Executive Functioning Strategies for Kids: An OT Perspective

By: Kelly Nesbitt, MOT, OTR/L  

What is executive functioning?

Executive functioning refers to organizing, problem-solving, working memory, sequencing and efficient execution of ideas to complete a task. Executive functioning is a complex process involving good sustained attention, organization of ideas, inhibiting impulses, time management, and problem-solving (Calderon, 2011).

General functioning would be tough without these skills in everyday life. There are many strategies that Occupational Therapists can help a child improve their executive functioning skills to better participate in their daily routines, which will be discussed below.

When do kids need to use executive functioning skills?

As an OT, I look at executive functioning specific to how kids can execute their daily “occupations,” such as getting dressed, packing up their backpacks, completing their self-care routines, or completing a craft.  Almost all tasks kids do during the day involve some executive functioning skills. For instance, when they encounter a problem, they must come up with a new idea, organize how to execute a plan, gather supplies needed, and adjust their plan if something new arises. Take the example of getting dressed in the morning, for example. When you tell your 7-year-old child, “Go get dressed before school,” your child must… 

1. Be regulated enough in their body to understand and process the verbal directions given to them. Do they know what “go get dressed before school” means?
2. Have an idea of what they want to wear- Do they need shorts? Leggings? Jeans? Once they realize it’s cold outside, do they know the necessary steps to take?
3. Visualize what supplies they need on a cold day: socks, shoes, underwear, a shirt and pants. They need to know where to go in the house to find all these supplies.
4. Once they have this “list” of what they need, they need to gather these materials. Your child must be able to draw on their memory to know where do I find my clothes? My dresser? My closet?
5. Then find all these articles of clothing in their room, keeping in mind everything they need and staying focused on this task (sustained attention) and getting it done in a reasonable amount of time before mom calls them to get in the car for school.
6. If they find every article of clothing but realize that they cannot find their jeans, do they have a strategy to solve this issue? Can they ask Mom? Can they look in the laundry room if mom or dad has washed their jeans and it just hasn’t been put away yet?
7. Once your child finds out that their jeans were just in their brother’s room, can they then sequence the steps accurately of dressing in their school clothes? (take off PJs, pull on their underwear, then pants, then their shirt)
8. Be able to evaluate to see if the task was completed correctly. Did they forget a sock? Did they miss a step? Did they complete the task on time?

Needless to say, a lot of brain power actually goes into what seemingly is a simple task to most adults.  

How do I know if my child has executive functioning difficulties?

A diagnosis like attention deficit hyperactivity disorder (ADHD) or autism can certainly be a factor, but there are many neurological, mental health and behavioral disorders that can affect a child’s executive functioning skills. An Occupational Therapist, Speech Pathologist or Social Worker, can help you determine if their difficulties are from executive functioning difficulties or if there are other sensory, postural, mental health, and/or motor planning issues underlying. Some signs that executive functioning may be hard for your child include (but are not limited to)…. 

• You have to constantly prompt kids to get dressed in the morning or walk them step-by-step through daily routines that you know they know how to do 
• Your child consistently forgets their homework assignments at home, or their binder is so disorganized that they cannot find what they need in it 
• Your child consistently forgets to do chores (not just avoiding them) or does them incompletely (when you know they understand what to do)  
• They get distracted easily. You ask your child to do something, and you consistently find them doing something completely different (watching tv, playing with a different toy) 
• Homework tasks are really hard (especially around 2^nd grade, where the workload increases) 
• Teachers have described them as “disorganized” or “getting distracted in class.” 

Strategies to help: 

Environmental setup: 

Picture from: HPIM4516.JPG (1600×1194) (googleusercontent.com) 

• Keep the environment at home decluttered (as much as possible). Have designated spaces where toys belong that are denoted with labels (for kids that read) or pictures (for children who are not yet reading). I recommend taking literal pictures on your phone of what goes in the bin and printing it out so that your child makes the connection of what actual items go in that bin.  

• For homework completion, you can have two bins at the table where the child does their homework, labeled “to do” and “done.” You can put all the papers the child must complete in the to-do bin, and as the child finishes each, they can move them to the “done” bin. Sometimes this concrete step helps a child’s brain visualize what is left to complete and what is already complete.

Visual schedules: 

• Have a visual schedule of activities you want your child to complete. This schedule has small pictures that go in see-through sleeves. Once an activity is completed, the child can take the picture out of the sleeve and put it in a pouch at the bottom. Again, I’d recommend you take pictures of the child’s literal tasks/them doing the tasks to help improve comprehension of what the picture represents.  

