What Therapists Need to Know About Executive Function Skills

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Today I want to welcome Paige Hays of Paige Hays, Therapy Services to the blog. You are going to love the information she has to share with you today about what therapists need to know about executive function skills. Even if you aren't a therapist, this is helpful information, so keep reading! 


What is “executive function”?

It is a set of skills that are part of higher-level cognitive processes that develop in the frontal
lobes from infancy through young adulthood. It is more abstract than other cognitive functions
(such as working memory or visual processing), so it is hard to define and assess. Therapist
usually notice children struggling with more complex skills during daily tasks, such as the

  • Self-regulation (focusing attention, filtering distractions, controlling impulses, coping and
    calming skills)
  • Problem-solving (goal setting, making a plan and considering possible scenarios, sequencing steps, and following directions, organization, recognizing errors and correcting them, evaluating self-performance, achieving a goal)
  • Multitasking (prioritizing, remembering and working with multiple pieces of information)
  • Flexible thinking (switching approach to a task, considering new ideas or strategies, making choices and decisions, maintaining social interaction)
A therapist's guide to executive functioning, for occupational therapists, physical therapists and speech therapists.

Why should therapist care about executive function?

1. Studies are showing that executive functioning is a core deficit underlying most disorders of attention (for example ADHD), as well being a functional deficit in many other disabilities, including learning disabilities, behavior and mental health disorders, autism spectrum disorders, and other developmental disabilities.

2. Executive functioning is one of the strongest predictors of success for children long-term. Many studies have been done that show that executive functioning, specifically impulse control and emotional regulation skills, are predictive of positive outcomes.

3. Executive functioning can be a hard skill to work on for children due to how the brain processes this skill. Parents usually need additional insight and training to help their children achieve their potential for higher-level thinking skills.

How do executive function skills develop?

This is a really hard question to answer. Executive functioning is a newer area of research in cognitive psychology, and it is not fully understood. Most research is pointing to the idea that the frontal lobes are first used in self-regulation through the maternal-infant bonding cycle (an infant being able to calm with the care from an adult).

It then progresses through toddlerhood and the preschool years as a children learn to self-regulate their behavior (learning impulse control, body control, and emotion recognition). As childhood progresses, higher-level skill, emerge, such as problem-solving, multi-taking, self-correcting errors in work, and prioritizing and goal setting.

A therapist's guide to executive functioning, for occupational therapists, physical therapists and speech therapists.

For a complete review and handout on how executive function and self-regulation develop, please visit a post by Paige Hays, Therapy Services on What Parents, Teachers, and Therapist Can Do to Help In Everyday Life.

How can therapists help children strengthen their executive functioning skills?

It really isn’t about what you do, it is about how you do it. The basic principle of learning applies- “neurons that fire together, wire together.” However, executive functioning skills are diverse and broad, requiring a child to use many neural pathways in a variety of activities and environments. (Compared to more concrete skills, such as learning to write a name, where you are practicing a specific skill to strengthen a specific neural pathway.)

This makes learning these skills challenging (and probably why so many children struggle with them). You can’t just drill a specific skill, but instead, use teaching strategies that help to activate and utilize many neural pathways in the frontal lobes. The more often children use the “wires” to the frontal lobes, the stronger they become.

5 several specific strategies to promote executive functioning development during therapy tasks: 

1. Slow down. Give a child more time to explore and problem-solve during therapy sessions. We are often so focused on getting through our tasks, that we forget that each little experience is a learning moment. Allow time for children to think and process, give then chances to make decisions and choices, and allow time for mistakes and encourage self-correction.

A therapist's guide to executive functioning, for occupational therapists, physical therapists and speech therapists.

2. Give less structure and direction. As therapists, we know that providing high-level of structure (such as visual schedules and routines) and clear directions often help children be more compliant and participate more easily, but it doesn’t often challenge them to use higher-level skills. Provide the structure children need to be successful, but remember to find the “just right challenge,” as we often control too much in sessions and prevent the natural learning opportunities that could arise.

3. Allow mistakes and encourage self-correction. There is a huge learning benefit to making mistakes. It promotes self-regulation (staying calm when a mistake is made), problem-solving and flexible thinking (as well as attention to task and task persistence), and self-monitoring and correction ones’ own work or behavior. Allow time for mistakes and give children more control over fixing mistakes.

4. Implement and use a program for self-regulation development. There are several well know programs available. I would recommend checking with your local school district to see if they use a specific program for consistency for your clients. In my local area, The Zones of Regulation by Leah Kuypers is widely used by OTs. I good program should teach emotion recognition, body awareness and control, and provide a variety of strategies for calming or alerting, such as sensory, behavioral, and cognitive strategies (because children need lots of options to try as they learn self-regulation and self-calming

5. Teach parents strategies to use at home. Because executive functioning uses a variety of neural pathways, it can’t be taught and mastered in therapy sessions. Generalization is key. It needs to be part of all daily routines to really build strong skills, so parents need to be part of this process. I have outlined parent-friendly ideas for a therapist to model and teach parents to use at home, please visit a post by Paige Hays, Therapy Services on What Parents, Teachers, and Therapist Can Do to Help In Everyday Life.

Links to other posts by Paige Hays, Therapy Services, LLC related to executive functioning for children:

The 5 Best Answers to Your Child’s Questions (that encourage executive functioning skills)

Impulse Control: Home Activities and Games


Understanding Executive Functioning Issues from Understood

Center on the Developing Child at Harvard University. Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence.

Center on the Developing Child at Harvard University. Building the Brain's “Air Traffic Control System: How Early Experiences Shape the Development of Executive Function

BIO: Paige Hays is the owner of Paige Hays, Therapy Services which provides in-home, pediatric occupational therapy services in the south metro area of the Twin Cities, MN. She is a mother of 2 girls, an avid DIYer, and a highly skilled and experienced OT. She specializes in working in pediatrics, with diverse expertise ranging from cognition and sensory issues to working with children with neuromuscular disabilities or complex medical needs.  You can also find her on Facebook.

Follow Heather | Growing Hands-On Kids's board Occupational Therapy Tips on Pinterest.
What are the executive functioning skills? Plus get a free printable on Executive Function.

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Heather Greutman, COTA

Heather Greutman is a Certified Occupational Therapy Assistant with experience in school-based OT services for preschool through high school. She uses her background to share child development tips, tools, and strategies for parents, educators, and therapists. She is the author of many ebooks including The Basics of Fine Motor Skills, and Basics of Pre-Writing Skills, and co-author of Sensory Processing Explained: A Handbook for Parents and Educators.

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  1. This is a very interesting subject to me. I didn’t realize that studies are showing that executive functioning is a core deficit underlying most disorders of attention. I can see how executive functioning can be a hard skill to work on for children, but it seems like one that would pay off. Thanks for sharing this article.

  2. We had several years with a very professional and understanding OT, Amy Neilson, she fully understood the correlation of Executive Functioning and my son’s autism spectrum diagnosis. I love that this is being recognised more, you have totally validated Amy work with our son where we had been told this was junk by her teachers. My question to you is that we’ve just had our sons first and second MRIs and there are frontal lobe lesions present, if the neuron pathways are damaged is it possible for remapping to be done? We have worked and work on his EF skills but with limited headway.

  3. That should be his teachers

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