The outbreak of the coronavirus isn't the first time Robert Spall has had to learn from home.
The 13-year-old and his mom, Kirsten Spall, a high school teacher from Sacramento, Calif., were once "reluctant homeschoolers" after Robert was pulled out of a handful of schools for focus and behavioral issues-all before the 1st grade.
"He didn't respond to normal redirection. He didn't respond to normal behavioral strategies, like giving choices," Kirsten Spall said.
Robert is working from home again, along with over 50 million students, as schools in 48 states have shut down in-person classes to curb the spread of the novel coronavirus. How will the long absence from traditional school routines affect Robert and the millions of other students across the country who struggle with self-control, focus, or mental flexibility?
For both teachers and students alike, paying attention might be especially challenging during the coronavirus crisis, and especially so for students like Robert, who struggle to focus in school.
Nearly 4 of 5 teachers think their students' ability to focus has gotten worse with school-related tasks during the shutdown, according to an April EdWeek Research Center survey.
Executive functioning is roughly defined as a cluster of skills required to sit still, concentrate, and be able to go from one activity to the next. Public attention to these kinds of cognitive skills in children started after psychologist Russell Barkley's seminal work in the 1990s, connecting ADHD, or attention deficit hyperactivity disorder, to deficits in executive functioning.
While others have since challenged Barkley's work, there has been an increase in the number of children prescribed ADHD medication as well as a plethora of sometimes questionable brain-training programs to boot.
Ironically, though, the original studies on executive functioning didn't even involve children; they focused on brain-damaged adults.
Research since then has shown that not all executive functioning deficits relate to ADHD. Not all kids who have ADHD have executive functioning issues, either. There is no "executive functioning disorder" in the most recent edition of psychiatric guidelines called the DSM-5.
The fuzziness had led to some overidentification problems. Stephanie Carlson, a University of Minnesota psychologist who developed an executive functioning assessment, finds teachers often overidentify students as having executive functioning deficits when they are actually within the normal range.
Students who turn 5 before starting kindergarten are more likely to be labeled as having ADHD than older peers. Often students who have issues with immaturity get labeled as disordered. Boys are more likely than girls to be singled out. And black and Latino students are less likely to be diagnosed with ADHD or taking medicine for it.
Also, executive functioning skills are not static; they involve work. Students do not have fully developed executive functioning skills on their first day of school; those skills are not fully formed by their last day of school.
There are normative measures based on a nationally representative sample of students. And then there is Robert Spall. He has been diagnosed with ADHD and oppositional defiant disorder. With this kind of combination, Kirsten Spall still does not know what came first-the aggression or the frustration of not having any self-control, of already not being considered "a good kid" by age 5.
What his mom is sure of, though, is that her background as a teacher didn't help.
"That worked against me in a lot of ways because I thought if you had a Clippy chart and you were consistent, and you provided rewards and consequences, it would be fine," she said.
Experts said the risk of concentration problems is exacerbated for students and adults by a variety of factors related to the COVID-19 crisis, including stress over health problems and unemployment and long hours of video game playing.
"Now more than ever, we will feel the effects of trauma on the brain. Heightened trauma, anxiety, and stress is an enemy of executive function," said Stephanie Carlson, a developmental psychologist and Professor at the Institute of Child Development at the University of Minnesota.
"What stress does is it narrows our options that we can perceive in how to act, think, or feel. When you shut down, the world shuts down, or you have the perception of your options being shut down. Stress goes up; what goes down is reflection and more-thoughtful and mindful responding."
Executive functioning issues are possibly even more heritable than IQ. Children home all day alongside parents who may also have difficulty sitting still in front of a computer screen could be at higher risk of experiencing attention issues.
The cognitive-developmental risks are more significant for students from impoverished communities. Aside from potentially not having access to WiFi or even a computer, these students are disproportionately more likely to score low on measures of executive functioning skills. The students can be roughly two years behind "normal" ones after controlling for IQ, according to Carlson.
Additionally, teachers who work in higher-poverty schools are 1.7 times more likely than educators in wealthier schools to think their students' ability to focus on school-related assignments is "a lot worse" than before the pandemic, according to the EdWeek survey.
Carlson, who previously found children's self-control had increased since the 1960s, wonders how the outcomes will change after COVID-19.
"In a perverted way, we have the opportunity to have a pre-and-post, to look at if the performance of a 48-month-old child changes," said Carlson, hypothesizing that when she next conducts the study, there might be a dip in self-control for the first time in nearly 60 years. She worries about how "the inequity of the pain will be distributed," as well as how the "learning gaps will widen during school closures."
Still, all experts agreed that teachers and parents both have a role to play in changing the environmental factors that interfere with children's executive functioning.
Carlson recommends establishing predictable routines before working on executive function or academic skills.
If children feel secure, Carlson believes one thing that can help with both executive functioning and socio-emotional coping during this time is to model "reflection talk." Reflection talk is an activity geared to improve children's ability to analyze their behavior. The practice involves both teachers and parents asking children to describe and think through the decisions, and mistakes, that they make. Experts said children are never too young to be asked questions, as well as modeled on how to reflect out loud.
Parents will have to sit alongside their squirming children to keep them on task while in class. Anderson, a clinically trained psychologist who works for the Child Mind Institute, said adults should understand that children only start being able to work independently on their organization skills later in elementary school.
Parents still need to mediate tasks for their middle- and high school-age children. Robert Spall, the 13-year-old with ADHD, still relies on his mother for support as he enters the developmental age of rejecting her-surprising no one when he sarcastically says on the phone in between playing Minecraft, "I'm a 'good boy' person this year."
Yet Robert manages to earn straight A's now, while many students diagnosed with ADHD report having trouble at school.
Kirsten Spall relies on writing lists for Robert of both schoolwork and house responsibilities. For younger children, experts recommend using pictures as well.
"I try to act as his coach now that he's in middle school, and then he writes [his to-do list] down, and he puts it in his backpack," she said. "At the beginning of 7th grade, I would have to text him at the end of the day, 'Hey, did you remember to talk to so-and-so?' Now he remembers, but he definitely still needs the support and that reminder."
Studies suggest, however, that most classroom teachers already feel unprepared to work with students with disabilities in a traditional classroom setting-let alone via virtual instruction. Nearly a quarter of the teachers indicated that they believe-incorrectly-that ADHD diagnoses result from poor parenting.
Kirsten Spall's voice still shakes as she remembers feeling also labeled "bad" by teachers.
"I feel like that's what I would say to other parents, especially other teachers, is that the parent is doing the best that they can do at that moment. And you can offer support, and you can offer resources," Kirsten Spall said.