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Executive Functioning Disorder (EFD) and Having a Learning Difference

Executive Function Disorder: An Introduction

My friend, Grace, is a great influence in my life. She is one of the most hard-working, focused, and expressive people I have the fortune of knowing today. She is has been an art student for a very long time (more than 4 years) and has won numerous local and national awards for her art; she is also a dedicated tennis player and a fantastic friend.

When Grace gave her senior speech this year, she talked about her experiences with executive function disorder (EFD) and how she is currently coping with the challenges that accompany having it. In her particular case, she has a frontal lobe deficit (parts of her frontal lobe are malformed) and has issues with her prefrontal cortex (which is included in the frontal lobe); since the frontal lobe controls decision-making (and a host of other abilities), she had a substantial amount of trouble regarding the speed and thoroughness with which she could evaluate information and make conclusions.

During and after her speech, I realized that that was the first time she had told others about her condition on such a large scale; however, as she had told me before, EFD is somewhat hard to ‘diagnose’ as a singular condition, as it is such a specific and variable set of factors that relate to other learning differences, such as ADHD. After her speech, many people commented that they had not only never known Grace has EFD, but also they had never heard of EFD on the scale of ADHD. This might be because some of the ‘symptoms’ of ADHD, such as impulsiveness and difficulty with organization, are directly related to parts of what EFD is.

Due to the lack of online resources partitioned exclusively for information about EFD, I believed that a compilation of verifiable explanations, an anecdotal piece, and a helpful infographic would be a helpful contribution to those who would like to know more about EFD.

Before you dig into my presentation, please take a moment to post on the Padlet below. Any and all experiences regarding learning differences (including if you, yourself, have one) are welcome.

Thank you for your input. Please enjoy my presentation on Executive Function Disorder (EFD).

A General Definition: What does “executive function” mean, and how is EFD diagnosed?

The following video includes Dr.Russel Barkley’s, Ph.D. (Medical University of South Carolina) breakdown of ; he is a professor of clinical psychology and has written multiple books on ADHD. He does a great job of explaining what the components of EFD are and how people who have challenges with executive function can self-regulate (inhibit their own behavior).

The following is an infographic on the components of executive function, what executive function is, and which parts of the brain are involved in controlling executive abilities.

What are the Testing Methods for EFD?

Since challenges executive function are often difficult to isolate and diagnose on their own (as something separate from ADHD), there are multiple tests for many aspects of executive function (i.e. attention). The chart below will be a detailed, but organized summary of the tests that are involved.

 

Skill Being Tested Associated Test/Related Tests Age of Testing What is Being Measured Importance of Test How Test is Conducted
Attention
  • Test of Variables of Attention (TOVA)
  • Integrated Visual/Auditory CPT (IVA-2)
  • Conners Continuous Peformance Test II
  • TOVA: 4+ yrs.
  • IVA-2 and CCP II: 6+ yrs.
  • ability to pay attention
  • processing speed
  • inhibitory control
  • key aspect of executive function
  • is a significant factor of ADHD

SKIP to 4:39 for actual test.

  • 15-20 mins.
  • on computer
    • presses ‘space’ each time he/she sees a particular letter
    • CPT II: presses when they don’t see a certain letter
  • misses letters: might be ‘zoning out’ or slower processing speed
    • missing towards end of test: trouble sustaining attention
  • responding to incorrect targets: inhibitory control or focus
Inhibitory Control
  •  Stroop Color and Word Test
  • Delis-Kaplan Executive Function System’s Color-Word Interference Test (D-KEFS)
  •  Stroop: 5-14 yrs. for children’s version; 15+ yrs. for older version
  • D-KEFS: 8+ yrs.
  •  ability to refrain from automatic responses
  • ability to think through consequences of actions before acting
  •  inhibitory control is tied directly to self-control
    • evaluation of options is essential skill for self-regulation
Image result for stroop color word test

  • timed test (processing speed)
  • could be either with words or shapes (dependent on reading level)
    • words: say the color of word written, not the actual word (example: the word ‘red’ is written in green ink; child should respond ‘green’)
    • shapes: say the color of the shape, not the actual shape
Working Memory  

