Executive Functioning Mini Series: Part 1 - Principles of Effective Executive Functioning Intervention

As a professional field, we’re getting stuck in old ways of thinking when it comes to designing services for students experiencing executive dysfunction.

With “social skills intervention”, we think of an adult teaching a group of kids how to follow the rules in social situations, while students answer questions and discuss to demonstrate their understanding.

Lack of generalization continues to be one of the biggest pain points for therapists using these models.

And while most clinicians agree that collaboration with other professionals and caregivers is important, the “planning” for those activities is often less intentional than the way we plan for direct intervention.

That’s why in the School of Clinical Leadership, the first thing I teach clinicians is how to create a long-term strategic plan for putting executive functioning support in place for their caseloads (and sometimes the entire school) using multiple service delivery models.

When the entire intervention starts and ends within a traditional therapy session, students don’t generalize executive functioning skills across settings.

We as a field need to evolve in the way we think about what’s included in “therapy” services for executive functioning.

There are three paradigm shifts clinicians, educators, and school leaders can make when thinking about supporting kids executive functioning in schools.

One of the biggest challenges therapists have when it comes to executive functioning is generalization. Clinicians also often express that they see poor generalization with “pragmatic language” or “social skills”.

The first distinction that clinicians can make is thinking of “pragmatic language” under the umbrella of executive functioning.

Successful application of “pragmatic language” requires someone to read a room and infer the thoughts, feelings, and perspectives in varying situations. This extends beyond casual socializing, because we can apply this to academic or vocational situations where you’d need to work with others.

When we think of pragmatic language as part of executive functioning, it becomes even more obvious why these skills can’t be addressed with a “pull-out” therapy model alone.

It’s therefore important for clinicians to shift from “therapy planning” to “service delivery planning”.

I like to use “buckets” as an analogy for explaining the difference between “service delivery planning” and traditional “lesson/session planning”.

When we think about therapy services, the “model” is like a bucket we can fill with things (materials, strategies, protocols, etc.).

We’d give that bucket a label with the right amount of flexibility and specificity that it could help us organize what we need to do to deliver services. Planning for direct intervention is one of those buckets because it’s one service delivering model.

Repeatedly, I see clinicians putting lots of things inside their “pull-out therapy” or “direct intervention” bucket. This includes things that can be delivered in a group therapy setting, in a “lesson”, or in a 1:1 format.

We need to have quality things in the direct intervention bucket. In fact, there are some skills that specifically need to be in this bucket in order for kids to get the intensity that they need with certain tasks and skills, as I explain in this post here.

But this isn’t the only bucket we need to fill.

We also need to fill the “consultation/coaching” bucket, the “training” bucket, the “protocols and materials” bucket, and the “long-term strategic planning” bucket. There are more we could include, but these are the big ones.

This means instead of just filling the “direct intervention” bucket with more therapy materials, we can create protocols for having a consultation or coaching session with a teacher.

We could be documenting our therapy techniques by creating sharable resources to give to other professionals or parents so they can implement strategies outside our sessions.

We can work with our leadership or adjacent team members on a long-term plan for how we’re going to block out time for all of these things over the course of the next year.

Even if direct therapy looks like the biggest bucket based on the time blocks in your daily schedule, you can (and should) fill the other buckets.

When we plan intentionally for how we’re going to deliver these other models for students, I call this “planning for service delivery”.

It’s macro level, strategic, and focused on what’s happening across a students’ day, instead of just one time block on your schedule.

I’ll cover the second paradigm shift for multidisciplinary teams implementing executive functioning support in “Part 2” of this article series.

About the Author

Dr. Karen Dudek-Brannan is the founder and owner/operator of Dr. Karen, LLC, a company focused on empowering therapists and educators to design interventions that support language, literacy, and executive functioning. She has a doctorate in Special Education and Director of Special Education and Assistive Technology credentials from Illinois State University, as well as a master’s and bachelor’s from Illinois State University in speech-language pathology. She spent 14 years in the school systems and has held various roles in leadership and higher education teaching and mentoring clinicians. She is the host of the De Facto Leaders podcast, where she shares evidence-based practices, her own experiences, and guest interviews on topics relating to education and healthcare reform. She currently holds a management role with the Illinois Department of Children and Family Services.

You can connect with Dr. Karen on LinkedIn here.

Sign up for her “How to Be Evidence-Based and Neurodiversity-Affirming bySupporting Executive Functioning” training here.

Download her “Executive Functioning Implementation Guide for School Teams” here.

Listen to the DeFacto Leaders podcast here.