In my experience of working with children for about 32 years, I have learned that there are very early and often subtle symptoms that suggest an Executive Function Deficit (EFD). First consider that there is a difference between attention/inhibition system problems and EFD. These disorders can exist simultaneously or separately, but EFD is more often seen with attention and impulsivity problems. What most people do not know is that EFD has to do with motor systems. All areas of higher order brain function are supported by motor systems. Early development is especially key to how the cerebellum works closely with the basal/ganglia, cingulate gyrus, and the frontal lobes via various feedback loops. This is why we say, “It takes a whole brain to function.” Habituation of procedural memory and routines are key to EFD. Habituation and consolidation can be used interchangeably to mean mastery of a skill to level that cognition is not necessary to execute the skill. For example, multiplication tables, riding a bicycle, or signing your name. Consolidated skills are deeply cerebellar and are in the service of freeing cognition for complex/novel problem solving. Many academic functions are negatively affected without the ability to consolidate.
Think about what consolidated skills do for you. Let’s take driving as an example; consider the first time you drove a car by yourself. It felt large and your head was on a swivel as you scanned the traffic. You were thinking about how to drive, it took a lot of concentration, and probably was not much fun. Think about how you drive now since the skill has become consolidated into an automatic procedural memory. You no longer have to think about how to drive the car, so look at what happens; you can sing with the radio, hold a conversation, think about getting your child a neuropsychological evaluation, etc. This is how the brain works for most tasks; the pathway wires where the neuron fires! Complex skills are consolidated into procedural memory, which in turn frees thinking/cognition for problem solving in the moment. What if we always had to think about how do to everything? Life would be cumbersome, slow and fraught with errors, and that is what it is like to have EFD.
Failure to appropriately express early reflexes or to habituate early basic skills may suggest later EFD problems. Watch for the delayed attainment of early developmental motor milestones that should be easily met (within normal limits). Key developmental milestones are attained in support of higher cognitive systems, which in turn support the consolidation of motor to cognitive procedures and routines. Some of these milestone failures may include lacking a four-point crawl or skipping crawling altogether, extremely sloppy eating and overstuffing the mouth, and late toilet training and subsequent poor toileting hygiene. Failure to habituate these basic skills may even later emerge as the child having difficulty getting ready in the morning without the imposition of a highly structured environment pushing them along. Slow ability to master skills of daily living like showering appropriately, washing and rinsing all the soap out of one’s hair, and/or poor drying after showering also may be present. These same children have the messiest desk in class and completely disorganized book-bags. Later, these children have difficulty transitioning from elementary school (being in one class) to changing classes and managing multiple teachers and syllabi in junior high.
The failure to consolidate skills of procedural memory raises ‘red flags’ for future academic problems. In my practice we call these EFD based learning disorders. Grammatical errors, poor consolidation of common/high frequency spelling and reading words (for example mis-spelling /mother/ as /muthr/ or reading /father/ as /feather/). The most common issue we see and likely is the most undiagnosed learning disorder is mathematical learning disorder (dyscalculia). These children may exert massive amounts of effort trying to master their arithmetic fundamentals like multiplications tables, only to lose the information minutes, hours, or days later. They must constantly re-learn the tables, despite understanding the process of multiplication. These failures cause the child to become misunderstood. Caretakers and school personnel call them lazy, lacking effort, or hard headed; when in reality the child simply cannot consolidate and execute skills based on repetition learning. The secondary problem is low self-esteem and learned helplessness in which the child begins to easily give up or fight homework. Finally, these students perform poorly on the SAT because they do not get a lot done, but what is done is correct. Thus, early identification and intervention is critical.
Parents may have the right intentions for their struggling child by hiring a tutor, but we commonly see what we have termed The Tutor Effect. Tutors inadvertently act as the child’s external executive functioning as they ask the key ‘who, what, when, where, and why questions’. The child performs well for a tutor because of the environmentally imposed structure; however, the child likely performs poorly on testing because it does not occur to them to ask him/herself these key questions. The repetition of subject matter is typically not enough when a child is struggling to master/consolidate certain areas of academics. Deficits in the underlying cognitive skills that are required to achieve academic success are the likely root of the problem. The student’s cognitive tools must be sharpened, specifically in the area of executive functions. Therefore, to successfully ameliorate the core of the problem, an evidence-based neurocognitive intervention is recommended. Identifying the underlying cause of a student’s learning problem is imperative in order to treat the problem and not the symptoms. When an EFD is appropriately identified and treated, the student can then become a more efficient and effective academician.
Dr. Beljan's professional focus is on Attention and Executive Functioning, Gifted Intelligence, Learning Disabilities, Traumatic Brain Injury, and Alcohol/Drug Related Neurodevelopmental Deficit (A/DRND). Beljan Psychological Services (BPS) administers pediatric and adult neuropsychological evaluations to accurately determine diagnoses and direct interventions. Dr. Beljan co-wrote Misdiagnosis and Dual Diagnoses of Gifted Children and Adults. Dr. Beljan also co-wrote Large Scale Brain Systems and Neuropsychological Tests: An Effort to Move Forward. He is also the developer of the Motor Cognition Squared® (MC2) program which is an effective intervention for individuals with ADHD/EFD.