Executive Functions

What’s in Your Wallet?

There is a commercial advertising a credit card company that ends with the question, “What’s in your wallet?” While this is an interesting question, at my house I am more likely to hear, “Where is my wallet?”

Life with the distractible and disorganized can be discombobulating. I live with three family members who have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and due to challenges with inattention and forgetfulness often items get lost or misplaced. Sometimes my kids will ask me if I’ve seen something that’s gone missing. Since I like things to be organized and put away in a logical place, there are times when I can locate the missing object because I put it away instead of leaving it out where it was dropped.

I have systems for cleaning and organizing. The problem is with implementation and cooperation from the rest of my family. I have a strong need for things to be put away where they belong so I can find them when I go looking for them. Just last night I pulled out all the ingredients to make a delicious smoothie, but when I went to get my smoothie maker only part of it was in the cupboard where I keep it. I had a blender base with the pitcher and a lid, but the ball on a stick part used to help move the mixture around in the pitcher was missing. I looked in all the places I could think of putting it, but only one place really made sense to me and that was to store all the smoothie maker parts in the same location. My husband came into the kitchen and joined me in the search for the missing part.

After looking in the same places I had looked, and striking out just as I had, my husband began looking in places that made no sense to me but just might contain the lost tool so they warranted a look. Even then we could not locate our smoothie tool, so we…looked in all the same places again! I’m not sure why we do this, as if the missing item that wasn’t there previously will somehow show up if we look again in the exact same place. This strategy was also unsuccessful, so we moved on to asking our children if they knew where the missing piece was hiding.

This is not generally a good strategy, either, because we are talking about distractible people who misplace things all the time and absentmindedly leave things in odd places. But it was worth a shot, since we had nothing else to go on at that point. Both children stated where they might have placed it, but neither actually remembered doing so and the item wasn’t where they suggested. This time, my husband decided to try substituting a silicon spatula in place of the missing tool, with the result that we had delicious smoothies with bits of a chopped spatula mixed in. I think I swallowed a piece.

Those types of lost items are frustrating and inconvenient, but not nearly as alarming as missing driver’s licenses, phones, or my personal nemesis the missing wallet. Not my wallet. Remember, I have a “wallet place” where my wallet lives and is predictably located when I need it. My daughter and husband have misplaced their wallets multiple times, though, and it sends me into a far greater panic than they experience. While my mind is racing with all the possibilities and security risks, they are unsystematically roaming the house looking in odd places for their wallets. Sometimes they leave the house for a minute and I realize they are checking the car to see if it’s there. Or maybe on the sidewalk, or in the grass, or…well, you get the idea.

My daughter will, at times like these, casually ask me if I’ve seen her wallet. She acts like it’s not really a big deal because it’s bound to turn up sooner or later, and she really believes that! Hunting for her wallet is like a treasure hunt and is only mildly irritating if she doesn’t find the wallet. I, on the hand, begin mentally listing all the items that will need to be replaced or cancelled.

My husband is more subtle about searching for his missing wallet or other items, and rarely asks me to help him look anymore. The reason he doesn’t bother seeking my assistance is because I’m not much help at finding whatever he has lost. I look in logical (to me) places where I would leave my wallet, for instance, and since I have a “wallet spot” I don’t have too many places to look.

Even when my husband doesn’t come out and say that he’s misplaced something of importance, I can recognize the signs. He enters a room scanning it like a secret service agent taking everything in at a glance. Then he moves around the room, picking up papers and small portable items while surreptitiously looking under and around them. He never panics, and never tells himself not to bother looking in strange places because he knows the missing item could be anywhere. While I fret about possible identity theft, my husband remains unruffled as he continues his quest for the missing wallet.

I no longer reach the panic stage as quickly as I used to, because more often than not my husband and daughter do find their missing wallets. Rather than berate themselves for having lost them, they congratulate themselves on another successful recovery. I would like to avoid the stress of “Where is my wallet?” but I do admire the resiliency of my family members who just don’t sweat it when these events happen. They take it in stride as casually as a driver stopping for a red light, doing what the situation calls for and moving on.

Speaking of moving on, I just heard my husband in the next room quietly asking himself, “Now where did I put my keys?”

I am quite confident that he will find his keys, no matter how strange a hiding spot they are in, because his experience and resiliency will win out. Keys, your time on the loose is limited. Give yourselves up! You will be found.

