computer as often as possible.

b. Use software to help teach skills.

Unfortunately students with ADD or ADHD are often punished for executive function deficits such as lack of organizational and memory skills that interfere with their ability to bring home the correct homework assignments and books. Hopefully, after reading this article, teachers and parents will develop more innovative intervention strategies. For example, one effective alternative would be to have someone (a friend or teacher aide), meet the student at his locker to get the necessary homework materials together. Ultimately, this process of "modeling" and "shaping" behavior at the critical "point of performance" will help the student master skills or at a minimum, teach him to compensate for deficits. In Closing.Clearly school is often very difficult for students with attention deficits. However, when executive function deficits are also present, the accompanying problems are often overwhelming to the student and family. Unfortunately, some parents and teachers have had little awareness or sympathy for the challenges presented by these combined deficits. Hopefully, teachers and parents now realize that attention deficit disorder is often a very complex condition! It's much more than just a simple case of hyperactivity. When deficits in executive function and related learning problems are present, students can try their very best and still not succeed in school!! So what should parents and teachers do with this new information?

1) Identify the student's specific learning problems (e.g. written expression or math)

2) Identify their executive function deficits (e.g. working memory, disorganization, forgetfulness, or impaired sense of time)

3) provide accommodations in both areas!

I leave you with this food for thought, "Succeeding in school is one of the most therapeutic things

that can happen to a child!

So do whatever it takes to help the child succeed in school." On a personal note, our youngest son struggled terribly throughout his school years with ADD inattentive and executive function issues. Although college was incredibly difficult, Alex did graduated and occasionally made the dean's list. We're so proud of him and his tenacity. So if your child is struggling in school, do not give up. My family offers living proof that there is hope and help for ADHD and coexisting conditions. Teaching Teens with ADD, ADHD, and Executive Function Deficits, 2nd ed was the source for this article. In addition see the original CHADD article for references including Barkley, Brown, Dendy, Deshler, Levine, Mayes and Calhoun.