executive functions

15 Strategies to Get Things Done

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AD/HD can effect both children and adults. The true challenge is the amount of impact that it has on someone’s ability to handle life’s responsibilities and that is important to be aware of. The impact may be interfering at home, work, school, or in social situations.  Often it is the executive functioning skills (or central control of the brain) that interferes with a person’s ability to focus, organize, plan, keep emotions under control and/or accomplish tasks.

Executive functions skills are defined as:

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/

Here are just three of the top executive functioning skills and strategies to help handle them. The links are to blog posts I wrote with more information.

1. Task Initiation – or Getting Started

  • Declutter your work space, set up materials you use often in easily accessible places.
  • Get help understanding what is expected (call a friend or coworker).
  • Break it down into smaller pieces and pick one piece to start.
  • Visual timers, alarms, and phone reminders all serve to designate a start time if you use them.
  • Start with the easiest to build momentum.

2. Memory – often called working memory or the ability to hold onto information while using it.

  • Write it down! Use a planner, smartphone app (Google Calendar, Color note,Evernote, Remember the Milk, Hiveminder, etc.), or notepad to keep track
  • Repeat out loud what you want to remember
  • 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

3. Action – 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.

  • Make a “must do” list that only includes the top two or three things you must get to
  • Start with the most interesting task first
  • Set false deadlines for yourself or be accountable to someone else for completion
  •  “Suffer” through five minutes – it may motivate enough to keep going
  • Exercise or do something active to increase the dopamine in the brain before beginning (snacks and water help too)

If executive functioning challenges are making it difficult for you or your child to accomplish things then try the above suggestions. Don’t give up too quickly though as it often takes more than the standard 21 days to create a new habit. If you are still looking for some help, contact us for information on our private and group classes. You can also find out more information on the National Resource Center on ADHD website.

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!

Ready, FIRE, Aim! 7 Strategies for Self-Regulation

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targetImpulse control or self-regulation is that ability to stop and consider the options before acting and/or do what needs to be done (even if you don’t want to). Not being able to control your response in a given situation can appear to be a blatant disregard for the “rules” (whether explicit or implicit) but it is usually not. This inability to control the reaction to a situation long enough to consider the consequences or alternatives is what gets many children with ADHD in trouble, even though after the fact they can clearly explain what went wrong. It is the immediacy of the reaction whether it is verbal, physical or emotional that causes difficulties in both academic and social situations. You’ve probably heard of the marshmallow experiment they did with some young children back in the 1960’s. If they could wait fifteen minutes before eating the marshmallow in front of them, they would get another marshmallow. Those that could wait, (showed signs of self-regulation) seemed to do better in school and in life.

As adults, those with self-regulation challenges will become more “tuned” in to other’s reactions to their behaviors and often they decrease but may continue to be seen as having a short temper.

In Children:

Blurts out answers or interrupts with questions

Hits, pushes, grabs or runs off

Blows up if homework becomes difficult or can’t continue 

Tantrums and play date disasters

In Adults: 

Road rage

Impulse buys

Yelling and screaming when things don’t go their way

Inappropriate comments or jokes (and not noticing the other person’s reaction)

Ways to help:

  1. Make sure your child/teen is really aware of what happened. Often times we assume they understand when they really don’t. Talk with him or her after everyone is calm and get their perspective of what happened and why. (I call this rewind and review)
  2. Sarah Ward suggests teaching children to STOP and Read the room. STOP (slide 34) is an acronym for Space, Time, Objects and People and it teaches children to use the information they can gather to make decisions based on checking such things as; where they are,  what is happening in the moment, what do they need, and what is that person asking them?
  3. Set up a secret signal or warning word that lets your child or teen know that they are heading towards an inappropriate response and should stop and consider alternatives before reacting.
  4. Before going into a potential situation discuss the types of things that could happen and work with your child to provide alternatives. Setting clear expectations with behavior options before the situation arises is the best way to prevent potential problems.
  5. Provide examples of your own use of self-regulation by talking out loud as you go through the mental process of choosing a response. Ex. “I am so frustrated that this is not working out and I feel like I am getting mad at myself, I think I need to take a short break and think about how else I can fix this.”
  6. Some teens benefit from having a preset reward. Be sure to build up their tolerance levels by slowing increasing the length of time and push the reward out as well.
  7. Understand that your child/teen is not doing this deliberately, it is neurobiological. Also those with ADHD are emotionally/developmentally about three years behind their peers (Barkley). If possible, change the environment in any way to prevent potential problems.

Self-Regulation is probably the toughest skill to master, yet it has the biggest payoff. Using positive reinforcement before your child acts out, asking “what” questions and not “why” questions, (which often imply wrongdoing) and practicing positive responses will help build your child’s ability to self-regulate. As school begins, be sure that your child’s teacher understands Executive Dysfunction and has effective, positive strategies to help your child – or find one that does.

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.

Hocus Pocus Focus!

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fairyThe ability to focus or to sustain attention involves ignoring distractions and continuing to work even though the task may be boring, tiring or frustrating. This executive function, often called sustained attention, may be impacted by other challenges such as auditory or visual processing problems, working memory challenges or the inability to shift current thought processes when becoming stuck on something. Adults are constantly monitoring themselves and even if distracted by some external cause are often able to get themselves back on track and get the task completed (if it is important to them). Children have much shorter attention spans (they develop as the child grows) and may find it difficult to “push” through to completion.

