Executive Function Disorders
Published on DyslexiaHelp at the University of Michigan (http://dyslexiahelp.umich.edu)
Your friend Theresa stops over. She’s not on your to-do lists or your calendar, but you let her in nonetheless and consequently spend thirty minutes talking to her which stops you from completing your reading assignment. Before she leaves you get an instant message from another friend to stop by on your way home from school tomorrow to pick up a pair of gloves you left there yesterday. You acknowledge back “OK” while you’re still talking to Theresa. You ask Theresa to repeat what she said and you forget about the reading assignment that was on your calendar to do in this time frame. And what was it that your mother told you to pick up? Milk? Your clothes from your room? Oh well, she will tell you again so it doesn’t matter. Theresa leaves and you have long forgotten about the gloves. You decide to play a video game and wait for your Mom to come home to tell you what to do next. Executive function (in this student’s case-Mom) is what gets us down to business when we’d rather just hang out.
For this student “Mom” acts as the executive function command center. She commands the actions that provide organization, remembers the details, makes sure that projects start and finish on time, helps to sequentially go from one assignment or play date to the next, and remembers the details. When this student is left on her own, life may become chaotic, assignments may be slow to start or never start at all, deadlines may be consistently pushed back or never met at all, and important details missed or overlooked. In today’s increasingly chaotic world, executive functions are essential to smoothly function and get tasks done.
Located in the frontal lobes of the brain, executive functions (EF) typically begin to develop in early childhood as the prefrontal cortex develops, then continue through adolescence into young adulthood. Parallel to the gradual development of EF, parents, teachers, and others in a child’s environment gradually escalate their expectations for the child to exercise an increasing measure of self-management, ranging from the simple tasks of dressing and self-care gradually to more complex responsibilities, e.g., managing multiple courses of study in high school or driving a motor vehicle. Like the student above, sometimes parents intervene so much to help their adolescents stay organized and on task that EF impairments are masked until the teen moves away from home, possibly to attend college or begin a job. Then, when she enters a situation where parental scaffolding is unavailable, she may experience much difficulty.
A collage of cognitive activities, EF encompasses the ability to design actions towards a goal, handle information flexibly, realize the ramifications of behavior, and make reasonable inferences based upon limited information. They are detailed functions of logic, strategy, planning, problem solving, and reasoning. There is no planning for the future without good EF planning skills.
Impairment of any or all of these EF skills may be present in spite of strong intellectual skills and unaffected language capacity. They are characterized by the following skills:
- Difficulty with planning and organization
- Trouble identifying what needs to be done
- Problems determining the sequence of accomplishment
- Difficulty carrying out the steps in an orderly way
- Difficulty beginning tasks
- Problems maintaining attention
- Trouble evaluating how one is doing on a task
- Difficulty taking feedback or suggestions
Four subtypes of EF
According to Levine (1994), there are four subtypes of EF:
- Material-spatial disorganization: This prevents students from dealing effectively with the equipment needed to be efficient in school. This is seen in such behaviors as losing things, creating messes among belongings, and not bringing home or returning assignments in a timely way.
- Temporal-sequential disorganization: In this case, students display confusion about time and the sequencing of tasks, such as being late, procrastinating; or having trouble allocating time, estimating how long a task will take to complete, or knowing the order of steps needed to complete a task.
- Transitional disorganization: This involves difficulty shifting gears smoothly and results in rushing from one activity to the next, having difficulty settling down to work, or being slow in preparing to leave home for school in the mornings.
- Prospective retrieval disorganization: This involves the inability to remember to do something that had been planned in advance, such as forgetting the deadline of a project until the night before or failing to follow through on a promise to finish a task.
Ways to help students develop EF
First and most importantly, the student needs to understand how she thinks (metacognitive processes) and gain knowledge about strategies. In doing so, she will learn that there is more than one right way to accomplish a task, be able to identify her mistakes and what to do to correct them, and how to evaluate her progress.
Time management – The ability to manage time includes the following: estimating the amount of time a task will take to complete, setting and following a schedule, completion of tasks on schedule, and the ability to modify or change the schedule as needed.