Homeschool Flashback #5 Executive Functions

Ahhh, executive functions. We love them, and when they are lacking we long for them. Children with AD/HD struggle to develop vital executive functions such as organization and planning. Students with learning disabilities and struggling learners (officially identified or not) often have some degree of executive dysfunction.

Any experienced teacher can look at a student’s notebook and tell if that student is able to organize and access the information and materials they will need. Intelligence plays a part in academic success, sure, but the organized student typically comes out on top. Executive functions help students to show what they know. If they have completed an assignment but can’t locate it the teacher has no way to assess their performance. A very bright student who forgets about an assignment or fails to complete the work even though he has the capacity to do so will be out-performed by an average student with the executive functioning skills to complete tasks accurately and on time.

Children with learning challenges work harder and longer to get results and deficits in executive functioning impact all areas of life, not just the academic realm. Consider, for example, the child who forgets he made plans with one friend and is off with another when the first friend comes calling. Or the child who struggles with time management and is chronically disorganized causing her to be late for practice again because she can’t find her mouthguard.

Some children just naturally seem to develop executive functions as they mature. Others need much more direct instruction than our modeling alone provides. In the picture above, you can see the rudiments of Josh’s attempt to develop some executive function skills. He has written out the date and the tasks he needs to accomplish each day. He put a check mark next to completed work. Josh’s system is far from sophisticated, but it reflects his burgeoning attempts to incorporate some organization into his day.

Is Josh’s method acceptable? It wouldn’t be what I would choose, but Josh is a unique individual. I had shown Josh various organizers and examples that I would use but he had to find something that worked for him. The picture shows what he came up with, and although there are many things I would do differently the idea was for Josh to find a system that worked for him.

It’s too bad executive function skills can’t just be absorbed by spending time with people who excel with them. The good news is that executive skills can be taught. It may take awhile, but they are so important that it’s worth the investment of time to help your children develop in these areas. Experts say that executive function skills continue to develop into the twenties, but don’t wait to start working on them until your child is already floundering. Help your young child to develop strategies to keep track of his possessions. Assist your older children in using calendars and organizational aids. Help your child write a list of what needs to get done for the day. When executive skills don’t come naturally, even the most primitive progress is just that – progress. 

Easy Materials You Make Yourself

I like to give my children a lot of different ways to learn. My two kids with AD/HD are strong visual learners, and their sensory processing challenges lead them to seek out hands-on experiences. So, besides offering them fidget items when the lesson doesn’t have manipulatives, I try to find ways that they can see and touch objects as they learn. I also know that my children are externally motivated (not unusual for those who have weak executive functions) and they need frequent reinforcement or reminders to stick with a task. In case I haven’t mentioned it before (though I think maybe I have either here or during my workshops) I am also reluctant to spend a lot of money on things I can make myself. Of course I always think I will go to craft shows and then make whatever has grabbed my fancy once I get back home, but I never seem to do that. But with school materials, I sometimes manage to get inspiration from my recycling bin. The picture above shows a simple set of materials that are readily available and can be used for a number of things. It took me about 15 minutes from start to finish to make it.
First, get a cardboard egg carton. Make sure it’s clean and no eggs have cracked and leaked in it. I spray mine with Clorox Anywhere Spray to kill any germs. (Disclaimer: Melinda cannot be held responsible for any icky things you pick up from your egg carton. I am not a doctor…blah, blah…) My egg carton had a little circle indented on the bottom of each cup, and I cut around them to make the holes in the middle of each cup. If your carton does not include these handy, preformed circles, you can just cut your own. The circles need to be large enough for a clothespin to fit through but small enough to hold the clothespin in place. Leave the lid on the carton so you can store small materials inside and to provide a base for the clothespin to stand on. There are many ways you can use your newly recycled materials, so I’ll just get you started with a few ideas. I’m sure you will be able to come up with more ideas, and I’d love to hear about them.

  • Use the clothespins to practice counting.
  • Practice fine motor skills by having the child place and remove the clothespins
  • Use as reinforcement by putting one clothespin in place for each completed task
  • Use as a motivator by placing clothespins in the carton for each task that needs completed. Remove a clothespin as the work gets done, visually depicting for your child that progress is being made.
  • Paint the clothespins (or use colored popsicle sticks or tongue depressors) to match colors

Making this is easy to make, easy on the budget, and easy on the environment. A winner all around!

