Here, you will find tools and information for the adult with executive function disorder. These are strategies that can impact executive functioning needs so that organization, impulse control, planning, time management, and other executive functioning skills are improved and regulated in daily life tasks.

My daughter has battled Executive Function Disorder all of her life, but right now, it is really preventing her from moving forward with her life. Things like completing a task, making decisions, time management, and projecting ahead are SO HARD. Is there anything that can help my adult daughter struggling with executive functioning disorder?

Does this sound at all familiar? So often, executive functioning challenges are present in adults. In fact, there are everyday challenges that are very difficult for adults with executive functioning needs. Things like organization, planning, and flexible thinking can be a real struggle. As kids with these challenges move into adulthood, some areas that we might expect to develop just never seem to change. It's not uncommon; the fact is that executive functioning skills are a very broad set of skills. Forgetting things, difficulty with inhibiting behaviors or actions, trouble with planning big projects, or staying organized in the daily life of an adult...everyone deals with these challenges at one time or another. The challenges become a problem when  social, emotional, intellectual, or organizational aspects are disrupted.  A person's career/job/family life/etc. can be devastated by difficulties with executive functioning skills. 

Difficulties with the higher-level cognitive skills that make up executive function can impact adults by limiting one's ability to "connect the dots" and can impact other areas of executive functioning as well. 

For the adult with executive function disorder, challenges can present in many different ways. There may be no trouble with impulsivity or attention struggles, however other mental skills can be quite difficulty. Sometimes, seeing the "big picture" is the problem. For others, it's just making decisions. Still others lack time management and have difficulty with multi-tasking. 

Executive Function Development in Adults

Here's the thing: There is a lot of information out there for kids who are struggling with these areas. However, for most of us, executive functioning skills are still developing well into the adult years. In fact, executive function skills don't typically develop until the early 20s. Development of executive functioning skills occurs up through the college years (and beyond), making that transition from the home setting of high-school into a college dorm very difficult for many. 

So, for some adults who are challenged in these areas, there can be simply a few accommodations or strategies put into place. Simply using a few set of tools designed to address these needs can allow for improved skills like organization and time management which are then carried over to other areas. 

For other adults who may have always struggled with seeing the big picture, planning tasks, or staying focused on a task, this is the typical development for that individual. In other words, some adults may be gaining improvements and strengthening the skills they've got, just at a lower level than another adult. In these cases, strategies and tools can make a difference here, too. 

Below, you will find curated information from around the web that will be instrumental in making an effortful improvement in executive functioning needs. Read through this information and use it as best fits the needs you or an adult with executive functioning challenges might be experiencing. Remember that everyone is different in their strengths, weaknesses, needs, interests, and experiences. This information is not intended to treat or address specific needs, but rather, as educational material. Seek professional help when needed. 

Executive Functioning Disorder in Adults

There are several areas that may be an area of difficulty for the adult with executive functioning challenges. Some of these problem areas may include:

Difficulty making plans

Difficulty making decisions

Time management

Trouble with organization

Difficulty keeping important papers organized

Trouble prioritizing 

Poor emotional control 

Difficulty with flexible thinking

Trouble thinking "on the spot"

Trouble using a schedule

Trouble getting out of the house on time

Trouble with impulsive buys

Difficulty paying bills on time

Difficulty with losing keys or important items

Trouble following through with plans

Trouble picking the most important tasks

Trouble doing the important parts of tasks first

Trying to do too much at once

Constantly running late

Difficulty listening to a person talking without thinking of other things

Easily frustrated

Forget the last step/steps in a multi-step task

It's easy to see how the list above can look so different for different people, especially when considering aspects such as job requirements, family obligations, outside situations or other issues that may make a difference in the occupational performance of an individual. 

Some easy to apply tools can include low-tech or high-tech strategies such as:

• Use a paper planner or calendar to keep track of obligations
• Set up a filing system to keep track of and manage mail and important papers
• Use highlighters and colorful sticky notes to make a visual organization system
• Use apps to stay organized. Here are some Alexa Skills that can help with executive functioning skills like organization, etc.
• Set up calendar reminders on a phone or smartwatch
• Set up automatic payment plans for bills
• Brainstorm routines and weekly/daily tasks and strategies to make decision-making less stressful and easier
• Think through and visualize the day or week ahead and predict any challenge that may arise
• Create routines and calendars for ongoing tasks
• Create brain dumping lists for big tasks and set goals with specific dates and timelines
• Use a daily journal to track each day's events. The Impulse Control Journal can be used by adults as well as kids. The "look" of the journal is not childish, and has many components that can translate to an adult's needs in promoting organizational, time management, etc. 

