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STUDENTS WITH EXECUTIVE DYSFUNCTION
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If students have deficits in ability to plan, initiate, sequence, sustain, and pace work, what is likely to happen to them in school?
Think of an academic activity such as writing a big report -- a common source of frustration for many students. The student who has Executive Dysfunction will have difficulty picking a topic, planning the project, sequencing the material for the paper, breaking the project down into manageable units with intermediate deadlines, getting started, and completing the activity. And because these students frequently underestimate how long something will take, they'll generally leave the project until the night before it's due.
Now consider another academic activity: conducting a laboratory experiment. In the laboratory, the student has a list of supplies that are needed to run the lab and a set of instructions. If the student begins the lab before lining up all the supplies, she may find herself having to run to get something at a time when timing was critical. If she cannot follow sequential steps, she may skip a step and ruin the lab.
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THE "TERMINALLY DISORGANIZED" CHILD
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How many of us have watched a disorganized or child and assumed that they were just lazy or that if they really and truly wanted to, they would be more organized? How many of us have wanted to pull our hair out over the child who never brings home their assignments and materials despite supervision from the teacher, who never starts the homework without a knockdown-dragout fight, and who when they do finally do their homework, seem to lose it before it gets handed in to the teacher?
How many of us watched these children suffer day after day and never thought to get a neuropsychological assessment of their executive functions? Maybe we shook our heads and just "knew" that the school's proposed behavior modification or incentive plan wasn't going to work, but we couldn't put our finger on why it wouldn't work, other than to say, "It's not a motivational problem -- he really can't seem to organize himself"?
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RECOGNIZE ANYONE YOU KNOW?
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The deficits associated with EDF can be in the form of difficulty in organizing time, difficulty in organizing materials and belongings, difficulty in organizing thoughts, difficulty in initiating tasks, difficulty in switching flexibly between tasks, difficulty in sustaining focus on the relevant aspects of a stimulus or task, or any combination of these skills. If you know someone who suffers from disorganization -- books that inexplicably disappear from desks, lockers, and home, papers that never seem to make it from work to home or back to work or school, school, home, or work projects that seemingly have no known due date, the mysterious disappearance of all writing instruments into some great Black Hole, you may know someone with executive dysfunction.
By now, many site visitors will be thinking, "Oh good grief, that's my [son/husband/student/self] she's describing!"
Others may be wondering, "Wait a minute. I thought all those things were Attention Deficit Hyperactivity Disorder. What's going on? Are Executive Dysfunction and ADHD the same thing?" Others may be thinking, "Wait -- that sounds like my student with Asperger's Disorder!"
As you will discover if you start to read the research, ADHD and EDF are intimately connected, and many students with Asperger's Disorder will also have aspects of executive dysfunction. EDF has also been found in adults with OCD and it also associated with depression, to name but some of the conditions.
But look at the difference in your own reaction when you thought more broadly about "impulsivity" or "hyperactivity," and compare that to your reaction when you saw an ability or function represented as a higher-order brain function. When viewed as executive functions, are you as likely to consider behavior modification as you were before (if you were considering it), or are you now curious about what kinds of skills-training, accommodations, or interventions might be appropriate to help a child or adult who has a neurologically based problem with executive dysfunction?
Remember that if you suspect EDF, the appropriate referral is to a qualified neuropsychologist.
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In a school-based psychoeducational assessment, executive functions are not normally assessed, leaving parents and educators without objective data about an important aspect of the student's functioning.
If you suspect your student has executive dysfunction, ask whether the school psychologist has and is qualified to use the NEPSY or B.R.I.E.F. assessment procedures. If neither is available or if the school psychologist is not competent or qualified to administer them, consider asking the district to consider referring the student for a neuropsychological evaluation.
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IF IT IS EDF, WOULD MEDICATION HELP?
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Most of the research relevant to this question looks at the role of stimulant medications (such as Ritalin) on specific types of tasks or activities. Although a detailed discussion of this research is beyond the scope of this web site, it is intriguing to note that there is some evidence that stimulant medications may be of benefit. For example, Kramer, Cepeda, and Cepeda (2001) reported that methylphenidate (Ritalin) improved task-switching ability in children with ADHD. Since multi-tasking is something that students are frequently asked to do, it suggests that medication might be indicated in some cases.
It would be misleading, however, to suggest that stimulant medications might be of benefit in all types of executive functions. For many problems, we will need to make environmental changes and provide the student with direct instruction of skills while we model the desired behavior.
Examples of such strategies and environmental cues are provided in other articles in this section of the web site.
Article continues on next page.
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FOOTNOTES
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1 The author is deeply indebted to Sheryl K. Pruitt, M.Ed., for her input and contributions to this section, but the author retains full responsibility for any errors.
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