Helping Children with Executive Functioning Problems to Manage Physical Impulsiveness

Provide external structure in the form of general guidelines and specific rules. Teach rules that can be applied in a variety of situations. For example:

• “David, it is not okay to hurt people. No hitting. Not ever. Unless your life depends on it. If you are angry, there are other ways to handle angry feelings. Let’s discuss some options.”
• “Sarah, if someone grabs something from you, you can look them in the eye and say, “That’s mine. Give that back.” But we do not hit other people in this classroom.”

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

• “Jack and Susan, you will each have a turn with the new pool toy. I am going to use my watch to keep track of the time. Ten minute turns each. If you grab the toy before it’s your turn, then you will lose your next ten minute turn.”

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

• A creative teacher of a small class of young children in a therapeutic preschool instructed all of her young students to hold onto their pants legs when they lined up to leave the classroom.

  This positive directive (“Hold onto your pockets!”) engaged the children in a behavior that counteracted the pushing and shoving that so often occurred when the children moved to a different location.

• A Speech/Language Pathologist in the same program found it difficult to set up her materials at the beginning of group intervention sessions.

  Seated across from her at a table, the students’ little hands darted out to reach for the novel, interesting materials as she took them out of her bag. She devised a simple, very effective approach to helping the children manage their impulsiveness.

  Before taking out her materials, she directed the children to hold on to the edge of the table, rewarding them with a sticker on every hand that was holding on.

Build on the older child’s desire for more freedom by tying the use of proper behavior to an independent activity. For example:

• “Tonya, I know that you want to rent that karate video game. My concern is that you are already having trouble controlling yourself when your brother irritates you. Show me that you can control your temper with your brother and find other ways to solve your conflicts with him besides physical fighting, and I will reconsider whether you can rent the game. We will talk about this again at the end of the week.”

One way to teach alternatives to impulsive physical behaviors is by stopping the action and doing a retake.

“Whoa, what’s going on here, David? I can see that you are angry, but it is not okay to hit when you are angry. You can say, ‘I’m mad’ and stomp your foot, but you cannot hit. Let me hear it. Say, ‘I’m mad!’ Good, now tell me what you are so mad about.”

Thus, the adults go through a pre-set problem-solving conversation: they identify the feeling triggering David’s unacceptable behavior, re-state the rule, provide an alternative, and then require immediate practice.

As David starts to use the new behaviors spontaneously, they will encourage him to build a broader repertoire of skills by brainstorming different ways to handle strong feelings.