Lynne Kenney, PsyDwww.lynnekenney.com

@drlynnekenneyPrintables can be found at http://pinterest.com/lynnekenney/

Executive Dysfunction & The Disorganized Child/Adolescent

Laurie Dietzel, PhD

Late, Lost & Unprepared

OVERVIEW

What we will explore today:

Definitions of Executive FunctionEducating parents and teachers ~ EFAssessment and interventionsCase examples and investigation

What we will learn

Domains of executive function Identifying EF dysfunction in children

and adolescents The role of EF in social and academic

functioning Strengthening cognitive skills Strengthening planning, previewing

and organization

Today’s Landscape

What is EF How to identify and intervene around

EF ADHD and EF Learning Disabilities and EF Social Skills and EF Play Math (STM, WM, VSM, M2T) Motor Intelligence Therapy

What does executive dysfunction look like:

Child completes work but “forgets” to hand it in Child has difficulty transitioning from one

situation or task to another Child doesn’t seem to catch “careless” errors Child needs more external support and

reminders than peers Child can’t seem to keep track of directions,

possessions, and assignments Child is very inconsistent in her performance

What is Executive Functioning (EF)?

An umbrella term covering related yet distinct skills

Refers to cognitive control/self-regulatory processes

Can be understood as Cognitive and Limbic

McCloskey 23 Self-Regulation Executive Functions

Perceive

Initiate

Modulate

Gauge

Focus/Select

Sustain

Stop/Interrupt

Flexible/Shift

Inhibit

Hold

Manipulate

Organize

Foresee

Generate

Associate

Balance

Store

Retrieve

Pace

Time

Execute

Monitor

Correct

EF Domains Attention, focus, distractibility Cognitive control, shift and flexibility Memory, input, manipulation, output Emotional regulation and modulation Problem solving, decision making Impulse control and management Organization, planning, and time management Motor management planning, pacing, initiation,

maintaining, stopping

I. Executive Functions include the ability to:

Survey and preview Plan, organize, sequence, initiate and

execute tasks Hold, manipulate and retrieve

memory Shift focus, sustain attention, tolerate

and adapt to changes in expectations Stop, think, decide, respond

II. Executive Functions include the ability to:

Conduct visual-spatial mental operations Track information and activities in working

memory Perceive, read, interpret and respond to social

situations Regulate and manage emotions Evaluate, plan and manage time Use language to facilitate communication

within relationships Reason, evaluate choices and make decisions

Don’t All Kids have Executive Dysfunction?

EF follows a developmental course as do all cognitive and social-emotional skills

We all have domains in which we could improve

EFD interferes with daily adaptive living skills

Good Books on EF

Twitter ~ The Research Playground BRAIN DEVELOPMENT

@davidnowell @drbethkids @all4mychild @braininsights @viviensabel @drmarty01 @DrEscotet @TheTeenDoc

Enhancing Executive Function with skill set development

Where we are heading:

Improving Neuronal ConnectionsKnowing the different between a skill deficit and willful non-complianceStrategies to build brain connections

Your Brain is Like A Placemat

Insulted? Don’t be.

A placemat is a good thing.

Connect the dots.

How do Neurons Connect?

The electrical signals (nerve impulses) carried by neurons are passed on to other neurons at junctions called synapses. The signal may be directly transferred at electrical synapses or, if there is no physical link between adjacent neurons, the signal is carried across the gap by chemicals called neurotransmitters. By using neurotransmitters, the nervous system can alter the way a message is passed on. Each neuron communicates with many others and this contributes to the amazing complexity of the brain. www.sciencemuseum.org.uk

What is The Synapse? When a nerve impulse reaches the synapse at

the end of a neuron, it cannot pass directly to the next one. Instead, it triggers the neuron to release a chemical neurotransmitter. The neurotransmitter drifts across the gap between the two neurons. On reaching the other side, it fits into a tailor-made receptor on the surface of the target neuron, like a key in a lock. This docking process converts the chemical signal back into an electrical nerve impulse. www.sciencemuseum.org.uk

Neurotransmitters Your brain uses over 50 different

neurotransmitter chemicals. Although electrical signaling between neurons is quicker and more energy efficient, chemical signaling is far more versatile. The signals carried by some neurotransmitters excite the target cell while others dampen down their activity, depending on the type of neurotransmitter released at the synapse and the receptors they reach. This is what sharpens the contrast between light and dark in the eye, for example. www.sciencemuseum.org.uk

Connections Neurons can connect with up

to a hundred thousand other cells. This number of connections is a truly enormous number: 10 thousand trillion.

