Executive Functioning and Co-morbid Conditions

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Executive functioning often comes up in my Facebook group where I provide free educational advocacy advice.  Many schools fail to recognize a child with executive functioning issues even though it is common for children with ADD, ADHD, and Autism along with many other conditions.   It is important a public school recognizes executive functioning problems and works with the child to put systems in place to help the child overcome their executive functioning issues.  Without help from teachers and adults, along with having positive supports in place, many children will feel overwhelmed and shut down in the educational setting.  Since the issue of executive functioning (EF) is so complex I have written another blog post to cover other areas of EF.

So what is executive functioning?

Executive function is a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.

Executive function helps you:

• Manage time
• Pay attention
• Switch focus
• Plan and organize
• Remember details
• Avoid saying or doing the wrong thing
• Do things based on your experience
• Multitask

When executive functioning isn’t working as it should, your behavior is less controlled. This can affect your ability to:

• Work or go to school
• Do things independently
• Maintain relationships

Types of Executive Function

Executive function can be divided into two groups:

• Organization: Gathering information and structuring it for evaluation
• Regulation: Taking stock of your surroundings and changing behavior in response to it

For example, seeing a piece of chocolate cake on a dessert cart at a restaurant may be tempting. That's where executive functioning can step in. The organizational part reminds you that the slice is likely to have hundreds of calories. Regulation tells you that eating the cake conflicts with goals you may have, like eating less sugar or losing weight.

Problems With Executive Function

Some people are born with weak executive function. And people with ADHD, depression, or learning disabilities often have weaknesses in it.  I will discuss more on the various learning disabilities in a later section.

An injury to the front of the brain, where the frontal lobe is, can harm your ability to stay on task. Damage from Alzheimer's disease or strokes may also cause problems.

Children and Executive Function

Problems with executive function can run in families. You may notice them when your child starts going to school. They can hurt the ability to start and finish schoolwork.

Warning signs that a child may be having problems with executive function include trouble in:

• Planning projects
• Estimating how much time a project will take to complete
• Telling stories (verbally or in writing)
• Memorizing
• Starting activities or tasks
• Remembering

Co-morbid Conditions of Executive Function Impairment 

ADHD/ADD is the hallmark condition for executive function impairment. The condition of ADHD/ADD is so pervasive in life it deserves its own blog post that will be coming at a later date.  It is possible to distinguish someone with an executive function disorder from someone with ADHD by trying ADHD medication.  Someone with true Executive Function Disorder will not improve on ADHD medication.  My daughter, Margaret, is a great example of this.  We also happen to know she has Hypoxic Ischemic Encephalopathy (HIE).  She has a cyst, or hole, in her right frontal lobe.  The right frontal lobe controls reasoning, impulsivity, and emotional regulation. For her, ADHD medication would not improve her impulsivity and inattentiveness. She has a true executive function disorder versus ADHD but she also carries the medical diagnosis of ADHD. The ADHD label is appropriate since she has some ADHD characteristics too like always being in motion and people understand what ADHD entails versus executive function disorder.

Autism is another co-morbid condition that typically entails executive function disorder and/or ADHD. I am seeing more and more children with high-functioning autism being mislabeled as behavioral. I think much of this stems from poor executive functioning and lack of addressing sensory issues.  In a study released in 2017 showed children with Autism are often diagnosed with a host of learning and behavioral disorders including ADHD, Anxiety, Depression, and Disruptive Impulse Conduct Disorder.  I think all of these are related to executive functioning disorder and untreated sensory problems. I often hear from parents in my Facebook group (IEP Assistance and Special Needs Parenting Advice) say teachers make comments about their child saying, "Your child could have made better choices this year." Really?  I think this is an indication the teacher needs training.  Obviously, the teacher does not understand how executive functioning works.  Students NEED structure and rules in place to HELP them make good decisions.

Other conditions impacted by executive control issues include Obsessive-Compulsive Disorder, Tourettes, Traumatic Brain Injury, Depression, Fetal Alcohol Syndrome, Developmental Coordination Disorder, and just being a preemie can greatly increase a child's risk of having an executive functioning disorder.

Signs of Executive Functioning Issues in Various Settings

At the preschool level you may see:

At Home                                         At School                                  The Issue

The child will respond                       Your child's answers                Kids with EF issues have
"yes" when asked to choose               are rarely on topic                   problems quickly retrieving
between two choices                                                                           information to answer questions

At home                                          At School                                 The Issues

Child is easily frustrated                 Child will get frustrated            Kids with EF struggle to keep
and quits without asking                 easily and give up when            information in working memory
for help                                            their attempt is not perfect        long enough to use the information

At Home                                         At School                                  The Issue
Child cannot remember to           Frequently raises hand but            Children with EF issues cannot
do multi-step directions               can't remember the answer            keep information in short-term
or does not start task                    when called upon                          memory long enough to use it.

At Home                                         At School                                  The Issue
When child is given several           Child can't seem to master         Children with EF can have task
tasks to complete at once they       simple classroom procedures      initiation problems and problems
freeze and stare like a deer             like packing up at the end of      problems with following multi-
in headlights                                   day                                              step directions


At the elementary school level you may see:

At Home                                         At School                                  The Issue
Child works on a project and         Child can solve a math               Children with EF deficits have
gets interrupted then loses             problem one way but when         problems with switching gears
interest in the project                     asked to solve the problem          and can have a hard time learning
                                                       another way they are not able     new skills and/or tasks

At Home                                         At School                                  The Issue
Child mixes up assignments        Child has a desk of school is        Children with EF have a hard time
and forgets to bring home            full of crumpled papers and         keeping their things organized
worksheets or books                    pencil stubs but folders and          even when given organizational
                                                     pencil box is empty                      tools

At Home                                         At School                                  The Issue
Child is insistent on eating           Kids are trying to play a game     Kids with EF can panic or feel
pizza on Friday night since           and Child argues how to play      frustration when rules or routines
that is traditionally pizza night     and then makes up new rules       are changed

At Home                                         At School                                  The Issue
Child seems to focus on the           Child cannot find the right         Children with EF issues can have
least important details of                information in a math word       a difficult time figuring out when
what you have said                         problem in order to solve           to look at the big picture versus
                                                        the equation                               the details and which details to
                                                                                                           focus on

How do you make the diagnosis of Executive Function Impairment?