Timers: 

Count “ups”/ Clocks– For children who both do and do not know how to tell time, I recommend using a clock to help them manage time. If you have an analog clock with a glass or plastic face, use Expo markers to draw pie segments on the clock face of what task you want the child to do.  

For this example, if you need to be out the door by 3 o’clock, tell the child that they need to get dressed while the big hand is in the orange area. Children who can read can have more complex segments delineated on the clock for multi-steps.  

Countdowns/timers: 

Time Timer clocks count DOWN how much time is left, which can be helpful for children when it’s almost time to transition away from the TV or leave for school in the morning.  

Executive Functioning Support

If you feel like your child is struggling consistently with executive functioning tasks, an Occupational Therapist can specifically look at these skills in an OT evaluation.  Our skilled therapy team works across ages and diagnoses and can help create a personalized plan to help your child.

To learn more about services at Easterseals DuPage & Fox Valley, call us at 630.282.2022 or email info@eastersealsdfvr.org.

References: 

Executive function in children: Why it matters and how to help – Harvard Health by Johanna Calderon, PhD 2011  

Chores and Executive Functioning

By: Jessica Drake-Simmons, M.S. CCC-SLP

People are not leaving their houses right now and you know what that is resulting in?  A need for lots of cleaning and organizing!  This doesn’t have to be a solo effort though!  Maybe we can embrace this unique opportunity, where we are being asked to be our children’s teachers, to show our children some new things we don’t normally have time for in everyday life.

Research has found that one of the best predictors of a young adults’ success was whether one participated in household tasks when they were young.  Chores help kids have a “pitch-in” mindset, which is an invaluable skill throughout the lifetime.  In the book, 50 Tips to Help Students Succeed, Marydee Sklar describes the executive functioning skills that are developed when completing chores including:

• Time management
• Delaying gratification
• Planning
• Prioritizing
• Problem-solving
• Focus and goal-directed behavior

Here is an idea of some of the chores your child might be ready to do by age.  The level of assistance a child may need will vary.

Age 2-3: This is a magical age in which your child is so enthusiastic in their desire to  “help”! The problem is that “help” feels like anything but help!  However, it appears that cultures that embrace and expect children in this age group to participate in household work raise children that are willing and proud contributors to household chores.

• Put toys away
• Throw garbage away
• Put dishes in sink
• Help set the table
• Put dirty clothes in the hamper
• Dust the baseboards
• Fold rags, washcloths and dishcloths

Ages 4-5:

• Make the bed
• Feed the pets
• Pick up toys
• Water the plants
• Wipe cabinets
• Put away dishes they can reach
• Clear and clean table after dinner
• Make easy snacks
• Wipe down doorknobs
• Match socks

Ages 6-7

• Sweep the kitchen floor
• Empty the dishwasher
• Sweep the hallways
• Mop the kitchen floor
• Organize the mudroom storage area
• Make a simple salad

Ages 8-9

• Clean room
• Bring in the empty garbage cans
• Put groceries away
• Clean out the car
• Clean room
• Wipe bathroom sink and counters
• Sweep the porch
• Hang, fold and put away clean clothes
• Make scrambled eggs
• Bake cookies

Ages 10-11

• Clean the toilets (inside and outside)
• Wash your own laundry
• Vacuum
• Sweep the garage and driveway
• Wipe down the counters
• Clean the kitchen
• Make a simple meal

Ages 12+: For this age group, help them be proactive in recognizing what needs to be done and initiating a plan for how and when to do it.  Work side-by-side on house projects with them. 

• Clean the garage
• Mow the lawn
• Wash the car
• Mop the floors
• Wash windows
• Clean bathroom
• Help with simple home repairs
• Cook a complete meal

Tips for success:

• Teach the skills- Don’t expect them to learn it on their own.  Break down the task into small steps.
• Help them come up with organizational systems for their belongings that they can maintain with little help from you.  Have written labels or pictures to assist in sorting items in different boxes.
• Take a picture of what their clean room (or other designated) area looks like.  Encourage them to match the picture when their chore is complete.
• Give them some control, even if that means it’s not done the way you would prefer. 
• Assist them in thinking through when they will have time in their schedule to do their chores. 
• Help implement designated chores into daily routines. 
• Schedule work time and break time.
• Help them recognize how long a chore should take to complete in order to maintain their focus to the task and motivation for completing it in a timely manner. 
• Make it fun! 
  • Play music
  • Make it a race or competition
  • Create a chore chart or list which will assist experiencing a sense of accomplishment as they complete their chores
  • Sometimes incentives might help!
  • Have everyone completing chores together

Stay home, stay well, embrace the ones you are socially isolated with and relish in those chores! For more information on Easterseals DuPage & Fox Valley, visit eastersealsdfvr.org.

