By: Dr. Nikita Patel, Psy.D.

Do you find yourself putting off errands or tasks unless there is an immediate deadline? Is it difficult for you to organize your thoughts and clearly explain them to someone else? Time management and organization are examples of executive functioning.

Executive functioning refers to the cognitive processes that help us meet the demands of our life. This can look like getting started on an assignment, tolerating anger that intensifies during an argument, and problem-solving when things go wrong. These processes sit in the prefrontal cortex, which is located at the front of the brain. This area is the last to fully develop in your mid 20’s. 

According to Thomas Brown (2005), there are six major areas of executive functioning that work together to help us meet a goal or accomplish a task:

1. Activation This is everything that we do before initiating a task. For example, getting to work requires you to prioritize the task of getting yourself to work on time by getting dressed and ready, organizing your bag, checking the weather, checking traffic or train delays.
2. Action This occurs during the task. For example, when commuting to school or work, it’s helpful to engage in self-monitoring to ensure that you’re on the right train and on time. In addition, you have to be ready to course-correct if your train suddenly goes express by evaluating the change and redirecting to another route.

3. Working Memory This factor is helpful with short-term memory tasks that require us to take in information and manipulate it. Taking notes requires both the capacity to remember what is being said as well as being able to jot down the information for later review. Imagine how much memory is required to engage in a back-and-forth conversation with a friend.

4. Emotion Regulation Can you imagine what would happen if we leaned into all of our emotional urges? The ability to manage and tolerate difficult emotions is important in staying effective towards meeting both short- and long-term goals without derailing from the task at hand.

5. Sustained effort Have you ever found yourself full speed ahead on a task and fatigued halfway through? Effort helps us to sustain our pace while working so we can get through a task.

6. Sustained focus We’ve all drifted into our thoughts during a work meeting or during class. This area helps us to shift our attention to what’s important in the moment and maintain that focus to help us effectively achieve that task.

You may find yourself having trouble in some areas and not others. However, weakness in any of these areas tends to generalize to different aspects of your life. For example, you may find yourself struggling with managing your time at work, with friends, and at home.

You may have noticed that you probably struggled with many of these areas as a child since the prefrontal cortex was still developing. Parents and teachers often took the role of being the source of our executive functioning to help us meet tasks. Think back to all of the reminders you received from parents and teachers to complete chores or homework assignments. If you find yourself having difficulties in any of these areas, there are skills and strategies that you can use to help such as, keeping planners to organize deadlines and events, keeping to-do lists, setting alarms to manage time, and using coping skills to manage intense emotions.

For individualized help, there are executive functioning coaches who can tailor skills to your specific needs. Below are two resources for both children and adolescents and adults:

Children, Adolescents and Adults

Children and Adolescents

By Laura Miller, LMSW

Most of us will face challenging and stressful situations at some point in our lives and find ourselves needing more support. This is a normal part of human experience; out of necessity, humans evolved into social beings, as dependence and cooperation with one another enhanced the ability to survive. Although survival threats may be lower today, we still see that people continue to need support from others. In fact, lack of support can actually lead to increase stress.

At times, you may be able to cope with stressful life situations on your own or with the support of a trusted loved one. However, difficult circumstances may also include emotional symptoms such as depressed mood or anxiety or cognitive symptoms such as repetitive and upsetting thoughts or uncontrollable worry. It may be that even with support, that these symptoms don’t resolve. When this happens, it makes sense to consider seeking professional mental health support. The American Psychological Association recommends seeking therapy when a problem has become distressing and it is interfering with some aspect of life. Yet, you also don’t need to have a significant stressor or problem to benefitfrom therapy. If you find yourself curious about the process and can find value in having more support, that is reason enough to begin!

Benefits of Therapy & Evidenced-Based Treatments

While therapy can be a daunting process to begin, there have been numerous advances in the treatment of psychological disorders and there are many research studies to show that therapy is helpful! Treatments known as “evidenced-based treatments” (EBTs) are treatments that have been developed through extensive research and shown to be effective in treating specific symptoms. Not all mental health treatments are equally helpful and some therapies have been shown to work better than others. Due to the extensive research that goes in to developing EBTs and the amount of data showing their effectiveness in decreasing symptoms, EBTs are listed as “best practice” and “preferred” approaches for mental health symptoms by both the American Psychiatric Association and the American Psychological Association. In fact, research has demonstrated that some EBTs actually result in larger symptom improvement than pharmacological treatments, as they teach life skills that last beyond the course of medication.  There are several EBTs, including therapies such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy and  Acceptance and Commitment Therapy.

What Can You Expect?