One neuron can have as many as 100,000 dendrites.

In a human, there are more than 125 trillion synapses just in the cerebral cortex alone

How Do We Build Brain Connections?

Exposure Experience Doing, thinking,

mirroring Practice ~ and a

lot of it

www.unc.edu

Pruning In a human fetus, almost a trillion

neurons are produced. During the last month, they are produced at the unbelievable rate of 250,000 per second.  Eighty-to-hundred billion of these neurons will be utilized by experience and become permanent, while the other 900 billion will be pruned – that is, carefully dismantled with the material recycled by the brain’s unique immune system. jonlieffmd.com

Executive Function and Education

EF and intelligence Twice Gifted Disorganized students Homework interventions Task Analysis Skill-set development Multi-sensory interventions (MIT)

EF and Intelligence

Intelligence and executive functioning are different sets of skills (Barkley, 1997a)

Modest correlations are seen between scores on IQ tests and measures of “higher-order” EF such as cognitive flexibility in problem-solving

UNITY AND DIVERSITY OF EXECUTIVE FUNCTIONS Miyake et al. (2000) Cognitive Psychology41,49–100 (2000)

Gifted/Talented Children

Many children who are highly gifted show uneven skill development; executive skills may lag behind the development of abstract thinking abilities

There is no reason to think that a child with accelerated academic skills will also have advanced EF

Twice Gifted ~ 2 E

Gifted individuals are those who demonstrate outstanding levels of aptitude (defined as an exceptional ability to reason and learn) or competence (documented performance or achievement in top 10% or rarer) in one or more domains.  Domains include any structured area of activity with its own symbol system (e.g., mathematics, music, language) and/or set of sensorimotor skills (e.g., painting, dance, sports). NAGT

2 E’s “…are identified as gifted and talented in one or more areas of exceptionality (specific academics, general intellectual ability, creativity, leadership, visual, or performing arts); {and have a} disability defined by Federal/State eligibility criteria: specific learning disability, significant identifiable emotional disability, physical disabilities, sensory disabilities, autism, or ADHD.” (Colorado Dept. of Education 2009)

Misdiagnosis and dual diagnosis of gifted children and adults ~ Webb et al.

Disorganized Students

Organizing The Disorganized Student

Determine “Help Me” domain listening attending, focus, note taking, impulse control, transferring data, input, output, audition, vision, organization, previewing, planning, execution, time-management

Identify needed skill-set Make a plan Execute, monitor, review plan

Calendars and Planners

Calendars (must build a habit for checking on a regular basis)

Request assignments in advance to allow for planning homework and studying (many students would benefit from a semester syllabus)

EF Management

Calendars, planners and schedules Routines and daily activities Task Lists Project Management

SYSTEMS: Digital, paper, post-it notes, planners, mobiles tools Cozi.com, myjobchart.com, famzoo.com

Planning/Time Management

Use timers (auditory, visual) Use alarms Estimate amount of time needed for a

task and then write down actual time Sarah Ward ~

cognitiveconnectionstherapy.com

What every student needs to know ~ How to…

Plan Initiate Execute Review Revise

Manage The Work Space

What does your space look like? How functional is it? How organized is your study space? Does your student have all the items he needs? Does your student have the ability to use multi-sensory transfer

skills? Describe the study space setting, could you work there? Is there an adult near-by? Do you have a time set aside? Are you working in 15 min increments or those suitable to your

child? Do you have prompts or cues? Is your workspace portable or stationary?

Monitoring Work Flow

The Workflow Schoolroom Backpack Car Back door OPEN IT UP! FIRST THING

ACTIVE HOME WORK Backpack Workspace (take action) Folder to Backpack car school back home to FILE.

