By: Madeline Kaleel

Sometimes referred to as cognitive controls, executive functions are mental processes that allow for the control of behavior. These controls range from basic to higher order, with higher order executive functioning requiring the use of two or more of the basic skills. Basic executive functions include attentional control (concentration), inhibitory control (self-control), working memory, and cognitive flexibility. Higher order executive functions, such as planning, organization, and fluid intelligence, require an individual to use multiple basic executive functions simultaneously. Sometimes described as “the CEO of the brain”, these functions allow us to set goals, organize, self-monitor, and overall get things done.

We aren’t born with these abilities, however. Executive functions are something that gradually develop and change over time, and they can be improved on at any point in your life. While growth in these areas typically comes about naturally through aging and experience, those with executive functioning issues may find one or more of these basic functions challenging. Executive functioning issues are not a diagnosis in and of itself, but it’s a common problem for those diagnosed with ADHD, a specific learning disability, or other learning and attention issues.

So how can I tell if my child is struggling with executive functioning?

Executive functioning issues present themselves different in each person. Kids may struggle with only one or two of the functions, while others may find all areas difficult. Similarly, different issues will present themselves at different points in life; the functions that a kid in elementary school struggles with are different than ones a high-schooler. Here are some possible signs that kids struggling with executive functioning may present:
 

• Difficult starting and/or completing tasks
• Quickly forget information they’ve been told or have read
• Difficulty switching tasks or following directions
• Become overly emotional and fixate easily
• Inability to manage time
• Unorganized, messy desk or backpack
• Have trouble planning or keeping track of assignments
• Panic when rules or routines change

 
My child shows one or more of these signs, how can I help?
 
There are countless online resources and activities that you can use to help your child improve their executive functioning skills and succeed in life and school. It’s important to work with your child and learn which areas they need to focus on and what best helps them. If your child needs extra help, it could be beneficial to enroll them in courses or psycho-educational group to get more in-depth training and attention. 
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​By Emily Kircher-Morris, LPC

​A child keeps kicking his brother's car seat, even after his mom has asked him to stop.

The class clown keeps interrupting the teacher with off-topic and mildly inappropriate comments.

A preteen girl crumples her homework and dramatically hides her face in her arms on her desk.

A young boy has a meltdown because he is told they are having cookies instead of ice cream for dessert.

When trying to figure out what is behind these problematic behaviors, parents and teachers may come to the conclusion the child is engaged in negative attention-seeking. They come to the conclusion that the best response is to ignore or give a negative consequence for the behavior.

Many people feel that attention-seeking behavior is a negative trait. The attention the child is seeking is unearned and the result of a child being overly emotional and dramatic. The reaction may be to ignore the behavior or even give a negative consequence to the child.

I'd like to suggest a different way to look at attention-seeking behavior. If we consider all behavior to be communication and ask ourselves, "What is the child needing from this interaction?" we may find some ideas of how to handle the behavior.

Let's reframe attention-seeking as reassurance-seeking. 

Their behavior is saying:
Am I alone? Do you love me? Am I worthwhile? Even if I act this way, will you stick with me?

We all need attention once in a while. We may seek it in positive ways, through accomplishments and helping others. The reassurance we get from those acknowledging us can keep us going. Sometimes kids don't have the language or emotional regulation skills to get their needs met in the most convenient way for us.

But, when we remind ourselves the attention-seeking is really reassurance-seeking, we build our relationship with the child and can help them learn more appropriate ways to seek that reassurance from us in the future.

By Karen Gniadek, PLPC

I clearly remember the day my daughter came home from school with a letter informing me that she had qualified for reading intervention. I was shocked and felt like a failure as a mother. After all, I was a stay-at-home mom and former special education teacher. I thought I had done everything right to set her up for success: I read to her from before birth on, took her on weekly trips to the library, exposed her educationally enriching experiences, and fostered her interests. How could this be happening?!
    
After only the first semester of first grade in reading intervention, my daughter’s teacher assured me that she had caught up and was working on grade level. And she did remain near grade level reading throughout school, yet I knew there were areas in which she was still struggling, including: memorizing math facts; spelling, reading out loud, test anxiety, and memorizing facts associated with history or science. I will admit that I often lacked compassion when working with her at home. I wanted to be patient and supportive, but was frustrated when couldn’t she recognize that a word she read two sentences before was the same word she was seeing now or that 6 x 8 = 48 (for goodness sake it rhymes). FYI - rhyming is something that dyslexics often struggle with.

