Executive Function Deficits in Children and Why It’s Crucial to Treat Them
Executive functions (EFs) are cognitive skills that allow for self-regulation, attention, problem-solving, working memory, multitasking, planning (including motor planning), flexible thinking, and time management. It’s all the skills used daily to be able to complete tasks. When executive functioning is impaired or isn’t implicitly learned, it has to be explicitly taught, otherwise, daily occupations can become difficult to complete.
EF Effects on Daily Living
EF problems are common in disorders such as ADHD, anxiety disorder, developmental disorders, learning disabilities like dyslexia, and autism spectrum disorders.1 At times, behaviors and problems stemming from EF deficits are difficult to identify since they are often attributed to other factors, or, alternatively, are not identified at all when sensory or motor issues are not present.2 When a child struggles with task and time management and homework, or really any daily tasks, they can be categorized as lazy. EF issues lead to an overall misunderstanding of children and cause significant effects in all aspects of their lives.
Since EF deficits make completing tasks difficult, children may present avoidance behaviors, which, again, can make them appear as though they are intentionally causing problem behavior when in reality, they have limited capacity for executive functions. If EF issues are not addressed, they will continue throughout a child’s school life, with the student not being able to manage their work capacity, and then well into adulthood. This can lead to many secondary issues such as anxiety and depression.3
Recognizing EF Problems
Sometimes, EF problems can be misattributed to other sensory, behavior, or motor problems. Alternatively, Ef deficits may not be recognized at all. Executive functioning isn’t something highlighted or thought to affect kids since it is mostly taught to OTs when it comes to treating adult brain injuries. However, it is common in many diagnoses, especially those like ADHD.
Since recognizing EF problems in children is not something always taught, many practitioners pick it up through experience or through learning from another colleague. EF is a core part of occupational therapy because it is required to complete daily occupations. So if a child is struggling with things such as organization, time management, problem-solving, memory, or attention, it is imperative to look at treating executive functions, especially if the child already has a diagnosis like ADHD, ASD, or dyslexia.
EF Treatment
EF treatment looks at breaking down the tasks where there are deficits. Each task has multiple components, so it’s about communicating to the child the step-by-step process of completing one task to make it seem less overwhelming.
Some popular treatment tools used include:
Visual tools
icon boards, stickers charts, schedules, checklists
Memory and matching games
Timers
Self-regulation to help with transitions
This is a great place to implement the Zones of Regulation.
Setting goals and writing out the steps to achieving them.
Cognitive-Functional Intervention on Executive Functioning in Children with ADHD
ADHD is associated with difficulties in executive functions. The Cognitive-Functional intervention, or Cog-Fun, was developed to target EF development in children with ADHD but can be used in many different populations as it targets things such as emotional, cognitive, and behavioral regulations, inhibition, working memory, personal care, academics, and many more.4
The goal is to learn the executive strategy in the therapy context and apply them in a fun activity. This program also relies on the support and interaction of parents for positive reinforcement as well as then being able to apply those methods in the home. Cog-Fun is an approach “that supports participation via metacognitive learning of executive strategies (e.g., stop, recruit effort and persist, check, plan) in an enabling context.”5
This method requires reproducing a social context, for example with the therapist and parents, and then challenging the child with whatever EF strategy that struggle with. This can be used for planning, turn-taking, something the child is working on in school, etc. The goal is to make it fun, yet also challenging.
Resources for EF Treatment
Although there is still a lot more research that needs to be done on executive functioning in children and occupational therapy techniques for treatment, it is crucial to continue looking to other therapists or disciplines for the best treatment methods. If EF goes untreated, it can have significant effects on the lives of children as they grow up.
Educators like Lev Vygotsky, Richard Lavoie, and Mark Ylvisaker have all done great work in regard to studying and treating EF. Articles and books regarding their theories and practices are great examples of how to treat EF deficits. The occupational therapy technique most often known for treating EF problems is the Cognitive Orientation to Daily Occupational Performance, or the (CO-OP). Here is a link to AOTA’s continuing education article that breaks down this approach.
Treating EF secondary effects but not approaching the initial problem is a band-aid fix, which is why it’s important for therapists to be able to recognize what EF deficits look like. It’s important to have therapists become aware of EF deficits, as they can be a huge contributing factor.
-
1. Cramm, Heidi, Terry Krupa, Cheryl Missiuna, Rosemary M. Lysaght, and Kevin C. H. Parker. “Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy with Children and Youth,” American Journal of Occupational Therapy. 67, no. 6 (2013): e139, doi: https://doi.org/10.5014/ajot.2013.008607.
2. Cramm, Heidi, et al., “Broading the Occupational Therapy Toolkit,” e140.
3. Ibid, e. 142.
4. Hahn-Markowitz, Jeri, Itai Berger, Iris Manor, and Adina Maeir. “Impact of the Cognitive-Functional (Cog-Fun) Intervention on Executive Functions and Participation Among Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial,” American Journal of Occupational Therapy. 71, no. 5 (2017): 1, doi: https://doi.org/10.5014/ajot.2017.022053.
5. Hahn-Markowitz, “Impact of the Cognitive-Functional,” 4.
-
“ADHD and Executive Functioning,” Occupational Therapy Helping Children, accessed 10 June 2022, https://occupationaltherapy.com.au/how-occupational-therapy-can-help-your-childs-executive-functioning/.
Cramm, Heidi, Terry Krupa, Cheryl Missiuna, Rosemary M. Lysaght, and Kevin C. H. Parker. “Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy with Children and Youth,” American Journal of Occupational Therapy. 67, no. 6 (2013): e139-e147, doi: https://doi.org/10.5014/ajot.2013.008607.
Hahn-Markowitz, Jeri, Itai Berger, Iris Manor, and Adina Maeir. “Impact of the Cognitive-Functional (Cog-Fun) Intervention on Executive Functions and Participation Among Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial,” American Journal of Occupational Therapy. 71, no. 5 (2017): 1-9, doi: https://doi.org/10.5014/ajot.2017.022053.