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Usually Messy and Always Late: Understanding Executive Functioning and Organizational Skills Challenges for Students with ADHD

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Presenter: Lisa Ahern, PhD, NCSP

Late homework, missing materials, procrastination, and daydreaming are the frustrating hallmarks of executive functioning weaknesses for many students. They may also struggle with stopping and thinking before acting, being flexible when things do not go their way, and regulating their emotions. “Executive Functioning” is a term that refers to the procedures the brain must go through in order to “ execute” a task. These processes, which primarily occur in the frontal lobe of the brain, tend to affect an individual’s ability to succeed academically, socially, and personally. Join Dr. Ahern to further understand these challenges and learn concrete ways to support students in building these skills.

Dr. Lisa Ahern is a licensed psychologist and certified school psychologist who holds a Ph.D. in school psychology from North Carolina State University. She has advanced training in ADHD assessment, the assessment of Autism Spectrum Disorders, and Learning Disabilities. Dr. Ahern refined her clinical expertise in cognitive behavioral therapy (CBT) for children and adolescents with anxiety and Obsessive Compulsive Disorder and Related Disorders and provided parent management training (PMT) for families with children who were experiencing difficulties with ADHD and other behavioral difficulties. She was also able to participate in research efforts as part of a nationally recognized team of experts.

 

Comments(10)

  1. genglehardt says

    How are ADHD and Executive Function issues diagnosed?

    • Dr. Ahern says

      ADHD can be diagnosed by a psychologist, a medical doctor (physician/pediatrician), a psychiatrist (physician with specialized training in mental health), a neurologist (physician with specialized training in brain-related issues), or even a social worker or counselor with specialized training. The assessment varies depending on the role of the person doing it. As a psychologist, I rely on a “multi-method, multi-rater” assessment to determine whether a person meets the criteria for ADHD in the DSM-V (a book of criteria that professionals use to diagnose mental health and developmental disorders). Multi-method means that different types of assessment tools are used, like questionnaires (or rating scales) that compare behavior to other people the patient’s age, or tests that are given one-on-one by asking questions or having a person do a task. Multi-rater means that the opinions of multiple people are gathered to see what behavior is like across settings like home and school. There are rating scales that look at ADHD specifically and those that look at executive functioning specifically. While there are tests for executive function difficulties, it is important to recognize that sometimes people can do well on an executive functioning task in isolation, but not as well when having to use that function in real life with distractions and competing demands. There is no one test ADHD or executive function difficulties, but rather a battery of tests to gather as much information as possible to compare to the ADHD criteria and to determine how severe the difficulties are in comparison to others. I use the information to make a diagnosis, but also to develop a profile of strengths and weaknesses and make recommendations for treatment.

  2. BarbaraF says

    What do you think are the best strategies for dealing with procrastination?

    • Dr. Ahern says

      Procrastination can come from a combination of poor time management and planning skills and general anxiety about the task. It may seem overwhelming or like it is too much effort to tackle, so it is put off until there is more motivation to face that anxiety and get started. The best thing is to make a plan – break the task down into smaller, more manageable parts and then plan exactly when to do those steps. Even just getting started with any step can get you moving in the right direction, but if you make a list of the steps you can prioritize and figure out which is easiest or which needs to be done first. Ask yourself, what specifically am I going to do, and then set a reminder to do it at a certain time in your calendar. Most tasks aren’t as bad as you think once you get started. Doing steps way in advance when you think of them can be helpful too (or at least setting the reminder way in advance) like buying a birthday present for someone when you think of it, and then putting somewhere consistent (where you keep all birthday presents) so you can find it later. Tell someone else about your plans to help yourself be accountable! Finally, use a little self-talk “If I do this now, I’ll feel so much better later” or “Maybe I don’t have time to finish it now, but I can get at least one step done” or “I won’t have time to go out with my friends if I don’t do this now”.

  3. HeatherR says

    I have a son going to college in the fall but he still struggles significantly with all aspects of Executive Function. Habits haven’t been formed because schools/teachers didn’t follow 504 that would have created it. What suggestions do you have for trying to help him with this at this stage of his life? How do you create “buy in” if he doesn’t view it as a problem?

    • Dr. Ahern says

      The short answer is, you really can’t teach someone strategies to address a problem they do not believe they have. At this age, students often need to experience the problems caused by executive functioning deficits in order to recognize the need to change. This may mean backing off your support a little bit and letting them “fail small.” That is, allowing them to feel the sting of getting a poor grade because of forgotten homework rather than bringing it to school for them, then help them make a plan for how to remember it next time. Recognize though that not all kids will see those minor consequences as a big deal either. I often work with students to develop life goals for themselves and then work on developing a plan to reach those goals. I ask them “What will be different about your life in college than now?” and “What are some things people currently do for you that you will have to do for yourself?” We discuss the challenges of managing time with a college class schedule and the need to remember to schedule meals, do laundry, and make car repair appointments. We discuss what EF problems might get in the way of achieving their goals and problem solve about how to address them. Often, I find that trying to force a specific strategy or process on students at this point in time does not work and can be counterproductive. Instead, I try to meet them where they are at and make small changes that they’re likely to continue to use. The most common strategies they buy into are setting electronic reminders, using self-talk mantras like “Do I have everything I need?” and “What am I going to do and when am I going to do it?”, and using concrete organizational materials like the accordion folder.

  4. JoyK says

    What do you mean by “Labeled praise”?

    • Dr. Ahern says

      Unlabeled praise includes general statements like “great job!” and “nice work!” Labeled praise specifies exactly what behavior was done well. Some examples “I like the way you put those dishes away like I asked you to,” “Thank you for closing that door behind you,” “Great job turning in your homework on time!” When you use labeled praise, you are helping your child learn to self-monitor and reinforcing behaviors you’d like to see happen more often.

  5. MarthaB says

    I would appreciate your comments on the idea that parents who have some executive function deficiencies themselves owe it to their child to say they do. I would think it would make a difference in how they interact with each other and help each other to build trust and understanding.

    • Dr. Ahern says

      Studies have shown that when parents are treated for the ADHD, outcomes are better for kids. Consider getting an evaluation, if you haven’t already, and getting some more direct treatment for yourself whether medication or an executive functioning “coach” or therapist. Do a little detective work – what are your strengths when it comes to executive function – are you great at planning but poor at keeping materials organized? Make a plan for yourself to tackle something that’s disorganized this weekend. Have your kids help – maybe create a space to put away shoes and jackets and do some role-play practices with the kids about what to do with their stuff when they get home. Don’t forget to make a space for yourself also! You’re modeling these behaviors for your kids and by watching you they can learn to do better. However, you may need to draw attention to what you’re doing. You can point out that you’re hanging up your jacket when you get home and then praise the kids for doing the same “Great job hanging up your jacket – Now you won’t have to look for it when you go out later!” Finally, acknowledge to your children that you also are struggling with the same issues and understand how they feel. If you can join together as a team to work on the problems, it can strengthen your relationship and also help you develop patience with your child’s struggles.

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