Jennifer Cardinal, PhD
I often receive referrals to assess children and teens who present with an array of issues. It is not uncommon that their core deficits are related to a neurodevelopmental disorder(s) such as autism, ADHD, Intellectual disability or a specific learning disorder. In fact, many of my clients have co-occurring neurodevelopmental conditions that are commonly associated such as autism and intellectual disability or ADHD and a specific learning disability. Despite the distinct symptoms of each neurodevelopmental disorder the level of disability (mild, moderate, or severe) in my experience is often associated most closely with the child’s executive functioning (EF). Deficits in this domain are not unique to any one neurodevelopmental disorder and are also seen in disorders like traumatic brain injury, schizophrenia, anxiety and depression.
Executive functioning represents a child’s ability to self-regulate and direct his or her actions with skills like organization, planning, attention,initiation, self-awareness, self-monitoring, inhibition, problem solving and working memory. In a presentation at the Annual International Trauma Conference, Zelazo described Executive Functioning as “essentially the conscious regulation of thought, emotion and behavior” (as cited in Margolies,2011). When I speak on the subject I often share with parents and teachers that we tend to confuse EF deficits with character traits. In the book The Wizard of Oz, when Oz appears to each of the characters he appears in a different form. To Dorothy he appears as a floating orange head, to the scarecrow as a lovely lady, to the Tin Woodman as a terrible beast and to the lion as a ball of fire. How often do we see a child’s behavior such as difficulty with following directions,trouble sitting still, incomplete work, forgetfulness, emotional meltdowns and difficulty managing time as a “terrible beast” and assign judgments such as “lazy”, “disrespectful” and “unreliable”? Remember the man behind the curtain that Toto exposed when he ran behind the Great Oz? In this metaphor, the man at the controls represents EF. In the case of disabilities this “man” is not an effective manager and does not provide, as Barkley describes, effective internal self-regulatory functions (Barkley, 2010).
EF develops slowly and occurs in age-dependent growth spurts reaching its peak in the mid 20’s. It happens primarily in the prefrontal cortex which is one of the most well connected parts of the brain. Development of EF generally moves from goal-directed behaviors (external skills) to metacognition (internal skills). Therefore, for children with executive dysfunction, it is important to provide interventions that follow the course of development by focusing on external to internal support at the level of the environment and of the individual (Avirett and Mortimer. nd).
Barkley emphasizes the use of environmental cues as he contends that EF deficits, especially related to ADHD, reflect a disorder of “performance rather than of knowledge or skill” (2010). He states that we need to understand that such deficits can be compensated for by modifying the environment and making other accommodations (visual-verbal cues at the point of presentation, supervision, rules and routines) so as to both buttress and facilitate the individual’s use of their own self-control” (Barkley, 2010). Interventions that are focused on improving internal supports include self-talking, thinking out loud, using planners, rehearsal strategies and coping skills (Avirett and Mortimer. nd). Other interventions include the direct teaching of EF skills and strategies, and new research including a study by Oord et al, shows promising results with the use of mindfulness; preliminary results found improvement in children’s parent-rated behavior and decreased parental stress and over-reactivity (2012).
The focus on parental stress and over-reactivity speaks to the day-to-day difficulty that comes with parenting or teaching children with EF deficits. It is well-accepted that children with a variety of issues, from learning disabilities to autism, are often encumbered by additional struggles related to EF deficits. Symptoms of these deficits can often be misinterpreted by adults, causing parental stress which can trigger anxiety in the child and further inhibit the child’s EF. It is vital that, as parents and educators, we “mindfully” develop interventions that provide the environmental supports that will engender our childrens’ growth.
Barkely, R. (2010). The important role of executive functioning and self-regulation in ADHD. In Russell A. Barkley, Ph.D. The Official Site. Retrieved August 8, 2010, from russelbarkley.org.
Executive Functioning and Learning Disabilities. (n.d.). Website for National Center for Learning Disabilities (11ed.). Retrieved on June 15,2014 from http://www.ncld.org/types-learning-disabilities/ executive-function-disorders/executive-functioning-learning-disabilities
Oord S. Bogels,S.M., Peijnenburg,D (2012). The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. Journal of Child and Family Studies ,2012 Volume 21,Number 1, Page 139
Margolies, L. (2011). Executive Function Problem or Just a Lazy Kid: Part 1. Psych Central. Retrieved on June 15, 2014, from http://psychcentral.com/lib/executive-function-problem-or-just-a-lazy-kidpart-1/0009272
Zelazo, D.P. (2010, May) Executive Function and Emotion Regulation: A Developmental Perspective Ph.D. Paper Presented at the Annual International Trauma Conference, Boston, MA.
Jennifer R. Cardinal, PhD
Nationally Certﬁed School Psychologist