Do You Recognize the Signs that Your Child May Have Executive Function Disorder?

The world of child development is abuzz with the term “executive functioning.” It sounds like a big word, but before closing this page please read the definition. Being aware of this emerging framework may change the way you look at children you parent, treat, or teach.

Executive Functioning Defined

I’ve used this definition before; it’s more of an analogy than a strict definition, but it works.

Executive functioning is an umbrella term for a set of skills that underlie children’s and adults’ abilities to think and to do. We are used to seeing the word “executive” associated with CEOs, not children, but just as a CEO is responsible for all the operations of a company, so too is this set of skills responsible for the successful completion of all our tasks and goals.”

For music lovers out there, executive functioning skills can also be viewed as serving the same role as the conductor in an orchestra. He might not be putting out much, but all the sounds, beats, and rhythms are controlled and regulated by him. Likewise, these skills stand front and center in controlling and regulating all of our thoughts and actions, and they determine how we experience the world.

What happens to a child when this set of skills is not functioning properly?

Let me answer the question by asking you two rhetorical questions:

• What happens to a company when its CEO is dysfunctional?
• How does the music sound when the orchestra’s conductor cannot even carry a tune?

Most of us would not want to work for, or invest in, that company nor sit through that concert. When a child’s executive functioning skills are maladjusted the same happens. The child’s jobs, healthy development, play, socialization, basic learning skills, etc., may unfortunately look like that company or sound like that concert, dysfunctional and maladaptive.

Is This the Missing Link?

A child may have weaknesses in executive functioning without being diagnosed with any specific condition. For example, not every child with executive function deficits has Attention Deficit Hyperactivity Disorder (ADHD), although every child who has ADHD has executive function deficits. Children who are on the autism spectrum also tend to have deficits in various executive functioning skills, as do most children with learning disabilities or mental retardation.

So why is all this important? Autism, ADHD and other disorders first noticed in childhood are rather complex and confusing disorders to understand, diagnose and treat. Using an executive functioning skills framework may make it not only easier but also more efficient and beneficial for the child. Instead of treating a diagnosis, we can help the child improve specific skills and perfect others. This approach might be the missing link to the successful evaluation and treatment of children with all types of developmental disorders. Think about it: focusing on improving a specific skill instead of being unfocused trying to solve a mysterious puzzle.

Where to start?

If you are a parent, teacher, or therapist, you are probably wondering where to even begin. What follows is a questionnaire for you to take a look at. This is not meant to be a diagnostic tool, and it is not a scientific instrument. It’s meant to introduce you to looking at a child from an executive functioning skills framework, by asking yourself these questions while thinking about a specific child. It’s meant to be helpful at looking at specific skills a child may be deficient in, and at guiding us in helping the child overcome the deficit/s and improve the skill/s.

Let’s take a look at executive functioning, one skill at a time

Here, I present a list of what is considered by most researchers and clinicians in the field of neuropsychology to be representative of the executive functioning skills. For each skill, I give a short definition as defined by these authors. Beneath each skill and its accompanying definition are 3-4 questions to ask yourself while thinking about a specific child. Going through this list carefully should help you get a clearer picture of whether the child in question may have what is referred to as executive function disorder or not.

(Please keep in mind that all questions listed are appropriate for children of approximately 5-7 years of age. Those specific questions are not meant for all age ranges; less may be expected of younger children and more may be expected of older children. I’m using an “in-between age” for illustrative purposes. Please let me know if you’d like me to expand on various other age groups etc.)

1). Response Inhibition/Impulse Control: A child’s ability to stop his own behavior at the appropriate time

• Can your child follow simple classroom rules?
• Can he sit or stand near other children without the need for physical contact?
• How about wait until you get off the phone before getting his needs met, with no more than one reminder?

2). Shift/Transitioning: The child’s ability to move freely from one situation to another and to think flexibly

• Does your child play well with peers without the need to be in charge?
• Can she share while playing?
• When your child does not follow instructions, can she be easily redirected?
• Does your child easily adjust to a change of plans?

3). Emotional Control: The child’s ability to adjust emotional responses by responding appropriately to a situation

• Can your child tolerate criticism from an adult?
• Can your child handle an “unfair” situation without becoming excessively upset?
• Can your child adjust his behavior and energy level with the change of a situation? (For example, calming down after playtime)

4). Sustained Attention: The child’s ability to keep paying attention to a task despite distraction, tiredness, or boredom

• Can your child complete a 20-30 minute homework project?
• Is she able to do a 20 minute chore?
• How about sit through a meal of average length?

5). Working Memory: The child’s capacity to hold information in mind needed to complete a task

• Can your child run an errand that has 2-3 steps? (For example, taking out the trash and picking up an item from the grocery store)
• Does he remember an instruction you have given him a few minutes earlier?
• Does he follow 2-3 steps of a routine (like getting dressed in the morning) with no more than one prompt?

6). Planning/Organizing: The child’s ability to manage current and future demands of a task

• Does your child put his coat, shoes, book bag, and other items in their proper location with no more than one reminder?
• Does she have assigned specific places in her bedroom for her belongings?
• Does she come home from school with the homework sheets, notices, or arts and crafts items?

7). Metacognition: The child’s ability to monitor his own thoughts and abilities and observe how he problem solves

• Can your child adjust his behavior in response to feedback from a parent, teacher, or friend?
• Does your child observe what happens to others and adjust his behavior accordingly? (For example, avoiding a broken swing after a friend got hurt on it)
• Is your child able to state two or more possible solutions to a problem and make the best choice?

8). Task Initiation: The child’s ability to begin an activity in an efficient and timely fashion

• Does your child remember and complete daily, routine activities (such as brushing teeth and combing hair) with no more than a simple reminder?
• Is your child able to start a classroom activity without hesitation once the teacher instructs the class to start?
• Can your child start doing her homework at a designated time without more than one reminder?

How to Interpret the Questionnaire

As mentioned, this is in no way a scientific or diagnostic measure. We all know plenty of children who are disorganized, spaced out at times, or somewhat rigid, yet perfectly functional. A concern arises when you find yourself answering “no” to many of the above questions in multiple skill areas. The more negative responses, the more likely the child in question will appear to have ADHD, be dysregulated, and have academic and social difficulties.

While this post does not offer many solution or ideas on how to treat deficits in executive functioning skills, I hope it gives you an idea about how to start identifying a child’s strengths and weaknesses in these skill areas. Please stay tuned for posts dedicated on treating children with deficits in specific skill areas, and ideas on how to help them be successful in school and life.

Do you know a child with deficits in executive functioning skills as defined above? How do those deficits manifest themselves? Please feel free to share your experiences.

Related posts:

1. Is This New Approach the Treatment for ADD/ADHD of the Near Future?
2. The Research Behind the Tools of the Mind Curriculum
3. 6 Lessons From the Tools of the Mind Program

Tagged as: ADD, ADHD, Cognition, Executive Functioning Skills