What are Executive Functions and What is Our Role as SLPs?

More and more these days we are hearing about Executive Functions in the literature, in our schools, and in the news related to autism, head injury, and post traumatic stress disorder.  If you are like me, maybe you touched upon it in grad school. Even in this case, it was not always clear to see what to do in speech therapy to help clients who struggle with attention, organization, and behavior.

Secondly, this is a hot topic for the general education folks and they are addressing these difficulties head on. Our job as special education people is to support the general education people. How do we do it in this case?

Thirdly, (and this is heartbreaking for me as I am a veteran), soldiers suffering from post-traumatic stress are healing but are struggling to cross the last distance where they can organize themselves professionally, keep their relationships together, and initiate on all the actions needed to restart their life back here in the states. These are all frontal lobe activities and I know executive function skills are at the heart of matter.

What do we do?

We do what we always do. We learn. We see how our unique communication skillset can improve lives. We become strong team members. We intervene. And, in the third case above, we save lives.
For some of us, this is a new topic. Others may have a lot of experience in this area but benefit from seeing what the more recent literature says. So, this is a three-part essay where we will:

1) start with a quick and interesting discussion about why our students with executive functioning disorders struggle with attention, organization, and behavior.

Then, in the next essay we will:

2) Introduce a simple framework for identifying which executive functioning skills your student might be struggling with

And we will finish with:

3) Match Executive Function Strategies to Areas of Need

Are you ready to be an advocate for the underdogs?

If I could sum up what knowledge on executive function can give each professional I would say “empowerment.” A tragic aspect of children with executive functioning (EF) difficulties is that they are frequently seen as being defiant, can’t remember what was just taught, have difficulty problem solving and planning, have trouble organizing materials, and do not adhere to a schedule. But the truth is, they are typically trying extremely hard and no matter how hard they try, they fall short. Or, they truly believe that the work they are producing is what the teacher wants and are surprised when they do not do well.

You Matter

With knowledge on EF you can be the voice of reason showing that the child is struggling with a deficit and not making a poor behavioral choice.

What Does Difficulty with Executive Functions Look Like?

Professionals often refer to EF as if it were a single disorder. In fact, there are many different features to the disorder and a student may demonstrate some strengths and some weaknesses. Here is a list gathered from several sources of areas of difficulty for those who struggle with EF.

• inhibition of impulses, stopping to choose an appropriate response
• previewing likely consequences of action (both short- and long-term)
• holding and manipulating information in working memory
• sustaining attention despite distraction or fatigue
• planning, both short- and long-term
• task initiation – getting started on a chosen task
• depth of processing, choosing a level that is not too superficial or too consuming
• tempo control, maintaining an appropriate speed and rhythm for work
• development of automaticity, making a skill routine so it takes no conscious effort
• satisfaction, perceiving and deriving pleasure from reinforcers
• organization, both internal (thoughts) and external (materials)
• time management – predicting how long things will take, planning, and acting
• flexibility – adapting strategies or plans in response to mistakes or new information
• self-monitoring – observing one’s own performance and comparing it to standards
• emotional self-regulation – being aware of and managing feelings
• metacognition – being aware of one’s own thought processes

What is Our Role as a Speech Language Pathologists?

Our job is to sift through these concerns and figure out which aspect of executive functions is being affected cognitively. Once we have a clear picture of our clients’ deficits, we can move on to identifying intervention strategies to use and share with colleagues.

Different authors have proposed varying lists of executive skills. These eight have been taken from the widely used BRIEF (Behavioral Rating Inventory of Executive Function).

The Core Executive Function Skills

Planning and Organization

The ability of a student to maintain order in their personal space and take care of their personal belongings and school work. It also involves mentally organizing and grouping information.

Working Memory

A dynamic process that involves reviewing new information and retrieving, holding, and manipulating stored information in our minds for the purpose of completing a cognitive task.

Initiation

The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies.

Task Monitoring

The ability to monitor one’s own performance and to measure it against a standard of what is needed for any given task.

Self-Monitoring

The ability to observe one’s own behavior and to determine whether it conforms to explicit behavioral expectations and unwritten social rules.

Inhibition

The ability to “put on the brakes’ or to stop behaviors at the appropriate time.

Emotional Control

The ability to reflect on one’s own feelings and then to use the understanding to guide one’s emotional responses.

Shifting

The ability to “change gears.” Moving freely from one situation to another and thinking flexibly in order to respond appropriately to a new or unexpected situation.

What is the most important role that executive function skills play in learning?

Executive Functions cue the use of learned strategies. Let’s say this together because it is the key to our role as special educators and the key to getting a child to move ahead.

Executive Functions cue the use of learned strategies

Executive Functions are not an academic topic.
Executive Functions are not the strategies.

They enable a child to remember and use strategies and access academic knowledge. General education teaches stuff. Special Education creates the structure that the learned stuff can stick on, be organized on, and be accessed.

Now that we know what we are looking for, on to parts 2 and 3 to be published in February!

A simple framework for identifying which executive functioning skills your student might be struggling with (Part 2 of 3)

Specific strategies to help children with executive function difficulties (Part 3 of 3)

And, if you want to learn more:

Executive Function 101: Speech Therapy, Evaluations, and Classroom Support

References

BRIEF (Behavioral Rating Inventory of Executive Function) Gioia, G. A. & Isquith, P.K., 2013
Cooper-Kahn, Joyce, and Margaret Foster. Boosting Executive Skills in the Classroom: A Practical Guide for Educators. San Francisco: Jossey-Bass, 2013. Print.
Gioia, G.A., Isquith, P.K., Retzlaff, P.D., and Espy, K.A. “Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a Clinical Sample.”                     Clinical Neuropsychology, 2002, 8(4), 249-257.
Moraine, Paula. Helping Students Take Control of Everyday Executive Functions. London: Jessica Kingsley, 2012. Print.
Logsdon, Ann. “Executive Functioning Understanding Executive Functioning Disorders.” Http://learningdisabilities.about.com/. Www.about.com, n.d. Web. 23 Feb. 2015.
McCloskey, George, and Lisa Perkins. Essentials of Executive Functions Assessment. Hoboken, NJ: Wiley, 2013. Print.