Smart but Scattered Kids

Our professional focus over many years has been on children with executive skill weaknesses. In working with parents and teachers, however, we discovered that we could enhance their understanding of the challenges that kids are up against by encouraging them to look at their own executive skill profile. In fact, we’ve been told by many readers of Smart but Scattered that their assessment of their own executive skills profile was the most interesting part of the book.

This led us to write a book for adults. The Smart but Scattered Guide to Success gives readers not only the opportunity to assess their executive skills, using several self-assessment questionnaires, but also strategies and tips for capitalizing on executive skill strengths and managing executive skill weaknesses. We adapt the same basic strategies we use with kids to an adult population. The book will certainly appeal to adults with ADHD, since they tend to have more significant executive skill challenges than a non-ADHD population, but we also believe that the book will be useful for anyone who can identify some problem areas associated with executive skills. And who among us can’t do that? In fact, throughout the book, the authors draw on their own profiles (and those of other family members) and the coping strategies they have developed to manage their challenges.

While the book was written as a “self-help” book, we think it can be a great resource for therapists, coaches, and other clinicians who work with adults struggling with issues in their work, home, or relationships that result from executive skill challenges.

We have also designed a training for clinicians to help them use our ideas to work with their clients with executive skill challenges. PESI is sponsoring these seminars, beginning in November. To learn more about these offerings, visit the PESI website (https://www.pesi.com) and type Smart but Scattered Adults into the search engine. Hope to see you at an upcoming training!

When parents bring their children to me for an evaluation because they are concerned about possible executive skill weaknesses, I spend the first part of the assessment process interviewing them about their child. Parents know their children better than any teacher, psychologist, or therapist ever will, and I get a great deal of useful information from that interview.

That said, it took me longer than it should have to realize that one of the questions I need to ask parents is about sleep. First of all, I didn’t learn about sleep at all when I was in graduate school, so maybe that’s my excuse. But once I realized I needed to ask about sleep, it began opening windows for me. I had no idea how many children can’t fall asleep at night without a parent lying down with them, or how many kids crawl into bed with their parents in the middle of the night, or may even sleep in their parents’ bedroom. More recently, I’ve come to understand that way too many children have technology in their bedroom—televisions and computers that are too tempting to set aside even as the lights should be turned off. And too many teenagers are bringing their smart phones to bed with them, remaining engaged with social media far into the night.

And then there’s the whole issue of sleep disorders, which I believe are probably under-diagnosed in children. These include sleep apnea (where the child stops breathing multiple times per hour and has to wake up in order to start breathing again), restless leg syndrome (which may be misdiagnosed as ADHD), and a circadian rhythm disorder called delayed sleep phase syndrome (which means the body is not ready to fall asleep at the normal bedtime). The prevalence rate of delayed sleep phase syndrome in teenagers is about 7 percent: it’s almost as common as ADHD, yet nobody knows about it.

But what does this have to do with executive skills? Just this: when the brain is deprived of sufficient sleep, executive skills are the first brain functions to suffer. Research indicates that a number of cognitive skills are diminished when individuals lack sufficient sleep on a regular basis. The impacts of sleep deprivation include: 1) daytime sleepiness (which is most problematic during periods of low stimulation); 2) tiredness or fatigue (which makes it difficult to initiate or persist at certain types of behavior, especially tasks deemed boring or tedious); 3) emotional factors (which can include depressive symptoms, low tolerance for frustration, as well as increased irritability); and 4) changes in attention and performance (which can produce ADHD-like symptoms and which can have a particularly negative effect on an individual’s ability to performance complex tasks or those requiring divided attention).

Given the symptoms of sleep deprivation described above, there’s not one of the 11 executive skills we write about that aren’t impacted. If parents are serious about helping their children improve executive skills, the first step they should take is ensuring that their children are getting an adequate night’s sleep on a consistent basis.

