ADHD, EXECUTIVE FUNCTION AND SCHOOL SUCCESS
Chris
A. Zeigler Dendy, M.S.
(This
article was adapted by CHADD for publication in the February, 2008 Attention
magazine.)
Five years ago, most parents and teachers of students with ADHD didn’t
have a clue that a child’s academic success was contingent upon strong
executive skills. However, today’s savvy parents and educators realize
that deficits in critical cognitive skills known as executive functions
are slower to mature in many children with ADHD. Researchers vary widely
in reports about the frequency of these deficits in students with ADHD:
some report 30-50 percent of children and others, including Drs. Barkley
and Brown, believe that by definition, 100% of people with ADHD also
experience these deficits. Practically speaking, problems with the
“brain’s CEO” contribute to several academic problems:
disorganization, difficulty getting started and finishing work, forgetting
homework, plus difficulty memorizing facts, writing essays or reports,
working complex math problems, completing long-term projects, being on
time, controlling emotions, and planning for the future.
Before we understood the role of executive functions, parents and
teachers were often baffled when students, even those who were
intellectually gifted, teetered on the brink of school failure.
Unfortunately, to the uninformed, deficits in executive skills often
appeared to be a simple matter of “laziness or lack of motivation”.
When a student had trouble getting started and finishing an essay or math
work, it was easy to assume that the student chose
not to do the task.
According to Dr. Russell Barkley, a leading researcher, students with
ADHD experience roughly a thirty percent developmental delay in
organizational and social skills. Practically speaking, our children
appear less mature and responsible than their peers. For example, a twelve
year old’s executive skills are often more like those of an
eight-year-old. To ensure academic success for these students, parents and
teachers must provide more supervision and monitoring than is normally
expected for this age group. I like to refer to this as providing
“developmentally appropriate supervision.”
Although scientists have not yet agreed on the exact elements of
executive function, two ADHD researchers, Dr. Barkley and Dr. Tom Brown,
have given us insightful working descriptions. Dr. Barkley describes
executive function as those “actions we perform to ourselves and direct
at ourselves so as to accomplish self-control, goal-directed behavior, and
the maximization of future outcomes.”
Through use of a metaphor, Dr. Brown gives us a helpful visual
image by comparing executive function to the conductor’s role in an
orchestra. The conductor organizes various instruments to begin playing
singularly or in combination, integrates the music by bringing in and
fading certain actions, and controls the pace and intensity of the music.
Although
our son Alex successfully struggled through the early school years, he
finally hit the proverbial “ADHD brick wall” in middle school.
Belatedly I realized that the demands for executive skills increase
exponentially in middle school (working independently, organizing oneself,
getting started, remembering multiple assignments). As a former teacher
and school psychologist, I’m also embarrassed to say I failed for many
years to recognize that a high IQ score alone was not enough to make good
grades. It wasn’t until Dr. Barkley identified the central role
executive function plays in school success, that I finally understood why
school was so difficult for my son. Teachers would say, “Alex is
very bright; he could make better grades if he would just try harder.”
In truth, our children often do try harder, but even then,
cannot make good grades without proper treatment and academic supports.
Components
of Executive Function
Based upon material from Barkley and Brown, I have outlined five general
components of executive function that impact school performance:
1.
Working
memory and recall (holding
facts in mind while manipulating information; accessing facts stored in
long-term memory.)
2.
Activation,
arousal, and effort (getting
started; paying attention; finishing work)
3.
Controlling
emotions (ability
to tolerate frustration; thinking before acting or speaking)
4.
Internalizing language (using “self-talk” to
control one’s behavior and direct future actions)
5.
Taking an issue apart, analyzing the pieces, reconstituting and
organizing it
into
new ideas (complex
problem solving).
Let’s take a more in-depth look at just one element of executive
functions – deficits in working memory and recall—and their impact on
school work.
