When executive functioning weaknesses are pathologized as behavior issues.

Executive functioning has become a popular buzz term in the education world as well as the ADHD and Asperger’s communities yet few people, including educators and mental health professionals have a clear understanding of the depth or expansiveness of the role of executive function skills.
I often find that many parents as well as educators believe the term executive functioning is limited to describe organizational skills and time management however the term executive functioning is an umbrella term used to describe a wide variety of brain processes that control some aspect of self-regulation as described by Dr. Russell Barkley in this article.
Frequently, I hear from parents about aspects of their child’s executive functioning challenges that frustrate them. Words like “lazy”, “unmotivated” or “oppositional” are frequently assigned to kids with executive functioning challenges.   I find it particularly sad when I see a student who has been labelled by the mental health word as having Oppositional Defiant Disorder (ODD) when in reality their oppositional behaviors are a result of a lack of age-expected executive functioning.  
Consider the following case which is a true story:
11-year-old Jake becomes frustrated whenever he is told to clean his room.  One Saturday afternoon his father asks him to clean his room before dinner.  He begins to pick up things and place them on his bed.   After 3 minutes becomes frustrated and yells “I don’t know how to do it!”  He begins to cry and yell.  Jake’s father tells him that he does know how to clean his room, he’s just being lazy.  Jake’s parents email Jake’s therapist about his unwillingness to clean his room and his “meltdown”.
Later that week during their session Jake’s therapist speaks to him about his oppositional behavior around cleaning his room.  The therapist asks Jake to verbalize his feelings around not wanting to clean his room and they spend an hour talking about feeling words and the function of his oppositional behavior.   The session leaves Jake disengaged and feeling worse about himself because neither his parents or therapist were able to understand that Jake was not unwilling to clean his room, rather he could not visualize what his room looked like when it was clean, nor understood the the steps required to clean his room.
Jake could not clean his room when asked because of his executive functioning challenges which include the following difficulties for him:

  • Episodic memory (the emotions associated with experiences.  If you can’t remember that you felt good when you completed cleaning your room you’re most likely going to lack the motivation to make it clean again).  
  • Non-verbal working memory: While Jake may understand that his room is messy he cannot visually picture what his room should look like when it’s clean. His weakness with non-verbal working memory makes it impossible to meet his parent’s expectations of cleaning his room.
  • Sequencing steps and prioritizing: Lack of understanding how to “scaffold” a process, start with the end result in mind and sequence steps correctly to reach an intended goal. Jake’s parent’s prompt of “clean your room” is too abstract for him to understand and does not provide the scaffolding he would need to successfully clean his room.  

I encourage both education and mental health professionals as well as parents of children with executive functioning challenges (ADHD, Asperger’s, learning differences) to not pathologize a child, rather take a step back and consider their brain development in the context of their executive function skills.   For individuals diagnosed with ADHD, there is a 30% developmental delay in their executive function skills meaning that a 13-year-old, regardless of their intellectual ability has the executive functioning skills of a 10-11-year-old.   If a child has consistently had things done for them that they could do on their own their executive functioning is possibly even more delayed.  You can read more about this aspect in my previous article
The good news is that strategies can be implemented to help improve these weak executive functioning skills and can be taught to children as young as elementary school through adults.
Ride the Wave Counseling provides executive function treatment, therapy, social skills programs and a summer travel camp.  Learn more at: www.ridethewavecounseling.com or www.summertripcamp.com  Ryan Wexelblatt, LCSW – Director

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