Executive Functioning: The Keys to Independence
“My son takes an hour to get up in the morning…”
“My daughter’s backpack is a disaster!”
“Yitzchak can’t sit still in class. He’s always so fidgety.”
“Batya doesn’t raise her hand in class. She always calls out.”
“Laurie doesn’t study for her Chumash test unless I am hovering over her.”
“Zachary doesn’t do his homework unless I sit with him, and half the time he forgets to hand it in anyway.”
“I don’t know how my 18 year old is ever going to move out and be independent. I do everything for him!”
What do these comments have in common? All the children in these scenarios suffer from deficits in Executive Functioning. Executive functions are the regulatory functions of the brain that direct cognitive activities, emotions, and behaviors. Our executive functions clearly impact our day-to-day functioning in a multitude of ways and help us with many skills such as prioritizing, focusing, managing time, and organizing. They are integral to basic functioning at many levels.
Many school-age children struggle with weaknesses in executive functioning. They may be bright and highly intelligent, but their poor executive functioning inhibits the true expression of their intelligence. Unfortunately, these children may appear unmotivated, apathetic, or even oppositional, when in fact they are suffering from executive dysfunction. Deficits in executive functioning are manifest as part of other psychiatric diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorders such as Asperger’s Syndrome. They may also appear on their own.
Executive functions are mediated by the prefrontal cortex of the brain; however, it is likely that input is received and processed in other parts of the brain. In a typically developing child, in the early stages of development, parents and teachers serve as models of executive functioning. Through setting guidelines and enumerating concrete steps, they provide a template the child can use as he or she develops his or her own executive functioning. For example, when a parent asks a five-year-old child to “clean up,” the parent will typically have to specify what that entails and break it down for the child (put your laundry in the hamper, put the Legos back in the bin, etc.), but for a ten-year-old, the directive, “clean up,” may be sufficient to know what that entails based on the modeling the parent has done over the years, combined with the maturational development of the child’s brain. In the child with executive dysfunction this process has become interrupted and the child continues to need support and guidance, in contrast to same-age peers.
Difficulties in executive functioning impact children differently at different stages of the child’s life. In school-age children, deficits in executive functioning may manifest with difficulties in everyday routines, such as getting ready for school or bedtime. At school, a teacher may have to repeat directives and the child may have difficulty staying on task or completing an assignment. Homework can be a nightmare for the child and his or her parents, and any changes in routine may result in inflexibility or meltdowns.
As a child gets older, there may be difficulty juggling increased demands at school with different subjects and more complicated assignments. Writing down and keeping track of these assignments becomes critical. The peer group becomes increasingly important and the child with executive dysfunction may struggle socially as well. Completing chores at home may result in a battle as the child may refuse tasks due to an inability to break down information into manageable chunks. High school is often extraordinarily difficult for the adolescents struggling with these issues., with its constant barrage of papers, which require planning ahead and creative writing. This time also confronts students with challenges such as planning for college and making plans for the future, which require a lot of executive functions as well.
Parents often react in two ways. Some parents become their child’s Blackberry by taking on full responsibility for their child’s life. They keep track of all their child’s assignments, exams, papers, social life, and room, with the child taking no responsibility. Other parents struggle with their own executive functioning difficulties, so the child is left to “sink or swim;” they usually sink. In either model, parents often become understandably resentful at their child’s lack of independence in basic everyday functioning.
To remediate these difficulties, a two-pronged approach is best. We want to improve the specific area of difficulty, both by strengthening the weak area and by compensating with other areas of strength. Modifications are often helpful as well. Each child has his or her own “list” of areas of difficulty that is unique. Through a careful assessment, a list of the child’s difficulties can be broken down with a specific plan for each area of difficulty. Teachers, parents, and a therapist can work together to tailor a specific approach to a child’s unique needs and modify the environment to improve the difficulties.
Some examples may be helpful. A child who has difficulty getting up on his own may be put on a behavior system whereby he gets rewarded for getting up on his own, or with minimal help. A child who has difficulty organizing her backpack can be put on a color-coded system where each subject is a different color. A checklist of subjects is printed out and she checks off each assignment as she places it in the folder. A child who cannot sit still in class may benefit from short breaks, preferential seating, or rewards for sitting still. In this way, a child’s environment serves to reinforce their independence and executive functioning to increase the likelihood of success.
When dealing with more complex executive dysfunction, or in cases where behavior problems are significantly impacting the child’s success, enlisting the help of a child therapist trained in working with executive dysfunction can be effective in creating an effective plan for success.