What is Executive Functioning (EF) and how does it impact so many skills?
I have always been fascinated by the work of occupational therapists and I am so excited because this post is a collaboration with Katie Zelinski of The Well Balanced OT. Executive Functioning (EF) includes our ability to:
plan
organize
problem-solve
control our impulses
attend
develop working memory
regulate emotions
sequence
A small area of the prefrontal cortex houses our executive functioning system. It’s an underdeveloped system at birth, gradually strengthening as we age and are exposed to a variety of experiences, strategies, and learning opportunities.
Have you ever wondered why our 5-year-olds need guidance solving their simple problems, our school-aged kids have trouble attending to seated classwork, or our teenagers engage in the riskiest behaviors? It’s because our Executive Functioning system takes years to develop. The system isn’t fully matured until in our 20’s, which leaves A LOT of time for mistakes and growth.
While challenges with executive functioning can be seen in isolation (such as a problem with working memory but no difficulty in other areas) you may have noticed that almost all our executive functioning (EF) skills are impacted with an ADHD (attention deficit hyperactive disorder) diagnosis. It’s been said that those with ADHD are generally about 30% behind their peers when it comes to EF skills (Barkley, 2021.) For example, you may have a 12-year-old, but they may function at an 8-year-old level.
Since the brain can only develop so fast, the sink-or-swim strategy with this population will not work. We cannot expect them to behave in a way that their brain is not yet capable of. As with all kids, we must meet them where they are and then slowly increase demands. So, what can we do? Caregivers, teachers, and other team members can offer emotional and visual support, adapt the environment, adjust our expectations, and set them up for success.
As an Occupational Therapist, I’ve found a few strategies that work very well with children with ADHD and those who struggle with Executive Functioning (EF.) Even though we can’t change the chemical make-up of the brain, we can offer support to help them feel more successful.
Without this support, many of these children often feel defeated and lost. They try the hardest that their brain will allow.
Sadly, they are often seen as behavioral problems in the classroom, which leads to feelings of embarrassment, if not disciplinary action. Some kids may “fall through the cracks” since they prefer silence over speaking up when they are confused. Others get labeled as the class clown because they would rather distract their peers from the real problem: they are drowning.
Top 5 Strategies to Help Children with Executive Functioning Skills
Here are 5 strategies to help kids with executive functioning skills:
1. Use Visuals
Working memory and attention are highly impacted with executive dysfunction and ADHD. Providing a visual for a daily schedule/routine, or explicit directions for a project or classwork, will help the student stay on task without frequently having to ask a classmate or teacher what is expected of them. Most kids won’t ask out of embarrassment, instead staring off or distracting themselves in non-productive ways. A big calendar at home and a planner for school will also be helpful to keep track of important dates and homework.
Provide a visual for daily schedule/routine
Provided a printed handout with explicit directions for classwork/project
Use a calendar or planner for all events and assignments
2. Set Up Organization Systems
Organization and planning can be a real struggle. Setting up systems from the start of the school year will help the child keep up with classwork and homework.
Use color-coded folders for each subject.
Make a laminated checklist attached to a bookbag or inside a pencil case that lists items that need to transition between home and school
Use pouches or cases to organize pencils, tools, and self-care items. Practice putting items in their home to reinforce the routine.
3. Provide Opportunities for Problem Solving:
The only way we get better at solving our problems is to practice it in a safe setting. Instead of telling the child no when they are doing something unsafe or provide them the answer to their problem, guide them through strategies to solve it on their own. Some of my favorite phrases include “How can we test if this is safe?” and “hmm, this reminds me of that time….”.
4. Set up a Quiet and Clutter-Free Workspace:
Controlling impulses is already a challenge. We are not setting them up for success if their work environment is cluttered, extremely colored or patterned, and just generally busy. What are the most impactful ways we can do this?
Push a work desk up against a wall to decrease visual stimuli.
Use headphones to muffle extraneous noises.
Limit use of pattern and color when decorating. Sticking to one color scheme is less visually distracting.
Decrease clutter from desk. Everything should have a home (and may need visual outlines to return there).
