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organisation-executive-functioningWhat is executive functioning?

Executive functioning is a process of higher brain functioning that is involved in goal directed activities. It is the part of the brain that enables people to make decisions and direct attention to a range areas in order to be successful in in a  more wholsitic goal. It is similar to an executive of a company who plans out how the resources of the company will be used, decides what the priorities are, decides what direction things will take in the long term and decides what to do when there is conflicting information. This is a process of understanding the concept that all actions cause a response or have a consequence. For most people executive functioning occurs without conscious thought and we improve as we mature. For some, however, they require explicit guiding to develop appropriate strategies to overcome their lack of innate functioning. Executive functioning deficits are not a diagnosis in themselves, but they make any other diagnosis that much more difficult to address.

 

Why is executive functioning important?

The skills involved in executive functioning allow us do the following:

  • 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.
  • Organise: 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 disorganised 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 information 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.

 

What are the building blocks necessary to develop executive functioning include:

Executive functioning is in fact the underlying skill for many other areas of development and as such there are no other building blocks relevant. There are, however, important key concepts that help develop executive functioning skills that all parents and carers should be aware of.

 

How can you  tell if my child has problems with executive functioning

If a child has executive functioning difficulties they might:

  • Have difficulty with goal setting
  • Show little awareness of the process involved in how things happen.
  • Have difficulty getting started on a task.
  • Live in the current moment and not think for the future or about consequences.
  • Be unable to reflect on past experiences to plan for the future, resulting in discipline measures producing little change.
  • Use the same strategy to solve a repeated problem, even if proven ineffective.
  • Change from impulsive to rigid rapidly, often when there is an increase in anxiety.
  • Have difficulty adapting to change.
  • Rarely match a strategy to a problem.
  • Have low self esteem and is unrealistic about their abilities.
  • Have difficulty overriding an emotion in order to behave appropriately.
  • Locate the source of their troubles outside their control.
  • Have a low tolerance for failure.
  • Skip steps in a procedure and is baffled when the outcome is not reached.
  • Have difficulty putting a sequence of steps in order or realising there are sub goals in a task.
  • Have difficulty shifting perspectives.
  • Need prompting to consider the feelings of others.
  • Fail to see the ‘big picture’ of a task or situation.

 

What other problems can occur when a child has executive functioning difficulties?

When a child has executive functioning difficulties, they might also have difficulties with:

  • Behaviour: The child’s actions, usually in relation to their environment or task demands.
  • Self regulation: The ability to obtain, maintain and change one’s emotion, behaviour, attention and activity level appropriate for a task or situation in a socially acceptable manner.
  • Social skills: Determined by the ability to engage in reciprocal interaction with others (either verbally or non-verbally), to compromise with others, and be able to recognize and follow social norms.
  • Academic performance: The ease with which a student is able to complete academic tasks.
  • Attention and concentration: Sustained effort, doing activities without distraction and being able to hold that effort long enough to get the task done.

 

What can be done to improve executive functioning?

  • 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.
  • Outline steps: Support the child by defining the steps involved in tasks ahead of time to make a task less daunting and more achievable.
  • Use aids: Use tools like time organisers, computers, ipads, or watches with alarms.
  • Visuals: Prepare visual schedules and review them several times a day.
  • Provide 2 types of information: Provide the child with written (or visual) instructions as well as oral instructions.
  • 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.
  • Use calendars to keep track of long-term assignments, due dates, chores, and activities.
  • Improve working environment: Assist the child to organise their work space and minimise clutter.
  • Teacher meetings: Meet with a teacher or supervisor on a regular basis to review work and troubleshoot problems.
  • Establish routines to try to consolidate skills and memory of what needs to be done.

 

What activities can help improve executive functioning?

  • Cut and paste projects requiring multiple steps in which they must complete tasks in a sequential manner.
  • Mind mapping to assist the child to get ideas down on paper strategically.
  • Games: Planning and problem solving games such as puzzles or games like ‘Go Getter’ (River & Road game).
  • 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.
  • Block building: Get the child to copy block designs from a picture or a 3D model.
  • 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.
  • 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.
  • Recall games that require the child to recall information such as Memory: “I went to the shops and bought a…”.
  • 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.

 

Why should I seek therapy if I notice difficulties with executive functioning?

Therapeutic intervention to help a child with executive functioning is important to:

  • Reduce behavioural problems due to stress and anxiety.
  • Allow children to develop the foundation skills that allow academic success to come more easily.
  • Make daily life easier for the entire family as everyday activities can become difficult (if not impossible) when a child can not copy with change, resulting in negative affects on all family members.
  • The earlier difficulties with executive functioning are address the easier it is to make change.
  • Executive functioning is a learnt skill in which some need more modelling and assistance than others. Only with the right guidance will they develop these skills.

 

If left untreated what can difficulties with executive functioning lead to?

When children have difficulties with executive functioning, they might also have difficulties with:

  • Making friends and poor self-esteem.
  • Inability to cope with the demands of school or life.
  • Poor work and organisational habits.
  • Frequently loosing track of personal items.
  • Poor academic results.
  • Not completing school work or daily chores in a timely manner.
  • Having grandiose ideas of what they wish to achieve but not being able to achieve it pragmatically.

 

What type of therapy is recommended for executive functioning difficulties?

If your child has difficulties with executive functioning, it is recommended they consult an Occupational Therapist.