Executive Functions

Are you raising a child who has trouble following directions?
Does it take your child a really long time to finish a task?
Are you often frustrated by how distracted your child becomes while he is supposed to be doing something "quickly"?
Does it seem like everything you say is going in one ear and out the other?
Maybe it is.

Executive Function is an umbrella term for the cognitive processes that manage, regulate and control other cognitive processes. In other words, Executive Function is the "office manager" of the brain. It is the brain's ability to manage learning and behavior. Many children on the Autism Spectrum have problems with Executive Function, though children who are not diagnosed with Autism can also be affected. When a child has impaired executive function, she won't be able to hold onto multi-step instructions. One of our 7 year old clients with this problem once described it (in his own words) like this:

"It's like there's a strainer in my head. You keep talking and telling me things, and it's all just falling through the strainer. I am trying to listen, but it's like I can't hear you."

Exactly how do Executive Functions (EF) work?  

And how can we alter what we do with kids who have impaired cognitive control? 

(1) Planning

Outworking a "plan" is a very common and natural process that most people develop in childhood. For children who have issues with EF, the process of creating a plan and working it out will be two very different things. It will often look like they are being impulsive or inconsiderate, but the fact is, they haven't developed the ability to think empathically. 

How can you help? Work with the child to overtly teach planning skills. For example, socially; If two children are playing a ball game together, running up and stealing the ball (in order to join in) would cause the other children to become upset. Looking at the game, seeing how it's being played and asking, "Can I play?" would be more likely to cause social success. 

(2) Working Memory

"Working Memory" is the system that actively holds multiple pieces of information in the mind, and figures out how to use (or discard) the pieces according to the situation. In other words, this contributes to the sentiment of the little boy's "strainer" quote. 

How can you help? Take a deep breath. Your child isn't being lazy or silly when he forgets what you've said. This can be very frustrating to an adult! You probably can't understand why it is so hard for your child to take in information, but just slow down everything you are saying. Present instructions in a FIRST/THEN/NEXT structure. 

(e.g. First eat dinner, then take your plate to the kitchen, next take a shower.) 

(3) Attention

Adults often overestimate a child's attention span. Enough said. 

How can you help? You can watch your child in various contexts and time how long she appears to be paying attention. If on average, she seems to be able to spend only 4 minutes listening to somebody speaking to a group of children, that is her current attention span. You can help by recognizing that is all she can do, but slowly trying to increase the span by providing environmental changes. At school, a child may be more attentive if they sit closer to the front. They may also benefit from sitting at the back and being allowed to move around while content is being taught. A "fidget" is a blanket term for a number of small items that can be held, manipulated and squeezed during direct teaching times, by children who may otherwise play with clothing, shoelaces or look out the window. 

(4) Problem Solving

Think about adult life - problem solving is undoubtedly one of the most important skills that you can develop. Childhood creativity is often birthed out of problem solving skills. If a child is conditioned to have problems to be "fixed" on their own, they will become less anxious when problems arise in life.

How can you help? Obviously a big part of problem solving is about planning. As planning is an issue with EF impairment, as a parent or teacher, we recommend that you regularly expose your child to safe versions of problems that require solutions. Build up your child's tolerance to unexpected situations, and make sure that he is the one developing and outworking the solution. At first, he may need some scaffolding, and you can provide a bridge for him through suggestion. It is so important to celebrate his efforts to make things right, by himself. 

(5) Verbal Reasoning

Your child may not understand what you are saying, the way you are saying it. Sounds complicated? 

How can you help? If your child seems to be taking everything you are saying at face value, totally literally or getting caught up in the semantics - take a moment to boil down what you are saying to its truest and most basic form. She may also be looking for loopholes in behavioral boundaries you are presenting. This can become very frustrating to adults, and sometimes this will be her version of cleverly disguised humor, but it is more likely that she is just hearing your words literally. By understanding that her processing is impaired, you will be able to alter your communication. 

(6) Inhibition

Kids with EF impairments may be extremely hilarious, because they lack inhibition. As a parent, caretaker or trusted adult, your job is to help your child understand when a certain behavior is inappropriate for the situation - because they will not realize it on their own. 

How can you help? When the child is acting in an unexpected way, try to help him by taking him aside to point out how the other children are behaving. Instead of making him feel bad about himself, help him with the empathic skills he hasn't yet developed. For a time, you may be like an external version of his self control, though it is a goal to transfer those skills to independence. 

(7) Mental Flexibility

If you change up a schedule, or throw an unexpected curveball at a child with EF impairments, you will notice that she will have a hard time accepting the change. You don't have to shield the child from changes, because real life involves curveballs. But you can help make them more palatable. 

How can you help? Firstly, understand that mental flexibility is a challenge for your child. The meltdown is not an attack at your inability to control the world, it is more of a coping mechanism from a child who is struggling to control anything in his world. Providing your child with daily schedules is a great tool, but also, creating some times where a "?" appears on the schedule is helpful in building up tolerance as far as mental flexibility goes. You can teach spontaneity through a schedule! And if you are brave enough, you can even start adding in some schedule changes in everyday life, to build your child's tolerance. Maybe once a day you can switch two items around, and  coach your child through the situation. 

(8) Task-Switching

Most people can go from one task to the next fairly seamlessly - think of it as "tabbed browsing" on a computer. Mental tabbed browsing is way too confusing for a child with EF impairments. 

How can you help? When one task finishes and another starts, be very specific about how the transition will play out. This will be very noticeable at school, when one subject ends and another begins. Saying "Get ready for Math" is very arbitrary, and may require a post-it note on the child's desk with the exact items he will need to have ready for Math. 

If you have more questions about Executive Function, or have sneaking suspicions that your child's EF development is delayed, contact an Occupational Therapist. If you are in the San Francisco Bay Area and are interested in behavioral services for your child, contact us on info@kahlonfamilyservices.com