More Resources for Adults with Executive Function Disorder

Here are some symptoms of executive function disorder in adults. Some of the symptoms include time blindness, self-motivation, and an inability to keep future events in mind. Do these symptoms sound familiar?

One symptom that is mentioned is the regulation of one's non-verbal working memory, or our inner critic. This is an area that can be detrimental to some, especially when self-conscious of weaknesses that impact life choices or struggles.  Here is one simple strategy for self-talk in kids, but can be morphed into an age-appropriate version for adults. 

If an adult or someone who is trying to help an adult with executive function needs would like to look into testing, here is a self-test that may help with self-awareness of the problems that can easily be addressed through strategies and tools. Use this information to move forward with professional help if necessary. 

Another article that can "bring to light" some of the concerns with executive functioning needs is this article about the day in the life of an adult with EFD. It really highlights the challenge of managing other people's schedules, the workplace juggling act, and managing relationships.

TIme management tools, including simple planners and time management apps can be helpful. Here are more tools for addressing time management and other tools such as motivation, scheduling, prioritization, and other challenges. 

This article discusses ADHD, but a lot of the tips and strategies can carryover to any need with planning ahead.

Finally, remember that many of the executive functioning strategies that are out there and presented in books can be used just as easily and seamlessly by adults. The same strategies that work for keeping track of homework tasks by a child can be used by an adult who needs to manage bills and important papers. 

Want to really take executive function skills like planning and prioritization to the next level of success? 

The Impulse Control Journal is your guide to addressing the underlying skills that play into trouble with planning and prioritization. 

The journal is an 80 page collection of worksheets and prompts to discover what's really going on behind executive functioning skills like planning, organization, prioritization, working memory, and of course, impulse control. 

While the guide was developed for students of all ages, this printable workbook is perfect for adults, too. It can help you discover strategies that make a real impact for all of the skills needed to get things done. 

Here's the thing; Everyone is SO different when it comes to struggles related to executive functioning and everyone's interests, needs, challenges, strengths, and weaknesses are different too. All of these areas play into the challenges we see on the surface. And, this is where the Impulse Control Journal really hits those strengths, weaknesses, and challenges where it matters...in creating a plan that really works for kids of all ages (and adults, too!)

Check out the Impulse Control Journal, and grab it before the end of February, because you'll get a bonus packet of Coping Cards while the journal is at it's lowest price. 

Read more about The Impulse Control Journal HERE. 

The Impulse Control Journal has been totally revamped to include 79 pages of tools to address the habits, mindst, routines, and strategies to address impulse control in kids. 

More about the Impulse Control Journal:

• 30 Drawing Journal Pages to reflect and pinpoint individual strategies 
• 28 Journal Lists so kids can write quick checklists regarding strengths, qualities, supports, areas of need, and insights 
• 8 Journaling worksheets to pinpoint coping skills, feelings, emotions, and strategies that work for the individual 
• Daily and Weekly tracking sheets for keeping track of tasks and goals 
• Mindset,Vision, and Habit pages for helping kids make an impact 
• Self-evaluation sheets to self-reflect and identify when inhibition is hard and what choices look like 
• Daily tracker pages so your child can keep track of their day 
• Task lists to monitor chores and daily tasks so it gets done everyday  
• Journal pages to help improve new habits  
• Charts and guides for monitoring impulse control so your child can improve their self confidence
• Strategy journal pages to help kids use self-reflection and self-regulation so they can succeed at home and in the classroom  
• Goal sheets for setting goals and working to meet those goals while improving persistence  
• Tools for improving mindset to help kids create a set of coping strategies that work for their needs  

This is a HUGE digital resource that you can download and print to use over and over again.  

Bilateral Integration is an area that kids need for so many tasks...but it's not a developmental milestone that stands out unless a problem is necessarily noticed. From writing and holding the paper, to holding a art project and cutting with scissors, to zippering a jacket, coordinating both sides of the body in an efficient manner is a skill that is necessary for almost everything we do. Bilateral coordination develops from a very young age. When babies begin to bring both hands together at their mouth, you are seeing coordinated efforts begin. When the infant pushes up on both arms while lying in a tummy time position, the integrated movements of both hands and legs occurs along with strength and control. Here you will find bilateral integration activities that can be incorporated at various ages. Use these bilateral coordination activities to promote coordinated and efficient movements in meaningful activities.

Bilateral Integration Activities 

Amazon affiliate links are included in this post.

