This is the fourth post in our series about children with ADD/ADHD and supporting our children.  These posts are meant to stimulate your own interest in research and dialogue with your child’s individual educational and health care provider teams, and also to link where I can to current research and current practice in this area, because this can be important in dealing with more mainstream educational and medical models .

Today, we are exploring executive functioning and what this term really means, and how we may strengthen it.  Executive functioning generally refers to a set of cognitive processes that develops and changes over the course of a lifetime of an individual and includes things such as attentional control, inhibitory control, working memory and flexibility in thinking, as well as reasoning, problem solving, and planning ahead.  This is shaped by physical growth and changes in the brain as well as by life experiences.  We often see difficulties with executive functioning in both people with ADD/ADHD, and also in people with addictions.

The sort of normal course of development of these cognitive actions takes place over the lifespan, often in spurts, with growth being particularly marked at the ages of 7-12 months, ages 3-5, ages 8-10 with a spurt around 12 of “goal directed” activities, throughout adolescence with a peak at around age 15 for increased attention to task and an increase in working memory, and then a peak in executive functioning skills in the 20s.  Declines are usually noted around age 70, although I suspect this might be changing with longer life spans.

There are many facets to executive functioning, but here are some varying ideas for areas related to executive functions with possible ways to help your child.  Take what works for you, and use these ideas as possibilities to talk about with your child’s health care and/or educational team.

Working Memory and Recall:  -One study found some teens with ADHD have the working memory of a seven-year old due to executive functioning deficits.  Working memory and recall affects holding facts in your memory and being able to retain them long enough to work with those facts, sequencing of information and getting organized and down on paper, memorizing facts.

• Possible ways to help:  teaching your older children how to visualize things in their mind’s eye (ages 10 plus, I would say); have your child teach you because in order to teach you will remember things better; play games that teach visual memory (ages 6 plus); make up categories to help remember things; connect emotions and senses to teaching methods (and visualizing)

Activation and alertness – Difficulty in activation of a task, staying alert throughout a task to complete it, finishing work – this can stretch over variability in school work during the day and over the week.  Some days are better than others.

• Possible ways to help:  make to do lists; make projects by breaking bigger projects down; give clear instructions; hold a steady rhythm;  manage sleep problems through a sleep specialist or clinic; use as graphic organizer; write ideas down in clusters; use manipulatives since physical activity leads to a higher level of mental alertness; use a timer or chime to indicate it is time to start work; if student is drifting off take a “brain break” with Brain Gym type activities or tap on the desk; fidgeting and chewing gum holds real value for increased alertness

Complex problem solving and difficulties with time management – Students with ADD/ADHD may experience trouble with these areas in learning, especially during the teen years as they need to write, memorize, comprehend reading,do algebra, be organized for deadlines for projects and homework with increased time awareness and planning ahead for the future.

• Possible ways to help:  allow enough time for activities and schedule backwards from due dates or times when you have to be somewhere; practice estimating time; block off time for homework if in traditional school or in homeschooling may need scheduled block of time to finish projects; use weekly or monthly planners; use a master calendar on wall;  work during peak energy times for your child;

Control of Emotions – low tolerance for frustration, emotional blow-ups.  This included difficultly internalizing behavior and difficulty using “self talk” to guide behavior; also usually difficulty in learning from past behavior so misbehavior is often repeated; diminished self-awareness; difficulty inhibiting speech or behavior

• Possible ways to help:  keep track of when blow-ups happen – many times they are around transitions or when there is a personal crisis (in teens this can especially be true); if a child is on medication it can be when the medication wears off and this would need to be addressed with your child’s health care team; teach your child to go and cool off (easier said than done, I know); help your child learn to recognize internal feelings of anger, rage, frustration and have a plan  in place for when those feelings occur – some schools are using a chart with a gauge of frustration to try to teach children with poor emotional control that not every situation demands the same level of frustration or response and then teach cooling off techniques – breathing, exercise, meditation

Please share with me your best strategies for helping executive challenges.  There are executive functioning specialists who do nothing but work with children and teens with these challenges; perhaps if you have a child with these challenges that is struggling there could be hope in an individualized plan from one of these professionals as well.

Many blessings,

Carrie

So our last post was more suggestions from published studies,  ADD/ADHD educational literature and the US Department of Education regarding general support for educational success.  Today we are going to focus on some of the more holistic options and ideas for general support for the child with ADD/ADHD that I have cross-referenced with just a few studies as I could find them.

The list of complementary therapies parents have used to support ADD/ADHD is long and cannot be adequately listed in one post:  elimination diets, avoiding food allergens and food colorings/preservatives, Omega 3 and other supplements, chiropractic work, craniosacral work, Traditional Chinese Medicine, EEG biofeedback therapy, Occupational Therapy , Physical Therapy, massage, yoga, homeopathy, work with naturopathic doctors.  Other things from a Waldorf perspective may include light or color therapy, sound therapy, anthroposophic medicine, therapeutic eurythmy.

Regular lifestyle choices that many parents who read this blog are familiar with but also supportive to children with ADD/ADHD include regular rhythm, simplification in the environment and outside of the home activities, a great diet of outdoor time and sensory play in the outdoors, warm and natural materials for warmth and play, not burdening smaller children with too many choices.  I am sure there are many other options that exist that I have left out.  Please be sure to leave a comment and let me know what you have used in your family if I have.

