Executive Functioning and the Impact on Learning

Executive functioning often comes up in my Facebook group where I provide free educational advocacy advice.  Many schools fail to recognize a child with executive functioning issues even though it is common for children with ADD, ADHD, and Autism along with many other conditions.   It is important a public school recognizes executive functioning problems and works with the child to put systems in place to help the child overcome their executive functioning issues.  Without help from teachers and adults, along with having positive supports in place, many children will feel overwhelmed and shut down in the educational setting.  Since the issue of executive functioning (EF) is so complex I have written another blog post to cover other areas of EF.

 

So what is executive functioning?

Executive function is a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.

 

Executive function helps you:
  • Manage time
  • Pay attention
  • Switch focus
  • Plan and organize
  • Remember details
  • Avoid saying or doing the wrong thing
  • Do things based on your experience
  • Multitask
When executive functioning isn’t working as it should, your behavior is less controlled. This can affect your ability to:
  • Work or go to school
  • Do things independently
  • Maintain relationships
Types of Executive Function
Executive function can be divided into two groups:
  • Organization: Gathering information and structuring it for evaluation
  • Regulation: Taking stock of your surroundings and changing behavior in response to it

For example, seeing a piece of chocolate cake on a dessert cart at a restaurant may be tempting. That’s where executive functioning can step in. The organizational part reminds you that the slice is likely to have hundreds of calories. Regulation tells you that eating the cake conflicts with goals you may have, like eating less sugar or losing weight.

 

Problems With Executive Function

Some people are born with weak executive function. And people with ADHDdepression, or learning disabilities often have weaknesses in it.  I will discuss more on the various learning disabilities in a later section. An injury to the front of the brain, where the frontal lobe is, can harm your ability to stay on task. Damage from Alzheimer’s disease or strokes may also cause problems with executive functioning. 
 

Children and Executive Function

Problems with executive function can run in families. You may notice them when your child starts going to school. They can hurt the ability to start and finish schoolwork. Warning signs that a child may be having problems with executive function include trouble in:
  • Planning projects
  • Estimating how much time a project will take to complete
  • Telling stories (verbally or in writing)
  • Memorizing
  • Starting activities or tasks
  • Remembering

Co-Occurring Conditions of Executive Function Impairment 

ADHD/ADD is the hallmark condition for executive function impairment. The condition of ADHD/ADD is so pervasive in life it deserved its own blog post and is in the Blog section as well as hyperlinked in this article.  It is possible to distinguish someone with an executive function disorder from someone with ADHD by trying ADHD medication.  Someone with true Executive Function Disorder will not improve on ADHD medication.  My daughter, Margaret, is a great example of this.  We also happen to know she has Hypoxic Ischemic Encephalopathy (HIE).  She has a cyst, or hole, in her right frontal lobe.  The right frontal lobe controls reasoning, impulsivity, and emotional regulation. For her, ADHD medication would not improve her impulsivity and inattentiveness. She has a true executive function disorder versus ADHD but she also carries the medical diagnosis of ADHD. The ADHD label is appropriate since she has some ADHD characteristics too like always being in motion and people understand what ADHD entails versus executive function disorder.

 

Autism is another co-occurring condition that typically entails executive function disorder and/or ADHD. I am seeing more and more children with high-functioning autism being mislabeled as behavioral. I think much of this stems from poor executive functioning and lack of addressing sensory issues.  In a study released in 2017 showed children with Autism are often diagnosed with a host of learning and behavioral disorders including ADHD, Anxiety, Depression, and Disruptive Impulse Conduct Disorder.  I think all of these are related to executive functioning disorder and untreated sensory problems. I often hear from parents in my Facebook group (IEP/504 Assistance) say teachers make comments about their child saying, “Your child could have made better choices this year.” Really?  I think this is an indication the teacher needs training.  Obviously, the teacher does not understand how executive functioning works.  Students NEED structure and rules in place to HELP them make good decisions.
 

Other conditions impacted by executive control issues include Obsessive-Compulsive Disorder, Tourettes, Traumatic Brain Injury, DepressionFetal Alcohol Syndrome, Developmental Coordination Disorder, and just being a preemie can greatly increase a child’s risk of having an executive functioning disorder.
 

How do you make the diagnosis of Executive Function Impairment?

