executive dysfunction

What to Do When They Won’t Change Their Mind

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I once had a student that was having difficulty turning in his homework. He would do it, but when it came time to pass it in, he could not find it. He had a “homework folder” where all of his finished work was supposed to go, but his work was not there. When asked, “Where else did you look?” He was unable to answer. In his mind (we later discovered), if it wasn’t in the homework folder there was nowhere else to look. Does this sound familiar?

This is an example of cognitive inflexibility – difficulty changing or shifting your mindset when the most logical answer does not bring results. Needless to say, upon further searching, other homework papers were found at the bottom of the backpack, stuffed inside a text book and also on his desk at home. All papers exactly where he had left them, yet he had no recollection.

Cognitive inflexibility is real. It is one of the Executive Function skills that develop in the pre-cortex of the brain. It can be measured on certain IQ tests and on the Behavior Rating Inventory of Executive Functions. It has two components: a cognitive shift and a behavioral shift. Simply put, if your child cannot change their thoughts or their behavior when they realize something is not working, then it may be from cognitive inflexibility.  You may have seen it when they get “stuck” on their math, or they don’t know what to do, but won’t accept your help because you, “don’t do it like the teacher.” Or have you ever noticed their perspective of what happened, does not quite agree with the other person’s perspective? All related to cognitive inflexibility.

As an Executive Function skill, cognitive flexibility will continue to develop but, in the meantime, it can cause some issues. Try to help your child see other people’s perspectives. You can explain how things are not always “black and white” (another sign of this underdeveloped skill and often related to ADHD), and that there are always other possibilities. They can help themselves by starting with some simple questions.  A research study indicated that there was a close relationship between cognitive flexibility and inner speech among both children and adults.  It appears as though inner speech may increase top-down control during shifting of thoughts (i.e. flexibility). https://mentalhealthdaily.com/2015/07/26/7-ways-to-increase-your-cognitive-flexibility/

Try having your child ask themselves these questions:

Before starting:

“What do I already know that will help me?

“What should this look like when it is done?”

“What should I do first, second and third?”

During: “How am I doing?”

“Am I on the right track?”

“Is there another or better way?”

“What do I do if I get stuck?”

After: “What strategies did I use?”

“Did I get stuck or have to change my thinking?”

“What did I learn from this?”

Developing this ability to shift thinking or shift behavior can also be improved through games and activities. Games to encourage the development of cognitive flexibility include: Set, Othello, Connect 4, Mastermind, and Gobblet. Activities include: Stroop (where color words are written in different colors and they must say the color they are printed in), optical illusions, maps with multiple ways to the destination and Tower of Hanoi. Other activities include changing up routines, learning a new skill, exercise, getting out in nature, and video games that have multiple streams of information that have to be manipulated simultaneously.

For more strategies: Check out our blog, Stuck? 12 Ways to Encourage Cognitive Flexibility

 

 

14 Things Your Kids Need to Know

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clrtestAs an Educational Consultant for Deaf and Hard of Hearing students I have the unique opportunity to observe different grade levels, schools and districts. Although I am observing the student’s ability to access the curriculum being presented I also look around to identify those with ADHD and watch how they are accessing the curriculum, communicating with their peers and maintaining their focus.

Here’s what I have noticed:

  • Students are asked to focus for anywhere from 45-90 minutes without breaks.
  • Many adults cannot focus for that long especially if they are only listening
  • Often they don’t know what is important to focus on – so they try to focus on all of it
  • Students either do not take any notes or try to write down everything that is said
  • They wait for the teacher to say things like, “This is important.”
  • They trust that they can remember the information
  • They do not try to put the details together to get the bigger picture and end up trying to memorize random facts that don’t go together
  • They do not realize that studying for a test begins in class
  • Students do not know how to study
  • Teachers are providing study guides that have “fill in the blank” answers and students think that if they memorize the sentences they will do well
  • Students do not look at their textbooks unless specifically told to
  • Often students only get a few days notice of upcoming tests or quizzes
  • Students are shocked at how poorly they do on tests that they think they prepared for.
  • 90% of my students think that 20 minutes is enough time to study for a test
  • Students are not given the chance to learn from their mistakes
  • Tests are collected after 2-3 minutes
  • If no one raises their hand with a question about the test, nothing will be reviewed
  • Students develop an “I can’t” attitude rather than an “I need to do more” attitude

So how can you help your son or daughter learn how to focus?