Tests That Assess Attention

Example: Test of Variables of Attention (TOVA) (ages 4 and up)

Similar tests include: Integrated Visual and Auditory CPT (IVA-2) (ages 6 and up), Conners Continuous Performance Test II (CPT II) (ages 6 and up)

What it measures: A child’s ability to pay attention. (It also looks at processing speedand inhibitory control.)

Why it’s important: The ability to pay attention is a key executive function. Having trouble with attention is a hallmark of ADHD. While this test isn’t an assessment for ADHD, it might signal that a child has an attention issue. Learn more about the link between ADHD and executive functioning issues.

How it works: In the classic version, different letters flash on a computer screen. A child presses the space bar every time he sees the letter A. The test lasts for 15 to 20 minutes. (With CPT II, kids press the bar when they don’t see the letter.)

Kids who miss targets may be “zoning out” because of attention issues. But this test also looks at other skills that can impact attention. Missing targets might be the result of slow processing speed, for instance. Responding to the wrong targets might be a problem with focus or with inhibitory control. And if the child was doing well up to a certain point but then makes mistakes, he may have trouble sustaining attention.

Tests That Assess Inhibitory Control

Example: Stroop Color and Word Test (ages 5 to 14; adult version starts at 15)

Similar tests: The Color-Word Interference Test of Delis-Kaplan Executive Function System (D-KEFS) (ages 8 and up)

What it measures: A child’s ability to hold back on giving an automatic response, or the ability to think through something before acting.

Why it’s important: Inhibitory control is tied to self-control. It allows kids to think before they act. It also allows them to assess each new situation and consider the correct or most effective way to respond.

How it works: The evaluator shows a child the words for different colors written out. But the color of the ink doesn’t match the word that’s spelled out. For example, the word red might be written in green ink. As quickly as possible, the child must say the color she sees, as opposed to the word. The test is usually timed, so it also looks at processing speed.

Kids who haven’t learned to read yet may perform a similar task with shapes instead of words. In this case, the child might see a circle in red ink. She then has to say the color, not the shape.
Tests That Assess Working Memory

Example: Digit Span and Spatial Span subtests of the Wechsler Intelligence Test for Children (WISC) (ages 6 to 16)

Similar tests include: Working memory tasks in the Woodcock-Johnson (WJ-IV) Cognitive battery (ages 2 and up)

What they measure: The Digit Span test measures verbal working memory (the ability to store information that’s heard). The Spatial Span test measures visual working memory (the ability to store information that’s seen).

Why they’re important: Working memory is an executive function that allows kids to hold onto new information in order to put it to use. (It’s also affected by attention.)

How it works: With digit span, the evaluator dictates a series of numbers, and the child has to repeat them back in reverse order. If the examiner says “9, 6, 3,” the child has to repeat the sequence back as “3, 6, 9.” When working with younger kids, the evaluator might list a series of animals in size order, such as bee, dog and cow. The child repeats them back saying the biggest to the smallest animal.

With spatial span, the evaluator touches a series of blocks in a certain order. The child has to touch the blocks in the reverse order that the evaluator touched them.

If a child does poorly on the digit span version but well on the spatial span, it might mean she has working memory issues that are more language related. If it’s the other way around, it might mean she struggles with working memory just for visual-spatial tasks.
Tests That Assess Organization and Planning Skills

Example: Tower of Hanoi (ages 5 and up)

Similar tests include: The Tower Test of D-KEFS (ages 8 and up); Rey–Osterrieth Complex Figure Test (ages 6 and up); Tower of London Test (TLT or TOL)

What it measures: The ability to plan, sequence and organize information for problem-solving. It can also assess working memory and inhibitory control.

Why it’s important: Planning, sequencing and organizational skills are key to following directions and completing tasks efficiently. They’re also important when it comes to participating in complex discussion. Kids with executive functioning issues often struggle with these skills.

How it works: A child must rearrange beads or disks to match a model while following specific rules. A rule might be that the child can’t place a larger bead on top of a smaller one. The goal is to complete the task in as few moves as possible.
Tests That Assess Concept Formation

Example: Matrix Analogies Test (ages 5 to 17)

Similar tests: Naglieri Nonverbal Ability Test (ages 4 to 18), WISC-V Matrix Reasoning (ages 6 to 16)

What it measures: The ability to form classes of items based on what they have in common; the ability to figure out patterns or relationships between objects.

Why it’s important: Concept formation allows kids to see relationships between things and develop ideas based on what they already know about them. It’s important for abstract thinking.

How it works: A child sees a grid of four boxes with pictures in them. The top row might have a big house next to a big apple. The box below the big house has a little house. The box under the big apple is empty. The child has to pick what logically belongs there (a little apple) from five choices. (The analogies are more complex for older kids.)
Tests That Assess Set Shifting

Example: Wisconsin Card Sorting Test (ages 7 and up)

Similar tests include: The Sorting Test of D-KEFS (ages 8 and up); Minnesota Executive Function Scale (MEFS) (ages 2 and up; measures other executive functions as well); Trail Making Tests
What it measures: A child’s ability to shift from one task to another. It also measures concept formation.

Why it’s important: This executive function allows kids to shift their attention and move from one task or situation to another. This type of flexible thinking helps kids see new ways of doing things, or try something else when the first approach doesn’t work.

How it works: A child is shown a set of five cards. Each card has a different figure on it. The figures switch around with each problem. For example, in one problem the figures on the cards might be: three green stars, one red circle, two yellow blocks, four yellow crosses, and two red crosses.

The child sees four of the cards lined up in a row, and one by itself below. She’s told to match that card to one of the four above, but not told the rule for matching. (In other words, she doesn’t know whether to match by shape, color, number, etc.)

The child only gets feedback on whether she’s right or wrong in the match she makes. So through trial and error, she needs to figure out the rule herself. She’s scored by how many correct sorts she makes.

Tests That Assess Word and Idea Generation

Example: Controlled Oral Word Association Test (ages 5 to 16)

Similar tests: Verbal Fluency Test in the D-KEFS (ages 8 and up); Word Generation subtest in the NEPSY-II (ages 3 to 16)

What it measures: The ability to think of words and generate ideas. (It also looks at set-shifting and processing speed in some versions.)