Tests That Assess Attention

Example: Test of Variables of Attention (TOVA) (ages 4 and up)
Similar tests include: Integrated Visual and Auditory CPT (IVA-2) (ages 6 and up), Conners Continuous Performance Test II (CPT II) (ages 6 and up)
What it measures: A child’s ability to pay attention. (It also looks at processing speedand inhibitory control.)
Why it’s important: The ability to pay attention is a key executive function. Having trouble with attention is a hallmark of ADHD. While this test isn’t an assessment for ADHD, it might signal that a child has an attention issue. Learn more about the link between ADHD and executive functioning issues.
How it works: In the classic version, different letters flash on a computer screen. A child presses the space bar every time he sees the letter A. The test lasts for 15 to 20 minutes. (With CPT II, kids press the bar when they don’t see the letter.)  Kids who miss targets may be “zoning out” because of attention issues. But this test also looks at other skills that can impact attention. Missing targets might be the result of slow processing speed, for instance. Responding to the wrong targets might be a problem with focus or with inhibitory control. And if the child was doing well up to a certain point but then makes mistakes, he may have trouble sustaining attention.


Tests That Assess Inhibitory Control

Example: Stroop Color and Word Test (ages 5 to 14; adult version starts at 15)
Similar tests: The Color-Word Interference Test of Delis-Kaplan Executive Function System (D-KEFS) (ages 8 and up)
What it measures: A child’s ability to hold back on giving an automatic response, or the ability to think through something before acting.
Why it’s important: Inhibitory control is tied to self-control. It allows kids to think before they act. It also allows them to assess each new situation and consider the correct or most effective way to respond.

How it works: The evaluator shows a child the words for different colors written out. But the color of the ink doesn’t match the word that’s spelled out. For example, the word red might be written in green ink. As quickly as possible, the child must say the color she sees, as opposed to the word. The test is usually timed, so it also looks at processing speed. Kids who haven’t learned to read yet may perform a similar task with shapes instead of words. In this case, the child might see a circle in red ink. She then has to say the color, not the shape.


Tests That Assess Working Memory

Example: Digit Span and Spatial Span subtests of the Wechsler Intelligence Test for Children (WISC) (ages 6 to 16)
Similar tests include: Working memory tasks in the Woodcock-Johnson (WJ-IV) Cognitive battery (ages 2 and up)
What they measure: The Digit Span test measures verbal working memory (the ability to store information that’s heard). The Spatial Span test measures visual working memory (the ability to store information that’s seen).
Why they’re important: Working memory is an executive function that allows kids to hold onto new information in order to put it to use. (It’s also affected by attention.)
How it works: With digit span, the evaluator dictates a series of numbers, and the child has to repeat them back in reverse order. If the examiner says “9, 6, 3,” the child has to repeat the sequence back as “3, 6, 9.” When working with younger kids, the evaluator might list a series of animals in size order, such as bee, dog and cow. The child repeats them back saying the biggest to the smallest animal. With spatial span, the evaluator touches a series of blocks in a certain order. The child has to touch the blocks in the reverse order that the evaluator touched them. If a child does poorly on the digit span version but well on the spatial span, it might mean she has working memory issues that are more language related. If it’s the other way around, it might mean she struggles with working memory just for visual-spatial tasks.


Tests That Assess Organization and Planning Skills

Example: Tower of Hanoi (ages 5 and up)
Similar tests include: The Tower Test of D-KEFS (ages 8 and up); Rey–Osterrieth Complex Figure Test (ages 6 and up); Tower of London Test (TLT or TOL)
What it measures: The ability to plan, sequence and organize information for problem-solving. It can also assess working memory and inhibitory control.
Why it’s important: Planning, sequencing and organizational skills are key to following directions and completing tasks efficiently. They’re also important when it comes to participating in complex discussion. Kids with executive functioning issues often struggle with these skills.

How it works: A child must rearrange beads or disks to match a model while following specific rules. A rule might be that the child can’t place a larger bead on top of a smaller one. The goal is to complete the task in as few moves as possible.

 

Tests That Assess Concept Formation

Example: Matrix Analogies Test (ages 5 to 17)
Similar tests: Naglieri Nonverbal Ability Test (ages 4 to 18), WISC-V Matrix Reasoning (ages 6 to 16)
What it measures: The ability to form classes of items based on what they have in common; the ability to figure out patterns or relationships between objects.
Why it’s important: Concept formation allows kids to see relationships between things and develop ideas based on what they already know about them. It’s important for abstract thinking.

