The transition from relaxing summer to a fixed school schedule can be difficult, especially for kids with executive functioning challenges. With increasing demands, students need to plan more and procrastinate less. You may be wondering what you can do to make this transition smoother for your kids. We have some tips!
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Like most areas of mental health, neuropsychologists seem to have experienced an uptick in the number of people seeking services in the last year. I think one of the reasons is that the pandemic and related issues have stressed our executive functions. Executive functions are higher order functions that are generally associated with the frontal lobe of the brain, an area that continues to develop well into our 20’s. Executive functioning includes planning and organizing, task initiation, task completion, working memory, and inhibiting impulses. In short, executive functioning skills underlie our ability to achieve at work and at school. There seem to be two main ways that the pandemic has affected executive functioning. First of all, the pandemic has globally increased stress and anxiety. When we feel stressed, our executive functioning breaks down. Think of a time that you felt extremely anxious and overwhelmed. I bet everyday tasks seemed daunting and overwhelming. One example I like to share with patients is my personal experience at the beginning of the pandemic. Prior to March 2020, when I left my house, I had a list of essentials items that I would repeat to myself, “Keys, wallet, phone.” This is my executive functioning skills ensuring that I did not forget these essential items. All of a sudden, this list evolved into, “Keys, wallet, phone, Clorox wipes, mask, hand sanitizer.” The very act of needing to wear a mask and having Clorox wipes in my car increased my level of anxiety. I was so focused on needing these new items that there were many times in April and May 2020 that I left my house with Clorox wipes and a mask but without my keys or phone. Secondly, without much warning, the pandemic shifted the way that we worked and attended school. The physical setting of a workplace or school adds structure that supports our executive functioning. For example, there are built in times in high schoolers’ days to go to their locker and switch out materials for class. An elementary student who spaced out when directions were given and is now unclear about what materials are needed for a science project, can look around the classroom and see what his neighbors are doing. Your workday had more structure to it, with physical meeting times, and maybe even a scheduled lunch break. Suddenly, these external structures were no longer in place. Even some of the strategies we used independently were no long relevant or helpful. Without these strategies and structure, many people who have inherent executive functioning difficulties have really struggled. In short, the pandemic has shed light on difficulties that people were previously able to manage independently. A neuropsychological evaluation can help pinpoint and quantify these difficulties, identify the etiology of these struggles (something like anxiety versus ADHD), and identify recommendations to help you or your child. This will be particularly important as we return to a modified version of in-person learning or work.
A frequently asked question that I get is to explain the difference between a private neuropsychological evaluation and a school evaluation. There are several differences, including expertise of evaluators and diagnostic considerations. Both types of evaluations can be instrumental in ensuring that your child gets the accommodations and support necessary to meet his or her individual needs. School evaluations are conducted by the special education department of your school district and are generally completed once a parent requests a full evaluation. A school evaluation has many parts, based on the presenting issue. The parts vary by school district, but generally a school psychologist will conduct a psychological portion, a special educator will conduct the educational portion, a speech and language pathologist will conduct a speech and language evaluation (if applicable), an occupational therapist will conduct an occupational therapy evaluation (if applicable), and a physical therapist will conduct a physical therapy evaluation (if applicable). Other types of evaluations may also be completed by different specialists, such as a home evaluation or functional behavioral analysis. Each evaluator has specialized training in his or her specific field. The purpose of the school evaluation is to identify any issues that impact the student’s ability to access school curricula. “Again, this varies district to district, but most districts in Massachusetts will not provide an emotional or neuropsychological diagnosis, such as anxiety, depression, ADHD, or autism. A school evaluation may be sufficient if the presenting issue is primarily academic or specific to one of these specialized areas (speech, occupational therapy, physical therapy).” The pitfall of school evaluations One pitfall of school evaluations is that typically if a child scores in the Average range on a given measure, he/she is seen as able to access the curricula, and often does not qualify for services. A private neuropsychological evaluation will consist of one evaluator who looks at most areas a school evaluation will look at. A neuropsychologist will also be able to look more in depth at certain areas and be able to tailor the evaluation to your child’s needs. A neuropsychologist will provide a diagnosis (if relevant), which may help make a case for school accommodations. Additionally, neuropsychologists will make specific recommendations to support a child’s functioning outside of school. If you are concerned that your child may have a diagnosis, such as ADHD, autism, or an emotional disorder, a private evaluation will give you the most information.