First, let's talk about some ways that coordinated use of the arms and legs are needed for coordinated movements. These are skills and tasks that can easily be performed by some children. Others, who struggle with motor planning, core strength, posture needs, left-right discrimination, visual motor skills, or many other areas can struggle. It's easy to see that simply addressing some areas won't fix the issue when an underlying concern is present.

Tasks that require bilateral integration

Know a child (or adult) who struggles with one or more of the tasks below? Bilateral integration may be a challenge.

• Writing and holding the paper in a stable position

• Cutting and holding the paper steady and at an appropriate height

• Putting on a coat while holding a backpack (or other item)

• Tying shoes

• Pulling up pants and not losing balance

• Putting socks on

• Jumping jacks with coordinated movements

• Turning a page and writing or copying work

• Typing

• Playing an instrument

• Reaching for objects

• Stabilizing an object with one hand while manipulating another object with the other

• Jumping rope

• Catching a ball

• Riding a bike

• Swimming

To promote the skills needed for these tasks, try some of the activities listed below to promote bilateral integration:

Related Read: Here are are some additional bilateral coordination activities with a winter theme.

Bilateral Integration Activities for Babies

Provide various toys and objects appropriate for young babies. Include bold colored objects including black, white, and red items or contrasting colors, toys, or pictures on a blanket or play mat during tummy time. This black and white board book can be propped up or used while on an adult's lap.

Provide gentle infant massage during and after bath time, and on all extremities. Here is a resource book on infant massage.

Provide toys and age-appropriate objects for reach and grasp. This banana toothbrush teether has molded handles that make it a great teething item for little ones.

Provide teething toys as baby brings hands together at their mouth.

Provide toys that are appropriate for mouthing that can be held in both hands.

Provide hand-held toys while the child is seated in a high chair. This one has a suction cup base to keep it stable, but has a black and white ring at the base that babies can grasp with one hand while manipulating with the other hand.

Provide toys of various weights when seated upright to provide resistance against gravity and to promote strengthening of the upper extremities. Blocks, rings, sorting toys, or something like this quality teething toy made of heavier materials can be useful to provide variances in weight, while still allowing the baby to manipulate the item.

Provide toys available on a high chair or table surface at various distances to provide opportunities for depth of perception when reaching for toys and bringing them to the mouth.

Continue tummy time while playing in prone to promote strength and stability in upper extremities

Bilateral Integration Activities for Toddlers

Provide toys requiring one hand to stabilize a base while the other hands manipulates an object. Shape sorters are great for this.

Other toys include:

Peg Boards

Blocks- These press and stay sensory blocks are perfect for encouraging one hand to use as a stabilizer and one hand as a

Play Dough

Drawing/coloring- Here is more information on the benefits of coloring.

Bilateral Integration Activities for Preschool

Encourage kids to participate in cooking activities.

Use play dough to cut with scissors and roll out play dough snakes or balls of play dough.

Age-appropriate crafts and craft sets are great for this age.

Play with stickers of various sizes.

Make "snow angels" on a carpet or fluffy blanket

Simon Says is a great game for encouraging novel and varied motor combinations.

Play various song and movement games such as the Hokey Pokey, Farmer in the Dell, etc. Here are movement and song activities that can be used in circle time, warm-ups, centers, or in group activities. All of these move and dance songs promote core strength and stability.

Climb on outdoor play areas at playgrounds and in low trees.

Add sensory! Try this table top bilateral coordination activity to draw shapes.

Draw with both hands! This four leaf clover activity is a powerful one as it covers a variety of skills.

Bilateral Coordination Activities for School-Aged Kids

Folding origami or other paper crafts are great at this age.

Try these gross motor dinosaur themed movements with a DIY game.

Fold paper airplanes.

Work on letter matching and eye hand coordination with a DIY rolling surface toy.

Build with LEGOS or other building toys.

Try craft activities such as beading, jewelry making, or perler bead crafts.

Build and create with Pop Tubes. This bilateral coordination activity is fun.

Weaving activities.

Lacing activities.

Try making this bilateral coordination weaving activity.

Last thoughts on encouraging bilateral integration

The best way to encourage and promote integration of both sides of the body? Movement and play! Get the kids active, moving, and experiencing various planes against resistance and with exposure to all types of sensory experiences. The combination of proprioceptive input into a play experience that promotes strengthening in a fun way provides all of the benefits kids need to improve bilateral coordination skills. Add personal interests as the child grows. And finally, have fun!

Adding movement breaks to the classroom can be a tool for helping kids focus and learn. Read below about some research related to classroom breaks and behavior, learning, and focus in the classroom. These are brain breaks that can be used as classroom breaks to take a short break from learning...OR used as a strategy to incorporate movement into learning activities!

