From Elementary to College: Executive Functioning Challenges and Supports for Twice-Exceptional Learners

A student can understand complex concepts yet forget to submit homework, have sophisticated ideas but struggle to put them on paper, or earn A’s while barely managing the demands behind those grades.

This is common among twice-exceptional (2e) learners, students whose advanced abilities coexist with learning, attention, or developmental challenges. Their strengths can mask their struggles, and their struggles can hide their strengths.

As students move from elementary school to college, executive function demands increase while adult support gradually decreases. The student may not have changed, but the demands have.

The four case studies that follow come from our work as educational therapists. They show how these challenges can emerge at different stages of development and why having a skill is not always the same as being able to access it independently and consistently.

Case One: Elementary School (Ethan)

I began working with a fourth-grade student I’ll call Ethan. His family wanted support with executive functioning, math fluency, and written expression, and executive functioning was their biggest concern.

Ethan was bright, curious, creative, and full of ideas. He enjoyed reading, art, music, games, and building things, and he could become deeply engaged when something captured his interest. During one of our early logic activities, he got distracted and started drawing on the whiteboard. Once the puzzle caught his attention, however, something shifted. He began developing his own strategies and progressed from solving a three-digit code to a seven-digit one.

Yet everyday school routines could be surprisingly difficult. Starting work often required repeated prompting. Reference sheets disappeared. Multistep directions could break down, and a strategy he understood one week might be hard to retrieve the next.

That was the puzzle with Ethan: he was clearly capable, but he could not always access that capability independently or consistently.

Strengths and Discrepancies

Ethan’s formal testing reflected many of the strengths I saw in our sessions. In a quiet, structured, one-to-one setting, he showed good attention and impulse control, and his visual working memory was particularly strong.

Everyday life told a somewhat different story. Parent ratings showed significant difficulties with getting started, maintaining focus, organizing himself, and accessing information when he needed it.

One memory finding captured this discrepancy especially well. After a delay, Ethan’s unaided recall was at the 7th percentile. With meaningful cues, his recall rose to the 84th percentile.

The information was there. Accessing it on his own was the challenge.

Writing showed a similar pattern. Ethan could generate ideas and build sentences, but longer written tasks were much harder. Handwriting and visual-motor demands added another layer of effort, so the mechanics of writing could get in the way of expressing what he knew.

His performance also shifted with context. Interest, anxiety, fatigue, cognitive load, and the amount of structure around him all affected how independently he could work, as well as his emotional regulation and executive functioning. When he was dysregulated, he could not reach the skills he had, and the resulting cycle of frustration led to frequent meltdowns.

For parents and teachers, that inconsistency can be confusing: If he did it yesterday, why can’t he do it today?

Ethan’s profile led us to a more useful question: What was different about the conditions in which he succeeded?

Tools and Strategies That Helped

With Ethan, I began thinking less about how to make him “remember better” and more about what we could move out of his head and into his environment.

We created predictable places for materials, visual checklists, reference sheets, sticky-note reminders, and a routine for putting completed homework directly into his backpack. These supports reduced the amount of information he had to hold in working memory.

We also taught metacognition explicitly. I used Dr. Liz Angoff’s idea of “highways” and “construction zones” to help Ethan recognize that some things came easily to him, while others took more time, more effort, or a different route. Instead of being told to “focus” or “try harder,” he began learning to notice what helped him learn.

Academically, we built on his strengths. Drawing on David Berg’s Making Math Real approach, we made math more visual and hands-on through patterns, games, structured reference sheets, the 9 Lines approach, prime factorization strategies, divisibility rules, and visual fraction models, always offering more than one way into a concept and more than one way to solve a problem. For writing, Dr. Bonnie Singer’s Brain Frames helped him organize his ideas, and voice typing eased the burden when handwriting got in the way of putting those ideas on the page.

When anxiety or frustration made thinking harder, movement, breathing, sensory tools, and short breaks became part of the learning process rather than something separate from it.

Over time, Ethan took a more active role in choosing strategies, estimating how long tasks might take, monitoring his attention, and recognizing when a tool such as voice typing could help.

Ethan’s case raises an important question for the elementary years: When a bright child appears to be managing well, how much is the child managing independently—and how much executive functioning are the adults and structures around them quietly providing?

The goal is not to pull those supports away too early, but to help the child gradually understand why they work so that, eventually, the child can choose and use them independently.

For a twice-exceptional learner, the shift from judging performance to understanding one’s own learning profile may be one of the foundations of real independence.

Case Two: Middle School (Neil)

Middle school can be a turning point for twice-exceptional students. Suddenly there are more teachers, more assignments, and more places to keep track of things—and far fewer adults making sure everything gets where it needs to go.