There are several options for time management – but most of all it is important to find a system that a student will use. Time management can be broken down into four divisions:
- Time estimation – how long will a task take
- Time schedules – generating an accurate and realistic time
- Completion of scheduled activities – ability to execute tasks within time allotment
- Alterations – ability to modify schedule
Time management can be facilitated by establishing routines throughout the day. Routines help to establish inner time clocks and can be facilitated initially by posting lists of sequential steps. It is important that the student be involved in developing the lists and discussing the time estimation of each sequence along with possible alterations that may need to occur, for example, on weekends.
It’s helpful to teach students the acronym CLASH to do daily:
Check your calendar or planner to see what is planned. This may include checking for assignments or tests for the next day to see if there is anything special to bring from home. If working, it may include checking for upcoming tasks and deadlines. It is helpful to make a plan utilizing a checklist before beginning tasks/assignments. This checklist should include: estimating how long each task/assignment may take, setting priorities, collecting materials, setting a timer, doing the task, collecting next materials, resetting time, and placing the completed assignments in one’s backpack/briefcase.
List the items you need for the next day the night before:
- On a piece of paper or in your cell phone, list all the things you will need for all of your classes/work the next day.
- Make sure you remember to bring any special forms that have to be signed by your parents or may need your attention if at work.
- Make sure that you bring home all the books/ materials you need to look over each night.
- Make sure that you have your notebooks, folders, or binder that you brought home with you.
- Recharge your cell phone so it works the next day.
Always gather the materials from you checklist (refer to checklist) and put them in your book bag/briefcase:
- Gather everything that you need the night before and put the things in your book bag/ briefcase.
- Refer to the materials checklist to help you stay organized!
- Don’t wait until the morning, because you may be rushed and forget to check.
Set your book bag/ briefcase and planner (cell phone) by the door.
Have a list with you of what materials you need before each class/meeting and look at this list before you go:
- At the beginning of the day, write a list on a sticky note of what you will need for each class/meeting and stick it on the inside of your locker or on your desk. If you have a dry-erase board on your locker or desk then use that. Use this method only if you go to your locker between each of your classes.
- As you take the materials for each class/meeting, pull off the sticky note or erase the item from the dry-erase board.
Students need to learn how to develop and use organizers. These external systems include calendars, to- do lists, daily logs, and checklists. These can be in paper form or by cell phone, iPad, or other technology devices. It may be best to initially start with both systems (paper and tech), depending on the age of the student, but in today’s world technology is often the preferable method for organizers and having two systems can be difficult to maintain. It is important to initially assist students in developing their schedules. They may especially need assistance in developing forethought to plan to start a task hours or sometimes even days before the task is due. Also, developing a time estimation worksheet can help students visualize how many hours they have in a day and began to estimate how long certain tasks may take. A student with dyslexia who is aware of how many words she reads a minute may be able to estimate approximate reading times needed for longer assignments or for the time she would want to spend summarizing an article after reading it.
There are many ways that students can make use of the features available on their cell phones to benefit time management and study skills. For example, online to-do lists such as Remember the Milk  can send text alerts (or IM or email) reminding students of an upcoming appointment, assignment, or project. (Unless the students have unlimited text messaging plans, it is important to discuss texting charges and how using these services can affect their cell phone bills.)
If the students’ phones are equipped with cameras (as most phones now are), they can use them to snap photos of the whiteboard/blackboard after class to make sure they don’t miss notes or an assignment. Photos may also serve as a helpful visual reminder of what needs to be done (i.e., create a photo series of packing up homework, lunch, and other typically forgotten items).
Students can use text messaging, such as Google SMS , to get definitions, facts, weather, and conversions sent directly to their phones. As with Google searches, if a student spells a word incorrectly, Google SMS will generally prompt with “Did you mean…?” and provide both the correct spelling and the related information.
Finally, many companies are capitalizing on powerful new cell phones and creating programs  for sending flashcards  and study materials  directly to your phone or iPod . Students can browse flashcards created by others or create their own and study wherever they are. The use of color coding is an effective organizing strategy. For example, a routine can be established in class (e.g., green for main idea, red for details in reading, blue for essential information in math word problems, etc.) that students can integrate into their own note-taking.
Prioritize and Be Flexible
Once events are scheduled, to-do lists established, and the time necessary to complete events are charted, the next step is to learn to prioritize. What is pressing vs. what could be moved forward to complete another day? This skill helps to not drop tasks that may not get completed due to interruptions, such as a friend stopping over. The ability to be flexible is an important skill to learn to manage. Having other options for completing or rescheduling tasks if such events occur allows for preparation of the unexpected.
