The Clinician’s Guide to Executive Functions

The phrase “executive functions” is becoming an increasingly common term in discussions of children with attention, learning, and psychosocial disorders. As there are varying definitions of executive functions, clinicians are encouraged to become more familiar with a basic understanding of the concept of executive functioning and how it applies to childhood psychiatric and learning disorders. The following section provides a general summary and a brief discussion of a modified Dawson and Guare (2004) model that LearningWorks for Kids recommends for use with children.

 Executive functions refer to a set of brain-based cognitive skills that help people regulate their thinking, emotions, and behavior. Executive functions are presumed to be centralized in the prefrontal cortex of the brain, which receives and coordinates incoming information from all other brain regions, including sensory experiences, current biological states, memories, and experiences. An individual’s evaluation of the current situation is coordinated and used for decision making and actions. Executive functions help people to set goals, develop an understanding of the tools necessary to complete a goal, and monitor successes and failures.

 Executive functions are built-in brain skills that emerge in infancy and early childhood and become more evident as children get ready to start school. Skills such as the ability to pay attention, remember what was learned in the past, and regulate one’s behavior become necessary for effective adaptation. While these skills are “built-in” or brain-based, they develop over the course of adolescence, and recent evidence suggests that they continue to develop until one’s mid-30’s. 

 The growth of executive functions directly parallels the brain growth and development of children. Current research indicates that the frontal brain systems, including the frontal and prefrontal cortex (which are the last brain regions to mature), are key areas involved in executive functioning. Individuals with significant damage to their frontal lobes and prefrontal cortex have numerous deficits in executive functioning, including high levels of impulsivity, poor judgment, irresponsibility, and difficulty with decision making and monitoring one’s behavior.

As children’s brains mature they not only grow in size through a regeneration of neurons but also develop an extraordinary number of branches that allow nerve cells to communicate with one another. This increases the capacity for complex thinking and decision making. Executive functions do not operate independently in decision making but are highly dependent upon the quality of the information the brain receives. The quality of executive-functioning skills may be based on accurate sensations of one’s world, emotional and motivational states, memory capacity, and ability to use language. 

Executive functioning in children appears to develop in a sequential fashion. Distinct growth patterns have been observed, with periods of intense development between the ages of 5 and 7, 9 and 12, and within adolescence. Babies as early as 1 year old begin to display the ability to be goal directed. By the age of 2 children are able to follow single directions and at 3 can begin to follow and understand distinctions among directions. 

One prominent theory of executive-functioning development has been formulated by Russell Barkley, Ph.D., who proposed that within the first 6 to 12 months of life, children develop the executive function of behavioral inhibition. Behavioral inhibition allows individuals to think before acting and to decide if/when to respond to a situation. Barkley suggests that the skill of working memory, which includes holding events in mind, occurs next, followed by the use of internalization of speech, or using language to aid in decision making. The next stage involves self-regulation of affect, emotional self-control, and regulation of motivation and energy to achieve a goal. Last is what Barkley refers to as reconstitution, which involves the ability to analyze and monitor one’s behavior and to develop strategies to use one’s skills to solve new problems. 

Executive Functions as Executive Skills

A slightly different conceptualization of executive functions refers to them as a set of psychological skills, including decision making, problem solving, resisting distraction and interference, selective attention, and inhibiting inappropriate responses. The skill-based perspective views executive functioning as impacting children’s ability to start tasks, plan and maintain mental information, regulate expression of feelings, sustain attention to tasks, manage time, display persistence and/or flexibility, think, monitor, and evaluate one’s actions. Executive functioning is extremely important in the development of effective goal-directed behavior. Children are generally able to display increasing skills in their use of executive functions as they grow older. Delays in one or many areas of executive-functioning skills are seen in many children and adults who have difficulty in diverse areas such as planning, social skills, time management, initiation, persistence, completion of tasks, memory, and learning.

The following is a list of the executive functions that are most useful in the LearningWorks for Kids model. As noted, many definitions of executive functions are found in the psychological literature. The descriptions that follow are those that apply most directly to the development of executive-functioning skills in children. The format that follows combines many viewpoints but uses the organization of work conducted by Peg Dawson and Richard Guare (2004).

