Catherine’s Executive Function Disorder
June 29, 2015
Signs of executive function disorder
It’s possible you’ve have never heard of this disorder, even if generally well-informed about learning difficulties. Yet, executive function disorders are rather common and often associated or confused with attention deficit hyperactivity disorder (ADD/ADHD).
For a few months, I monitored a young girl who had received this diagnosis. Catherine was highly intelligent and had normal development since her early years. All through elementary school she passed her classes successfully, often with above-average grades. I met her for the first time in high-school; she had just received her first report card, which included the following comments from her teachers:
- “Catherine has trouble prioritizing, starting an assignment, organizing and completing her work, especially when she has to write essays under pressure (time schedule) or when faced with unexpected situations.”
- “She has significant difficulty with problem solving.”
- “Catherine doesn’t seem capable of controlling her immediate impulses or focusing on her work.”
- “This student needs to learn to manage her time and organize more efficiently.
In sum, she didn’t seem to be off to a very good start! A shame really; she had worked so hard to be accepted in a private school with all her friends. Wanting to get to the bottom of things, her parents asked for a neuropsychological evaluation.
What are the different traits of executive functions?
The following aspects of executive functions are evaluated during a neuropsychological examination:
Organizing and planning:
This refers to the capacity to use effective strategies, set priorities, plan and organize the steps of a task.
This refers to the capacity to ignore distractions or restrain from making unexpected comments or saying the first thing that comes to mind. Inhibition is a often compared to a filter.
This is the mental ability to adjust to new and unexpected conditions in the environment.
The capacity to determine the best course of action to solve a problem based on goals, values and social rules. This is also the ability to make appropriate decisions and adopt behaviours adapted to a given situation/environment.
Finally, this function aims to properly assess one’ own abilities and behaviour and to be aware of one’s strengths and weaknesses.
What role do executive functions play?
Executive functions play a crucial role in terms of goal-oriented actions. The combination of these functions could be compared to the role of a foreman or an orchestra conductor, which is the efficient coordination of other cognitive functions. For example, as adults, when we want to solve a problem or plan a vacation, we:
- Analyse the task with a “bird's-eye view” and determine what needs to be done or planned;
- Establish a plan or gather information and structure it for evaluation;
- Determine a solution to the problem or make an itinerary of the trip;
- Assess the solution’s effectiveness or the overall satisfaction level of the trip.
Executive functions are what orchestrate these stages.
For Catherine, these functions weren’t working as they should due to neurological immaturity. Whether or not this situation is linked to her being born prematurely (one month early) is uncertain.
However, scientists do know that brain development occurs from back-to-front. Incidentally, the frontal lobes control executive functions and constitute the last areas of the brain to reach full maturity.
So what happens now?
Establish an intervention plan:
When establishing a school intervention plan with Catherine, we chose to prioritize the strategies described bellow.
Strategies to help her plan her work and manage her time:
- Breaking down assignments into segments and assigning a time frame to each of these;
- Using a code word and/or signal to let her know it’s time to start her work;
- Whenever possible, giving visual instructions to accompany the oral ones, as well as examples;
- Using graphic organizers to identify the steps/sequence of a task and due dates;
- Using timers or watches with an alarm
- Giving explicit instructions on the proper use of an agenda and prompting her to use it;
- Reinforcing efforts and improvements;
- Giving feedback regularly;
- Reviewing the student’s work more frequently;
- Using self-correction checklists, whenever possible;
- Establishing execution contracts for assignments with clear consequences;
- Planning a structured transition period (break) between each segment of her assignment.
Strategies to help her analyze a task and adapt to change:
- Asking her to explain her problem-solving process;
- Modeling effective problem-solving strategies;
- Using graphic organizers to identify the steps of a task and reinforce problem-solving techniques (defining the problem, establishing options, selecting an option, thoughts on this choice, etc.)
- Giving examples.
Strategies to help control her inhibition:
- Teaching her appropriate ways to ask for help;
- Explaining to her explicitly the social skills she is lacking;
- Giving examples;
- Asking the student to verbalize thoughts or write them down;
- Reinforcing improvements and progress;
- If possible, giving the student a head’s up regarding important changes to the class schedule.
What was the outcome?
Thankfully, Catherine’s teachers understood she was not ill intent but going through very real difficulties. This year, she is attending the same school surrounded by her friends.
Her difficulties have subsided for the most part, mostly thanks to her cooperation and to the effort she put in. She also had a positive environment, since her parents and teachers were supportive and considerate of her situation.
However, Catherine’s neurological maturity (still in development) is also responsible. The development of her frontal lobes may not be complete, but with the help she received, she was able to maintain her self-esteem; she is considering a higher education with a positive outlook.
Les fonctions cognitives (AQNP) (French only)
Complementary Information and Resources:
Executive Functions (Wikipedia)
- Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention
- Late, Lost, and Unprepared: A Parents' Guide to Helping Children with Executive Functioning
- Smart but Scattered: The Revolutionary "Executive Skills" Approach to Helping Kids Reach Their Potential