In Aldous Huxley’s book Island, trained myna birds fly around frequently squawking, “Here and now, here and now!” The author wisely predicted the necessity of having reminders to pay attention, to stay in the moment. In today’s world there is much to absorb and a great deal of information to process every day. Each day calls to attention detailed facts and complex concepts, family members and friends, projects at work or at school, news items, planning meals, managing the instructions and assignments of several classes or work tasks. It’s no wonder we are sometimes not aware of what is going on right in front of us! Students with EF struggle to determine the most important information to pay attention to and then use that information as needed. Developing appropriate levels of alertness for attending to a lecture, reading a text book, writing a report, or solving mathematical problems are essential and necessary skills. Students who effectively control their alertness are able to concentrate without becoming mentally fatigued (especially when sitting still and/or listening for long periods of time) and to pay attention without feeling excessively “bored” or “tired.”
Here are some tips for increasing attention:
- Get enough sleep at night – Getting adequate amounts of sleep enables a student to be fully awake and have the mental energy to learn and perform in school. Students who get adequate periods of true sleep fall and stay asleep at night with few, if any, problems. Going to bed at the same time each night and establishing a bed-time routine, starting at dinner or just after dinner will assist in maintaining appropriate levels of alertness throughout the day.
- Develop a state of alertness or readiness for action, similar to getting ready for a kickoff at a football game. Help students do this through the acronym SET. Sit straight, Eyes on teacher, Think about words being said and place an external focus on others to listen to them.
- Learn to develop internal attention – metacognition? How is it going? Am I on track?
- Minimize any distractions such as outside noise, being hungry, thinking about what you need to do in the future.
- Create a Picture and MAKE IT VISUAL!! Visual memories are more effective and are remembered longer!
- Read the STOP signs and Read the Room
- Space – Where is it? What are the parts to that space?
- Time – What time is it now? What usually happens at this time? What is coming up? The task/activity I am doing now, when does it need to be done by? How much time do I have? How long will it take? What can reasonably be accomplished in this amount of time? What is the usual sequence that I do in that amount of time? What is the pace of activity? Can I dilly-dally or do I need to rush?
- Objects – What materials are in front of me? What materials do I still need? Anything I need to practice?
- People – Who is around? Who do I need? What are they doing? What is their pace? What is their mood? What is coming up for them?
- Using highlighters, and/or graphics can help to draw attention to important information.
- Examine social relationships in the same way as a new learning situation. Talk aloud about what to attend to in social interactions, e.g., which are most important when forming friendships, dating relationships.
- Take frequent breaks during the day and vary the length of work periods. Use stretching and walking as ways to revitalize your body, getting the blood flowing more evenly throughout the body. Use quiet time to rejuvenate mental energy.
- Adjust seating. Sitting in front of a classroom can facilitate attention and keep distractions from other students to a minimum.
- Become aware of your periods of lower energy; keep a diary or a log of the times during the day when this occurs. Plan on having a healthy energy snack in the afternoon.
- Learn to use textbooks efficiently, for example: how to use the table of contents and the index, how to use the questions at the end of the chapter to guide reading, and how to preview text before reading a chapter (by skimming for key words, dates, and names, looking at pictures for clues to meaning, etc.).
- Provide assistance when mental effort wanes. For example, work together with others as mental energy buddies, or provide jump-starts such as starting one or more math problems, reading the first passage of a text, etc.
- Use special devices, e.g., calculators, word processors, or tape recorders that help stretch mental effort during periods of high output.
- Use a word processing program to develop templates for later use, e.g., a template for getting my homework done, for solving a math word problem, for asking for help in class, etc. Learn to self-monitor your work by evaluating the quality of planning and performance throughout a task.
- Practice making predictions while learning. For example, use prediction charts in reading to help organize predictions and maintain them for later reflection, use story starter activities in writing to contribute the rest of a story based on the beginning, use historical events in social studies to make predictions before learning the actual outcomes, or estimate answers to math problems and science experiments before doing the actual solving.
- Self-monitoring after a task allows a student to think about the effectiveness of a strategy based on a particular outcome, for example thinking about how the amount of studying or planning relates to a high or low grade received on a test.
