Understanding Executive Function and Its Importance for Your Child in School and Completing her School Work

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The Plan to Make a Plan

          Executive function skills are the mental skills that allow oneself to accomplish set goals. These skills allow you to plan, prioritize, hold details in memory, become flexible in strategy to achieve a goal, avoid distractions, discount the immediate for the returns of the future, manage time, manage emotion, and so much more.  Many students with disabilities, especially those with ADHD, have difficulty with their executive function skills.  These students are unable to produce the product that they wish to complete.  They have a plan to make a plan but don’t quite get there.  The internal mechanisms that allow a student without executive function deficits are not present, therefore, the work product for students with executive function deficits becomes stalled or halted.

          Not surprisingly, an academic environment such as attending school calls upon executive function skills to be successful and as a child progresses through grades, these skills are called upon even more.  A child needs to create a plan to complete their homework each night and then get it back to the teacher the next day.  A student writing an essay needs to hold in working memory their thoughts, vocabulary, recent teachings in their classroom, grammar rules, etc.  A student studying for a test needs to create a study plan, prioritize what to study, remove the distractions while studying, and self-monitor their understanding.  Long-term projects require planning, monitoring, and time management.

            One can easily see how students with executive function deficits can quickly struggle to do well in school.  Couple these difficulties with learning disabilities and a student now has complications with production output (executive function weakness) and learning input (learning disability).  However, just as with learning disabilities, executive function skills can be supported.   

     

                                                                                         

a production output disability - Behavior Regulation and Metacognition

          It is widely recognized through a considerable amount of research that executive functioning holds a major role in determining student academic and life success.  But what exactly is executive functioning?  Executive function is the ability to control one’s cognitive function to achieve a goal.  It has been defined as a set of regulatory processes necessary for selecting, initiating, implementing, and overseeing thought, emotion, behavior, and certain facets of motor and sensory functions (Roth et al., 2005, as cited in Schroeder, Kelley, 2008).  It has also been noted that executive functioning has two dimensions, behavior regulation and metacognition (Gioia et al., 2000, as cited in Schroeder, Kelley, 2008).  Behavioral regulation is the ability to effectively control one’s own behavior and emotions, to exhibit appropriate regulation of thoughts, actions, emotions, and adaptability to changes that occur in problem-solving tasks (Roth et al. 2005, as cited in Schroeder, Kelley, 2008).  Metacognition involves planning and organizational abilities to solve problems through appropriate control of working memory (Roth et al. 2005, as cited in Schroeder, Kelley, 2008).  

         One’s ability to use hindsight, self-talk, anticipate, plan, discount the present for a distant and gratifying future, hold in memory, resist distractions, shift plans, self-monitor, problem-solve and redirect oneself are necessary executive function abilities to achieve a goal and find success.  These are necessary skills in studying for a test, completing homework on a sunny day, planning for an essay, and finishing projects both in the short and long-term.  It is a production output disability.  The student may have all the knowledge necessary to complete their goal (the necessary input), but is unable to demonstrate their abilities due to the many obstacles involved in reaching the goal (the output).

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The School Curriculum Effect

          Recent changes in public education may have inadvertently compounded the problems of identification and diagnosis of executive function disorder by placing a strong emphasis on high-stakes testing and, consequently, shifting the curriculum toward what appears to be highly challenging, developmentally demanding goals (Meltzer, 2011).  Many students may, therefore, be required to complete academic tasks that are developmentally and cognitively too challenging.  The curriculum emphasis may, therefore, be fueling a surplus of referrals of students of all ages for assessment of executive function processes, the implication being that more and more students display deficits in this area (Meltzer, 2011).

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Executive Function and Brain Development

          It was research first presented in the 1960s and 1970s that introduced the idea that brain development, in particular, the prefrontal cortex where executive functioning abilities take place, develops beyond early childhood.  In the 1970s and 1980s, studies further proved that the prefrontal cortex is significantly changed during puberty and adolescence.  Two main changes are understood to happen before and after puberty, the myelin layer is formed and the synaptic density is changed in the prefrontal cortex.  Myelin acts as an insulator and massively increases the speed of transmission (up to 100 fold) of electrical impulses from neuron to neuron (Blakemore, Choudhury, 2006).  Synaptic pruning occurs throughout adolescence and results in a net decrease in synaptic density in the frontal lobes during this time (Blakemore, Choudhury, 2006).  The pruning’s purpose is to strengthen frequently used connections (the wirings of connections) and eliminate those that are infrequently used.

