"Helping you to help your ADD ADHD child"by Anthony Kane, MD
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Operational Definitions:Please note that executive functions have been described by various researchers using different terms. Although the different vocabularies occasionally lead to confusion, the actual observations of researchers have generally been similar. To better understand how important executive control is, consider the following list of executive functions (Barkley, 1988; McCloskey, 2001):
Executive Function Domains, Definitions, and Associated Behavioral Dysfunction
Definition: Beginning a task or activity
Dysfunction: Has trouble getting started on homework or chores
Definition: Not acting on an impulse or appropriately stopping one’s own activity at the proper time
Dysfunction: Has trouble “putting the brakes” on behavior; acts without thinking
Definition: Freely moving from one situation, activity, or aspect of a problem to another as the situation demands Dysfunction: Gets stuck on a topic or tends to perseverate
Definition: Anticipating future events, setting goals, and developing appropriate steps ahead of time to carry out an associated task or action
Dysfunction: Starts assignments at the last minute; does not think ahead about possible problems
Definition: Establishing or maintaining order in an activity or place; carrying out a task in a systematic manner
Dysfunction: Has a scattered, disorganized approach to solving a problem; is easily overwhelmed by large tasks or assignments
Definition: Checking on one’s own actions during, or shortly after finishing, the task or activity to assure appropriate attainment of goal
Dysfunction: Does not check work for mistakes; is unaware of own behavior and its impact on others
SKILL: Emotional control
Definition: Modulating/controlling one’s own emotional response appropriate to the situation or stressor
Dysfunction: Is too easily upset, explosive; small events trigger big emotional response
SKILL: Working memory
Definition: Holding information in mind for the purpose of completing a specific and related task
Dysfunction: Has trouble remembering things, even for a few minutes; when sent to get something, forgets what he or she is supposed to get
ADHD and Learning DisordersBy definition, all children experiencing ADHD have executive control deficits. Of particular importance to parents and teachers is the critical link between executive control and ADHD.
Effective working memory is essential to concentration. Most individuals diagnosed with ADHD have a problem retaining information in working memory due to inattentiveness or impairment in blocking environmental interference. When working memory is impaired, newly learned information is not fully encoded, and is thus unavailable for retrieval later on. All of the executive control deficits indicated above have been observed in people diagnosed with ADHD. Neither ADHD, or disorders of executive function, come in “cookie cutter” forms. Rather, the expression of these syndromes is somewhat unique in each individual. Thus the basic rule in assessing these problems is to detect patterns of dysfunction.
Of particular importance in assessing attentional problems is a child’s tonic level or general state of alertness. When children are understimulated relative to their own threshold for attention, learning and performance will be impaired.
InterventionExecutive control intervention comes in two primary forms: environmental adaptation and psychostimulant medication. Stimulants may provide relief by correcting the underlying neuropsychological deficit in behavioral inhibition. This means that for some individuals, medication makes it possible to block the interference of information competing for a child’s attention so that attention is focused on appropriate priorities.
From a behavioral perspective, teachers and parents can assist those with executive dysfunction by acting as surrogate executive controls. This means providing an appropriate level of stimulation while reinforcing directives, goals, and related forms of future-oriented planning, organizing, and thinking.
Acting as a surrogate also involves helping a child to understand the meaningful links between performance and outcome; clarifying for children the consequences of not initiating an action, or not inhibiting various types of environmental interference. Parents and teachers working together can expect to measurably improve a child’s self-awareness by setting the stage for repeated rehearsal, and actively using reinforcement techniques; (as always, reinforcement is most effective when applied immediately and consistently).
Unfortunately, it is not reasonable to expect intervention benefits to carry over to new places or dramatically new tasks. Everyone involved in helping those with executive control problems should recognize that related learning challenges and/or behavioral problems are not due to a poor attitude. Inattention is not defiant or lazy behavior.
Ideally, the “dysexecutive” child will be placed in a learning environment where she or he will receive the type of compensatory instruction that the syndrome requires. Such placement is clearly a challenge in these days of stretched budgets. However, as parents, teachers and mental health professionals, we owe children our energy and advocacy for thoughtful and fair treatment. Our scientific sophistication in understanding the syndrome of ADHD has grown so remarkably that we can no longer dismiss the syndrome’s symptoms as nuisance behavior that a child will outgrow. The learning challenges of ADHD often extend well into the college years. The good news is that we can make a difference by working in a strategic and cooperative manner. Let’s challenge ourselves to make the commitment to helping that this difficult syndrome requires.
Barkley, R.A. (1988). Attention-deficit hyperactivity disorder; A handbook for diagnosis and treatment. New York: Guilford.
Holmes, J.M. (1987). Natural histories in learning disabilities: Neuropsychological difference/environmental demand. In S. J. Ceci (Ed.) Handbook of cognitive, social and neuropsychological aspects of learning disabilities (Vol.2, pp. 303-319). Hillsdale, NJ: Erlbaum.
McCloskey, G. (2001) Executive functions overview: Operational definitions, clinical classifications and assessment methods. Unpublished.
Simeonsson, R.J., & Rosenthal, S.L. (Eds.) (2001). Psychological and developmental assessment: Children with disabilities and chronic conditions. New York: Guilford Publications Inc.
Article Source: http://www.ArticleStreet.com
Adam J. Cox, PhD, ABPP, Board Certified Clinical Psychologist, American Board Professional Psychology www.dradamcox.com
Anthony Kane, MD
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