Skill Set Tracking

Go Multi-Sensory

Encourage transfer skills Use video, audio and tactile strategies Use marker boards Use quad bulletin board Draw and doodle Vary the types of paper available Plain, graph, wide ruled, narrow ruled

Habit Development I

A rule of thumb (for kids and adults without ADHD or other neurodevelopmental conditions) is that it takes at least 30 days to build a new habit (make a behavior automatic)

Use sound behavioral principles including tying adequate impulse control to positive reinforcers (must make sure that the interval is appropriate-some kids will need to have chance to earn reinforcer after just a few minutes)

Use visual cues (e.g., big stop sign on door)

Habit Development II

Develop habits that interfere with impulsive behavior (e.g., everyone put their hands on the table, hands in pockets or holding sides of pants/skirts while walking)

Use of a fidget toy (if you are holding a squishy ball, you cannot grab someone else’s belongings) – this only works if kid doesn’t throw the fidget object www.abilitations.com www.kidscompanions.com

The Outliers ~ Malcolm Gladwell

Talking with Students about their Study Styles

Emphasize strengths Keep it short and simple! Use visuals Discuss weaknesses as hypotheses (it

seems that you lose track of your ideas when you are writing...is that true?)

Instill hope as you describe interventions

Collaborate, collaborate more…

There are no BUT’s here

Help the student feel valued Let the student have some control in

the discussion and plan Ask questions without making

assumptions The relationship is the agent of

change

Prioritization

The modified Sullivan technique for prioritizing, planning and execution

A B C

48 hrs

Initiation

Use of software for writing (e.g., Kidspiration®, Inspiration®, Draft:Builder®, Co:Writer®)

Allow student to begin by dictating a writing assignment

Writing on slant boards

Working Memory Lists – words or pictures

Use voice recorder (including on cell phone or leaving oneself a voicemail message) to record tasks, assignments, and reminders

Notetaking services

Cognitive Flexibility + Classroom Previewing

Review upcoming changes to schedule or environment

Preview what is upcoming Who, what, when, where, how Use multi-sensory strategies Cornell Method for note-taking Quad boards

Building Cognitive Flexibility

Social stories (relaxkids.com, mindfulness, meditation, stressfreekids.com)

Social skills training (individual, dyad, group)

Positive reinforcement for managing a change or generating a new way of responding

Even the Playing Field

This is the goal of a 504 Plan and IEP accommodations/modifications –accommodations and modifications do not directly build skills- they buffer the negative effects of the disability

Remember that the educational impact of executive dysfunction may not always be apparent from grades and test scores

Interaction with Cultural and Environmental Factors Some kids with typically developing

executive skills have trouble because the expectations at school or home are unrealistically high

Expectations for planning, organization, time management, and autonomy vary widely depending upon a person’s cultural/ethnic context

Families may not be well functioning

Proper diagnosis Behavioral skill building Academic support Medication Brain Training An organized home environment Access to competent parental figures Nourishment

Interventions

HOW TO HELPAccommodations

Strategies

Skill Building

At Home ~ The Family Coach Method

Stay out of The Discipline Trap Establish routines and rhythm Clarify the family culture Collaborate on behavioral expectations Build a pond for better behavior Focus on what works

Intervention Pyramid Medication

Neurotransmitters Food/Nutrition

Developmental, Behavioral, Learning Interventions

Brain Training Some programs include Luminosity,  Captain’s Log,

COGMED, MC2, Brain Gym and Brain Builder. If your child has not had a neuropsychological or executive function evaluation that may be a first step.

Exercise is brain training. Activities that involve motor control and thinking at the same time build brain connections. Some activities to consider include: XBox Dance Dance Revolution, karate, double dutch jump rope, yoga, hacky sac, swimming and tennis. Getting up, out and moving in any way possible is good for everyone.

You are what you assimilate

Get back to real whole food Consider amino acids

neurogistics.com

5 Food Rules

1. 1 oz water per pound per day2. If it does not rot or sprout do without3. Consider 1-2 oz protein/fats every four hours for children 4. Consider 8-10 servings of color per day (1/2 cup per serving)5. Consider pharm grade or whole food multi-vitamins, Omega 3’s, probiotics and antioxidantsPlease consult with your physician regarding your specific needs.

Twitter ~ The Research Playground NUTRITION

@NutritionBlogs @MelissaMcCreey @childobesity (nourish interactive) @ RMNutrition @eatingarainbow www.KidKritics.com www.pathways4health.org

Skill Deficits vs Willful Non-compliance

The 80/20 rule A skill deficit is when the task

demands exceed the skill level Are the expectation clearly

understood? Chunk Be detailed Model role play, practice

Is this a skill deficit?

