Diagnosis Barriers and Treatment Executive Function

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According to the American Heritage Medical Dictionary (2007, para. 1), Executive Function (EF) is "the cognitive process that regulates an individual's ability to organize thoughts and activities, prioritize tasks, manage time efficiently and make decisions". EF allows people to plan and control their behaviour in any state and condition in which they could be (Encyclopaedia of Mental Disorders, 2010). Mauro (n.d. para. 1) points out that EF "refers to the role of the brain's frontal lobes" in taking responsibilities and learning from failures.

In the American Heritage Medical Dictionary (2007, para. 1) it can be determined that "impairment" of EF is found in several disorders, like "Pervasive Developmental Disorders" (PDD) and "nonverbal learning disabilities". Deficiencies in EF are associated with "psychiatric", "developmental disorders", "obsessive-compulsive disorder", "Tourette's syndrome", "depression", "schizophrenia", "Attention-Deficit Hyperactivity Disorder" (ADHD), "autism" and "antisocial behaviour" (Encyclopaedia of Mental Disorders, 2010, para. 4).

Remediation for Executive Functioning matters is comparatively hard but a series of basic activities in the study of the cognitive process can improve skills such as "auditory processing, visual discrimination, processing speed, phonological awareness, planning, sequencing, attention to detail, etc" (Learning Abled Kids, 2010, para. 1). The academic performance of a child can be improved by extending the capacity of any cognitive part of intelligence.

Executive Functions are crucial for success in life; it enables individuals to proceed steadily and to confront any problems (Encyclopaedia of Mental Disorders, 2010).

Diagnosis

Executive Functions have the utmost capacities to affect the essential mental power, such as "attention, memory and motor skills" (Encyclopaedia of Mental Disorders, 2010, para. 2). Eberle (2003, para. 2) stated that Dr. Stixrud, a psychologist, described EF as a series of actions that contain "planning, organizational skill, maintaining a mental set, selective attention, and inhibitory control" and which are specially managed by the "prefrontal regions of the brain". In the Encyclopaedia of Mental Disorders (2010, para. 5), it is explained that the frontal lobes are the large part of the brain cortex that "lie near the front of the brain"; and this cortex is the part of the brain where function of the senses takes place in the mind to record, to plan and to act. The traumatic brain injury (TBI) is also a cause of executive dysfunction, it may contain a deficiency in "reasoning, planning, concept formation, mental flexibility, aspects of attention and awareness, and purposeful behaviour" (McDonald, Flashman & Saykin, 2002, para. 1). Logsdon (2010) explained that children with learning disabilities frequently face executive functioning disorders as well.

Executive functioning skills are necessary to participate in daily activities to decide upon directed goals and develop successful actions (Lezak, 1982, as cited in Rocke, Hays, Edwards & Berg, 2008). Thus, EF forms part in the achievement of individuals to enable them handling every day pressure whether in school, at work or at home. Some examples of executive functions are: planning things for the future, paying attention to the decision taken, determination in solving a problem, that is, students need to arrange beforehand how to collect suitable materials for school work, how to establish priorities to perform an assignment and how to maintain and follow the course (Lerner & Johns, 2009). EF also enables people to avoid inappropriate behaviours. Children and adolescents with EF deficiency frequently undergo embarrassment to participate in daily life (Biederman, Monuteaux, Doyle, Seidman, Wilens, & Ferrero, 2004, as cited in Rocke et al., 2008). Individual who lack executive functions may frequently get difficulty expressing to other people as they may be offensive and say strange things to them. Most people with EF act without thinking about the results, they may say or do things that could put them into trouble, such as making negative comments on others appearance or act insolently towards a police officer or any authority; executive functions are thus an important element to be able to fit in the society (Encyclopaedia of Mental Disorders, 2010).

Students with executive dysfunctions often suffer from "poor working memory and recall" (Dendy, 2004, para. 5). Such students have short memory capacity, they cannot hold information in their short-term memory for a longer period of time, therefore they easily forget things and as a result they could not remember instructions, nor could they perform calculations and spell words properly (Dendy, 2004). As these students could not recall from the past, therefore they could not learn easily; they also face difficulties using their senses to prepare for future events and could not complete a given task; finally they could not remember lessons learned in the past to be able to move forward for future lessons (Dendy, 2004).

