Executive Function Disorder In Children
The human brain is the most intriguing part of the anatomy. It acts as a funnel taking in information, aiding you to respond, plan and act accordingly. Yet, this tricky muscle can be taught tricks
By Komal Porecha
The executive function, which refers to the mental and cognitive abilities, of the brain plays a pivotal role in our day to day lives. It helps us get started on a task, get organised, stay focused on it, follow through, respond in accordance and finish it to the end within a time frame.
Children today, live in a technology-infused, hyper-stimulated environment. It is important for every parent, teacher and academic institution to be aware and understand their growth and development patterns. And, even more important is to identify these patterns correctly and address them in a suitable manner. The executive function, from an early age, helps children to get things done. Executive function disorder (EFD) tends to come to light when children start school and are given specific tasks to complete.
“Psychotherapist - Erinda Shah, is part of Mental Health First Aid - India (MHFA-I) and is focused on issues concerning mental health. Passionate about creating public awareness on mental health issues to reduce social stigma in the country; Erinda throws some light to help better understand the executive function disorder. “
What is executive function?
Executive function is yet to be categorized as a diagnosis with Diagnostic & Statistical Manual of Mental Disorders, 4th edition; (DSM IV) and many specialists do not consider it as a mental health problem. Rather they view it as a weak capacity of a person to put into work certain mental skills. It is a deficit or problem that needs to be acknowledged and addressed.
It allows us to plan and organize and to link our past experiences to the present. Executive function helps us to manage time, pay attention, switch focus, plan and organize, remember details and do things based on experience.
With children; such concerns emerge when they start school where they are introduced to more complex tasks, problems to resolve and projects to plan & execute independently. Simply put; when we hear teachers or parents complaining how disorganized a child is and how he/she is not able to get things done properly; it may be a sign of the executive function disorder.
Executive functioning is controlled by the prefrontal cortex:
Research has shown that people who have disorders, diseases or injuries to the prefrontal cortex often develop executive functioning issues.
Experts are using that research to study whether the prefrontal cortex in kids with executive functioning issues works differently than in other kids.
To define that the child has and EF deficit are tested in different settings like school , home, and other social spaces with close collaboration of teacher, school psychologist, friends, coaches.
Executive function disorder can develop at a later stage:
Researchers give a good amount of credit of executive function problem to the gene and heredity. Many studies are in process to understand the difference between the brain of a child of executive function and other kids.
Executive function disorder can be developed at a later stage in life as well due to injury, or development of other diseases like ADHD, dementia which has functionality depending on the prefrontal cortex.
Warning signs a child may be having problems with executive function:
Children’s lives today are far more complex. Factors such as technology, the internet, spending lesser time in outdoor activities, demands in the education system, directly and indirectly, contribute to the child’s formation and development.
There are complex issues involved in a child’s performance and we should be very restrained and take all the necessary time to study the behaviour of each child before stamping a diagnosis on paper.
Usually they struggle in three main domains:
1. Being organized
2. Managing time
3. Performing in school
A check list which is not exhaustive can be:
• Struggle to do school work.
• Forgetting their homework.
• Cannot resolve problems that have several steps.
• Cannot understand the essence of a story/lesson.
• Cannot build sentences in a logical way.
• Cannot remember what learned early.
• Cannot stay on top of the things they have to do.
• Forgetting and loosing things regularly.
• Problem with working memory.
• Lack of Fluency.
• Switching from one activity to another.
• Lack of attention.
• Keeping their things organized.
• Completing the tasks.
However, those signs should be persistent for a minimum of 6 months. One needs to be very careful though to understand many aspects of the child’s life before coming to a conclusion.
Separation of parents, loss of family members, bullying, and other traumatic events which can lead to high levels of stress in children can temporarily lead to a problem with the executive function.
Careful analysis of the child’s behaviour in different settings such as home, schools and other social activities needs to be carried out to exclude matters that may be causing temporary stress.
Educators recognize the need to identify young children who may require intervention because the sooner intervention is initiated, the greater the possibility for remediating the problem. Executive functions play a fundamental role in a child's cognitive and social-emotional/behavioural functioning; hence the importance of early detection and early intervention is necessary.
Studies suggest that children diagnosed with ADHD, dyslexia exhibit problems of executive function. However, even children with no ADHD can struggle with executive function.
What if the child’s environment is not conducive to this growth?
It is difficult to find data on executive function disorder among children in India. However, research in developed countries suggests that the executive function disorder is common and it can be compensated if recognized and worked diligently to make up for the weaknesses.
There may be several reasons for a non-conducive environment such as lack of decent parental care, social stigma, lack of knowledge on the topic and how to deal with it. Not only from parents but the faculty and staff at schools and lack of access to mental health services.
At school, parents can ask and work together with the teacher for an Individualized intervention/ education plan.
What kind of support can parents provide to develop these skills?
Educational strategies and behavioural approaches for addressing executive function difficulties, suggested by the National Center for Learning Disabilities in USA include:
- Take a step-by-step approach, break down long assignments into chunks
- Use visual schedules and review them frequently
- Create checklists and “to do” lists
- Organize work space and minimize clutter
- Schedule a weekly time to clean and organize
- Meet with teacher/supervisor on a regular basis to review work and troubleshoot problems
More specifically, in the classroom, they may need extra help to understand assignments, get started, and stay focused. Stickers, coloured cards that can remind the child of the tasks, making the child repeat instructions, assisting the child with peers to help in taking notes; can make a difference in the school performance.
At home set a clear visual organizer, set clear space for the child to study, let the child be active for a bit before sitting down to study, break the home work and tasks into segments if he/she is unable to keep up with time use a timer.
Technology and several games can help in sustain attention like Monopoly. Teachers and family members should focus on the achievement and praise and reward them.
If the child is detected with impairment, what is the treatment available in India?
The prevalence rate of child and adolescent mental disorder in India is suggested to be 12.5% among children aged 0-16 years old.
Access to mental health services for children with a mental, emotional or behavioural disorder is currently substandard. It is not provided early enough, there is in sufficient supply and accessible only to a fraction of children and adults.
A parallel problem in India is the high prevalence of social stigma. Societal pressures and inhibitions of being ostracized or labelled prove to be huge deterrents for parents to seek timely help for their child.
At this juncture, educating the public on mental health issues among adults and children may help in reducing this hurdle. Early identification of symptoms and problems, providing help and creating a supportive environment, accessing professional services when possible would help avoid severe mental health issues in adulthood.
In today’s world, awareness coupled with an open minded, comprehensive approach to your child’s growth and wellbeing is crucial. Providing a conducive environment without jumping the gun is as important as reaching out for help should he/she need it. Certain hurdles might prove worrisome and tend to wear patience thin; but then; “Behind every young child who believes in himself is a parent who believed first.” — Matthew Jacobson, blogger
Erinda Shah can be reached on: firstname.lastname@example.org
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