How Do I Know If My Child Has Executive Function Issues?
A look at how problems with organization are evaluated
Clinical Expert: Michael Rosenthal, PhD
What You'll Learn
- What are executive functions?
- What are the signs that a child might have issues with executive functions?
- What should I do if I think my child has trouble with organization?
Executive functions are mental skills that we all use every day. Organization, problem-solving, planning and memorization are all executive functions. Some kids (even very bright ones!) have trouble with executive functions. Kids with executive function issues often have trouble keeping track of schoolwork and staying organized. They might forget to write down assignments, lose homework, and have trouble following directions.
If you notice signs like these in your child, check with their teacher to see if that pattern shows up at school too. If it does, a neuropsychological evaluation can help you figure out what’s causing the issues and what kinds of support your child might need.
During the evaluation, a psychologist will spend several hours talking to the child, parents and teachers. They will give the child tasks to do and see how they respond. The psychologist might also observe the child at school. From there, the psychologist can give you a better idea of what your child is struggling with and make a recommendation for treatment. Treatment can be very helpful and often includes working with a learning specialist or school psychologist to build executive function skills.
It’s also important to make sure that your child’s disorganization isn’t caused by a different issue. Kids who are distracted by depression or anxiety may appear disorganized. Or a child who constantly loses homework may be avoiding showing the teacher their work. In that case, an undiagnosed learning disorder could be the cause. Children who have experienced trauma often struggle in school as well. Finding the real cause is the key to getting your child the right treatment.
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 he’s 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 him in the classroom, to describe the things he seems to be having trouble with. Is he failing to bring his homework into class? Does he have trouble shifting from one activity to another? Writing down assignments? Putting materials where they belong? What seem to be his 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 his homework or losing his books, it could be because he has a learning disability and feels bad about doing, or showing, his teacher his work. “Rather than organizational issues, he might need help with math,” notes Michael Rosenthal, PhD, a pediatric neuropsychologist.
- She could also be losing things and forgetting things because she’s distracted by anxiety. And it could be an anxiety that she keeps to herself, perhaps because she’s embarrassed by it, so her teachers and parents don’t know about it.
- A child could seem disorganized because she’s depressed, which causes her to feel disconnected and indifferent about things she normally would care about. “The issue could be her motivation and mood,” Dr. Rosenthal notes.
- A child who’s had a traumatic experience could be disorganized because he’s 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 she has 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 her jacket, forgetting her 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 she’s reading, putting things in a reasonable order when she’s 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 he is presented with something he has never seen before, and he don’t know what the expectation is, how does he devise a strategy for solving this problem? Does he 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 his equipment when he’s playing sports, and things he 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.
Other testing that focus on executive functioning issues
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 her perform a series of tasks and observes how she goes 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.
How to help
Once you have a good idea what your child’s specific issues are, her teacher and a school psychologist will usually work together to find ways to support her in the classroom, focusing on her strengths and helping where she’s weak.
You may want to have her work with a learning specialist, who is trained to help her with the skills that she needs 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 her ability to learn as well as keep track of assignments and sports equipment. Helping her get more organized will not only make things easier for her (and for you) but will allow her to be as accomplished and successful as she can be.