          Since MRI studies have demonstrated changes in the frontal cortex during adolescence, executive function abilities might be expected to improve during this time.  For example, selective attention, decision-making, and response inhibition skills, along with the ability to carry out multiple tasks at once might improve during adolescence (Blakemore, Choudhury, 2006).  During adolescence, behavior studies have also pointed that inhibitory control, processing speed, working memory, and decision-making continue to develop (Blakemore, Choudhury, 2006).

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Working Memory and Executive Function

          Working memory, the cognitive system that provides temporary storage of information in the course of complex activities, appears to play a crucial role both in supporting learning and in maintaining focused behavior in practical situations (Holmes, Gathercole, Dunning, 2009).  The impact of working memory on academic achievement is considerable.  Between the ages of 7 and 14 years, children who score poorly on working memory measures linked with executive skills typically perform below-expected standards in national curriculum assessments of English, mathematics, and science in England (Gathercole et al., 2003, as cited in Clair-Thompson, Gathercole, 2006).  Of children whose working memory abilities fall in the bottom tenth percentile, over eighty percent have substantial problems in either reading or mathematics or, most commonly in both (Gallercole, Alloway, 2008 as cited in Holmes, Gathercole, Dunning, 2009).  Working memory, along with inhibition, is important in learning.  Children with poor working memory function have been found to make frequent errors in a range of learning activities including remembering and carrying out instructions, keeping track of places in tasks, writing while formulating text, and carrying out mental arithmetic (Gathercole et al., 2003, as cited in Clair-Thompson, Gathercole, 2006).

          Working memory training appears to make a positive difference.  In a study that provided working memory training to twenty-two children with working memory at or below the fifteenth percentile, the majority of children in the program which adapted the training to their skill level improved their working memory abilities.  The results were still seen during the testing period and six months after the training was complete.  The training consisted of intensive training in a computerized game environment for thirty-five minutes a day for at least twenty days for five to seven weeks.  The gains generalized to independent and validated working memory assessments that were not trained, and were greatest for the tests involving either the storage of visuospatial material or the simultaneous storage and manipulation of either visuospatial or verbal material (Holmes, Gathercole, Dunning, 2009).  Math performance was also significantly helped and was seen to have an expected delayed response to the cognitive training (identified six months after training).

          Working memory improvements through strategy training and core training have also been studied and found beneficial.  Strategy training paradigms involve the teaching of effective approaches to encoding, maintenance, and/or retrieval from working memory (Morrison, Chein, 2010).  Rehearsing out loud, telling a story with stimuli, or using imagery to make stimuli salient are training strategies that have been studied and shown to increase the information remembered and increase working memory with transfer effect.  For example, participants trained to rehearse a series of images of concrete nouns showed improvements in digit and letter memory (Comblain, 1994 as cited in Morrison, Chein, 2010). Core training programs take a “kitchen-sink” approach, in which a compilation of several tasks with widely varying stimulus types is used to impact multiple components of the working memory system  (Morrison, Chein, 2010).  CogMed is a working memory computerized training program that uses computer games that increases its working memory demands as the user advances.  Six months after the training, executive function benefits remained as found in two studies (Diamond, Lee, 2011).  Another multifaceted core training program is COGNITO which includes various working memory, perceptual speed, and episodic memory tasks (Schmiedek et al., 2010 as cited in Morrison, Chein, 2010).  An advantage of these types of programs is that the diversity of exercises increases the chance that one of, or some combination of, the training tasks will produce desired training-related gains (Morrison, Chein, 2010).  Core training programs showed significant improvement on the trained working memory measures, as well as untrained working memory measures.

