What is Executive Function Disorder?

Article 2: What is Executive Function Disorder?

Eleni Siderias Associate Head of School The Gateway School

Walter is entering his junior year of high school. He wants to apply to college next fall, and he knows an impressive transcript these next two semesters could really help expand his list of choices. In addition to his academic course load, he’s once again playing trumpet in the marching band and will be swimming for the varsity team this year. On any given day it’s a lot to manage, but he’s up to the challenge. In fact, Walter prides himself on being one of the most organized kids in his class.

This was certainly not always the case. In elementary school, Walter was always described as a bright kid. He was also always described as forgetful. Whether it was a notebook left at home or a jacket left on the playground, barely a day went by without Walter losing track of some personal item. With an IQ well above average, he perfectly embodied the absentminded professor trope.

Oftentimes, Walter’s forgetfulness was so acute that he could be in the middle of an assignment, become distracted by something a classmate said, and be completely unable to regain his focus on the lesson at hand. Other times, he would become so fixated on a minor detail he would lose track of the big picture and was often left to finish incomplete classwork at home. The problem was that by the time Walter got home, practicing his trumpet or a FaceTime call from his cousins would completely push his homework assignments out of mind, and they would go unfinished.

By fifth grade, things really started to unravel. Walter’s desk was forever messy, his locker was a certified disaster area, and his backpack was essentially a black hole with papers shoved in at random moments of the day, never to be seen again. Homework didn’t get submitted, and Walter struggled to remain focused when transitioning

3 from class to class. When routines or plans changed, Walter could quickly become irritable, which was frequently causing conflict with his classmates.

What was once laughed away as quirky and distracted was now presenting as symptomatic of something else: executive function disorder.

The Center on the Developing Child at Harvard University describes executive function and selfregulation skills as “the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses. Executive function and self-regulation skills depend on three types of brain function: working memory, mental flexibility, and self-control. These functions are highly interrelated, and the successful application of executive function skills requires them to operate in coordination with each other. Each type of executive function skill draws on elements of the others.”

Working memory describes a person’s ability to process and use discrete amounts of information. It is part of our short-term memory system and is crucial to learning because it allows the brain to keep track of information until it needs to be used.

Mental, or cognitive, flexibility describes a person’s ability to switch thinking between two or more topics, or to think about multiple things simultaneously. The capacity to switch back and forth between tasks and incorporate new instructions in the middle of a task is governed by a person’s mental flexibility.

Self-control describes the individual’s ability to regulate their thoughts, emotions, and behavior. It allows for prioritizing and goal-setting and supports one’s ability to resist impulses and temptations.

Attention-deficit/hyperactivity disorder (ADHD) is a type of disability that impedes a person’s ability to self-regulate.

Someone with executive function disorder has a combination of challenges with working memory, cognitive flexibility, and self-control. Weaknesses in any of these three types of brain function have a meaningful impact on learning. If a task is automatic, then executive functioning and self-regulation skills are not engaged. With tasks like writing and speaking, however, the brain relies significantly on working memory, flexible thinking, and self-regulation.

“In many ways, the three brain functions that executive functioning depends upon are essential to academics,” says Eleni Siderias, Associate Head of School at The Gateway School. “If a student has an executive function disorder, they may cognitively understand subject matter but can’t manage their thoughts, stay organized, recall information, motivate themselves to start their work, or manage the anxiety that attends all of that.”

For any student with executive function disorder, the essential challenges of organization and planning interfere with language in several ways. These students struggle with spontaneous speech and have problems with self-expression (pulling ideas together in logical order, finding the right words), placing the burden of interpretation on the listener. The student, pressed to stick to his point and maintain organization, tends to be concrete or inflexible. This can result in misunderstanding with academic and social ramifications.

Walter’s messy desk and disorganized backpack were classic symptoms of an executive function disorder. So too was his forgetfulness and his outbursts in the face of unexpected change. That’s because his working memory wasn’t helping him recall information correctly; he did not have the mental flexibility to switch between tasks easily, and he couldn’t regulate his emotions.

