March 13, 2013

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

After a brief introduction two weeks ago to Dr. Mel Levine’s ideas on four subtypes of executive function issues, last week we delved more deeply into two of them: material-spatial disorganization and temporal-sequential disorganization. This week we will focus on the other two, namely transitional disorganization and prospective retrieval disorganization. As with past weeks, and when discussing individual students’ personal difficulties with executive function overall, it is important to note that this is merely one viewpoint. Each child (and adult) experiences executive function and any associated problems with it in a different way. Therefore the purpose of this blog and the two associated with it is to help parents, educators and the other adults in the lives of children struggling with executive function disorder find the familiar threads and pieces of information, as well as potential solutions and helpful tips, that will enable them to work best with their own student or students.

The difficulties Levine describes as being associated with transitional disorganization are something to which all parents can relate to some degree. How many of us have gotten a child up for school with plenty of time to do all of the necessary tasks of the morning (getting dressed, eating breakfast, brushing teeth, packing the school bag, perhaps making lunch) only to go into her room with a scant 10 minutes to “show time” to find the child sitting on the bed only half-dressed, school supplies “tornado’ed” around the room and breakfast still to be eaten? The frequency of this scenario varies from household to household, but for children with executive function issues it is likely to be a daily occurrence at home, and one that is mirrored at school when it is time to return home, not to mention each and every time she has to move from class to class or even activity to activity in the classroom.

Think about the number of transitions most students deal with every day, and then imagine the difficulty this presents to students with transitional disorganization, under Levine’s description. Students may employ avoidance strategies so as not to deal with transitions, including ignoring the information or instructions about the transition, “dawdling,” or even racing through the transition (and often forgetting crucial steps or missing important information). Obviously these coping mechanisms can’t prove successful in the long run and may even create their own set of additional problems, so the task becomes to try to help students struggling with transitional disorganization to replace them with more effective strategies.

The “time warning system” is one very effective means of helping children who have difficulty with transitions. At home, alerting your child that he has, for example, twenty minutes before leaving the house for school, and then giving additional updates every five minutes can help him recognize that the transition is coming. Using a timer, especially one that can be set to go off in appropriate increments, can work even better as it takes the onus off the parent to be the whip-cracker. In fact, the timer can be utilized and set by the child himself to set incremental, time-related parameters as a means of his accepting more responsibility (age- appropriately) as time goes by.

As with so many areas of difficulty around organization, clear communication can be a tremendous help. Not only letting your child know that a transition is upcoming (be it at home by a parent or at school by a teacher – or even during a tutoring session here at Engaging Minds!) but also letting him know that before the transition x,y and z must be accomplished and after the transition a, b and c will be coming up can remove some of the unspoken uncertainty that many students dealing with transitional disorganization experience. It is important to judge the individual child’s ability to process varying amounts of information and adjust how much you provide based on that and the usefulness of the information (telling a nine year old that after he finishes doing his math homework and empties the dishwasher, you are going out for ice cream right away might only lead to incomplete homework and a full upper rack remaining in the dishwasher).

What am I forgetting

Speaking of incomplete homework, children dealing with prospective retrieval disorganization struggle just to remember that they have things to do for which a plan or pattern has already been put in place. While that may seem like something that we have already covered in the other subtypes Levine describes, it actually has its own manifestations. These students will frequently forget to do assignments (particularly long-term ones), even though they themselves have carefully transcribed the deadlines in their assignment notebooks. They may promise to do their chores, then act surprised when you scold them about not having done this an hour later. Prospective retrieval disorganization can also lead to things such as yes, remembering to take out the trash but then forgetting to bring the can back into the house or remembering to complete a math worksheet for school but then leaving the sheet at home so that the end result is the same as if she hadn’t done it – a zero in the grade book.

As we have mentioned, at Engaging Minds we work towards a process of gradually increasing the responsibility a student accepts for his own work. But with students dealing with prospective retrieval disorganization, adult oversight may be necessary for longer and with more frequency than is the case with students with the other subtypes. So while a simple checklist completed by the student himself may suffice for another student, these students may need to have the final step – turning in the homework or finishing the research project – checked off by the teacher or parent. These students also benefit from having their assignments signed by parents when completed at home, and emails from teacher to parent being sent to make sure important documents and assignments are noted and completed. As the child seems more ready to accept responsibility for his own work and deadlines, the adults can use Post-It Note reminders left in key locations (the homework notebook, desktop at home or school, on the pillow before bed, at the breakfast table). These benefit from using task-specific language, such as “Did you remember to put the lid back on the dog food bin after you fed Spot?” or “Please make sure to give me your math worksheet from last night before you leave class. It should be in your ‘in’ folder.”

Another effective tool for helping with this subtype of executive function difficulty in relation to schoolwork is the in/out folder (see above). By having one specific, physical location where the student can put work that must go home and then go back to school (rather than placing it in the subject folder), it gives her one less thing to think about and one less way of forgetting to hand in assignments. Of course, she still might forget to hand the assignment in once she is at school (or forget to take it out at home), but again this is where adult assistance can be helpful – our old friend the Post-It Note can deliver the message of “Did you check your entire ‘out’ folder to make sure you completed all the work you brought home?”. As the student becomes more adept at remembering on her own to follow through on an assignment to the very last step, the adults in her life can allow her more independence, but it is important to monitor this carefully and even step back into a more guided approach as needed.

As we have stated before, there are many different ways of examining executive function and methods to improving it, and this is just one approach. Likewise, no one child is going to conform exactly to the guidelines Levine has lain out nor strictly fall into the parameters of one of his subtypes. What works for one child may be ineffective with another, and a once successful intervention may need to be altered or replaced to best help your child at any given time. The important thing to take away from all of this information and these suggestions is that flexibility is key, and that the adults in your child’s life (you and your child’s teachers and tutors) need to communicate with your child and with each other to provide a unified and effective way of helping her become the best student she can be.