How Do I Know If My Child Has Executive Function Issues?

When we are concerned about kids being disorganized — so disorganized that they have trouble keeping track of their stuff and keeping up with schoolwork — the first thing we want to do is try to understand what’s going on with them.

There are tests that highlight different kinds of organizational skills your child could be weak in. But the first thing to do is to get a good picture of when and how they are disorganized.

That’s where your child’s teacher can be very helpful. Ask her to give you a rundown of the things your child is struggling with. It also might be possible to have the school psychologist observe them in the classroom, to describe the things they seems to be having trouble with. Are they failing to bring their homework into class? Do they have trouble shifting from one activity to another? Writing down assignments? Putting materials where they belong? What seem to be their issues? They can help you decide whether testing would be a good idea.

And before you focus on organizational skills, you want to rule out other things that could be causing your child to seem disorganized. For instance:

• If a child always seems to be forgetting to turn in homework or losing books, it could be because they have a learning disability and feel bad about doing, or showing, the teacher their work. “Rather than organizational issues, they might need help with math,” notes Michael Rosenthal, PhD, a pediatric neuropsychologist.

• They could also be losing things and forgetting things because they’re distracted by anxiety. And it could be an anxiety that they keep to themelves, perhaps because they’re embarrassed by it, so their teachers and parents don’t know about it.

• A child could seem disorganized because they’re depressed, which causes them to feel disconnected and indifferent about things they normally would care about. “The issue could be their motivation and mood,” Dr. Rosenthal notes.

• A child who’s had a traumatic experience could be disorganized because they’re constantly feeling stressed out.

But if you’ve ruled out these emotional problems that could be contributing to the behavior, it’s possible that your child is disorganized because they have a weakness in what are called executive functions.

Executive functions are mental skills that we all use every day to get things done. We use them to set goals, plan how we’re going to do something, prioritize, remember things, manage our time and possessions, and finish what we start.

Some children have weaknesses in executive functions, and, regardless of how bright they are, they struggle to do schoolwork and stay on top of things they’re responsible for.

Some of these functions are more obvious than others, because they involve a child’s behavior in the world — losing their jacket, forgetting their homework, not following directions. Others are less obvious but just as important, especially for learning: retaining facts, solving problems that take several steps, figuring out what’s important in things they’re reading, putting things in a reasonable order when they’re writing.

There are several different kinds of tests that can be used to see what kinds of executive functions your child might be having a problem with.

The most comprehensive way to assess a child’s organizational issues and determine their cause is a neuropsychological evaluation. This is made up of a set of tests, questionnaires, interviews, and observations that clinicians use to get a good picture of what each kid’s strengths and weaknesses are. The test shows how kids complete tasks and process information.

“Most parents who come in and say my kid is disorganized usually have some other problems, too,” says Dr. Rosenthal. “Organization is often one piece of the picture. But it’s important to be comprehensive in a neuropsych evaluation to evaluate all the other pieces, to isolate whether this is specifically an executive function problem or if there’s a larger issue at play.”

As a result, neuropsychological evaluations involve several sessions and require time and work on the part of the child as well as his teachers, parents and clinicians.

The evaluation includes:

• Testing that measures how a child approaches a task that doesn’t have a lot of structure to it. For example, when they are presented with something they have never seen before, and they don’t know what the expectation is, how do they devise a strategy for solving this problem? Do they come up with a good, organized strategy or a haphazard, impulsive, ineffective strategy?

• Parent and teacher questionnaires that parents and teachers complete to share their impression of what the child’s organizational issues are. Are they pervasive, meaning they’re present in all aspects of the kid’s life — at school, at home, even recreationally? For example, parents can say if a child is also losing their equipment when they’re playing sports, and things they cares about at home.

• Clinical questionnaires are used to compare your child’s responses to thousands of other kids to see what’s normal and what’s a problem.

Dr. Rosenthal says he spends 8-9 hours face-to-face with the child doing testing, about an hour-and-a-half interviewing parents, and additional time on the phone talking with teachers. Only after all of that is completed does he collect, score, and interpret the information.

There are two kinds of tests that measure executive functioning issues without doing a thorough neuro-psych evaluation (in fact both kinds are included in a neuro-psych evaluation).

• The first kind is questionnaires that ask parents, teachers, and perhaps the school psychologist to observe closely the behaviors they see in a child and fill out a rating scale. The Behavior Rating Inventory for Executive Function (BRIEF) is an example of that kind of test.

• The other kind of test is one in which a child is assessed by a psychologist who watches them perform a series of tasks and observes how they go about each one. The Cognitive Assessment System (CAS) is that kind of test.

Dr. Rosenthal reports that he’s found the first group of tests, including the BRIEF, to be particularly good at identifying what is happening with a child. That’s because kids can often function better in a controlled setting like a doctor’s office, while functioning in the real world, where there are so many distractions and interruptions, is more challenging.

Once you have a good idea what your child’s specific issues are, their teacher and a school psychologist will usually work together to find ways to support them in the classroom, focusing on their strengths and helping where they’re weak.

You may want to have them work with a learning specialist, who is trained to help with the skills that they need to perform in school, such as memorizing facts, digesting important information, organizing thoughts in writing, and solving multi-step problems.

The older a child gets, the more these executive functions affect their ability to learn as well as keep track of assignments and sports equipment. Helping them get more organized will not only make things easier for them (and for you) but will allow them to be as accomplished and successful as they can be.