How To

People often refer to executive function as the “CEO” of the brain because it is what helps us set goals, plan, and get things done. It is a term professionals and lay people have used for years and it’s likely you have used it or heard it used in reference to people with autism, who often have trouble with executive functions.

How we think about executive function and teach the skills associated with the processes that make up executive function is changing. In fact, we can start by throwing out the metaphor of a CEO. Executive function is, as noted, a set of processes, rather than one overall skill. It is important to recognize how complex, and how involved, our executive functioning is in absolutely everything we do all day, every day in order to provide effective supports and interventions for those with executive function deficits.

For example, getting ready in the morning requires you to plan for how much time you’ll need to accomplish your tasks, remember to set an alarm, and, in the morning, decide to turn off the alarm and get out of bed (as opposed to hitting snooze over and over again).  Next, you need to be able to properly sequence and organize the “getting ready” tasks appropriately.  You need to monitor your time as you move through each task, remember the next task, and be able to initiate the next task once one task is completed. If someone interrupts you, you will need to be able to shift your attention momentarily and then get back on task. Difficulty with these “meta” skills, rather than the actual act of getting dressed or eating, is what usually gets in the way of a smooth morning routine. 

Although our executive functioning is a highly complex system, providing effective interventions doesn’t have to be. Here are some steps you can take to help an individual with autism spectrum disorder (ASD) who has trouble with executive function:

Use (Good) Visuals

Parents and professionals working in the autism field have been incorporating visuals into their interventions for a long time. Being able to picture and visualize our way through specific tasks as well as into the future helps us plan, organize, and execute larger, more complex tasks.

To make the evidence-based intervention even more effective, use photographs of the materials and spaces your child is actually using and living in rather than clip art or generic photos. For example, instead of listing out pictures for a morning routine visual schedule, take a photograph of the child’s bedroom. Next, have your child use their fingers to “tap” their way through their morning routine on the photograph. By using this visual activity schedule, they will actually be rehearsing their way through the morning routine, picturing themselves in the space where they are meant to get ready. They “walk through” all of the steps of getting ready as they point their path from the bed to the dresser to the hamper.

Finally, you can increase the impact of visual activity schedules using social narratives to help guide a child with ASD through the steps of a morning routine. For example, “when I wake up, I get out of bed and put on my clothes for the day.”

Gestures, Gestures, Gestures!

A growing body of literature explores the role of gesturing in executive functioning. One particularly interesting finding from that research is that young neurotypical children who used a lot of gesturing performed better on cognitive tasks than children who did not use much gesturing, even when they were prompted to do so. Because of the core underlying deficits in social communication, many individuals with ASD have difficulty using and understanding gestures. By directly attending to teaching and prompting the use of gestures, parents, teachers, and providers have the potential to help individuals with ASD improve their ability to solve problems, achieve goals, keep information in their working memory, and shift more flexibly between tasks.

For example, tapping out and pointing through the morning routine on the visual map is a form of gesturing. If your child looks at the visual map and speaks aloud their steps without tapping the photograph, then prompt them to show you by pointing. If your child requires it, you can begin with a hand-over-hand prompt to help them move through the process.

Plan Backwards, Execute Forward

Using visuals, show your child what the finished product (i.e., being ready in the morning) looks like. If your child is able, help them talk about what it would feel like when they are ready in time and prepared for the day. This step helps your child develop their future thinking. Now, work backwards. Help your child go through the steps of what needs to be done to reach the finished product and what they need to have ready in order to go through the steps. Taking photographs of each step along the way and having your child sequence the steps from left to right (as opposed to up and down) will help them to think through the process of getting ready.

While a visual task analysis like that one is commonly used with people with ASD, it’s often illustrated with generic pictures, rather than photos. Additionally, the steps are often listed from the top of the page to the bottom. Using photographs of the individual doing those tasks in addition to sequencing the steps left to right are slight modifications to common interventions, that can play an important role in helping an individual develop improved executive function skills. Of course, parents, teachers, and providers will need to design appropriate visual schedules based on their child/student’s individual needs.

When focusing on building independence, you should remember this simple phrase “do with, not for; do less, not more.”  As in the case of the visual activity schedule, interventions should be done with as much engagement from the child as possible, not simply created and then given to a child. Over time, adults can take less of a lead in the process and the child can take on more of the responsibility, having learned a system (planning backwards, executing forward) to rely on.

For further information on how to develop, implement, and maintain visual schedules, check out these resources:

• NPDC Module on Visual Supports
• Indiana University’s “Using Visual Schedules: A Guide for Parents”
• 360 Thinking Seminars

By incorporating visuals, teaching and prompting the use of gestures, and planning the execution of tasks wisely, parents and providers can strengthen the foundation for improved and independent executive functioning. 

Meghan Barlow, Ph.D. is an Ohio-based pediatric psychologist specializing in the assessment and treatment of children with autism spectrum conditions, anxiety, attention deficit disorders, depression, behavioral concerns, developmental issues, and chronic medical problems.  She uses a cognitive behavioral approach to therapy and a variety of evidence-based therapeutic interventions in treatment.  She serves as a member of the board of directors for Connecting For Kids, a non-profit dedicated to providing support and educations for families with concerns about their child’s development, and she earned the 2017 Board Member of the Year Award for her service.