Executive Functioning Skills: CO-OP Model Part 3: Time Robbers

By: Laura Van Zandt, OTR/L

I was recently asked by a parent to elaborate more on a concept I integrate within Goal–Plan–Do–Check called “time robbers”.  The concept of “time robbers” was first introduced to me at a continuing education class taught by speech therapist Sarah Ward. A “time robber” is something which keeps us from doing other things which have more value or importance to us.

The concept of “time robbers” can be a fun way to call to attention all the little (or maybe not so little) things we do that take away from our goal. Time robbers can occur to everyone. They can occur anywhere. They can also be anything. Time robbers can be things we do as well as things other people do. Sometimes time robbers are imposed upon us by others or circumstances and are less in our control. Other time robbers are self-inflicted. Some examples of time robbers are being hungry, tired, or worried. They can also be sounds in our environment, noises/shows on the television, or games on the iPad.

The following is a handout I developed to help introduce the concept to children.

What?	Time robbers are a little like impulses. Impulses are the feelings we have to do or say something…sometimes without even realizing! Time robbers are just like impulses. They are the things that we do that take away time from our overall goal and plan.
When?	Time robbers can happen all the time. They don’t have to be limited to just school or home.
Examples?	Time robbers can come in all forms. They might as easy as a thought that should remain in my thought bubble or as complicated as getting your bike out, riding to the store, buying a snack, and returning home to finish your homework. Other examples can be having the television on when doing homework, wanting to play longer with a favorite toy, arguing, changing ideas, etc.
Consequences?	Time robbers are not our friends. They take away time from us getting things done. If they take away from one thing it means there is less time to do something that might be more preferred or fun.
How to fix?	Practice your thought bubbles and keeping any time robbers hidden away inside our brains until we are finished with our goal and initial plan. STOP and Think – monitor your space, time, objects, and people. Think if this is an expected time to bring up your time robber.

When beginning any new strategy or tool with your child, I often find it helpful to first identify in yourself examples and then start calling attention to different tools you use to help defeat the different time robbers. When your child is starting to recognize time robbers, then it is a good time to introduce the concept to your child to help identify and address them.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

 

Executive Functioning Skills: CO-OP Model Expanded

By: Laura Van Zandt, OTR/L

Recently I wrote a blog on how to develop and strengthen executive function skills using the CO-OP (Goal–Plan–Do–Check) model. I thought I’d take a moment and expand on a very important foundational skill.

“Do with me and not for me”

So often we have great intentions and we do for our children. This isn’t a bad thing; we want our children to succeed. It’s hard to see them struggling. When we do for our children we neglect one very important step in developing their executive function skills. We accidentally take away their ability to plan, prioritize, problem solve, manage their space/time/materials, and reflect.

If we do not expect our children to be an “active participant” in his or her life, then we take away the many opportunities to learn the daily life skills needed for adulthood and the ability for learning how to tackle and master challenges. Involving your child in daily activities and encouraging them to be an active participant builds a strong sense of competency and positive self-esteem. It helps provide the confidence that your child can do many things and learn to ask for assistance when things go wrong.

Getting your child involved doesn’t have to be an elaborate process. Take whatever you are currently doing for your child and give him/her a simple job with the task. If the child is used to doing “nothing” start very small. Any job, regardless of how small (e.g. hold the pillow and place it on the bed while you make the bed, put one or two dishes into the dishwasher, drop a few articles of clothes in the washer, raise his arms to put his shirt on, etc.) is a start.

The best therapeutic opportunities are often right in front of you. There are endless activities (e.g. cooking, laundry, shopping, bathing, etc.) that make up your day.  You can use all your little interactions for many opportunities to develop executive function skills. By taking a little more time, you can  get your child involved around the house. Instead of just doing, slow down and ask for help. You might find your child enjoys helping and you may even start making some new memories together!

