The Family Foundation School

In my life before The Family School I was extremely self-centered. I hurt everyone around me to get what I wanted and got a lot of negative attention by acting like a psycho. I had no interest in God because he probably didn't want me to steal, lie, cheat, or use substances.

A.C.

My life became unmanageable early on. I was kicked out of 8th grade for drinking and drugging, and a year later was thrown out of 9th grade for the same reasons. I also owed thousands of dollars in gambling debt and spent my life running from those I owed money to.

A.H.

Before FFS, my life was unmanageable and out of control. I was shooting heroin, selling drugs, stealing, and lying to my parents. I did anything to blind me from reality because I hated who I had become.

C.B.

At home I was an overeater and extremely overweight. Going to school was the last thing on my mind. I stayed home and slept all day, then got up and stayed out all night. I was rude and disrespectful and had fits of temper.

D.W.

At home I perfected the art of quitting. My attempts at sports, school, and relationships amounted to nothing but pathetic stories because I never followed through. I did not like myself and wanted to escape the judgment of others.

J.C.

My life at home was full of lies and deceit. I became part of the tough crowd in middle school, and in high school I was in and out of detention, got into bad relationships, ran away and was sent to a psych ward.

J.G.

To put it bluntly, I was a drunk. I didn't care about my family, or God, just drinking and smoking. I was drug-tested for the first time at 12, at 13 I was in outpatient rehab, and at 15 I was sent to wilderness and then to The Family School.

J.M.

I was 15 and my mother was driving me to the hospital. She was crying, but all I could think of was what a good job I had done not eating. I felt no remorse, only the desire to leave and continue killing myself.

M.R.

I am an alcoholic and a drug addict who couldn't live life on life's terms, so I drank. When my dad was diagnosed with cancer, I was introduced to heavier drugs and started stealing and selling his pain medication.

R.B.

I was empty, angry, miserable, and lonely at home, and used any means possible to numb my feelings. I dropped out of school. Nothing really mattered, and I was quickly using up my friends and family.

V.K.

From the Desk of Dr. Vogel

In this article:

  • The link between ADHD and Executive Dysfunction
  • Common Symptoms
  • Executive Functions and Adolescent Development

Previous articles in this series...

April, 2010

EXECUTIVE FUNCTIONS/EXECUTIVE DYSFUNCTION

In my last article I addressed Attention-Deficit/Hyperactivity Disorder (ADHD). While people with ADHD are typically inattentive, hyperactive, and impulsive, these symptoms do not fully account for the range of academic, social, emotional, and behavioral problems present. All people with ADHD exhibit some degree of executive dysfunction which is central to many of their problems. So what is executive dysfunction, and what are executive functions?

So often we see adolescents who do well on IQ tests, and seem bright in any number of ways, but they never seem to perform well in school. Work is not completed, deadlines are missed, and important opportunities for learning are wasted. Similarly, social situations with family and friends may have a high degree of drama, misunderstanding, and disruption. What is going on? General intelligence and social intelligence may be present to an adequate extent. In order to make good use of these abilities, the brain must be able to organize which skills to select, inhibit, coordinate, and apply to a given task or set of circumstances. A frequently used analogy is that the executive functions are the conductor of the orchestra, with each musician (virtuosos they may be) needing organizational direction in order to play as a unit. Executive function include emotional regulation, concentration, self-regulation, planning, initiation, purposeful action, volition, pacing (of self, time, projects) behavior inhibition/initiation, mental alertness, coordination of cognitive tasks, and cognitive flexibility (list offered by psychologist Laura Ehlert, Psy.D). Executive dysfunction is always present to some extent in teens with ADHD, and usually present in other conditions including Learning Disabilities, Developmental Disorders, Disruptive Behavior Disorders, and Traumatic Brain Injury.

No two individuals with executive dysfunction appear the same, but there are frequently occurring characteristics. Emotional expression may be heightened and changeable or conversely flattened and deadened. The teen may be described as irritable, excitable, impulsive, erratic, careless, and rigid. There is a reduced ability to self control, so spontaneous, inappropriate expression is exhibited. Reduced self-direction leads to aimless activity, with little planning. Rapid shifts in attention and poor cognitive flexibility are particularly difficult, leading the teen to seeing much of the world in black and white terms. This deficit complicates academics (multi-step math problems, shades of meaning in literature), and social interaction as the teen takes things literally, missing nuance and subtlety. This leads to misunderstanding and often argument. Teens with executive dysfunction often have impairments in motivation and cannot will themselves to initiate a project. The tools of goal directed behavior; planning, organizing, recognizing time requirements, and following a sequence of steps, may all be lacking. Finally, Working Memory, the ability to hold two or more mental images in mind simultaneously while performing some operation on one of those images, is frequently impaired. Thus the teen cannot listen to the teacher, and take notes simultaneously, or focus on writing a sentence and remember the overall point being made in the essay he is writing.

Executive functions are generally performed in the prefrontal cortex of the brain. The prefrontal cortex goes through significant growth and development during adolescence, and thus adolescence is viewed as a "window of sensitivity" for the development of executive functions. There is much opportunity to create positive change during adolescence, but if the opportunity is lost, dysfunctional characteristics may endure, perhaps for a lifetime. The emotional and memory areas of the brain (hippocampus, amygdale) are also under development during adolescence. These areas as well as the prefrontal cortex are sensitive to the effects of alcohol and drug use. Chronic use during the adolescent period can confound the "window of sensitivity", causing no growth in executive functions.

Treatments exist to deal with executive dysfunction. There are three main areas of treatment; external (changing the environment), internal (changing the person), and medication. Ideally, use of all three areas over an extended period of time is most helpful. There are other lesser used programs including neurofeedback, working memory training, and Cerebellar Stimulation Training. Evidence suggests that therapies are successful, and make a significant difference in the life of the executive dysfunctioning teen. With treatment, there is good reason for optimism.

Mark Vogel

 

The Family Foundation School is just that—a school founded on the structure, ideals, relationships and lessons of family life. Our program is simple: rigorous academics, daily counseling, and the principles of 12-Step living.