One of our YouTube viewers asked, “How do you help a child with executive functioning problems?” First off as Vicki and I discuss this, (we both have some experience professionally with the topic), It's important to acknowledge that this is not a diagnosis, and sometimes it's treated that way. When you do a search online for example, “My child has executive functioning disorder,” or whatever it is not an official diagnosis. This is really a description of a certain constellation of challenges or problems that a child has. There are three main areas that it covers.
Vicki: The first one might be considered the working memory. How do they remember what tasks they have to do? Can they take what's brought in and stay focused on it long enough to do a task.
Paul: Think about the executive suite in a company. You've got the chief executive officer and the chief operating officer. The executives in a company are up at the top of the company. And they control and manage everything that's happening down below it. So, executive functioning can be compared to that. How does this child organize their world? And how do they stay on top of things? So, when you mentioned the memory, the working memory is part of that executive functioning. We have a little neighbor boy who was watching, I think it was Finding Nemo or something and how Dory that…
Vicki: Has the short-term memory loss.
Paul: Short-term memory loss. And he's how old?
Vicki: He just turned 5.
Paul: Just turned 5. And now he's picked that up. He's like, “Oh, I must have short-term memory loss.”
Vicki: His mom said, “Why? You know, you were supposed to pick up your boots,” or whatever. “Oh, I am having a short-term memory loss.”
Paul: But that's a good example of what we mean by the working memory. They just totally spaced things off. Another area that is implied with executive functioning is cognitive flexibility or as the case may be inflexibility. Where they get so rigid…
Vicki: This is a super common trait or the way children show up who are on the autistic spectrum. Things are very rigid. I need it to be this way, this way or this way, or I am not going to function well. To be highly functioning executively implies that you have cognitive flexibility. You can kind of go with the flow, change as the circumstances change.
Paul: And then there's one other area of executive functioning that ties into one of the ones we've already talked about. But it has to do with inhibitory control. We all have impulses. And Vicki's better at controlling her impulses than I am at controlling mine.
Vicki: Children who have cognitive functioning problems tend to have a really difficult time just inhibiting those impulses. I am a very tactile person, I love to touch things. If I see something of a different texture, I really want to touch it. And I noticed this even at school that sometimes, I see an interesting shirt and I want to reach out and feel it. But I inhibit it. Whereas the little first graders have a hard time inhibiting their impulses. There is a first-grade teacher that I absolutely adore at our school and she has this velour one-piece suit. I don't know how you wear that in a roomful of first graders. They've got to be petting it all day because they don't always have that inhibitory control yet.
Paul: Which is a good point, Vicki. Sometimes developmentally, we might expect a child to have a higher executive functioning level than they are capable.
Vicki: Yeah, adjust our expectations appropriately is one way we can help kids with their executive functioning problems. Well, let's get into a couple of strategies that we can use to assist children who may be at typical development or as we've also talked about, kids with ADHD for example, where executive functioning problems are very common. The kids who might be on the autism spectrum, younger children.
Paul: I was going to say even just typical development. I said the functioning is something that is constantly being developed. And interestingly sometimes that's what people lose in later life or if they have a degenerative problem. We've both got people in our family who have had Alzheimer's. Executive functioning is one of the first things to go. Obviously, the working memory but inhibitory control also.
Vicki: Definitely.
Paul: Those impulses, they just can't control those anymore. So, you can see that this is a description of problems that could come up in a variety of circumstances. Let's talk for a minute about some of the strategic things we can do. Vicki, you've done some things with kids especially in a school setting to help them with organizational skills. Can you talk about that for just minute?
Vicki: When setting up organizational skills for children, a lot of times you want to make sure that they have a place and a situation for everything. A very specific place where their schoolwork is kept. Maybe where they put their backpack when they come home. Working in a school, I know the children that I can send a note home and the parent will get it and others that I cannot do that with because their organizational skills are not there. So, as a parent, maybe you have very specific boxes or things where their toys can go. Maybe your child can separate the toys, and if you have one that can’t, they all go in one box. But you are going to try to teach them how to manage their skills according to their own personal traits.
Paul: Yes. And this could be as simple as an organizational system for their backpack, for example. We are talking about a school kind of application, but this could be in a home too. Where everything has a place, everything has a home. I remember you used to teach our kids this way. “Everything has a home. Where is this things home?”
Vicki: What the kids probably remember is “Gum has 2 places. Your mouth or the garbage can. Which one is it going to be?” Don't be touching it. That was a big one for me because I found gum in the carpet too many times. But we want to help our kids organize. And this can mean also lists in a lot of different manners. We would organization our chores, or our activities, or what was expected for the day. We have used things like popsicle sticks that you move from place to the next until everything is done. You know, things might be cleaning my bedroom and brush my teeth, doing the dishes, whatever. So, you can use organizational tactics that way or you could make an actual list. List it out for kids, especially kids with executive functioning problems. A lot of the times, they just don't know where to start, so making lists is really important. And then teaching them the skill to go back to the list. So, when they come to you and say, “I don't know what to do next.” So, let's grab your list. You did this, you did this. So, what would be next? And you are helping them discover what is next. This is so key. It's great to do in the elementary school year ages. Teachers are still really willing and available to help children. As you teach them to go to the steps, you are teaching them that ability to then go off at the secondary level and do it themselves where the teachers are not so likely to come over and point out the next step.
Paul: Obviously, also you're going to adapt this to the development and maturity of the child. So, the list might be simply visual pictures. The steps for brushing the teeth for example might be posted on the bathroom mirror where it shows someone pulling out the toothbrush and then putting the correct amount of toothpaste on their brush. And then brushing the teeth for a certain amount of time. And then it can graduate to more written lists. I remember Vicki did this with our kids in terms of chores around the house. Each room had a little list right by the light switch about what was required for that room to be clean to her satisfaction. And as long as they had done everything on the list, they knew that they had accomplished that particular chore. So, adjust and adapt according to age and maturity. Another thing that we can do to help kids with executive functioning problems is behavioral training. Now, we won't go into a lot of detail here but I will link up at the bottom a video you can watch about this topic. The idea here is simply training these kids to do things in a way that you prefer. And it has to be done in a way that makes sense to them. When you ask yourself, “Why should my kid do this?” You've got all kinds of answers. They don't have so many. So, when I say behavioral training, I'm talking about connecting with those kids at their current level and stage of development in a way that's going to make sense for them.
There are a lot of challenges for parents, and we have some resources for you. Our Parenting Power-Up program is where we get down to the nuts and bolts of how to actually implement some of the things that we talk about on YouTube. I hope that you are connecting with some of the ones we've created for you. Go to www.drpauljenkins.com/breakthroughcall to speak with one of our coaches who can let you know about the resources and tools we have developed with you in mind.