So how do we do that? The American Pediatric Association developed some guidelines for parents to help them improve sleep hygiene in the home. For youngsters who resist going to bed or who need the presence of adults in order to fall asleep, pediatricians generally recommend the following conditions be put in place (adapted from an article that appeared on the Medscape website):

1. Establishing a consistent bedtime routine. A regular and well-structured set of pre-bedtime activities usually helps settle children and promote sleep onset. This may include bedtime stories and being “tucked in.” Stimulating activities, such as vigorous play or watching cartoons, should be avoided due to their potential alerting effect. Keeping the routine quiet and regular helps young children achieve a quiet, relaxed state more conducive to sleep onset.
2. Maintaining a regular sleep schedule. Consistent bedtime and waking time 7 nights a week is usually helpful. Eliminating late sleeping and any daytime napping that is inappropriate for age may increase the chance that a child will be tired at the usual bedtime. In addition, regularity of sleep schedule may help promote the stabilization of biological rhythms that will make sleep onset come more quickly.
3. Maintaining a sleep environment conducive to sleep. Quiet, dimly lit environments make it easier for children to fall asleep than noisy, brightly lit environments (although nightlights can be appropriate for children who are afraid of the dark). Experts generally recommend that children be put to sleep without a parent remaining in the room since this provides the child with an opportunity to learn to fall asleep independently and to minimize dependence on parental presence. Another reason for this is that it helps children learn to confront their fears or anxieties and learn to “self-soothe” rather than rely on external supports for this.
4. Using limit setting. Children who stall, cry, or leave the room at bedtime in an attempt to stay up later will sometimes repeat this behavior to the point where a parent or caregiver “gives in” and allows the child to stay up. For some children, this pattern of behavior may be repeated nightly to the point of causing consistent delay and disruption of sleep onset. Setting and enforcing appropriate limits on inappropriate bedtime behavior are crucial for the effective treatment of limit-setting sleep disorder. Limits must be enforced consistently by all caregivers, usually for periods of days or weeks, for maladaptive bedtime behaviors to subside. Parents should be aware that temperamental and agitated behavior often transiently worsen during the first days of treatment before gradual improvement becomes evident, making the initial days of treatment the most difficult.

In September of this year, the American Pediatric Association addressed the issue of school start time for the first time. As children enter adolescence, their sleep patterns change. Now, the typical teenage body wants to fall asleep around 11. Sleep experts state that teenagers still need 8-9 hours of sleep a night, which means that too many high school students are living with chronic sleep deprivation because early start times at most high schools don’t permit them to get their full ration of sleep. They accumulate sleep debt as the school week progresses and then they try to catch up on weekends by sleeping in. While this may address the problem of sleep debt, it exacerbates the problem during the school week because on Saturday and Sunday, they’re often sleeping until late morning and on Monday they have to wake up very early to go to school. Some sleep experts have described this as similar to what it would feel like to fly from Hawaii to New York every weekend.

Where schools have addressed this problem and pushed school start times back, they see immediate gains in all kinds of ways: fewer school absences, better report card grades, higher standardized test scores—and even lower incidents of unwanted pregnancy and delinquent behavior (since it turns out these problems typically occur during after school hours before parents get home from work).

Influencing school boards to look seriously at the issue of high school start time is a worthy endeavor. But for individual parents who can only control what happens within the walls of their own homes, ensuring that their children get a good night’s sleep will reap dividends in many domains—including executive functions.

Procrastination is usually not an issue for me. In fact, task initiation is one of my strongest executive skills. But ever since we got this website up and running, I’ve put off writing the blog I had every intention of writing when the whole thing started.

 Now, with a new school year looming, I decided it’s time to make good on my promise. Here’s the process I went through to get this going. First, I wanted to understand why, if task initiation is one of my stronger executive skills, I had delayed for so long in updating this blog. I can use the usual excuses—too much to do, too little time, but that doesn’t work because I manage to fit in computer solitaire games and (almost) daily exercise. I’ve even planted a vegetable garden and mopped a few floors along the way—things that involve some tedious labor that one would think I would choose not to do if I could get away with it.

