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Late, Lost, and Unprepared

A Parents' Guide to Helping Children with Executive Functioning
Joyce Cooper-Kahn, Ph.D. & Laurie Dietzel, Ph.D.




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isbn# 978-1-890627-84-3
2008
Paperback
5 1/2" x 8 1/2"
232 pages
Photos


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Copyright controlled materials. Cannot be reprinted without permission of the publisher.

From Chapter 4, The Child’s Experience of Executive Weaknesses

THE BASICS

  • Efficient executive functioning is important for managing the practical demands of daily life.
  • Executive weaknesses affect a child both in and out of school so the impact of weak executive functioning can be quite profound.
  • Executive skills, such as impulse control and cognitive flexibility, also play a crucial role in managing social situations and dealing with stress.
  • Some effects of executive weaknesses are direct in that the child or teen has trouble meeting expectations. Other effects are indirect, affecting a person’s self-esteem and attitude.
  • As parents, it is important to put ourselves in our child’s place to understand her experience and to maintain a compassionate, helpful approach.
As frustrating and worrisome as it can be to raise a youngster with executive skill weaknesses, it is all the more frustrating for the child, herself. Whether a child expresses this frustration openly or presents an “I don’t care” façade, her emotional development is intricately interwoven with her acquisition of executive skills. Sometimes, we need to step back and consider how these executive weaknesses affect the child’s experience. How can we maintain a helpful, supportive approach without empathy for the child?

After all, executive skills must be considered in the context of a developing human being. At the same time that executive skills are progressing, kids are also developing emotionally and their experiences of themselves and their environment are coalescing into a self-image. The feedback that they get from the world around them, including from adults and peers, contributes positively or negatively to self-esteem and to the child’s developing sense of herself.

Weak executive skills affect a youngster in many more ways than just how they perform in school, although this is often the impetus for seeking help. Kids receive feedback from people and from their environment in numerous ways over the course of a single day. So, let’s look at a typical day and consider the child’s experience of the daily routine. In the second half of the book, we offer suggestions for how you can help your child meet these expectations. For now, though, let’s focus on the child’s experience.

Daily Life

Getting Started

The sun comes up and it’s another new day! Full of hope and enthusiasm, you head into your daughter’s room. Her alarm is beeping, but she is still lying in bed and has the covers pulled up to shut out the light and the sound. In your most cheerful voice you say, “Time to get up, Sweetheart. The bus will be here in forty-five minutes.” That may be the last positive thing she hears from you that morning!

Think about what we ask of a child every morning: Get up on time, shift from sleep mode into action mode, keep track of time, and complete a sequence of tasks that culminates in being dressed, fed, presentable, and ready to head out the door with all that she needs for the day.

Disorganized kids may become distracted or lose track of what they are supposed to be doing. Since many of them have problems keeping track of time, they only realize they are not ready at the very last minute (when they hear an irritated parent call out their name). Children with initiation difficulties need considerable help “getting going” and “keeping going.” We have talked to many a parent who has discovered their child half-dressed and playing in her room when it is time to leave for school. We have also talked to many children who report that they just lose track of time. Often children promise to do better, because they feel badly about their lapses and really want to do what their parents are asking of them. Despite their promises, they have no clue how to change the situation.

Off to School
Schoolwork demands increasing levels of organization as the child goes from one grade to the next. Kids with weaknesses typically have more and more difficulty with each passing year. The most critical changes in school demands occur in mid-elementary school and at the transitions to middle and high school.

At all levels, though, adequate executive functions are generally taken for granted. Here are just some of the behaviors that we expect of children at school:

  • Pay attention to the teacher
  • Remember and follow instructions
  • Refrain from socializing with friends during class
  • Interact with a range of peers during informal parts of the school day (during lunch, before and after school)
  • Remember your locker combination
  • Bring the appropriate books and materials to class
  • Work efficiently and rapidly on timed tasks
  • Work slowly and carefully on more complex assignments
  • Move easily from room to room and subject to subject
For students with executive weaknesses, a school day is filled with challenges to their performance and self-esteem. A child with weak working memory may struggle to follow directions while a child with weak self-monitoring skills may make “careless” mistakes and not tune into details. When a student has trouble with cognitive flexibility, changes or transitions throughout the school day may result in anxiety. These changes may be as common or seemingly begin as a substitute teacher, an assembly, or an assignment that is novel and unstructured. To an inflexible child, these can cause considerable discomfort or even meltdowns. Each of these experiences can result in negative feedback from school staff and personal concern as the child perceives a difference between her own performance and that of her peers.