  • Those with ADHD tend to get bored quickly and when that happens the brain shuts down or switches to other off task thoughts. Teach your child how to get themselves back on track by using examples that happen at home. Using a non-judgmental tone you can point out when you see them go off topic before you are finished with it.  Ex. “I can see how you might have thought I was done talking about “x” but I really wanted to say two more things ….are you ready to listen to me again?” Then ask them to summarize what you were talking about. Be sure to give them time to share their thoughts without interruption as often their working memory can only hold onto the thought for a short amount of time.
  • ADHD brains also shut down when there is too much information to focus on. Skip the details and give them the bottom line first so they don’t miss it.
  • Allow them to fidget with things and don’t insist they make eye contact as often that is too much distraction for them especially if they are being reprimanded.
  • Ask them how they stay focused in school and offer suggestions like taking notes, doodling related drawings to the topic, counting how many times they get distracted and pull themselves back or fidgeting quietly with something inconspicuous

We’ll combine taking notes and studying together. Here are ways to help:

  • Most information for tests comes from class lecture and discussion. Students need to realize that taking notes about the key points can help tremendously when it comes time to study. From 6th grade and up, students should be taking some notes. If they are given a copy of the Powerpoint presentation they should add to it.
  • Looking ahead in the text book can often give clues as to what will be presented in class. If the brain already knows what to expect it is better able to make connections and tie new information to old.
  • Students can create a study guide by writing questions in the left margin about the topic in the notes. If they can answer those questions without looking at the notes, they probably know the information.
  • It takes 4-7 exposures to the information before it can be “learned” so students should review the information (by asking themselves questions) at least three times over several days.
  • Reviewing class notes after homework is done especially in their weakest subject is a great way to get extra exposure to the information. Or choose to write the questions in the margins the same day as notes were taken.
  • Study guides don’t always have all the necessary information on them. Students should reread their notes and check the text. Turning the statements on a study guide into a question will help them understand the information better.

The biggest mistake teachers are making is to be more concerned about their test questions getting out than in helping students learn the information. Collecting tests 3 minutes after students get them back is a major disservice to students. I have heard about only one town that allows students to take the test home, correct all incorrect answers and receive added points.  That motivates students to find the answers rather than just hearing them reviewed in class (which doesn’t seem to happen often unless someone asks a question). Help your student learn better by developing as Carol Dweck says a “growth mindset.”

  • Teach kids that their intelligence is not fixed, it is malleable. Push them to roll up their sleeves and try again. Avoid saying things like, “you’re so smart” as it implies that intelligence is fixed and sends a conflicting message to them when they fail.
  • Build resiliency. Focus on the positive.
  • Level the playing field by helping students learn to use the tools, strategies and technologies that work best for them and not necessarily what the teachers want
  • Bottom line – do whatever it takes to keep your child’s self-esteem intact. It’s how they feel about themselves that will determine how well he or she succeeds.

Lights! Camera!…..ACTION! 15 Steps to Get Going

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frustrated studentTaking action and following through on something that has to be done is often difficult for those with ADHD or Executive Functioning challenges. In most cases, students and adults understand the importance of completing something but find it difficult to actually “move themselves” to action. What is happening in the brain, in my understanding, is that the level of dopamine is not sufficient to reliably carry messages/signals from one side of the brain to the other or to provide enough motivation for action. That makes this difficulty neurobiological and not motivational. There is a big difference there as often we have seen things get completed before and feel that if it can be done once why not every time? Such is life with ADHD and/or Executive Dysfunction. Inconsistent ability to take action doesn’t occur alone, it often involves other executive functions like, organization, planning, working memory, task initiation, self-regulation, focus and time management. So rather than it being one simple cause, it is often a combination of things that is getting in the way. Also not learning from previous experiences plays into why this same thing continues to happen over and over again. If possible try to break it down to see what is really getting in the way and work on one piece of the puzzle at a time.