  • Wechsler Intelligence Test (Digit/Spatial Span subtests) for Children
  • WJ-III Cognitive battery (Working Memory tasks)
 

  •  WISC: 6-16 yrs.
  • WJ-III: 2+ yrs.
  •  Digit Span: verbal working memory (remembering what he/she heard)
  • Spatial Span: visual working memory (remembering what he/she saw) 
  •  working memory allows people to retain new information and apply it
  • working memory is affected by attention

Example of Spatial Span test is above.

  • Digit Span: series of numbers or animals is spoken; child repeats in reverse order
  • Spatial Span: series of blocks are touched in some order; child touches blocks in reverse of order shown
Organization/Planning
  •  Tower of Hanoi 
  • Tower Test of K-DEFS
  • Rey–Osterrieth Complex Figure Test
  •  Tower of Hanoi: 5+ yrs.
  • Tower Test of K-DEFS: 8+ yrs.
  • R-O Test: 6+ yrs.
 planning/organization/sequencing abilities

  • working memory
  • inhibitory control
  •  people who can execute said skills can follow directions and efficiently complete tasks
Image result for tower test d'kefsStack disks/beads in specific order while abiding by rules of stacking. Completed in as few moves as possible.
Conceptualization
  •  Matrix Analogies Test
  • Naglieri Nonverbal Ability Test
  • WISC-V Matrix Reasoning
  •  MAT: 5-17 yrs.
  • NNAT: 4-18 yrs.
  • WISC-V: 6-16 yrs.
  •  categorizing items based on similarities
  • figuring out relationships/patterns among objects
  •  able to ascertain relationships between concepts and develop ideas based on prior knowledge (abstract thinking)

Choice ‘A’ would be the completion of the pattern.

Set Shifting (Switching Tasks)
  •  Wisconsin Card-Sorting Test
  • D-KEFS (Sorting Test)
  • Minnesota Executive Function Scale (MEFS)
  • Trail Making Tests
  •  WCST: 7+ yrs.
  • D-KEFS: 8+ yrs.
  • MEFS: 2+ yrs.
  •  ability to switch tasks
  • conceptualization
  •  able to shift attention (flexible thinking)
    • able to see other perspectives
    • able to try other approaches

Image result for wisconsin card sorting test

Attempt to match card at bottom with one of the cards at top. Trial and error are used to figure out the sorting system for each set of five cards (each ‘problem’). 

Word/Idea Generation
  •  Controlled Oral Word Association Test
  • D-KEFS (Verbal Fluency Test)
  • NEPSY-II Test (Word Generation subtest)
  •  COWAT: 5-16 yrs.
  • D-KEFS: 8+ yrs.
  • NEPSY-II: 3-16 yrs.
  •  ability to think of works and create ideas
  • some versions: processing speed/set shifting
  •  allows person to solve problems
    • quickly think of words/ideas is essential skill

Person thinks of as many words as he/she can that start with a certain letter within a given time frame. 

 

 

Interview with Grace 

      I wanted to have a loosely-guided conversation with my friend, Grace, regarding her experiences with EFD. As with any condition, there is a person experiencing that condition, so said person may want to divulge the details of his or her condition. This video is a detailed account of what EFD is, how Grace experiences the factors that accompany EFD, and how she views her social and educational experiences. I wanted to give Grace a space in which she could share her experiences and, in the process, help others who either have a similar learning difference or those who want to know more about EFD. The video below is that interview.

 

                                     

 

Please take a moment to complete the following survey about the video:

https://www.surveymonkey.com/r/2WHH2LD

 

For Parents: Methods of Organization for Your Child

Now that you have a solid understanding of what executive function is, how it’s tested, and what the experiences of someone with EFD are, we should note the ways in which children with EFD can be helped.

