Alicia Eden, BOccThy
Executive functioning refers to our higher order thinking skills; the ability to solve problems, think rationally and make sense of the world around us. We use them every day without even noticing, our brains are very clever like that! Our executive functioning skills develop through adolescence and into our adult life. A child’s ability to develop executive functioning skills at the right time affects their ability to engage in age appropriate activities at home, at school, and with their peers. Many populations are at risk for difficulties with executive functioning, including individuals with Autism Spectrum Disorder (ASD), Traumatic/Acquired brain injury, schizophrenia, multiple sclerosis and general developmental delay.
Executive functioning skills can be hard to pull apart and look at as separate skills, as more often than not, you’ll use a mix of these skills to do your everyday activities. In general, there are five commonly recognised skills you might hear about:
- Working memory – the ability to hear/see information, then hold it in your brain long enough to do something with it. E.g. reading an instruction in a cook book then complete the task without having to check back too many times, playing the card game snap (remembering the card that was put down before).
- Organisation and planning – the ability to plan activities out in a way that is organised and is likely to be successful. E.g. ensuring you have enough work uniforms to last the week, planning to put the washing machine on before you need to hang your clothes out.
- Response inhibition – the ability to stop yourself from doing things you may feel the need to. E.g. yelling at the shop assistant when they don’t have something you want in stock, crying when you spill your coffee.
- Cognitive flexibility – the ability to adapt and change your plans and ideas as needed, or when new things come up. E.g. when a road is closed and you need to take a detour, believing a friend’s fact without having seen it for yourself.
- Attentional capacity – the ability to hold your attention to something you know that you have to. E.g. not walking out on an uninteresting work meeting, being able to finish washing the dishes without walking away to do something different.
Each area or skill develops at different times in life. For example;
- 6 – 8 years – planning and organisational skills are developing.
- 12 – 14 years – more mature response inhibition and ability to foresee inexplicit consequences kicks in.
- 15 – 19 years – development of mature cognitive flexibility, working memory and complex problem solving.
Although it is important to note, none of these skills fully mature until adulthood.
Psychologists are responsible for assessing a child’s executive functioning skills, using a range of standardised testing methods. Occupational therapists are interested in how an individual’s executive functioning skills relate to their ability to do their everyday activities. A person with poor planning will have difficulty knowing to boil the jug before pouring it into the cup of tea they’re making. Difficulties with working memory will mean they may not put in the two sugars you asked for, and put in three instead. Walking away to do something else after boiling the jug may elude to difficulties with sustained attention. The person needs to be able to cope and have the flexibility to change their plan when after they boil the jug, you change your mind from tea to coffee. They also need to stop themselves from drinking the coffee they made for you, even if it smells delicious (response inhibition).
Occupational therapists are skilled at looking at a person completing an activity, pulling it apart, and considering how to help the person complete the task effectively. The most effective and researched backed method is to help the person with compensatory strategies. We aim to observe a person doing the task they’re having trouble with, and provide suggestions to change the way they do the task so they’re able to be more independent. Strategies we might help a person to implement might include using lists and calendars to plan, use of visual schedules and checklists, and alarms to remember to do certain tasks.
There is also evidence to say that you can improve a person’s executive functioning skills. At TOTS, we like to play games and challenge our kids in a way that develops their ability to sequence and problem solve. Games like Simon, Rush Hour and Rubix Race are great for this. We teach social skills programs and cognitive strategies to help children with difficulties regulating their impulses, or have difficulty maintaining their attention.
It’s also important for us to consider the environment the person completes a task in. The environment can be set up in a way that helps or hinders a person’s ability to complete everyday tasks, particularly individuals with executive functioning difficulties. OTs are skilled at providing suggestions that make life a bit easier, and therefore allowing the person to be that bit more independent.
Executive functioning skills are complex, and many of us take them for granted. Difficulties with executive functioning in children are often discovered when they hit school, where you may be referred to an OT or psychologist to look into these skills further. Rest assured that with adequate support, a person can make positive changes towards being more independent, and engaging in the activities that are important and meaningful. Please don’t hesitate to contact us if you have concerns for your own child’s executive functioning skills!