What is executive functioning? Simply put, executive functioning is a decision-making process that allows us to achieve our goals by responding to our environment in a flexible way, solving problems and monitoring our behavior to change course as needed. A person with an intact executive functioning system can initiate tasks, tune out distractions, focus attention, organize information, and set and accomplish goals. For example, executive functioning skills are evident in tasks such as driving, where we need to map out our route, leave enough time to reach our destination, make sure we have enough gas, and avoid accidents and tickets.
The core cognitive dimensions of executive functioning involve working memory, inhibitory control, and cognitive flexibility. Working memory allows us to temporarily hold on to and manipulate information. Inhibitory control enables us to refrain from acting impulsively and focus on relevant tasks. Cognitive flexibility allows us to shift our attention and adapt to changes as we process new information.
Executive Functioning’s Impact on Communication
How does executive functioning affect communication? Children with executive functioning deficits may have difficulty organizing their thoughts and thereby fail to communicate information clearly. With impaired attention and focus, they may not be able to sustain engagement in conversations over extended periods of time. Impulsive speech may disrupt the flow of their conversations. Without flexible problem solving skills, they may be unable to adjust their communication styles based on context or by attending to cues from their conversational partners. Poor working memory may make it difficult to recall important information. Additionally, children with impaired executive functioning often have impaired social language and pragmatic skills.
Task-Oriented Movement Therapy
Speech therapists are experts in language organization and social language skills, and thus we are uniquely qualified to treat children with executive functioning deficits. One approach that we use is Task-Oriented Movement Therapy (TOMTx), in which we ask children to solve complex problems by making a plan, executing its steps and reviewing their actions before marking each step as complete.
For example, in a TOMTx play scenario, we may ask children to help us rescue animals from a forest fire by transporting them to a nearby shelter. The children need to demonstrate an understanding of the problem: the animals are in danger and need help! Then they need to create a rescue plan and execute it: a helicopter will pick up the endangered animals and fly them to the shelter. Finally they need to check their list to see who has been rescued and who is still in danger.
TOMTx encourages children to use working memory to plan and execute a series of steps to solve a problem. Because they are working towards a goal, it is easier to focus only on the relevant tasks and ignore distractions (inhibitory control). Reviewing the completed tasks allows them to organize the information in front of them and decide whether their plan needs to be updated or changed in some way (cognitive flexibility).
Targeting Diverse Goals Simultaneously
When we concentrate on executive functioning during therapy, we don’t have to put our other speech and language goals on hold. As we work on problem-solving and organizational skills, we can also cue students to use complete sentences to describe a sequence of events in a plan, which helps with formulating narratives. The repetitive nature of TOMTx also provides an excellent structure for working on articulation goals, since we can cue children to work on producing the same words over and over. When we strengthen children’s executive functioning, we enhance their working memory, focus (inhibitory control) and cognitive flexibility, while priming them to learn other needed skills as well.