Here’s what it may look like in students:

Inconsistent ability to complete homework regularly (or long hours spent doing it)
Last minute approach to long term projects
Being late or last minute
May look like a lack of motivation, not caring, or teen age “attitude”
Failing tests due to inability to study enough (or up past midnight studying)

In adults:

Often late (but only by a little bit) or last minute on meeting important deadlines
Procrastination and/or lack of follow through
High energy and always appear to be very busy without actually accomplishing a lot.
“Paralyzed” when they don’t know how to do something or don’t want to do it
Inability to prioritize

Here’s what can help:

    1. Make a “must do” list that only includes the top two or three things you must get to
    2. Start with the most interesting task first
    3. Set false deadlines for yourself or be accountable to someone else for completion
    4. Break it down into manageable size actionable steps and use verbs for each step
    5. Set goals and behavior contracts weekly with students (too far in advance is worthless)
    6. Act as a body double for your student by being close by during homework time and doing your “homework”
    7. Teach your child to “talk to themselves” and ask questions to keep themselves on track
    8. Support them or provide supports for them but don’t do it for them
    9. Keep the end in mind – what will the homework look like when completed and what will I do after it is?
    10. “Suffer” through five minutes – it may motivate enough to keep going
    11. Exercise or do something active to increase the dopamine in the brain before beginning (snacks and water help too)
    12. Remind yourself and/or your student of past successes
    13. Change the environment, change the task or change the expectations
    14. Use timers and allow five minute breaks for every 30 minutes of work (minimize distractions)
    15. Use plenty of positive reinforcement that mentions specific actions you see your child doing

Motivating someone else or even yourself to take action often depends on how important the task seems (that adrenaline rush is actually raising the dopamine levels too). If someone else (usually your kids or spouse) is waiting on you to do something you may be more likely to do it. In school, students can often “force” themselves to get something done for a favorite teacher or subject but may feel it is torturous for their least favorite. Start small and put checklists, timers, notes to self (especially where you leave off on a project) and use the steps above that help. Having something to look forward to can often provide an extra push so be sure to reward yourself and/or your child. Now, get going!

What DID I Come in Here For?

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Have you ever walked into a room and forgotten what you went in there for? Or sent your child to do two things and they only did one? If this kind of thing happens often then it may be a working memory issue.

Working Memory is an Executive Function skill that plays an important role in remembering what to do and how to do it.  It can have an impact on how much you and your child get done and how quickly and/or completely. Peg Dawson and Richard Guare1 define working memory as, “the ability to hold information in mind while performing complex tasks. It incorporates the ability to draw on past learning or experience to apply to the situation at hand or to project into the future.” This explains why your child can do the homework one night and the next night not have any idea. It also explains why things are left unfinished, or multiple step directions are not followed and why they do the same thing over and over even though they “know” or should know that it is wrong. It also interferes with learning from past mistakes. Multitasking or being distracted and not paying attention to details can also have an effect on your ability to use your working memory effectively.

In Children it may look like:

  • Difficulty following multi step directions (or forgets some but not all of the steps during a project)
  • Struggles with math, especially processes of more than two or three steps (ex. long division).
  • Struggles to get out the door in the morning or to remember the steps in a routine
  • May “get in trouble” for the same thing over and over
  • Really studies but fails the test

In adults:

  • Walk into a room and forget why
  • These are the people that forget they are driving when they are on their cellphone
  • Leave tasks in midstream
  • Wake up in the middle of the night remembering something they forgot to do
  • Get home from the store without the item they went for

Strategies to help working memory:

