By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA
Alexis is a 5-year-old girl midway through kindergarten. She is well-liked, social, and has a strong vocabulary for her age. But her kindergarten teacher has noticed that Alexis has some difficulties in the classroom. Alexis raises her hand often during circle time, but when she is called on she usually freezes or contributes something unrelated to the class discussion. Alexis also frustrates easily. When her first attempt at an art project doesn’t look like the example, she will throw it away or ask to do something else. And when she is given a multi-step direction to put her work away and get on her coat to go outside, she usually stops working but doesn’t move until she sees what her peers are doing, then she will follow along. Alexis’ parents have always noticed similar challenges at home such as giving up on difficult activities, forgetting where she has left her toys, and freezing when given too many choices or directions. But until her kindergarten teacher mentioned these classroom challenges, and they took her to see a neuropsychologist to better understand her classroom struggles, they did not realize that there was a name for her difficulties: Alexis is struggling with executive functioning.
What is executive functioning?
Executive functioning can be considered the “conductor” of all cognitive skills. Research has shown that executive function and self-regulation skills are critical for learning and development and help a person manage life tasks of all types. While humans are not born with executive function skills, we are born with the potential to develop them. Moreover, studies show that we can continue developing the skills throughout our lifespans.
Executive function and self-regulation skills include three key components:
- Working memory (the ability to hold and manipulate information in your mind),
- Inhibitory control (inhibiting impulsivity, to pause and think before reacting),
- Cognitive flexibility (the ability to adjust to changing demands).
While neuropsychological evaluation can be a critical step in learning about a child’s executive functioning skills and gaining recommendations for helping to remediate executive functioning challenges, there are a number of activities that parents can initiate to develop executive functioning skills at home.
Part 1 of this blog post highlights activities suggested to enhance the development of executive functioning and self-regulation skills from infancy through age 12 (taken from developingchild.harvard.edu booklet titled “Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence.”). The full guide is available for download and describes many additional activities and games that provide ways for adults to support various aspects of executive functioning and self-regulation in children (Center on the Developing Child at Harvard University, 2014).
Here are some examples of activities suggested for children of different ages.
Ages 6-18 months old
- Peekaboo —this activity exercises working memory, challenging the baby to remember who is hiding, and also introduces basic self-control skills as the baby waits for the adult to be revealed.
- Pat-a-Cake — Predictable rhymes that end with a stimulating yet expected surprise. Infants exercise working memory, becoming familiar with the rhyme and anticipating a surprise.
- Songs or chants with simple hand motions help develop working memory and language. Infants can learn to copy the movements to a song and, with practice, will remember the sequence (e.g., Eensy Weensy Spider; Open, Shut Them).
Ages 18-36 months old
- Older toddlers can enjoy simple imitation games (e.g., Follow the Leader) which can help develop working memory as well as attention and inhibition.
- Song games with many movements are also fun (The Hokey Pokey; Head, Shoulders, Knees, and Toes). These require children to attend to the song’s words and hold them in working memory, using the song to guide their actions.
Ages 3-5 years old
- Encourage children to tell you stories while you write them down. Also, have the children act out stories they have written. The story provides a structure that guides children’s actions and requires them to attend to the story, while inhibiting their impulse to create a new plot.
- Play matching and sorting activities that promote cognitive flexibility. Children can first sort or match by one rule (such as by color), and then immediately be asked to switch to a new rule (such as by shape).
Ages 5-7 years old
- Games that require players to remember the location of particular cards are great at exercising working memory (e.g., Concentration).
- Games in which the child can match playing cards, either by suit or number, are also good to help strengthen cognitive flexibility (e.g., Crazy Eights, Uno).
- Games that require attention and quick responses help children practice attention and inhibition (e.g., for younger children – Red Light, Green Light or Duck, Duck, Goose; for older children – Simon Says, Mother May I?).
Ages 7-12 years old
- Games that require monitoring and fast responses are great for challenging attention and quick decision-making in children at this age (e.g., Spit)
- Physical activities/games help develop a child’s ability to hold complicated rules and strategies in mind, monitor their own and others’ actions, make quick decisions and respond flexibly.
- Brain teasers (e.g., Sudoku, Rubik’s Cube) require children to be mentally flexible and consider spatial information.
Are you concerned your child’s trouble keeping his/her emotions in check, answering questions in vague or off-topic ways, managing their belongings, or forgetting what comes next could be related to executive functioning issues?
There are many things you can do to get the answers you need to best help your child. The most comprehensive way to assess a child’s executive functioning difficulties and determine a cause is a neuropsychological evaluation. A comprehensive neuropsychological evaluation is made up of a set of tests, questionnaires, interviews, and observations that a clinician will use to gain a good understanding of a child’s strengths and weaknesses, along with learning how a child processes information and completes tasks. At NESCA, we offer comprehensive evaluations that can look for potential learning disabilities, attentional difficulties, and other challenges that can negatively impact a child’s executive functioning development. In addition, a NESCA evaluation will include explicit recommendations to address challenges that have been identified.
Also, if you want to learn strategies for helping a teenager or young adult develop executive functioning skills, stay tuned for next week’s edition of NESCA Notes!
About the Author:
To book a neuropsychological evaluation or consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate that you would like to see “Dr. Talamo” in the referral line.
Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.