After School
Finally, the students are let loose. Home again, the child now needs to face the after-school routine. Yes, that means homework.

Many students (and parents) have described homework time as the worst part of their day because of the level of tension within the family. Children may associate home with unstructured time and resist parental efforts to set routines around studying and homework completion. Worn out by the efforts of the day, students are ready to be free of demands. (Parents could use some down time, too!) The content of the homework may be frustrating if the work is difficult. Often, though, the homework itself takes relatively little time and effort (particularly in the early grades) compared to the time and energy it takes to gear up to actually do the homework, which can be a struggle that is quite draining.

As students move along in school, homework and studying demands increase. As they get older, students understandably want more independence and may resist parental involvement in homework. At the same time, the students may actually need more supervision and support due to increasing work complexity and volume. In addition, some students who were able to do quite well on tests in earlier grades, simply by listening in class, have trouble adjusting to the need to more actively take notes, study, and prepare for tests in later grades.

Homework requires a child to:

  • take down homework assignments and due dates
  • bring home the proper materials
  • properly estimate and budget the amount of time necessary to finish homework
  • break down an assignment into its component parts and do all the parts in sequence
  • work efficiently on simple assignments and work more carefully on more difficult projects
  • check work for errors and completeness
  • assemble all that is needed into the backpack
  • remember to bring the assignments to class and turn the assignments in
Is it any wonder that many children with executive weaknesses (and their parents) dread homework? Although executive function weaknesses are not an excuse for insufficient effort, we do understand why so many students engage in avoidance, procrastination, and even lying when it comes to homework.

Winding Down (The Evening Routine)
Just as important as the morning routine, the evening routine provides a structure that includes preparing for the next day and getting ready for bed. Some disorganized kids take a very long time to transition in bedtime. They may need reminders or physical supervision to brush their teeth, bathe/shower, pack for the next, day, and settle info bed. We all know that it can be very helpful to select clothes, check the calendar, and pack lunches and backpacks the night before so that the morning routine runs more smoothly; however, to build these routines, many kids (even adolescents) need adult supervision and prompting.

Stressed and frustrated at the end of a long day, patience and understanding may be in short supply for both you and your child. Many kids who have “held it together” at school express their stress verbally or behaviorally at home. Without tolerating unacceptable or unsafe behavior, parents need to appreciate those children who must invest more effort than peers to meet demands and stay in control need to be able to vent frustration and “blow off steam.” Many kids with poor self-monitoring have limited awareness of their fatigue and need help figuring out how best to manage stress. Note that some children and adolescents have good insight into the types of activities and routines that help them transition from the day to sleep.

Nighttime rituals and a slow progression towards bed and sleep help children to develop the sense of calm and soothing that allows them to give up the day with a feeling of well-being. Rituals construct a foundation of consistency and security that buffers against some of the challenges to your child’s positive self-esteem. While younger kids may be comforted by listening to music, reading books, or snuggling with a parent before bed, adolescents should be supported in identifying how to “wind down” so that they get adequate rest before beginning the new day.

You and your child may have to give up some extracurricular activities to make the evening more relaxing. You may also have to start the routine much earlier than you would with another child to allow for your child’s pace. However, both you and your child need some time to connect in a relaxed manner each evening. Depending upon temperament, Some kids need a good amount of “alone time” while others crave interaction and personal contact.

Be mindful of your child’s television viewing habits if she has problems with sleep. Researchers have found that excessive television-viewing during the day and watching television before bedtime are associated with sleep disturbance. It appears that television-viewing over stimulates children, as opposed to granting them the sort of relaxation of being a “couch potato” that we tend to think it does. Research on this issue is not yet at the point of being able to definitively claim a direct cause-and-effect link between TV-viewing and sleep disturbance. However, the accumulation of data is clear in finding at least a correlation between television habits and sleep problems, including resistance to bedtime, delay in sleep onset, and anxiety around sleep. When children and adolescents have televisions in their bedrooms, problem with sleep are even more likely to occur. Our advice: if your child or adolescent does not have a television in her room, keep it that way. If she does, you might want to consider moving it out of the bedroom.