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ADHD and Executive Function Disorder, the Same or Two Distinct Disabilities

          ADHD and Executive Function Disorder are heavily intertwined in literature.  There are some researchers and specialists that believe that ADHD is Executive Function Disorder (EFD).  That is, they are one in the same disability.  Dr. Russell Barkley, retired from the University of Massachusetts, Amherst is one of such specialist.  “ADHD is EFD(D) in my opinion” (Barkley, 2011).  However, he argues that even if all came in agreement with ADHD and EFD being the same disability, he does not believe the name should be changed.  This argument, in effect, is due to the protections afforded to those with an ADHD disability.  The protections, if ADHD were renamed to EFD would all disappear.

          Interestingly, in a research study of children with and without a diagnosed disability of ADHD, parents of children with ADHD reported that their children had significantly poorer behavior regulation and metacognition abilities (Schroeder, Kelley, 2008).   Other research has also pointed to such findings.  Whether one is convinced that ADHD and EFD are the same, research points to students with ADHD having more difficulty with executive function abilities than students without ADHD.

          In a large study of both children and adolescents with and without ADHD, EFDs were much more common in the study participants with ADHD.  Among participants with ADHD, EFDs increased the risk for grade retention, learning disability, and lower academic achievement, even after stringent statistical controls (Biederman et al., 2004).  In contrast, it was not found that EFDs had the same effect on academic outcomes for those participants without ADHD.  This points to the potential disruption and difficulties those with ADHD and EFDs face versus those with EFD minus ADHD.  The results also document that children with ADHD and comorbid EFDs have significantly worse academic deficits compared with children and adolescents with ADHD without EFDs.  These results suggest that children with ADHD plus EFDs suffer from the detrimental synergism of two conditions such that their academic performance is severely compromised (Biederman et al, 2004).

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Executive Function Strategies

         Strategies to overcome executive function processes in the classroom address (a) how to plan and organize new concepts and material, (b) how to memorize, (c) how to shift flexibly in order to process and learn new information efficiently and easily, (d) how to check and edit for errors in spelling, writing, and math (Meltzer, 2011).  Young and older students can be taught effective planning and goal-setting strategies.  Teacher modeling for students with their own expectations will be a valuable source for students to learn from and benefit.  These could include making checklists, providing a daily schedule, and modeling out loud planning strategies.  It is the responsibility of the parent and teachers to find effective methods and provide appropriate interventions focusing on: teaching students to work around deficits by providing proper supports, such as accommodations or modifications, and providing direct instruction for weak or missing skills (Ozonoff & Schetter, 2007 as cited in Reed, 2016).  Many strategies have been developed and used by educators to address student needs using visuals and reducing demands on the executive function process (Azano & Tuckwiller, 2011 as cited in Reed, 2016). Books have been written, complete with various strategies and hands-on interventions, to address very specific executive function deficits depending on student needs (Reed, 2016).

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Executive Function Supports

          What can parents do to help their child with executive functioning?  A home environment with organization and low family conflict may increase a child’s behavioral and metacognitive abilities.  That is, research has found that higher levels of family conflict and less organization in the home were related to parents’ reports of children’s behavioral and metacognitive difficulties (Schroeder, Kelley, 2008).  Also, parents of children with ADHD reported lower limit setting than parents of children without ADHD (Schroeder, Kelley, 2008).  Limit setting was the only difference identified in parenting with children with ADHD versus without ADHD.

          There are programs and interventions that have been show to develop executive function skills in young children.  These programs and interventions include computerized training, such as CogMed.  Other strategies include a hybrid of computer and noncomputer games, aerobic exercise, martial arts, classroom curricula, and add-ons to classroom curricula.  Those with the deepest executive function deficits are able to gain the most of the programs and interventions.  It’s also important to note the importance of the continued increase in level of challenge of executive function skills.  Those that were in a program but the level of executive function demands remained the same did not show improvement.  Executive functions must be continually challenged to see improvements (Diamond, Lee, 2011).