Can he do it?If yes, expect itIf no, teach it

EF and Behavioral Change

Visualizing and verbalizing Role Play Social Stories The Beginning, Middle & End Going Full Circle See, say, play, touch, build Mentoring others Motor movement

Cognitive Skills

Let’s Start Building

Suzy Koontz suzykoontz.com Jean Blaydes Madigan abllab.com SparkPE Eric Jensen www.jensenlearning.com Gil Connell @movingsmart now

Breaking Down Skill Sets I

Listening I chose not to speak I established eye contact I listened to someone speaking I nodded my head to show I was listening I repeated back what I heard, when asked I asked a question when I did not understand I remembered instructions I followed the instructions

Breaking Down Skill Sets II

Listening I chose not to speak I established eye contact I listened to someone speaking I nodded my head to show I was listening I repeated back what I heard, when asked I asked a question when I did not understand I remembered instructions I followed the instructions

Breaking Down Skill Sets III

For The Parent I defined an expected behavior I named the expected behavior I chose my behavior, thinking it through I practiced ready, steady, act I practiced “I have a choice” I thought about the next step I spoke the sequence of my actions I wrote the sequence of my actions

Impulsivity Waiting one’s turn Refraining from touching others Keeping one’s hands to self Not grabbing without permission Keeping one’s body still Thinking before you act Managing oral-motor movements Verbalization, waiting one’s turn Speaking in turn

Helping children “do as expected” takes previewing and planning

1. Tell the children what is about to happen. “We are going outside to play. We will quietly get in line, stand helicopter distance from one another and keep our voices quiet.”

2. Tell them what they can do with their hands and their bodies. “While you are on the playground, keep your hands to yourself as you run, jump and play.”

3. Tell them how they will know the activity is over. “When you hear our ‘secret signal’, you will line up at the red door and we will slowly walk back inside.”

Self-Regulation

Anger Mountain

Polyspot Stories

The Caveman and The Thinker

Your Child’s Two-Part BrainThe Defensive BrainCollaboration WorksCalm the caveman to engage the thinker

We Calm Down To Think

Teach relaxation breathing and self-talk Allow for a break (including a physical

place to calm down) when child encounters a change

Provide warnings (signals) prior to transitions – they can be visual, touch, or verbal

@stressfreekids Lori Lite

EF ~ Social Skills I

1. Perspective-taking - The ability to see a situation from another person’s perspective

2. Impulse Control - The ability to control initial impulses (thoughts, desires) without acting on them

3. Delaying gratification - The ability to delay gratification of needs and desires

EF ~ Social Skills II 4. Conflict Resolution – The ability to solve an

interpersonal problem satisfactorily to both parties, without resorting to aggression (verbal or physical)

5. Reading social cues – The ability to decode facial expressions, actions and words

6. Mood modulation – Managing the ups and downs of feelings in the moment, employing calming skills, using one’s thoughts to manage one’s feelings

Twitter ~ The Research Playground INTERVENTION

@Inclusive_Class @marianne_russo @special-ism @movingsmartnow @micheleborba @talkingteenage @Kiboomu @kidlutions

5 Things About The Teen Brain You were afraid to ask, but need to know

Teen brain growth (neuronal connections) is in spurts and starts The Teen Years Explained: A Guide to Healthy Adolescent Development (Johns Hopkins University, 2009) by Clea McNeely and Jayne Blanchard

Go away! Wait, where are you going? (Separation and Independence)

Why do moody? The limbic interference relates to neuronal growth, hormonal changes and brain re-organization

Why so cliquey? Teens are herd animals… What? Your brakes aren’t working? (Impulsivity and risk

taking and the teenage brain)

Teens and Tweenies

Teenage as a second language ~ Barbara R. Greenberg, & Jennifer A. Powell-Lunder

Get out of my life! But first will you take me and Cheryl to the mall ~ Anthony Wolf

Why do they act that way? ~ David Walsh

Freedomland

Field Trip!

Play Math is a cortico-cerebellar math program that alternates fine and gross motor movement to teach children ages 6-12 fact families, factors and fractions (Kenney 2012)

Mirror or Skip Count (Balls) Slide and Glide (Blocks) Over and Up (Blocks) How do numbers fit together? What makes a family? Advanced techniques

The Method

Three things children taught me about how they learn math.

1. We build to learn:  Exploring fact families in “arrays” (we call them squares and rectangles) we have 7 year olds learning order of operations, distributive property and fact families all through play.

Three things children taught me about how they learn math.

We need to touch the blocks for better encoding: With base ten blocks, when children start to see with their own eyes or feel with their own hands/feet/rhythm or say with their own voices, that 6 fits into 12 and you can make 12 several different ways 3+9=12 9+3 =12; 6+6=12 11+1 = 12, the children love it. They make patterns and do grouping naturally. This enhances memory encoding.

