What is Executive Functioning (EF)?
It is a set of mental skills or thought processes that help a person to get things done. EF includes tasks that help us learn new info, remember and retrieve info we’ve learned in the past, and use this info to solve problems of everyday life. Executive functions are produced and managed in the frontal lobe of the brain. There are two types of EF: Organization and Regulation. Organization is the gathering of info and structuring it for evaluation. Regulation is the taking stock of your surroundings and changing behaviors in response to that info.
There are many skills that are part of EF and we typically don’t even think about doing them. For those who do have EF disorders/delays, it takes much effort, training, and accommodating. These skills and tasks include:
Initiate: Beginning a task or activity.
Impact of difficulty: May have trouble getting started on homework or independent tasks.
Inhibit: Not acting on an impulse or stopping one’s own inappropriate activity at the proper time.
Impact of difficulty: May have trouble stopping negative behavior or acts without thinking.
Shift: The ability to move from one situation, activity, or aspect of a problem to another as the situation demands.
Impact of difficulty: Can get stuck on a topic or tends to perseverate on ideas or actions.
Plan: Anticipating future events, setting goals, and developing appropriate steps ahead of time to carry out an activity.
Impact of difficulty: May start assignments at the last minute; does not think ahead about possible problems.
Organize: Establishing or maintaining order in an activity or place; carrying out a task in a systematic manner.
Impact of difficulty: Often has a scattered or disorganized approach to solving a problem; is easily overwhelmed by large tasks or assignments and unsure where to begin.
Self-monitor: Checking on one’s own actions during, or shortly after finishing the task or activity to ensure appropriate attainment of goal.
Impact of difficulty: Unlikely to check work for mistakes; is unaware of own behavior and its impact on others.
Working memory: Holding info in the mind for the purpose of completing a specific and related task.
Impact of difficulty: Trouble remembering things, even for a few minutes; when sent to get something, forgets what he or she is supposed to get.
Emotional control: Modulating/controlling one’s own emotional response appropriate to the situation or stressor.
Impact of difficulty: Is easily upset, explosive; small events trigger a big emotional response.
If a child has Executive Functioning Disorder or delays, it does not mean that all of the above mentioned skills and tasks are negatively impacted. A child may be delayed in one skill or all skills.
Since there are many other diagnoses associated with EF skills, such as, ADD, ADHD, Autism Spectrum Disorder, and Traumatic Brain Injury, many tend to look at the larger diagnosis and not look through the EF lens. This can lead to missed opportunities to assist a child with gaining independence and confidence. Often times a child may be called “lazy” (which I am not a fan of that adjective at all), when really they have EF difficulties and are unable to plan out how to do something.
What to do?
Here are some great tools to help a child that may be experiencing EF difficulties:
1. Rationale: When a child learns new skills, provide the rationale behind them or things like planning for the task might feel like a waste of time.
2. Outline steps: Support the child by defining the steps involved in tasks ahead of time to make a task less daunting and more achievable.
3. Use aids: Use tools like timers, computers, iPad, or watches with alarms.
4. Visuals: Prepare visual schedules and review them several times a day.
5. Provide 2 types of information: Provide the child with written (or visual) instructions as well as oral instructions.
6. Create checklists and “to do” lists, estimating how long tasks will take. Use checklists for getting through assignments. For example, a student’s checklist could include items such as: get out pencil and paper; put name on paper; put due date on paper; read directions.
7. Use calendars to keep track of long-term assignments, due dates, chores, and activities.
8. Improve working environment: Assist the child to organize their work space and minimize clutter and distractions.
9. Establish routines to try to consolidate skills and memory of what needs to be done.
10. Cut and paste projects requiring multiple steps in which they must complete tasks in a sequential manner.
11. Mind mapping to assist the child to get ideas down on paper strategically.
12. Games: Planning and problem solving games such as puzzles or games like ‘Go Getter’ (River & Road game).
13. Lotus diagrams: Use lotus diagrams with the child to help with structuring thoughts on paper whilst creating clear expectations as to how much to write.
14. Block building: Get the child to copy block designs from a picture or a 3D model.
15. Drawing: Draw a picture as a model. Then draw an incomplete version of the same picture and ask the child to finish the picture to make it look like the model.
16. Practice goal setting with the child (e.g. Help the child to set attainable goals that are well-defined). Break goals down into smaller steps and talk about alternative approaches with the child.
17. Recall games that require the child to recall information such as Memory: “I went to the shops and bought a…”
18. Multi-tasking: Practice doing a number of activities at once (it may be helpful to number the activities) to encourage the child to learn to shift from one activity to another.
-Madonna Smith, OTR, LLA Therapy
Heidi Cramm, Terry Krupa, Cheryl Missiuna, Rosemary M. Lysaght, Kevin C. H. Parker; Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy With Children and Youth. Am J Occup Ther 2013;67(6):e139-e147. doi: 10.5014/ajot.2013.008607