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STUDENTS WITH EXECUTIVE DYSFUNCTION
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If students have deficits in
ability to plan, initiate, sequence, sustain, and
pace work, what is likely to happen to them in
school?
Think of an academic activity
such as writing a big report -- a common source of
frustration for many students. The student who has
Executive Dysfunction will have difficulty picking
a topic, planning the project, sequencing the
material for the paper, breaking the project down
into manageable units with intermediate deadlines,
getting started, and completing the activity. And
because these students frequently underestimate how
long something will take, they'll generally leave
the project until the night before it's
due.
Now consider another academic
activity: conducting a laboratory experiment. In
the laboratory, the student has a list of supplies
that are needed to run the lab and a set of
instructions. If the student begins the lab before
lining up all the supplies, she may find herself
having to run to get something at a time when
timing was critical. If she cannot follow
sequential steps, she may skip a step and ruin the
lab.
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THE "TERMINALLY DISORGANIZED" CHILD
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How many of us have watched a
disorganized or child and assumed that they were
just lazy or that if they really and truly wanted
to, they would be more organized? How many of us
have wanted to pull our hair out over the child who
never brings home their assignments and materials
despite supervision from the teacher, who never
starts the homework without a knockdown-dragout
fight, and who when they do finally do their
homework, seem to lose it before it gets handed in
to the teacher?
How many of us watched these
children suffer day after day and never thought to
get a neuropsychological assessment of their
executive functions? Maybe we shook our heads and
just "knew" that the school's proposed behavior
modification or incentive plan wasn't going to
work, but we couldn't put our finger on why it
wouldn't work, other than to say, "It's not a
motivational problem -- he really can't seem to
organize himself"?
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RECOGNIZE ANYONE YOU KNOW?
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The deficits associated with
EDF can be in the form of difficulty in organizing
time, difficulty in organizing materials and
belongings, difficulty in organizing thoughts,
difficulty in initiating tasks, difficulty in
switching flexibly between tasks, difficulty in
sustaining focus on the relevant aspects of a
stimulus or task, or any combination of these
skills. If you know someone who suffers from
disorganization -- books that inexplicably
disappear from desks, lockers, and home, papers
that never seem to make it from work to home or
back to work or school, school, home, or work
projects that seemingly have no known due date, the
mysterious disappearance of all writing instruments
into some great Black Hole, you may know someone
with executive dysfunction.
By now, many site visitors
will be thinking, "Oh good grief, that's my
[son/husband/student/self] she's
describing!"
Others may be wondering,
"Wait a minute. I thought all those things were
Attention Deficit Hyperactivity Disorder. What's
going on? Are Executive Dysfunction and ADHD the
same thing?" Others may be thinking, "Wait -- that
sounds like my student with Asperger's
Disorder!"
As you will discover if you
start to read the research, ADHD and EDF are
intimately connected, and many students with
Asperger's Disorder will also have aspects of
executive dysfunction. EDF has also been found in
adults with OCD and it also associated with
depression, to name but some of the conditions.
But look at the difference in
your own reaction when you thought more broadly
about "impulsivity" or "hyperactivity," and compare
that to your reaction when you saw an ability or
function represented as a higher-order brain
function. When viewed as executive functions, are
you as likely to consider behavior modification as
you were before (if you were considering it), or
are you now curious about what kinds of
skills-training, accommodations, or interventions
might be appropriate to help a child or adult who
has a neurologically based problem with executive
dysfunction?
Remember that if you suspect
EDF, the appropriate referral is to a qualified
neuropsychologist.
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In a school-based
psychoeducational assessment, executive
functions are not normally assessed,
leaving parents and educators without
objective data about an important aspect
of the student's functioning.
If you suspect your
student has executive dysfunction, ask
whether the school psychologist has and is
qualified to use the NEPSY or B.R.I.E.F.
assessment procedures. If neither is
available or if the school psychologist is
not competent or qualified to administer
them, consider asking the district to
consider referring the student for a
neuropsychological evaluation.
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IF IT IS EDF,
WOULD MEDICATION HELP?
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Most of the research relevant
to this question looks at the role of stimulant
medications (such as Ritalin) on specific types of
tasks or activities. Although a detailed discussion
of this research is beyond the scope of this web
site, it is intriguing to note that there is some
evidence that stimulant medications may be of
benefit. For example, Kramer, Cepeda, and Cepeda
(2001) reported that methylphenidate (Ritalin)
improved task-switching ability in children with
ADHD. Since multi-tasking is something that
students are frequently asked to do, it suggests
that medication might be indicated in some
cases.
It would be misleading,
however, to suggest that stimulant medications
might be of benefit in all types of executive
functions. For many problems, we will need to make
environmental changes and provide the student with
direct instruction of skills while we model the
desired behavior.
Examples of such strategies
and environmental cues are provided in other
articles in this section of the web
site.
Article
continues on next
page.
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FOOTNOTES
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1 The author is deeply
indebted to Sheryl K. Pruitt, M.Ed., for her input
and contributions to this section, but the author
retains full responsibility for any
errors.
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