Do you talk to parents about executive function? Many parents are not familiar with this term. The executive function (EF) skill set acts as a coordination center in the brain and depends on three main functions: working memory, mental flexibility, and inhibition control. 1 These crucial skills are needed to perform daily tasks, such as prioritizing, controlling impulses, filtering distractions, and accomplishing goals. Issues with executive function in children may look like:
- Trouble with organization
- Struggling with time management
- Difficulty with open-ended assignments or tasks and trouble starting tasks by themselves
- Inability to complete assignments efficiently
- Difficulty with memorizing or remembering rules2
Executive function involves goal-directed behavior that not only influences success in academic achievement and daily activities, but it influences success later in life through job skills, social skills, and independent living skills.3 If a child is having issues with executive function, it is important to intervene early in order to give this child every opportunity for success.
It is important to understand that children are not born with these skills, but they’re born with the potential to develop them.1 Adults aid in the development of a child’s executive function skills in various ways including: establishing routines, demonstrating social behavior, guiding children through modeling the use of executive function skills, and maintaining supportive, stable relationships.1 If parents notice executive function issues, they should begin intervention by making adaptations at home. Using charts, checklists, and schedules on a daily basis helps children build a routine and accomplish goals. Examples of home interventions include but are not limited to the following:
- For homework time: Set a specific time each day after school when the child will begin homework and designate a distraction-free area. This will help establish a routine and allow the child to focus on the tasks each day.
- For managing the day: Teach the child to use a daily agenda planner to promote organization.
- For getting ready for school: Create a morning routine with visual cues and reminders for each step of the process, such as brushing teeth, combing hair, putting on each layer of clothing, tying shoes, etc.
- For remembering instructions: Create a mnemonic to help with recalling multi-step instructions.4
Along with adaptations to daily activities, parents should also use scaffolding as a method to teach their children and guide them through tasks. Scaffolding is a learning technique in which the adult relinquishes control of a task to the child over time. The effectiveness of scaffolding hinges on the contingency rule: when the child struggles, the adult should increase the level of support provided, and when the child succeeds, the adult should gradually decrease the level of support.5 Scaffolding allows parents to adjust their support based on the child’s needs. For example, when teaching a child to brush their teeth independently, parents can use scaffolding to help their child achieve this daily skill. The parent may first start by brushing the child’s teeth for them and then slowly decrease their amount of help over time, from being prompted with cues to complete independence.
While scaffolding and daily home adaptations are effective beginning steps for early intervention at home, clinical intervention may be necessary if improvements are not seen. For a diagnosis, refer your patients to a neuropsychologist or a child psychologist. For ongoing treatment, you should refer patients to occupational therapists or speech therapists. Occupational therapists and speech therapists will work on the underlying issues with the child that are preventing the child from developing healthy executive function skills, as well as, work with the child and family to develop specific strategies that will most benefit the child.
1 Executive Function & Self-Regulation. Center on the Developing Child at Harvard University.
https://developingchild.harvard.edu/science/key-concepts/executive-function/. Accessed October 26, 2017.
2 Morin A. 9 Terms to Know If Your Child struggles With Executive Functioning Issues. National Center for Learning Disabilities. www.ncld.org. Accessed November 6, 2017.
3 Anderson M, Brydges CR, Fox AM, Reid CL. A unitary executive function predicts intelligence in children. Intelligence. 2012; 40(5):458-469. doi: 10.1016/j.intell.2012.05.006
4 Executive Function Interventions. Children’s Hospital of Philadelphia. http://www.chop.edu/centers-programs/executive-function-consultation-education-and-skills-excel-clinic/interventions. Accessed November 8, 2017.
5 Mermelshtine R. Parent-child learning interactions: A review of the literature on scaffolding. British Journal of Educational Psychology. 2017; 87(2):241-254. doi:10.1111/bjep.12147