One might suspect that I hate to write and that explains it, but that doesn’t hold water either. After all, I’m the author of several books  and while admittedly book-writing can be a painful process when you’re in the throes of it, I definitely get some satisfaction from writing, otherwise I wouldn’t do it. On top of that, for the past 15 years or more I have kept a personal journal in which I have written something every day about my life as I live it and want to remember it. And I write annual Christmas letters and anniversary letters, and take some enjoyment in those compositions as well.

I think it comes down to not knowing what to write. This actually connects to one of my executive skill weaknesses, flexibility. Even if I could come up with one idea for something to say about executive skills, I was worried I couldn’t sustain it over time and keep finding fresh material to write about. Generating new thoughts or ideas on a month in and month out basis overwhelmed me…so I kept putting the whole project off.

So how did I go about overcoming those obstacles and resistances? A number of factors conspired to make this seem like a more do-able project to me. First of all, I took a break from traveling this summer and I kept my work schedule to a minimum. I made some headway with the book I’m currently working on (the folder on my computer that holds the manuscript is labeled The Last Book I’ll Ever Write—but don’t tell my publisher that!), so that left me feeling I had a little breathing room. But I did two additional things.

I began by just making a list of possible topics. That was easier for me once I realized that I didn’t need to write an essay or an op-ed piece. The thought I could write relatively brief commentaries (like my daily journal) freed me up to think more creatively about possible topics. The whole project didn’t feel so hefty any more, so it felt like something I could persist with over time. I now have a list of 10 or 12 different topics that can occupy this space over the coming weeks or months.

Then I decided to just start writing. I got momentarily side-tracked thinking I needed to come up with a title for my posting (another task that requires flexibility—i.e., imagination), so I had to reassure myself that the title would follow the content rather than dictating the content. And then, when a no-show opened up an unexpected hole in my office schedule, I just sat down and put my fingers on the keys of my laptop. If I wrote the whole piece right then, that would be great, but even if I needed to do more work, the writing would have been started—and that’s always the hardest part, even if task initiation is a strength of mine.

Oh, and one more thing. When my colleague Dick and I developed our coaching process (as described in our book Coaching Students with Executive Skills Deficits), we survey the literature to find an evidence base to support our approach. In so doing, we realized that the behavioral literature on correspondence training had something to offer. There is a body of research (e.g., Paniagua, 1992) that demonstrates that if you make a public commitment to engage in a certain behavior or do a certain task, there is a much greater likelihood that you will actually do what you said you were going to do than if you don’t make a public commitment.

Here’s an example of this: say I’m going out to a restaurant with my husband that serves my favorite dessert (it happens to be crème brûlée). If I’m trying to watch my weight and know I’ll be tempted by the dessert I may tell my husband before we even leave the house, “Okay, so I am NOT going to order dessert tonight. I will just end my meal with coffee.” Having made that public statement, I invariably think twice about ordering the dessert, and when the waitress comes by and asks if we want to see the dessert menu, I am more likely to say, “No thanks, just coffee,” than if I hadn’t announced my intentions to my husband in advance.

So I will end this posting in a similar way: my goal for the coming year is to write at least one posting per month between now and next June.

I’m pretty strong in goal-directed persistence, but this public announcement will help me stay on track—and if readers have ideas for future blog postings, please write—I’m always open to new directions to take!

Reference:

Paniagua, F. A. (1992). Verbal-nonverbal correspondence training with ADHD children. Behavior Modification, 16, 226-252.