5. Teach Emotional Regulation Strategies:
The key to this is to do it when they are regulated. Imagine an already frustrated child who has trouble with impulse control and regulating their emotions. No matter how many times you tell them to take a deep breath instead, their body and brain cannot process your words and cannot implement the strategy because they are already in fight-or-flight mode.
Teaching self-regulation strategies when they are calm provides their brain a much better opportunity to learn.
Model what we want them to do.
Use characters in books or shows to talk about self-regulation strategies.
Have the family practice strategies throughout the day – this is good for everyone.
Check out Skills for Big Feelings for a comprehensive program for teaching emotional regulation strategies, and family handouts to send out.
You might ask: once they are successful can we start to pull back from these supports?
Well, it depends.
Some of these strategies are effective throughout a lifetime. We all use planners, a calendar system, or checklists. What would happen if someone tried to take that away from you? Likely you’d miss some appointments or feel a little lost. We all use visuals and organization systems to keep our life on track and, more importantly, to keep us sane.
Teaching our kids to set up their environment to be the most effective living and learning space is also an important life skill.
If I walk into my house and there is clutter everywhere, I immediately feel anxious. I’m currently sitting at a table with books, swim goggles, sunglasses, a college football schedule, and random papers. Am I focused? Not as well as I could be. Should I follow my own advice? Totally.
What we want to pull back from are those verbal supports. Slowly, as they become more independent with problem-solving we provide less verbal direction. This may be a hard one to ease up on, but trust that you have provided them with a lot of practice and modeling. They might make mistakes, but all kids do.
If you want to learn more, please check out Katie's resource guide: An OT's Guide to Regulation in the Schools.
How to Teach Self-Control Skills to Children in a Small Group Setting
Hunter and His Amazing Remote Control by Lori Ann Copeland is one of my favorite picture books of all time! I love this book so much that I even created a tier-2 ten week small group to help kids work on self-control. This group was completely inspired by this book and the companion resource! I find that this is THE perfect book for kids who struggle with executive functioning skills.
One of the things I like the most about the companion book is there are sections for “classroom language shifts” that I can share with the teachers to ensure they are using the same language in the classroom with the students.
I also share about the work that we are doing with the families so they can use the same language and reinforce the skills at home. As I wrote in my book, Skills for Big Feelings, "when families, counselors, teachers, or group facilitators work collaboratively together, by using the same language, modeling, and reinforcing the same skills, the child succeeds."
Here is an overview of the impulse control group activities. Remember, you can get lots of other free resources by subscribing to my free resource library at the top of this page.
In week one, I read the book to the kids. Each time we read about a new button (and skill that Hunter learns in the story), the kids take turns sticking that button onto my giant remote control with velcro. I created this giant remote control out of black cardstock, foam sheets, adhesive velcro dots, and I cut vinyl stickers with my cricuit for the words on the buttons. The kids also make their own remote controls in week one.
At each subsequent week, we review one new skill (button) per session. I start every group by reviewing our group agreements (expectations) and then I briefly re-read the pages that correspond with the skill for that week. Each week they also learn the “finger remote” for the weekly skill which is outlined in the companion book, The Amazing Remote Control Self Regulation Program.
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So, in week two we focus on the Channel Changer button. They draw pictures to reflect on when they can use the channel changer button at home and school and they do a Stroop Effect coloring activity from the companion book: The Amazing Remote Control Self-Regulation Program.
In week two, we learn about the Pause button by reading the pages from the book and reviewing the finger remote. We play freeze dance and play red-light green-light with an auditory version and then a more challenging visual version where I just point to the colors on this stoplight that I’ve printed out and laminated. We also play The Pause Game from the companion book The Amazing Remote Control Self-Regulation Program.
In week three, we learn about the Fast Forward button by reading the pages from the book and reviewing the finger remote. We practice with role play scripts from the companion book: The Amazing Remote Control Self-Regulation Program. I print out three versions of each of the scripts, highlight the various parts (narrator and two actors), laminate for durability, and pass them out to each of the students to act out. They have a lot of fun with these! They draw a picture and tell us a story about a time someone could have used their Fast Forward button.