Neil was a middle school student who had already been diagnosed with ADHD when I began working with him. He was bright, funny, social, and curious, with a particular interest in science, engineering, chess, sports, and anything he could build or figure out. He was also doing well academically, which made some of his struggles easy to overlook.

Behind those grades, though, was a great deal of effort. Neil could complete an assignment and forget to submit it. Papers and notebooks disappeared. Studying often meant rereading rather than checking whether he could actually recall the information. Writing and spelling were especially frustrating.

A later evaluation helped explain why. In addition to ADHD, Neil had dyslexia and significant difficulties with written expression and handwriting. His profile was remarkably uneven: his visual-spatial reasoning and working memory were at the 93rd percentile, while his processing speed was at the 6th percentile.

Strengths and Discrepancies

Those numbers reflected the Neil I knew. He could understand complex concepts and think analytically, but getting that thinking onto paper could be painfully slow. His broad reading comprehension could look perfectly adequate, while reading accurately and efficiently was much harder. He could earn A’s and still lose a notebook or forget the final step of turning in completed work.

This is what can make a 2e middle schooler so confusing to adults: the student is capable, and the struggle is also real.

Neil’s strong reasoning had helped him compensate for weaker skills. But middle school was asking him to manage more of the learning process himself, and intelligence alone was no longer enough.

Tools and Strategies That Helped

Our work focused less on telling Neil to “be organized” and more on giving him systems he could actually use.

We set up consistent homes for papers and digital files and used the SPACE framework from SMARTS Connect (Sort, Purge/Prioritize, Assign, Containerize, Evaluate) to make organization a process rather than an expectation. We also looked closely at where assignments were getting lost. If Neil finished something on the computer but forgot to print, pack, or submit it, the problem was not the assignment itself but the final executive function steps.

Studying changed too. Instead of simply rereading his notes, Neil practiced encoding, retrieval, and re-encoding: learn it, try to recall it without looking, then reorganize it in a new form. We leaned into his visual strengths with Brain Frames, graphic organizers, formula sheets, acronyms, and visual summaries. Typing and dictation helped separate his strong ideas from the handwriting and spelling difficulties that could get in their way.

Over time, Neil took on more responsibility for choosing and managing his own strategies. He maintained strong grades, earned a 97% on a math final, and eventually needed coaching less often.

Neil’s story captures something important about the middle school years: success can hide struggle just as easily as struggle can hide ability.

The goal was never to make Neil perfectly organized. It was to help him understand, “This is where I get stuck, and this is what I can do about it.” That self-awareness would prove more valuable than any color-coded binder.

Case Three: High School (Hanna)

By high school, the demands compound. The workload grows, the scaffolding thins, and the social stakes of looking different are at their highest. For a student who has been masking since elementary school, this is often when the cost finally comes due.

In 2021, I got a call from the parent of an extremely bright, extremely anxious 16-year-old I’ll name Hanna. A private assessment at age ten had identified ADHD and high anxiety alongside a gifted-range IQ. By the time I got that call, Hanna was refusing to go to school. The question was no longer about her grades; it was whether she would graduate at all.

We met online during the pandemic, and we spent our first sessions playing games. The games had a purpose: when a child’s nervous system is stuck in fight-or-flight, no amount of academic support will land. It helped her build a relationship of trust with me and regulate her nervous system. After three months of biweekly sessions, Hanna finally told me how she felt about school. Soon afterward, she moved to a private, one-on-one school setting, and we could begin building skills.

As I got to know her, I saw a girl with real strengths who masked constantly, badly wanted to fit in, and was frightened of her peers. I suggested her family to seek an updated evaluation, which found that she was autistic. Autism research has historically centered on boys, so her presentation was easy to miss. Bright girls are often very good at appearing typical at school, and keeping up that performance takes its own toll.

When I asked Hanna how she felt about the diagnosis, she said she was relieved. It explained a lot, she told me, and it did not surprise her at all.

Strengths and Discrepancies

Hanna had a lot going for her. She had a high IQ, with particular strength in math and engineering. She was a sharp critical and analytical thinker and a creative, out-of-the-box problem solver. She was deeply curious about science and history, and she loved animals; just by talking with her, I learned a great deal about many different species. All of this kept her reading and learning.

At the same time, rigid thinking, weak working memory, slow processing speed, difficulty with social communication, and severe writing anxiety kept her from getting things done and wore down her self-esteem. Even opening her laptop could feel frightening.

Writing was the flashpoint, as it often is. Writing asks a student to organize language, hold ideas in working memory, switch between tasks, and use several skills at once. On top of that, the finished piece has to make sense to someone else, and in school it is usually due quickly, which adds even more pressure.

