My Child Has Been Diagnosed with Executive Functioning: Now What?

by Candice Lapin

IMG_9239.PNG

If you just walked out of the neuropsychologists office scratching your head, you are not alone. More and more parents are now looking to neuro-psychologist to get information on their child and his or her learning profile. Some parents are prompted by their child’s school. While others of you may be prompted by your own observations in your child. However, you may be confused by the diagnosis since Executive Functioning is something that all humans have to develop. And, there is a lot of debate on what the diagnosis is and is not!

What does it mean?

The term Executive Functioning is an umbrella term for a set of processes that involve mental control and self-regulation in order to achieve a short term task or a long term goal.  It has become a more recent buzzword. It is often used interchangeably with ADD or ADHD because children with inattention or ADHD have more difficulties acquiring and developing these executive functioning without strong modeling over time.(1)

Definitions:

ADHD is an Attention Deficit and Hyperactivity disorder. Like executive functioning, these children or adults have trouble staying focused, completing tasks as well as self-regulation. However, they also exhibit struggles with sitting or staying still.(2) ADD is an Attention Deficit Disorder. People of all ages with ADD do not exhibit the hyperactivity component.

It is helpful to think of the executive functioning label as a more detailed way of understanding what skills your student will have trouble acquiring.

What are the differences:

ADHD and Executive functioning are not the same. Like a venn diagramm, there is certainly cross over between the two terms. ADHD is often considered the “official diagnosis”. While executive functioning is a more detailed term to detail the specifics of the inattention piece of Attention Deficit Hyperactivity Disorder.

What does it include?

Children that struggle with executive functioning express difficulty with:

Task Initiation: The ability to begin a task or address a project by generating a free flow of ideas, arguments or strategies.  

Task Completion: The ability to complete a singular task by assessing the set of independent smaller tasks necessary to complete a short term or long term issue or project.  

Working Memory: The ability to hold pieces of information together for the purpose of completing a project.

Planning/Organization: The ability to manage and schedule a set of tasks over a set or given amount of time.

Organization of Materials: The ability to gather and arrange a set of materials needed for a project.

Self-Monitoring: The ability to measure their work against a rubric or standard of measurement.  

Impulsivity: Children with EF have difficulty with controlling their actions or stopping actions and thoughts.  

Flexibility: They have difficulty being flexible in action or thought when asked to solve a problem or approach something that they do not immediately understand.  

Emotional Regulation/Control: The inability to be reasonable when posed with a situation that causes emotional stress. An inability to control extreme emotional responses.

You may look over this list and if you have a child that has ADHD or inattention, you may be thinking that most or all of these items are struggles for your child!  You are not wrong! Children with ADHD and inattention may not just struggle with all of these items but they also struggle to acquire core executive functioning. In other words, they fail repeatedly to acquire the ability to organize or stay on tasks.

We also get comments from many parents stating that they are confused by the diagnosis because most children are still developing their executive functioning.  You are correct too! Traditional learners may have trouble or struggle with some of the components of this list.

Demystifying the diagnosis

Here is what is confusing and here is what should be demystified.  Most kids have an underdeveloped pre-frontal cortex! The pre-frontal cortex is where we develop our ability to organize, plan, and even understand consequence.  By the way--it doesn’t finish developing until most people are 25.(3) That is why so many accidents still happen to young adults in college who fail to fully comprehend consequence. Their brains don’t fully develop until they are 25. (4)

But...the children who typically have ADHD and inattention have the most difficulty with executive function acquisition!  This is why the diagnosis often goes hand in hand.

Short hand….sort of

The “Executive Functioning” diagnosis is a more detailed way to understand why your child with ADHD or inattention has trouble with listening to directions, following through on homework or even calming down under stress.   

Confused yet?

All children do need to acquire these skills and acquisition may take most of elementary, middle and high school to do so. But, not all children struggle to acquire them.  

So now what?

If you have a child that has recently been diagnosed with inattention or ADHD, all is not lost.  We get a lot of calls from parents wondering what they can do! The diagnosis does not mean your child will never pay attention or never be able to sit still or never be able to self-regulate their emotions.  The diagnosis means that your child will require a longer runway, more routine and regular modeling of behavior to do so!

What are your options as a parent?

IMG_1315.JPG

Since children with the executive functioning diagnosis require more attention, this is definitely not the time to throw in the towel of defeat.  What it does mean is that special time and attention needs to be paid towards nurturing these skills.

1. Exercise

Most parents used to want to avoid exertion because they want to avoid “riling” up their child but studies now show that exercise is an effective way of building focus, attention and routine in children with any type of executive functioning challenges.

2. Routines

One of the struggles that most children have with an executive functioning diagnosis is a struggle to get into planning and time management.  The good news is that all children thrive under structure. If you are hesitating to create structure and boundaries, because your child bristles against rules, think twice. Building homework routines, mealtime routines and bedtime routines and structure actually help build feelings of safety in not just children but in adults as well. (5) According to the British Journal of Psychology, Studies now show that routines help inspire feels of well being! (6) If you are worried about what your child might do if you tell them to go to bed, take heart that you are actually doing him or her some good!

3.   Sleep

It goes without saying that kids that are hyperactive or ADHD struggle with getting a good night of rest. Whether restlessness or medication woes, setting up a nightly sleep and bedtime routine will help tell the body it’s time to head to bed.

4. Food

Kids that struggle with executive functioning and ADHD also regularly combat spikes in mood and irritability. Because they often have a difficult time regulating mood, it is extremely helpful to stay away from certain foods that can spike or affect mood like sugar.  To read more about our recommendations for foods that improve mood, click here.

5. Modeling/Mentorship/Tutoring

Kids that struggle with ADHD, ADD or any executive functioning disorder also require a longer runway to acquire planning and strategy, reading, and strong study habits so it is essential that homework routines and executive functioning strategies are modeled over time.  We suggest not just sitting with your child but also trying to model the right listening, planning and organizational behaviors with your child. If you yuorself struggle with executive functioning, we suggest bringing in an outside party who can routinely sit with your child to properly model the behavior regularly (2-4 times per week).

If you are worried about what you child or teen might do with all this structure, its really important to remember that the initial challenges that erupt around setting routines, rules and structure will actually dissipate as the routine becomes common place!

If you would like more information on boundary setting, goal setting and routine building, feel free to reach out to our staff about webinars and other materials we offer to parents in addition to scheduling consultations.

For more information and tips on the executive functioning diagnosis, click here.

Sources:

(1) https://www.additudemag.com/executive-function-disorder-adhd-explained/

(2) https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/difference-between-executive-functioning-issues-and-adhd

(3) https://www.goodtherapy.org/blog/psychpedia/prefrontal-cortex

(4) https://www.goodtherapy.org/blog/psychpedia/prefrontal-cortex

(5) Avni-Babad, Dinah. “Routine and Feelings of Safety, Confidence, and Well-Being.” British Journal of Psychology, vol. 102, no. 2, 2011, pp. 223–244., doi:10.1348/000712610x513617

(6) Avni-Babad, Dinah. “Routine and Feelings of Safety, Confidence, and Well-Being.” British Journal of Psychology, vol. 102, no. 2, 2011, pp. 223–244., doi:10.1348/000712610x513617


More Articles on Teens and ADHD