Logsdon (2010, para.1) stated that, psychologists used the term EF to describe how the brain performs to "think", to "act" and to find solutions for any problem. Executive functioning comprises helpful exercises to retain and restore knowledge learned in the past, and use this knowledge to work out daily activities (Logsdon, 2010). Evaluating EF may help to conclude a "patient's capacity to execute healthcare decisions and discharge plans" and to be able to live in the society without anybody's help (Kennedy, 2010, para. 2).

Barriers

A child with poor EF will need help especially from parents to be able to maintain the duties at home, that is, to complete homework, to change from one activity to the other, to remember rules and to avoid dangers; even though they may appear comprehensive on some particular occasion, they will be unable to stand still in certain areas by themselves (Mauro, n.d.). Children with behavioural disorders, such as ADHD, may suffer from brain dysfunction, it can be dangerous and lead to "ill-considered" and "illogical actions" (Mauro, n.d. para. 1)". Research has shown that children with ADHD "exhibit deficits on numerous experimental and neuropsychological tasks that are interpreted as difficulties in executive functions" (Hinshaw et al., 2002; Nigg et al., 2006; Pennington & Ozonoff, 1996, as cited in Wicks-Nelson and Israel, 2009, p.236).

Dendy (2004) stated that many students with ADD or ADHD have weaker working memory and are below average rapidity, that is, they lack important elements of executive function, such as skills for writing essays and solving math problems. Thus, writing essays is not easy for these students, they often have difficulty: acquiring and composing ideas in the mind; recalling grammar, spelling and punctuation from long-term memory; managing the entire information one after the other; examining and correcting mistakes (Dendy, 2004).

These children also have difficulties in memorising multiplication tables or working a math problem; they must retain several numbers and questions in mind while deciding how to solve a problem; next they must recall math rule from long-term memory; then they must carry out important facts in short-term memory and work the problem to find the correct answer (Dendy, 2004).

According to Solarz (n.d.) Executive Function is a domain that has been evolving and has been of huge importance to psychologists and other professionals who treat individuals with cognitive disabilities. Children and adults with ADHD have weak executive skills compared to others of the same age and developmental level; for example, the first sign of impairment in a child may be the difficulty in completing class work alone (Solarz, n.d). 

Brown (2000, as cited in Solarz, n.d., para. 3) represented a model (appendix) that comprises "six clusters of cognitive function involved in Executive Function": "Activation, Focus, Effort, Emotion, Memory and Action". These functions work as a whole to handle everyday works (Solarz, n.d.). Solarz (n.d.) stated that Dr. Brown (2000), who studied children, adolescents and adults with ADHD, discovered that they all undergone impairments in all the six clusters of his model (appendix).

These six clusters of cognitive function involved in EF are explained as follows:

Activation pertains to the organisation of any task, duty and work, where time is an essential factor and has to be taken into consideration but many people with ADHD often delay in this function (Solarz, n.d.).

Focus pertains to peak concentration on work to be done and completed but some people with ADHD get easily distracted and could not focus (Solarz, n.d.).

Effort has to do with the completion of work within a period of time but many people with ADHD can perform short-term projects but could not make effort over long periods of time (Solarz, n.d.).

Emotion "indicates difficulty modulating an array of emotions" but many people with ADHD get difficulties to control their emotions (Solarz, n.d., para. 7).

Memory pertains to recall from working memory but people with ADHD often get difficulty to recall recent events (Solarz, n.d.).

Action has to do with modifying behaviour to fit into proper environment but individuals with ADHD fail to notice whether others are hurt by their doings (Solarz, n.d.).

Logsdon (2010) stated that executive dysfunction has a negative influence on learning in general. These influences are: problems in the feasibility of projects; difficulties to evaluate time frame of a work; problems in maintaining sequences with relevant details; trouble in introducing tasks or activities or organising ideas alone; and difficulty in remembering information while doing related things.

Treatment

Treatment most likely needs family support, use of medication and school based intervention; starting intervention as early as possible is very important, intervention will require support from teachers, caregivers, parents, siblings and peers (University of Southern Queensland, 2010).

