March 5, 2013

One Perspective on Four Subtypes of Executive Function Disorder (Part 2 of 3)

In last week’s blog, we introduced Dr. Mel Levine’s interpretation of executive function disorder and the four subtypes that comprise these difficulties (as outlined on the DyslexiaHelp website via the University of Michigan and in Levine’s numerous books). This week (and next) we will go more in-depth about two of them, defining in more detail what each subtype involves and focusing on strategies and approaches to help students who are struggling with executive function.

According to Levine, material-spatial disorganization focuses specifically on the student’s difficulty in dealing with his “stuff,” to put it simply. He may lose things (books, sports equipment, clothing) and may have no clear sense of where things are supposed to go, even if he has hung his coat on the same hook in the same spot for years. Students struggling with material-spatial disorganization may spend an inordinate amount of time and energy searching for misplaced items around the house or at school. They may miss important instructions or information in school as they desperately rifle through their backpacks, cluttered with old papers, to find a pencil with which to write down the very information they are missing.

material spatial disorg

For a child dealing with material-spatial disorganization, labeling of things is key. The old maxim “Everything in its place and a place for everything” isn’t enough for these students – they need visual reminders of just where that place is and what is supposed to go there. This includes designated, labeled folders or binders for each subject, specific compartments in the backpack or a box/pouch for tools (pencils, pens, erasers, calculators, rulers, etc) and specific locations in the student’s room and on his desk for everything he will need to do schoolwork.

Writing down assignments in a designated notebook is only helpful if the student can keep track of the notebook, so it is important for parents and teachers to make sure the assignment book is available and accessible when it comes time both to record homework at school and to recall it at home. Regular clean-outs of backpacks, binders, and desks, at home and at school, can reduce the clutter and make the task of finding things a bit less onerous (Engaging Minds tutors often help our students clean out and reorganize their backpacks and binders, sometimes on a weekly basis; it is amazing, the amount of paper one student can amass in the span of one short week!). If the student is having trouble remembering to bring textbooks back and forth from school, sometimes a second set can be borrowed and left at home.

It is important to remember, however, that the responsibility for his “stuff” must ultimately fall on the student. One of the things that we at Engaging Minds encourage is “gradual release of responsibility.” So while adult oversight of these measures may be necessary in varying degrees throughout the student’s academic career, there should also be an effort made (specific to the needs of the individual child) to encourage the student to accept an increasing amount of ownership for remembering to bring what he needs to and from school, place it in a location that will allow him to find it when he needs it later and know what he will need to have available to complete a given assignment.

Levine describes students with temporal-sequential disorganization as being in a constant “time warp.” They literally are unable to predict how long an assignment will take, what steps are needed to complete it and in what order, and how they must budget their time to finish something. These students are often the ones you see rushing from place to place, always tardy, or who procrastinate getting started on a task simply because they erroneously – but earnestly – believe they have “all the time in the world” to complete it. They also can have difficulties with any academic task involving multiple steps, such as math word problems, sequencing of events in a book report or history paper or anything involving a series of instructions (which is often the way classroom teachers verbally convey their wishes about what they want their students to do).

To help students struggling with temporal-sequential disorganization, frequent check-ins are essential (again, keeping in mind that the goal is to gradually help your child become more self-sufficient). Going over the daily, weekly and even monthly schedules and making sure all calendars are up-to-date can help avoid unpleasant surprises about due dates and the like (we will go into this more when discussing prospective retrieval disorganization next week). “Chunking” of assignments by breaking them down into smaller, more manageable blocks of time minimizes the feeling of being overwhelmed that students with this type of executive function difficulty may experience. Keeping checklists of tasks, in sequence, that can be crossed off as each item is completed also helps make things seem more manageable and gives the student a well-earned sense of accomplishment.

If you ask your child how long she thinks a given assignment will take and she gives you a seemingly unreasonable response, help her to see why this is unlikely (“If you have to go to the library to get the books you need for the research project, then take notes, then organize those notes, then write them up into a rough draft, do you really think you only need two hours? That is about the length of an average movie in the theater! Do you think it might take longer than that?”). Also be aware that students struggling with temporal-sequential disorganization may see no problem with doing what is clearly a less time-sensitive sub-task (for example, drawing an elaborate cover for a report) before they complete the more essential steps of a project. As with all aspects of improved executive function, communication here is key and as time goes on, and with coaching and encouragement, your child will come to see for herself how better to utilize her time and sequence her activities.

Next week we will delve more deeply into Levine’s remaining two subtypes of executive function difficulties – transitional disorganization and prospective retrieval disorganization. As always, if you have any tips for other parents and educators about approaches you have found helpful in working with your child, please feel free to share them in the comments or via email.