Executive Functions – Falling Within the Speech-Language Pathologist’s Scope

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Many Speech-Language Pathologists agree that there is nothing greater about our field than its amazing diversity. I have been told by my mentors several times, “you will never work with two clients who are the same.” It is inherently clear that each person is their own unique individual. The various speech and language disorders are just part of what makes the people we serve so diverse. From your basic articulation case, to apraxia, fluency, AAC, swallowing/feeding, and TBI, there is a reason why the Praxis training booklet is so large. Even with all of this incredible diversity, there are still some glaring similarities. Many of us know that one child who loves to read, speaks with excellent vocabulary, yet cannot seem to stay organized, remember their homework, or complete a task. The one child who has several friendships, yet cannot control their impulses at home. How can one child be so strong in so many areas, yet fall short at the simplest tasks that we all seem to complete unconsciously everyday? What these children lack is a specific set of skills. Neuroscientists who have studied child and human development have specified these as skills of Executive Functioning – the skills needed to execute, learn, and live productively. 

A complete list of specific executive function skills are still up for debate and being researched thoroughly. Based on my own research and clinical experiences, I have compiled the following list:

Core Executive Function skills:
1)  Working Memory - ability to retain and manipulate distinct pieces of information over short periods of time
2)  Mental Flexibility - ability to sustain or shift attention in response to different demands or to apply different rules in different settings
3)  Self-Control - ability to set priorities and resist impulsive actions

Special skills:
1) Metacognition - ability to stand back and take a view of yourself in a situation to observe how you problem solve. Self-monitoring and self-evaluation
2) Resiliency - ability to bounce back and recover from disruption, misfortune, or change
- Resilience builds the ability to plan, monitor, and regulate behavior, enabling children to respond adaptively to adversity and thrive.
- The single most common factor for children who develop resilience is at least one positive and committed relationship with a supportive parent, caregiver, or other adult.

Specific Subset skills:
1)  Task Initiation
2)  Task Completion
3)  Time Management
4)  Response Inhibition
5)  Self-Regulation
6)  Focus
7)  Organization
8)  Planning/prioritization
9)  Goal-directed persistence

    According to the Harvard University Center on the Developing Child, children are not born with these skills; they are born with the potential to develop them. Specific and meaningful life experiences with an individual outside of the direct family are most often deemed as the best possible course of action. The parent-child relationship is regularly too dynamic to produce these unique experiences at the appropriate frequency needed to foster these skills. Children need to be able to try new things, fail, learn, continue trying, and eventually gain new abilities and start to succeed. With a direct family member, children start out feeling safe and supported. To build these skills, children need to attempt new tasks with specific guidance from more of an unbiased party. There is no doubt – that children and keen observers and excellent people-readers.  The core of executive function intervention will be building a rapport between clinician and student. Executive function skills go far beyond academics – they are life skills necessary to succeed and achieve independence. Fostering intrinsic motivation will be a core asset toward successful therapies, as therapist and student will be partaking in new experiences, stepping out of the comfort zone, trying new things, failing until success, and building self-worth (Harvard University Center on the Developing Child, 2017).

    From birth to the teenage years, the brain grows at a speedy pace due to massive growth of nerve cells. These nerve cells are crucial as they use their axon and dendrite branches to send and communicate information to other cells. These branches grow rapidly during the infant and toddler years. As these branches grow, myelin builds a fat-based protective covering around the axons. This process, known as myelination, insulates the branches and makes the signals faster and more efficient. Myelination helps create the white matter of the brain, which connects different brain regions and allows them to communicate. Myelination continues to take place throughout adolescence into early adulthood. This is a crucial time of self-development when a child develops into the adult they will become. Much of this myelination and the development of white and gray matter during these adolescent years take place within the frontal lobe and prefrontal cortex. It is this frontal area of the brain that connects to other areas and is the basis for the foundation and development of the many executive function skills (Guare, Dawson, & Guare, 2012).

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    Each executive function skill humans possess is crucial for academic success, job attainment, and lasting social relationships. Speech-Language Pathologists have an interesting opportunity to assist children in the development of these skills. As SLPs, we have unique training and experience in the development and interaction of appropriate social behaviors and pragmatic language. It is in these social situations where many executive function disorders come to light. A child in middle school who still cannot share or handle losing a board game. A child in high school who gets too easily distracted to remember plans she had with a friend or to return their text message. Several executive function deficits carry over into pragmatic language, which an SLP is distinctively qualified to assess and treat. Speech-Pathologists also have explicit training in language comprehension and receptive language. This is crucial for effective treatment for executive function disorders. One of the most effective strategies is to learn to utilize positive self-talk. This is a practice many of us use subconsciously everyday. We wake up and talk to ourselves throughout our morning to ensure we are productive and get to work on time. We use self-talk as we prepare to work with our clients to ensure we have successful sessions. Children and adolescents with executive function disorders are often too unorganized and scattered to effectively utilize self-talk.  With the use of this strategy, we can teach our students to talk themselves through life’s situations, both basic and complex. Improving internal language use can aid with time management, task initiation, task completion, metacognition, working-memory, and self-control. Enhancing these crucial skills will aid our students in all aspects of their life: family, friends, school, and work. With our comprehensive trainings on both pragmatic and receptive language, Speech-Language Pathologists are well equipped to treat students with executive function deficits.             

    Michael McLeod, MA CCC-SLP
    Speech-Language Pathologist
    Owner – GrowNOW Therapy Services, LLC
    MGMGrowNOW@gmail.com
    GrowNOWTherapy.com 

    References
    American Speech-Language-Hearing Association. (2003). Evaluating and treating communication and cognitive disorders: approaches to referral and collaboration for speech-language pathology and clinical neuropsychology [Technical Report]. Available from www.asha.org/policy.

    Cicerone, K. D., Dahlberg, C., Kalmar, K., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., ... & Herzog, J. (2000). Evidence-based cognitive rehabilitation: recommendations for clinical practice. Archives of physical medicine and rehabilitation81(12), 1596-1615.

    Guare, R., Dawson, P., & Guare, C. (2012). Smart but scattered teens: The executive skills program for helping teens reach their potential. Guilford Press.

    Harvard University Center on the Developing Child (2017). Executive function and self regulation. Retrieved from https://developingchild.harvard.edu/science/key-concepts/executive-function/