Jones (2002) stated that since ADD or any executive dysfunction cannot be cured; treatment must go on for life. Stimulants are the most common treatment, however due to side effects and dependence on drugs adults are advised to live without it (Jones, 2002). It is better to teach a person how to contribute to the progress of the brain to treat ADD as an EF disorder; therefore parents and schools need to collaborate for special classes and controlled schedules (Jones, 2002). Brain injuries disorders are treated in a more systematic way; that is, instead of treating the symptoms, the person is advised to activate the other parts of the brain (Jones, 2002). For severe damages there are "computer systems" which are similar to "palm pilots"; these computers can easily be carried and have sufficient powers to store "complex schedules", "placement of items" and which remind the user what to do at any time of the day; these computers can even "make decisions" for the user (Jones, 2002, para. 5)".

According to Murphy (2009, as cited in Solarz, n.d., para. 11) using the same EF model (appendix) with both adults and children would mean to recognise in which particular areas "cognitive challenges" appear in order to get a better apprehension of its meaning to be able to focus on treatment. According to Bloom (as cited in Munday, 2001, para. 4) "the two highest levels of cognitive thought are synthesis and evaluation"; in "synthesis, the individual is able to put ideas together, propose plans, form solutions, and create new information"; and in the "evaluation stage, the thinker is able to make choices, select, evaluate and make judgments about information and situations".

Students with special needs can perform simple tasks but face difficulties beyond the

"concrete level of processing information" and are disappointed when they are asked to perform "higher levels of thinking on academic tasks" (Munday, 2001, para.5). Therefore, professionals, teachers and parents who understand a child's cognitive capacities and deficiencies, can afford to be more supportive and reflective in parenting or teaching the child (Murphy, 2009, as cited in Solarz, n.d.). For these children, the "true-false test, the matching tests, and the fill-in-the-blank tests are likely to be more user friendly"; "some elements of phonics" can render their learning experiences more familiar; and "drill-type teaching" is an important element, where repetition can produce concrete knowledge for future learning (Munday, 2001, para. 5,6,7).

According to Munday (2001) student should be allowed to climb up a higher level of Bloom's taxonomy if they have attained a reasonable level of mastery in a limited set of cognitive abilities. Such children should be encouraged to restate information in their own words; they should be allowed to compare objects and contrast the differences; they should be shown how to estimate (Munday, 2001). Use of concrete examples is very important during the treatment since they help to reinforce their strength and help them "stretch their boundaries" at the same time (Munday, 2001, para. 8).

According to Bloom's taxonomy (as cited in Munday, 2001, para. 11) "application is a higher order thinking skill" rather than simply recalling or saying, so students should have the capability to narrate all that they have learned; "the complex working of the mind that allows this kind of integration to occur" allows students to achieve higher grade. Parents should encourage students to look for information before solving problems, designing projects, writing plays and making portfolios, in the other way helping them to apply new learning (Munday, 2001). Making research work would facilitate the tasks for students as they may be provided with examples, thus less stressing. Testing should involve higher order thinking skills like essay writing, hands-on projects or presentations since these help to see whether students can target key concepts and illustrate their ideas clearly (Munday, 2001).

Logsdon (2010) has provided some strategies which may help individuals with EF deficiencies, they are listed here:

Instructions should be clear with visual aids as students may not understand the logic.

Use planners, organisers, computers or timers and other appropriate devices.

Display visual schedules and review them as frequently as needed.

Give directions in writing, verbally and visually.

Make use of everyday routine.

Provide lists and specify tasks.

Use positive reinforcement to encourage students in their works.

Devise assignments into simpler tasks; work out step by step if necessary.

Use visual calendars to remind them about assignments, activities and deadlines.

Use of software as adults may prefer new technology (try for effectiveness)

Organise tasks and avoid confusions.

Provide suitable materials for each activity and have different working areas.

Keep the same strategies whether in classrooms, at home or in the workplace so that individuals with EF disorders may not get confused with different settings.

Logsdon (2010) suggests that if the strategies are not helping a person or there is no improvement after a considerable period of time, therefore children and adults may help to adjust more effective strategies.

And some of the teaching strategies that Dendy (2004) proposes are:

As far as possible let the learning process be visual and concrete.

