REVIEW OF EXECUTIVE FUNCTION DEFICITS IN ADHD AND ORGANIZATIONAL STRATEGIES TO MANAGE THEM
Let's review the five basic areas of executive function deficits that most often interfere with learning in individuals with ADHD.
1. Initiate - The ability of an individual to get started on a task.
2. Working Memory - The individuals ability to keep something in mind so that they can use it, at the right time.
3. Plan/Organize - An individuals ability to plan how they will approach anything from simple assignments to complex tasks. For an individual with ADHD, even the simplest of tasks can appear overwhelming.
4. Organization of Materials - This is their ability to have correct materials available at the time they are needed including, in the case of homework, having the correct assignments written down and all needed materials available.
5. Monitor - The ability to review what was done and make necessary changes. Truly knowing the answer to the question: "How did I do?" is the spirit of this dimension.
Remember, the ultimate goal of the intervention with executive function/prefrontal cortex disorders is to establish regular, behavioral control routines. Doing this maximizes independent, goal oriented problem solving. This is not an easy task and it is done over the course of months and years, not days and weeks. It is, however, critical for the optimal long term functioning of child.
The following recommendations are provided to help parents develop a routine and organized approach to assist their child. These strategies can be used in any and all activities, including those in the classroom, recreational activities, and home activities. Once parents and other significant individuals in the child's life (such as teachers) have helped the child develop appropriate habits in this area, using these techniques should take little time or effort. How are appropriate habits developed? Routinely repeat these five steps with your child, aloud, in as many situations as possible on a daily basis. Make a cue card for them to self-review and reward them whenever they apply these routines. It should be noted that these strategies could be practiced and used by adults with ADHD as well.
The following five strategies should be overlearned and applied as often as possible.
1. Goal Setting: Ask, "What do I need to accomplish?" Set a goal.
2. Estimate level of difficulty: Ask, "How easy or difficult is this task or goal?" This helps a child to minimize frustration if this is accurately estimated ahead of time.
3. Develop an Organized Plan: Ask, "What materials do I need?" "What do I do first, second and third?" "How long will this take?"
4. Remember to be Flexible: Complications and unplanned issues often arise. The child should be mentally prepared for this possibility to minimize frustration. Ask, "How else could I reach this goal?" Should I ask for help?"
5. Self-monitor: Ask, "How did I do?" at the end of the task. Practice going back and cleaning up weak spots.
The more complex or difficult task for the child, the more carefully the above steps need to be followed. At first, they should be applied in all situations for learning purposes.
All children with ADHD that struggle in school or with homework should overlearn these steps and questions. Although these may seem simple and unnecessary to some parents to children with pre-frontal cortex disorders such as ADHD they are easy to learn but can be very difficult to apply. Remember, ADHD is a disorder of doing not knowing.
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)
1. Initiate - The ability of an individual to get started on a task.
2. Working Memory - The individuals ability to keep something in mind so that they can use it, at the right time.
3. Plan/Organize - An individuals ability to plan how they will approach anything from simple assignments to complex tasks. For an individual with ADHD, even the simplest of tasks can appear overwhelming.
4. Organization of Materials - This is their ability to have correct materials available at the time they are needed including, in the case of homework, having the correct assignments written down and all needed materials available.
5. Monitor - The ability to review what was done and make necessary changes. Truly knowing the answer to the question: "How did I do?" is the spirit of this dimension.
Remember, the ultimate goal of the intervention with executive function/prefrontal cortex disorders is to establish regular, behavioral control routines. Doing this maximizes independent, goal oriented problem solving. This is not an easy task and it is done over the course of months and years, not days and weeks. It is, however, critical for the optimal long term functioning of child.
The following recommendations are provided to help parents develop a routine and organized approach to assist their child. These strategies can be used in any and all activities, including those in the classroom, recreational activities, and home activities. Once parents and other significant individuals in the child's life (such as teachers) have helped the child develop appropriate habits in this area, using these techniques should take little time or effort. How are appropriate habits developed? Routinely repeat these five steps with your child, aloud, in as many situations as possible on a daily basis. Make a cue card for them to self-review and reward them whenever they apply these routines. It should be noted that these strategies could be practiced and used by adults with ADHD as well.
The following five strategies should be overlearned and applied as often as possible.
1. Goal Setting: Ask, "What do I need to accomplish?" Set a goal.
2. Estimate level of difficulty: Ask, "How easy or difficult is this task or goal?" This helps a child to minimize frustration if this is accurately estimated ahead of time.
3. Develop an Organized Plan: Ask, "What materials do I need?" "What do I do first, second and third?" "How long will this take?"
4. Remember to be Flexible: Complications and unplanned issues often arise. The child should be mentally prepared for this possibility to minimize frustration. Ask, "How else could I reach this goal?" Should I ask for help?"
5. Self-monitor: Ask, "How did I do?" at the end of the task. Practice going back and cleaning up weak spots.
The more complex or difficult task for the child, the more carefully the above steps need to be followed. At first, they should be applied in all situations for learning purposes.
All children with ADHD that struggle in school or with homework should overlearn these steps and questions. Although these may seem simple and unnecessary to some parents to children with pre-frontal cortex disorders such as ADHD they are easy to learn but can be very difficult to apply. Remember, ADHD is a disorder of doing not knowing.
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)
