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Thursday, June 7, 2012

Executive Function: Helping Your Child’s Brain Take Charge

From www.pediatricsafety.net

By Lynne Kenney, Psy.D.
May 21, 2012

Joey is a seven -year-old referred by his pediatrician because he has difficulty paying attention in school. His mind wanders, he responds to his teacher’s questions in class with “What, I don’t know,” and he is a bit self-conscious about his declining grades.

Joey is a super-sweet little boy, he does not squirm in his seat, bother other kids or anger the teacher. She simply wonders, “Why is he always day-dreaming?”

The answer, as pediatric neuropsychologist Dr. Paul Beljan says is, “Joey’s boss is out.” Here’s “ADHD and Executive Function: When the boss is out” a blog-talk-radio episode on the boss in Joey’s brain.

Joey’s boss resides in the frontal lobes of the brain. His boss is in charge of the executive functions that help him to preview, plan, think, inhibit, organize and execute tasks of daily living. I call this area of the brain “The Thinker.” You can read all about The Caveman and The Thinker here in The Family Coach Method.

Let’s learn a little about what executive functions are, how we assess them and how we can improve them.

What is Executive Function, and why does it matter?

The executive functions are a set of processes that all have to do with managing oneself and one’s resources in order to achieve a goal. Executive functions are the neurologically-based skills involving mental control and self-regulation.

Executive functions take place in the frontal lobes, specifically the neocortex of the brain. If you’ve never heard of an executive function that’s no surprise yet, you use them every day. When you get up, choose your outfit, make your bed, make your coffee and plan your day, you are using your executive functions.

Planning, organizing, holding information in your immediate memory, inhibiting your behavior, making good choices and managing your emotions are all activities mediated by executive function.

Let’s look at a description of a few executive functions. Think about yourself, your spouse and children. How do you see these functions evident in the behavior of those you care about? What might you, your child or spouse need more of?

Executive Functions
  • Inhibition – The ability to stop one’s own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; if you have weak ability to stop yourself from acting on your impulses, then you are “impulsive.”
  • Cognitive Shift – The ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation.
  • Emotional Control (self-regulation) – The ability to modulate emotional responses by managing one’s feelings. I call this using one’s thinker to manage one’s caveman.
  • Initiation – The ability to begin a task or activity. This includes the ability to independently generate ideas, appropriate responses and useful problem-solving strategies.
  • Working memory – The capacity to hold information in mind for the purpose of completing a task. Working memory is what you are using right now as you read this article. You are holding the information in memory and thinking about it.
  • Planning/Organization – The ability to identify, plan and manage current and future task demands.
  • Organization of Materials – The ability to create order in work, play and storage spaces.
  • Self-Monitoring – The ability to monitor one’s own internal feelings and performance in order to manage one’s thought, behavior and feelings.
We can improve executive function through a variety of activities. Play is a modality I often use.

As I sit and play with a child I teach them how to approach the play environment, how to choose, arrange and interact with toys, art or play materials. I teach the children that every activity has a beginning, middle and end. We begin a task, participate in the task or activity and then end the experience by putting materials away and making a conscious choice regarding what we will play next.

Managing our feelings, body space, speed of movement and impulsivity are also well-addressed through play.

Brain Training is also another modality of executive function enhancement. Cognitive training or brain training consists of a variety of exercises designed to help improve functioning in areas such as sustaining attention, thinking before acting, visual and auditory processing, listening, reading – areas in which ADHD individuals often experience difficulties.

Modalities include computer work, person to person motor-cognition work and neurofeedback.

If an individual is having attentional or learning problems, tutoring or drill and practice in academic areas are often not effective. The principle underlying cognitive brain training is to help improve the “core” abilities and self-control necessary before an individual can function successfully academically. The exercises “drill for skill” directly in the areas where basic specific cognitive difficulties occur.

Brain Training is like exercise for the brain with specific exercises for specific neuropsychological functions or deficits. The key is to build neuronal connections. Activities that include a motor and cognitive component may work best, but the research is not yet to a degree that one can assert Brain Training is an evidence- based treatment. In a few years, we’ll surely know more.

Research is ongoing as to what forms of brain training are effective. The key is to personalize your choice of program. The methodology of the program needs to meet the needs of your child. Does your child have attention challenges? Is their issue inhibition? Reading social cues? Staying on topic? Dyslexia?

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.

If you need to know more about the specific skills you wish to enhance in your child, a neuropsychologist can do an assessment of executive function. Here is a valuable audio on psychological testing and executive function http://www.lynnekenney.com/what-type-of-testing-is-best-for-my-child-adhd-ef/.

Here are some excellent books on the topic http://www.researchild.org/publications.

Valuable Links
About Dr. Lynne Kenny

Lynne Kenney, Psy.D., is a mother of two and a practicing pediatric psychologist in Scottsdale, AZ. She has advanced fellowship training in forensic psychology and developmental pediatric psychology from Massachusetts General Hospital/Harvard Medical School and UCLA Medical School. Recently named one of the Top 100 Docs to "Listen to" on Twitter, Dr. Lynne’s parenting advice and tips can be found on www.Socialmoms.com, Dr. Oz's new site www.Sharecare.com, BlogTalk Radio (Dr. Lynne Weighs In) and on Smart Family ABC 15 in Phoenix.

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