How it works: A child sees a grid of four boxes with pictures in them. The top row might have a big house next to a big apple. The box below the big house has a little house. The box under the big apple is empty. The child has to pick what logically belongs there (a little apple) from five choices. (The analogies are more complex for older kids.)

 

Tests That Assess Set Shifting

Example: Wisconsin Card Sorting Test (ages 7 and up)
Similar tests include: The Sorting Test of D-KEFS (ages 8 and up); Minnesota Executive Function Scale (MEFS) (ages 2 and up; measures other executive functions as well); Trail Making Tests
What it measures: A child’s ability to shift from one task to another. It also measures concept formation.
Why it’s important: This executive function allows kids to shift their attention and move from one task or situation to another. This type of flexible thinking helps kids see new ways of doing things, or try something else when the first approach doesn’t work.
How it works: A child is shown a set of five cards. Each card has a different figure on it. The figures switch around with each problem. For example, in one problem the figures on the cards might be: three green stars, one red circle, two yellow blocks, four yellow crosses, and two red crosses. The child sees four of the cards lined up in a row, and one by itself below. She’s told to match that card to one of the four above, but not told the rule for matching. (In other words, she doesn’t know whether to match by shape, color, number, etc.) The child only gets feedback on whether she’s right or wrong in the match she makes. So through trial and error, she needs to figure out the rule herself. She’s scored by how many correct sorts she makes.
 

Tests That Assess Word and Idea Generation

Example: Controlled Oral Word Association Test (ages 5 to 16)
Similar tests: Verbal Fluency Test in the D-KEFS (ages 8 and up); Word Generation subtest in the NEPSY-II (ages 3 to 16)
What it measures: The ability to think of words and generate ideas. (It also looks at set-shifting and processing speed in some versions.)
Why it’s important: Kids rely on executive functioning to solve problems. Being able to quickly come up with words and ideas is key to problem-solving.

How it works: A child names as many words as she can, based on a certain letter. For example, she might have to come up with words that start with M. Or, on a harder version of the test, she may have to name as many kinds of fruit and furniture as she can, in pairs. She might start with apple/chair or banana/couch, and so on.

 

Other Possible Considerations When Testing Executive Functioning

The Picture Arrangement (PA) sub-test of the Wechsler Adult Intelligence Scales (WAIS) is not really known as an executive test. In the ‘bible’ of neuropsychological diagnostics, Lezak’s Neuropsychological Assessment (2004), this test is never described as an executive function test.

Remember, executive functions are really several different cognitive functions all humped together: concept formation, formulating a plan (planning), formulating a goal, sequencing the correct order of steps to take in order to reach a goal or follow a plan (logical reasoning), executing the steps and monitoring your own actions, mental flexibility to reformulate a plan and change the actions to reach your goal/plan and the ability to control your automatic, instinctive or impulsive reactions in order to follow your action plan consistently. In short, executive functions are functions that represent goal-directed actions: taking initiative, planning, executing actions, monitoring and self-correcting those actions.

 

The task requires several cognitive processes. First, you have to see all the pictures in clear detail. Then you have to form several ideas about what is going on here. That’s what neuropsychologists call ‘concept formation’ or ‘formulating a plan’. Then you have to form a picture in your mind of a sequence of the 3 pictures. Not randomly, but guided by your plan or idea about what is going on in this story. Then you have to put these pictures in this planned order and finally, you have to check this whether it matches your plan/ideas. When the sequence is looking wrong, you will have to correct the order. Remember, in the PA test all pictures are separate pictures you can move around. I have programmed these pictures so that they are displayed on a computer screen and can be moved by the clinician. The patient has only to point at a picture and to point at where it should go. Except for planning, sequencing, and monitoring cognitive processes like visual perception, divided attention and memory all work together to do this task correctly.

Wrap-up
I hope you found this post helpful and full of ideas. I will post later this week some assistive technology (AT) and accommodations that can help a child with executive functioning issues. I like doing these posts since two of my children struggle with severe executive functioning issues. Completing this post helps to remind me to give them grace when they are having executive functioning problems (practically every minute of every day!) and how EF issues impact their learning.

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