Why it’s important: Kids rely on executive functioning to solve problems. Being able to quickly come up with words and ideas is key to problem-solving.

How it works: A child names as many words as she can, based on a certain letter. For example, she might have to come up with words that start with M. Or, on a harder version of the test, she may have to name as many kinds of fruit and furniture as she can, in pairs. She might start with apple/chair or banana/couch, and so on.

Another possible factor to consider when testing EF
The Picture Arrangement (PA) sub-test of the Wechsler Adult Intelligence Scales (WAIS) is not really known as an executive test. In the ‘bible’ of neuropsychological diagnostics, Lezak’s Neuropsychological Assessment (2004), this test is never described as an executive function test.

Remember,executive functions are really several different cognitive functions all humped together: concept formation, formulating a plan (planning), formulating a goal, sequencing the correct order of steps to take in order to reach a goal or follow a plan (logical reasoning), executing the steps and monitoring your own actions, mental flexibility to reformulate a plan and change the actions to reach your goal/plan and the ability to control your automatic, instinctive or impulsive reactions in order to follow your action plan consistently. In short, executive functions are functions that represent goal-directed actions: taking initiative, planning, executing actions, monitoring and self-correcting those actions.

The task requires several cognitive processes. First, you have to see all pictures in clear detail. Then you have to form several ideas about what is going on here. That’s what neuropsychologists call ‘concept formation’ or ‘formulating a plan’. Then you have to form a picture in your mind of a sequence of the 3 pictures. Not randomly, but guided by your plan or idea about what is going on in this story. Then you have to put these pictures in this planned order and finally, you have to check this whether it matches your plan/ideas. When the sequence is looking wrong, you will have to correct the order. Remember, in the PA test all pictures are separate pictures you can move around. I have programmed these pictures so that they are displayed on a computer screen and can be moved by the clinician. The patient has only to point at a picture and to point at where it should go. Except for planning, sequencing, and monitoring cognitive processes like visual perception, divided attention and memory all work together to do this task correctly.

Accommodation for Executive Function

To begin, there are some questions to start you off on your journey...

Questions to ask parents

• What tasks does your child need help with at home?
• Does your child lose things?
• How often do you need to explain how to do a task?
• Does your child have trouble concentrating?
• Can your child plan ahead for activities?
• Does your child get upset with change?
• Does your child often interrupt others?

Questions for teachers

• Does the student get distracted easily?
• Does the student have an organized backpack or locker?
• Can the child fix their own mistakes?
• Is the child aware of the consequences of their words or actions?
• Does the student demonstrate incomplete or careless work?
• Can the student develop plans and strategies?

Goals for strengthening EF during Testing

• Student will develop the ability to attend to individual tasks and will improve processing speed through the use of timers and cueing utilized with the entire class in the general classroom.
• Student will successfully complete 12 or more weeks of a proven cognitive enhancement program that addresses deficits in processing speed, short-term working memory, attention to detail, monitoring, sequencing and organization skills, with instruction, for at least 1 hour per day every weekday, to alleviate effects of executive functioning disorder deficits.

Self-Awareness/Self Advocacy goals for an IEP

• Given a specific routine for monitoring task success, such as Goal-Plan-Do-Check, student will accurately identify tasks that are easy/difficult for him.
• Given a difficult task, student will indicate that it is difficult.
• Student will explain why some tasks are easy/difficult for him, help develop management strategies.
• If tasks are difficult, Student will request help.
• When he is more capable than the other child, Student will offer help to others.
• If student has negative behaviors, debriefing session held at appropriate time and place and student is able to identify his triggers and possible strategies.

Executive Functioning-Organizing goals for an IEP

• Given support and visual cues, student will create a system for organizing personal items in his locker/desk/notebook
• To tell an organized story, student will place photographs in order and then narrate the sequence of events. Given visual cues and fading adult support, student will select and use a system to organize his assignments and other school work
• Given a complex task, student name will organize the task on paper, including the materials needed, the steps to accomplish the task, and a time frame
• Using learned strategies and given fading adult support, student will prepare an organized outline before proceeding with writing projects.
• student will improve organization skills for classroom work and homework through specific, repetitive instruction, and use of (list SDIs or supports) and measured by a frequency or %

Executive Functioning-Organizing goals for an IEP

• Given training in a self-regulatory routine and visual cues and fading adult supports, the student will accurately predict how effectively he will accomplish a task. For example, he will accurately predict:

           ~whether or not he will be able to complete a task
           ~how many (of something) he can finish
           ~his grade on tests
           ~how many problems he will be able to complete in a specific time period; etc.

• Given a specific work checking routine, student will identify errors in his work without teacher assistance.
• student’s rating of his performance on a 10-point scale will be within one point of the teacher’s rating.
• Student will self-initiate editing activities to correct spelling, punctuation, capitalization, and grammar on all typical classroom assignments in all settings
• Student will self-edit his work to correct spelling, punctuation, capitalization, and grammar on all typical classroom assignments in all settings to eliminate all errors from his work

Problem Solving goals for an IEP-Executive Function:

• Given training in and visual reminders of, self-regulatory scripts student will manage unexpected events and violations of routine without disrupting classroom activities
• Student will use a structured recipe or routine for generating new ideas, or brainstorming to respond successfully to open-ended assignments
• When faced with changes and/or transitions in activities or environments, student will initiate the new activity after {decreasing number of supports}
• Given concrete training, visual supports and fading adult cueing, student will appropriately label flexible and stuck behaviors in himself
• Given training and practice with the concept of compromise, and in the presence of visual supports, student will accept and generate compromise solutions to conflicts when working cooperatively with others.

IEP goals for personal goal setting/ self-correction and improvement

• Student will participate with teachers and therapists in setting instructional and therapy goals
• Given explicit instruction, visual reminders, and fading adult support, student will successfully distinguish target goals (doing well in school, making a friend, learning to read, graduating from school) from interfering goals (playing video games instead of doing homework)
• Having failed to achieve a predicted grade on a test, student will create a plan for improving performance for the next test

IEP goals for keeping track of time/planning/time management:

• Given a routine, student will indicate what steps or items are needed and the order of the events
• Student will learn (after helping to develop) a self-regulatory plan for carrying out any multiple-step task (completing homework, writing an essay, doing a project) and given practice, visual cues and fading adult supports, will apply the plan independently to new situations
• Given a selection of 3 activities for a therapy or instructional session, student will indicate their order, create a plan on paper and stick to the plan
• Given a task that he correctly identifies as difficult for him, student will create a plan for accomplishing the task

Another break down of accommodations....  

