What is Executive Dysfunction and Could Your Kid Have It?

It turns out, after another appointment with a new psychiatrist, that he doesn't have ADHD or an anxiety disorder at all. Both were ruled out and the doctor told us what he suspects that Morgan has that I've been researching ever since: Executive Dysfunction.
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Written by Kelly Wickham for

All these years I assumed that this diagnosis for my youngest child, Morgan, was correct; all of his behaviors lined up perfectly with those we found in the DSM-III (the Diagnostic and Statistical Manual of Mental Disorders) and he shared the same symptoms as my eldest son, Mason, who was diagnosed with ADHD in 1997.

Morgan has always been big for his age -- at birth he was close to 10 pounds -- and has always been treated as if he's older than he is. The home daycare he attended provided more problems because the older kids wanted to play with him (due to his size) but became frustrated that he didn't act more like them. When he was 2 he looked 4, and every parent knows that the behavioral responsibility of a 2-year-old is vastly different from a 4-year-old. I've spent many years worrying about how this would affect him.

ADHD is the most commonly diagnosed behavior disorder for school-aged children and it's far more common in boys than girls. It's also known as a co-morbid disorder, which means that you have something else with it such as depression or anxiety. The behaviors that Morgan, my 17-year-old son, has been dealing with are learning disabilities, overactivity, impulsivity, and inattentiveness. I think a lot of people overlook the comorbidity of ADD and ADHD and assume that when they're done with school they no longer need to worry about it, but that couldn't be further from the truth.

While we fought medicine for a long time and tried dietary changes and homeopathic remedies, we realized, after many years, that there was little change in him. At home he was fidgety, in constant motion, and acting out. At school it was the same. What is not well known among parents is that whatever behaviors your child displays with ADHD in school or at home will also have to be dealt with later on in life -- this is something that our psychiatrist stressed to us upon Morgan's diagnosis. For him, however, medication works.

Fortunately for us, Morgan has had some phenomenal teachers who don't blame him for this behavior, and who have helped us monitor it and modify it. But despite the fact that he manages himself well, especially with the help of medication, school continues to be a struggle for him. We know when he's missed a day of taking his medication, for example, because his speech gives him away every time. He can't stay on topic or let you know what he's thinking about. Often, I explain to people that he'll be having this conversation in his head and when he's halfway through with it then he'll invite you in by talking. "Wait. What? What are you talking about? Slow down and catch me up" is the most common response his father and I use with him. That's doubled since our divorce and other adults have lived with him. When I met my boyfriend, The Cuban, I immediately told him that Morgan was an interesting child and that he'd have to get used to him.

About 5 years ago I started telling people that he was "somewhere on the spectrum" and realized that I should look closer at what is going on with him. There are things that he should get by now, but he still doesn't. A few months ago I finally had a difficult conversation with my ex-husband about my suspicion that Morgan was either high functioning Autistic or perhaps Aspergers.

It turns out, after another appointment with a new psychiatrist, that he doesn't have ADHD or an anxiety disorder at all. Both were ruled out and the doctor told us what he suspects that Morgan has that I've been researching ever since: Executive Dysfunction.

ED, as we've shortened it, is what is used to regulate cognitive processes and mostly affects deficiencies in how he plans things, his abstract thinking (or lack thereof) and how flexible he can be. Or not. For instance, when he was younger I would tell the kids to get in the car because we had errands to run, but Morgan had to know exactly where we were going. If I said, "We have to go to the bank, the grocery store, and Target" but I went out of order and stopped at the grocery store first, he would have a meltdown.

You said we were going to the bank. This isn't the bank. Why aren't we at the bank? WHEN WILL WE GO TO THE BANK?

It's changed my parenting for sure and I have learned far more patience with him than I ever expected myself to have. He is task-oriented so I give him fewer lists of things to do, but he's also incredibly sophisticated at vocabulary. What's bizarre, then, is that he is awfully unsophisticated with language. Even with that and a long memory for other things (and blame, oh, the blame of "You said we were going to do THIS!") he is a very black-or-white thinker. Math, therefore, comes easily to him but if you ask him to do something that doesn't make sense he will push back and wear you down. Trust me. His teachers have told me about it.

Even discussing this with Morgan was difficult. Our doctor asked him if he'd ever watched The Big Bang Theory at home.

Yes, why?

You know Sheldon Cooper?

Yeah. (Slowly dawning on him.) Oh, wait. You think I'm like Sheldon?

Well, yes, in the way he behaves socially.

I'm no rocket scientist. I'm not as smart as he is. He's a genius.

Right, but listen. Think about how he behaves with his friends. Often difficult, never likes to change his behavior or thinking, and is always right no matter what.

We are still at the beginning stages with all of this and it's a relief to have something to go on, but there's a long road ahead of us. In many ways, it feels difficult to manage as if we'll never have all the right answers or that we're trying to learn Australian rules football (which I'll never understand), but this is where we are.

For now, we're just trying to understand this and shouting BAZINGA in our house a whole lot more often.