The Magic of Tootsie Rolls

My daughter, Beckie, has AD/HD. Now that she’s a teenager, her primary challenges are with the executive functions (EF) like planning, organization, and working memory. She also continues to need more prompts and external rewards than her peers without EF challenges.

Beckie and her sister have been sharing a hair dryer for years. It is important to Beth, the older sister, to have the hair dryer put away after use. Beckie couldn’t care less if the hair dryer gets put away, so there is little internal motivation on her part to do so. Remember, anything that requires extra steps is not popular with our kids or adults with AD/HD. Additionally, they need more frequent rewards than their “neurotypical” peers. This need often extends into adulthood.

The hair dryer wars went on for a while, with hard feelings on both sides. Since the girls were not able to work out their differences and the hostility was escalating, we met as a family to problem solve together. If something didn’t change, the hair dryer wouldn’t be the only thing to blow at our house. At one point in the discussion, Beth told Beckie she just needed to remember to put the hair dryer away. “After all, you are a teenager. It’s not like I’m going to give you a Skittle every time you remember to put it away. You just have to make yourself do it.”

When I heard Beth say that, it was a light bulb moment for me. Having recently attended a conference on Executive Functions, it was fresh in my mind how the presenters shared that many with EF struggles will continue to be externally motivated throughout their lives. Since the EF challenges continue throughout the lifespan, affected individuals also continue to need more encouragement, praise, recognition, and rewards than those without EF struggles. This explains why my husband, who regularly makes the coffee, asks me how it is sometimes before I’ve even taken a sip. My first thought is, “Um, it’s fine. It’s always fine?”

I’ve come to realize that my husband needs that frequent positive reinforcement because making coffee and doing other chores is not intrinsically satisfying to him. He needs to know that his efforts are appreciated. Once I understood that, and realized that my son with AD/HD is the same way, I trained myself to make a point to express thanks for even mundane, everyday things. They need that. I can easily give them that. So when Beth made the comment about Skittles, I realized that Beckie was getting no reward when she remembered to put the hair dryer away. She honestly tried to remember, but since having the hair dryer put away was meaningless to her and she is highly distractible she often forgot. Since it wasn’t important to her in the first place, she experienced no internal satisfaction when she completed the task.

I devised a simple plan to help Beckie be more successful, and hopefully end the hairdryer war or at least reach a truce. Knowing that she loves Tootsie Rolls, I bought a bag of miniature Tootsie Rolls and put them in a small bowl in the bathroom. I told Beckie that every time she remembered to put the hair dryer away, she could have one Tootsie Roll. Beckie thought it was a great idea.

Now some of you are thinking, “Why should a teenager need a treat to do what she is supposed to do? Won’t that just keep her dependent on external rewards?” Good questions. Here’s what I think. By showing Beckie a simple way to motivate and reward herself, she is learning a strategy that she can eventually use on her own. Because her EF difficulties are likely to continue into adulthood, she absolutely needs to figure out ways to reward herself. Would it bother you as much if she were buying the Tootsie Rolls herself and using them as rewards for completing tasks? Probably not, because most of us do this in one form or another. I’m just showing Beckie an example of what she can do to keep herself motivated and on task. In the future, she will know how to do this for herself.

Asking Beckie to try to remember to do a task that was not important to her just didn’t work. She meant to, intended to, sometimes did remember to, but not with adequate consistency. Now, every time she goes into the bathroom, she sees the little bowl of Tootsie Rolls. It is a visual reminder and incentive several times a day, even though she only dries her hair once a day. She is aware that one of those treats will be hers if she remembers to put the hair dryer away. Guess how many times she has forgotten to put it away since the Tootsie Roll plan has been in place? Zero! She has not forgotten to put that hair dryer away a single time, and it has been several weeks since we implemented the plan. Did this teenager benefit by an external reward system? The results would indicate an absolute YES!

The hair dryer war seems to have ended peacefully, and Beckie has had great success while learning a strategy that will serve her throughout her life. She reports that she feels she has met the challenge, although she adds with a grin that once in a while she has forgotten to take a Tootsie Roll reward.

Clark Lawrence at CHADD of Columbus

I know this is a very late announcement, but Clark Lawrence will be speaking at the CHADD of Columbus meeting tomorrow, January 24, 2009 at 2:00 in Gahanna, Ohio.  His topic will be “Developing a Positive ADD Lifestyle”.  Clark is Director of the Executive Function Center in Cincinnati, Ohio.

