Problems With Executive Function- How To Deal With It?

My 15 year-old son has some pretty major executive function problems. This manifests as everything from short-term memory loss to poor impulse control to problems with organization and planning. It stems either from his severe ADHD or a congenital defect that he has where his cerebellum extends into his neck, although his neurologist now says that after two surgeries, this is no longer a problem for him.

He sees two different counselors, a neurologist, his primary care doctor, is in the court system, and has a coordinator for community services, so he’s extremely plugged in to all that the “system” has to offer him for help.

What I am looking for are things that I can do, or he can do, or that we can do together to help him overcome this. It seems to be such a misunderstood, or little-understood, affliction, and there is seems to be a lot of conflicting information on it out there for the average layperson. There’s also the issue of what a 15 year-old boy is willing to do on a regular basis- playing video games, yes; doing crossword puzzles or other brain exercises, not so much. Up until now, I and everyone else that works with him have pretty much just assumed that as he matures, he would get better and these issues would resolve themselves and he would be okay. But sadly, I don’t see it happening so far, and like I said, he’s 15 now. I am feeling a sense of urgency now.

It’s extremely frustrating to be the caretaker/parent of a person with this disorder. I often say that it’s like he wakes up every day to a whole new world where he has to learn the rules to everything all over again. We have posted rules around the house for such things as taking a shower, cleaning up after a snack, cleaning his room, etc., and that’s helped somewhat, but it’s still an issue. I’ve been extremely patient and understanding, trying not to blame him for this, which I feel is really not within his control- however, I am starting to worry a lot about how his life is going to be as an adult. I’m sorry, but I don’t want to take care of him for the next however-many years (not that I don’t love him but you know) and I can’t imagine any roommate or girlfriend or wife in the world is going to be willing to take care of him, either. Less for me, though, and much more for himself, I want him to get better and overcome this.

People that meet him have a hard time believing that he even has these problems at home- he presents as very polite, intelligent, with adult-level conversational skills- which is good, but I don’t feel that many of all these people that are there to help him take this seriously, because he doesn’t seem to have these problems unless you live with him. He does well at school because he has an IEP and a lot of modifications.

Anyway, I have been doing some research online, and talking to his various support people, trying to sort this all out, and I thought, why not ask you people- there are very few situations that *someone * here has not been through.

Is this something an occupational therapist would be knowledgeable about?

He gets occupational therapy, has for years, because he has fine motor problems stemming from his cerebellum thing. But I will be meeting with her in a couple of weeks, so I definitely could ask her if she has any ideas for this aspect of him.

But thanks for answering! It’s a difficult situation for him and me and everyone involved.

I’ve recently gotten the idea to get him into equine therapy. Not really sure why I even think it will help him, but I do. I just have to convince Medicaid to pay for it.

Make a routine of it, that has been the only thing that has ever worked for me.

Shower, laundry, dishes, make a daily and weekly whatever routine. For the stuff only done one one or two days a week post a schedule and display of what day it is. The daily routines can probably be memorized and done in proper sequence.

Accept that he is always going to have weaknesses in this area most likely, and there is no problem with that.

I keep the money to pay my taxi fare in a special pocket, which I check at a certain point in the ride, and make sure the money is there before leaving home, if not I’ll forget to pay the fare!

My wife rearranging a crucial object can derail my whole morning routine and turn me into a jumbled mess.

You have this?! Not that I’m excited about it, but it’s good to know that someone else does, and that you’re apparently fairly successful in life, at least enough to live independently and have a wife and kid! Were you worse as a teenager, and have you gotten better since then, just from maturing, aside from the schedule and routine things? I would feel better if I knew that can happen with him, even if he did need a little special help even as an adult.

I have ADD and struggle with executive functioning skills as well. I am on 10mg of methylphenidate (Ritalin) once a day.

I know it is frustrating for you to watch, but it is probably frustrating for your son too. I get very dissatisfied at how little I seem to accomplish compared to my friends.

Your son will need to work on ways to build structure into his life. He may have to start small. For example, “every day I get up by 7am”. Then, once he’s got that down, maybe “every night I’m in bed by eleven” or “do homework as soon as I get home” (so he doesn’t get distracted), etc.

He has to be on board with whatever structure you support him in building. For example, it may be important to you that he has his laundry ready to go by Saturday morning. This may not be important to him. Try to start building a schedule with things that matter to him, it will make him much more enthusiastic about it. Then you can start adding stuff that’s a little more of a stretch.

It is good of you to think about this now, because he is going to need the foundations of structure to get through college.

Good luck to you and your family and I hope you’re able to work this out. :slight_smile:

Thank you! I’m glad to hear that you have found structure and schedules help you as well. We do have a lot of that, but I’m sure there is room for improvement there.

On just the point above, can you get him interested in playing video games that exercise his brain? I don’t necessarily mean those specific designed “build your brain in 10 days” apps. There are many games with very complex tasks, that require planning with delayed gratification. Unfortunately I’m not tuned in enough with current games to offer a strong suggestion for a specific title. I’m thinking strategy and puzzle solving type games.

That might not be getting at what you’re after, but if he’s going to play games anyway, then perhaps they can be ones that make him think and stress skills he’s weak in.

Anybody with ADD symptoms can tell you about this. It has to be a pretty common problem where the effects are not so pronounced, and I think an awful lot of teenage boys exhibit these symptoms to some degree. And teenage boys wanting to play video games instead of doing crossword puzzles is called normal. The others’ advice about structure and routine is good, but I think you also need to find other things he likes as much as the video games. It doesn’t have to be brainy stuff, just different things for him to do. If his problems are severe your going to have to set up a whole life schedule for him and you’ll have to find a way to do it that he’ll be satisfied with or he’ll never get anywhere with it. I’m sure it’s frustrating for you, I hope you and he can work your way through this. Having a parent who cares about him is something he’s got going for him.

I know it’s normal for him to want to play video games over doing puzzles and things like that. I also get counseling with his therapist, in order to know things like what’s normal for teenagers, since I was never allowed to be a normal teenager myself, so that I don’t have unrealistic expectations. (I was born an adult.)

But I don’t know how much of how he is is really normal for people with ADHD or teenagers. I’m talking about things such as shutting a cupboard door when you get something out, or making sure the water is turned all the way off after you’ve washed your hands, any one of the dozens of tiny rules everyone has for their homes that most people just learn and do by rote by a certain very young age. I don’t know anybody that struggles with these things like he does. You’d almost think he was retarded, but he has an average IQ of around 100, although it tests at 65 because he does so poorly on tests. He’s obviously not got an IQ of 65, but I am hopeful that he will qualify for independent living services as an adult if he still tests that low.

Glad you started this thread. I agree that the more you read about executive functioning, the more muddled it seems. My daughter has other issues as well, and it’s hard for me to see how much she lacks in this area. She’s only 9, and I’m trying to focus on a few areas at a time in her self-help. I worry that we enable her too much. But she made a sandwich the other day, so you know, progress.

I think I’ll make a morning checklist for her and post it. I shouldn’t have to ask every day whether she brushed her teeth. And her hair.