Tools and Strategies That Helped

Hanna showed features of pathological demand avoidance (PDA). Even small demands she wanted to meet could trigger intense resistance, so we lowered the demand itself. I used declarative language instead of instructions (“I wonder what would happen if…”), offered her real choices, and let her lead each session. From there, we built a toolkit:

• Sketch notes and storyboards to take the load off her working memory (she was a strong artist)

• Brain Frames to help her organize language before drafting and reduce cognitive fatigue

• Writing tasks broken into pieces so small that, on some days, success meant a single word

• Nervous system regulation before any hard task

• Built-in time to decompress during and after school, so she could recover instead of burning out

No single provider could cover all of this. We built a team that included her teachers, a school administrator, a therapist, and later a speech-language pathologist. I served as case manager so that everyone’s efforts supported one another instead of pulling in different directions. Most importantly, her parents were full members of that team, not just people who received updates.

Hanna graduated and took a gap year to build functional living skills. She was accepted to an Ivy League university and now lives on her own, far from home. She still has challenges, as we all do, but she is a capable, successful adult.

Case Four: The College Transition (Zach)

Zach’s mother first reached out with concerns about her 22-year-old son’s academic and social functioning at college. Because Zach was an adult, I explained that the decision to pursue services would need to be his. He scheduled a consultation and described difficulty prioritizing tasks, managing his time, exercising, and keeping up with daily routines. He also mentioned that he occasionally forgot to refill his ADHD medication. He did not see any academic challenges and said he enjoyed his classes, so we began with practical executive function strategies to support his independence.

Zach had been diagnosed with ADHD and generalized anxiety disorder in middle school, but neither had held him back; he graduated from high school without difficulty. Then, away from the structure of home and school, he slept through classes, stopped attending, failed every course, and was dismissed. He moved home and reapplied to a college in his home state.

Beneath the Surface

Zach’s collapse was never about ability. What looked like a student who had stopped trying was actually a collision of executive function deficits, unaddressed anxiety, and a new environment without the scaffolding that had quietly been doing much of the work all along—work that no one, including Zach, could see. That is the risk unique to this stage. Supports do not thin out gradually, as they do through middle and high school; they end all at once.

Rejection sensitive dysphoria made it hard for Zach to start conversations, including the ones in which he most needed help. He was also managing Cushing’s disease along with his ADHD, and he arrived with low self-esteem and a harsh inner narrative built on “lazy” and “should have, could have, would have.”

Tools and Strategies That Helped

Our work centered on building habits. We used micro-habits from BJ Fogg’s Tiny Habits and James Clear’s Atomic Habits so that change did not depend on willpower, the Pomodoro Technique to lower the cost of getting started, and Christine Miserandino’s Spoon Theory to help him track and communicate his energy on harder days.

Ongoing self-compassion work helped Zach separate his worth from his output, so he could see rest as something he needed rather than as being lazy. We built a multidisciplinary team centered on his autonomy and included parent coaching to help his parents keep him engaged on days that felt hopeless. A service dog gave him daily, concrete evidence of how responsible and attuned he really was, which directly contradicted the story he had been telling about himself.

Zach finished the semester with high grades, found summer work, and moved into his own place, where he now cooks, cleans, and takes care of his room. Along the way, he also started anxiety medication and therapy, which helped him move forward.

What the Four Cases Teach

The profile does not change; the exposure does. Across the four stages, the same underlying gap meets a different level of outside support: heavy in elementary school, thinning through middle and high school, and gone in college. That is why a student can do well for years and then suddenly fall apart, even though nothing about the student has changed.

Competence is camouflage. Waiting for a 2e student to fail visibly before looking more closely is a costly strategy at any age, and the longer it goes on, the greater the toll on the student’s well-being.

There is no fairy-tale ending. Progress came from consistent support, small changes that added up over time, and accepting that each student’s timeline is different. 

The relationship is the intervention. Trust is what gives a student enough safety to drop the mask, whether they have been hiding their struggles behind competence, humor, withdrawal, or meltdowns, and to begin the deeper work of self-acceptance.

When a bright student cannot start an essay or get to a 9 a.m. class, the instinct (theirs and ours) is to reach for a character explanation: lazy, unmotivated, not trying. Every student we have worked with had internalized some version of this negative self-talk long before anyone said it out loud.

The answer is not to lower expectations, but to name the situation accurately: “This is a skill I’m still building, and I can’t do it yet.” That framing points toward the support that will actually help, and it keeps the child’s sense of self intact while the skill develops.

About the Authors

Maayan Glaser-Koren and Jasleen Kaur Monga are educational therapists and executive function specialists at Educational Therapy LLC (www.educationaltherapyllc.com) and Unicorn Minds (www.myunicornmind.com). They have spent years supporting children and adults with learning differences, ADHD, and autism spectrum disorder (ASD).