Tools of the Mind:

Thinking about Executive Skills on Many Levels

Peg Dawson

When I first started thinking about executive skills, I came at it from my experience working with students with ADHD. With that population, problems with task initiation, sustained attention, and response inhibition are paramount, and I spent a lot of time thinking first about how to structure the environment to better accommodate kids with these skill deficits and then thinking about how to teach them to initiate and stick with tasks and control their impulses more successfully. Working with these skills in particular usually involves an adult (teacher, parent, coach) providing a lot of direction—cues, structure, schedules, routines, checklists, social reinforcement if not more formal incentive systems, and providing students with lots of opportunity to practice under controlled and supervised conditions.

By doing all these things described above, we can shape kids up. They’ll be more likely to complete classwork and homework, they’ll stay out of trouble on the playground and with their friends, and they’ll make life easier not only for themselves but for their parents and teachers as well. But is that really the goal?

Recently I’ve begun thinking about executive skill development from a whole different angle. While having well-behaved kids may make us (parents, teachers, coaches, scout leaders or whatever) enjoy them more, and getting to this stage may increase the chances of smoother sailing as they continue on in school, that’s a pretty narrow way of thinking about executive skills.

If you look at our definitions of executive skills, we’ve arranged them in the order in which we think they emerge developmentally. The skills I’ve listed above are all on the first half of the list. The skills on the second half are more complex and multi-faceted and they tend to emerge later. But those are the skills where the payback is the greatest. When kids develop planning and time management, goal-directed persistence and metacognition—then they become masters of their own fate. More than that—they become skilled problem solvers, deep thinkers, and active pursuers of the skills and knowledge that matter to them. And those are the tools that will enable them to achieve their potential and follow their lofty dreams.

While these executive skills may be fully mastered only toward the end of the developmental period, the seeds for mastery can be sown much earlier. And in many ways, to help kids acquire those skills requires a very different skill set on the part of the adults working with them. Rather than prompting and cueing kids to do specific things (get started, remember stuff, stick with the task at hand), we want to help them learn to think for themselves. For adults to do this, they need to pull back and provide less structure rather than more—provide more subtle cues and supports. Ask questions rather than issue directives.

School-Based Applications

 Tools of the Mind is a preschool curriculum that emphasizes this approach. Based on the developmental theories of Russian psychologist Lev Vygotsky, this approach is built around the notion that children learn and develop by acquiring mental tools that help them think, attend, and remember—“tools of the mind,” in Vygotsky’s terminology. Many of those tools are executive skills. As described by CASEL (Collaborative for Academic, Social and Emotional Learning) the Tools of the Mind preschool/kindergarten program “encourages teachers to scaffold student learning while encouraging use of mental ‘tools’ through self-regulation activities, make-believe play, and a structured classroom environment that enable students to control their social, emotional, and cognitive behaviors.” (CASEL, 2013) CASEL chose to include Tools of the Mind in their list of effective social and emotional learning programs published in 2013. To be included, programs must be well-designed, deliver high quality training and implementation supports, and to be evidence-based, as shown by at least one carefully conducted study. A copy of this guide can be obtained in PDF format through the CASEL website (http://www.casel.org/). For a more in-depth description of this approach, check out the Tools of the Mind website (http://www.toolsofthemind.org) or take a look at the book by the program developers (Bodrova & Leong, 2007).

Tools of the Mind at Home

 This approach can be applied at home as well as at school. In many ways, it’s well-suited to home-based applications, since a cornerstone of the program involves make-believe play. When children engage in dramatic play, they practice executive skills at a higher level and more independently than in any other daily activity in the early years. Play involves creating an imaginary situation (which requires cognitive flexibility), developing a scheme for how the play will progress (which requires planning), adopting roles, such as parent, doctor, pirate that enable the child to view the world from different perspectives (which requires metacognition) and establishing the rules of play (which requires response inhibition). As Bodrova and Leong (2007) point out, “Unlike other activities where children comply with directives imposed from outside, in play children place constraints on their own behavior. It is the first time that children engage in self-restraint—the beginning of self-regulation.”