Sustained Attention - ability to maintain attention despite distractibility, fatigue, or boredom

Elementary Classroom Behavior

• Distractable
• Inconsistent performance
• Forgetfulness
• Zoning out/daydreaming
• Making careless mistakes
• Difficulty completing assignments
• Poor note-taking skills
• Off task behaviors

Middle School Classroom Behaviors

• Poor attention
• "Zoning out"
• Inconsistent performance
• Difficulty with note-taking
• Distractible
• Pays attention to everything and not just the target activity
• Inability to stay on task
• Asks questions that were just answered

Elementary Classroom Accommodations

• Provide frequent breaks
• Establish eye contact with student
• Break down tasks
• Repeat information
• Check for understanding
• Rotate subjects
• Check for understanding
• Rotate students work areas
• Use assistive technology
• Provide preferential seating area near the teacher
• Teacher should move around the room
• Ask for the student to repeat back instructions/directions
• Inject novelty into instruction
• Use multi-sensory/hands-on materials
• Present the questions first
• Ask student to make predictions
• Ask student to summarize information

Middle School Classroom Accommodations

• Inject novelty into instruction
• Games
• Interesting and colorful material
• Provide visuals
• Allow for breaks as necessary
• Structure tasks and activities
• Rotate subjects
• Complete homework in intervals
• Provide extra review for material covered at the end of a class period
• Engage attention
• Through challenge (e.g. Few people know the answer to this...)
• Active student participation
• Preferential seating

Working Memory - Holding information in the mind while performing complex tasks

Elementary School Classroom Behavior

• Student gets confused when too much information is presented
• Has trouble remembering things (eg. phone numbers)
• Student may lose track of what they are doing as they work
• Student may forget what they need to retrieve when sent on an errand
• May frequently switch tasks or fail to complete tasks
• Difficulty keeping up with classroom lessons
• Difficulty remaining attractive and focused for an appropriate length of time
• Difficulty sequencing math word problems
• Extreme difficulty solving problems mentally (eg. mental math)
• Poor reading comprehension
• Difficulty summarizing
• Inconsistent performance
• Difficulty following directions
• Difficulty keeping track of a lot of information

Middle School Classroom Behavior

• Difficulty in keeping up with information to complete tasks
• May look like poor attention
• Misses important pieces of information
• Gets confused when too much information is presented at once or too quickly
• Poor note-taking from lectures
• Extreme difficulty with solving problems mentally (e.g. mental math)
• Difficulty with keeping up and maintaining conversations
• Frequently asking questions
• Difficulty sequencing

Elementary School Classroom Accommodations

• Teach visualizing techniques
• Pre-teach and preview new information
• Establish eye contact with the student
• Give student a copy of class notes
• Student should practice new skills in short sessions over the course of the day
• Use graphic organizers
• Use visuals
• Chunk information
• Use of mnemonics
• Avoid extraneous comments and information
• Color-code information and/or materials
• Personalize the information taught
• Have student design own tables and keys
• Use a variety of tests that assess both recall and recognition

Middle School Classroom Accommodations

• Provide structured outlines
• Provide visuals
• graphic organizers
• pictures and charts
• maps
• Promote note-taking to avoid memory overload
• Chunk information to help student with comprehension
• Allow frequent breaks
• Provide class notes
• Repeat key concepts/information
• Pre-teach information
• Encourage the use of post-its for questions that cannot be contacted immediately
• Model relevant comments during conversations
• Introduce memory strategies

Inhibition - The ability to stop one's own behavior at the appropriate time (eg. stopping actions and thoughts)

Elementary School Classroom Behaviors

• Difficulty waiting 
• Interrupts and disrupts group activities
• Student may call out
• Touching things or people
• Makes careless mistakes
• Displays hyperactivity
• Acting on auto-piolet without reflection
• Perseveration
• Many false starts
• Dives right into problems without pausing, reflecting, developing a strategy or game plan
• Excessive talking
• Unlike to reflect or self-monitor
• Misinterprets directions

Middle School Classroom Behavior

• Calling Out
• Touching Objects/Peers
• Invading others personal space
• Interrupting conversations
• Making careless errors - written & verbal
• Issues with directions (Not reading/misreading/misinterpreting)
• Misinterpreting text
• Attempting problem-solving without planning
• Starting and stopping tasks repeatedly
• Difficulty with perspective taking
• Understanding someone else's point of view
• Often unaware of own behavior or impacts on others
• Difficulty with empathy
• Difficulty knowing what to say and when to say it

High School Classroom Behaviors

• Calling out
• Not following directions
• Inconsistent test performance
• Touching things/other people
• Restlessness
• Over-active behaviors

Elementary School Classroom Accommodations

• Give an explicit and clear set of rules and expectations
• Preferential seating near the teacher with frequent eye contact
• "Catch" the student being good
• Ignore the disinhibited response
• Positive reinforcement plan
• Use checklists
• Have student hold the pencil up until directions are given
• Have student repeat the directions
• Have student verbalize how they will solve the problem before they begin
• Give verbal reminders
• Model your thought process
• Ask questions to make student stop and think
• Use visual cues (eg. stop sign, traffic light)
• Emphasize procedures of an assignment
• Identify the skill being work on

Middle School Classroom Accommodations

• Ask questions of students; when student answers question impulsivity is redirected
• Repeat verbal information (Directions, assignments, and tasks)
• Have student repeat back directions to ensure understanding
• Emphasize on HOW to solve a problem - Don't just focus on the correct answer
• Direct students to stop and think before acting/responding
• Offer specific real-time feedback
• Incorporate positive reinforcement/rewards as part of task/activity 
• Provide effective feedback
• Make eye contact with student
• Give immediate feedback
• Be specific
• Praise appropriate behavior
• Identify the problem and use social stories and role-playing to determine the solution
• Create a self-monitoring rating scale with the student
• Encourage verbal mediation 

High School Classroom Accommodations

• Ask the student to take a few seconds before answering the question
• Students should be given an explicit, extensive, and clear set of rules and expectations along with giving reminders as needed
• Ask the students to explain their plan for the task (e.g. Goals for accuracy and timeframe)
• Seat student close to the teacher to facilitate monitoring of behavior
• Catch student "being good"

