Smart but Scattered Kids

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.