lunedì 24 luglio 2017

Executive functions and ADHD by Salvatore Sasso

If a child has a diagnosis of ADHD, or whether it is going for him an evaluation for ADHD, or even if as technicians are doing a study of the literature on the subject, you might encounter with a statement regarding the presence at the same time, problems with executive functioning. This can be confusing!
They seem to be two different ways to describe child difficulties.
In a nutshell, the executive functions are self-regulating abilities. All of us use every day in the execution of our actions as, for example, plan ahead, to be organized, the solve problems and focus on what is important. These are some of the skills that children with ADHD have difficulty putting into practice. So there is a difference between matters of executive functioning and ADHD? And if so, what is?
ADHD is a disorder that is defined by three major series of behaviors or symptoms: inattention, impulsivity and hyperactivity. Children with ADHD have difficulty in operationalizing, using the attention, following directions, sitting quietly and waiting for their turn.
The children diagnosed with ADHD, if they demonstrate these symptoms more often than other children their age, will have difficulty both at school and in life everyday.
The executive functions, on the other hand, are very specific ways through which the brain functions. This means that variables such as inattention and impulsivity are divided into more distinct skills that children usually develop during childhood and adolescence.

There are many individual features, which fit into these areas:
• Planning;
• The organization;
• The establishment of priorities;
• The transition between the situations or thoughts;
• The control of their emotions and 'impulsivity;
• L 'use of working memory;
• Monitoring towards themselves in being able to keep track of how you are working (level - meta ).
Scholars point out that the issues relating to executive functions can be seen in two different fields. In the first place, may be observed in the behavior of a child facing outside; secondly, they affect the inside of children, in the way they think and learn. Let's look at each of them separately analyzed:
a) Mode externalizing
• Being disorganized;
• Losing continually of its objects;
• Having difficulty in time management;
• Being unable to finish a task;
• Being unable to make a plan and put it into practice;

b) Conditions internalizing
• Owning the difficulty of deciding what is important / unimportant when reading or listening;
• Have problems in absorbing / retain what is taught at school;
• Have trouble understanding and following verbal directions ;
• Having trouble organizing thoughts;
• Having problems with writing clear and organized;
Many kids who have ADHD are not confronted with the difficulties arising from concerns with executive functions. But it is also possible that a child has problems with executive functioning without ADHD
( Brown, T., 2000, Attention deficit disorders and comorbidities in children, adolescents, and adults , Washington, DC: American Psychiatric Press)
How can this information help the child?
First, the understanding if the child has problems with executive functioning may make it easier to search for adequate help through a "support" more effective.
Secondly, experts in executive functioning have developed tests and questionnaires to measure how much  a child can  make good use of the specific functions. These measures allow them to identify where he needs more assistance. Knowing all this puts teachers can organize in class more focused aid.
It is also possible the intervention of a specialist of learning disabilities that can teach you how to compensate for areas of weakness. Children with impaired executive functioning often need to create routines and use special techniques to do tasks that other guys play without thinking. A detailed analysis also allows you to identify areas in which a child is stronger, so that he may learn to better use its strengths to compensate for the weaker ones.
In some cases, know more about the executive functions can also give a deeper understanding of the diagnosis of ADHD in a child. Indeed, the application of the concept of executive functioning just for ADHD can improve the treatment of each individual child, making the objectives of intervention even more specific through a better understanding and management of the strengths and weaknesses.
Regarding the use of medication in ADHD, research clearly shows that their use reduces symptoms of inattention and impulsivity, while a child is taking medication. Clinical experience also shows that many children with ADHD, despite taking medication, they still need to be supported to manage their problems of executive functioning. In this way, they can prove to be competent both at school and in other extracurricular areas.
With this extra support -insegnamento / learning of metacognitive strategies (see for example the Meta lab of #Cad Skole), children can outsource what they are capable do.

The development of executive functions in children
According to Welsh, Pennigton and Groisser (Welsh MC, Pennington BF, Groisser DB, 1991 A normative developmental study of executive function: A window on prefrontal function in children. Developmental Neuropsychology , 7: 131-149), executive functions evolve in three phases and their development would not be complete before puberty. In the first stage, up to six years, children reach performance levels equal to those of adults in visual search tasks and planning simple; in the second, up to eleven, they develop the ability to schedule more complex; while in the third, that is, from puberty onwards, develop skills verification, assumptions and control of perseveration and impulsiveness.
During the first six years of life the memory function and procedures are carried out in verbal form, so externalized. During the primary school, the self-directed speech is internalized and develop those skills level - half that allow self-monitoring and self-regulation of attentional processes and their motivations. Through the acquisition of these skills, children learn to finally break down the observed behaviors into their individual components and reassemble them into new shares, which are not part of its experience (reconstruction). This allows, in the course of growth, to control their own work for longer and longer periods of time and to plan their behavior in order to achieve the aim (Zuddas, A., G. Masi, 2002 Lines SINPIA guide ).

According to Stephanie Carlson (Carlson S. et al., The development of executive function in early childhood , Boston, Blackwell Publishing, 2003), the opportunity for the child in the first year of life to form categories of events and sequences, as well as to detect the predictive character of some relationships between events, the basic structure of behaviors that gradually become more targeted and monitored, so that, if the characteristic of children from one to three years is the lack of control of voluntary modulation and emotional, this capacity increases sharply preschool. The ability to control allows you to take advantage of the emotional scaffolding environment for the success in the tasks of problem solving and the ability of symbolization and the internal language are integrated simultaneously in executive development. The same Carlson states, in fact, that children of four to five years, which are capable of activating behavior inhibition in situations where they are required, are also skilled in the understanding of their and others' feelings as a guide in action.
Both levels, cognitive and emotional in the sense of self-regulation as the motivation, help to define the efficiency of executive skills.
Between two and four years of age is detected, in the prefrontal cortex, a significant increase in metabolic activity and synaptic connections. This development coincides with the increase in working memory, inhibitory control, the budgeting skills and social behaviors that are based on these traits. The neuronal density does not decrease up to seven years of age and it is during this period of maximum plasticity that the higher cognitive processes are particularly influenced by the experience (Barkley, RA, 1997  Defiant Children: A Clinician's Manual for Assessment and Parent Training , New York: Guilford Press (800-365-7006;
Among the tests suitable for the detection of Executive Functions are reports the BVN (Erickson, Italy - there is just a german version) in the two versions 5-11 (children) and 12-18 (boys). The BVN is a battery of tests for the neuropsychological assessment of the main cognitive functions (language, visual perception, memory, praxis, attention, executive functions above, reading, writing and arithmetic).

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