Organizing/Planning/Task Initiation - Organization is the ability to impose order on work, play, and storage spaces.  Planning is the ability to manage current and future-oriented task demands.  Task initiation is the ability to begin a task or activity and to independently generate ideas, responses, and or problem-solving strategies. 
Elementary School Classroom Behavior

• Student may forget homework assignments/materials
• Student can be unprepared and unable to find materials
• Student has messy desk/workspace
• May get "stuck"
• Appears to be daydreaming
• Difficulty completing assignments in a timely manner
• Difficulty expressing ideas in an oral and/or written format
• Student approaches tasks in a haphazard manner
• Difficulty in responding to open-ended questions
• Performs better with multiple choice questions
• Difficulty making decisions
• Difficulty starting an assignment independently
• Difficulty generating ideas, responses, and problem-solving
• Difficulty with multi-step problem-solving

Middle School Classroom Behaviors

• Doesn't begin tasks (e.g. just sit and stares when given directions)
• Messy desk/notebook/locker/backpacks
• Difficulty with unstructured tasks
• Off task (e.g. Looks lost or Daydreaming)
• Difficulty understanding what to do
• Difficulty with time management
• Difficulty understanding what to do
• Overwhelmed by large amounts of information
• Difficulty retrieving information spontaneously or answering open-ended questions
• Difficulty handing in assignments on time

High School Classroom Behaviors

• Blank Page
• Task avoidance behavior such as leaving the classroom
• Gives excuses on a constant basis

Elementary Classroom Accommodations

• Use a checklist for multi-step tasks
• Demonstrate where to begin and what steps to follow
• Use a timer to help student pace their work
• Provide a model of completed projects
• Have student verbalize a plan of approach before beginning an activity
• Provide a "to-do" list
• Use color-coded materials
• Use schedules
• Provide deadlines and timelines for assignments (be specific with exact times and dates)
• Provide "how-to" templates
• Break long-term assignments into sequential tasks
• Use graphic organizers
• Use brainstorming techniques
• Place student in small groups with more organized peers to serve as a model
• Provide access to assistive technology
• Assign student planners and check for accuracy
• Coordinate with the parents to generate a positive incentive homework plan
• Provide access to assistive technology

Middle School Classroom Accommodations

• Provide explicit directions
• Don't assume information is "obvious" to the student
• Check for understanding
• Create mental framework
• Provide template to help student organize the information as student hears it
• Identify/Label steps and put it on an index card
• Identify what to listen to
• Color code
• Categorize information
• Use multiple choice versus open-ended questions
• Set time limits, use timelines, and checklists
• Provide access to assistive technology
• 
  

High School Classroom Accommodations

• Demonstrate where to begin and what steps to follow
• Provide "to do" list on index cards to provide external cues and encourage the development of routine
• Encourage students to keep a "cookbook," or list of steps for routines, in a binder for reference
• Set up time limits for completing a task. Use of a timer may increase the initiation of a task and the speed in which the task was completed
• Provide access to assistive technology
• Allow student to verbalize the expectations of the assignment and give them a chance ask questions concerning potential problems in completing the project 

Emotional Regulation - The ability to regulate emotional responses by bringing rational thought to bear on feelings
Elementary Classroom Behaviors

• Difficulty making or keeping friends
• Emotional reactions are out-of-sync with the situation (small problem triggers huge emotional response)
• May laugh hysterically, or cry easily, with little provocation
• Temper tantrums and explosive outbursts
• Bossiness
• Easily upset/ overly-sensitive
• Aggressive behavior
• Rigid/ inflexible thinking
• Emotional lability (rapid mood changes without cause)
• Low frustration tolerance
• Socially immature
• Appears insensitive to other people's perspective and emotions

Middle School Behaviors

• Tantrums
• Crying
• Laughing at inappropriate times
• Calling out
• Making irrational statements
•  "Teacher hates me."
•  "Someone's laughing at me."
• Aggressive behavior physically and/or verbally

High School Classroom Behavior

• Often calls out in class without consideration of others
• Lacks emotional regulation
• Difficulty redirecting and refocusing once the child exhibits the lack of emotional control (e.g. temper tantrums, cursing, crying, extreme laughter, and etc.)
• Exhibits unpredictable emotional response that is out-of-sync with the situation

Elementary School Accommodations

• Use of social stories and narratives
• Role-playing activities
• Try to anticipate problem situations
• Manage stimuli and antecedents that appear to lead to emotional outbursts
• Provide opportunities to discuss upcoming situations that may provoke emotional outbursts
• Teach coping strategies to manage emotions
• Introduce self-monitoring strategies
• Provide scripts of appropriate language and behaviors
• Model self-statements
• Provide breaks
• Attempt to plan the child's optimal time of day
• Utilize a positive reinforcement plan/behavioral interventions
• Provide positive role models/ model appropriate emotional regulation
• Provide as many opportunities as possible for physical activity
• Give the student to write down concerns to discuss later

Middle School Accommodations

• Model positive thoughts and behaviors
• Turn the negative and/or irrational thoughts/statements into positive ones
• Identify possible positive outcomes
• Identify problem
• Discuss privately
• Acknowledge frustrations
• Use narratives and social stories
• Offer the student the opportunity to write down their concerns for later discussion
• Set a specific time and place to discuss concerns
• Offer breaks from current (physical) setting

High School Classroom Accommodations

• Maintain consistency and predictability in terms of teaching methods
• Include aspects of social-emotional learning to create a safe and supportive environment with student-centered classroom rules
• Provide verbal and visual reminders
• Encourage peer monitoring
• Foster empathy among classmates; highlight strength and weaknesses
• Plan small group activities that encourage positive and productive interaction
• Clarify expectations in order to reduce the student's feeling of being overwhelmed
• Communicate effective strategies with parents and consult specialists as needed (e.g. school psychologist, speech therapist, social worker, and etc)
• Be aware of stressful situations (e.g. calling on student unexpectedly, public speaking, etc)
• Help students create rating scale of 1-5 to help them evaluate problems and put them in perspective
• Help students be aware of the consequences of their emotional outbursts on the learning environment 

