A guide to tests that identify problems with organization.

Original Source: Child Mind InstituteOriginally posted April 22, 2014

Executive Function. When we are concerned about kids being disorganized—so disorganized that they have trouble keeping track of their stuff and keeping up schoolwork—the first thing we want to do is try to understand what’s going on with them.

There are tests that highlight different kinds of organizational skills your child could be weak in. But the first thing to do is to get good picture of when and how he’s disorganized.

That’s where your child’s teacher can be very helpful. Ask her to give you a rundown of the things your child is struggling with. It also might be possible to have the school psychologist observe him in the classroom, to describe the things he seems to be having trouble with. Is he failing to bring her homework into class? Does he have trouble shifting from one activity to another?  Writing down assignments? Putting materials where they belong? What seem to be his issues? They can help you decide whether testing would be a good idea.

And before you focus on organizational skills, you want to rule out other things that could be causing him to seem disorganized. For instance:

• If a child always seems to be forgetting to turn in his homework or losing his books, it could be because she has a learning disability and feels bad about doing, or showing his teacher her work. “Rather than organizational issues, he might need help with math,” notes Dr. Michael Rosenthal, a pediatric neuropsychologist at the Child Mind Institute.
• He could also be losing things and forgetting things because he’s distracted by anxiety. And it could be an anxiety that he keeps to himself, perhaps because he’s embarrassed by it, so his teachers and parents don’t know about it.
• A child could seem disorganized because she’s depressed, which causes her to feel disconnected and indifferent about things she normally would care about. “The issue could be her motivation and mood,” Dr. Rosenthal notes.
• A child who’s had a traumatic experience could be disorganized because she’s constantly feeling stressed out.

But if you’ve ruled out these emotional problems that could be contributing to the behavior, it’s likely that your child is disorganized because she has a weakness in what are called executive functions.

Helping Kids Who Struggle With Executive Functions

Executive functions are mental skills that we all use every day to get things done. We use them to set goals, plan how we’re going to do something, prioritize, remember things, manage our time and possessions, finish what we start.

Some children have weaknesses in executive functions, and, regardless of how bright they are, they struggle to do schoolwork and stay on top of things they’re responsible for.

Some of these functions are more obvious than others, because they involve a child’s behavior in the world—losing her jacket, forgetting her homework, not following directions, and other executive function issues. Others are less obvious but just as important, especially for learning: retaining facts, solving problems that take several steps, figuring out what’s important in things she’s reading, putting things in a reasonable order when she’s writing.

There are several different kinds of tests that can be used to see what kinds of executive functions your child might be having a problem with.

Neuropsychological evaluation

The most comprehensive way to assess a child’s organizational issues and determine their cause is a neuropsychological evaluation. This is made up of a set of tests, questionnaires, interviews, and observations that clinicians use to get a good picture of what each kid’s strengths and weaknesses are with their executive function. The test shows how kids complete tasks and process information.

“Most parents who come in and say my kid is disorganized usually have some other problems, too,” says Dr. Rosenthal. “Organization is often one piece of the picture. But it’s important to be comprehensive in a neuropsych evaluation to evaluate all the other pieces, to isolate whether this is specifically an executive function problem or if there’s a larger issue at play.”

As a result, neuropsychological evaluations involve several sessions and require time and work on the part of the child as well as his teachers, parents and clinicians.

The evaluation includes:

• Testing that measures how a child approaches a task that doesn’t have a lot of structure to it. For example, when he is presented with something he has never seen before, and he don’t know what the expectation is, how does he devise a strategy for solving this problem? Does he come up with a good, organized strategy or a haphazard, impulsive, ineffective strategy?
• Parent and teacher questionnaires that parents and teachers complete to share their impression of what the child’s organizational and executive function issues are. Are they pervasive, meaning they’re present in all aspects of the kid’s life—at school, at home, even recreationally? For example, parents can say if a child is also losing his equipment when he’s playing sports, and things he cares about at home.
• Clinical questionnaires are used to compare your child’s responses to thousands of other kids to see what’s normal and what’s a problem.

Dr. Rosenthal says he spends 8-9 hours face-to-face with the child doing testing, about an hour-and-a-half interviewing parents, and additional time on the phone talking with teachers. Only after all of that is completed does he collect, score and interpret the information.

Other testing that focus on executive functioning issues

There are two kinds of tests that measure executive functioning issues without doing a thorough neuro-psych evaluation (in fact both kinds are included in a neuro-psych evaluation).

• The first kind is questionnaires that ask parents, teachers, and perhaps the school psychologist to observe closely the behaviors they see in a child and fill out a rating scale. The Behavior Rating Inventory for Executive Function (BRIEF) is an example of that kind of test.
• The other kind of test is one in which a child is assessed by a psychologist who watches her perform a series of tasks and observes how she goes about each one. The Cognitive Assessment System (CAS) is that kind of test.

Dr. Rosenthal reports that he’s found the first group of tests, including the BRIEF, to be particularly good at identifying what is happening with a child. That’s because kids can often function better in a controlled setting like a doctor’s office, while functioning in the real world, where there are so many distractions and interruptions, is more challenging.

How to help

Once you have a good idea what your child’s specific issues are, her teacher and a school psychologist will usually work together to find ways to support her in the classroom, focusing on her strengths and helping where she’s weak.

You may want to have her work with a learning specialist, who is trained to help her with the executive function skills that she needs to perform in school, such as memorizing facts, digesting important information, organizing thoughts in writing, and solving multi-step problems.

The older a child gets, the more these executive functions affect her ability to learn as well as keep track of assignments and sports equipment. Helping her get more organized will not only make things easier for her (and for you) but will allow her to be as accomplished and successful as she can be.