The answer lies in dyslexia. The truth is that many parents and children do not realize that it is impacting them. Oftentimes, people develop compensatory skills which hide their weaknesses.

Dyslexia is defined as a learning disability in reading that is neurobiological in origin and affects phonetic (letter sound) recognition, word decoding, and spelling. In short, students will be disfluent readers who have difficulty applying the strategies necessary to sound out words. There is much more to dyslexia, but I will go into this more in another blog. It is estimated that 20% of the overall population has dyslexia at some level. Like most brain differences, the severity of dyslexia symptoms spans a continuum from mild to severe. Those most severely impacted are often identified in school and helped via the IEP or 504 process. Those moderately to mildly impacted oftentimes go undiagnosed and unserved. It is these students for whom the new Missouri dyslexia law hopes to help.
    
The law went into effect this school year, 2018-2019. It has three major components. The first component requires districts to screen all students in grades kindergarten through three for dyslexia. Students who via the screening are found to have delays in reading possibly related to dyslexia will be monitored for reading growth and should receive “reasonable accommodations” in the classroom. The final component mandates that all teachers receive two hours of professional development about dyslexia.
    
Notably missing from the law is a requirement for schools to offer specific dyslexia reading interventions. With that said, the final recommendations of the task force tasked with developing recommendations on how districts should implement this law put forth numerous recommendations on the best types of instruction to remediate those students fitting a dyslexic profile. The final recommendations of this task force were completed in October 2017 and can be found on Missouri’s Department of Elementary and Secondary Education’s website. Districts have the freedom to choose which screening devices to use, who should screen the students, and how to accommodate and/or remediate students flagged as demonstrating characteristics of a reader struggling due to dyslexia.
    
What, then, is a parent or caregiver to do?

1. Be vigilant to information your district and local school will be sending home about dyslexia screening and results during the first quarter of this school year.
2. Keep in mind that a child who fails the initial screening is not diagnosed with dyslexia, he/she is simply making errors that indicate possible dyslexia.
3. Ask questions if your child is one that does not pass the screening. Again, schools should be publishing information to help parents understand the process, but kindly ask those in charge if you are confused.
4. Be aware that the law recommends that students initially found at risk for dyslexia may get more targeted follow-up assessment. Targeted follow-up assessment gives more detailed information and can be used to assess a child’s progress and response to any intervention given.
5. The results of this type of assessment can also help parents and teachers figure out what sort of accommodations may be helpful to the child. Concerned caregivers should educate themselves by reviewing the specifics of the law on the above mentioned DESE website. Parents can also explore websites sponsored by dyslexia experts such as Susan Barton’s Bright Solutions for Dyslexia, the International Dyslexia Association or Decoding Dyslexia Missouri.
6. Lastly, please be patient with your school and their staff. This is law and its requirements are new to all involved. There is sure to be confusion as it is implemented. ​

For information about how Unlimited Potential can conduct further assessments to determine the presence of dyslexia, please call our office.
Karen Gniadek is under the clinical supervision of Andrea Schramm, LPC (MO #2013041567)

By Emily Kircher-Morris, LPC

Because I work with many high-ability, gifted, and twice-exceptional individuals in my practice, I've noticed an interesting pattern with some of my clients. The story follows a specific path: A bright child was diagnosed with ADHD at a young age. Medication after medication had minimal benefit; often the parents abandoned medication altogether. As the child gets older, their lagging social skills cause more and more problems with friends and at school. We finally determine the appropriate diagnosis of Asperger's Disorder has been missed.

Many children compensate well for social struggles and concerns may go unnoticed by parents and educators. If the child is gifted, asynchronous development explains many of the quirks the child may show. However, one would expect that as the bright, quirky, asynchronous child grows older, some skills (such as the ability to meet typical social expectations) would balance out. However, the DSM-V says that for a diagnosis of Autism Spectrum Disorder, symptoms may not fully manifest until social demands exceed the abilities of the individual. When a child's struggles increase with age instead of balancing out, a diagnosis of Autism Spectrum Disorder (ASD)/Asperger's should be considered.