In week four, we learn about the Rewind button by reading the pages from the book and reviewing the finger remote. We play The Game of Life (the kids absolutely love this because it looks like a video game!), The Should Cards, and The Rewind Detective all from the companion book: The Amazing Remote Control Self-Regulation Program.
In week five, we learn about the Slow Motion button by reading the pages from the book and reviewing the finger remote. We practice some gentle stretches and saying phrases in slow motion which is really fun! I have this yoga alphabet poster so we also use the letters to spell out our names by doing yoga poses. We then do a Slow Motion Egg Race, Quick Draw, 3-2-1 Breath, and How Would You Feel if... (we use this feelings visual poster that is in my free resource library) from the companion book: The Amazing Remote Control Self-Regulation Program.
In week six, we learn about the Coach button by reading the pages from the book and reviewing the finger remote. We do some of my affirmation mazes and then the Divide and Organize Task Cards from the companion book: The Amazing Remote Control Self-Regulation Program.
In week seven, we learn about the Zap button by reading the pages from the book and reviewing the finger remote. The kids use the Zap That Thought scenarios from the companion book and and we put them inside the head from What's In Ned's Head The kids take a shot in my indoor basketball hoop every time they zap an unhelpful thought.
In week eight, we learn about the Way to Go button by reading the pages from the book and reviewing the finger remote. We use the Strength Cards from the companion book: The Amazing Remote Control Self-Regulation Program. Each child writes their name in the middle of a paper, and then their peers pick out strengths for each other, and then they give the strengths to each other to arrange and glue onto their paper around their name. It is a really touching activity! We also create a positive fortune teller.
In week nine, we focus on self-control. We play the Someone Took my Remote Control! Game from the companion book: The Amazing Remote Control Self-Regulation Program and talk about how it felt to be controlled by someone else. We also use scenarios from the What's In My Control Activity from Skills for Big Feelings and the kids jump inside a hula hoop if it's something they have control over, or jump outside of the hula hoop if they do not have control over it. In week ten, we celebrate the ending of the group and playing a Jeopardy game to review all of the skills.
Using Books to Help Kids Increase Impulse Control and Executive Functioning Skills
I was so pleased to find the picture book Buckle Up: A Children's Imaginary Story about Self Control by Stephanie Scott and Olga Barinova because I am always looking for resources for children about self-control!
In this imaginative picture book, the child gets to drive on a road trip with a bird named Nini. There is so much positivity and great metaphors in this book: "stay calm and be alert at all times. Life may throw some curve balls, but together, we can conquer anything!"
There are so many strategies are sprinkled throughout this little gem of a book including breathing techniques, using a checklist, being aware of your surroundings, being prepared, communicating your plan to others, positive self-talk/encouragement, taking a break!
Here is a video social story I made to introduce kids to self-control.
I also wanted to share a few other bibliotherapy books with you that I have used to help work on impulse control (or self control) with children. Some of these books include:
My Mouth is a Volcano by Julia Cook
It's Hard to Be Five: Learning How to Work My Control Panel by Jamie Lee Curtis
Don't Squeal Unless It's a Big Deal by Jeanie Franz Ransom
Hands Are Not for Hitting by Martine Agassi (This is a go-to so I have the board book and paperback editions)
Words Are Not for Hurting by Elizabeth Verdick
Self-Control to the Rescue!: Super Powers to Help Kids Through the Tough Stuff in Everyday Life by Lauren Brukner
The Kids' Guide to Staying Awesome and In Control: Simple Stuff to Help Children Regulate their Emotions and Senses by Lauren Brukner
If you're looking for a training to learn some interventions to help children with ADHD< I want to recommend Creative Interventions for ADHD by Liana Lowenstein and Core Well CEU.
This blog was a collaboration with Katie Zelinski. Katie graduated from New York University with a masters in Occupational Therapy. She currently lives in Cleveland with her husband. You can find her on Instagram at @The.Well.Balanced.OT or visit her website: www.TheWellBalancedOT.com. She has additional training in Ayres Sensory Integration, Reflex Integration, Feeding, and TOTS.
References
Barkley, 2021. 7 Executive functioning deficits linked to ADHD. Additude Magazine. Retrieved from https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/