A description of his topic:

Positively addressing adult ADD requires more than working on the problem areas (goal-setting, procrastination, etc); people with ADD also need to adopt a lifestyle that works with their ADD to overcome its effects -­ as opposed to continually working against their ADD. This talk will address the lifestyle problems of people with ADD and offer a vision and techniques to create a positive ADD lifestyle

The meeting is being held at Mifflin Presbyterian Church, 123 Granville St., Gahanna, OH  43230

Melinda had the opportunity to interview Dr Lawrence at the 2009 CHADD conference in Cleveland, Oh.  Here is the interview.

Clark Lawrence Interview

Answering Questions

I’ve noticed something interesting about the way my AD/HD guys (husband and son) answer questions. Their approach to conversation is sometimes a challenge for me, the mere “neurotypical” that I am. When I was first getting to know Scott, I would ask him questions to see how he thought and to learn more about him. I am pretty logical and sequential and so is my communication style. We didn’t know back then that Scott had AD/HD because he wasn’t diagnosed until after our son was and by then we were in our early 30’s. So it puzzled me when I would ask Scott a question and he would answer by asking me a question. This was not a matter of repeating back what I’d asked for clarification purposes, but would be a different question that could change the course of the conversation. I might ask something like, “What was your favorite vacation while you were growing up?” Scott’s response might be to ask, “Do you like to travel?” It wasn’t a matter of Scott’s evading the question, and there was still a connection with what I’d asked. It’s just that his response didn’t answer the question. Scott’s amazing brain just works in a way that allows him to connect with one topic and from that topic quickly make connections with many related thoughts that shoot off like the spokes from the hub of a bicycle wheel – only probably not as organized and predictable as the spokes. If I really needed a definitive answer, I learned to come out and say, “You can’t answer a question with a question.” This forced Scott to slow down and give me something definitive to work with so we could reach some sort of conclusion. Often he would ask me out and have no plan in mind for what we would do. I didn’t know him well enough yet to understand that he was tapped out in the planning category just by setting up an exact time to be with me. So he would pick me up, and I’d ask what he wanted to do. Then he would ask me what I wanted to do, etc. We have since learned how to communicate when I need specific information even though it still does not come naturally to Scott. I’ve noticed with my son, Josh, that he often doesn’t answer a straightforward yes/no question with “yes” or “no”. Today his dad asked him if he’d had enough pizza. Josh responded that he’d had five pieces. So, does that mean “YES, I’ve had enough,” or “NO, I’m still hungry”? I’ve learned to communicate with Josh to narrow things down for him in very specific ways and eventually I can usually pull the answer out. Sometimes with Josh it’s a matter of distractibility or making excuses rather than just saying “yes” or “no”. For example, when asked if he liked a certain movie he might give you enough information that the answer is implied even though he doesn’t come right out with it. Other times, I’m still unclear even after his response so I just have to try again and ask, “So does that mean you DID or DID NOT like it?” To me this way of communication seems like it would be much more work for Josh and Scott than just responding with a simple reply or an affirmative or negative response, but to them it is natural to answer questions in a more circuitous way. What comes naturally to us does not feel like hard work, and as long as it’s working for us that’s what we’ll tend to do.

Empty Containers Put Back In The Fridge

I don’t know if this happens in other families, but it is not uncommon at my house to look for something in the refrigerator only to find that the container is empty. I have rolled my eyes at the empty milk jugs that have been carefully replaced sans content. I write that off to habit combined with inattention. The habit dictates replacing the lid and putting it back in its original location while the inattention fails to note the emptiness of said container. It’s more frustrating for containers that I can’t see through, because I think I’ve found what I’m looking for until I actually remove the lid and discover the vacancy. Not that the containers are clean, by any means. There is usually a teaspoon of food or liquid remaining. I think if there is a full tablespoon, my family justifies putting it away because anyone can see it isn’t “gone” yet. The other day I found an empty 2-liter pop bottle left on the pantry shelf. It was the pop that Josh drinks, and for the first time I considered that he probably had done this deliberately and not in an inattentive moment. So I added to my usual eye roll response, and asked Josh why he had put an empty bottle away instead of into the recycling bin. He immediately responded that he had done so to remind himself that he was out of pop and needed to get more. Every time he’d go to get a drink of pop he’d see it and be reminded that he was out of his soda of choice. My strategy is to use a grocery list and write down what I need to replenish next time I’m at the store. But lists and pre-planning are to Josh what cooties are to young children. Eeew! Icky! So his AD/HD strategy, and it is a strategy, is to cue himself repeatedly through visual and tactile means. Then, when he thinks about getting a drink of pop and sees a display in a store, he will respond by buying the pop and can then recycle the empty bottle that he’s replacing.