Probably the most frequently asked question when I was doing family therapy was, “How do I make my kid STOP doing something.” Research shows that positive reinforcement is the best way to make lasting behavior changes, not punishment. This means that you need to rethink things and concentrate on the behavior you want to increase, not the behavior that you need to stop. For example, a few weeks before quarantine started, my daughter started being mean to my son (hitting, grabbing toys, etc.). Instead of working on STOPPING that behavior, we worked on increasing the number of times that she was kind to him (although dangerous behaviors like hitting were addressed with a time out). To do this we used the positive behavior jar technique. She earned a jelly bean in a jar every time we saw her doing something kind to her brother, with the promise of a present when the jar was full. It could be sharing, giving him a hug, anything. Soon enough, she started looking for ways to earn jelly beans and their relationship shifted. Gradually, we phased out the jelly beans but she was still nice to him. “Why does this work? You are reinforcing the behavior you want to increase in two ways. First, you are giving external rewards with the jelly bean and with your praise. Eventually, most children also develop an intrinsic sense of accomplishment, first for earning the reward, and eventually for mastering something.” Once that is fully developed you can remove the external reward. It also works because it changes your mindset. Instead of looking for negative behaviors you watch for positive ones. it’s not bribery, it’s positive reinforcement. The biggest roadblock I see is the parent’s reluctance. I can’t tell you how many times I’ve heard, “I don’t want to bribe my child.” Remember, it’s not bribery, it’s positive reinforcement. Ok, it’s a little bit of bribery but we all do this all the time. Did you wait to relax after bedtime until the kitchen was clean? Or did you hold off on buying that new gadget until you completed that big project at work? You are positively reinforcing yourself! When introducing any new plan like this to your child, it is so important that you are excited about it. It’s so important that I will say it again. Be enthusiastic when you introduce it! Make them feel that this is something special that they GET to do. Better yet, create some buy in by getting the child to help by decorating the jar or chart, and identifying special rewards.
5 ultimate tips for helping your child with ADHD succeed both at school and at home. Trouble paying attention, easily distracted, acting impulsively. We, as a society, commonly think of these as negative characteristics that lead to failure at school; yet, they are also attributes of many children with ADHD. ADHD (attention deficit/hyperactivity disorder) is one of the most common neurodevelopmental disorders of childhood. In fact, around 6.1 million children in the US were diagnosed with ADHD in 2016. So, are we saying that 6.1 million children in the US are doomed to fail at school? No, of course not! Now I’m not denying that there are special challenges that children with ADHD will face at school. Research does suggest that children with ADHD are more likely to need tutoring and receive lower test marks. Therefore, as a parent or teacher of a child with ADHD, their performance at school is definitely a reasonable concern. First things first, it is most important to remember that helping children with ADHD is not about getting them to try harder. While it may be tempting, it’s actually quite counter-productive to push them to try harder to concentrate or stop getting distracted. Rather, it is about providing them with a supportive environment and appropriate accommodations for them to succeed. So, here are a few steps you (as a parent or teacher) can take to help accomplish this. 1. Get a proper diagnosis This might seem obvious to some, but it’s a step that is sometimes overlooked. Lack of treatment is a major consequence of not receiving a diagnosis. Behavior therapy provided by specialists or medication can be extremely helpful and is only possible with an ADHD diagnosis. In order to be diagnosed, one must be evaluated by a medical professional at a neuropsychological testing center, much like our very own Newton Neuropsychology Group. A medical professional will not only be able provide you with an accurate diagnosis, but also provide any medications or suggestions for cognitive-behavioral therapy . 2. Work as a team Parents, the school administration, and teachers are all essential components in creating a supportive environment for the child. Parents are vital in providing information about their child’s needs and goals to the school. This is fundamental in ensuring that all important adults in the child’s life have context and information. In turn, the school may be able to place the child with teachers that fit their learning style. Teachers can also adjust their help by minimizing distractions in the classroom. Some examples include seating them at the front of the classroom, away from windows and doors. Teachers can also observe specific behaviors in the classroom that they can communicate with the parents. "Helping children with ADHD is not about getting them to try harder...it is about providing them with a supportive environment and appropriate accommodations for them to succeed."