Chores
In addition to homework, kids are expected (we hope!) to help out around the house. This means that they need to follow through with daily expectations, track chores done only on specific days (e.g., taking out the trash), and do the job completely. For many children, chores are simply a part of the day, easily folded into the flow of the daily routine with only occasional reminders. However, chores can be a challenge for those with weak executive skills. Like homework time, chores can be seen as another demand by children who wish to be free of demands at the end of the school day.

We hear the same concerns about kids completing their chores around the house as we do about homework. Many parents we know have given up on requiring that their children do household chores in favor of putting all the emphasis on school-related work. Chores can be an important way to help kids build their executive skills in a nonacademic setting. Just as important, there are great developmental benefits to learning to be a contributing member of the family group, with the self-esteem that follows from a sense of competence as additional payoff. The intervention chapters in the second half of this book will arm you with strategies for teaching your child to do homework and chores without all the nagging.

Friends and Social Life
Managing social situations is also challenging for many kids with weak executive control. The same impulsive responding, inflexibility, and poor self-monitoring that can get in the way of classroom performance can interfere with peer relationships. Just as academic demands increase as students progress through school, social situations also become more complex. For example, the kid who “doesn’t know when to stop” may not be that different from the other kids, except that the other kids don’t get caught because they are watching for the teacher and are paying good enough attention to other’s reactions to stop shy of irritating.

Kids with weak impulse control are at significant risk for social difficulties due to interrupting, trouble with turn-taking, and insensitivity to others’ feelings or reactions. Many impulsive children and adolescents desperately want to have friends and a social life but alienate peers without understanding why kids don’t want to spend time with them. It can be a painful process for kids who long to be included and accepted, and for their parents, too.

Children with cognitive rigidity may appear blunt, insensitive, and overly literal; they often have trouble reading social cues. They tend to rely heavily on rules and have trouble determining when the situation requires a more diplomatic response. When children are quite young, it is the parents’ job to teach the basic rules. “Always tell the truth.” “Never break the rules.” However, as kids get older, they begin to understand the shades of gray, and that are not absolute. Fortunately, most typically developing kids figure out that there are exceptions to all rules. However, children with cognitive rigidity have trouble with the exceptions to the rules. For example, a general rule may be, “Use an inside voice. Don’t scream.” Although this is usually the case, it may be appropriate to scream at a basketball game or if someone is in danger. Since it is impossible to actually teach a child all of the possible exceptions to rules of conduct, cognitively inflexible kids may be quite confused by these situations.

Characterized by “black-or-white” thinking, kids with this profile tend to adhere rigidly to rules and expect others to do the same. When a middle school student points her finger at a peer and says, “Bus driver, she is chewing gum and that is not allowed,” there are liable to be social consequences that she has not anticipated. That child, who is just trying to do what she thinks is right, may earn the reputation of a tattletale. Her compulsion to strictly adhere to rules makes her easily misunderstood, leading to unfair treatment from her peers. In more severe cases, she may wind up a victim of teasing, bullying, and other social cruelty.

In addition to ensuring that vulnerable children and adolescents have adequate supervision, parents, teachers, and other important adults can help inflexible kids develop increased social competence and coping skills that may buffer them from secondary emotional distress. We discuss some of these approaches in Chapter 12: Helping Children Shift Gears.

FACILITATING BETTER SOCIAL INTERACTIONS
Parents can help their children in the social realm by discreetly figuring out what is going wrong and coordinate more successful social interactions. Jamal’s mom sought a consultation with a psychologist because her son was becoming depressed. Stating that nobody liked him. An energetic, “over the top” twelve-year-old, he felt sad at never being invited over to friends' houses and at being frequently ignored at school.

At the suggestion of the psychologist, Jamal’s son mom called the parents of one of his friends and learned that other kids enjoyed his sense of humor but became irritated because he always needed to control what they would do. With the cooperation of another parent, she invited a peer of Jamal’s choosing to accompany their family on a tour of a “hands-on” science museum. Before the activity, Jamal’s mom reminded Jamal that he would receive extra video game time for allowing his friend to decide which exhibits they visited and for thinking before acting. She told him that she would help by reminding him briefly if he started getting too bossy. With some verbal prompting and the help of a secret sign they had previously agreed upon, the outing was a success and Jamal began to consider that he could have more satisfactory peer interactions when he worked at controlling himself, Jamal and his mother made this a target behavior for a weekly reward and they continued to work on the goal of letting his friends choose activities. Later, will need to work on building a collaborative approach decision-making.

