Many children and teens with CHD work harder than it appears to keep up with everyday demands. Even when medical issues are stable, attention and follow-through can be harder to sustain—especially at school, during homework, or when routines change.

This month’s focus is on understanding how attention and executive functioning can be affected in CHD, and on practical ways to support kids without assuming they “should be able to do more.”

You’ll find ideas below for different ages and situations—take what fits your family right now.

This section may be especially helpful if:

• your child seems capable but struggles to follow through or stay with things; they don't show or do what you think they know

• daily routines or homework take far longer than expected

For younger children (preschool–early elementary):

• Use first/then language with simple steps (“Let's put all Legos in the bin, and then have snack time”)

• Keep instructions short and add visuals when possible. Get their attention first. Try a visual schedule with photos (sequence for a bedtime routine).

• If your child shows you wiggles, fidgeting, and high activity - this is a signal that they need to release energy. Embrace and help them find ways to do this as appropriate for the setting or task. Making them "sit still" won't work.

For school-age children:

• Break homework into small chunks with short breaks. Don't allow a highly desirable task during a break (technology/screens) or the transition back may be a bigger challenge. Instead, breaks could involve a less demanding or more neutral task (snack, walk the dog).

• Try visual checklists with check boxes rather than verbal reminders. Kids like to to visually see their progress.

• Notice when effort drops—fatigue often looks like inattention. Pushing through cognitive fatigue or overwhelm may not be the solution. If homework is not getting done within reasonable time, talk to the teacher(s) and brainstorm (odd problems in math when overwhelmed?).

For teens and young adults:

• External supports (alarms, planners, shared calendars) are tools, not crutches. Help your teen find what works. Don't expect them to use the same system that works for you.

• Rather than expecting full independence right away, focus on helping your teen learn individual steps and routines. When there is structure and consistency, it's easier to follow through.

• Expect executive skills to mature more slowly than thinking abilities. Knowing something versus doing something are different. Get curious and talk with your teen to problem solve together. If they understand what they need to do but can't seem to actually do it, they are showing readiness for growth. Can you lower the expectations and slowly increase demands?

Children with executive function challenges are often told—directly or indirectly—that they’re not trying hard enough. Maybe they are seen as "lazy". Over time, this can affect motivation, confidence, and emotional wellbeing when the child believes their effort isn't good enough.

This section may be especially helpful if:

• your child seems to give up quickly

• your child describes feeling misunderstood

• you find yourself unsure how much to push vs. protect

For parents and caregivers:

• Assume effort before assuming avoidance. Believe that your child wants to please others, receive praise, and do the right thing. They want you to be proud.

• Separate skill challenges from behavior choices. Just because a child can do a skill sometimes does not mean they can do it all the time.

• Use curiosity-based language: “What made this hard today?” "What do you need from me?"

For children and teens:

• Naming challenges (“My brain gets tired”) reduces shame. Separate these challenges from their identity. They don't define your child. They are a small part of their whole, amazing self. Help them put things in context.

• Normalize using supports. Give them examples of how you use supports yourself to stay organized and attentive.

• If worry or stress have your child feeling stuck, talk with your care team. Anxiety can also show up as procrastination and avoidance of age typical things. Don't wait to see if things will get better because it can take time to find the right support. Start the conversation. Does your child need a (updated) neurodevelopmental evaluation?

Notes About the Newsletter: Each month’s newsletter highlights a few themes that commonly come up for families raising children with CHD. As your child grows and circumstances change, different topics may feel more or less relevant over time.

This newsletter is for educational purposes only and does not replace individualized medical or behavioral health care. For urgent concerns, contact your care team.