There are an abundance of terms used to describe memory, such as long term, short term, episodic, sensory, tactile, active, and verbal. It is important to have appropriate testing that will help to simplify and focus what type of memory difficulties a student may be experiencing. Students who experience difficulties with memory encounter extreme challenges with learning and with reading. Sometimes what appears to be a memory problem may actually be a reduction in attention, poor planning, and other organizational challenges.
Memory can be like an office. On the desk is immediate or active memory. This is the memory that allows a student to read an assignment and hold on to the information from one paragraph to another or to complete the multiple steps required for a math problem. In the to do basket are short term memory items, these are items to do next, they are not in front currently, but they will need attention soon. In the file cabinet is long term memory. These are items that will need attention in the near future, but can be stored away for now.
To properly encode a memory, the first step is to pay attention. It is impossible to pay attention to everything so most of what is encountered every day is simply filtered out, and only a few stimuli pass into conscious awareness. What scientists aren’t sure about is whether stimuli are screened out during the sensory input stage or only after the brain processes its significance. What we do know is that paying attention to information may be the most important factor in how much of it is actually remembered.
Important information is gradually transferred from short-term memory into long-term memory. The more the information is repeated or used, the more likely it is to eventually end up in long-term memory, or to be “retained.” (That’s why studying helps people perform better on tests.) Unlike sensory and short-term memory, which are limited and decay rapidly, long-term memory can store unlimited amounts of information indefinitely.
People tend to more easily store material on subjects that they already know something about, since the information has more meaning to them and can be mentally connected to related information that is already stored in their long-term memory. That’s why someone who has an average memory may be able to remember a greater depth of information about one particular subject.
Here are some tips for increasing memory:
- Explicitly and frequently connect reading material to a student’s lives and daily experiences.
- Preview the highest priority points to glean from reading material, such as those likely to be discussed in class or asked about on a test.
- Coach students to use strategies for storing information, such as mental imagery (like associating a top hat with President Lincoln), acronyms (like HOMES for the Great Lakes), acrostic elaboration (like “King Philips Court…” for Kingdom-Phylum-Class), and rhyming (like “i” before “e” except after “c”). Such strategies can be used to prompt students to retrieve information during presentations and interactions.
- Provide extra instruction and practice regarding the multiple letter patterns (such as “k,””c,” “ck,” “ch,” “que”) that can be linked with a particular sound (like /k/).
- Emphasize word families (like take, bake, rake, fake, etc.) to consolidate common letter patterns (such as –ake) and vary words with prefixes and suffixes (like taking, baking, raking, faking, etc.)
- Nonsense words (such as “bik”) can bolster sound-symbol pairs in long-term memory because they have to be sounded out rather than identified as sight words; students can practice reading nonsense words or even develop their own.
- Show students how to make a flowchart that breaks down a procedure into its component parts.
- Ask students to explain the steps of a procedure orally and in writing.
- Use acronyms or phrases to improve storage of procedural sequences, such as PEMDAS or “Please Excuse My Dear Aunt Sally” for the order of operations: Parenthesis, Exponents, Multiplication/Division, Add/Subtract.
- All students need to understand how their memory works and identify their particular profiles of memory strengths and weaknesses (metamemory).
- Information on any topic should be presented to students in a variety of formats including spatial, linguistic and sequential. For example, if students are presented with an outline, it may be given in the traditional sequential way as well as with using a strategy called “mind mapping”. Mind mapping is a spatial/configurational format while the traditional way in which students are instructed is a linear/sequential format.
- Students who have difficulty with short-term memory registration and/or working memory may need directions repeated to them. As they get older, they will need to write directions down to help them remember them.
- When students have difficulty remembering what they have read, they should be taught to paraphrase (recode information) as they read and to take notes in the margins, underline, highlight and/or make notes on a Post-It. If they made notes on a Post-It, they can place the Post-It on paper and have a summary of what they have read.
- Note taking is an activity that may help students register information in memory as well as to consolidate it. Note taking is a skill that should be taught to all students. Students with handwriting problems may have a difficult time with this task, however, and may need alternative strategies.
- Students who have working memory problems may need to use a calculator to solve multiple step math problems. Also when completing a writing assignment, they should use a “staging” procedure that allows them to focus on one aspect of writing at a time. With this procedure, they would first generate ideas, then organize them, and finally attend to spelling and mechanical and grammatical rules. Students should also write the topic and any key ideas they have down and refer to these when writing their assignment.