Three things children taught me about how they learn math.

We build brain connections with:

a. Rhythm b. Fine and Gross Motor

Movement c. Mentoring

Audition and Rhythm For younger kids who have trouble getting

started with the morning or evening routine at home, use a song they like to guide them through

Before starting a seated task, engage in some gross motor activity (quick walk, throw a koosh ball, etc.)

Alex Doman ~ Healing At The Speed of Sound @Kiboomu

We think then we feel then we act

The Importance of Play

Gill Connell ~ Play

PLAY: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul by Stuart Brown, M.D.

THE POWER OF PLAY: Learning What Comes Naturally by David Elkind, Ph.D.

PLAYFUL PARENTING by Lawrence J. Cohen, Ph.D. A CHILD'S WORK – The Importance of Fantasy Play by

Vivien Gussen Paley THE ART OF ROUGHHOUSING by Anthony T. DeBenedet,

M.D. and Lawrence J. Cohen, Ph.D.

The Power of Hopscotch HOPPING = MIDLINE DEVELOPMENT For children,

hopping signals sophisticated advances in both physical coordination, balance, AND cognitive development. You see, as your child refines her physical coordination, she is also building essential neural pathways in the brain. It's those exact same pathways which will one day become the conduits for left/right brain thinking tasks such as creativity, reasoning, and self-regulation.

DON'T STEP ON THE LINE = BODY CONTROL STOP & START = BODY RHYTHM LEAPING = MUSCLE STRENGTH SPACES = SPATIAL AWARENESS

movingsmartblog.blogspot.com

We Teach EF Through Play

Decision making Inhibition Cognitive Flexibility Attention Focus Shift Creativity/Imagination

Diagnostic Considerations

The BRIEF Model of Executive Function Adapted (Based on Gioia, Isquith,

Kenworthy & Guy’s Approach)

• Inhibit - putting on the brakes • Shift - changing gears • Emotional Control – using the thinking

brain to reason about feelings• Initiate – flipping the switch • Working Memory – internal scratch pad • Plan/Organize + Organization of

Materials – having a map and tools • Monitor – a personal GPS (quality control

manager)

Rating Scales

Behavior Rating Inventory of Executive Function (Preschool, 6-18, Adult)

Behavior Assessment System for Children Second Edition (BASC-2)

Conners-3 Barkley Deficits in Executive

Functioning Scale (Adults)

Diagnosis

Currently, there is no diagnostic category for executive dysfunction in the DSM-IV-TR or ICD-9

Most often, these difficulties are coded under ADHD NOS, LD NOS, or, at times, Cognitive Disorder NOS

DSM-V Preview (www.dsm5.org)

Still in progress

ADHD is proposed to be included under Neurodevelopmental Disorders

Broaden age of onset from “on or before age 7” to “on or before age 12”

Neurodevelopmental Disorders and Special Population

It Can Be Tricky

Much of the time, there is no known cause of executive dysfunction – there may be risk factors such as prematurity/low birth weight, family history, fetal distress during delivery– we refer to these conditions as developmental in nature (e.g., ADHD, learning disabilities, PDD, Tourettes)

EF Deficits Can Be Acquired

Sometimes, executive weaknesses are acquired through brain injury or disease

There are a range of genetic syndromes which often include EF weaknesses (such as Fragile X, Turner Syndrome, or Velocardiofacial Syndrome)

Medical Conditions and EF Weaknesses(this is not a comprehensive list!)

Diabetes Sickle Cell Neurofibromatosis Hydrocephalus Phenylketonuria Seizure Disorders Thyroid Dysfunction Brain Tumors

ADHD Kids with attentional disorders have

associated weaknesses in at least one aspect of executive functioning.

This may include trouble with time management, planning, organization, self-monitoring, and keeping track of assignments, possessions, and schedules.

Medication

Medication can be effective in reducing impulsivity and emotional

overreactivity and improving attention Generally speaking, medication does

not directly improve other aspects of EF

Laurie Dupar, PMHNP, RN

Learning Disabilities

Many children with LD also have weaknesses in one or more of the executive functions

Barbara Arrowsmith-Young The Woman Who Changed Her Brain Brain School ~ Howard Eaton

EF and Reading

Efficient EF is essential to reading comprehension- need to adjust reading rate to level of difficulty of material and monitor as one reads

How to Help Less Efficient Readers

-Visualizing and Verbalizing-Planners & Organizers Sarah Ward-Change the Way they Read (recorded books, reading aloud)-Fernette Eide

EF and Math

Some students with EF weaknesses and math disability have great trouble memorizing math facts

They may appear to know their multiplication tables and then – POOF! It is as if they have never seen them before..