All too often in today’s world, parents sign their children up for organized activities under the direction of adults, or they give them toys to play with that diminish the child’s need to draw on their own imagination (using a wooden block as a cell phone requires more imagination than giving the child a toy cell phone to play with). Children enjoy these activities and parents feel good about exposing their children to activities and materials that they enjoy. But is there something lost in the process? Are we actually slowing down the child’s ability to develop problem solving skills and self-regulation?

The Tools of the Mind website provides detailed and well thought-out instructions for how parents can help their children learn to play (http://www.toolsofthemind.org/parents/make-believe-play/). But there are other things parents can do to support the development of those more complex executive skills. These include:

• Asking good questions to get your child to think for himself. Why do you think your baby brother is crying? Is he hungry? Could he be tired? Do you think he’s reacting to too much excitement? Why do we have to brush our teeth after eating breakfast? What fun thing could you do after we clean your bedroom? Since it’s raining and we can’t go to the beach, what else could we do this afternoon?
• Don’t rush in to solve your child’s problems for her. Your sister’s playing with the toy you want to play with. How could you handle this situation? I know you wanted pancakes for breakfast but I don’t have time to make them—what’s another choice? I think Tommy doesn’t want to play with you because he feels you always need to decide what you’re going to play. What could you do to help Tommy change his mind?
• Ask your child to wait—and help them think of things they can do while they wait. Learning to wait, it turns out, is an excellent way to develop response inhibition—or delayed gratification. If your child wants you to play a game with him right now, feel comfortable telling him You know what? I have to finish folding the laundry first. It will take about 15 minutes. What can you do while you wait for me to finish my chore?
• Help your child make plans or to organize things. We’re going on a camping trip this weekend. What do we have to remember to bring? Let’s make a list. You want to make a picture book for Grammy? That’s a great idea. What materials do you need? What will you do first? How can I help you—or do you want to do it all by yourself? We have to pick up your room now. What should we start with? And then what?
• Help your child set goals. Saving up money for something the child wants is one way to do this (plus it helps develop delayed gratification). But you can build goal-setting into every day tasks as well. How long do you think you can work on your homework before taking a break? How many books do you think you can read this summer? If you’re ready for school 15 minutes before the bus comes, you can watch part of that video you like. How many days this week do you think you’ll be able to do that? Let’s mark it on the calendar.

It’s a balancing act, isn’t it? Provide enough structure and support for kids to feel comfortable with routines and schedules—but provide enough free time and encouragement to help kids learn on their own. Kids need to make mistakes and learn to solve their own problems. The advice Dick and I frequently give to parents and teachers is Provide the minimum support necessary for the child to be successful. That’s a flexible maxim: on some days and in some situations, the child needs more support, at other times less. It’s not just kids who are learning as they go—adults who work and live with kids are doing the same.

References

 Bodrova, E. & Leung, D. J. (2007). Tools of the mind: The Vygotskian approach to early childhood education. Upper Saddle River, NJ: Pearson.

Collaborative for Academic, Social and Emotional Learning (2013). Effective social and emotional learning programs: Preschool and elementary edition. Chicago, IL: CASEL.

As a psychologist who specializes in children with learning and attention disorders, I see a lot of kids who are struggling in school. Very often, their parents are struggling too, with what is causing the problem. When they come to see me, the initial interview often goes like this:

Me: Why don’t you start by telling me how you ended up here and what you’re hoping to get out of this evaluation?

Parents: We can’t figure out why Sam (this could be Samuel or Samantha, but for the sake of simplicity, we’ll assume Sam’s a boy) is having such a hard time in school. He did fine in early elementary school, and his achievement test scores are consistently above average, so we know he’s not stupid. To be honest, we’re beginning to think he’s just lazy.

Me: Tell me what leads you to suspect that.

Parents: Well, if he hasn’t “forgotten” that he has homework or forgotten to bring it home, he puts it off until the last minute and then rushes through it. He makes a million mistakes but can’t bring himself to go back and check his work. And if he has a choice between playing video games or studying for a test—forget it, video games win every time.

