Helping Clients Strengthen Executive Functioning: What SLPs Can Do
Executive functioning might seem complex, but as SLPs, we have the tools to make it practical and meaningful. In this post, we will discuss assessing these skills, recognizing when clients are struggling, and using proven strategies to help them improve. Let us get into it!
Assessing Executive Functioning: Where to Start
Assessing executive functioning begins with understanding the client’s strengths and challenges (Harvard University, 2023). Since executive functioning influences communication, learning, and social interaction, the following tools and methods are beneficial (Cleveland Clinic, 2023):
1. Dynamic Assessment
Why Use It? This approach evaluates how clients learn and adapt during tasks, providing insight into cognitive flexibility, working memory, and problem-solving.
Example: Use a test-teach-test model where you assess a client’s ability to follow directions, teach them a strategy to improve performance, and then reassess their ability to apply the strategy (Understood.org, 2023).
2. Standardized Tests
Examples: Tools like the BRIEF-2 (Behavior Rating Inventory of Executive Function) or the TILLS (Test of Integrated Language and Literacy Skills) can measure specific executive functioning components, though they should be used judiciously and interpreted carefully to ensure cultural and demographic alignment with the client (Mohapatra, 2019).
Be Careful: Ensure the test’s norming sample aligns with the client’s demographic and cultural background, and interpret results judiciously as part of a broader assessment. Ensure the test’s norming sample matches your client’s demographic and cultural background. Interpret the results thoughtfully and as just one piece of the more considerable assessment.
3. Observation
What to Look For: Observe behaviors like task initiation, ability to stay on topic, or handling interruptions. Use a variety of contexts, such as classroom activities, play-based interactions, and home routines, to get a well-rounded view of the client’s skills (Harvard University, 2023).
4. Parent and Teacher Input
Ask parents and teachers specific questions, such as how the client follows multi-step directions, transitions between activities, or manages emotions during challenging tasks. Provide structured questionnaires or checklists to gather consistent and actionable insights from their everyday observations (Bilinguistics, 2023).
Populations That Benefit from Executive Functioning Support
Executive functioning challenges can appear in various populations. Here are some groups that often benefit from targeted interventions:
Individuals with ADHD: Difficulties with attention, organization, and impulse control are standard.
Individuals with Autism: Executive functioning challenges may affect flexibility, planning, and emotional regulation.
Clients with TBI (Traumatic Brain Injury): Injuries often disrupt working memory, cognitive flexibility, and inhibition.
Children with Language Disorders: Executive functioning is closely tied to language use, and intervention is a dual priority.
Evidence-Based Strategies to Support Executive Functioning
The goal is to help clients build skills they can use in real life. Here are some practical, research-supported interventions:
Visual Supports
What It Does: Helps clients plan, organize, and remember steps (Bilinguistics, 2023).
Example: Use visual schedules or graphic organizers to map out multi-step tasks.
Role-Playing
What It Does: It encourages the practice of real-life scenarios to build cognitive flexibility and emotional regulation (Harvard University, 2023).
Example: Practice a conversation where a client needs to adjust their tone based on the listener’s response.
Chunking Information
What It Does: Breaks tasks into manageable steps, supporting working memory and task initiation (Understood.org, 2023).
Example: When practicing narrative skills, teach clients to tackle one part of a story at a time.
Self-Monitoring Tools
What It Does: Builds awareness of performance and progress (Cleveland Clinic, 2023).
Example: Use checklists or rating scales to help clients evaluate their communication efforts.
Aided Language Stimulation
What It Does: Models language use while addressing executive functioning, such as turn-taking or managing impulses (Mohapatra, 2019).
Example: Model how to wait for a communication partner’s response during AAC device use.
Why SLPs Are Uniquely Positioned
As SLPs, we work at the intersection of communication and cognition. Executive functioning skills help clients with tasks and underpin successful interactions, narrative organization, and social relationships. We improve communication and equip clients for broader life success by addressing these areas.
If you’re an SLP looking to enhance your ability to assess and support executive functioning or a parent concerned about your child’s skills in this area, we can help. Join one of our specialized training sessions for SLPs to learn actionable strategies, or schedule a consultation to explore personalized support for your clients or family. Together, we can build the skills that lead to better communication, stronger relationships, and lasting success.
References
Bilinguistics. (2023). Executive function in speech therapy. Retrieved from https://bilinguistics.com/executive-function-in-speech-therapy/
Cleveland Clinic. (2023). What is executive function? Retrieved from https://my.clevelandclinic.org/health/articles/executive-function
Harvard University. (2023). What is executive function and how does it relate to child development? Retrieved from https://developingchild.harvard.edu/resources/what-is-executive-function-and-how-does-it-relate-to-child-development/
Mohapatra, B. (2019). Exploring the interaction of executive function and language processing in adult cognitive-communication disorders. Clinical Archives of Communication Disorders, 4(3), 137-145. https://doi.org/10.21849/cacd.2019.00129
Understood.org. (2023). What is executive function? Retrieved from https://www.understood.org/en/articles/what-is-executive-function