Identifying and addressing executive function problems in your child

A Q&A with Dr. Tarnow

Jay Tarnow, M.D., is the founder and director of the Tarnow Center for Self Management based in Houston. He has been treating children and adults with attention deficits and learning disorders for more than 30 years.

How do executive function problems affect children?
The development of executive functioning occurs throughout a child’s life. The aspects of dysfunction that you see in ADHD and kids with attention problems are that these kids as adolescents and adults have problems with prioritizing, organizing, and being able to keep track of their things. They lose things. They have difficulty with time management. They have difficulty in controlling and managing their emotions.

When are parents likely to observe executive function problems in kids?
A problem I see occurring very often, especially with children who are just put on medication, is that when they reach middle school or high school, the expectations from schools change. The students are expected to be able to manage themselves better and carry out a higher level of executive functioning, like organizing and prioritizing their work and then being able to hand it in to the teacher.

We see a lot of kids who are very, very bright, who never had any training and experience in executive functioning, who come to us at middle school, and they can’t function. The same is true of high school students and in some cases—when a child is really intelligent—this can happen in college. We have a number of groups of kids who have failed out of college because they were not able to manage themselves. What they depended on was their parents to manage them, and they were not able to be independent.

What can parents do to address executive function problems?
Parents need to know that giving medicine to kids does no good unless they’re also helping that child improve his or her self-management skills. Otherwise you’re just putting a band aid on the problem, but you are not dealing with the underlying dysfunction difficulty and the mental disorder.

Parents need to really create an environment of teaching children self-management skills and reinforcing them. It’s not a matter of managing the child—which is what most people do—but rather teaching the child self-management skills, and then reinforce those skills, and reinforcing the process of carrying out those skills.

When this happens it makes children have better self-esteem, because they feel competent, which is the biggest problem that these children have. And it makes them feel more functional in terms of creating very important self-management skills.

How does Cogmed working memory training affect executive function?
Cogmed is important to improve working memory—a critical component of executive function. What I hear from the parents, children and adolescents who have gone through working memory training is: “I am better at organizing things. I am better at prioritizing things. It doesn’t seem to be such a chore anymore. I don’t feel so inadequate anymore. I feel that I can do this on my own.”

We have seen children and adolescents really improve their independent function, and parents have responded by allowing the children to function more independently, building more confidence in their children.