*This post originally appeared on The PediaBlog on August 24, 2017.
Executive Dysfunction
About 20% of American schoolchildren have a diagnosed (or diagnosable) problem affecting their ability to learn efficiently. We call these situations where there are obstacles to efficient learning “learning disabilities.” Last year on The PediaBlog, we considered what a student means when he raises a “red flag” by telling us, “I hate school,” and decided that the term “learning differences” was preferable:
“I hate school” really means “I’m having a really hard time learning.” Obstacles in learning pathways can come from an inability to pay attention and focus on learning tasks (ADHD is an example) or a specific learning disability. There are several different types of learning disabilities — dyslexia, dyspraxia, dysgraphia, dyscalculia are some examples — that can occur in isolation, which can be approached more directly, or in combination, which requires a multi-pronged effort to overcome. Because most learning disabilities can be overcome with first acknowledging the problem, then recognizing a child’s learning strengths (and not only his/her weaknesses), and then following a multidisciplinary approach to teaching, learning disabilities are better described as “learning differences.”
The obstacles on the road to efficient learning occur along neural pathways which very often involve the areas in the brain responsible for executive functioning. An intact and well-integrated center of executive functioning is vital for age-appropriate academic, social, and behavioral learning, according to the learning experts at Understood.org:
Executive function is a set of key mental skills that act as a command center in the brain. These skills help kids do things like plan, manage time, control emotions, work with information and get tasks done. They’re also important for staying focused and solving problems. So having executive functioning issues can impact kids both in school and in everyday life.
Some people with executive function issues have severe learning challenges, even though their intelligence is in the normal range. This includes the kids with the diagnoses starting with “dys-” mentioned above, and even children and adults with attention deficit and hyperactivity disorder (ADHD). Others — think about people you know who have poor organizational skills or, by use of medication and/or by developing coping strategies, milder ADHD — can more or less get by in life, flying under the radar as students and adults. What’s interesting is that the brain dysfunction affecting the executive learning center is usually present at birth, unless an unfortunate birth (perinatal) injury, post-natal infection like meningitis, or early-life toxic insult (lead poisoning, for instance) is the cause. This is important because early diagnosis of learning differences can mean all the difference between having a happy academic experience and successful life, and not:
It’s important to identify children who are struggling academically as early as possible — even in preschool — before their natural curiosity and developing feelings of self-esteem are squashed.
Kids can provide indications as early as preschool that their learning pathways are dysfunctional. Some signs of executive function issues in preschool include:
> Gets frustrated easily and often throws things on the floor instead of asking for help.
> Has trouble following directions and often forgets what to do.
> Has frequent tantrums over things that seem fairly minor and manageable.
> Acts out aggressively instead of expressing feelings and frustrations.
> Can’t master simple classroom tasks like finding things in a cubby or packing up at the end of the day.
> Frequently raises his hand but doesn’t remember the answer when called on.
> Often insists on doing things a certain way, and has trouble making adjustments.
> Frequently gives unrelated answers to questions during group time.
It’s possible that some kids with executive function issues who experience one year (or no time) in preschool before starting Kindergarten might not be picked up so early. For kids already in grade school, the signs of learning differences will change as they get older:
> Starts one task and gets distracted, then doesn’t ever finish the original task.
> Can solve a math problem one way but gets stuck when asked to solve it using another method.
> Focuses on the least important thing you said.
> Often mixes up assignments and doesn’t bring home the books and handouts needed to complete the work.
> Has a desk full of loose papers and pencil stubs. But her schoolwork folder and pencil box are empty.
> Panics when rules or routines are challenged, like going out to dinner instead of ordering in because it’s Friday and that’s pizza night.
> Struggles to find the right information in a word problem to come up with an equation.
> Sticks with a plan even when it’s clear that the plan isn’t working.
A child who manages to get by in school despite struggling with the work (and “hating” school) can still be identified as having executive function issues and learning differences. ADHD is the most common diagnosis given to these kids if they are having problems by middle school or even high school. Understood.org lists the signs of executive function issues at these higher grade levels here.
The bottom line is this: If your child is having difficulty learning the tasks and concepts expected of them at their grade level, it may indicate a “wiring” problem in the executive function brain center. Whatever grade they are in, it is imperative that parents and teachers recognize the benefits of identifying a specific learning difference (and the risks associated with not doing so) by requesting a learning (psychoeducational) evaluation performed in school, by the school district’s psychologist, or privately, by a psychologist specializing in educational and learning issues.
Don’t wait for the teacher to come and speak to you about their concerns regarding your student’s learning. (Also, don’t wait until your child’s next checkup before bringing the subject up with your pediatrician!) Parents are a child’s most important and most effective advocate. Teachers (and pediatricians!) are on your side. Speak up early, and, if need be, often.