Executive Function Disorder

How to Treat Executive Function Disorder

Learn about the therapies, reward systems, and classroom accommodations built to strengthen executive functioning skills in children and adults who struggle to plan, coordinate, and execute long-term projects.

A mother helps her children work through difficult problems one step at a time, a good strategy to avoid homework stress.
A mother helps her children work through difficult problems one step at a time, a good strategy to avoid homework stress.

Experts recommend a range of strategies to help strengthen the areas of weakness that executive function disorder (EFD) creates. The first method uses occupational or speech therapists, psychologists, or reading tutors to help devise systems that work around problem areas. Cognitive behavioral therapy (CBT), used in combination with medication to treat any coexisting conditions like ADHD, is very effective at treating executive functioning deficits including problems with inhibition, emotion regulation, time management, and planning in adults. CBT is less effective with children.

Treating EFD with Therapy

For children, behavior modification programs like token systems and daily report cards work better than cognitive behavioral therapy. Parents can request special accommodations at school via a 504 Plan or individualized education program (IEP). If your child does not qualify for these, a teacher may try informal accommodations, like seating a child near the front of the room. Additional accommodations like splitting assignments into small pieces, and giving frequent breaks can help supplement problem areas, and give the executive system a chance to recharge.

Add rewards and privileges at home if the child does well at school. Focus first on the positives before the negatives. Encourage the things the child is doing well with external reinforcement and then bring in mild forms of discipline if necessary, like taking away points or privileges. Be more structured and systematic by implementing checklists, planners, and timers to help a child with her tasks.

For people with EFD, it’s important not to just focus on teaching new information, but also on teaching the skills they need to better use the knowledge they have. For example, put time into helping redesign the environment to help people with EFD remember what they need to be doing.

Some individuals compensate for working memory deficits by making information external — using cards, signs, symbols, sticky notes, lists, journals, and apps. They make time external by using clocks, timers, computers, counters, and other devices that track time intervals. Many parents use external motivation, like points systems, being accountable to others at work and school, daily school report cards — anything that reinforces accomplishing goals.

Give yourself a problem-solving manual. Take the problem, and break it into pieces that are easy to tackle. Allow the self-regulatory system to pause and refill by giving rewards and positive emotions during tasks that are stressful to the executive functions system. For example, engage in positive self statements, encourage yourself to try harder and visualize accomplishing the goal. Take 3- to 10-minute breaks periodically to relax or meditate. Use physical exercise to help cope with symptoms.

Treating EFD with Medication

There is no medication typically used to treat EFD.

Treating EFD with Lifestyle Changes

Children with EFD have unique needs in the classroom. They might need extra help to understand assignments, get started, and stay focused. Accommodations along with games and technology can help compensate for an area of weakness.

For the child who always loses homework or forgets assignments:

  • Post tasks on the board
  • Read assignments out loud
  • Ask the student to repeat instructions
  • Appoint a row captain to check that everyone has written down the assignment
  • Teach note-taking skills
  • Use color and put different tasks on different color cards

For the child who loses focus and is easily frustrated:

  • Have kids run in place or be active for a minute
  • Have two work stations so that kids can get up and move between assignments
  • Let kids use fidget toys
  • Give kid graphic organizers

The key to choosing successful accommodation is identifying the two or three most important deficits and picking accommodations that address them. To help children at home, provide structure by designating a special homework space and equipping it with the supplies they need to get started. Set a start time for beginning work after school, sit with your child while he starts his assignments, and then check homework when it’s finished.

Break homework into segments. Give kids a snack, or let them run around before starting homework. Let kids listen to music while they work to stimulate focus. Have the phone number of someone in class to check the assignment or borrow a forgotten book. Try using assistive technology to supplement areas of weakness. If writing by hand is difficult, use a computer. If keeping track of time is a problem, try a timer. If staying organized is the issue, find iPhone apps to help.

Games can help to improve executive function skills, too. Games like Checkers, Monopoly, and Clue use planning, sustained attention, response inhibition, working memory and metacognition. Games like Zelda and SimCity help with problem solving and goal-directed persistence. Managing a fantasy sports teams also use executive skills like task initiation and time management while having fun.

Support groups — both online and in person — can help parents and adults connect with people who are experiencing similar difficulties, and give ideas of treatment or accommodations that have helped.

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