Monday, October 14, 2013

Executive Function

I'm learning some things that help explain Missy a little.

I keep saying there is something not working right in her brain but I have had so little understanding of what it is exactly that's screwed and just how that is related to her behavior even though I have been trying to for quite some time. I've been asking where does won't end and can't start? Why are we experiencing 3 to 4 tantrums a day and 2 to 3 rages a week when we have worked so hard to make life as simple as possible for her and fine-tuned the routine to a T? Why does she FIGHT everything so hard all the time? Why is it she seems to make connections theoretically and knows so much and can keep track of everyone else's business and knows what she must do to get from point A to point B and knows the consequences of not making it to point B, but CAN'T get there even when she wants to?

It's played out in the morning routine daily. We have it down to a fine art on paper with little check boxes and an incentive for each and every minute thing. She wants the little treats - sort of, she wants the bigger prize - getting on the bus on time. She does want to get on the bus. She really wants to go to school.  She doesn't want to do all the stuff in between necessarily. In fact there are a few things that she WON'T do if she can help it and she will employ every avoidance technique in the book to make sure she doesn't have time to, but I can say that she does want to get to school with clothes on even if sometimes she refuses to get dressed.  WHY?

So, I've been searching for an answer. And searching and searching. . . The problem, judging from where I sit, seems to have a hereditary component to it knowing her bio- mother and having heard stories about grandma and others in the family. There's something in common being passed from one generation to the next. So, while I do know the twins have experienced trauma (obviously) and Missy has had actual brain damage from birth and multiple resuscitation, etc..., there is something bigger than that involved because it affects more than just Missy. From everything that I have been told there were no drugs or alcohol in the history. Do what you will with that. There's no way to know the truth, but EVERYONE denies its involvement. Yes, they were drugged up with prescription medication to make them quiet and sleep. This had its effect, but James would be worse off than Missy if that were the greater part of the picture and he is overcoming his obstacles where she is not and maybe that's where the brain damage shows its face in the comparison. 

Here's where it starts to get technical. If anybody is still reading, you are welcome to move on.... I write for my own clarification. If you have a kid with these issues maybe you will stick with me and help me sort the problem out. Once we get to the why we will need to know how to handle it in the best possible way.

We're dealing with an executive function deficit of some sort, Or maybe of ALL types. Executive Function development takes place in the pre-frontal cortex of the brain which is more sensitive to stress than any other part of the brain. Any kind of stress will flood the pre-frontal cortex with dopamine and shut down executive functioning...  I see this all the time. A stressor comes along (from within, or from without) and BOOM! Instantly the thinking brain is GONE on VACATION! You might as well talk to the wall and cradle the lamp for all that you might try to do with your child to bring them back to rational thinking will NOT WORK. In Missy's case the screaming begins and there's not a thing I can do about it. I cannot get her to deep breath, or calm down in any way. The game is lost and I CANNOT get it back no-how, no-way. My most successful response is to walk away. Anything I try to do makes it worse, so I give her space and time...

I'm pasting a quote here: "Executive functioning is essentially the conscious regulation of thought, emotion, and behavior (Zelazo, 2010). It is different from what we usually think of as intelligence, because it is independent of how much we know. It is an aspect of intelligence in that it involves expressing or translating what we know into action (Zelazo, 2010)."

This could explain why it seems Missy has the smarts to talk about how things should go logically and yet she can't translate that into action. She has the right answers. She can tell you how something should be done.... She often says, " I want to obey!!!" but often that is as far as it goes... It has been such a mystery why she says that and then plows along to the opposite of what she is declaring she wants to do. She says, "I'm going to do my jobs and be on the bus on time today!!" and then she proceeds to sit there and do nothing to get ready to go,  and woe be to anyone who suggests she's not doing something towards making her dream come true. The executive function of being able to PLAN towards her goal is completely missing. This could suggest her concept of the passing of time is warped... Telling her to look at the clock and pointing out what time it is now and what time the bus arrives and telling her to hurry only baths her brain in stress hormones because I think she doesn't know how to translate that into time management. She just goes off into a tantrum. A interesting side to that is, if I ask her drink a cup of water (which she doesn't do on her own without prompting) she will stand there with that cup for an hour or more if I say nothing. If I say "drink it up and hurry" she will become defiant. If I just go over to the stove and put the timer on for 2 minutes she will face the timer and drink the water in 20 seconds flat then continue to stand in front of the timer watching the seconds tick away until it dings.

A friend was watching Missy at church the other day and came to the conclusion that she was minus the ability to make any sort of  judgement. Spot on! I hadn't put it into those words before, but it is absolutely true. That would be an executive functioning deficit. Prioritizing, organizing goes along with making judgement.

 Shifting and thinking flexibly, being able to access a working memory, impulse control, managing her feelings, initiating tasks are all executive functions...... Life is overwhelming indeed. Some children struggle with one or two of these things. Missy struggles with ALL of it. Oh, and from what I've read, there seems to be a hereditary link to this problem.

"A common denominator and basis of all executive functioning is the ability to hold things in mind, step back and reflect. Without this capacity, it is difficult to have perspective, judgment, or control. Studies with children at different ages before and after executive development is in place demonstrate that without being able to inhibit impulses and distractions and hold multiple things in mind, even if we know what to do and want to do the right thing, that intention may not translate into behavior (Diamond, 2010; Zelazo, 2010)."