In just digging around, here is just a tiny sampling of the links to research I have found that you as a parent could share with your health care or educational team for your child or delve into for yourself.  Parents can sometimes end up spending lots of money on therapies for their child; I think that not everything wonderful has studies behind it, but on the other hand it is  nice to see some do and maybe that is a place to start if you have limited funds and want to look into supportive therapies.

Is there a link between ADD/ADHD and Celiac Disease?

Omega-3 and Zinc Supplementation; the role of zinc 

Case study of chiropractic care and another case study here.  A 2010 systematic review.

EEG Biofeedback (there are many studies out there; this is well-researched.) Here is an example of one study; some studies include only children or teens on Ritalin, so look through and see the study criteria when you look at a study.

Traditional Chinese Medicine efficacy versus Ritalin; meta analysis of acupuncture and its affect on AD/HD

The relationship between Obstructive Sleep Apnea and  AD/HD; outcomes after surgery

Yoga and ADD/ADHD

This is just a tiny, tiny tip of the research out there. I urge you to go onto PubMed’s website and search for yourself under these topics to see what is out there.  Please share with me what complementary choices or lifestyle choices your family has made that you felt had the greatest impact and success for your child with ADD/ADHD.

Blessings,
Carrie

(The suggestions in this post are more being pulled from research and mainstream literature and really geared more toward a traditional, not homeschooling, environment – although some of these ideas could work quite well there.  They do not represent my independent total ideas of general suggestions, which would include more holistic options as well. However, I feel it is extremely important that parents know what mainstream health care professionals are saying, what research is saying, because if a child is in a traditional school setting particularly I think parents need to have familiarity with what is out there from this perspective.  There are more posts to come in this series in which I hope to detail some other suggestions for teaching)

In our last post, we looked at the neurobiologic differences of children who have ADD/ADHD compared to children who don’t.  However, this often leads to the inevitable question of how to best help children who are experiencing these challenges.  The work of the family due to children who have ADD/ADHD and its often related co-morbidities are real.    And, although not all readers who read this blog homeschool, I think it can feel very difficult in the beginning for the homeschooling parent who is teaching a child with ADD/ADHD where it feels like finding all the answers are on their shoulders.

Here are a few things I would think about regarding teaching and support in general.  Some of these are ideas borne out in studies, some are ideas that parents of children with ADD/ADHD have told me were helpful over the years, and some of my own ideas based on the children I have worked with when I was an actively practicing pediatric physical therapist.

Some very general things:

Exercise – Exercise improves learning in general for all children, and especially  for children with attentional deficits, exercise helps increase neurotransmitter activity.  Here is an example of one study regarding exercise and boys with ADD/ADHD.  Here is one meta-analysis  on this subject from February of 2016.  There is some evidence that exercise in nature is particularly wonderful.

Positive strengths – making a list of your child or student’s positive traits is so important.  It can carry a parent through hard times, it can help to have something to say when a child with ADD/ADHD suffers with low self-esteem or feels rejected socially, and it gives a teacher a place to draw from in teaching.

According to this document regarding teaching children with ADD/ADHD from the U.S. Department of Education, it is important to assess exactly how, when, and why the child becomes inattentive or disruptive.  Then the teacher can make up a strategy based upon academic teaching, behavior management, and accommodations.

Some general strategies could include:

Older children and teens in the classroom or a noisy environment can use noise cancelling headphones for working or use white noise.  Here is a study from March of 2016 talking about this issue.

Movement can be incorporated by teachers.  Teachers in schools and in homeschools can design their teaching  to have “Brain Breaks” and get up and move every 20 minutes or so.  Brain breaks in the classroom can include any number of activities, but true physical therapy may be needed to deal with increased motor issues, as many children with ADD/ADHD do have motor challenges.

This recent meta-analysis shows that to decrease disruptive behavior during school, consequences and self-regulation techniques provide the best effects (but what “consequences” were used or what self-regulation techniques were used were not specifically explored).

“High Interest” teaching strategies are important – because children and teens with ADD/ADHD have reduced dopamine receptions and transporters in the area of the brain that is involved with reward and motivation, high interest subjects help improve academic performance.  Students with ADD/ADHD often do not learn well with just visual or auditory input – they often need a more hands-on style with visual cueing.

Understand that learning is DEVELOPMENTAL.  If a child or teenager with ADD/ADHD has delayed neurobiologic brain maturation, he or she will not have the learning or memory capacity of students of the same age.  (This is where structural maturation CAN impact function).   Working memory for student with ADD/ADHD, even a teenager, may be limited to about five items or fewer.  So, a lesson in which the student is supposed to remember ten things will not be learned in one lesson.

For children with ADD/ADHD, if you are the teacher, you must be very clear as to your objectives in learning.  This seems to really help children with ADD/ADHD.

As a teacher, you can orally ask questions as you go along and point to visual cues to help assist in answering.  In public schools, some of the methods being used include the teacher giving the student a copy of lecture notes to the student in outline form with key points marked to help the student, or to provide skeletal outlines to provide compensation for poor working memory.  Reducing notetaking for teens is important.

Showing sample completed projects or pages helps.  Reduced written work should be expected.  Having an older child or teen  write the correct answer only or fill in blank often works better than having a child try to write full essays or summaries.

Quality over quantity.  Pick your assignments for your child carefully.

These are general suggestions.  I hope to address helping with language arts and math in future posts to help parents and homeschooling parents.

Blessings,

Carrie