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Aerobic Exercise    

          Executive function appears more sensitive than other aspects of cognition to aerobic exercise training (Colcombe, Kramer, 2003 as cited in Davis et al., 2011).  A recent study with overweight children between the ages of seven to eleven was conducted using aerobic exercise for a period of three months.  Two different exercise dosage levels were tested -- one or two doses of twenty minutes of exercise; the group with one dose of aerobic exercise followed with twenty minutes of sedentary activities such as board games, drawing, etc.  The aerobic exercise emphasis was on intensity, enjoyment, and safety, not competition nor skill enhancement.  It included activities such as running games, jump rope, modified basketball and soccer (Davis et al., 2011).  Both aerobic exercise doses proved a positive effect on cognitive performance, namely improvements in executive function and math achievement.  Increased prefrontal cortex activity and reduced posterior parietal cortex activity due to the exercise program were observed (Davis et al., 2011).  The finding of improved math achievement is remarkable, given that no academic instruction was provided, and suggests that a longer intervention period may result in more benefit. The improvement observed on achievement was specific to mathematics, with no benefit to reading (Davis et al., 2011).  A dose-effect response was found, with the two doses of twenty minutes of aerobic exercise resulting in significantly higher executive functioning and math achievement than a single dose of aerobic exercise.  Both doses of exercise resulted in a stronger performance than the control group of no aerobic exercise.

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Mindfulness Training        

          Mindfulness training shows a promising direction.  Mindfulness training for both mothers and their children ADHD also had a positive effect on children’s compliance.  Often children with ADHD are non-compliant with their parent instructions and parents often lean on behavioral contingencies to manage unwanted behavior.  As a result, the parents are often imposing restrictions or consequences that do not teach self-control to their child and often puts the child and parent as adversaries.  Mindfulness training was provided through twelve sessions first to the mother and then to the child.  The twelve sessions, which were appropriately adapted to the mother and child, involved the basics of mindfulness, mindfulness in everyday life, basic mediation exercise, meditation exercises, on being mindful, and the final session was about putting all session work together.  After the training, child compliance with parent imposed requests increased.  Increased compliance was evident in small terms with just the parent training, but real increases were seen after both the parent and child training.  In addition to the increase in compliance with parent’s requests, the parent-child interactions were positively enhanced, and the two children in the study were able to reduce or remove their medication for ADHD.

           It’s important to note that the mothers reported the likelihood of dropping out of the mindfulness training had they not sought it out.  Both mothers reported that they found the meditation practice to be initially physically and mentally difficult, and foreign to their way of life (Singh et al, 2010).  The dropout rate in parent training programs is high, such as the almost 60% reported by Ducharme et al. (2000) as cited in Singh et al. (2010), and the mother’s comments show an inclination with this.

Discussion

           Understanding how executive function abilities affect the academic abilities of students with executive function deficits allows me to better advocate for them.  Understanding how the deficit presents in the academic environment (lack of output, lack of studying, homework or classwork completion, etc.) gives me a discerning eye on how to approach supports and make accommodations.  It also provides me the opportunity to help frame a student discussion with his or her educators and suggest supports and strategies that could be used as a helpful starting point for academic success.

           Also, having a strong understanding of executive function struggles also allows one to request additional testing.  For instance, I’m working with a student with ADHD that is showing tremendous difficulties with his school output.  With the understanding of executive function disorder, I was able to successfully request an independent educational evaluation for executive function disorder.  I strongly suspect this disorder will be confirmed.  In the meantime, we are moving forward in conversation and with his supports with the understanding that he holds, at a minimum, a severe executive function weakness.  His executive function disorder to soon be confirmed.

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Conclusion

          Executive function skills are the mental skills that allow one to successfully complete a goal.  Reading comprehension, homework, note taking, long-term projects, studying, and test taking all require students to integrate and organize multiple sub-processes simultaneously and to shift approaches frequently (Melzter, 2011).  The executive function abilities are housed in the prefrontal cortex of the brain.  This area of the brain, despite earlier beliefs, is now understood to undergo continual develop into the ages of the 20s or 30s and shows pre and post-pubescent differences.  Recent changes in public education may have inadvertently led to increased number of students being identified with executive function weaknesses.  This is due primarily to the higher emphasis on developmentally demanding goals created from high-stakes tests which require a stronger emphasis on executive function skills.  Working memory, the cognitive system that provides the temporary storage of information plays an important role in supporting learning and maintain focus on academic success.  Students identified with low working memory have shown to have substantial problems in reading, math, and/or both subjects.  Working memory training appears to make a positive difference and can be generalized outside of immediate training.  ADHD and Executive Function Disorder (EFD) are often intertwined in literature with some research and specialist believing they are one in the same disability.  However, of studies that kept the two disabilities separate, those students that had ADHD and EFD had increased risk for grade retention, learning disability, and lower academic achievement.  Results suggest the synergies derived from both disabilities deeply compromise academic performance.  A home environment with organization and low family conflict can be beneficial to a student’s behavioral and metacognitive abilities.  More stringent limit setting also works positively for students with ADHD and their executive function capabilities.  Mindfulness training for both parent and child appear to work in children with ADHD and their compliance with parent requests.  Other programs and interventions to develop executive function include computer and hybrid computer training, aerobic exercise, martial arts, and classroom curricula.  An important finding on aerobic exercise is that math achievement (despite no tutoring) improved with twenty minutes of aerobic exercise on overweight children, and increased even more with two doses of twenty minutes of aerobic exercise.