Self Monitoring - The ability to monitor one's own performance and to measure it against some standard of what is needed or expected
Elementary School Classroom Behavior

• Makes careless mistakes
• Rushes through work
• Appears to lack pride in work
• Disorganized
• Difficulty check over work/proofreading
• Work may be sloppy
• Acts without thinking things through
• Unaware of behavior and impact on others
• Difficulty with time management
• May have difficulty monitoring volume of voice
• Difficulty with pragmatic language skills
• Difficulty in empathizing
• Procrastination
• Missing deadlines
• Difficulty in completing work

Elementary School Classroom Accommodations

• Provide student with a checklist
• Use a timer
• Graphic organizer
• Use of a picture schedule
• Breaks tasks down into steps
• Provide a peer buddy
• Check on student progress during a project
• Role play different situations
• Provide grading rubrics to define the quality of work
• Provide reinforcements for using a self-monitoring checklist
• Teach student to talk through a task
• Provide self-monitoring questions (eg. Am I a space invader?)

Shift - To move freely from one thought/activity to another and to think flexibly in order to respond to the situation 
Elementary School Classroom Behavior

• Difficulty making transitions
• Difficulty in starting a new task before the first task is complete
• Difficulty switching gears (eg. addition and subtraction problems on the same page)
• Repeats the same behaviors
• Gives the same answers to different questions
• Difficulty switching to a new topic or subject
• Inflexibility
• Difficulty with problems solving and conflict resolution
• Failure to comply with task instructions

Middle School Classroom Behaviors

• Stuck on a topic, idea, or activity
• Repeating the same behavior after the task has changed
• Driven by routine and consistency
• Needs the same seat
• Wears the same color
• Eating the same foods
• Difficulty transitioning between classes
• Unable to tolerate changes in schedule
• Difficulty in transitioning within conversations

High School Classroom Behaviors

• Stuck on the previous task when working on the current task
• Not being prepared for next activity
• Student may sit and stare when given too much information at once
• Non-participation

Elementary School Accommodations

• Give sufficient warning for upcoming transitions
• Make the day as predictable as possible
• Provide a break between activities
• Guide students to highlight math signs before solving
• Pause between different chunks of information
• Emphasize where one piece of information ends and the next begins
• Provide a stopwatch/timer
• Model problem-solving techniques
• Model self-talk strategies
• Use of visual organizers, schedules, planners, and calendars

Middle School Accommodations

• Make the day as predictable as possible
• Clearly separate different types of problems to help with task shifting
• Identify new topic clearly
• Change where teacher stands for new topic
• Change student's seat for new topic
• Begin new unit after break
• When presenting information stay away from general remarks
• Provide verbal feedback to individual students having difficulty shifting conversations and tasks

High School Classroom Accommodations

• Give ample notice to the student so they have time to accept transitions
• Allow a few minutes of "downtime" between activities
• Be consistent with expectations
• Use a timer to break down classroom period to promote time management
• Leave time at the end of the period to answer questions the student may have from that day's lesson
• Use visual organizers, schedules, planners, and calendar boards to help learn routines and adapt to changes

Abstract Reasoning/Concept Formation - The ability to make connections and to synthesize/categorize information 

Elementary School Classroom Behavior

• Difficulty with social problem solving
• Difficulty with perspective taking
• May ask the same questions repeatedly
• Concrete, literal learners
• Difficulty in what they cannot see, hear, or touch
• Difficulty sorting/organizing information
• Difficulty with abstract concepts
• Difficulty with reading comprehension
• Difficulty in determining the most important points in a lesson
• Difficulty in summarizing information
• Focus on details and miss the "big picture"
• Difficulty in determining what is relevant or not
• Difficulty in making inferences
• Performs better during structured tasks
• Struggles in unstructured tasks (eg. writing a story)
• Difficulty in reading between the line and "catching on"

Middle School Classroom Behaviors

• Difficulty forming theories and solving problems
• Difficulty in understanding what they cannot see, hear, or touch
• Difficulty in understanding
• Figurative language
• Ambiguous language
• Multiple meaning words
• Similies and metaphors
• Humor and sarcasm
• Difficulty synthesizing information
• Difficulty in determining important information
• Relevant versus irrelevant
• Details
• Main ideas
• Related concepts
• Difficulty "reading between the lines"
• Misses the "big picture"

Elementary School Accommodations

• Multi-sensory lessons
• Social Stories
• Ask student to come up with a title of the story first
• Give question prompts (eg. How might you best solve that?)
• Provide explicit instruction (Don't assume it seems obvious)
• Check for understanding
• Ask student to repeat back information
• Ask student to read questions first before reading a passage
• Break down tasks into steps
• Define the skills to be learned, list the steps for the skill, and then practice the skill in a variety of ways
• Positive reinforcement plan for using defined skills
• Model the thought process needed for the skills
• Simulate social situations and role play
• Highlight the most important details in one color and the supporting details in another color
• Summarize and retell stories
• Help student to sort and outline information (eg. outlines, venn diagrams, & graphic organizers)

Middle School Classroom Accommodations

• Don't assume what is "obvious" is obvious to the student
• Scaffold questions
• Use effective reading strategies
• Close reading
• Graphic organizers
• Teach how to summarize a story
• Teach how to make predictions (inferencing)
• Use sorting and categorizing games
• Identify fact or opinion
• Identifying key concepts and ideas

Some current research on Executive Functioning

In a 2018 paper by Angeliki Kallitsoglou, Executive Function Variation in Children With Conduct Problems: Influences of Coexisting Reading Difficulties, the author discusses the variations in executive functioning of children with reading problems, conduct problems, and children with both disabilities. 

Abstract

It is unknown whether children with conduct problems (CP) and poor reading (PR) skills exhibit more profound executive function impairments than children with CP only and whether such impairments are explained by coexisting PR. Executive functions were compared in four groups of 7- to 8-year-old children: 26 CP only, 35 PR only, 27 CP-PR, and 31 comparison (COM) children with neither CP nor PR. The Conners’ Teacher Rating Scale–28 and a sentence completion reading test were used to assess CP and PR skills. The Wechsler Intelligence Scale for Children–Third Edition Backward Digit Span, the Conners’ Continuous Performance Test, and the Tower of London were used to assess three aspects of executive function: verbal working memory, response inhibition, and planning, respectively. The CP-PR group had lower verbal working memory than the CP-only and COM groups, but the difference was not significant after intellectual ability, inattention, and hyperactivity were controlled. The CP-PR group made more errors in the planning task (rule violations) than the COM and CP-only groups, but the difference was not significant after intellectual ability was controlled. No significant group differences were found in response inhibition. A specific PR group effect was found for verbal working memory. Children with CP-PR have more prominent executive function impairments that cannot be attributed to coexisting PR.

