Executive Functioning

[Anonymous]

Our DC (a rising 6th grader) recently completed a battery of tests which suggests an executive functioning deficit. If you have a child in an independent school who has executive functioning deficit, what strategies has the school/teacher used to help your child succeed? Similarly, what strategies do you use at home?

[Anonymous]

Saw your post on the other board. Welcome! Saw the suggestion of medication-- have to say in the one case I witnessed all last year, after the entire year of strategies/tutoring, the thing that worked best was medication.

This child entered middle school and just floundered in the sea of homework, tons of transitions, 9 different teachers, schedules on different days. She struggled to get the homework done in 4-5 hours at night. The mom got a tutor who provided homework help and strategies, they got colored binders, she went on a 504 plan at the school, the mom emailed constantly following up on the assignments. Finally the child was diagnosed with ADD inattentive type with executive functioning problems. She started Strattera which didn't work, and then went to adderall (ritalin).

The change was instant and amazing. She stopped having homework at all, as she completed it all during the school day. No more lost papers, etc. Excellent grades. Her mom was thrilled.

So just food for thought-- good luck!

[Anonymous]

Don't just rely on medication. It is also helpful to use strategies and in some cases therapy, because ADHD does have other issues that come with it...anxiety, depression, aggression, etc. Strategies that could be successful for your child are simple things like a checklist, timer, have your child repeat instructions back to you, rewards/punishment (1:4 ratio (for every 1 correction, you need to reward 4 times)), behavior contract, problem solving strategies, and most of all a lot of praise! Sometimes they just need a break. Find out what destresses your child, then get back to work. Also, encourage your child to ask for help. This is a very important skill for every child.

[Anonymous]

Thank you for all your responses. I just want to clarify that the psychologist was pretty explicit in stating that DC does not have ADHD. I'm not sure if various psychologists use different lingo for the same thing. But from what we understand from the psychologist, ADHD and executive functioning deficit (EFD) are two different things. Many (a little more than 50%) who have ADHD also demonstrate EFD, and certainly ADHD combined with EFD can be complicated. However EFD impacts about 12-15% of the population. We were told there is not much research on how medication affects children with EFD. Inattention and hyperactivity respond well to ADHD medication, but EFDs often don’t. At this time we are not considering medications but wanted to know if anyone had success with other strategies, CogMed for example or other brain exercises.

[Anonymous]

Anonymous wrote:Thank you for all your responses. I just want to clarify that the psychologist was pretty explicit in stating that DC does not have ADHD. I'm not sure if various psychologists use different lingo for the same thing. But from what we understand from the psychologist, ADHD and executive functioning deficit (EFD) are two different things. Many (a little more than 50%) who have ADHD also demonstrate EFD, and certainly ADHD combined with EFD can be complicated. However EFD impacts about 12-15% of the population. We were told there is not much research on how medication affects children with EFD. Inattention and hyperactivity respond well to ADHD medication, but EFDs often don’t. At this time we are not considering medications but wanted to know if anyone had success with other strategies, CogMed for example or other brain exercises.

Can you be more specific as to what types of deficit? For example, is it working memory, organization etc? That might be helpful in formulating responses.

[Anonymous]

Yes, exactly -- working memory and organization. DC was extremely motivated and focused during the two days of testing There were no distraction issues at all.

[Anonymous]

With respect to CogMed, I have posted on this board before asking if anyone has tried it and no one has (although there have been positive articles written about it). You can search the archives for the posts. My son is just going into 3rd grade and he has both ADHD (inattentive type) and major executive functioning issues and I don't feel he is quite ready for CogMed yet. He is still in speech therapy for auditory processing and is doing OT (not to mention his psychiatrist and his social group) so maybe once he makes some more progress towards the end of the next school year we will revisit it. There is only so much we can do at one time .

[Anonymous]

I really think you should not blow of the med suggestions so quickly. The meds help with the executive function of people with ADD. It's also used for executive function in other disorders like tramatic brain injury. I suggest speaking with a child psych for more info if you haven't already. They will help his executive function...that's what they are for regardless if it is a primary executive dyfunction or a condition associated with ADHD, TBI, etc. I think you are confusing the ADHD issue, ie, he doesn't have a ADHD diagnosis so he doesn't need meds.

You will be putting your child through a lot with the interventions etc. and it's going to be very tough. I think his life will be whole lot easier if the root cause is helped with medication and strategies are implementing in conjunction.

[Anonymous]

Here are some links to scientific studies to support the use of stimulant meds in executive dysfunction:

http://www.ncbi.nlm.nih.gov/pubmed/10405075

http://www.ncbi.nlm.nih.gov/pubmed/11513378

http://www.nature.com/npp/journal/v31/n11/full/1301164a.html

[Anonymous]

FWIW, my child with working memory issues now takes the "Attentive Child" supplement and a fairly high dose of omegas, Nordic Natural brand. That combined with addressing an underlying hypoglycemia with frequent meals and cutting out sugar has really made a difference, his brain literally seems to work better and more consistently. Attentive Child is dosed based on weight, you can get it at Whole Foods or more cheaply on the internet. It made a huge difference for DS, whereas coaching was of very limited benefit, he did not seem to remember the strategies, etc, much of the time. The school noticed a big difference.

[Anonymous]

I am not the OP but this Attentive Child supplement sounds very interesting (I don't mean to hijack). Do you know if it can be taken in conjunction with medication? He is on 5mg of Adderall (more gives him the "flat effect" and we tried several others that did not work at all). I am going to ask his psychiatrist about it at his next appointment. Thanks!

[Anonymous]

Anonymous wrote:I really think you should not blow of the med suggestions so quickly. The meds help with the executive function of people with ADD. It's also used for executive function in other disorders like tramatic brain injury. I suggest speaking with a child psych for more info if you haven't already. They will help his executive function...that's what they are for regardless if it is a primary executive dyfunction or a condition associated with ADHD, TBI, etc. I think you are confusing the ADHD issue, ie, he doesn't have a ADHD diagnosis so he doesn't need meds.

You will be putting your child through a lot with the interventions etc. and it's going to be very tough. I think his life will be whole lot easier if the root cause is helped with medication and strategies are implementing in conjunction.

Thank you for your post. However, I think you are making assumptions in the absence of enough information. We have not blown off medication. though we certainly are not going to use it as a first step. We are not considering it at this time. We have spoken extensively with the child psychologist who conducted the two days of testing for DC. Medication was not recommended.

[Anonymous]

PP 11:01 thanks for the suggestions regarding attentive child. We'll take a look. Our other DCs use the Nordic brand for omegas. However, this one is allergic to white fish and cannot.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I really think you should not blow of the med suggestions so quickly. The meds help with the executive function of people with ADD. It's also used for executive function in other disorders like tramatic brain injury. I suggest speaking with a child psych for more info if you haven't already. They will help his executive function...that's what they are for regardless if it is a primary executive dyfunction or a condition associated with ADHD, TBI, etc. I think you are confusing the ADHD issue, ie, he doesn't have a ADHD diagnosis so he doesn't need meds.

You will be putting your child through a lot with the interventions etc. and it's going to be very tough. I think his life will be whole lot easier if the root cause is helped with medication and strategies are implementing in conjunction.

Thank you for your post. However, I think you are making assumptions in the absence of enough information. We have not blown off medication. though we certainly are not going to use it as a first step. We are not considering it at this time. We have spoken extensively with the child psychologist who conducted the two days of testing for DC. Medication was not recommended.

I'm sory if I offended you. I was honestly trying to provide helpful info. I am an adult with executive dysfunction (among a few other things) and struggled throughout my schooling without medication. I had an IEP with MCPS, a team of professionals, tutors, all the support and love in the world from my parents. But, these things didn't solve the organic problem. All the charts and lists and timers were overwhelming and I resented all the energy I had to put into them.

As an adult I've struggled with time management and organization and impulsivity. Once I went out to lunch with my family and came home with a car I couldn't afford...impulsive to the highest degree. My credit score sucked because I couldn't keep organized and I was constantly getting reprimanded at work for lateness.

I finally broke and went to a psych and was put on Metadate. It was a godsend. My life was instantly easier. I worked with a pyschologist for coping mechanisms as well. I can't emphasive what a positive impact the medications have made for me.

I personally wished with all of my heart that I was medicated growing up. I think my experience in school and my subsequent career would have been dramatically different. By the time I graduated from highschool I had no interest in persuing a degree. I wanted nothing to do with a classroom any more.


The NIH studies that were posted are very compelling and clearly state a marked benefit. Your psychologist is not well informed if you were told that medication does not help. If nothing else please seek a second opinion.

Good luck to your family. I really hope my perspective is helpful for you.

[Anonymous]

I wanted to point out that psychologists are not medical doctors. They can not perscribe medications and should not be giving guidance more than an opinion on the matter.

I'm certainly not saying that there aren't a great number of highly qualified psychologist with a wealth of valuable expertise. But their role is not to recommend or not recommend medications for DSM conditions.