By doing with your child, you have the opportunity to break down the task so your child can be successful. In the process your child then starts to learn that a goal (e.g. making a bed) has many steps to the plan (e.g. put on the fitted sheet, do opposite corners, put on the sheet, put on the duvet/comforter, hold open the pillow case and put in the pillow, place the pillows on the bed). When we do the goal sometimes we work with a team (e.g. you and your child) and sometimes we need to adjust our plan (e.g. having them help this time) and sometimes we check throughout the process (e.g. did we get all the pillows?). You should celebrate with your child by “doing it together” with praise, giving high fives, and other gestures of companionship that you and your child share together. In turn, your child feels productive and competent; driving a desire to learn more. Over time your child learns to feel “good” about doing, and the typical daily challenges that are now a major struggle start to melt away. The child becomes more eager to learn, rather than driven to avoid.

I briefly used Goal–Plan–Do–Check but let’s use the concept in two better examples. Let’s use the first example for getting your children ready for school and let’s use the second example to model tools you use to help yourself get ready. Both ways involve your children.

1) Helping Your Child Get Ready in the Morning

Goal– While first getting your child up in the morning, tell them “It’s time to get ready so our goal is for you to be at school on time.” Use the word goal so your child knows that is your expectation.

Plan– Talk to your child about the steps. “First we need to go the bathroom so we can wash your face and brush your teeth. This usually helps wake you up so you can focus on getting dressed all by yourself. When you are getting dressed all by yourself, mom and dad will be downstairs making your breakfast. You need to eat your breakfast and then grab your lunch so we can get you to school. Don’t forget to double check your backpack and make sure you have everything you need for school or any after school activities.”

Depending on your child and the age of your child, you might simplify the plan. You might use visuals to help your child remember the plan. There are tons of different strategies that can worked within each child’s individual plan that are tailored to his or her specific needs and specific interests to ensure motivation. Depending on your child you might also need to use incentives to help with motivation and time management.

Do– Divide and conquer. Depending on your child’s age, he or she would not be expected to do all the pieces of the plan.

Check– Keep talking to your child. “Did we get everything? Are we on time? What helped us stay on time? What were time robbers?”

2) Modeling Tools You Use to Get Ready in the Morning

Children learn through modeling. This is a great way to begin introducing your child to this concept as well as teach through modeling different strategies.

Goal– While first getting up in the morning and working with your child, talk aloud to them. Talking aloud is not something that comes naturally and must be practiced; however, talking aloud is a great strategy for modeling the development of executive function skills. Tell them “It’s time to get ready so our goal is for you to be at school on time.” Use the word goal so your child knows that is your expectation.

Plan– Talk to your child about the steps; however, instead of listing the steps like we did in the first example, we are going to focus on you and tools that you use. This is important for kids who just seem disorganized, can’t get their arousal level just right, and just need help. Modeling is great to let them know we all use a variety of tools and that tools can be helpful. Here is an example of a conversation you might have while getting ready with your child:

“It’s time to get ready so our goal is for you to be at school on time. I don’t know about you, but mom is feeling really tired today. I have to get up earlier than you so that I can help you get ready. Do you know what helps me wake up so I can focus on getting ready? I start my morning with a shower. Sometimes the feel of the water on my skin wakes me up. Let’s try washing your face since we don’t have time for a shower.”

Notice how in this example, you discussed with your child a tool you use (shower) and provided them with an option to try. This is a great way to model. There are lots of other dialogues you can have with your child to model tools. This was just one example.

Do– Looks the same as in the first example; however, depending on the tool you may or may not be modeling. Do in the example above was telling your child and then providing your child with an example to do together.

Check– Remains the same. In this stage, we are actively involving our child to think and problem solve.

Have fun with it and know that you are working on developing and strengthening your child’s executive function skills. Executive function skills are developmental and must be taught. When working with your child, you are setting a path toward greater independence. Start simple and build gradually.

If your child is not used to doing much, start with a couple of activities a day. Pick a time of the day when you are not feeling rushed and your child is not feeling stressed. This will give you practice in how to guide, assist, and engage your child. Once it starts to feel natural, expand the “we-dos” into many daily activities. Do them together, giving him/her a little part to play, and gradually expanding his/her role to build more competence.

You are an important part in the development of your child. The more you can help your child think about what they do and why, the more they will be able to use that thinking in any problem solving situation. As my other blog concluded, the overall goal is to teach your child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Executive Function Skills: CO-OP Model

By: Laura Van Zandt, OTR/L

GOAL–PLAN–DO–CHECK.

