Impaired Executive Functioning - time to ditch the briefcase?

It's been a week since I went through the results of some testing H had done when I saw his Psychologist on Monday. And it's taken me that long to process the (extremely helpful) information.

I learned that H has poor Executive Functioning - which is often seen in children on the Autism Spectrum and in those with ADHD. But what does that MEAN?

Impaired Executive Functioning - Time to ditch the briefcase?

Image courtesy of savit keawtavee / FreeDigitalPhotos.net

What IS "Executive Functioning"?

Executive Functioning is a set of mental processes that helps connect past experience with present action.

It is used to perform activities such as planning and organising, paying attention to and remembering details, and managing time and space.

If you have trouble with executive function, these things are more difficult to do. You may also show a weakness with working memory, which is like visualising problems and planning in your head. This is an important tool in guiding your actions.

As with other learning disabilities, problems with executive function can run in families. It can be seen at any age, but it tends to become more apparent as children move through the Primary Years.

How does this impact on our son?

I have to admit I have a healthy scepticism for psychologists. Too-brief encounters invariably based on a subset of assumptions brought to the meeting on their part have led in the past to half-baked notions which rarely apply to my child. But THIS one is Gold. She gets him/us and took a whole hour chatting to learn more about what makes him, and his family tick. Not in a nosy "how deep can I dig" way but in a profoundly sensible, academic and purposeful way and very quickly saw a route through to possibly help him, hence the testing.

It's not unexpected with Autism or ADHD - so when both are present impaired executive functioning will likely be an issue to some degree. But no one had ever mentioned it to us before. Interestingly sometimes it can be confused with ADHD or ADD and may be the real issue which prompts an incorrect diagnosis.

As "ADDitude" website says:-

"Children and adults with executive function disorder (EFD) have problems with organizing and schedules. They may also have attention deficit hyperactivity disorder (ADD/ADHD) and/or learning disabilities, but not always. ADHD is a common misdiagnosis for those who are actually living with EFD."

The Tests

H had to plan a route through a zoo with a few key requirements. He just couldn't do it - it took several tries and every time he rushed through and got in a muddle. Then he had to work out how to release something locked in via a series of puzzles - which he found very easy individually but the sequencing and planning really stumped him. There were several other similar tests in which he performed much the same.

So no career in business then?!!
So maybe we could be ditching the briefcase as a diagnosis of Impaired Executive Functioning has been given but not as you might expect - do we ditch the ADHD diagnosis?

Certainly some should, having been incorrectly given an ADD or ADHD diagnosis because their impairments are not thoroughly investigated, since ADHD is so superficially similar in many ways.  But we don't think that is the case with our son, and neither do the professionals. His diagnoses stand, with the additional executive functioning impairment.

What this means for us.

I'm actually really excited about all this. That might sound daft but the thing is, nothing has changed. H is the same child I've mothered for twelve and a half years. He's still gifted and talented. He's still unbelievably skilled with computers and with his degree from the University of YouTube phenomenally knowledgable about so much. (Granted being able to speak Elvish and draw a map of Middle Earth accurately without looking are not crucial life skills but he's smart.) I have no more or less worries than before this information.

But information truly IS power. Because now we have more understanding we can help him more appropriately. He is completely unable to pack his bag for school, get himself ready in the morning remembering everything he needs to do. He cannot go out to meet friends without only one thing to remember, and everything else taken care of. He will honestly wander up and down the street unsure of where to go next if his route is not planned for him. He cannot remember, record, plan and execute homework, prepare for tests and needs a phenomenal amount of additional support.

  But the key thing here is that once that support and acceptance is in place, the focus can be on what he can then do with it, rather than why he cannot do without it.

So now we make sensible strategies to support him - rather than  constantly lecturing him on how to improve, nagging him for losing stuff, supporting teachers giving detentions for homework not done despite considerable support..... the emphasis has been constantly on what he ISN'T doing, what he SHOULD be doing and trying to make him meet targets his peers do.

It isn't going to happen. 

At least not in the same way.
And taking that constant cloud away from him - and us- is amazing. So liberating.
I can stop berating myself for his lack of organisational skills, my apparent failure to help him meet school targets for homework and preparation, for his inability to plan and prepare and grow more independent. Instead, I can slip a few support mechanisms in place, accept my parenting role isn't likely to change any time soon and focus on what he CAN do, what he CAN improve and know that in time, he will get there.