EXECUTIVE FUNCTIONING SKILLS

Executive Functioning skills guide everything we do.  From making decisions, to staying on track with an activity, to planning and prioritizing a task. The ability to make a decision, plan it out, and act on it without being distracted is what allows us to accomplish the most mundane of tasks to the more complicated and multi-step actions. These skills develop and become stronger during typical child development. Executive functioning deficits can occur in one area or across multiple areas. Executive dysfunction can interfere with independence and the ability to perform activities.

After allowing your child some time to transition back to school—-for many of them, this is a transition back to in-person learning after an extended distance learning experience. It is important to allow them some time to adjust to this big change—-if after a few weeks, you are seeing that they are struggling with the executive functioning aspects of their daily routine, or their teacher is reporting concerns, they may need some extra support to help them strengthen these skills.

As with any skill, executive functioning skills can be strengthened with practice and supported by accommodations. Executive functioning skills can be addressed in occupational therapy with recommendations made by the therapists to parents and to the teacher to assist with executive functioning at home and school. Smart but Scattered by Peg Dawson and Richard Guare is a wonderful resource to learn more about executive functioning skills and strategies to help support your child.

There are various ways to categorize executive functioning skills. According to the parent version of the BRIEF-2 (Behavioral Rating Inventory of Executive Functioning, 2^nd Edition), which is a questionnaire that we use here at Therapy at Play that assesses executive functioning in children 5-18 years old, there is a behavioral regulation component, an emotional regulation component, and a cognitive regulation component to executive functioning. This assessment breaks down these three areas even further.

Behavioral regulation

Inhibit: Ability to control impulses and to stop engaging in a behavior.

Self-Awareness: assesses awareness of the impact of one’s own behavior on other people and outcomes.

EMOTIONAL REGULATION

Shift: Ability to move freely from one activity or situation to another; to tolerate change; to switch or alternate attention.

Emotional Control: Ability to regulate emotional responses appropriately.

COGNITIVE REGULATION

Initiate: Ability to begin an activity and to independently generate ideas or problem-solving strategies.

Working Memory: Ability to hold information when completing a task, when encoding information, or when generating goals/plans in a sequential manner.

Plan/Organize: Ability to anticipate future events; to set goals; to develop steps; to grasp main ideas; to organize and understand the main points in written or verbal presentations.

Organization of Materials: Ability to put order in work, play and storage spaces.

Task-Monitor: Ability to check work and to assess one’s own performance

STRATEGIES AND ACCOMMODATIONS TO HELP BUILD EXECUTIVE FUNCTIONING SKILLS

1. Practice completing an activity start to finish: help them plan it, collect needed materials, do the activity, clean up, reflect: How did it go? Obstacle courses, a family member’s birthday party, cooking, and crafts are just a few ideas for activities to do this with. So often we only invite the child in for the “meat” of an activity part but then they miss out on all the planning etc. that goes along with it that are opportunities for executive functioning growth and fun.
2. Teach the concept of positive self-talk or “Inner Coach” to help improve their persistence. Have them make a positive self-talk bracelet with letter beads with saying like “I can do this”, “I am strong” so they have a constant reminder when they need encouragement. Books like “The Little Engine That Could” are fun ways to introduce the concept of positive self-talk too. Teach them positive self-affirmations to say to themselves daily or for use when needed (e.g. “I am brave.” “I am strong.” etc.)
3. Teaching them the power of a list. We use lists as adults to help us remember things. If you have a child who struggles with remembering things, teach them to make a list.
4. Activities that engage working memory: memory card matching games; games that require following 2-3 step directions; have them look at a busy picture for 1 minute; remove the picture, and then recall as many details as possible
5. Provide them with an example of what the finished product will look like: for kids with executive functioning deficits they often are unable to visualize the end product of what they are doing.
6. Help them break down bigger tasks into smaller ones: one big task can be overwhelming and may negatively impact initiation, planning/prioritizing, organization, self-monitoring, and attention. They might not know how to make a task more manageable. Help them to break it down into several more manageable ones.
7. Use of a timer
8. Using a visual schedule: can be detailed or general, in pictures or words
9. Help strengthen their emotional intelligence skills. Zones of Regulation is a wonderful curriculum to start teaching children about their emotions and sensory regulation arousal levels in a concrete way. Talk to your child’s OT if you are interested in learning more.
10. Help them to make reflection a habit. After they complete something, how did it go? What went well? What can go better next time? Mistakes are OK. It’s how we learn and become smarter.

Other considerations:

1. Identify your child’s strengths and weaknesses when it comes to EF skills
2. Know your own EF strengths and weaknesses
3. Capitalize on your child’s EF strengths while also addressing the weaknesses
4. Consider your child’s age/developmental level and make sure your expectations are appropriate
5. They will likely need to be TAUGHT in the skill areas that are deficient rather than expecting them to pick it up via observation or osmosis
6. Start with the external (changes made to the environment, task, or your interaction with your child) and then move to the internal
7. Use incentives to augment instruction
8. Provide just enough support for your child to be successful. Keep supports in place long enough for mastery and then slowly fade to help transition from external to internal.

Here at Therapy at Play our occupational therapists are qualified to treat executive functioning deficits. If you feel like you/your child needs additional support in this area, please reach out to us for an evaluation or if your child is already receiving OT services with us be sure to mention your concerns with your child’s treating therapist.