It can be difficult for parents and teachers to know what to do to help a child reach their potential when they have a developmental disability, such as autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD). About one in 68 children in the United States are diagnosed with ASD, a diagnosis that is nearly five times more common in boys. ADHD affects approximately 11 percent of children ages 4-17, and boys are diagnosed nearly twice as often as girls.
Science has not yet provided a clear answer why boys are diagnosed with these conditions more often than girls. One reason may be that symptoms can manifest differently in boys and girls. With ADHD, boys may be more likely to have outward behaviors that make them more noticeable while girls may be more likely to have inattention issues that are harder to see. It’s similar with autism; girls generally develop language skills at a younger age, so it may take longer to notice issues than with boys.
One of the specific challenges for kids with these conditions has to do with what’s known as executive function. These are a set of skills that enable us to be efficient and effective in carrying out goal-directed behaviors, such as performing a school assignment. These skills rely on three types of brain function: working memory, mental flexibility, and self-regulation. We aren’t born with these skills—just the potential to develop them. The concern is that people who don’t develop good executive function skills often have more trouble performing academically or getting a job.
We’re currently part of a research project, funded through the Patient-Centered Outcomes Research Institute, that works in schools in low-income areas to help children with ASD or ADHD learn how to develop those necessary executive functions.
We want to try to improve behavior that is causing problems that the kids (and their parents and teachers) want help with rather than say, “We’re going to treat autism, or ADHD.” In fact, the strategies we’re using grew out of work on trying to improve executive function in kids with traumatic brain injury. We look at the behavior, such as being inflexible, having meltdowns.
The interventions we’re using target those executive skills. There are ways to help anyone be more flexible and more goal-oriented. We’re examining two types of interventions aimed at improving executive functions to see whether there are differences in the outcomes they produce, including changes in children’s classroom behavior, problem-solving abilities, and academics. We aim to find out whether a newer treatment called Unstuck and On Target works better, worse, or the same for low-income children with ASD or ADHD as the best treatment available now, Contingency Behavioral Management.
One of the reasons we’re excited to do this research is because executive functions are very vulnerable in early development. It’s not restricted to kids with developmental disabilities. There is research to show that for every year a child lives in poverty, there is an impact on executive function. For low-income kids who also have developmental disabilities, it’s like a double whammy that’s likely to make building these skills even harder.
We don’t work directly with the kids, but rather with the teachers, the school staff, and the parents. Once teachers and other school staff learn to do the intervention, they can keep doing it year after year and train others. So it is important to find out which interventions are the most effective for children with different backgrounds and situations.
The transformation can be powerful. There was one child in particular who went from having discipline referrals to winning an award at the end of the year for being a good and engaged student, which was really meaningful to him.
We get a lot of feedback from the teachers, parents and especially the kids themselves. It’s important to recognize their ideas about what’s important to them and what does and doesn’t help. We really respect their input. You’re not going to achieve change if the kids aren’t interested in putting in the work. What we’ve found is that kids set high goals for themselves when given the opportunity.
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