Executive functioning skills seems like the new ‘buzz’ word for therapists and parents working with children of all ages. Executive functioning skills include the ability to pay attention, recall a series of information, manage your time, be flexible, self-monitor for your emotions and impulses, initiate tasks, problem solve, persist as well as plan, organize, and sequence. One of our former speech therapists, Jennifer Tripoli, wrote a nice blog in August 2014 which you can refer to for more information regarding the definition of executive function skills.

One strategy that I like to teach children is a concept from the Cognitive Orientation to Occupational Performance or CO-OP model by Helene Polatajko and Angela Mandich called GOAL–PLAN–DO–CHECK.

The CO-OP model is a “client-centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.” Occupational performance is what we do and how we do things throughout our day. Cognitive orientation implies that what we do and how we do things involve a cognitive process. The approach is designed to guide individuals to independently discover and develop cognitive strategies to meet their goals. That sounds like a lot of executive functioning skill development to me!

The use of self-talk is key with GOAL–PLAN–DO–CHECK. When we require children to walk us through their plan and teach us their steps by talking aloud, they engage in more effective approaches to learning.

When teaching children, we start with the GOAL. We teach the child to understand the word GOAL as being something we are working towards completing. One strategy that has been helpful for visualizing the end GOAL is the concept of “future glasses.” Have the child wear funny glasses or simply make your hands in the shape of glasses. Then close your eyes and visualize the completed GOAL and what it might look like when completed.

The word PLAN implies there are a series of steps we need to do in order to meet our GOAL. To me the PLAN is critical for developing our problem solving skills.

Next we DO our goal.

Finally, we CHECK. The CHECK is really important for developing and strengthening our meta-cognitive skills. It is very important to understand how we can do better next time based on what we did today. CHECK gives the opportunity for feedback control by finding and correcting a mistake before the plan is final. It allows for incorporating flexibility and the ability to shift strategies when the current plan is not working.

This process helps children strengthen their executive function skills in the areas of working memory to pull from previous experiences, planning and prioritizing steps involved, persisting to achieve goals, and reflecting back by checking in with the plan to see if it was successful. If not, make alterations in order to be successful, eliminate time robbers to help with impulse control, and manage their time. Remember, initially it is about the practice and not the end result. It is okay to make mistakes. We all learn from mistakes.

Parents and family are an important part of the CO-OP approach. The effectiveness of the intervention is greatly increased when everyone is involved. Parents and family help the
individual child to acquire and practice these skills. It also helps them to transfer and generalize the learned strategies into everyday life. By providing explanations as well as guidance and asking questions at an appropriate developmental level, we provide just enough support necessary for the child to be successful. The more you can help children think about what they do and why, the more they will be able to use that thinking in any problem solving situation. The overall goal is to teach a child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Motivation Comes From Seeing Your Future Self

By: Jessica Drake-Simmons M.S. CCC-SLP

We all have a range in abilities of executive functioning.  Kids and adults alike can struggle with organization, memory, focus, managing time, initiating a task and completing a task.

Being able to visualize the future is an imperative skill for moving from event to event and showing up on time with the needed materials.

Some of our kids who struggle with executive functioning may seem distracted, disorganized and struggling to keep up with the pace of the day.

Additionally, some of these kids can be perceived as being unmotivated.   They might be smart kids that simply don’t appear driven to work up to their potential.  Executive functioning guru, Sarah Ward, asserts that these kids have difficulty imagining their future emotions.  They don’t intuitively imagine what they will feel like or what they will look like when they complete a task or achieve a goal.

What I need to look like now.                                   So that I can look like this later.

We want kids to be able to see the future, say the future, feel the future and plan for the future.  So how can we facilitate this skill of ‘future imagery thinking’?

• Have your child make an image by helping them talk through the following:
  • What will the environment look like?
  • Who else do you see being there?
  • What will I look like?
  • What will I feel like?

• Ask questions that encourage future imagery thinking.
  • Ask:  “When you walk into class tomorrow, what do you see yourself handing to your teacher?”
    • Instead of:  “What do you have for homework tonight?”
  • Ask: “What would you look like if you were standing by the door, ready to leave for soccer?”
    • Instead of: “Go get ready for soccer.”

Making a mental movie of the future requires us to actively think through the necessary steps in order to complete a task.  It enables us to envision and play a ‘dry run’ of a task without the risk of error.  Seeing the future helps us to persist through the present challenge in order to achieve our goals.

To learn more about Easter Seals DuPage and Fox Valley programs, visit eastersealsdfvr.org.

 

Featured image by: Lauren Sims