My child is so disorganized! He can’t finish anything. He can’t even figure out how to get started. He can’t seem to make any decisions or keep track of anything. His mind seems so scattered. I’m worried he might have some sort of medical problem. Is there a test for organization issues?

There are tests that look at different organizational skills. But the first step is to ask his teacher to give you a description of when and how your child is disorganized. It also might be possible to have the school psychologist observe him in the classroom.

You want to rule out other things that could be causing him to seem disorganized. For instance:

  • If he forgets to turn in his homework or loses his books, it could be because he has a learning disability and feels bad about doing the work or showing it to the teacher. “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 lose be distracted by anxiety. Perhaps because he’s embarrassed by his anxiety, so his teachers and parents don’t know about it.
  • A child could seem disorganized because he’s depressed. This can cause him to feel disconnected and indifferent about things he normally would care about.
  • A child who’s had a traumatic experience could be disorganized because he’s constantly feeling stressed out.

Have you ruled out these emotional problems? Then it’s possible that your child is disorganized because he has a weakness in what are called 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, and remember things. They help us manage our time and possessions, and finish what we start.

Some kids have weaknesses in executive functioning. No matter how bright they are, they struggle to do schoolwork and stay on top of things they’re responsible for.

Some of these functions are obvious, because they involve a child’s behavior in the world: losing his jacket, forgetting his homework, not following directions. 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 he’s reading, putting things in a reasonable order when he’s writing.

Several different kinds of tests 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 set of tests, questionnaires, interviews and observations gives clinicians a good picture of strengths and weaknesses. 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. “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.”

Neuropsychological evaluations involve several sessions. They require time and work on the part of the child as well as her 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
  • Parent and teacher questionnaires in which they share their impressions of what the child’s organizational issues are
  • Clinical questionnaires that compare your child’s responses to those of thousands of other kids

Dr. Rosenthal says he spends eight to nine hours face-to-face with the child doing testing. He spends 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

There are two kinds of tests that measure executive functioning issues without doing a thorough neuropsych evaluation. (Both kinds are included in a neuropsych evaluation.)

  • The Behavior Rating Inventory for Executive Function (BRIEF) and the Comprehensive Executive Functioning Inventory (CEFI) are 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 Cognitive Assessment System (CAS) is given by a psychologist who watches the child perform a series of tasks and observes how he goes about each one.

Dr. Rosenthal reports that he’s found the first group of tests, including the CEFI, to be better tools to get a good idea of what’s happening with a child than the individual assessments like CAS. Kids can often function better in a controlled setting like a doctor’s office. 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, his teacher and a school psychologist will usually work together to find ways to support him in the classroom.

You may want to have him work with a learning specialist. The specialist is trained to help him with skills that he needs for school, such as memorization, digesting important information, organizing thoughts in writing, and solving multi-step problems.

The older a child gets, the more these executive functions affect his ability to learn (as well as keep track of assignments and sports equipment). Helping him get more organized will making things easier for both of you and will allow him to be as accomplished and successful as possible.

About the Author

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Child Mind Institute, Understood Founding Partner

The Child Mind Institute is dedicated to transforming mental health care for children everywhere.

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