I was thinking about the cold weather we've been having recently. My kids have been cooped up in school and when they get home from school, it's been FREEZING. Sure, we can bundle up and run around the yard for a bit (and I try to get all the kiddos to do this)...but it is downright cold out there. We can't last too long when the wind chill is -4 degrees F!

Not only that, but many schools aren't having outdoor recess when it's this cold. Some are getting their kids bundled up and outside, but for the most part, it's been indoor recess for many kids.

So when the school day is an indoor affair all day long, kids can become antsy!

Research on Classroom Breaks

Research tells us that activity breaks in the classroom can improve classroom behavior and can increase students' overall physical activity.

We know as therapists, that behaviors are just the tip of the iceberg. They are the sign that something bigger is causing the behavior we see. It might be anxiety, worries, sensory needs, communication issues, emotional concerns, social situations, or a myriad other underlying areas that lead to the behavior we see. 

So, to know that science tells us that a brain break can help get out of that rut of behaviors is huge! It's a strategy to help reduce the behavior and move toward focused learning and attention. In fact, there's been some findings indicating physical activity during the school day improves attention-to-task in elementary school students. 

The evidence suggests that increasing physical activity may improve academic performance, in the forms of recess, physical education class, and physical activity in the classroom. But if indoor recess is the only option this time of year, and gym class occurs every one day out of 6 in a classroom rotation schedule, or even one day/week, where does this leave us? Movement and learning and classroom breaks seem to be the option left!

In my research of the available evidence-based practice scenarios out there, I found some interesting points related to learning and specifically executive functioning skills and overall cognitive functions related to learning. 

Here is some more information on physical activity and brain structure such as brain white matter and brain function. 

Executive function is related to learning

It seems that executive functioning skills play more into learning that just having a neat and tidy desk space or remembering homework. 

In fact, executive function plays very much into the use of those mental skills in learning and classroom tasks. These skills can play a big role in attention levels and impulse control of kids in the classroom. They play a part in learning in many ways. Here are just a few examples:
-Arriving to class on time
-Staying on task in an assignment
-Staying focused when completing minor tasks such as retrieving a pencil. Here's a scenarios you may have seen before: A student drops their pencil. They bend to retrieve that pencil and then get distracted and lose focus on the assignment they are working on. Sound familiar?
-Visual attention in order to scan a math worksheet and going through the assignment part by part without skipping sections or getting distracted or overwhelmed

Activity and Learning

• Evidence suggests that mathematics and reading are the classroom subjects topics that are most influenced by physical activity. These academic areas depend on "efficient and effective executive function, which has been linked to physical activity and physical fitness".
• Executive function and brain health are the basis of academic performance. The cognitive functions of attention and memory are essential for learning. These executive function skills are enhanced by physical activity and higher aerobic fitness.

Physical activity and behaviors

It seems that when physical activity is used as a break in the classroom, whether as a brain break or , during gym class, recess time, or during active learning, attention, on-task behavior, and academic performance  improves as well. 

How to add more physical activity to the school day 

Some ideas for adding physical activity into the classroom in order to improve behaviors include:

1. Offering physical activity breaks within the curriculum or learning activity

2. Allow students to stand at the student's discretion. This strategy should be used with a training period and even a contract signed by the student that says they will not move away from their desk and that they will perform the work that's asked of them while standing at their desk.

3. YouTube Videos- Here are our recommendations for YouTube brain breaks that can be added into classroom breaks. Some of these would be great for an indoor recess dance party, too. 

4. Print off a collection of brain breaks and pull them out at different times during the day or as a transition activity. Here are some printable sheets of brain breaks: Bear brain breaks, Squirrel Themed Brain Breaks,  apple themed brain breaks

5. Add a beach ball or bean bag to group activities. Toss while naming the answer to questions. 

6. Jumping Jack Spelling Words- This is a whole-class exercise drill that gets the brain and the heart moving!

7. Make indoor recess an active time. Here are indoor recess ideas to get the kids moving. 

References:
Grieco LA, Jowers EM, Bartholomew JB. Physically active academic lessons and time on task: The moderating effect of body mass index. Medicine and Science in Sports and Exercise. 2009;41(10):1921–1926. 

Mahar MT, Murphy SK, Rowe DA, Golden J, Shields AT, Raedeke TD. Effects of a classroom-based program on physical activity and on-task behavior. Medicine and Science in Sports and Exercise. 2006;38(12):2086.

Donnelly JE, Lambourne K. Classroom-based physical activity, cognition, and academic achievement. Preventive Medicine. 2011;52(Suppl 1):S36–S42. 