In children and teens, sustained attention challenges may look like:

  • Taking hours to complete simple homework assignments
  • Incomplete assignments (skipped problems, hurried work, etc.)
  • Jumping from one thing to another
  • Problems with friends due to misunderstandings from not really “hearing” what was said
  • Failure to notice when what they are doing isn’t working and an inability to switch their approach

In adults:

  • Unfinished projects, missed deadlines, incomplete work
  • Extra time needed for tasks (due to distractibility)
  • Multitasking without actually completing anything or completing the less important but more interesting task
  • Difficulty getting through a multistep process

Removing the roadblocks:

1. Distractions can be visual, auditory or cognitive:

  • Clear the clutter or move to another space and be sure to have everything you need before beginning.
  • Work at the library.
  •  Use a tri fold foam board that has been cut in half to create a “focus place” for your child. Add visual reminders.
  • Use noise cancelling headphones or play “focus” music or classical music or white noise. Create a 30 minute play list and allow breaks if they work until the music ends.
  • Keep a notepad nearby and write down any thoughts that interrupt.
  • Keep a beverage and snacks within reach so your body won’t interrupt you.
  • If you still notice difficulty in focusing, set your phone to vibrate or use a motivaider to periodically force you to check that you are on task

2. Start with the end in mind:

  • Picture the end product and then work backwards to determine the steps involved.
  • Have students create a schedule with time estimates for homework and visualize (or sketch out) the finished product.
  • Help your child use their preferred learning style whenever possible.
  • What will be the reward for finishing? Make it motivating!

3. Break it down into smaller parts:

  • Divide the task or homework into bite sized steps so that at least one step can be completed before taking a short break.
  • If you leave a task unfinished, write a note that reminds you of the next step so you can get quickly back to it.
  • Try to determine the length of your child’s attention span and slowly push them to increase it – do the same for yourself.
  • Start with the most challenging piece first and get it over with unless your child needs time to “warm up” to working.

4. Provide incentives:

  • Check in frequently with a positive comment or words of encouragement (no nagging allowed)
  • Use a reward system that motivates.
  • Make the task interesting by making it a game or fun challenge.
  • Provide active breaks

5. Make time visual:

  • Use a visual time timer or have an analog clock within sight.
  • Use a clock with a glass face to highlight with dry erase markers, the homework schedule. Sarah Ward suggests using different colors to block off each subject (great for an hour or less at a time).
  • Online timers work for those using computers. Try Cinnamon software for a talking alarm clock or ifocusonwork.com to keep you on track and off of Facebook.

The ability to maintain attention long enough to get information, or complete a task is important whether you are a student or an adult. Noticing what is getting in the way and dealing with it will go a long way towards increasing your attention and getting things done.

Just Get Started!

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procrastination-fortune-cookie-500x300The ability to get started on something is called “task initiation or activation” by the experts on Executive functions (Russell Barkley, Peg Dawson, Thomas Brown, etc). Executive functions are those skills that help us get things done.  Task initiation is just one of these executive skills and it involves the ability to START. Difficulties getting started can be the result of not knowing where to begin, what to do, how to generate ideas or how to problem solve to move forward on something. It differs from procrastination in that it is often not deliberate avoidance but a lack of understanding in knowing what to do to start. It can also show up as a difficulty with transitioning from one activity to another.

In children and teens, task initiation may show up as:

  • Difficulty getting started on homework
  • Struggles with generating ideas for writing
  • Problems with morning and evening routines (often needing excessive prompting to be ready for school)
  • Procrastination or being seen as unmotivated

In adults:

  • Procrastination followed by hyperfocus to meet deadlines
  • Projects that never get started
  • Unpaid or late bills, missed deadlines, and feelings of guilt

Removing the roadblocks:

1. Is the environment getting in the way?

If your space is cluttered or you can’t find what you need to get going on something then it is time to take care of that. You end up expending more energy just looking for what you need to get started that by the time you do that, you don’t have the energy or inclination to continue.
Declutter your work space, set up materials you use often in easily accessible places. Rulers, scissors, pens and pencils fit nicely in a mug on the desk.
Set up colored plastic folders or boxes to hold all pieces of an ongoing project.
Take everything out of the backpack and pile the “to do” items on the left and as you complete them move them to the right.

2.  Are you not sure what to do?

Get help understanding what is expected (call a friend or coworker).
Break it down into smaller pieces and pick one piece to start.
Work with a friend (use them as a body double to get you started).
Have someone tell you what to work on.
Use a graphic organizer.
Start with the end in mind. Sketch out what it will look like when completed and work backwards to determine the first few steps. 

3. Nudges, pokes and jabs:

Visual timers, alarms, and phone reminders all serve to designate a start time if you use them.
Set the sleep timer or automatic shut off on your TV, or use ifocusonwork.com to help shut down other distractions so you can get started on the important things.
Set false deadlines for yourself or have someone else set them for you. Put your cellphone in another room and don’t check it until you have worked 30 minutes. Use a timer here so you are not constantly checking how much time has passed. 
Make a deal with someone that you know has your best interests at heart and ask them to help you get started.

 4. Routines

Create a basic week plan so that you know what day you will do what.
Students set up a routine for your homework with a break, snack and start time. Then work for 30-45 minutes before taking another break.
Start with the easiest to build momentum.
Meet your friends at the library to do homework together.
Create a mnemonic that helps you get ready to begin and use it daily.
Create a play list for the length of time before you need to start and use it daily. The more you listen to it, the more your body and brain will get the message that it is time to get to work as soon as this is over.

5. If you still can’t….

Just start, after about ten minutes you will get into it.
Create a mind map or draw out what you need to do. Use colors and shapes to help your brain remember them and pick one.
If you are really procrastinating on something, stop and consider, “What is the worst that could happen if I don’t do this?” If it’s not too serious, then let it go or delegate it. 

Often times looming deadlines, promises to others and fear of failure will push adults to complete a task they have been putting off. Many students though are not motivated by deadlines, grades or loss of privileges. They need help in learning what is preventing them from getting started and help designing a strategy that will work for them.

 

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!