Assistive Technology for EF

There are numerous apps to help with executive functioning issues.  The following list is from TechPotential.net:

Listening to Recorded Audiobooks. Audiobooks are recordings of human narrators reading aloud.

Learning Ally Link (Mac, PC, iOS, Chrome)
Kindle Fire and Immersion Reading (see e-text highlighted while listening to narrated audiobook)
Audible app (Mac, PC, iOS, Android, Windows Phone)
Overdrive Media Console (borrow digital audiobooks and e-books from local libraries)
________________
Simple text-to-speech, E-readers with text-to-speech and other tools

TextAloud MP3 (PC)
GhostReader (Mac)
NaturalReader (Mac & PC)
VoiceOver and Speak Selected Text (included in Mac operating system)
Speak Selection and Speak Screen (included in iOS)
Speak command for Microsoft Word (PC)
Bookshare Web Reader extension (for Chrome on Mac, PC; Safari on Mac; Chromebook)
Read2Go (iOS app for Bookshare books)
Voice Dream Reader (iOS and Android app for Bookshare books and other text)
GoRead (Android app for Bookshare books)
Darwin Reader (Android app for Bookshare books)
iBooks (Mac, iOS) - use device's built-in text-to-speech
________________
Read, Write & Study Software Suites

Software that bundles multiple supports for reading, writing, and studying.
Kurzweil 3000 (Mac & PC)
Read&Write (formerly Read&Write Gold) (Mac & PC)
Read&Write for Google (Chrome extension) - for use in Google Drive on Mac, PC, Chromebook
WYNN (PC)
ClaroRead (Mac & PC)
SOLO Literacy Suite (Mac & PC) – comprises four interrelated applications: Read:OutLoud, Draft:Builder, Write:OutLoud, and Co:Writer
Read:OutLoud-Bookshare Edition (Mac & PC)
Premier Literacy Productivity Suite (Mac & PC)
________________
Resources for Alternatives to Printed Text - Electronic Text (E-text) and Narrated Audiobooks

Bookshare (e-text) - eligibility required
Learning Ally (formerly Recording for the Blind & Dyslexic-RFB&D) (audiobooks, some with e-text) - eligibility required
National Library Service (audio materials) - eligibility required
Amazon Kindle (e-text) - also see Immersion Reading in "Listening to Recorded Audiobooks", above
Audible (audiobooks)
Blio (primarily e-text in proprietary reader)
CourseSmart (e-text in proprietary reader)
Project Gutenburg (e-text)
NIMAC (e-text) - materials must be secured by a school; not available to individuals
check local digital libraries (e.g., Northern California Digital Library) to borrow downloadable audiobooks via Overdrive Media App or other platforms
check individual publishers for accessible online or e-text versions of textbooks
_______________
Graphic Organizer and Mind Map Software

Outlining and mapping software can help students organize ideas for writing, take notes while reading, break a large project into smaller individual tasks, understand broad concepts or complex processes -- any information that benefits from a structured framework and clarifying the relationship between the whole and its parts. Some of these programs, apps, and web tools also include ready-made templates (and allow creation of custom templates) to scaffold a student's thinking and learning.
Inspiration (Mac & PC)
Inspiration Maps (iOS)
Kidspiration (Mac & PC)
Kidspiration Maps (iOS)
Webspiration (online)
XMind (Mac & PC)
Free Mind (Mac & PC)
MindMeister (iOS, Android, Chrome, online)
Mindomo (Mac, PC, Linux, Chrome, online)
MindMup (online)
LucidChart (Chrome, online)
SimpleMind (Mac, PC, iOS, Android)
MindNode (Mac, iOS)
SmartArt Graphic organization layouts built into Microsoft Word (2007 and later)
Graphic organizer tools also included in some literacy software such as SOLO (Draft:Builder), Kurzweil 3000, and Read&Write (Fact Mapper)
________________
Speech recognition (speech-to-text)

Dragon NaturallySpeaking (PC)
Dragon Dictate (Mac)
Windows Speech Recognition (included in Windows operating system)
Dictation and Dictation Commands (utilities built into Mac OS)
Dictate and commands (utilities built into iOS)
Dragon Anywhere (iOS, Android) - syncs custom words and macros with some Dragon desktop editions
Voice Typing (Google Docs on Chrome browser)
(also see MathTalk and SpeakQ, below, for other software that employs speech recognition)
________________
PDF Annotation

Type on PDF version of worksheet, quiz, or other handout vs. handwriting on it.
Preview annotation toolbar - annotate PDF documents (included in Mac OS)
Skim - free PDF reader with annotation tools (Mac)
Adobe Reader version 11 - PDF reader with annotation tools and markups; discontinued 2015, replaced by Acrobat Reader (Mac, PC)
Acrobat Reader DC - PDF reader w/ annotation tools, markups; replaces Adobe Reader (Mac, PC)
PDF-XChange Viewer - annotate PDF documents (PC)
FoxIt Reader - PDF reader with annotation tools (PC)
ClaroPDF-Accessible Pro and ClaroPDF Lite - PDF reader app w/ annotation tools; Pro has text-to-speech (iOS)
PDF Expert - PDF reader with annotation tools, text-to-speech (iOS)
Kami (formerly Notable PDF) - PDF reader with annotation tools (Chrome)
SnapType for Occupational Therapy - simple app to snap photo and annotate (iOS)
PDF Reader tool in Read&Write for Google (Chrome extension) and Read&Write-WIndows (PC) - PDF reader with text-to-speech and annotation tools
________________
Assorted Reading & Writing Supports