 SO OKAY! That was helpful to a certain extent. Now that we know that.... what do I do about it?   **sigh** For one, I'm thinking I'm shooting myself in the foot if I am trying to teach her to be responsible in any way at this point. She's missing the tools. I guess that changes the words in my search engine.

Part 2 will happen someday when I figure this out.

Diamond, A. (2010, May). What Do We Know About Child Development and the Brain That Can Help Promote Resilience and Help More Children Be Strong and Joyful? Paper Presented at the Annual International Trauma Conference, Boston, MA.

Zelazo, P.P. (2010, May) Executive Function and Emotion Regulation: A Developmental Perspective Ph.D. Paper Presented at the Annual International Trauma Conference, Boston, MA.


2busyannie said...

First off, let me say, I'm not an expert but I have been living this same life with adopted kiddos for nine years and have researched these same issues. I always assumed just from the topbar photograph and the issues you deal with that your twins had FASD. They have several of the facial hallmarks of FAS: small eyeballs, wide set nostrils, thin upper lip, lack of philtrum. Facial features form very early in the pregnancy, often before the mother knows she is pregnant (around day 19) so maybe your birthmom had a binge or two without anyone putting the cause and effect together.

My child with FAE/RAD is ALWAYS contrary. He cannot help it. If there is human involvement, especially with mom or a big sister, he will oppose everything even if it means losing out on a treat or it makes no sense. Using a timer instead of telling her what to do is an excellent adaptation. Remove yourself from the opposition equation as much as possible--you have to adapt Missy's environment for your success and hers because she cannot.

I used to try to separate which of my son's behaviors came from which cause--does his lack of reading skill come from: the FASD, the brain damage from the malnutrition, the lack of trust from the neglect, the opposition from the RAD? Because I figured we'd "fix" what can be fixed and then help him adapt to the permanent deficits. Trouble is he doesn't want to be "fixed" exactly, he doesn't want to participate in therapy, doesn't want to be different, and I guess it doesn't really matter which behavior comes from what cause after all. He is a whole and complete child and he doesn't like it when I pick apart his individual issues to change him to suit myself. I don't know if that makes sense.

During one of his kinds of therapies we learned that the best learning happens when the person is stressed just enough--relaxed brains are good at creative thinking but not retaining, too much stress and no learning/thinking happens at all. Well our children with issues have such a low thresh-hold for stress and such a narrow window for effective learning that academics is very tough for them; add in the mommy issues and homeschooling just did not go well for us.

What you describe with Missy talking a good talk but not being able to walk the walk is classic FASD. Very verbal but poor decision-making. My son also is hypervigilant but almost completely un-self-aware. He can be yelling at the other kids at dinner to chew with their mouths closed while he has his mouth full of food. I think that is part of his RAD. Telling him to hurry always backfires.

What has helped me the most is lowering my expectations. Whatever the cause may be, his brain is taking much longer to mature than I expect, so if I can imagine that he is about 4-6 (he is almost 11) then my expectations mesh well with his abilities. Some 11 yr olds can drive a tractor and manage their own 4-H animal, but I am happy if mine can take out the trash all the way to the can and then remember to put in a new bag. He must constantly be supervised so that I can adapt his environment to suit his fluctuating skill and mood levels or he gets too stressed and starts verbally attacking the other kids.

Mama Ds Dozen said...

Great post, and great comment from Annie. We are all walking this walk, and learning together. Whew!
While I wouldn't wish this life on my worst enemy, I am so glad that I am not walking it along. :)

While my daughter with the severest rages is currently living in a care facility (for the safety of the family), our 14 year old daughter at home has serious issues with brain functioning. She doesn't rage . . . but, as Annie says, "He must constantly be supervised so that I can adapt his environment to suit his fluctuating skill and mood levels"

My daughter is in high school now, and it is very difficult for her to understand why she can't be allowed to do everything her high school friends do. But . . . in many ways her brain still functions at a 5 or 6 year old level. So hard.

Keep learning. Keep sharing. Keep praying. Keep seeking HIS strength to make it through each day.

:) :) :)

Emily said...

It makes perfect sense! It seems like the research is paying off and you are on to something. Now, what to so with it...but at least you're on the right track.

Anonymous said...

Good post! Our 13 year old daughter has the executive function level and non verbal skills of a 9 year old or lower (emotionally 6 years old) so I'm very interested in what you learn. The neuro psychologist is positive it comes from mom's use of alcohol and the very chaotic and dysfunctional first 5 years of life.

To me it can be so frustrating to be her 'brain' all the time. Choices and consequences, planning anything, getting out of her routine or just trying to get ready to go away is just so difficult! That translates into rages......Ugh. Having an 11 year old sister that does not suffer from that just fuels the rage and jealousy, way too many times.

Blessings to you as you work with her.


Preacherstribe said...

Boy Ange, what do you do with a boy that needs to split the wood, but has no arms? Except for a miracle, the situation is hopeless. Is it?

acceptance with joy said...

perhaps explaining why I've lost hope a time or two....