Return to ADDvisor Volume 3 2001 Index

Number 13 July 1, 2001

1. Remediation Strategies - Part 3

2. Resource - Good Friends Are Hard To Find

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REMEDIATION STRATEGIES - PART 3

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The series of articles, which are appearing in the first ADDvisor newsletter of each month, are focusing on remediation strategies for neuropsychologically based difficulties. The suggestions that follow will benefit those with ADHD, widely considered a neurologically based impairment.

These strategies are adapted from Morse,P. A. and Montgomery, C.E., Neuropsychological evaluation of traumatic brain injury, in R.F. White (Ed.) Clinical Syndromes in Adult Neuropsychology: The Practitioner's Handbook. The Netherlands: Elsevier Science Publishers B.V., 1992)

EXECUTIVE FUNCTIONS

Let's take a minute for a brief review. The individual executive functions most commonly associated with difficulty in individuals with ADHD include; self-regulation (the ability to think before acting), shift (the ability to move from one task or activity to another without emotional distress), emotional control (the ability to self regulated intense emotions), initiation (the ability to get started - sometimes seen as a lack of motivation), working memory (the ability to keep in mind something long enough to use it, at the right time), organization/planning (the ability to organize thoughts and apply them to future events), organization of materials (the ability to keep track of materials necessary for work and organize them so that they can be properly used), monitor (the ability to look back over completed work or behaviors and adjust them for improvement purposes).

We recently heard executive function described as being like the conductor in an orchestra. All of the individual functions described in previous newsletters such as sustained attention and concentration, selective attention, problem recognition, and planning as well as the individual functions yet to be discussed including, organization, initiation, self-regulation and self-monitoring, are like various instruments in the orchestra. Some of these individual instruments may be playing/working well, while others may need help (e.g. music lessons). The conductor, or the frontal lobe in our case, helps the individual instruments to work together to produce a satisfying result.

Your job, as the parent of a child with ADHD, is to find out which of the individual instruments is working well and which need "lessons", and then to pursue remediation (lessons) in any area that is deficient. There are some diagnostic checklists available to help pinpoint deficient areas of executive function without going through a complete neuropsychological exam. Your local psychologist, who specializes in ADHD, should be familiar with these.

The more efficiently each of the individual sections is working, the more successful the conductor (the frontal lobe) will be in helping them work together to produce a satisfying result. It is important to note, however, that a frontal lobe deficiency in any one area cannot be "cured", but remediation strategies can help improve function in a specific area as long as it is in place, much like a step stool helps a short individual reach a high shelf.

The two executive function problem areas we will look at today are initiation and organization. As described above initiation is an individual's ability to begin a desired behavior. First, because in individuals with ADHD, this is often a neurological dysfunction (especially when oppositional behavior can be ruled out) is important to reframe the "lack of motivation" explanation often attributed to this by teachers and sometimes, parents as "poor initiation", a neurological disorder.

Second, sometimes individuals with ADHD have difficulty with initiation because the task appears too large. Breaking tasks down into smaller, more manageable, steps can improve their ability to get started. Third, an individual may need a "jump start" to begin tasks. This "jump start" may take the form of a parental reminder, or another external cue such as an alarm, a message on a note card or sticky, or simply maintaining a daily routine so that the same tasks (such as homework) are done at the same time each day.

Organization, is the ability to organize information or tasks so that they can be put to productive use. First, helping the individual to implement a "memory" book or organizational system such as a homework planner, day planner, or simply maintaining a daily routine can help with this problem area. Second, presenting information in a pre-organized manner and reviewing how you organized it can help an individual with the task at hand and will help them to learn how to search for organization in the future. This, of course, will take an enormous amount of repetition.

In trying to implement any of the suggestions, a reward system can be of significant help an increasing motivation.

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RESOURCE - GOOD FRIENDS ARE HARD TO FIND

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Good Friends are Hard To Find by Fred Frankel, PhD is a helpful book for parents of 5-12 year olds to learn and maintain improved social skills.