Communication To Cognition: How Speech Therapy Improves Executive Functioning Skills

Is your teenager experiencing difficulty with back to school tasks including managing assignments, organizing their materials, or getting into a daily routine? Is your loved one experiencing difficulty managing their appointments or staying organized with their daily activities? They may be having challenges in the area of executive functioning.

What is Executive Functioning?

Executive functioning refers to a group of cognitive processes. Similar to memory and attention, our brains use these processes everyday. When individuals have difficulty in one or more areas of executive functioning, it can be referred to as executive dysfunction. Executive dysfunction can impact our ability to carry out daily activities, or participate fully in our lives. Executive functions can be divided into the following processes:

Flexibility

Flexibility refers to the ability to shift our actions given unexpected situations, or being adaptable to changes in schedule. This could include switching from math to English homework, or going to the pharmacy after work since they weren’t open before work. Difficulty in this area may present as having a “fixed” mindset, or an inability to stray from the normal routine. 

Initiation

Initiation refers to beginning, or starting a task or activity. This could include starting homework, or getting in the car to drive to an appointment. Difficulty in this area may present as an inability to “get going”. 

Inhibition 

Inhibition refers to suppressing distractions or thoughts that get in the way of our scheduled tasks/thoughts. This could include saying the wrong thing, or watching TV instead of doing work. Difficulty in this area may present as a lack of “filter” or trouble attending relevant versus irrelevant tasks. 

Judgement/Reasoning 

Judgement refers to evaluating the benefits or consequences of a situation to make the

right choice. This could include knowing not to interrupt when the teacher is talking, or deciding not to drive when you notice your memory declining. Difficulty in this area may present as finding yourself in unwanted situations, or causing harm to yourself or others. 

Planning

Planning refers to figuring out a schedule, or course of action for things that need to get done. This could include making your daily schedule, or booking a trip to Disney. Difficulty in this area may present as missed opportunities, or inability to think ahead. 

Problem Solving

Problem solving refers to identifying an issue, and coming up with possible solutions for that issue. This could include rescheduling an appointment due to a conflict, or figuring out how to manage your finances. Difficulty in this area may present as trouble moving forward when things go wrong, or choosing the best option when presented with multiple choices.  

Organization

Organization goes hand in hand with planning, and refers to keeping tasks/schedules/events in a structured manner. This could include keeping track of appointments with a calendar, or checking off items on a to-do list. Difficulty in this area may present as missing events, or not achieving planned tasks.   

Time Management 

Time management refers to identifying how long a task will take to complete, and scheduling your day efficiently given the scheduled tasks. This could include scheduling your errands around work, or scheduling appointments with enough time in between to drive there. Difficulty in this area may present as missing deadlines, or not finishing work on time.

Why Speech Therapy? 

Speech language pathologists are trained to assess and treat in the area of cognition which includes memory, attention, and executive functioning. During an evaluation, we assess which cognitive processes are strengths or challenges. Then, we create a treatment plan that builds on strengths, and identifies ways to improve challenges to increase participation, and success in everyday life. Communication and cognition go hand-in-hand. Executive dysfunction can affect thought organization, sequencing, and the overall cohesiveness of our communication. 

Focus on Function

Treatment for executive dysfunction is centered around function. In other words, successful treatment focuses on targeting the impairment in activities, or tasks that are relevant to the individual. For instance, if a high school student was having difficulty with organization and time management, treatment would focus on strategies to complete homework and class assignments timely and efficiently. If an older individual was having difficulty with judgement, treatment would focus on working through real-life scenarios to improve judgement, and identify barriers to making good judgements. Materials, or strategies that are used in one’s daily life including calendars, planners, alarms, or reminders can be implemented in treatment. The goal is to maximize carryover of the skills and strategies from treatment to everyday life.

External Aids and Executive Functions

When experiencing executive dysfunction, specifically in the areas of planning, organization, or time management, there are many external resources that can improve those processes. These resources provide our brains with assistance to carry out our daily tasks. 

Calendars 

Calendars can be used to track appointments, upcoming events, or assignments. Paper or digital calendars may be used. These can assist with various executive functions including time management, organization, and planning because they allow multiple upcoming events to be displayed in one location. Digital calendars, including Apple or Google calendar, allow you to input the name of a task, the specific date/times, and a reminder to be displayed ahead of time.

• Tasks: appointments, events, social gatherings, birthdays, assignments, work deadlines, upcoming trips, meetings

  
  

Timers/Alarms 

Timers and alarms can be used to track time, or remind you to do something that is time-bound. These can assist with various executive functions including initiation, inhibition, planning, and time management. Timers/alarms can be set as a key reminder to initiate a task. For individuals who have difficulty with flexibility and inhibition, timers/alarms can be used as a prompt to switch tasks (e.g. when the timer goes off after 30 minutes, I have to stop watching TV and go do my homework). There is a clock app on iPhones that allow you to set alarms, use a stopwatch, or set a timer. Handheld devices may be used as well. 

• Tasks: cooking, baking, laundry, assignments, chores, exercise 

Reminders

Reminders can be used to remind yourself of an upcoming event, or to complete a task. These can assist with various executive functions including initiation, planning, time management, and organization. Digital apps, including the reminders app on the iPhone allows you to set reminders for specific dates/times as well as their priority level. Similar to calendars, they can be used for a variety of functions. For instance, a reminder could be set to “pick up the kids from school at 3pm” or “take my medication everyday at 8pm”. 

• Tasks: appointments, events, birthdays, assignments, work deadlines, meetings, medications, tasks 

Planners

Planners can be used to manage to-do lists, daily schedules, or other lists (grocery, Christmas shopping, etc.). Planners provide us with a manageable way to keep track of multiple items. Planners can be paper, or digital. The notes app on iPhones allow you to make lists with a checkbox next to it, so you can check things off as you go. 

• Tasks: to-do lists, daily schedule, chores, packing list, birthday list, grocery list 

These external aids can be used in conjunction with one another to maximize functioning. A reminder may be entered to “check to-do list”, or an alarm may go off as a reminder to begin homework. It is beneficial to trial different formats and varieties of aids (paper, digital, small, large, etc.) to see what aligns best with your needs. Once your preferred aids are identified, try to implement them naturally in everyday tasks.

Conclusion

Executive functions are cognitive processes that our brains use everyday to achieve goals, or complete tasks. When one or more of these processes are impaired, it can impact our ability to reach our goals or manage daily functions. Speech therapy can assist in identifying which executive functions are strengths or challenges, as well as ways to overcome them. Resources including external aids can also be used to assist with our daily tasks. Whether it is difficulty completing school assignments, or managing a daily routine, the therapists at Insight Speech and Swallowing bring expertise and compassion to every client. If you or a loved one is having difficulty in one of these areas, please reach out to schedule a consultation. We would be happy to help.

If you’re looking for speech therapy for executive functioning near Cherry Hill, NJ, our specialists are here to help. Contact Insight Speech & Swallowing Therapy today to schedule your first session.

Phone: 856-200-8392

Website: www.insightspeechandswallowing.com

Kelli Humphrey, M.A. CF-SLP

About the Author

Kelli Humphrey is a clinical fellow in speech-language pathology licensed in New Jersey. She is supervised by Sophia Apgar, M.A. CCC-SLP. Kelli received her master’s degree from University of Delaware and is experienced across multiple settings including acute care, outpatient, and schools.

Specializations:

-Swallowing Disorders/Dysphagia

-Parkinson's Disease

-Mild Cognitive Impairment

-Traumatic Brain Injury

-Dementia

-Stroke- Aphasia, Apraxia, Dysarthria