  • Grade Schoolers
    • Distinguish between “wants” and “needs”. Prioritization is a good skill to learn.
      • Example: The child wants  to play with friends, but needs to do his/her homework first.
    • Clean up after him/herself.
    • Categorize/label/sort things together.
      • Turn it into a game. Have them sort their toys or a grocery list to establish relationships between things.
    • Visualize the day.
      • Make a comic book that schedules out the day’s events.
    • Make a checklist. Transfer unfinished tasks to the next day.
    • Make a family calendar.
      • This will improve the child’s sense of time and awareness of future events.
    • Break down projects into steps.
      • Think of an idea, then work with your child to think about the steps necessary to bring that idea to life.
  • Middle Schoolers
    • Organize lists logically.
      • Put tasks in order of due date, time needed, difficulty, etc.
    • Practice “divide and conquer”.
      • Use a calendar with your child to help them plan ahead.
    • Designate an area for your child’s “school stuff” in the morning.
      • This way, your child will be more collected and composed as he/she leaves for school.
    • Color-code tasks.
      • Label chores different colors depending on when they need to be done (i.e. green for end of the week, red for tonight).
    • Establish one day a week to clean out his/her backpack, room, etc.
      • Your child we be more organized and have an easier time finding things.
    • Practice time-keeping.
      • Write down specific start/end times for assignments so your child can practice being focused and efficient within a period of time.
  • High Schoolers
    • Practice prioritization.
      • Organize assignments in order of difficulty, due date, etc.
    • Encourage a “divide and conquer” approach.
      • Categorize small chunks of a project by order and importance.
    • Designate an area for study materials.
      • Encourage him/her to have one place or a few designated areas for school supplies.
    • Demonstrate organizational skills.
      • Keep a family calendar or to-do list; set an example for how to plan ahead and budget time.
    • Use whiteboards.
      • Encourage him/her to use them for daily checklists, visualizing assignments, or writing down things he/she needs to remember.
    • Get him/her a planner.
      • Either on paper or a computer/smartphone, promote the management of his/her own time on his/her own accord.
    • Ask about how your child will go about doing something.
      • Getting your child to explain and provide reasoning for his/her method of approach will help him/her think through it. You can also help him/her fine tune their method as needed.

 

Thank you for taking the time to view my presentation on EFD. I strongly encourage showing this presentation in full or any part of this presentation to your peers, friends, colleagues, etc. There are currently not enough websites to find information exclusively about EFD and executive function, so if any of this information piques your curiosity further, please have a look at the links in the Works Cited section for more information about executive function.

Again, I hope you enjoyed my presentation, and I hope it was thorough and informative. Please, don’t hesitate to leave a comment on your thoughts regarding the formatting, content, pacing, etc. of any part of this presentation.

Thank you.

 

 


Works Cited

Kelly, K. (n.d.). Types of Tests for Executive Functioning Issues. Retrieved April 21, 2018, from https://www.understood.org/en/school-learning/evaluations/types-of-tests/tests-for-executive-functioning-issues

Prefrontal Cortex. (2015, August 18). Retrieved April 17, 2018, from https://www.goodtherapy.org/blog/psychpedia/prefrontal-cortex

S. (n.d.). Frontal Lobe. Retrieved April 18, 2018, from https://www.spinalcord.com/frontal-lobe

Team, U. (n.d.). 3 Areas of Executive Function. Retrieved April 17, 2018, from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/3-areas-of-executive-function

Team, U. (n.d.). Executive Functioning Issues: Strategies You Can Try at Home. Retrieved April 22, 2018, from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/executive-functioning-issues-strategies-you-can-try-at-home

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COMMENTS: 2
  1. April 27, 2018 by David Long Reply

    Lauryn,

    You do a great job of explaining the differences between ADHD and EFD and I like how you personalized it with Grace’s story. Your suggestions for parents in terms of organizational strategies is fantastic. Great job!

  2. April 28, 2018 by Mila Tewell Reply

    Lauryn, this is such a thoughtful and in depth exploration of EFD, and I learned a great deal from your presentation. I particularly appreciated the several ways in which you told this story, including your fine interview with your friend Grace. Well done!

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