  • Task Initiation (Getting Started)
  • Sustained Attention (Keeping Focused)
  • Planning (and Prioritization)
  • Working Memory (Keeping It in Mind)
  • Organization
  • Goal-directed Persistence (Stick-to-itiveness)
  • Flexibility
  • Response Inhibition (Self-control)
  • Regulation of Affect (Handling Emotion)
  • Time Management/Prioritization
  • Metacognition (Thinking about One’s Actions)
  • Social Thinking 

Metaphors for Executive Functioning

A number of psychologists have referred to executive functions as the conductor of an orchestra (Brown 2005). The conductor is seen as being connected to all aspects of the music that is produced (the observable behaviors) and having to pay attention to each of the musicians and instruments and the interactions among them and to process many channels of information. The conductor must be organized, constantly check and monitor what is happening, and be responsive to the here and now. Conductors must also use their memory of previous experience, identify strengths and weaknesses, and make adjustments when necessary to the volume and emphasis of the music being produced. 

LearningWorks for Kids has developed a different metaphor that may be helpful to explain executive functions to children, that of a coach or manager. Coaches and managers need to organize their thoughts and actions in response to the environment, history, and strengths and weaknesses.

For example, managers of baseball teams makes decisions about whom to play, which players to start, what aspects of the game require the most attention, and how to employ players so that they can be most successful to benefit the team. They may ask themselves what the other team’s reaction would be if they made a particular move or how to respond to changing situations in the game. Executive and planning skills such as having the team prepared to play a game and keeping their effort focused and sustained on the game have a direct impact on performance.  Managers also require other executive-functioning skills: they need to handle their emotions when the team is doing poorly, estimate or judge what might happen in certain circumstances, and think about and review what they are doing so they can use that learning for future games.

Managers and coaches often provide guidance, direction, encouragement, and perspective taking, which are all components of successful executive functioning. Children with difficulty in these areas require external managers and coaches (such as parents, teachers, counselors, or peers) to guide them, model, and give effective feedback so that they can enhance their use of executive-functioning skills. Parents, teachers, and clinicians are sometimes asked to serve as the “temporal lobes” for children with executive dysfunctions, and in this respect, adults serve as supports or scaffolds for executive skills for these kids. LearningWorks for Kids describes strategies for using digital technologies and other tools to support executive functions in children. We also strongly believe that these skills can be practiced and learned through the use of digital technologies and other methods. Specific strategies for doing so can be found at LearningWorksforKids.com.

Teaching and Coaching Executive-functioning Skills: The LearningWorks for Kids Model

Our approach at LearningWorks for Kids recognizes that many children naturally acquire excellent executive-functioning skills through their interactions with family, friends or the biological predisposition for skills such as organization, working memory, and inhibition. However, as many as 30% of children struggle in developing effective executive-functioning skills. These kids, whom we refer to as alternative learners, may have good executive skills in some areas but weakness with specific skills. They need help to succeed in the competitive 21st century world in which we live.

For the most part, parents, teachers, and clinicians do not actively attempt to teach children executive-functioning skills. In contrast to our educational systems, where we have a very clear curriculum of what we want children to learn, there is not a set of instructional guides for teaching executive skills. As a result, kids with weak executive-functioning skills get support haphazardly. Fortunately, in the last decade many leading educators and child care professionals have begun to recognize the importance of executive-functioning skills, sometimes referred to as life skills, thinking skills, grit, or character skills, and have developed strategies that can be used to improve these skills. Unfortunately, most of the strategies tend to be curriculum based, used in the classroom or individually by a parent, clinician or coach, and may be only modestly engaging for the learner.

Our approach at LearningWorks for Kids is to find activities that children already engage in and love to do and to use these opportunities as teaching moments for improving executive-functioning skills. Primarily, we use video games and technologies to teach executive-functioning skills, catching kids where they are at and using their engagement, attention, and persistence with technology to develop the capacity to identify, think about, and connect their technology play to real-world opportunities that improve executive functions. We also provide a variety of other strategies that use children’s play, whether through their involvement in sports, art, music, or other daily activities, to improve executive-functioning skills.

To learn more about how to use these different types of technology in activities the children already love to improve their executive-functioning skills, check out the following articles:

https://learningworksforkids.com/2017/11/build-improve-executive-functions-team-sports-basketball/

This article links LearningWorks for Kids with basketball to enhance team and group work skills.

https://learningworksforkids.com/2018/05/the-importance-of-executive-functions-in-the-classroom/

This article describes the significance of learning and applying executive functions in and out of the classroom.

https://learningworksforkids.com/2018/03/train-brain-success-teenagers-guide-executive-functions/

This link is a helpful guide about how teenagers can improve their executive-functioning skills.

https://learningworksforkids.com/2018/02/classroom-strategies-improve-executive-functions-progressing-accommodations-mastery/

This link is an extension to how teenagers can highly improve their executive-functioning and performance skills.

https://learningworksforkids.com/executive-functions-ebook/

This links to a free e-book (designed for patients) about executive functions.

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