Executive Dysfunction Therapy

This week I was involved in a conversation with a 16 yr old A student, his teacher, and his mom.  The trouble  is that he had not turned in several homework assignments, and had gotten zeros, threatening his A average.  He reminded the teacher that he has a  plan of accommodations for his diagnosed ADHD, including extra time.  The teacher him another chance to turn the work in, so the student’s mother emailed the teacher  supporting her son’s reference to the accommodation plan.  The teacher then agreed to give him an extra day to turn in assignments.  Of course, tempers were running hot by this point.

As the mother cc’d me in her email conversation with the teacher,  I talked with the student, and we deconstructed what was actually happening.  The teacher assigns  homework each day.  About once a month, she puts  a list of 10-12 assignments to turn in on the chalkboard.  The students read the list on the board and pull those assignments from their binders, clip them together, and hand them in.  Even though my student does the homework every night and aces the tests, his homework turn-in packets tend to be incomplete.  Some assignments don’t get turned in. Why?

Some probing turns up what is going wrong.  Although pulling out a dozen assignments from the binder and turning them in sounds like a simple enough thing to do, it is actually quite a series of actions which must be coordinated.

1. The student looks up at the board,
2. reads an item from the list,
3. looks down to his binder to find it, and
4. pulls it out for turning in.
5. Then, he looks up to the board again and reads another item in the list, repeating the process.

The Problem is that sometimes he skips an item or two from the list without knowing he is doing so.  Unconsciously, he tries to keep up with the speed at which the other students are completing the task so he does not take the time to be sure he has all that has been asked for, so his packet is incomplete.  The teacher does not find out that his packet is missing items until she comes to it later, in her process of grading,  so the second day goes by without the student knowing that he has missed anything, and full of other things to occupy his mind.  He gets the packet back with a lower grade than he is expecting.

All the proper steps have been taken, but the extra time accommodation – one the schools are comfortable to provide, and which sounds like a good thing – does not solve the problem and everyone is unhappy with anyone else.  There are solutions.  They depend on understanding what the problem really is, a difficulty with sequencing, working memory, and moving between a vertical and a horizontal visual field.

• One is for the teacher to provide the extra time at the front end of the process instead: she can supply the student with the list of assignments she wants turned in the day before she puts the list on the board.  But that ruins the surprise of having to turn in a selection of the assignments given over the course of the month, and feels unfair to the other students who wouldn’t get such a heads up.
• Another is to hand the student a list on paper at the same time that the others have the list on the board,  so that he can physically check off each item as he pulls it, and doesn’t get disconnected, losing his place between looking up at the board and down at his binder.

We could think of several others, and I am tempted to offer ones that do not depend on the ongoing game of  “gotcha” that is implied in the processes of this class.  That will be a post for another day.