Emotions
As we noted above, executive skills do not develop in a vacuum, we need to remember that a child’s temperament, or personality, also plays a big role in her attitude, perceptions, and responses to executive weaknesses.

Temperament
You probably already appreciate that your child came into the world with some characteristics and features that are not in any way related to experience. A child’s temperament encompasses some very clear preferences and characteristics. This is particularly apparent if you have more than one child.

Take sisters, Carol and Kayla. Carol has always had a “glass half full” perspective. When she spills her juice, she pops up, gets a paper towel, tells her dad, “Don’t worry, I’ll take care of it,” cleans up the spill, and quickly returns to what she was doing. When Kayla spills her juice, on the other hand, she automatically apologizes multiple times, begins to worry that her parents will evaluate her negatively, and can’t stop thinking about her mistake. Her “hard-wiring” results in a more pessimistic view of herself and the world.

How you respond to your child, as well as how your child responds to you and to life experiences, is interactive. For those who seek to please adults, meet expectations, and perform well, there is rarely the need to question motivation. It is clear that Kayla, from our example above, cares about how she is doing, as she is the first one to call attention to her shortcomings and to vow to work harder when she experiences failure or inconsistency. However, many children and adolescents with executive dysfunction or delays react to frustration and failure with decreased effort, avoidance, and declarations that they “don’t care.” Although both groups of kids are at risk for social, emotional, and daily living difficulties, those who deny their difficulties and who adopt an “I could not care less” attitude pose notable challenges for their parents and teachers. We encourage these important adults to look beyond the surface presentation to see the underlying weaknesses and frustration.

Self-Understanding and Self-Esteem
One of our most important jobs as parents is to help our kids develop a realistically positive self-image. Good self-esteem is built on a levelheaded appraisal of one’s own strengths and weaknesses and a sense of competence in the world. People who view themselves as helpless, ineffective, or inferior are at risk for lifelong problems in social, emotional, and vocational functioning. On the other hand, people who deny their own weaknesses and fail to realistically appraise themselves will have an inflated view of their abilities and will be unprepared for the real world.

Given the fact that children and adolescents with executive weaknesses may experience more disappointment and frustration than their peers, there is a notable risk of developing negative self-esteem. We have talked with many kids who have come to believe that they are just not smart enough. Like many of their parents and teachers, they are frustrated by the fact that they can sometimes excel but often fall short of expectations. How do we help children to feel good about themselves in the face of their weaknesses?

In addition to acknowledging and encouraging kids in their areas of strength, it is important that we help them to understand their own weaknesses and put them into context. Even in the most supportive of environments, negative feedback arises from the fact that a person with executive weaknesses is out synch with expectations. Such experiences play a powerful role in self-assessment. You cannot (and should not!) convince a child that everything is fine when that child’s experiences confirm a weakness. What parents can do is to help the child to express her feelings about the experiences, develop a straightforward approach to the problems, and work on problem-solving. In our examples in the second half of the book, these principles are in action. Although it is important to help kids understand their weaknesses, it is also important to convey that these alone do not define them as a person.

In addition to parents’ input on these issues, professionals can play a strong role in the process. It can start with the initial evaluation/assessment and an explanation of the results with the child geared to her level of understanding and emotional development. (For more information on the assessment process, refer to Chapter 6.) sometimes, parents worry about how we will summarize evaluation results when we meet with their kids. They express concerns about the possible negative effects to self-esteem and they worry that talking about problems will make the child feel different from peers. In reality, many kids view their problems and differences as more severe than they actually are. They also often underestimate their true strengths. Our goal is to help kids understand their difficulties without defining themselves by them or becoming overwhelmed. We don’t like to hear someone say “I am AD/HD.” In fact, although she may have attention weaknesses, she is so much more than the sum of these and it does her a disservice to focus exclusively on these characteristics. On the other hand, research clearly indicates that students with disabilities are most successful in college when they are able to clearly and comfortably discuss their strengths and needs as good self-advocates. Working toward this level of self-understanding and confidence requires beginning much earlier, by supporting honest self-appraisal and acknowledgement of strengths and weakness. As parents, you have the power to play the biggest role in this process.


 
   
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