ADHD and Executive Function Skills


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Q. My son is 10 years old and has ADHD. His fifth-grade teacher mentioned that he struggles with executive function skills, but I'm not sure I fully understand what that means. Can you explain?

A. Imagine being the head of a large organization, the principal of a high school or being in charge of three small children as a stay-at home mom. We are all executives of our lives, and we rely heavily on executive function skills to carry out our daily responsibilities. Students diagnosed with ADHD often have executive function deficits.

Executive function skills are those based on our ability to receive information, remember that information, and then ultimately organize it and integrate it into a current set of circumstances, which can rapidly change without warning. Sound complex? It is. The human brain, specifically the frontal lobe of the cerebral cortex, has the amazing ability to handle all of these functions and more. However, when there are delays or disruptions in the flow of information, executive function becomes compromised and certain skills become difficult to carry out.

For example, I am reminded of all the tasks involved in preparing a large meal for family and friends. To begin, we create a list of ingredients necessary to make everyone's favorites. Next, we plan the steps and the timing so that everything is hot and ready at the same time. We then adapt as necessary when Aunt Jean shows up with her great-grandmother's special cranberry sauce. Quick, someone hide the jellied stuff from the can! All of these steps require perception, memory, decision-making and adaptation. This is an example of executive function in its finest hour.

In an academic setting, these skills are not only necessary for the success of the individual student, but for the general function of the classroom as a whole. In addition to affecting the ability to carry out plans, executive function is also responsible for the regulation of one's emotions and impulsivity. These are areas where impaired perception of social cues and poor judgment can cause students to become labeled as disruptive or "hard to manage."

Long-term projects such as book reports and term papers, which are challenging for most students, can be perceived as nearly insurmountable by students with this deficit. The steps of estimating the length of a project, reading an entire book, doing research and organizing its contents in such a way that it can be "re-presented," is an enormous undertaking. A very special educator once showed my son (who struggles with ADHD and executive function) a system for organizing his first term paper. She provided him with a large office mailing envelope. Listed on the back was a time line of tasks and completion dates to help him manage him time while meeting "mini-goals." The timeline included steps such as: gather research, organize cards, rough draft, edit and final copy. The envelope provided him a place to keep all of his cards and papers until it was time to assemble the content.

These and other interventions such as scheduling once or twice a week to go through your student's backpack can be invaluable in locating completed work and following up to see that the work is turned in. The goal, of course, is to teach your student these skills as he or she will not always have the benefit of your oversight.

Keep in mind that needs change as a student's brain matures. Some skills that are difficult one school year may not pose a problem with another year of growth and development.

Affirming your child's innate value is so very important during these years of learning. Offering children the skills to stay organized while undergirding them with love and acceptance regardless of their accomplishments will no doubt be of significant benefit over their lifetime.

Susan Michels, a registered nurse, works with children and adolescents at Cone Health Behavioral Health Hospital. Please submit your questions to "Is My Kid OK?" by emailing sherri.mcmillen@conehealth.com.

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