The Miracle of the Fish

No, not THAT miracle! I’m talking about Beckie’s fish, a pet Beta she keeps in a wall-mounted bowl in her room. It’s not that she doesn’t like the fish or care what happens to it. It’s just part of how her AD/HD manifests, that she can remember the daily task of feeding the fish but the non-routine cleaning of the bowl eludes her attention. I noticed in July that her poor fish was swimming in about 2 inches of water in a very dirty bowl. I told her she needed to clean the bowl and add water right away, because I didn’t see how the fish could survive much longer in those conditions. She said she would, but that she’d need her Dad’s help to get the bowl off the wall to be cleaned. Her Dad said he would help, but he also has AD/HD so they both immediately forgot about it. Last week, I thought about it again and checked in with Beckie to make sure she had taken care of it. She still hadn’t! Yet the fish lived on. So I managed to catch both Beckie and her Dad at home and called them together to remind them about the fish and to urge them to act on it right away before they forgot again. They managed to get the bowl cleaned and filled with fresh water in about 30 minutes. It wasn’t that the task was too hard, it was that it wasn’t part of an established routine and the fish was unable to do anything to get their attention long enough for them to take the necessary action. Though things were looking pretty grim for him in his bowl of evaporating water, Neon the fish is presently happily swimming in a full bowl of clean water.

I’ll prioritize that…later!

Sometimes there are so many things to do that it’s hard to figure out where to start. This is true whether you are organizationally challenged or not. It’s easy to become overwhelmed when faced with a long to-do list. I’ve noticed that the naturally disorganized members of my family have a hard time with the executive functions of initiating and prioritizing, and often they start with less important things that are easier and will take less time to get done. Unfortunately, that often means that pressing matters wait while non-critical items get done first. I have tried to help my son Josh with prioritizing by reviewing his to-do lists, putting stars by the most important items or high-lighting them. (Some of you know that Josh is color blind, but he can still see differences in color contrasts.) I’ve discussed with him the items that are on a deadline to be completed, and the items that can wait a little longer though hopefully not indefinitely. After one such heart-to-heart chat with Josh, he pensively nodded his head before replying, “Okay, Mom. I’ll prioritize that later.” Aaarrgh! At least Josh realized the contradiction and gave me one of his famous “maybe being cute will be enough this time” grins as a reward for my fruitless efforts!

A New Planner

For most of his life, it seems my son Josh and I have been working together to find some organizational system that he will actually use. I personally love organizational tools, planners, and post-it notes. I am also naturally organized, and these materials fit in nicely with the way my brain works. Josh’s brain operates very differently from the way mine does. We have had a much harder time finding anything that appeals to him. He is color blind, so although he sees differences in shades of color it is not as helpful to him to try and color code things. He tends to lose things, so smaller planners disappear like so many socks in the dryer. A wall calendar was somewhat useful, but since he couldn’t carry it with him it didn’t help him once he was out and about. He tried an audio recorder, but since he’s a visual learner he had difficulty remembering to use it and then attending to listen to the recordings. And that’s if he could find the recorder, since it was pretty small and may have joined the missing dryer socks by now. Josh picked out a nice planner a few years ago, and the first week we sat down together to write out appointments. It was downhill after that, with Josh either sure he could remember and therefore didn’t need to write things down, or not having it with him when he needed it, or having it gone for a visit with the dryer socks… But every optimistic bone in my body is tingling now, because Josh himself discovered that the newest generation of the video gamer’s friend, the Game Boy Lite DS, has a planner feature built in! Josh can record appointments, phone numbers, and reminder notes using a stylus that comes with the DS Lite. Unlike other things, Josh always knows where his Game Boy is, and keeps his newly purchased DS Lite in his coat pocket so he will always have something to do if he gets bored. I’m not worried about him losing this, and the potential for this to work for the way Josh’s brain works is great.