  • Write it down! Use a planner, smartphone app (Google Calendar, Color note, Evernote, Remember the Milk, Hiveminder, etc.), or notepad to keep track
  • Make it multisensory whenever possible
  • Simplify and slow down. (Multitasking reduces your IQ by 10-20 points, so use your full capacity)
  • Visualize the “end” – what will it look like when I am done/ready?
  • Cut out distractions and focus on the task at hand
  • Visual cues like using your fingers as placeholders for what you need to remember (3 things=3 fingers) and “don’t forget” lists on the back of the door.
  • Chore cards (Russell Barkley’s idea) that list the steps involved in a chore
  • Repeat out loud what you want to remember
  • Have your child repeat back what they need to do
  • Do one thing at a time until you or your child can handle more
  • Use mnemonics, acronyms or make up silly songs to remember what to do
  • Templates, checklists and pictures for processes, chores, and routines

For Learning:

  • Graphic organizers and mind maps using color, shape, and placement help the brain recall
  • Preview before reading
  • Use outlines, take notes and use highlighters when possible (different color for each step in directions)
  • Have a note buddy to share notes with your child or to call if they forget what to do
  • Write out the steps first so you can check back to see they are all done
  • Templates, checklists and pictures for processes, chores, and routines (long division, morning get ready routine, what to take to school, etc.)
  • Play games that rely on remembering to build working memory

Once you become aware of what is preventing you from remembering or can find a few strategies that will work to help you compensate for a weak working memory you can then help your child learn about what is getting in his or her way. Use reflective listening that shows you “hear” them and guide them to figure out their own solutions, don’t provide them for them. Lots of people have working memory challenges and part of it is just how the world is today. For example, the media is constantly trying to redirect our attention with what is now termed “interrupt marketing” like the pop ups on the bottom of your TV screen during a show. It is annoying and it takes determination to not let outside influences interfere with your ability to remember. So, find what works for you and help your child find what works for them.

If you care to share your favorite strategy, I’d love to hear.

1 Executive Skills in Children and Adolescents by Peg Dawson and Richard Guare (2010)

Also recommend: Late, Lost and Unprepared by Joyce Cooper-Kahn and Laurie Dietzel, and Smart but Scattered also by Peg Dawson and Richare Guare.

What is an Executive Function?

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ADHD brainThe term “executive function” or “executive dysfunction” refers to those skills that are used to “get things done” and to “manage oneself” and they are often associated with ADHD/ADD.  They develop in the precortex of the brain which is in the front forehead area and damage to this area can also impact the executive functions.

I once heard it explained as the skills that a secretary or administrative assistant would handle for an executive. Those things like making sure appointments and schedules were made and kept, projects kept moving, tasks completed, etc. You may have heard it described as the conductor of an orchestra who can come in and transform the racket of multiple instruments tuning up into a beautiful symphony. Here is a more formal definition:

The executive functions are a set of processes that all have to do with managing oneself and one’s resources in order to achieve a goal. It is an umbrella term for the neurologically-based skills involving mental control and self-regulation. Taken from: Joyce Cooper-Kahn and Laurie Dietzel (2008) http://www.ldonline.org/article/29122/

Why is this important? If your child has a weakness in one or more of the executive functions with or without ADHD then it might show up as:

  • Spending hours on homework but be unable to find it when it is time to hand it in
  • Last minute projects that take hours and change course several times
  • Inability to sit down and get started on homework
  • Messy backpacks and notebooks with papers hanging out everywhere
  • Unaware of upcoming tests so fails to study and fails the test

As an adult:

  • Late fees on overdue bills, extra trips to the store for forgotten items, running out of gas
  • Missed appointments and deadlines
  • Difficulty organizing the process of steps for projects and reports
  • Clutter and disorganization due to ineffective or missing household systems

Although the authorities agree on what executive functions are, they do not appear to agree on names for the individual skills that are delayed (up to 3 years according to Russell Barkley). For example, the terms “activation” and “task initiation” basically mean the ability to get started. Kids with this weak skill may have difficulty getting up and out the door in the morning and/or working on homework. Each skill impacts several areas of their life. Over the summer I will be exploring several of these executive function skills and providing some strategies to help strengthen them. So, please check back often.

Thanks for reading!