Language Therapy addresses the comprehension and expression of spoken and written language in children with varied diagnoses and levels of ability. Children with executive dysfunction tend to have disorganized expressive discourse in both spoken and written modalities. The child may struggle to tell the details of a story or event in an organized, sequenced manner.
The speech-language pathologist may teach the child to use context to deduce meaning, identify main ideas, and make inferences. Therapy may help to improve the child’s language organization and production of complex oral and written language. For the older child, therapy may increase the child’s use of nonliteral meaning, multiple meaning, figurative speech, metaphors, similes, and ambiguous language.
Additional language therapy treatment may address convergent reasoning, divergent reasoning, inductive reasoning and deductive reasoning skills.
Mental Flexibility, or shifting set, refers to the ability to problem solve and revise plans in the face of obstacles, setbacks, new information or mistakes. Mental flexibility requires the child to generate alternate approaches during a task or at the completion of the task. Children with an executive function disorder often ‘get stuck’ on a certain problem, topic or activity and struggle to switch between these easily. This child may be viewed as stubborn and unwilling to attempt an alternate approach, even when guided by parents or teachers.
Therapy may include teaching the child to adapt his performance to changing conditions and to adapt to these changing circumstances in a timely manner. The child will be taught to generate alternate or multiple strategies.
Time Management refers to the ability to be aware of and regulate an activity according to time constraints. Children with executive dysfunction may have trouble estimating the time required to complete a task. They may dawdle each morning and ‘waste time’, only to rush at the last minute to catch the school bus. They may start homework and other tasks late, without allotting sufficient time for completion.
Therapy may focus on helping the child accurately estimate how long tasks will take and how to alter his pace to complete tasks within the allotted amount of time.
Metacognition refers to the ability to think about one’s own performance; to monitor and evaluate one’s performance in relation to the goals of a task. Metacognitive skills include monitoring, modifying, repairing and self evaluating. It is the ability to learn from past experiences and apply that knowledge in new experiences. Enhancing metalinguistic and metacognitive skills is fundamental to applying any of the learned executive dysfunction compensatory strategies. These children often have poor self-awareness of their deficits and, thus, don’t independently apply given strategies or techniques when instructed. Children with an executive function disorder do not seem to learn from their mistakes as their poor insight prevents them from analyzing their own performance.
The speech-language pathologist may help these children develop increased deficit awareness and insight. The child will learn to identify his weaknesses, utilize strategies to compensate for these weaknesses, evaluate his performance toward the intended goal and revise his approach as needed. As the child’s awareness and insight increase, inner language will help the child apply learned strategies in daily contexts.