- It may be helpful for students to review material right before going to sleep at night. Research has shown that information studied this way is better remembered. Any task that is performed after reviewing and prior to sleeping interferes with consolidation of information in memory.
- All students would benefit from self-testing. They should identify the important information, formulate test questions, and then answer them. This is also a useful exercise to perform with a study buddy.
- When students need to remember a series of steps or events, it may be helpful for them to draw diagrams or flow charts of the steps/events.
- Paired associations as well as most other information is remembered better when it is rehearsed using multiple sensory modalities. For example, a student who is trying to remember basic math facts would walk a number line as they were saying the math facts.
- Many students are very adept with computers and there are a number of software programs such as “Reading Blaster” and “Math Blaster” that can help a student retain basic skills.
- Students should be taught the necessity of “overlearning” new information. Often they practice only until they are able to perform one error-free repetition of the material.
- Students should be required to identify the particular memory strategies that they will use for specific situations. For example, they should be asked how they plan on remembering all of the states and their capitals in the United States.
Apps for EF
Evernote – Free 
Remember everything! Forget writing on your hand or sticky notes. Use your iPhone or iPad to take a picture, record a note, send a PDF, or just jot a note.
Write Pad allows you a variety of options: handwriting recognition, write your note with your finger or a stylus, check spelling, executive shorthand, change of character recognition. It is $9.99, but worth every cent for those who are not familiar with keyboarding or find type too difficult.
Notability – $0.99 
Notability is a note-taking app that allows you to type, insert a figure, and insert a web clip or a picture. It also allows you to record a teacher’s lecture.
Nudge – $0.99 
Nudge is a quick note to remember something for tomorrow: bring pens to school, tie-dying bring in a white shirt. It is set, and until you shut it off, it nudges you.
Students: CourseNotes color codes your notebooks and adds teachers. Take notes during your classes and organize them by class and subject. Review your notes later, and search through multiple classes and notes at once. Also, keep To-Do lists and track assignments by providing due dates.
iAnnotate – $9.99 
Teachers: iAnnotate allows you to receive PDF files from your students or an article you are reading. It lets you take notes or highlight an important fact, and of course, lets you assist a student in corrections. It is a fabulous app to keep your notes organized, with the ability to make corrections or add notes.
Websites for EF
All Kinds of Minds  The All Kinds of Minds website provides resources to help parents, educators, and clinicians understand why a child is struggling in school and how to help each child become a more successful learner. The Web site provides a free monthly newsletter, articles by Dr. Mel Levine and others, case studies, discussion groups, a Learning Base of strategies, and much more.
The Hallowell Center  This website describes the Hallowell Center for Cognitive and Emotional Health which specializes in the understanding and managing of attention deficits, worry/anxiety, and child and adult learning difficulties. The site offers informative articles and materials by Dr. Ned Hallowell.
HAPPYneuron  These brain games help you improve your memory and attention through award-winning, innovative and fun cognitive training exercises.
The Hello Friend/Ennis William Cosby Foundation  This website is dedicated to helping you learn about Ennis William Cosby, about the foundation established in his memory, and about learning and learning differences. The site offers resources and information on how parents and teachers can help individuals with learning differences. Information is also available about the new video “Ennis’ Gift: A film about learning differences.”
Family Education  Parents find practical guidance, grade-specific information about their children’s school experience, strategies to get involved with their children’s learning, free email newsletters, and fun and entertaining family activities.
Kids Health  Created by The Nemours Foundation’s Center for Children’s Health Media, Kids Health provides families with accurate, up-to-date, and jargon-free health information they can use. Kids Health has separate areas for kids, teens, and parents – each with its own design, age-appropriate content, and tone. There are literally thousands of in-depth features, articles, animations, games, and resources – all original and all developed by experts in the health of children and teens.
Misunderstood Minds  PBS has created a companion Web site to the Misunderstood Minds special on learning differences. Within the site are stories from the show and information and resources for parents.
Read•Write•Think  Read•Write•Think is a partnership between the International Reading Association (IRA), the National Council of Teachers of English (NCTE), and the MCI Foundation to provide educators and students with access to the highest quality practices and resources in reading and language arts instruction through free, Internet-based content.