Supports for spelling, grammar, word choice, reading level, and visual readability.
Dyslexie and OpenDyslexic - fonts designed to ease visual aspects of reading for those with dyslexia
Visual Thesaurus - visual word map (online, Mac & PC)
Ginger - contextual spellchecker (online, PC)
Ghotit - contextual spelling/grammar checker with word prediction, other supports (Mac, PC, iOS, Chrome, Android, Linux)
Grammarian Pro2X - grammar and spelling checker (Mac)
Co:Writer - standalone word prediction with topic dictionaries (Mac, PC, iOS, Chrome)
WordQ - word prediction, word lists, abbreviation/expansion (Mac & PC)
SpeakQ - WordQ plus speech recognition (PC)
Clicker 7 - custom onscreen keyboards, talking word processor, word prediction, more (Mac & PC)
Clicker Apps: Sentences, Connect, Docs, Books - each app focuses on a key Clicker 7 feature (iOS)
DocsPlus - word banks, talking word processor, word prediction, mind mapping (online, Mac & PC)
BeeLine Reader - text color gradients aid visual tracking, improve reading speed, reduce effort
Mercury Reader - reduces webpage visual clutter for distraction-free reading (Chrome)
Reading Focus Cards - virtual index card-like reading guide to aid visual focus (Mac, PC)
Rewordify - automatically defines, or substitutes simpler words in place on webpages
Snap&Read Universal - text-to-speech, convert image to text, and text leveling (simplify difficult words) (Chrome)
________________
Taking Notes & Organizing Notes

Microsoft OneNote - digital notebook (PC, Mac, iOS, Android, Chrome, online)
Growly Notes - digital notebook (Mac, iOS)
Evernote - digital file cabinet (online, Mac, PC, iOS, Android)
Livescribe smartpens - pens link recorded audio to handwritten notes (works with Mac, PC, iOS, Android depending on model: Echo, Sky Wifi (discontinued 2016), Livescribe 3)
IRISPen - handheld scanning pen captures print text, transfers to computer (Mac & PC)
C-Pen - handheld scanning pen reads print text aloud, defines/translates words, captures print text for transfer to computer (Mac & PC)
Notebook Layout w/ Audio Notes - link recorded audio with typed notes in Word (included with Microsoft Word for Mac 2008 & 2011 only)
Sonocent Audio Notetaker - software integrates audio recording, notes, slides, images, and annotations (Mac & PC)
Sonocent Recorder - companion app to Audio Notetaker; record and annotate audio (iOS, Android)
AudioNote - multi-functional notetaker app (iOS, Android, Mac, PC)
Notability - robust notetaker app (iOS, Mac)
________________
Math & Science Notation, Graphing & Drawing

MathType (Mac & PC)
MathMagic (Mac & PC) and MathMagic Lite (Mac, PC, iOS, Android)
EquatIO (Chrome)
FX Equation (Mac & PC)
FX Graph (Mac & PC)
FX Draw (Mac & PC)
FX Chem (Mac & PC) - type chemical equations
FX ChemStruct (Mac & PC) - type chemical structure diagrams
GeoGebra (Mac, PC, iOS, Chrome)
Desmos Graphing Calculator (iOS, Android, Chrome, online)
Desmos Test Mode (iOS) - restricted test-safe version of Desmos
MathPad & MathPad Plus (PC - discontinued)
MathPad by Voice (PC - discontinued)
MathTalk (PC)
Panther Math Paper (iOS)
ModMath (iOS)
________________
Math Concepts

National Library of Virtual Manipulatives (online, Mac, PC)
McGraw-Hill Virtual Manipulatives workspace (online)
Kidspiration-Math View (Mac & PC)
InspireData (Mac & PC)
________________
Math Problem Solving and Processes

Apps and resources to help understand and practice multistep problem solving and sequencing steps.
Algebra Touch (iOS)
Long Division Touch (iOS)
Math 42 (iOS)
Esa Helttula Math Apps (iOS)
Khan Academy (online)
________________
Assorted Aids for Managing Digital Distractions

Isolator - dims, blurs, or hides all but frontmost window to reduce visual distractions (Mac)
HazeOver - dims or hides all but frontmost window to reduce visual distractions (Mac)
Dropcloth - dims or hides all but frontmost window to reduce visual distractions (PC)
ScreenRuler - dims entire webpage except for movable horizontal reading ruler to aid visual focus and tracking (Mac, PC)
Screen Masking tool in Read&Write for Google - dims entire webpage except for movable horizontal reading ruler (Chrome)
Screen Masking tool in Read&Write - dims entire webpage except for movable horizontal reading ruler (Mac, PC)
Mercury Reader - reformat "main article" text on webpage, removes visual clutter (ads, images) (Chrome)
Simplify Page tool in Read&Write for Google - reformats "main article" text on webpage, removes visual clutter (ads, images) (Chrome)
AdBlock - browser extension prevents ads from loading to webpages (Safari, Chrome browsers)
Text Mode - replaces webpage images and videos with gray rectangles for uncluttered, text-only reading (Chrome)
SelfControl - restricts access to selected websites for preset times (Mac)
StayFocusd - restricts access to selected websites for preset times (Chrome)
Cold Turkey - restricts access to selected apps, websites for preset times (Mac, PC)
RescueTime - tracks time on apps, websites (Mac, PC)
________________
Assorted Aids for Attention and Executive Functioning

VibraLite - watches with multiple customizable vibration alerts
WatchMinder - watch with multiple customizable vibration alerts, messages
Reminders - simple but capable to-do list with alerts included with Macs and iOS devices
Wunderlist - task manager app (online, Mac, PC, iOS, Android)
DropTask - visual task manager app (online, Mac, PC, iOS, Android)
Trello - visual taskboard for managing tasks and workflow (online, iOS, Android)
Assignment Calculator - break down large projects into manageable chunks (online)
Research Project Calculator - break down large projects into manageable chunks (online)
CoPilot - breaks assignments into sequence of tasks and schedules them on calendar according to learning style and study preferences (online)
30/30 - task timer app employs a modifed very of the Pomodoro Technique (iOS)
Brili Routines - "routine manager" with prompts to assist staying on task (Mac, Windows, iOS, Android, Pebble, online)
Octopus by Joy - icon-based task scheduler watch designed for young kids (shipping late summer 2017) (iOS, Android)

Wrap-up

I hope you found this post helpful and full of ideas.  I like doing these posts since two of my children struggle with severe executive functioning issues.  Completing this post helps to remind me to give them grace when they are having executive functioning problems (practically every minute of every day!) and how EF issues impact their learning.