Poor Working Memory and Recall
Deficits in working memory and recall negatively affect these
students in several areas:
1. The
“here and now”: Our
children have limited working memory capacity that often impacts their
behavior at home and in the classroom:
-
remembering and following
instructions.
-
memorizing math facts,
spelling words, and dates.
-
performing mental computation
such as math in one’s head.
-
completing complex math
problems (algebra)
-
remembering one part of an
assignment while working on another segment.
-
paraphrasing or summarizing.
-
organizing and writing essays.
2.
Sense of past events: Because our students have
difficulty recalling the past, they have limited hindsight; in other
words, they don’t learn easily from past behavior. This may help explain
why our children often repeat misbehavior.
3.
Sense of time: Many
students with ADHD also have difficulty holding events in mind and
using their sense of time to prepare for upcoming events and the
future. Consequently, they have difficulty judging the passage of time
accurately. Practically speaking, they don’t accurately estimate how
much time it will take to finish a task, thus they may not allow enough
time to complete the work.
4.
Sense of self-awareness: As a result of their
diminished self-awareness, these students don’t easily examine or change
their own behavior. Perhaps this explains why they often are unaware of
behaviors that may alienate friends.
5.
Sense of the future: Most
students with a working memory deficit
focus on the here and now and are less likely to talk about time or
plan for the future. Thus, they have limited foresight; in other words,
they have difficulty projecting lessons learned in the past, forward into
the future. Not surprisingly, they have difficulty preparing for the
future.
Common
Academic Problems Linked to ADHD and Executive Function Deficits
Many students with ADHD have impaired
working memory and some
also have slow processing speed, which are critical elements of executive
function. Not surprisingly,
these skills are critical for writing essays and working math problems.
A research study by Mayes and Calhoun has
identified written expression as the most common learning problem among
students with ADHD (65 percent). Consequently,
writing essays, drafting book reports or answering questions on tests or
homework is often very challenging. For example, when writing essays,
students often have difficulty holding ideas in mind, acting upon and
organizing the ideas, quickly retrieving grammar, spelling and punctuation
rules from long-term memory, manipulating all this information,
remembering ideas to write down, organizing the material in a logical
sequence, and then reviewing and correcting errors.
Since learning is relatively easy for most of us, sometimes we forget
just how complex seemingly simple tasks such as memorizing multiplication
tables or working a math problem really are. For example, when a student
works on a math problem, he must fluidly move back and forth between
analytical skills and several levels of memory (working, short-term, and
long-term memory). With
word problems, he must hold several numbers and questions in mind while he
decides how to work a problem. Next
he must delve into long-term memory to find the correct math rule to use
for the problem. Then he must hold important facts in mind while he
applies the rules and shifts information back and forth between working
and short-term memory to work the problem and determine the answer.
To further complicate matters,
other serious conditions may co-occur with ADHD.
According to a landmark National Institute of Mental Health study
on ADHD (known as the MTA), two-thirds
of children with ADHD have at least one other coexisting problem, such as
depression or anxiety. Accommodating students with complex cases of
ADHD is critical! These children are at greater risk than their peers for
a multitude of school problems, for example, failing a grade, skipping
school, being suspended or expelled, and sometimes, dropping out of school
and not going to college.
Favorite
School Success Strategies
Over the years I have identified several teaching strategies and
accommodations that work well for students with ADHD. So here are just a few
of my favorite tips:
General Teaching Strategies
·
Make
the learning process as concrete and visual as possible.
Written
expression
o
Dictate
information to a “scribe” or parents.
o
Use
graphic organizers to provide visual prompts.
o
Use
“post-it” notes to brainstorm essay ideas.
Math
o
Use
a peer tutor.
o
Use
paired learning (teacher explains problem, students make up their own
examples, swap problems, and discuss answers).
(After
barely passing high school and college algebra, my son made an A in
calculus plus had a 100 average on tests when the professor used this
strategy.)
