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.
With all of this diversity, there are some glaring similarities. Many of us know that one child who loves to read, speaks with an 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. 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 every day? 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 is still up for debate and being researched. Based on my own research and clinical experiences, I have compiled the following list:
Three Core Executive Function skills:
1) Working Memory – ability to retain and manipulate distinct pieces of information over short periods of time
2) Mental Flexibility – sustain or shift attention in response to different demands or to apply different rules in different settings
3) Self-Control – set priorities and resist impulsive actions
Two Special skills:
1) Metacognition – the 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 – the 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.
There are four (more specific) subset Executive Function skills:
1) Task Initiation
2) Time Management
3) Organization
4) Goal-directed persistence
Susanne Phillips of LinguiSystems states:
“Impairment of any or all of these executive functions may be present in spite of strong intellectual skills and unaffected language capacity. When executive functions are impaired, all other cognitive systems have the potential to be affected, even though those same systems may remain undiminished in isolation. Individuals with executive function impairments have difficulty with planning and organization. They are unable to identify what needs to be done and/or are unsure of how to accomplish the steps to completion in an orderly way. Individuals often appear inattentive and disorganized. Frequently, they miss deadlines, are late for appointments, or overschedule themselves. People with executive function impairments demonstrate difficulties with initiation as well as experience pitfalls in beginning tasks. This may be evident by the person sitting idle when directly asked to do something, or in a more subtle form, by someone appearing less spontaneous or less energetic than might otherwise be expected. Once the person begins a task, he or she may have problems maintaining attention to the task or in persisting to the end. With executive function impairments, self-monitoring and self-regulation become arduous. People with executive function disorders are inconsistent in their performance and have problems integrating feedback or suggestions. “ (Source for Executive Function (2003), Susanne Phillips, Linguisystems, pg. 8-11)
According to the Harvard Center of 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 (http://developingchild.harvard.edu/science/key-concepts/executive-function).
From birth to the teenage years, the brain grows at a speedy pace due to the 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 takes 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 (Smart But Scattered (2009), Dawson & Guare).
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 SLP’s, 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 every day. 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 training on both pragmatic and receptive language, Speech-Language Pathologists are well equipped to treat students with executive function deficits.
References
- Dawson, Peg & Guare, Richard. Smart but Scattered. Guilford (2003).
- Keely, Suzanne. The Source for Executive Function Disorders, Linguisystems (2003).
- The Harvard Center for the Developing Child: developingchild.harvard.edu
