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Wednesday, April 3, 2013

Executive Dysfunctions

From Learning Works for Kids - Playing Smarter in a Digital World

March 22, 2013

Executive dysfunctions, or difficulties employing executive functioning skills, are telltale features of most psychiatric diagnoses in children. In fact, many leading researchers are now primarily defining Attention Deficit Hyperactivity Disorder as an executive functioning disorder.

Similarly, many youngsters who have learning disabilities display an array of executive dysfunctions that underlie many of their academic struggles.

The Diagnostic and Statistical Manual IV (DMS-IV) did not incorporate executive dysfunctions into psychiatric diagnoses. However, understanding the executive dysfunctions that are characteristic of psychiatric disorders is very helpful in developing educational and psychological interventions for individuals.

It is common for individuals to experience difficulties with one or two executive functions. For example, many adults will describe themselves as struggling with organization, or occasionally having difficulties regulating their anger. The presence of moderate difficulties in executive functions does not warrant a psychiatric diagnosis.

However, in the school setting, students’ difficulties with executive functions such as planning, organization, working memory, and time management can often lead to their meeting with serious setbacks in academic performance.

The following is a list of broad diagnostic categories (not formal psychiatric diagnoses) and the primary executive dysfunctions that are likely to be encountered by individuals who have these disorders.

This list is designed to assist educators in two ways:
  • Should a child have a specific psychiatric diagnosis, it may help you to identify some of the executive difficulties that they are likely to experience in the classroom.
  • If you are identifying some of these executive difficulties in the classroom, it may help you in developing a broader understanding of other issues that the child may be experiencing.
One of the tools we use at NESCA

Diagnosis: ADHD

Impaired executive skills:
  • Sustained attention – has difficulty attending in the presence of distractions; has problems sustaining attention and effort levels while engaged in tasks;
  • Working memory – has difficulty following multi-step directions; has problems remembering what he/she has read;
  • Response inhibition – has difficulty thinking before acting;
  • Time management – may waste time or rush through tasks, thus executing them inefficiently and ineffectively

Diagnosis: Executive Functioning Disorder

Impaired executive skills:
  • Task initiation – has difficulty knowing how to get started on a task and sustaining the attention and effort levels needed to complete the task;
  • Planning – has difficulty identifying and employing strategies and systematic approaches in order to reach a goal;
  • Working memory – has difficulty keeping things in mind and controlling attention while engaged in an activity;
  • Organization – has difficulty organizing objects, ideas, and possessions;
  • Flexibility – has the tendency to be rigid and to not learn from mistakes;
  • Regulation of affect – struggles to manage feelings, actions, and frustrations;
  • Time management – lacks efficiency in starting and completing tasks;
  • Social thinking – has difficulty understanding his/her motivations and the thoughts and feelings of others

Diagnosis: Asperger’s Disorder

Impaired executive skills:
  • Social thinking – struggles to understand social cues and lacks social-communication skills;
  • Flexibility – may be rigid with regard to his/her interests; struggles with changing routines;
  • Planning – may have difficulty thinking about all the different sides of a situation or determining where to devote his/her energy and effort.

Diagnosis: Pervasive Developmental Disorder NOS

Impaired executive skills:
  • Social thinking – struggles to understand social cues and lacks social-communication skills;
  • Flexibility - may be rigid with regard to his/her interests; struggles with changing routines;
  • Planning – may have difficulty thinking about all the different sides of a situation or determining where to devote his/her energy and effort.

Diagnosis: Autism

Impaired executive skills:
  • Social thinking - struggles to understand social cues and lacks social-communication skills;
  • Flexibility - may be rigid with regard to his/her interests; struggles with changing routines;
  • Planning – may have difficulty thinking about all the different sides of a situation or determining where to devote his/her energy and effort.

Diagnosis: Dyslexia

Impaired executive skills:
  • Working memory – may struggle to keep phonemes (letter sounds) in mind when decoding/sounding out words;
  • Working memory – may struggle to keep in mind the meaning of previous sentences in order to attain/enhance reading comprehension;
  • Organization – may struggle to keep ideas in mind in order to understand a paragraph, story, or book;
  • Time management – may struggle with fluency and pace while reading, causing comprehension difficulties and other issues;
  • Sustained attention – may have difficulty sustaining the attention and effort levels necessary to support the constant practice that struggling readers require.

Diagnosis: Dysgraphia

Impaired executive skills:
  • Time management – struggles with writing fluency and experiences difficulty due to the length of time that it takes to engage in producing written language;
  • Organization – may struggle with organizing ideas for written materials; may have good ideas but cannot put them together in a meaningful fashion;
  • Planning – may struggle to connect ideas in written form;
  • Working memory – may have difficulty holding ideas in the mind while in the process of writing them down;
  • Task persistence – may struggle to sustain the attention and effort levels necessary to complete tasks that are difficult for him/her.

Diagnosis: Nonverbal Learning Disability

Impaired executive skills:
  • Social thinking – struggles to understand social cues and lacks social-communication skills;
  • Flexibility - may be rigid with regard to his/her interests; struggles with changing routines;
  • Planning – may have difficulty thinking about all the different sides of a situation or determining where to devote his/her energy and effort.

Diagnosis: Social Skills Deficits

Impaired executive skills:
  • Metacognition – has difficulty understanding the impact of his/her behavior on others;
  • Social thinking – may experience difficulty in observing nonverbal and social cues;
  • Flexibility – may struggle to adapt to new or unexpected changes in social settings.

Diagnosis: Anxiety

Impaired executive skills:
  • Regulation of affect – may struggle to manage feelings of fear, worry, and tension;
  • Flexibility – may be rigid and experience the need to have control in situations in order to reduce tension;
  • Task initiation – has difficulty knowing how to get started on a task; becomes concerned with whether or not he/she is doing it correctly

Diagnosis: Depression

Impaired executive skills:
  • Regulation of affect – struggles to manage sad and pessimistic feelings;
  • Regulation of affect – may have difficulty managing negative self-thoughts;
  • Metacognition – may struggle to accurately estimate his/her abilities, often underestimating him/herself;
  • Task initiation – may struggle to get him/herself started on and energized to complete uninspiring tasks.

Diagnosis: Oppositional Defiant Disorder

Impaired executive skills:
  • Response inhibition – may act before thinking and engage in defiant behavior;
  • Flexibility – may be rigid with regard to his/her expectations and oppositional when things do not go the way that he/she expects them to;
  • Regulation of affect – may easily anger with little cause/provocation.

Diagnosis: Conduct Disorder

Impaired executive skills:
  • Response inhibition – may disregard the rights of others;
  • Response inhibition – may act out in a violent or aggressive fashion;
  • Flexibility – may be rigid with regard to his/her expectations and oppositional when things do not go the way that he/she expects them to.

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