EF and Math

Word problems require the ability to ignore extraneous information, sequence steps, and monitor one’s work

Many kids with executive dysfunction make “careless” computation errors and use inefficient strategies

EF and Writing Writing is the most complex task we

ask students to master. It involves: keeping track of directions physical act of writing using correct mechanics (spelling,

punctuation, and capitalization) creating complex sentences transferring ideas into written form deciding on main ideas, details, flow of

ideas

Asperger’s, Autism, and other Pervasive Developmental Disorders (PDD)

Students with PDD almost always have executive difficulties

They may become “stuck” in one way of thinking or behaving and may have trouble thinking and problem-solving flexibly

Kids with PDD often have an over reliance on routine and sameness which can be just as disabling as kids who are disorganized

Stress Tolerance/Emotional Control

Many kids with PDD also have trouble responding to stress or changes in a controlled way – once upset, it can take a long time before they recover

For most kids on the “Autistic Spectrum”, cognitive rigidity directly contributes to anxiety and loss of emotional and/or behavioral control

Tourette’s Disorder Many children with Tourette Syndrome

(TS) have EF weaknesses (most common are inhibition problems)

Let’s not forget PANS Those who also have Obsessive-

Compulsive Disorder may be cognitively rigid and have trouble with transitions – they tend to be “overly organized” and can’t tell when a job is done well enough

Sleep Disorders/Deprivation When kids and adults do not get sufficient

“good quality” sleep, executive and other cognitive skills suffer

Research has shown that many adolescents do not get enough sleep; children and teens who are sleep-deprived may appear “wired” rather than sleepy but still suffer considerable attention and memory problems

Sensory Integration Dysfunction

There is considerable overlap between executive and sensory processing

Both are related to self-regulation Many kids with sensory integration

difficulties also have trouble with cognitive flexibility

Lucy Jane Miller Lindsey Biel

Psychiatric Disorders Most children and adults who are

anxious or depressed experience some impairment in executive functioning

Working memory and self-monitoring are often diminished by mood disorders

All kids with psychotic disorders have significant internal disorganization

Post-Institutionalized Adopted Children Many children who have been

adopted from other countries following a period of institutional care show deficits in EF

Dr. Ron Federici has extensive experience with children adopted from Romania and other Eastern European countries. He describes the poor regulation which is typical of many of these kids

Set Realistic, Individualized Expectations

Developing executive skills and compensatory strategies takes most kids a considerable amount of time

For most students with delays in executive functioning, it will take years not months for them to develop improved functioning (this happens due to an interaction of experience and brain maturation)

At School Teachers and parents may be concerned that

accommodations and modifications are unfair to other students

Reframing these supports as equalizers may be helpful…just as we wouldn’t expect a child who is nearsighted to see without glasses, it is not realistic to expect a student with EF delays to manage tasks independently without support

“Raising the Bar” without letting a child “Fall off a Cliff”

If a child regularly does not meet expectations, the bar may be set too high with too little support

It’s very important to scaffold, chunk and be specific in teaching new skills and assessing current levels of functioning

Two-Pronged Approach

Set individualized expectations and provide appropriate supports, accommodations, and modifications

ANDHelp student develop improved

executive skills and compensatory strategies – much of this involves building habits and routines

Can’t or Won’t?: Motivation vs. Executive Dysfunction Very few children choose to be

unsuccessful Kids with EF weaknesses may appear

unmotivated due to their inconsistent, unpredictable behavior (e.g., earning a D on one assignment and an A on a similar task)

@davidnowell

Instill Hope

Parents may begin to wonder if their children will ever be independent

Kids often feel very inadequate and overly dependent

We need to let parents, kids, and teachers know that most children can be successful with appropriate supports and that using supports and accommodations is a smart way of managing brain-based weaknesses

Final Thoughts Executive Dysfunction contributes to

academic underachievement, behavior problems, social difficulties, and variable performance more than teachers, parents, and medical and mental health professionals may realize

We must educate all of these groups so that students can be provided with the supports they need to be successful

Slides adapted from Laurie Dietzel, PhD