Conference: Executive Functioning.

As mentioned, I recently attended the Annual Visions Of Community Conference sponsored by the Federation For Children With Special Needs. One of the three workshops I attended was called, "Executive Function Skills" and, it was, by far my favorite.

For those who may be unfamiliar, executive functioning is a term that refers to an array of cognitive functions associated with being able to generate and executive a strategy for managing unfamiliar or open ended tasks. Executive functioning skills include self regulation( or arousal, attention, and emotion) and task management skills such as organization, planning and self monitoring. Executive functioning also encompasses problems with cognitive organization.

The presenter, besides being obviously familiar with what exactly executive functioning is, was probably one of the best public speakers I have ever seen. She kept my attention throughout, was humorous, and very well informed in her area of expertise. She gave an excellent description of the different parts of the brain, which part was responsible for what, and how it all came in to play regarding executive functioning. She gave "real life" examples (some of which I could completely relate to and understand) and overall, presented a very engaging, informative and useful workshop.

Perhaps the most interesting and beneficial part for me was the "what to do and how to help" part of the workshop. I had researched on my own exactly what EFD was and how the different parts of the brain affected it (although the refresher was nice and I did learn a number of things I did not already know in this regard), but had not had a lot of success looking at the different things that I could employ in my everyday life with Emily.

Before I get any further in to the "what to do and how to help" part of this, there were three very critical things I learned. The first thing was in regard to the connection between attention and executive function. At any one time, the human brain can only hold on to 7 (+ or - 2)pieces of information at a time. In a child, the capacity to hold information is less, as their attentional systems are still developing. In a child with EFD, who has trouble with cognitive organization, the ability of the mind to hold information is diminished even further. Another key piece that I really felt was important was this: There is an unfortunate tendency for some parents and teachers to assume that their role as "helper" requires that they assume responsibility for executive dimensions of tasks. This means doing such things as settings goals for the child, planning and organizing all of their activities, and solving their problems. Doing for them is not teaching them how to use their executive functioning skills themselves. The predictable outcome is learned helplessness and oppositional behavior. This leads to the last critical thing: Don't cue to do, cue to know what to do. Again, if you do it from the, they will never learn how to do it themselves. Ask questions like, How long do you think it will take? How did you manage or know how to do it? Have you done anything like this before? How did that work out? How are you going to know what is most important? What do you want it to look like? How much time did it take you the last time you did this? This will teach them to reassess and evaluate on their own what has worked best, how to estimate time, and feel a sense of accomplishment when they have completed a task.

The main concepts taught in regard to how to help a child with EFD were; teaching forethought, teaching self directed talk, making visual aids, reading the room and minimizing multitasking. In the interest of organization, I have broken each one down in to a list form, with a description of what each concept is, and how to "make it work" for your child.

1. teaching forethought

-Ask questions like, "What will it look like if...?", "How do you see yourself?", If everything goes your way, what will it look like?" Example: American Idol is on at 8. You have told your daughter that if she wants to watch it, she needs to finish her homework first. You go in, help her set up to get it going, go put a load of laundry and come back to check on her, only to find out she hasn't even started. Initiation is a HUGE problem for people with EFD. Generally, prioritizing and goal setting is difficult. So, you ask her, "Where do you see yourself at 8 tonight? On the couch with me watching AI or doing your homework?" This helps present a "mental image" and involves your daughter by asking her where she sees herself. The steps for teaching this skill are as follows: Set a goal. Ask, "what will it look like if your achieve your goal? Look ahead. Ask, "What time will it be? Look back. Ask, "Have you been in this situation before?" "What would you do differently next time?" "What would you repeat?" Plan. Gather everything needed to accomplish your goal. Do. Do it. Stay on the timeline. Set up time checks. Are you on track? Review. "How did you do?" "Does it look like what you pictured?"

2. Teaching Internal Self Directed Talk

This was the one I found most interesting. Basically, this is teaching your child to use the "voice in their head. "You know the one that says, "Don't worry. Relax. Does this feel right? Does this make sense?" The teaching of self directed talk facilitates the development of working memory and speed of processing, and serves the cognitive functions of organization, and structuring behavior, all areas that Emily specifically needs help with. One method of teaching this was by doing it for them, literally. For example, if I walked in and saw Emily doing something she wasn't supposed to rather than speaking to her and giving her the chance to react with a "But Mom..." or a "Why can't I________?" which could lead to a potential fight and more stress for all, I would simply walk up behind her and say, "I bet Mom would be really upset with me if she saw me going this." Eventually, after a number of times doing this, the hope is that Emily would catch on and start using the "voice in her head" herself. Emily is right at the age where this method might not work well (younger kids are more impressionable etc.) but, I think I might try it anyway. In some respects, she is a "young 10" and she is right on the borderline as far as the age group that the presenter talked about.

3. Using Visual Aids

I became aware of just how visual Emily is when I read the results of her neuro-psych testing. She is definitely a visual learner which will make this next idea easy to employ (I hope)! Basically, the concept here is to get your child to "match the picture." So, for example, you would take a picture of what your child looks like when they are ready for school...coat, backpack, hat etc. Take a picture of what it looks like to do homework...complete with all materials needed and your child actually sitting and doing the work. Take a picture of the bedtime and morning routines. Then, put them in a small album or binder and when it comes time to complete one of the tasks, show your child the picture and say "match the picture." This makes it more of a game to them and perhaps, will make it easier to follow.

4. Reading The Room

Many children with EFD have difficulties with the concept of time, reading people, and assessing the situation. This is where S.T.O.P comes in to play.

S=Space and Situation: Assess the space you are in and the situation you are presented with.

T=Time: Ask, is this a good time? When do you need to be done? What other things do you have scheduled(look ahead)? Is the pace fast or slow?

O=Objects: Do you have everything you will need(make a list)? Are you using something that does not belong to you(ask first)?

P=people: Are you giving them your attention? Can you ear and understand them? Are they busy? Are they interested in what you are saying? Read their body language (facial expressions, body language).

This is something that most of us do the minute we enter a room, in the space of a few seconds. For someone with EFD, this kind of organized thought is not usually present and is a learned behavior. Teaching the concept of S.T.O.P. will help!


5. Multi tasking in most cases of EFD is an unheard of skill. Multi tasking requires organization and planning, skills that are generally not present in someone with EFD. So, things must be broken down in to manageable chunks, and worked on individually.

See it.

Say it.

Do it.

Shift it.


I have used this concept with Emily already with a writing assignment she had to do. We sat down, separate each topic she needed to write about it and she completed one at a time, until she was done. Looking at it in smaller pieces helps keep her from getting overwhelmed.

One pretty significant thing I learned about EFD was that it is greatly influenced by experience, teaching, and expectations in the environment. For people with EFD, skills that may seem implicit, are not and need to be taught in order to achieve success.