Thursday, March 10, 2016

Executive Functioning and the Impact on Leaning



Executive functioning is a complex issue.  I know since all my children have executive functioning issues! The real question is how does executive functioning issues impact learning in both the homeschool and public education environment?

First, let's discuss homeschool.  It is easier, when you homeschool, to address executive functioning issues because you can tailor a child'e learning environment around their disabilities.


So what is executive functioning?

WebMD defines executive functioning as a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.

Executive function helps you:
  • Manage time
  • Pay attention
  • Switch focus
  • Plan and organize
  • Remember details
  • Avoid saying or doing the wrong thing
  • Do things based on your experience

When executive function isn’t working as it should, your behavior is less controlled. This can affect
your ability to:

  • Work or go to school
  • Do things independently
  • Maintain relationships
This is a huge problem for children with ADHD, depression, and learning disabilities. These conditions are often associated with issues with executive functioning. 

How does executive functioning impact homeschool?

When you have a child with executive functioning problems you cannot expect them to manage their time, day, or classwork.  They will have a difficult time organizing information and paying attention to the task at hand.  They will have problems with switching between tasks and are horrible multi-taskers. This means you will need to give them more one-on-one attention in both tasks and academics.  For my three children this means I have to teach them all separately.  They cannot be taught as a group in reading and math.  We do these separately.  For science, history, and social studies we learn these together.  I often have James or Margaret read while the others listen and ask questions. Since retaining information is also an executive function issue and an issue with working memory (another common problem with EF and in my children) we often will repeat the same lesson 2 to 4 times in the same week.  This helps the children to retain the information they are learning. This is something I can do in a homeschool setting that would not typically occur in the public school setting.


How does executive functioning impact school?

Executive functioning in a public school setting can be a nightmare and this is one of the reasons why I enjoy homeschooling.  It is often called by parents an "invisible" disability.  The signs are often subtle but there. Then there is the challenge for parents to figure out the symptoms are issues of executive functioning and request a school district to test for EF issues. 

So which tests can tell if a child has a problem with executive function issues? Well, the sky is the limit!  LOL   There are a LARGE verity of tests, partially because EF covers so many functional areas, so it is hard to say which test could be used to test your child.  Some of the more common tests are:

  • Wisconsin Card Sorting Test
  • Category Test
  • Stroop Test
  • Trail Making Test-B
  • WAIS Subtests of Similarities and Block Design
  • Porteus Maze Test
  • Multiple Errands Test (MET)
  • Serial Sevens
  • Mini-Mental State Exam
These tests should be used in conjunction with other other testing to examine Intellectual functioning, Academic achievement, Language processing, Visuospatial processing, Attention/ concentration, Verbal learning and memory, Visual learning and memory, Speed of processing, Sensory-perceptual functions, Motivation, and Personality assessment. All of these tests play a role in defining issues with executive functioning and other learning disabilities. Most of these tests are best completed by a neuropsychologist.  I promise you a school district will never have a neuropsychologist on staff no matter what they say.  If it does ever happen someone please let me know but I feel confident in my statement. Why? It is because a neuropsychologist is a specialist and schools tend to only employ psychologist for testing. 

What is a neuropsychologist and how are they different from a school/typical psychologist?

There are basically three types of psychology: clinical, school, and neuropsychology. Clinical psychologists assess and treat children with a wide variety of psychological problems, but particular with emotional/behavioral issues. They may be found working in hospitals, community health centers, or private practice. Although most clinical psychologists are generalists, who work with a wide variety of populations and problems, some may specialize in a specific population and specific disorders (e.g. attachment or post-traumatic stress disorder). They are trained in universities or professional schools of psychology and may not be very familiar with school settings. Clinical psychologists provide both assessment and treatment (psychotherapy).

School psychologists are involved in enhancing the development of children in educational settings. They assess children's psychoeducational abilities and recommend actions to facilitate student learning and overall school functioning. They are typically trained in the Schools of Education at universities and work in school systems, community-based agencies, or private practice. A few may specialize in a particular school-related problem such as learning disabilities or ADHD. While specializing in educational issues, they may not be well trained in medical-based disabilities and disorders. School psychologists usually administer both norm-based psychological tests and criterion-referenced educational (achievement) tests.

Neuropsychologists represent a specialized discipline within the field of psychology that mostly focuses on cognition (the ability to think, remember, learn, etc.) in relation to the effects of brain damage and organic brain disease. A neuropsychologist can administer standardized psychological and neuropsychological tests to patients in private office and hospital settings.

Why is a neuropsychologist examination helpful? 