So, why are these kids given an ADHD diagnosis instead of ASD? A close look at the symptoms of ADHD through the lens of Asperger's can help understand how this misdiagnosis can be made:

• Inattentiveness - A classic symptom of ADHD is the inability to focus and pay attention. A child with ASD may indeed look like he or she can't pay attention. However, is this inattentiveness better explained by a lack of understanding of the social expectations to focus in certain situations? Is the child only motivated to engage when the topic is within his or her area of interest?
• Impulsiveness - Another symptom that leads to a diagnosis of ADHD is impulsive behavior. Again, when examined through the lens of ASD, impulsive behavior could be explained by a inability to understand the norms of typical reciprocal conversation and manifest as verbally interrupting conversations. There are social norms and hidden rules in game play and other interactions that a child with Asperger's doesn't interpret; his or her behavior can look impulsive. Intense emotions and "meltdowns" associated with ASD may also be written off as the impulsive behavior of ADHD.
• Hyperactivity - Constant movement, bouncing, or pacing could easily be more directly related to a sensory need or stimming behavior instead of true hyperactivity. Hyperactivity can also present as a need to talk constantly; a child or teen with ASD may talk about his or her areas of interest without pausing for feedback due to difficulty understanding the social rules of reciprocal conversation.

Parents, educators, and medical/mental health professionals need to be aware of the overlap of behaviors between these two diagnoses. If medications don't seem to make a difference for ADHD, it may be beneficial to consider the presence of ASD. If social skills seem to be regressing as a child enters late elementary, middle, or high school instead of balancing out, taking a look for Asperger's could help. And finally, considering each of the behaviors that was originally explained by ADHD, and whether the motivation for the behavior is better explained by traits of ASD, can help find an accurate diagnosis. 

While any mental health diagnosis for a child can be overwhelming, accurately identifying the cause of problematic behaviors allows for proactive interventions to be implemented earlier and with better efficacy.

By Emily Kircher-Morris, LPC

'Tis the season to rack your brain for gift ideas for some of those hard-to-buy-for family and friends. One of the hardest among these is your child's teacher. As parents, we don't really always know the teachers personally enough to get them something they really want. So goes the annual search for a gift that is unique (yet general enough that any teacher would like it) and in the right price range (somewhere between $5 Starbucks gift card and a full spa day).

I used to be a teacher and a school counselor. Gift cards are always easy and appreciated but sometimes feel impersonal. Snacks are hard because some teachers don't eat gluten or sugar or coffee or chocolate (What????). Knick knacks and ornaments are tough because, eventually, there just isn't enough space to keep them.

So - don't spill the beans to my kids' teachers yet - but here is what they are getting for Christmas this year: I'm giving each of them a gift basket filled with fidgets for their classrooms.

Research is showing that more and more students learn better when their psychomotor needs are met. Especially for children with ADHD and other sensory needs, a small, unobtrusive fidget actually can help them focus better than without because it stimulates the small portion of the brain that needs a distraction so the other 95% of the brain can focus on the lesson. Adults need this, too; when I provide professional development, I bring baskets of fidgets, Play-Doh, markers, and candy to fill that sensorimotor need.

Now, don't worry. I'm not going to stockpile my child's classroom with a full set of fidget spinners. (I know teachers who've had nightmares about out-of-control fidget spinner mutinies in their classrooms!) When I *teach* kids how to use fidgets appropriately (yes, kids need to be taught how to use fidgets to improve their focus), we have a few rules. The fidget cannot distract others, either visually or by making noise, and the person using the fidget needs to be able to maintain eye contact with the person who is speaking or teaching the lesson.

Here are some of my favorite fidgets that I'll be giving my kids' teachers this holiday season. I've bought and tried all of these items and have them at my home and office. 

These little tangles are a classic fidget that kids love. They twist and coil and wrap. The one downside is that some kids like to pull them apart and put them back together, which can be distracting in the classroom.

This is perfect for those kids who are always tipping their chairs. Simply wrap this exercise style band around the bottom two legs of a classroom chair for kids to use for counter pressure for their legs. Bonus: It won't result in falling over backwards!

Fun little fidget rings roll up and down a thumb or finger with minimal distraction or noise. They provide some pressure - kind of like a little massage for your finger!​

File this under "Why Didn't I Think of That?" This little mesh tube that kind of looks like a little Chinese finger trap has a marble trapped inside. Squeeze the marble back and forth to engage kids without distracting others.

Another style of fidget ring, instead of rolling vertically on the finger, it rolls around the finger. The smooth roll this fidget provides is surprisingly calming and satisfying. Again, it is small and won't be distracting to other kids!

Another great option for the child who has a hard time staying still in his or her seat. These wobble seats take just enough effort for kids to stay stabilized so their wiggling isn't a distraction to themselves or others.