Interventions for Executive Functioning Challenges: Children, Teens, and Young Adults

Interventions for Executive Functioning Challenges: Children, Teens, and Young Adults

Questions often arise in consultations or assessments about strategies and interventions for children and young adults when executive functioning weaknesses are evident. Sometimes these challenges are in isolation, or they very commonly also overlap with other factors like anxiety and learning disorders. Interventions in school settings, such as preferential seating arrangements where both auditory and visual stimuli are optimal are essential. Extended time on tests, usually defined as time and a half on testing, is also a common recommendation as is a separate, quiet testing location either in small group or individually.

There are also instructional/educational modifications in the classroom that are very useful and typically recommended. The exact recommendations will vary depending on very specific information about a person’s overlying challenges and the patterns of strengths and weaknesses as defined from an evaluation:

• Checking with the student for their understanding
• Repeating things, paraphrasing, or simplifying instructions/directions/information
• Depending on areas of weakness, a child may need to avoid copying tasks if there are visual-spatial difficulties.
• Cues and markers on worksheets and assignments to highlight the student’s attention to particular tasks.
• Providing graph paper and lined paper for completing math exercises or other assignments where this strategy can be deemed useful.
• Providing handouts that are clearly written and providing oral instructions to reinforce written directions.
• Break long assignments into chunks and assign time frames for completing each chunk.
• Clear communication of rules, expectations, and consequences.
• Provide structure by explaining what is coming next “You have 3 more math tasks & then….”
• Capitalize on the person’s interests and hobbies to build motivation around tasks.
• Promote routines and schedules to meet deadlines.
• Consistent teacher guidance and positive feedback is effective. Sometimes simple behavior plan that offers rewards for such goals as working independently, starting class assignments promptly, staying on task, and working efficiently. The latter modifications in class can aid children in feeling successful.
• Allow the student to wear earplugs or noise-cancelling headsets during independent study.
• Provide notes in advance or a preview of notes so as to prepare before a new topic is introduced.

There are environmental modifications as well that can make a meaningful difference for optimal executive functioning abilities:

• Keep the work space free from extraneous distractions by removing all visual clutter that is not necessary to the task.
• Clear desk completely before beginning a task and remove all visual clutter from work space before assembling any materials needed for a task.
• Establishing and posting a daily agenda/to do list can be most helpful.
• Organize assignments that need to be completed in smaller steps instead of one large finished product.
• Applications for mobiles and desktops, such as Trello, help to organize tasks.

There are mindfulness and self-monitoring strategies for children, teens, and young adults who need support. These strategies teach the person how instead of multitasking or becoming overwhelmed with stimuli, to focus on one thing at a time and shift between activities. With reassuring guidance, they can practice doing one activity, stop, shift to the next one, and then maybe coming back to the first. Creating checklists with pictographs can help with self-monitoring and mindfulness of daily routines/schedules. Weekly/monthly print outs of the one’s schedule can also help focus on what is expected in the long term. Usually, self-monitoring strategies that involve mindfulness incorporate a rewards system whereby the person has feeback/positive reinforcement along the way for completing various steps of a larger project or assignment.

There are also approaches of direct instruction for executive functioning skills. Some learning specialists and tutors work explicitly as executive functioning coaches/teachers to support students in their learning (i.e., organizing school projects, maintaining focus to complete tasks, keeping school materials in order). Psychologists too may incorporate executive functioning skill-building in their treatment plans with people (i.e., planning schedules, learning how to apply strategies for staying organized). Cogmed, Lumosity, and other applications (i.e., Constant Therapy), special play-based approaches, and toys (i.e., Tetris, Katamino, Aftershock, memory games) can also be of use for building skills associated with executive functions (i.e., working memory, processing speed, attention/concentration, speed/fluency with tasks). Cooperative learning structures (group therapy) for social skills and other executive functioning skills are also a recommendation for some people. Teaching a student how to prioritize and address disorganized expressive discourse verbally may warrant the support of a speech and language therapist and if academics are impacted due to executive functioning differences (i.e., written expression and time management with larger projects) specialized tutoring would be beneficial.