EBTs are structured and focused, and they are meant to help improve specific problem areas. In order to best meet a client’s needs, treatment first begins with a therapist conducting a clinical interview to determine problem areas. During the interview a therapist will ask a series of questions to assess overall functioning and may also give specific checklists or questionnaires to further understand the severity of problems.

EBTs require the client to take an active role. Therapy is geared at changing thoughts and behavior, rather than just talking about problems or listening to a therapist give advice. In order to achieve this, a client and therapist will collaboratively develop a plan or agenda for every session. The agenda then acts as a guide to complete several steps that are aimed at solving the problem.

Clients will learn to practice specific skills that are aimed at helping to improve the client’s problem areas. In order for clients to learn skills and integrate them into their day to day life, clients are asked to practice skills in-between sessions. Most EBTs usually involve some form of homework as practice is key to developing new behaviors and generalizing them to outside of the therapy session. Many EBTs will also include some form of self-monitoring, so that clients can learn to observe their behaviors, keep track of interventions and skills to help, and see overall improvement.

Treatment is typically short-term, lasting anywhere from 12-20 sessions. However, many people find it useful to return to treatment after completing the EBT for “booster” sessions as needed, in which clients can continue to refine their skills.

Throughout the COVID-19 pandemic, many EBT programs started to be conducted online through tele-therapy. Check out a previous BPS blog post to learn more about how an evidenced-based treatment can also be delivered virtually!

The decision to begin therapy is personal, however, with so many evidenced-based therapies that have extensive data to show their effectiveness, there is certainly something that could benefit everyone!

“Ugh, but I’m just not in the mood to do that right now!” Sound familiar? Perhaps you’ve heard something like it from a loved one or caught yourself thinking similarly prior to starting a difficult or unpleasant task.  It’s natural and common for our mood or opinion toward a task to impact our motivation to complete it. However, we don’t actually needmotivation to get something done! Many people believe that they need to be motivated to do something in order to begin the task (i.e. motivated to begin spring cleaning or motivated to try a new workout routine in order to start cleaning or exercising). However, if you wait until you feel motivated to begin, you might find yourself stuck waiting.

Why? Well, action actually comes first and then motivation comes as an after effect of our actions! Think about the last time that you felt like staying home and relaxing and weren’t that motivated to go to the gym. However, sometimes, there’s something that occurs that you get yourself to go anyway regardless of your motivation. Have you ever noticed that after going you not only felt better about yourself but were also more motivated to go back later? That is evidence for your action morphing into more motivation! It’s normal to not feel motivated all of the time, however, if you start acting in ways that are consistent with your long-term goals and values, your motivation will build after!

Even with the understanding that we don’t absolutely need motivation to act, it can still be challenging to start tasks and stay focused and organized throughout. Since the pandemic’s start, work and school has transitioned to virtual and hybrid models that at times, may make it challenging to feel motivated and productive. In stressful environments, your productivity may look different, and that’s okay and understandable. In fact, there is some research to suggest that employees have noticed a change in their levels of energy and productivity since remote work has increased. Below, you will find tips for staying organized and productive. Remember, once you’ve decided to act, motivation will build!

 

1. 1. Change your perspective. If you believe that you have to feel like doing something in order to do it, it might not get done. Do an action step because you can, not because you have to. Changing your inner dialogue from “Ugh, I have to…” to “I get to do this...” can have a positive impact on your ability to get things done. Positive thinking has been shown to reduce stress and overall improve health.

1. 2. Create Urgency. Sometimes, procrastination continues because there’s no real deadline of when something has to get done. For example, you may have an ideal time of when you would like to finish folding the laundry, but there’s not a specific “due date.” You can create a sense of urgency by scheduling to complete tasks right before something that you would like to do! For example, choose to schedule cleaning up the kitchen thirty minutes before your favorite show begins! This way, you’ll be motivated to move quickly and get the task done so that you don’t miss out on your pleasant event!

1. 3. Begin a calendar and task list system. Develop and commit to using a system that you can use to keep track of all of your tasks. Consolidate everything into a phone, notebook, or app. You don’t want to have any loose papers or appointment slips, instead, keep everything in the same place. When you write out your task list, break down large tasks into multiple do-able steps. Often times, when there’s a task on a to-do list that seems too large, you can become overwhelmed and avoid it. Instead, choose a complex task from the to-do list and break it down. For example, if the task is “buy a house” it will never get completed, instead, if it is “look up realtors in town”, it’s much more likely to be completed. Set yourself up for success by having a clear system with manageable goals.

1. 4. Cope with distractions. It’s entirely natural for your mind to wander off to different topics and get distracted from tasks. Begin, by deciding on a reasonable length of time that you can expect yourself to focus on a difficult or unpleasant task. Set a timer for this amount of time and if distractions occur during this period, write them down and then go back to the task. Check in with the distractions that come up once your timer has gone off. Second, look for distractions in your environment and eliminate them in advance to set the stage for success!

