Malik was 6 years old and in the middle of his first grade year when his mom reached out to me for parent support. Malik had received OT services in the past, but his mom felt disconnected from the process and didn’t feel informed enough to support him confidently at home, especially during this rough patch she was telling me about.
Malik had been struggling with focus and attention for as long as his mom could remember. But since beginning first grade, and more recently after coming back from holiday vacation, his skill set seemed to decline and the impact was magnified. You could give him a simple instruction, he’d repeat it back to you accurately, and then he’d initiate the task but quickly get sidetracked by jumping on the bed or rearranging his cars along the wall.
These are the areas Malik’s mom wanted more education around:
-
Sustained attention and focus on a task he’s working on. He almost always gets sidetracked and requires multiple reminders from a parent or teacher.
-
Rage and anger outbursts. These are only happening at home and typically directed toward Mom or his younger sister.
-
Self-confidence when faced with any level of challenge. He often gives up before he even tries, which affects him both at home and at school.
-
Sensitivity to touch, which affects hygiene tasks. His mom is more than willing to help him with his morning hygiene routine to decrease the cognitive load, but he is hyper-responsive to touch, which creates additional stress for both of them.
My Initial Thoughts
The first thing that jumped out to me was the link between executive functioning demands at school and his anger and rage outbursts at home. Since starting first grade, the cognitive demand has increased, not only in intensity but also in duration, since his days are longer. At the same time, he hasn’t really built up emotional regulation skills yet. So he is likely functioning with a very large skills gap between what he is currently capable of and what is being demanded of him.
His lack of self-confidence around challenging tasks, plus the big emotional outbursts, also made me think about Rejection Sensitivity Dysphoria, often linked to ADHD, which could fit Malik’s profile.
Coming Up
Follow along over the next three weeks to learn more about Malik’s executive functioning challenges at home and at school. We’ll talk about the executive functioning accommodations that have and haven’t worked in both environments and explore some new ones to try. We’ll also unpack what’s underneath his big angry explosions, including something Malik said to his mom that was actually a huge green flag for his emotional regulation skills.
And don’t forget, if you like what you’re reading, please let me know. It truly makes my day hearing from real readers. If you think someone else would benefit from this information, please encourage them to subscribe.
PS, don’t forget, you can always catch up on previous case studies here.
Disclaimer: These case studies are inspired by real-life clients I have worked with, with permission from their parents to share. Some aspects of the case are authentic, and other details are added to include more variability for our discussions. None of the strategies and advice here substitutes medical advice, diagnosis or intervention with an Occupational Therapist.
If you're reading this before March 6th 2026, I wanted to let you know that my popular group coaching program for parents, Sensory Detectives BootCamp (SDBC) is open for enrollment. Doors won't open again until 2027, so learn more about it here.
Continue learning from me:
Responses