Effective Tools for Managing Deficits in Executive Functioning
Based on Barkley, R. (2016) Managing ADHD in School: The Best Evidence-Based Methods for Teachers. The Guildford Press
Help Students to Externalize Information
Rationale: Many students struggle with Active Working Memory. This is the form of memory used to hold mental information in the mind. Students who have poor Active Working Memory may appear to have comprehension issues, have difficulty using prior information to make inferences, or struggle with the step-by-step processes of math. As the demand for effective Active Working Memory increases over time in school, many students find themselves struggling as they transition into middle school, and from middle to high school.
Intervention: Help students by externalizing information that would otherwise be internal. Provide physical representations such as lists or cheat sheets. Use verbal cues or prompts. Teach students to utilize technology such as digital recordings or reminders.
Make Problem-Solving Manual
Rationale: Mental problem solving can be difficult as many students with Executive Function Deficits have poor Active Working Memories and therefore struggle to hold information in their minds.
Intervention: Make the problem or parts of the problem physical by using manipulatives in math and science (such as marbles, number line, abacus, etc.), by outlining steps to tasks on index cards or in documents with bulleted points, by creating booklets or electronic cheat-sheets of formulas or rules, and by using mnemonics (e.g COPS for editing written work).
Externally Represent or Remove Gaps in Time
Rationale: Students who struggle with Executive Functions are unable to monitor time. Accordingly Russell Barkley, students with ADHD have two time zones: Now and NOT now! This deficit impacts the students’ ability to estimate time (how long it will take to complete an assignment), to plan across time (break assignments down into smaller components and start components in a timely manner), and to delay gratification. Students have “little regard for future events…their behavior is driven by the desire to maximize immediate rewards, and escape from immediate hardships or aversive circumstance without concern for the delayed consequences of those actions” (Barkley, 20).
Intervention: Represent time externally by using clocks, timers, watches, etc. Break down long-term events or assignments into smaller components with specific deadlines, and hold students accountable for each deadline. Remove gaps in time by providing immediate consequences and rewards over short periods of time.
Rationale: Students who struggle with Executive Functions are simply unable to motivate internally in order to achieve a goal (even if the goal is desirable). This inability to self-motivate is often characterized as ‘laziness’ – which implies a moral judgment – as it is difficult for those who are able to motivate to understand this very real struggle.
Intervention: Provide externals sources of motivation such as token systems with immediate rewards or consequences in school or at home. Barkley draws an analogy between these artificial reward programs (which he calls “motivational prosthetics”) and prosthetic devices used by the physically disabled, as they both allow students to perform more effectively in some tasks and settings. In order for reward programs to be effective, they must be consistently implemented over long periods of time, must provide frequent opportunities for reinforcement (e.g. daily monitoring), and must provide meaningful rewards at the point of performance.
Intervene at the Point of Performance in Natural Settings
Rationale: The Point of Performance is the “natural setting where the problem exists” (Barkley, 23). For example, it is more helpful to teach how to externalize information or how to study effectively and efficiently through authentic work (classwork and homework) during school than to teach the skills in isolation during a study skills summer program, or to talk about how to study effectively with a therapist.
Interventions: Teacher-parent-coach-tutor collaboration is essential so that the interventions that are implemented can be shared, consistently reinforced and appropriately adapted for all the ‘points of performance’ (classroom, home, soccer field, Sunday School, etc.)
Approach ADHD and Its Executive Function Deficits as a Chronic Condition
Rationale: According to Barkley, “the approach taken to managing ADHD should be the same as the approach taken to manage other chronic medical or psychiatric conditions such as diabetes” (23). There is no ‘cure’ for ADHD, but there are changes and interventions that can be implemented that can alleviate some of the challenges faced daily by students with Executive Function Deficits and their families.
Interventions: One intervention that is highly effective for many students is medication (see ‘ADHD Myth’ tab for more information on medications). It is also possible to change settings (such as schools, or where homework is completed), tasks (if possible, choose tasks that match preferred learning styles or modes of expression) and lifestyle (exercise consistently, schedule short breaks between tasks, develop a positive sleep routine, etc.). Education about ADHD and Executive Function Deficits should be a key component of the treatment plan for both the student and the family. And keeping a long-term perspective is key. There is no quick fix for Executive Function Deficits, so any treatment plan needs to implemented over time and modified as the student’s brain develops, and needs or contexts change.