Helping Children with Executive Functioning Issues Manage Behaviors

Clearly lay out expectations for specific situations so the child knows what is expected. For example:

• “Rachel, it looks like we will have to wait in line for a little while. I expect you to stand here next to me until it is our turn to order food. No pushing and no running off.”
• “Jack, your brother needs to get his homework done now. No talking to him or crawling around under the table. He needs quiet time and a calm space until he is done.”

Offer support to bolster the stop function, i.e., work out with the child some private cues, so that you can help him know when to stop. For example:

• Use simple, non-judgmental language to cue the child to stop, for example:
  • “Arthur, tapping your pencil bothers the other kids. You need to stop.”
• Work directly with the child to create an unobtrusive non-verbal signal to cue the need to stop the behavior of concern. For a pencil tapper, perhaps holding up a pencil would do the trick. Or tapping once or twice on the student’s desk. Consider this a collaborative, trial-and-error effort between you and the child to figure out what works.
• Use a verbal prompt to help the child think about the rules, for example:
  • “Matthew, we are going to pick up your brother from his music lesson. We may have to wait for him to finish. Do you remember the rules during Michael’s music lesson? You must stay in the waiting area and not make loud noises.”

Plan in advance. When possible, head off problems by setting the scene ahead of time and laying out the guidelines. For example:

• “Sarah, before we leave the car we need to talk about guidelines for when we are in the doctor’s office. I know that it is tempting to sing to the music on your MP3 player, but please keep the music in your head and not out loud.”
• “Emma, we are going into the restaurant in just a minute. Remember, when you swing your feet under the table, you end up kicking other people. We will try to give you some extra space by putting you at the end of the table. Please try to keep your feet under your own chair.”

Teach alternatives to negative behaviors; i.e., replace a negative behavior with a different, possibly unexpected, behavior. For example:

• “Jared, here is a pipe cleaner for you to hold in your hands while we wait for the show to start. You may not poke your brother or pull on my sweater. Keep your hands busy with the pipe cleaner instead.” (Many different quiet, soft toys work well in this regard. Look for “fidget” toys that have some texture or other kinesthetic property of interest. For kids who like to draw, you can teach them to keep a small note pad with them so they have something to do during down time.)

Use rewards to reinforce successful behavior. For example:

• When working with a child to build better control of a specific behavior, it is important to reinforce periods of good control. The more difficult the situation or entrenched the behavior, the more important it is to offer praise or provide concrete rewards.
• For specific behaviors that recur, a behavioral plan can help the child by reinforcing good control. As noted above, there are many versions of behavioral plans, but all involve using age-appropriate rewards for the desired behavior (e.g., five minutes of free time for each half hour of quiet work). Build in success by using frequent rewards and adjusting the goal to start the child at a level that allows him to meet expectations a large percentage of the time. You should continue to adjust expectations upward as the child’s abilities increase.

When we work with families with impulsive children, we often introduce them to the metaphor used by authors Patricia O. Quinn, M.D. and Judith M. Stern, M.A. in their book, Putting on the Brakes. Even young children can understand that some kids, like cars, have weak brakes. We explain to the child that he must exercise his brakes to make them stronger and that his parents will help him to do so. It is a metaphor that translates into immediate understanding and lends itself to brief, direct verbal prompts. “Denise, you are moving so fast that you are bumping into people. You need to put on your brakes.”