For Walter to become such a successful student in high school, he would have needed an environment like Gateway to prepare him.

“At Gateway, we have high but consistent expectations for all students,” says Ms. Siderias. “We want them to be strategic in their approach to learning, self-motivated, and have the metacognition necessary to manage their own learning challenges. Gateway is very intentional in this approach and individualizes it to each student.”

Understanding that a child’s world is school, Gateway’s near-term focus is on teaching children how to navigate the academic and social aspects of the classroom so they can succeed there, as well as at other times throughout the school day. Students are taught self-awareness, the skills of self-advocacy and social communication, and the essential qualities of good character: temperance and compassion. Gateway’s approach acknowledges that its students learn in ways that are different from their mainstream peers; as they benefit from instruction that truly meets their needs, they become skilled, strategic, independent learners increasingly ready to meet the demands of mainstream education and life. Helping students with executive function disorder regulate their emotions is a central feature of Gateway’s program. “For a child with a dual diagnosis of a language-based learning disability and ADHD or an executive functioning disorder, selfregulation becomes more complex,” says Dr. Christy Brockhausen, Director of Lower School.

In the Lower School, students are introduced to the Zones of Regulation®, a framework developed by Leah Kuypers, MA.Ed., OTR/L, to help students foster emotional regulation and self-control. This program aligns with Gateway’s focus on explicit, systematic, and cognitive linguistic teaching. Lower School students first learn the language needed to identify, label, and categorize their feelings and then are explicitly taught strategies and methods that empower them to problem solve and, in turn, regulate their response to challenges. As they grow older, through one-on-one advising and small group work, students practice strategies that enable them to pause and reflect before responding or reacting. Academic instruction is also structured to meet the needs of students who struggle with executive functioning. Teachers employ direct, multisensory instruction and never assume that students know how to complete a task. By providing clear routines and explicit steps to follow, students stay on task and manage their stress levels, and learning proceeds.

At the beginning of each day, students get an executive functioning “boost” in homeroom, when they review expectations and goals for the day. The Aim and Agenda reinforces this by providing structure for each class. Direct instruction supports students in knowing what to do, how, and why. In combination, these approaches to instruction assist a student with maintaining focus and anticipating learning that might require a specific strategy.

Guided practice, thinking out loud, and using timers are all strategies employed to teach younger students how to maintain attention and strengthen their working memory. Story Grammar Marker® is an example of a framework used specifically to help students understand the structure of narrative text that is read out loud.

An important feature of instruction at Gateway is that teachers always explicitly model the tasks they want students to complete. Skills are built incrementally. Teachers allow plenty of time for repetition. And, they are reinforced across subject

areas. Writing, for example, begins with the creation of an outline and is done collaboratively many times before a student is asked to write independently.

Students at Gateway are also given practical tools to help them stay organized and focused. Older students are each issued a zippered binder to keep their schoolwork organized. They also receive colorcoded folders for each subject, with one side of the folder meant for completed assignments and the other for work that needs to be done. A student planner is used to practice organizing time and keeping track of due dates. Teachers, and eventually students, will estimate how long an assignment should take to be completed, so each student can track their progress against that expectation.

Students receive immediate feedback that not only measures the quality of the work, but also assesses how well the student demonstrated their use of strategies and skills to stay on task and manage their time.

For a student like Walter, this approach can be transformative. By spending so much time developing consistent routines, Walter’s strategies became automatic, which reduced cognitive load and mitigated his anxiety. By the time he reached high school, he was better equipped to manage the demands of school than many of his typically developing peers.

“What is most effective about an approach like Gateway’s for a student with executive function disorder,” as Ms. Siderias explains, “is that process is emphasized as much as product. Gateway knows that a student has to be aware of their challenges and gaps before they can begin to regulate them.” n