Therapeutic Strategies to Help Children with Executive Functioning Difficulties
Executive functions (EF) are a set of cognitive skills required for self-regulation and are comprised of skills such as working memory, self-control, and mental flexibility. Children who struggle with executive functioning often have low self-esteem and feel like they are failing in daily activities at home and school.
As therapists, we must support a child’s confidence through therapeutic interventions that address these essential skills. The interventions we use should be targeted to build on the child’s strengths, and help them identify what they enjoy doing to help them grow their EF skills so they can flourish at home and school.
The Role of Executive Functioning Skills
EF skills play an essential role in children’s everyday life by enabling them to remember daily self-care routines, learn in school, and socially engage with friends. Children are not born with EF skills, but rather develop these through experience and practice, as they grow from infancy through early adulthood. Studies show that children with attention deficit hyperactivity disorder (ADHD) and children with sensory processing disorder (SPD) experience more challenges with executive functioning than typically developing children.1,2
Real-world difficulties with executive functioning might look like:
- Problems with perseverance & initiating or completing tasks
- Difficulty maintaining focus
- Poor time management
- Challenges with following directions and/or sequencing
- Decreased self-regulation
Exploring Therapeutic Interventions for Executive Functioning
A variety of interventions can be implemented into therapy practice to help facilitate EF skills while also working on a child’s foundational motor and sensory skills. Consider integrating board games into your practice. Board games are excellent tools to aid in the development of fine motor skills, social skills, turn-taking, as well as important EF skills.
Different board games address different skill sets in the following ways:
- Strategic board games develop problem-solving skills
- Chess develops focusing skills
- Spelling board games develop planning and organizing skills
- Games with timers develop time management skills
- Block games develop sequencing skills
Some common therapy activities you may already utilize in your practice, such as puzzles and crafts, can easily be used to work on EF skills.
Therapy activities can be employed to develop different executive functioning skills in the following ways:
- Crafts develop flexibility skills, as well as the ability to initiate and complete tasks
- Puzzles develop problem-solving and perseverance skills
- Card games (such as “Memory” and “Go Fish”) develop the working memory
- “Find the Hidden Picture” activities develop working memory and prioritization skills
- “Color-by-Number” activities develop focus and organization skills
Both EF skills and self-regulation skills depend on three types of brain function: working memory, mental flexibility, and self-control. These functions are highly interrelated, and the successful application of executive function skills requires them to operate in coordination with each other.3 Helping children develop self-regulation by teaching them sensory strategies is vital to enriching EF skills.
The following strategies can be used to promote both sensory self-regulation and executive functioning skills:
- Deep relaxation breathing techniques
- Yoga poses
- Progressive muscle relaxation
- Physical activity
- Exposure to nature
The Connection Between Executive Functioning Skills and School Success
Children are dependent upon EF skills to achieve academic success in school.4 They help children remember and follow multi-step instructions, avoid distractions, control rash responses, adjust when rules change, persist at problem-solving, and manage long-term assignments.
There are a variety of effective school accommodations and modifications that can help students who struggle with EF, such as:
- Breaking tasks down into small steps for sequencing
- Simplifying instructions for perseverance
- Providing color-coded binders for organization
- Allowing the student to get up and move to help with focus
- Using a visual timer for time management
Explore which strategies work best for each student and the environment in which they learn.
To learn more about working with children that struggle with executive functioning, particularly those with ADHD and SPD, I offer this course for pediatric occupational therapists that will help you identify executive functioning skill deficits and learn how to implement practical takeaway strategies to help children and youth with success in childhood occupations.
- Brown, T., Swayne, E., & Mármol, J. M. P. (2021, January 31). The relationship between children's sensory processing and executive functions: An exploratory study. Taylor & Francis. Retrieved February 23, 2022, from https://www.tandfonline.com/doi/full/10.1080/19411243.2021.1875386?scroll=top&needAccess=true
- El Wafa, H.E.A., Ghobashy, S.A.E.L. & Hamza, A.M. A comparative study of executive functions among children with attention deficit and hyperactivity disorder and those with learning disabilities. Middle East Curr Psychiatry 27, 64 (2020). https://doi.org/10.1186/s43045-020-00071-8
- Harvard University. (2019, February 22). A guide to executive function. Center on the Developing Child . Retrieved February 15, 2022, from https://developingchild.harvard.edu/guide/a-guide-to-executive-function/
- Cortés Pascual, A., Moyano Muñoz, N., & Quílez Robres, A. (2019). The relationship between executive functions and academic performance in primary education: Review and meta-analysis. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01582