           Students with executive function weakness can be supported just as we are able to support students with other disabilities.  It will be important for the student, parent, teachers, and administrators to understand how this weakness, disorder, or disability presents itself in academic life, and to avoid the thinking that the student is just lazy and doesn’t care.

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                                                                                              References

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Barkley, R. A. (Director). (2011). ADHD: Executive Functioning, Life Course Outcomes & Management [Video file]. Retrieved from http://search.alexanderstreet.com.www2.lib.ku.edu/view/work/1771800

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Biederman, J., Monuteaux, M. C., Doyle, A. E., Seidman, L. J., Wilens, T. E., Ferrero, F., . . . Faraone, S. V. (2004). Impact of Executive Function Deficits and Attention-Deficit/Hyperactivity Disorder (ADHD) on Academic Outcomes in Children. Journal of Consulting and Clinical Psychology,72(5), 757-766. doi:10.1037/0022-006x.72.5.757

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Blakemore, S., & Choudhury, S. (2006). Development of the adolescent brain: implications for executive function and social cognition. Journal of Child Psychology and Psychiatry,47(3-4), 296-312. doi:10.1111/j.1469-7610.2006.01611.x

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Clair-Thompson, H. L., & Gathercole, S. E. (2006). Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. The Quarterly Journal of Experimental Psychology,59(4), 745-759. doi:10.1080/17470210500162854

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Davis, C. L., Tomporowski, P. D., Mcdowell, J. E., Austin, B. P., Miller, P. H., Yanasak, N. E., . . . Naglieri, J. A. (2011). Exercise improves executive function and achievement and alters brain activation in overweight children: A randomized, controlled trial. Health Psychology,30(1), 91-98. doi:10.1037/a0021766

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Diamond, A., & Lee, K. (2011). Interventions Shown to Aid Executive Function Development in Children 4 to 12 Years Old. Science,333(6045), 959-964. doi:10.1126/science.1204529

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Holmes, J., Gathercole, S. E., & Dunning, D. L. (2009). Adaptive training leads to sustained enhancement of poor working memory in children. Developmental Science,12(4). doi:10.1111/j.1467-7687.2009.00848.x

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Meltzer, L. (2011). Executive Function in Education: From Theory to Practice. New York: Guilford Publications.

Morrison, A. B., & Chein, J. M. (2010). Does working memory training work? The promise and challenges of enhancing cognition by training working memory. Psychonomic Bulletin & Review,18(1), 46-60. doi:10.3758/s13423-010-0034-0

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Reed, S. L. (2016). A qualitative case study: Teacher perceptions of executive function (Doctoral dissertation, Missouri Baptist University) [Abstract]. (UMI No. 10010909)

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Schroeder, V. M., & Kelley, M. L. (2008). Associations Between Family Environment, Parenting Practices, and Executive Functioning of Children with and Without ADHD. Journal of Child and Family Studies,18(2), 227-235. doi:10.1007/s10826-008-9223-0

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Singh, N. N., Singh, A. N., Lancioni, G. E., Singh, J., Winton, A. S., & Adkins, A. D. (2009). Mindfulness Training for Parents and Their Children With ADHD Increases the Children’s Compliance. Journal of Child and Family Studies,19(2), 157-166. doi:10.1007/s10826-009-9272-z