Executive Dysfunction Therapy

Most of the teenagers I meet because they are referred to me for improvement of their executive functioning are “in trouble” of some kind because their behavior in school and out of it is seen as irresponsibility, or an attempt to get away with something. It’s understandable that teachers and parents would get the feeling that something in the student with EDF’s behavior is amiss. Given their spikes of ability, their areas of difficulty seem perplexing. The first judgment folks tend to make is that the kid is disrespectful, lazy, uncaring, not motivated, rebellious ….you get the idea. The response is to punish, as in the list of demerits in the post I made before this one, and when the punishments don’t work – that is because a change in the pattern of behavior – the student is expelled as a person not worth the school’s time and effort. In the case of the boy with the impressive list of demerits, and the one discussed in this post, misdiagnosing the trouble as a failure of character led to rejecting the kid and this can have terrible consequences. I write here because if we can see what’s going on for these kids differently, and apply the diagnostic measures necessary to accurately understand what is going on, we can adopt a course of response that leads to much happier and healthier outcomes.

I don’t mean to suggest that these kids are either incapable of, or unwilling to, engage in behavior deserving of a scolding, however I am saying that when achievement is below what we might expect from someone’s age and intelligence, the problem is often rooted in difficulties with mobilizing and using his resources smoothly and with efficiency. Often his less than honest moments derive from the impulse to hide the misstep, and acting on that before he’s had time for thought.

Reading the report card comments on his work by one such student’s teachers, it is evident that they can see where his areas of struggle lie. His Pre-Calculus teacher, comments that “In analyzing a particular mathematical context, [student] is not always sure which of his store of learned operations and processes to bring to bear.” This comment is exactly my point. Not only is the boy not sure of which operation or process to apply, he has trouble sorting it out from similar knowledge chunks, bringing the needed one to the fore, and then setting it in motion with the new learning even if the process is firmly in long-term memory.

All this happens fairly unconsciously for most of us, and fails if we haven’t really done the learning, because we deployed our attention elsewhere. Explanations of our failure involve choice of one kind or another. The Student with EDF’s choices are made more impulsively, more incompletely, and faster than is the case with most of us. He’s had the experience many times of deploying something not quite right so he is hesitant to commit to the one to use now, lest it be inaccurate or inefficient, and thus embarrassing. It doesn’t necessarily mean he hasn’t learned what he needs to use, although that may be part of the problem here and there. He’s hesitant to claim he knows something when he might not be able to prove it in the spotlight. The Pre-Calculus teacher notes that “Many of the concepts do not come easily for him and he has trouble remembering ideas and techniques from the past.” Similarly his English teacher says “…when I asked him the definitions of some words I hadn’t seen before in his work, he faltered and mentioned he used a thesaurus to find them” seeming to conclude that there was something fishy about the student’s use of those words.

The observations of both teachers here focus on instances when the student’s retrieval of information failed him. Additionally, when he does take a risk (using words from a thesaurus, for example) he may make a simple verbatim substitution, not taking shades of meaning into account. When he doesn’t nail down the meaning of new words he uses in an English assignment and sputters when put on the spot, it tends to raise a question of his integrity but an attribution of the matter to a failure of conscience is not what is happening. It is an example of how EDF plays out in his thought process, skipping connections and meanings that would not elude the mind of a person without the disorder.

I’ll leave it there for now and talk next time about more constructive than punitive responses to failures of EDF in school. I want to leave it there for now in the hope that readers might imagine what they might do differently if they understood a person with EDF’s behavior in this way – then we can talk about it!