Here, you will find a variety of information on executive functioning. These are resources curated from around the internet designed to improve executive function. I wanted to create a space that has information on executive functioning skills that can be accessed all in one place. It is my hope that this space is one where you can find strategies and tools for addressing problems with attention, organization, task initiation, planning, prioritization, and many other mental skills that cause so many individuals to struggle. Use these tools, tips, and information to work on executive functioning by starting at the beginning!

Depth perception is a pretty amazing thing. It allows us to see the world in three dimensions; for us to crawl, navigate stairs, play catch with a ball, drive and many more activities. But what happens if our depth perception is impaired? These activities become exponentially more difficult, and may be even impossible. Read more about visual problems here.

What is Depth Perception?

Depth perception is a visual processing skill that allows us to perceive visual input in multiple dimensions. The American Academy of Ophthalmology describes depth perception as the ability to see things in three dimensions (including length, width and depth), and to judge how far away an object is. Read here for more information to understand this visual skill. 

When Does Depth Perception Develop? 

We are not born with the ability to perceive depth. In the beginning, we are only able to see two dimensions, making everything appear flat, for the first 6 months of life. During this time, our eyes are not yet working together and monocular vision is predominant. 

Around 6 months of age, our eyes begin to work together, and binocular vision, the use of the eyes together, becomes a dominant pattern.  Binocular vision patterns is what allows our brains to perceive depth and view the world in a three dimensional way.  This is because both sides of the brain are receiving input, and interpreting that information in synchrony. 

However, our depth perception must grow and develop over time as new challenges are presented.

As we move through gross motor development from rolling, to sitting, crawling and walking, our depth perception and binocular vision is constantly challenged to meet our gross motor needs. 

As the left and right sides of the brain begin to strengthen communication through the reciprocal motor patterns of crawling and walking, our binocular vision, neck strength and neck control is also then indirectly developed. 

Impact of Impaired Depth Perception

Impaired depth perception can leave a child with significant challenges in life. Individuals with impaired depth perception may struggle with sports, navigating familiar and unfamiliar spaces, and may even struggle with driving. These are just a few areas that may be impacted, but in reality, all areas of a person’s life are affected by impaired depth perception. 

Signs of Impaired Depth Perception

The signs of impaired depth perception are often very subtle and may be missed at a young age or passed off as “slow” to develop, with serious concerns being caught at an older age. 

Signs of impaired depth perception include: 

 Late to crawl or walk 
 Hesitancy or fear of surface changes 
 Resistance to going up and down stairs 
 Exaggerated stepping over lines in the floor or parking lot
 Frequent falling 
 Inability to catch/hit a ball—early anticipation or late response 
 Runs into furniture, walls or items in a familiar environment that have not changed position 
 Difficulty anticipating turns or space needed to navigate playground equipment and use ride on toys 
 Overshoot or undershoot when reaching for an item 
 Heavy footsteps or stomping up down stairs and over items/changes in floor surface 
 Frequent falling up or down stairs

How is Depth Perception Assessed? 

Due to the complexity of monocular and binocular vision, your therapist may recommend an evaluation with a developmental optometrist if they note any of the signs of depth perception impairment above. Chances are that your therapist has also noted other vision concerns during a vision screening that has lead them to suspect poor or impaired depth perception. 

Depth Perception Treatment

Depth perception impairments are treated in vision therapy as directed by a developmental optometrist or an occupational therapist with special training in vision therapy. Treatments provided by either professional utilize special equipment, lenses and activities that challenge binocular vision directly. 

Final Note on Depth Perception

Poor or impaired depth perception can be identified and addressed at any time throughout childhood. Like many vision impairments, there are a wide variety of presentations and levels of severity in which your child may present with. If left unaddressed, your child may continue to struggle with self care, sports, driving, and many other tasks later in life. If you have concerns, ask your OT for a vision screening and to discuss your concerns. 

What if you suspect vision problems? 

Now what?  When vision problems are suspected after a screening by the OT, it is best practice to refer the family to a developmental optometrist.

A developmental optometrist will complete a full evaluation and determine the need for corrective lenses, vision therapy or a home program to address vision concerns.

As occupational therapists, it is imperative that we rule out vision problems before treating handwriting or delays in visual motor integration, to ensure the best possible trajectory of development and success for the child.

Occupational Therapy Vision Screening Tool

Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Our newest Visual Screening Tool is a useful resource or identifying visual impairments. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care. 

This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings. 

This is a digital file. Upon purchase, you will be able to download the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.

Click here to read more about the Visual Screening Tool 

A little about Kaylee: 

Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR