Questions about Executive Functioning

[Anonymous]

I know enough to be "dangerous" at this point, so I'd appreciate some thoughts and advice. I have a general understanding what executive functioning is, and I know that some believe that ADD is a "malfunction" of executive functioning (not sure if the opposite is true - i.e. that problems w/ executive functioning are all related to ADD).

Here is my concern. I look at DH and some other members of his family and I see lots of executive functioning problems - poor judgment, inability to plan, poor impulse control and anger management, etc. Perhaps this is all undiagnosed adult ADD - not sure if it matters. But I also see some issues with my 4 y.o. His impulse control isn't great - it is much improved from when he was 2 and 3, but we can't, for example, sit on the couch without his jumping or climbing on us. He's always had really good temper tantrums, and while they may be slowing down he still can get easily upset and scream rather than use his words. For example, if he's watching something on the computer and it stops functioning, he'll start to scream or cry rather than calmly tell us that there is a problem or ask for help. I have to remind him, probably at least once a day and more on weekends, that I can't understand him unless he speaks calmly, and that he needs to use his words so we understand that he needs help. And I give him words to use ("You can just say 'Mommy, I need help with the computer' and I'll come help you"). He is better at calming down and getting to using his words more quickly than when he was younger, but still needs reminders at least once most days. He seems to do fine at school, though his teacher is young so I'm not sure problems would be detected. (Plus, the school is pretty laid back in terms of giving children time to mature, so expectations aren't as high as what I hear other schools expect.) He does complain that he doesn't like rest/nap time at school because he doesn't like sitting still - perhaps that is because he is not getting as much exercise since it is winter or perhaps it is more. He is in OT for some sensory as well as motor planning issues, though the school and OT both tell us that he'll be "fine" once he finishes treatment.

One question I have is whether executive functioning problems are like autism or some other developmental issues in that it is better to get a diagnosis and treatment sooner rather than later? And, if so, who would do that? Or is this something I give another year or two to see if he is just slow to mature, or to see if there is an ADD diagnosis (which I understand is probably better made at 6/7 than now; and actually, I don't think we'd be able to show there is a problem with school functioning right now, so I don't think we could get an ADD diagnosis at the moment.)?

[Anonymous]

There are a ton of questions here and I'll just try to respond a bit.

Poor judgment, inability to plan, impulse control and anger management are qualities that many people have. In fact, we ALL have these issues from time to time. So as you look around your family and decide that they must have ADD because they occasionally can't manage their impulses/anger/planning/judgment I think you are misunderstanding executive functioning. People who consistently cannot control their impulses, their anger, etc. MAY have executive function issues. They may be having trouble processing their thoughts and systematizing their actions.

That having been said, no young child is going to display the level of frustration tolerance that is ideal. If something goes wrong with the computer while he is enjoying a fast-paced computer activity, you are not going to see a calm request for aid. It's going to be a bit of a crisis for him. I think you're expecting too much. Add in executive functioning issues, and the notion that he can calmly request aid while still having his mind on the computer game is really tough, OP.

Giving him reminders about what to say and do is your job, OP. It's part of being a mom. Expecting perfect behavior is not reasonable. I think the school is correct -- he will mature and grow out of this.

[Anonymous]

I think I'd take DC to a developmental pediatrician. It certainly can't hurt and the more information you have, the better. I was going to wait til my DC was 5 or 6 for an evaluation but now feel that at 4, he needs help and I'd rather start early than later.

[Anonymous]

Anonymous wrote:One question I have is whether executive functioning problems are like autism or some other developmental issues in that it is better to get a diagnosis and treatment sooner rather than later? And, if so, who would do that? Or is this something I give another year or two to see if he is just slow to mature, or to see if there is an ADD diagnosis (which I understand is probably better made at 6/7 than now; and actually, I don't think we'd be able to show there is a problem with school functioning right now, so I don't think we could get an ADD diagnosis at the moment.)?

I don't know if getting an ADHD evaluation right now would really shed much light on things right now. I'm not seeing anything that just screams ADHD and you didn't mention a signficant negative impact on your home life or school so it's likely that an evaluator would take a "wait and see" approach. I haven't found a whole lot that improves executive functioning other than maturing and repetition. (If anyone can chime in, I'd be happy to learn something new). We've had similar issues that you describe with our DS who's now 7. The OT adapated the How Does Your Engine Run program to ehlp him better understand his regulation and what he can do to change how he's feelings. It's worked really well for our DS and we use the same techniques with our younger kids.

I would recommend you continue to learn more about ADHD (have you found CHADD?) and keep watch. When your DS enters the more structured, demanding environment of K, it may be more clear to you. If your DS gets an enlightened teacher, you could share your concerns/observations and ask for feedback. But, don't rely on the school exclusively. It's hit or miss with them.

[Anonymous]

OP here. Thanks. I should point out that my concern stems from seeing these certain family members really struggle with life - unemployment, financial crises due to making poor decisions or lack of impulse control when shopping, failed relationships, etc. I'm not talking about run-of-the-mill issues that most of us have from time to time; these are people who are really unhappy because they can't function like the rest of us (despite being smart and educated). Obviously, I'm not a clinician and can't diagnose them, but there's something going on with them. So I worry about my son's future, given my understanding that some executive functioning problems (ADD) are heredible (sp?). To whatever extent he might be prone to these issues and I can help him function better in life, I want to do that.

[Anonymous]

OP, my son has both executive functioning issues and ADHD, and he is nothing like what you describe. Maybe because his ADHD is the inattentive kind, but literally, the things you describe sound nothing like what I worry about in him.

[Anonymous]

I totally understand where you're coming from, OP. I see just what you describe extensively in my own family. It's had some very tragic consequences in my family and I'm determined my kids won't suffer the same fate. No one in my family was diagnosed with a disorder but in hindsight it's clear that ADHD was as factor. I'm assured by professionals that my kids are unlikely to follow in my family footsteps because we've identified challenges so early, are addressing them and making sure our kids are educated about their challenges - forewarned is forearmed. My advice is along the lines of the others - learn all you can, set up good structures/routines, have an effective and consistent approach to discipline and keep an eye out. The CHADD site has some really good resources. I especially like their monthly magazine Attention. They also periodically run parent-to-parent ADHD workshops which are good. HTH.

[Anonymous]

poor judgment, inability to plan, poor impulse control and anger management, etc. Perhaps this is all undiagnosed adult ADD - not sure if it matters.

These can be symptoms of a lot of things. I know a few adults who have self diagnosed themselves with ADHD-inattentive, but upon further evaluation it was depression or anxiety. Not saying that adult ADHD does not exist, but it is often co-morbid with other things. As a PP said, everyone has "executive function" issues at times. But especially for men, chronic anger management issues is a red flag for depression. http://www.webmd.com/depression/depression-men

[Anonymous]

OP here. I'll give some other examples of concerns. We recently went to a play (for ages 3-5), and out of at least three dozen kids there, many of whom were at least a year younger, my son was the only one who wasn't sitting still and paying attention for most of the time. Some kids got restless towards the end, but my son was changing positions and crawling on top of me most of the time (I would have left but we were there for a party). Perhaps this was due to self-selection - people with kids who won't stay still don't go to these things - I don't know. My son also doesn't (won't?) say hello or goodbye to his friends and classmates - I don't know what's going on there.

So . . . . some things he does I understand, other things make me worry. But I appreciate the links to CHADD and I guess I just have to keep watching and waiting.

[Anonymous]

Anonymous wrote:

poor judgment, inability to plan, poor impulse control and anger management, etc. Perhaps this is all undiagnosed adult ADD - not sure if it matters.

These can be symptoms of a lot of things. I know a few adults who have self diagnosed themselves with ADHD-inattentive, but upon further evaluation it was depression or anxiety. Not saying that adult ADHD does not exist, but it is often co-morbid with other things. As a PP said, everyone has "executive function" issues at times. But especially for men, chronic anger management issues is a red flag for depression. http://www.webmd.com/depression/depression-men

My husband has these characteristics and was diagnosed as an adult with ADHD and depression, for which he now receives treatment.

DC, age 9, was also just diagnosed with ADHD primarily inattentive. We got the dx through nueropsychological testing. In retrospect, she shows a lot of the same issues and some other, learning-based ones. She was misdiagnosed at age 7 with dyslexia, which led to ineffective treatment until we straightened out the dx.

All this to say -- you may be right about the adults in your family, and it's good to keep an eye on your child as he develops. I think age 4 is too young to effectively test but I wouldn't wait as long as we did, if the indicators persist.

[Anonymous]

OP, your DS sounds a lot like mine.
His DX - ADHD/Inattentive with Expressive/Receptive Language disorder.

I think your son not saying hello or goodbye to his friends could be an expressive/receptive language issue. If so, you need to need to see a Speech/Language Therapist.
...unless you're saying that he does not interact with other children at all (spectrum-ish) ?
Kids with expressive/receptive interact and play, but don't always understand the inferences and nuances of all conversations. and those need to be taught unlike typically developing kiddos where it comes naturally.

Your DS also sounds like he has some sensory issues going on - the changing of positions during the play, crawling on top of you. Those are sensory seeking actions.

Definitely needs neuro-psych testing.

[Anonymous]

OP - your son sounds very similar to mine, now 6 years old. He is half way through kindergarten, and although we've struggled with issues at home with him for years (impulse control, argumentative, can never sit still, jumps around/runs round/spins around, mood swings), it was never a problem at school until K. We're starting to see negative social effects of his behavior too, so we've decided to get him evaluated for ADD/ADHD . It runs in my family, so I wouldn't be at all surprised if that's what it is. My family members, and my husband's family members, went untreated for years and some have never been treated; they've all suffered negative impacts throughout their lives. My take is to look into it now b/c what can it hurt? Someone on this message board directed me to an NIMH study where they accept patients as young as 4 years of age. If you're really struggling at home, you may want to look into it.

[Anonymous]

The good thing about an evaluation is that also you get recommendations for therapies to try. Behaviorial? play group for social skills? OT? Speech? They will probably help and can't hurt (except for time and money involved, most likely).