Memory
o
Use
mnemonics (memory tricks), such as acronyms or acrostics, e.g., HOMES to
remember names of the Great Lakes.
o
Use
“visual posting” of key information on strips of poster board.
·
Modify
teaching methods.
o
Use
an overhead projector to demonstrate how to write an essay. (Parents may
simply write on paper or a computer to model this skill.)
o
Use
color to highlight important information.
o
Use
graphic organizers to help students organize their thoughts.
·
Modify
assignments
– reduce written work.
o
Shorten
assignments.
o
Check
time spent on homework, and reduce it if appropriate (when total homework
takes longer than roughly 10 minutes per grade as recommended in a PTA/NEA
Policy, e.g. 7th grader = 70 minutes).
o
Write
answers only, not the questions (photocopy questions).
·
Modify
testing and grading.
o
Give
extended time on tests.
o
Divide
long-term projects into segments with separate due dates and grades.
o
Average
two grades on essays– one for content and one for grammar.
·
Modify
level of support and supervision.
o
Appoint
“row captains” to check to see that homework assignments are written
down and later turned in to the teacher.
o
Increase
the amount of supervision and monitoring for these students, if they are
struggling.
·
Use
technology.
o
Use
a computer as often as possible.
o
Use
software to help teach skills.
Unfortunately students with ADHD are often punished for executive
function deficits such as lack of organizational and memory skills that
interfere with their ability to bring home the correct homework
assignments and books. Hopefully, after reading this article, teachers and
parents will develop more innovative intervention strategies.
For example, one effective alternative would be to have someone (a
friend or teacher aide), meet the student at his locker to get the
necessary homework materials together. Ultimately, this process of “modeling” and “shaping”
behavior at the critical “point of
performance” will help the student master skills or at a minimum,
teach him to compensate for deficits.
In Closing
Clearly school is often very difficult for students with ADHD.
However, when executive function deficits are also present, the
accompanying problems are often overwhelming to the student and family.
Traditionally, some parents and teachers have had little awareness or
sympathy for the challenges presented by these combined deficits.
Hopefully, teachers and parents of today realize that ADHD is often a very
complex condition! It is much more than just a simple case of
hyperactivity. When deficits in executive function and related learning
problems are also present, students
can try their very best and still not succeed in school!!
So what should parents and teachers do with this new information?
Identify:
1) the student’s specific learning problems (e.g.
written expression or math) and
2) their executive function deficits (e.g. working
memory, disorganization, forgetfulness, or impaired sense of time) and provide
accommodations in both areas!
I leave you with this food for
thought,
“Succeeding in school is one of the most therapeutic things that
can happen to a child!! So do whatever it takes to help the child succeed
in school.”
A
Personal Comment: Our youngest son, Alex, struggled terribly
throughout his high school and college years with ADHD and executive
function issues. We’re proud that he beat the odds and graduated from
college. So if your child is struggling in school, do not give up. My
family offers living proof that there is hope and help for ADHD and
coexisting conditions.
Please
visit my website
www.chrisdendy.com
to learn more about my family and how we have coped with ADHD.
Several helpful articles are also available for you to download and
share with friends. Best wishes
for school success to you, your children and students with attention
deficits!!
References:
Chris Dendy has over 40 years experience as a
teacher, school psychologist, mental health counselor and administrator
plus perhaps more importantly, she is the mother of two grown sons and a
daughter with ADHD. Ms. Dendy is the author of three popular books on ADHD
and producer of three videos, Teen
to Teen: the ADD Experience and Father
to Father. A new DVD for children and teens, Real
Life ADHD, featuring 30 teens is currently in production. She and her
son Alex coauthored a book specifically for teenagers: A
Bird’s-Eye View of Life with ADD and ADHD: Advice from Young Survivors.
She and her husband are members of CHADD’s President’s Council. She
served on the national CHADD Board of Directors from 2001-2005. She was
inducted into the CHADD Hall of Fame for outstanding contributions to the
field.