PBS Parents  The PBS Parents Guides address important aspects of your child’s early years such as school readiness and social and emotional development. You can also find information about your children’s favorite PBS KIDS programs: schedules for your local area, educational activities related to the programs, and explanations of educational goals.
Schwab Learning  is a “parent’s guide to helping kids with learning difficulties” that emphasizes useful information and practical strategies for children in kindergarten through high school. With over 350 research based articles, resources, message boards, email newsletter and more, parents will find the guidance and support they need.
Cherkes-Julkowski, M., Sharp, S., & Stolzenberg, J. (1997). Rethinking Attention Deficit Disorders. Cambridge, Massachusetts: Brookline Books.
Dornbush, M. P., & Pruitt, S. K. (1995). Teaching the Tiger: A Handbook for Individuals Involved in the Education of Students with Attention Deficit Disorders, Tourette syndrome or Obsessive-Compulsive Disorder. Duarte, California: Hope Press.
Fowler, M., Barkley, R., Reeve, R., & Zentall, S. (1992). CH.A.D.D. Educators Manual: An In-Depth Look at Attention Deficit Disorders from an Educational Perspective: A Project of the CH.A.D.D. National Education Committee. Plantation, Florida: CH.A.D.D.
Hammeken, P. A. (1995). Inclusion: 450 Strategies for Success – A practical guide for all educators who teach students with disabilities. Minnetonka, Minnesota: Peytral Publications.
Jensen, E. (1998). Teaching with the brain in mind. Alexandria, VA: Association for Supervision and Curriculum Development.
Levine, M. D. (1994). Educational Care. Cambridge, Massachusetts: Educators Publishing Service.
Levine, M. D. (1998). Developmental Variation and Learning Disorders. (2 ed.). Cambridge, MA: Educators Publishing Service.
Markel, G., & Greenbaum, J. (1996). Performance Breakthroughs for Adolescents with Learning Disabilities or ADD. Champaign, IL: Research Press.
Parker, H. C. (1992). The ADD Hyperactivity Handbook for Schools: Effective Strategies for Identifying and Teaching ADD Students in Elementary and Secondary Schools. Plantation, Florida: Impact Publications.
Rief, S. F. (1993). How To Reach and Teach ADD/ADHD Children: Practical Techniques, Strategies, and Interventions for Helping Children with Attention Problems and Hyperactivity. West Nyack, New York: Center for Applied Research in Education.
Strichart, S.S., Mangrum, C.T., & Lannuzzi, P. (1998). Teaching Study Strategies to Students with Learning Disabilities, Attention Deficit Disorders, or Special Needs. (2ed.). Boston: Allyn and Bacon.
Cooper, L. A., & Lang, J. M. (1996). Imagery and visual spatial representations. In E. L. Bjork & R. A. Bjork (eds), Handbook of perception and cognition. San Diego: Academic Press.
Gaddes, W. H., & Edgell, D. (1994). Learning disabilities and brain function: A neuropsychological approach. (3rd edition). New York: Springer-Verlag.
Kail, R. & Hall, L. (2001). Distinguishing short-term memory from working memory. Memory and Cognition, 29, 1-9.
Levine, M. D. (1998). Developmental variation and learning disorders. Cambridge and Toronto: Educators Publishing Services, Inc.
Links:  http://www.rememberthemilk.com/  http://www.google.com/mobile/sms/#p=default  http://www.studystack.com/  http://www.studycell.com/  http://mobileprep.positivemotion.com/home/index.php  http://www.flashmybrain.com/index.php  http://www.evernote.com/  http://www.phatware.com/  http://www.gingerlabs.com/  http://www.gingerlabs.com  http://simpletailor.net/nudge  http://www.coursenotesapp.com/index.php  http://itunes.apple.com/us/app/iannotate-pdf/id363998953?mt=8  http://www.allkindsofminds.org  http://www.drhallowell.com  http://www.happy-neuron.com/brain-games/executive-function  http://www.hellofriend.org  http://www.familyeducation.com  http://www.kidshealth.org/parent/  http://www.pbs.org/wgbh/misunderstoodminds/index.html  http://www.readwritethink.org/  http://www.pbs.org/parents/  http://www.schwablearning.org SchwabLearning.org