Encourage peer tutoring.

Use acronyms for memory tricks

Update the method of teaching by using overhead projector for demonstrations.

Use graphic organisers.

Make the assignment become shorter.

Modify grading and give more time to complete test.

Divide huge projects into easier tasks and allow much time for submission.

Use computer and suitable software.

According to Dendy (2004), students suffering from ADD or ADHD are also victims of EF; they lack organisations and memory skills to perform better, he suggests that anyone who can help a student should do so because success in school is the most important things that could happen to students.

Conclusion

According to research, it has been noted that EF plays a great role in the life of every individual. People with executive dysfunction need help to be able to prosper in life. The cognitive profile of an individual is flexible and keeps on developing throughout childhood, adolescence and adults life (Brown, 2000, as cited in Solarz, n.d.). Therefore treatment is necessary and in order to help individual with executive dysfunction, it is important to look for the problematic executive skills. Treatment can be guided to teachers and parents about the cognitive strategies in favour of children's achievement and participation in daily tasks (Rocke et al., 2008).

References

American Heritage Medical Dictionary. (2007). Retrieved November 19, 2010, from http://medical-dictionary.thefreedictionary.com/executive+function

Brown, T. E. (2007). A new approach to attention deficit disorder. Educational Leadership, 64 (5). In EDU5335 Emotional and behavioural problems of children and adolescents: Selected Readings (2010, pp.22-27). Faculty of Education: University of Southern Queensland.

Dendy, C. A. Z. (2004). Executive Function... "What is this anyway?". Retrieved November 21, 2010, from http://www.chrisdendy.com/executive.htm

Eberle, L. (2003). "Executive Functioning" New Research about Familiar Behavior. Retrieved November 19, 2010, from http://www.strugglingteens.com/news/executivefunctioning.html

Encyclopedia of Mental Disorders. (2010). Executive Function. Retrieved November 18, 2010, from http://www.minddisorders.com/Del-Fi/Executive-function.html

Jones, R. (2002). Treating Attention Deficit Disorder as an Executive Function Disorder. Retrieved November 20, 2010, from http://serendip.brynmawr.edu/bb/neuro/neuro00/web1/Jones.html

Kennedy, G. J. (2010). The Assessment of Executive Dysfunction: Importance for Diagnosis and Prognosis. Retrieved November 19, 2010, from http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=738

Learning Abled Kids. (2010). Executive Functioning and Executive Dysfunction. Retrieved November 19, 2010, from http://www.learningabledkids.com/learning_disability_LD/executive_functioning.htm

Lerner J. W. & Johns B. (2009). Learning Disabilities and Related Mild Disabilities. (11th ed.). U.S.A.: Houghton.

Logsdon, A. (2010). Executive Functioning. Retrieved November 19, 2010, from http://learningdisabilities.about.com/od/eh/a/executive_funct.htm

Mauro, T. (n.d.). Executive Function. Retrieved November 19, 2010, from http://specialchildren.about.com/od/behaviorissues/g/executive.htm

McDonald B. C., Flashman L. A. & Saykin A. J. (2002). Executive dysfunction following traumatic brain injury: neural substrates and treatment strategies. Retrieved November 19, 2010, from http://www.ncbi.nlm.nih.gov/pubmed/12547981

Munday, J. B. (2001). Applying Bloom's Taxonomy to Teaching and Testing. Retrieved November 20, 2010, from http://www.hishelpinschool.com/specneeds/Bloom.html

Rocke K., Hays P., Edwards D., & Berg, C. (2008). Development of a performance assessment of executive function: The Children's Kitchen Task Assessment. Retrieved November 19, 2010, from http://ajot.aotapress.net/content/62/5/528.full.pdf

Solarz, J. (n.d.). Executive Functions. Retrieved November 19, 2010, from http://www.murphypsychologygroup.com/Executive_Function.html

University of Southern Queensland. (2010). EDU5335 Emotional and behavioural problems of children and adolescents: Study Book. Faculty of Education: Toowomba, Qld: University of Southern Queensland.

Wicks-Nelson, R. & Israel A. C. (2009). Abnormal Child and Adolescent Psychology. (7th ed.). U.S.A.: Pearson

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