The way learning and living is complicated when we have trouble with organization

Hello world!

Welcome to a discussion on Executive Dysfunction, a set of obstacles to smooth management of life’s challenges which impacts people who may have any of a number of diagnoses (or none) from ADHD to Traumatic Brain Injury, mood disorders to stroke and Alzheimers Disease.  I am interested in EDF (Executive Dysfunction) because it cuts across so many diagnostic clusters.  If we can learn how to treat EDF better, we can help so many people live more productive and satisfying lives.  I’ll post thoughts here, and I hope others will do the same sharing their experiences with EDF.

Later is ok

A word about timing here.  We know that kids with executive function disorders mature more slowly than the norm.  Pushing them to drive at 16, graduate high school “on time” at 18, go to college 3 months later and become independent then is often unrealistic and can cause ENORMOUS Trouble.  

I had a conversation with a mother of a 6 year old today who was told that her child was “behind” because she isn’t reading on her own yet.  People! Differences in hitting normal milestones are not disasters!  Taking a look at what is coming easily to this little girl and what is giving her some trouble is the thing to do.  We should be doing that with each kid! Some will be blowing through achievement timelines in one area and “behind” in others.  The question in both cases is “what does s/he need to master skill x ?” 

Transition Season!

Graduations, parties, Senior trips, Prom, exams, = STRESS!!  This is often a joyful time of year but it’s hard on the executive functions!  Take some extra care about communication.  Connect about expectations each day!

What really matters is forward motion, not graduating “on time.” Even though significant people in the life of the student are very much looking forward to the ceremony, the photos, the gifts and the celebration, if the student is not ready, all that can be a whopping amount of pressure.  The celebration can wait until the student has completed the work, and the love can be delivered sensitively as encouragement.  Here are a few suggestions:

  • Offer typing assistance
  • Smile
  • Ask what is feeling insurmountable?
  • Offer practical assistance like doing the laundry, food, coffee, etc.
  • Keeping distractions at bay

A paradox of extra time

Often an accommodation of “extra time” is made for students and workers who have a diagnosis that includes Executive Dysfunction.  They need extra time on tests and other assignments, but they may also need a reduced workload.  An example is a child who has 10 math questions for homework but it takes her the hour most kids use to complete just 5 of them.  The same child may also need to do 20 such questions to get the process involved really learned.  She needs both more time to answer fewer questions, and more practice to achieve knowledge and fluency than her classmates do with less. Unfortunately we cannot make more time in the day, and school schedules are packed!  What to do?   

One thing schools can do is to plan some practice time into the class period. Practice won’t harm anyone doing a little more than they strictly need, but it will help those who need a bit more.  Parents can facilitate practice at homework time, but many children have too much homework already.  It is a problem!

False Dichotomies!!

Imagine a family with two kids.  One of them struggles with Executive Dysfunction, and the other doesn’t.  One fits in easily at school and shines academically, the other one “has issues.” One of them is no trouble at all, and the other one…. It’s always something.  You get the idea! The family, the school, the neighborhood, all begin to think of one as “THE GOOD ONE” and the other as … well, not.  

What is going on here? These are good people who love their children. They are intelligent, educated and involved with both kids.  Part of what is wrong is that they never expected to have kids who had trouble in school.  

Often people are not especially conscious of what they expect before they become parents, but they do have a script in the back of their minds.  One couple told me in our first meeting that they thought the school years would be packing lunches, saying goodbye at the bus stop in the morning, family dinners and kids doing their homework in the evening, bathing, brushing teeth, and good night at bed time.  They really did expect this, but their two absolutely adorable hyperactive Aspergery boys who loved puzzles and the Zoombinis, did not fit seamlessly into the school day.  The parents wanted SOMETHING that “would work” and by this, what they really wanted was something to re-synch their reality with their not-so-conscious expectations.  What they needed to do was adjust their expectations to the reality of the children they had.  I’ll write more on this soon. 

Does this sound familiar? 

Family dynamics

I want to bring up a pattern that I see in families where one of 2 kids is identified as having executive function problems and one is not.  There is a tendency to see one as good and the other not so good, healthy and fragile, easy and a workout.  Once they are categorized that way, it becomes hard for the family to see the good, healthy, easy one as having needs or the not-so-good, fragile, work out one as having the ability to succeed unaided.

Folks tend to be unaware of doing this, they really see the older boy as badly behaved and given to poor choices, while the younger one has a teacher who doesn’t understand, and a coach who asks too much. Sometimes it’s the older kid who is identified as needing help while the younger one doesn’t essentially because the older one has hit a heavier workload in the upper grades, while the younger one hasn’t yet.

The thing is when you get in the habit of seeing one kid’s difficulties as faults needing correction (punishment)  and the other as having a need for support, you’ve got a bigger problem than you think.  You are teaching your children how to think about themselves and each other.  If I think of myself as the troubled one, how does that influence my choices about, say alcohol?  Worth thinking about…..

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.