1. 5. Use Reminders and Alarm Devices. When distracted, you generally don’t have an accurate sense of how much time is passing by. Set an alarm on your phone or computer to go off at regularly scheduled intervals like thirty minutes. Each time the alarm goes off, you can use this as your cue to ask, “Am I doing what I’m supposed to be doing right now or did I get distracted? Alarms can also be very useful in helping to schedule your daily routine. Develop a schedule for the day, and use alarm reminders to keep you on track!

1. 6. Reward yourself. Keep the momentum going by rewarding yourself after you’ve completed a task. For example, for every chore completed, allow yourself to get something from the amazon shopping cart you’ve been creating! Positive reinforcement is a useful tool in increasing the chances that someone will continue to engage in a desire behavior. Throughout the task, you can imagine yourself enjoying your reward!

Over the last year learning environments have drastically changed due to COVID-19. Many students have transitioned to remote and hybrid learning models and faced virtual learning challenges. For example, students must maintain focus despite home distractions being readily available, manage technical issues, all while coping with decreased socialization. These changes require a new set of skills and it’s entirely understandable if your child has needed extra support this school year.

However, in some cases, it may be important to consider if your child is struggling with something beyond the difficult transition to remote learning. According to the National Center for Learning Disabilities, one in five children in the United States experience learning and attention issues indicative of a learning disorder. Furthermore, forty-eight percent of parents falsely believe that children will outgrow these brain-based difficulties, when a child may actually require more support and intervention.

In order to more fully understand your child’s learning profile, an assessment known as a neuropsychological evaluation can be completed to identify your child’s strengths and weaknesses as well as determine the kinds of supports that can help your child thrive. Keep reading to better understand what this type of evaluation includes as well as know when it may be helpful to consider.

What is a Neuropsychological Evaluation?

Neuropsychology refers to the study of the relationship between behavior, emotions and thoughts and brain function. Neuropsychological testing gathers information through several sources, including standardized tests, observations of the child during testing and questionnaires completed by both parents and teachers. By gathering this information, evaluators can determine how a child learns and processes information.

In order to further understand how someone processes information, a range of domains including verbal, spatial, attention, memory, reasoning and organizational skills are assessed. Academic skill development is also measured so that there can be a clear picture of where a student is in terms of their reading, math, spelling and writing skills. Furthermore, this in-depth assessment can help identify underlying problems that a child may be having. For example, if a child is struggling to follow directions, an evaluation can help determine if the child has difficulty concentrating when directions are given, difficulty comprehending directions received, difficulty remembering directions, or a combination of several difficulties. Once underlying causes are determined, then appropriate supports can be put into place.

Gathering the information needed for a neuropsychological evaluation can be a lengthy process. Often times, this process usually requires several meetings and involves both the child and the parent. While lengthy, many children actually report enjoying the process because they are interacting with a supportive adult and receiving positive attention.

When Might My Child Benefit From More Testing?

Of course, when you see your child having any difficulty in school, there is the natural instinct to want to help. So, how do you determine if your child truly needs neuropsychological testing? One of the ways to make the decision is to ask; “Is there a persistent problem across contexts? For example, are multiple teachers having concerns regarding attention, behavior or academic performance? Do problems persist despite tutoring sessions? Is your child’s overall well-being being negatively impacted by their cognitive, emotional or behavioral abilities? For example, a child may do poorly on their math test and it might be a point of concern, yet not have ongoing negative impact. However, if a child is consistently doing poorly, and hasn’t gotten higher than a C- in the last six months and is now reporting a negative view of their overall ability, it may be an indicator that there are problems to further investigate. Below is a list of some behaviors that may indicate a need for neuropsychological testing:

· Inability to sustain attention

· Anxiety /fear or reluctance to engage in developmentally appropriate activities

· Slow acquisition of academic skills compared to peers

· Behavioral problems in school

· Difficulty maintaining organization and focus for sequenced (multiple-step) tasks

· Low self-esteem and anxiety about school performance

· Intellectually mature yet inconsistently performing or underperforming academically

If you’re wondering if your child may need a neuropsychological evaluation, start by reaching out to your child’s teachers and gathering information on their functioning in school. Often times, school districts will also have the ability to complete some testing within the school or can provide a recommended list of trusted evaluators. You can explain to your child that all kids learn differently and everyone has strengths and weaknesses, and that you want to help them figure out how they can learn best! Ultimately, a neuropsychological evaluation will help your child get on the path to being their most effective and productive self in school. Check out this webinar on evaluations to continue to learn more!