Me: Does he remember to hand in his homework?

Parents: That’s another problem. If he has a teacher who’s really strict and checks up on him, then he usually doesn’t forget. But if a teacher is looser about that or expects him to take responsibility for handing it in on his own, then there’s trouble. And long term projects are a nightmare!

Me: What do you mean?

Parents: He often forgets he has them or forgets when they’re due. He has a terrible time coming up with a topic, particularly when he has to write a paper, and he’s not very good about planning his time or organizing the paper, so he leaves it till the last minute. He hates proofreading, and he usually forgets to look at the scoring rubric, so he leaves out stuff the teacher’s asked for. You can imagine the grade he gets.

Me: What’s his report card look like?

Parents: It’s like a roller coaster—he does well one marking period then lousy the next. And if it weren’t for progress reports, he’d probably fail everything. He’s usually failing a couple of classes when those come out and then he has to scramble to bring his grades up.

Me: Are there problems outside of school—like keeping his bedroom neat or keeping track of things like sports equipment?

Parents: How’d you guess? Even when we make him pick up his room, he does the minimum and then seems clueless about why we’re upset—he doesn’t even seem to see the clutter. So then it takes him forever to find his mouth guard or shin pads. He’s a good soccer player, but his coach has taken to keeping an extra shirt on hand—he’s the only kid on the team who doesn’t have an assigned number.

Me: So you think the problem with school is he just doesn’t care?

Parents: Actually, no. He seems to get pretty mad at himself when he forgets something or when he gets low grades on papers or tests—but we just don’t know why he doesn’t make the effort or put in the time to do quality work!

This gives a flavor of the kind of child I see. I also ask about what his backpack looks like, whether he can estimate how long it takes to do something, if he can work on homework without taking breaks, etc., etc. The answers are predictable. And when I ask parents when the problems began, the answer I get, invariably is, “Things were a little bad in elementary school, but it all started falling apart in middle school.”

When you scan the parents’ concerns, it sure looks like laziness. But there may be a better way to conceptualize the problems Sam has. Many youngsters who are considered “underachievers” have a constellation of challenges that fall under the category of executive skills. Executive skills refer to the cognitive processes required to plan and organize activities, including task initiation and follow through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal-directed persistence. Located primarily in the prefrontal cortex (the part of the brain just behind the forehead), these are skills that begin to develop in some form soon after birth, but neuroscientists are now realizing that it takes a full two decades for these skills to fully mature. And for kids with attention disorders, these skills tend to develop even more slowly.

Youngsters who are deficient in these skills, especially when they are seen as having average intelligence, are often viewed by both parents and teachers as chronic underachievers. They have trouble getting started on tasks, get distracted easily, lose papers or assignments, forget to bring home the materials to complete homework or forget to hand homework in. They may rush through work or dawdle, they make careless mistakes that they fail to catch. They don’t know where to begin on long-term assignments, and they put the assignment off until the last minute, in part because they have trouble judging the magnitude of the task and how long it will take to complete it. Their workspaces are disorganized, and teachers may refer to their desks, backpacks, and notebooks as “black holes.”

For better or for worse, the problem is a little more complicated than laziness. But while executive skills do mature over time, they can have a significant impact on school achievement. Fortunately, there are ways to help youngsters develop these skills. In addition, there are ways to modify the environment (such as putting in place systems to ensure that homework gets written down, completed, and handed in on time) to reduce the impact of poor executive functioning.

This is just a brief introduction to executive skills. Those who want to know more can obtain a copy of the book Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention, 2^nd Edition (Dawson & Guare, 2010, published by Guilford Press and available at amazon.com). The authors have also written a book for parents called Smart but Scattered, also published by Guilford.

Peg Dawson, Ed.D. is a psychologist at the Center for Learning and Attention Disorders, a program of Seacoast Mental Health Center, in Portsmouth, New Hampshire.