Children with special needs often struggle with executive functions. For parents whose children face these challenges, it is important to understand what executive functions are, the common warning signs of problems with them, and how learning specialists can help children who face this difficulty.

Executive functions are cognitive processes that control other cognitive processes, connecting past experience with present action. Executive functions are crucial to children’s daily activities like dressing themselves or doing chores, and difficulty with executive functions will especially impact a child’s schoolwork. We all use executive functions for such actions as making plans, keeping track of time, making corrections while thinking, reading or writing, and engaging in group discussions. Executive functioning is what permits us to keep track of more than one thing at a time, holding on to information until it is appropriate or useful for it to be applied.

Children who struggle with executive functions will often seem to be disorganized. Thy may have trouble planning projects and have little understanding of how long they may take. These children may have trouble memorizing information, and when telling a story may have trouble keeping events in sequential order. In addition, a child may have problems with working memory, for instance being unable to remember a phone number while dialing it. There is no one test to identify problems with executive functioning. Educators, psychologists and others may use a variety of methods to identify such problems, including careful observation, tests and trial teaching.

If a difficulty with executive functions has been identified, there are many learning tools that educators and parents can share with children to help them with organizational skills.

Four Learning Tools Available:

• Checklists: One tool that helps with executive functions is using a checklist. If a child has trouble conceiving of or keeping track of the steps necessary to accomplish a complex task, then a checklist can be a tremendous help. Instead of struggling to understand what step should be done next, a child can simply move through the list. Checklists can be useful at school or with the tasks of daily living, such as getting ready for school in the morning. It can be especially helpful to set time limits for each task on a checklist, as children with executive dysfunction will often not be able to judge how much time each step should take.

• Calendars and Plans: Because struggling with executive functions make planning difficult, it is all the more essential for children to be introduced to the importance of writing down a plan. Frequent use of a calendar and writing down homework assignments are habits that should be encouraged, and that will take time and energy.

• Encouragement: Children who find organization challenging often do not understand why being organized is important and may become frustrated with planning. However, encouragement and repetition can help children develop these skills, and establishing a reward system can help them see the benefits.

• Routines: Developing a routine is also important for children with executive function problems. Doing homework at the same time every day is an especially useful routine, especially with older children who may prefer to do homework when they feel like it. This leads to procrastination and problems with the work. A child who has trouble planning and getting organized may not see that putting off a task will have bad results, and encouraging a routine is one way to help.

Difficulty with executive functions is a common problem for children with special needs, but if the challenge is identified and addressed, then there is a lot that parents and teachers can do to help. If you believe your child’s executive functioning difficulty is becoming debilitating, be sure to discuss this with his or her teacher or section 504 or IEP team and document concerns in writing.

For more information about our legal services for families with special needs, visit www.specialneedsnewyork.com.

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Tags: asd, autism spectrum disorder, disabilities, exectutive functioning, IEP, special needs

The New Year brings significant changes to the way certain mental disorders are diagnosed, in the    Diagnostic and Statistical Manual of Mental Disorders –V (“DSM-V”).   In December,  the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual.   The final version of the DSM-V will be available in May 2013.

One of the most controversial changes for the DSM-V is creating a single “autism spectrum disorder” category, with stricter requirements than the DSM-IV.   After considerable study and controversy, the American Psychiatric Association voted to approve a new, streamlined definition of autism, that technically eliminates the diagnosis of Asperger’s Syndrome or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).    The Work Group has proposed that autism, Asperger‘s disorder, PDD-NOS and childhood disintegrative disorder be consolidated within  the category of Autism Spectrum Disorder.  But the new definition notes that psychiatrists should  with take into account a person’s diagnostic history. Thus, the new definition would include anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before.   According to Commentary by the America Psychiatric Association, “The change signals how symptoms of these disorders represent  a continuum from mild to severe, rather than being distinct disorders. The new category is expected to help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, instead of providing general  labels that tend not to be consistently applied across different clinics and centers.”

Specifically, the new definition requires:

A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1.     Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,

2.     Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated-verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3.     Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different
social contexts through difficulties in sharing imaginative play and  in making friends to an apparent absence of interest in people.

B.    Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of  the following:
1.     Stereotyped or repetitive speech, motor movements, or use of objects (such as simple motor stereotypes, echolalia, repetitive use of objects, or idiosyncratic phrases);
2.     Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes);
3.     Highly restricted, fixated interests that are abnormal in intensity or focus (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests);
4.     Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects);
C.    Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).
D.         Symptoms together limit and impair everyday functioning.

Pediatric bipolar disorder also posed a challenge to the Work Group.   Psychiatrists are more frequently giving the diagnosis of Bipolar disorder, characterized by episodes of depression and mania, even  to children as young as 2 — along with powerful psychiatric drugs and tranquilizers.  To stop this trend, the committee created an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

The DSM-V new mental disorders include:

• Hoarding; (previously considered a symptom of obsessive-compulsive behavior)
• “Premenstrual dysphoric disorder,”
• “Binge-eating disorder “

The changes above should not have a significant impact on school classification of students and will not result in fewer students being classified.   The 13 areas of disability under the Individuals with Disabilities Education Improvement Act remain constant and depend on the discussion and consensus of the Committee on Special Education, not on a medical diagnosis.  For autism, the changes proposed by DSM-5 are designed to better identify autism spectrum disorders and distinguish them from other conditions.   In some ways, the criteria for DSM-5 are actually broader.   For example, while DSM-IV criteria require evidence of difficulties related to autism prior to age 3, the DSM-5 definition only requires a child to show examples of unusual behavior in early childhood, whether or not they occur before age 3.

For more information, visit www.specialneedsnewyork.com.

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Tags: american psychioatric association, aspergers, autism, autism spectrum disorder, changes to the DSM-V, developmental disabilities, DSM-V