A pediatric neuropsychologist work closely with schools to help them provide appropriate educational programs for the child. There are five major reasons why a thorough neuropsychological evaluation performed by an pediatric neuropsychologist is superior to a psychoeducational evaluation. These are the inadequate range of a psychoeducational evaluation, the training of the personnel performing psychoeducational evaluations, the narrow focus of psychoeducational evaluations, the level of performance model employed in psychoeducational evaluations, and the failure of psychoeducational evaluations to assess brain behavior relationships. The school and general psychologist tend to focus on achievement and skills needed for academic success. Generally, they do not diagnose learning or behavior disorders caused by altered brain function or development.

Even in the homeschool setting this testing is very helpful to the parent so the parent can understand the learning deficits and strengths of their child.  This will help the parents to better teach their child in the home setting.

Children are referred by a doctor, teacher, school psychologist, or other professional because of one or more problems, such as:

  • Difficulty in learning, attention, behavior, socialization, or emotional control; 
  • A disease or inborn developmental problem that affects the brain in some way; or 
  • A brain injury from an accident, birth trauma, or other physical stress. 

A neuropsychological evaluation assists in better understanding your child’s functioning in areas such as memory, attention, perception, coordination, language, and personality. This information will help you and your child’s teacher, therapists, and physician provide treatments and interventions for your child that will meet his or her unique needs.

A pediatric neuropsychologist can evaluate school-age child many areas such as:

  • General intellect 
  • Achievement skills, such as reading and math 
  • Executive skills, such as organization, planning, inhibition, and flexibility 
  • Attention 
  • Learning and memory 
  • Language 
  • Visual–spatial skills 
  • Motor coordination 
  • Behavioral and emotional functioning 
  • Social skills 
Some abilities may be measured in more detail than others, depending on the child’s needs. A detailed developmental history and data from the child’s teacher may also be obtained. Observing your child to understand his or her motivation, cooperation, and behavior is a very important part of the evaluation. Emerging skills can be assessed in very young children. However, the evaluation of infants and preschool children is usually shorter in duration, because the child has not yet developed many skills.


So what can the results from the testing tell you?


By comparing your child’s test scores to scores of children of similar ages, the neuropsychologist can
create a profile of your child’s strengths and weaknesses. The results help those involved in your child’s care in a number of ways.

Testing can explain why your child is having school problems. For example, a child may have difficulty reading because of an attention problem, a language disorder, an auditory processing problem, or a reading disability. Testing also guides the pediatric neuropsychologist’s design of interventions to draw upon your child’s strengths. The results identify what skills to work on, as well as which strategies to use to help your child.

Testing can help detect the effects of developmental, neurological, and medical problems, such as epilepsy, autism, attention deficit hyperactivity disorder (ADHD), dyslexia, or a genetic disorder. Testing may be done to obtain a baseline against which to measure the outcome of treatment or the child’s development over time.

Different childhood disorders result in specific patterns of strengths and weaknesses. These profiles of abilities can help identify a child’s disorder and the brain areas that are involved. For example, testing can help differentiate between an attention deficit and depression or determine whether a language delay is due to a problem in producing speech, understanding or expressing language, social shyness, autism, or cognitive delay. Your neuropsychologist may work with your physician to combine results from medical tests, such as brain imaging or blood tests, to diagnose your child’s problem.

Most importantly, testing provides a better understanding of the child’s behavior and learning in school, at home, and in the community. The evaluation can guide teachers, therapists, and you to better help your child achieve his or her potential.

Wrap up


Links have been included in the blog to the sources of my information. Some of the information comes from personal experience. All of my children have executive functioning issues.  The executive functioning is also impacted by their working memory issues and ADHD. Knowing my children have executive functioning issues has really given me a lot of patience since I now understand their limitations and issues.  I don't get so annoyed when I have to repeat myself 6 times or get angry when I ask for a task to be completed and it never gets done. I understand now and know the problem.  It has made me think about how I parent my children, my expectations of them working independently, and what I need to do to help them in the future.

I am including a link to a list of accommodations written up by a school district in New York that covers all areas of executive functioning and has accommodations from Kindergarten to 12th grade. It is a great resource for both the homeschooled and public schooled child.  The link can be found here and it is a PDF.  I am also including a link (click here) to a redacted version of Margaret's last neuropsych report. It is not as comprehensive as it could be because all my children had neuropsych testing completed three years ago but it gives you a good idea how a report should be written and what to expect. I hope this has been help and always feel free to send me questions in the comment section!


1 comment:

  1. That was a wonderful wealth of information on executive functioning and the tests that can be helpful to use to tailor education to fit the needs of individual students. Love it!

    ReplyDelete