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7 Executive Functioning Strategies for Adults PDF

In this post, you’ll find 7 step-by-step executive functioning strategies for adults—plus free PDF worksheets for your speech therapy patients!

Executive functioning covers a lot. From problem solving, to initiation, to awareness, it can be hard to even know where to begin.

Thankfully, there’s a 4-step, evidence-based framework for improving executive functioning.

The Game Plan Worksheet covers these 4 steps and has been formatted for your speech therapy patients. For those patients who need more support, keep scrolling for 6 bonus executive functioning strategies for adults.

And for hundreds of patient worksheets and handouts, check out The Adult Speech Therapy Starter Pack!

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How to Treat Executive Functioning

When treating executive functioning, you’re teaching your patient how to solve problems and gain more control over their own behaviors.

How do you do this?

By teaching them a strategy for how to set and achieve a goal. In having your patient practice this strategy over and over again, your intention is that they internalize it.

4-Step Executive Functioning Strategy

  1. My Goal. The patient sets a goal
  2. My Plan. They plan the steps to achieve that goal, including anticipating any obstacles and solutions
  3. Do The Task. They are organized and motivated enough to do the task
  4. How Did I Do? They reflect on how they did

    (These steps are described in detail below)

Teach this strategy with a structured worksheet like the Game Plan Worksheet. Again, over time, your aim is for the patient to internalize this strategy in order to set and achieve their goals more independently and successfully.

For patients who need more support, add in the bonus executive functioning strategies.

Free Executive Functioning Strategies for Adults PDF

executive functioning worksheets pdf

Your FREE download comes with:

  1. The Game Plan Worksheet (short version)
  2. The Game Plan Worksheet (long version)
  3. The Self-Assessment Worksheet

The Game Plan Worksheet

Below is a step-by-step guide to using The Game Plan Worksheet.

You’ll also find a description of the executive functioning skills being practiced in each of the 4 steps.

1. My Goal

executive functioning strategies for adults pdf

Executive Functioning Skills Being Practiced

Metacognition (self-awareness and self-evaluation)
Working Memory (holding information in memory while doing a task)

The first step is to help your patient identify their goal.

As a person-centered clinician, this means that you’re allowing your patient to choose their own meaningful goal. Your role is to help them narrow it down into a task that’s doable, specific, and the right level of challenge for them.

For example, your patient may want to cook all of their own meals. They’re able to safely remain standing for about ~20 minutes and they have mild short-term memory impairments. You can help them narrow down their goal to: I want to cook dinners for myself at least 3 times a week.

Once they’ve chosen a goal, you’ll prompt them to write it down on the Game Plan Worksheet. Next, you’ll ask them to write down how they’ll feel when they accomplish their goal. This helps keep them motivated!

This step requires Self-Awareness. After all, a person needs some awareness of their own deficits in order to set an appropriate goal! The Executive Functioning Worksheets PDF includes a Self-Awareness Worksheet.

2. My Plan

executive functioning strategies speech therapy

Executive Functioning Skills Being Practiced

Planning (figuring out the steps to reach a goal)
Organizing (creating and using systems to keep track of things)
Working Memory (holding information in memory while doing a task)
Time Management (estimating time, allocating enough time to meet deadlines)

The second step is to teach your patient how to plan.

You’ll do this by modeling how to break down any goal into 3 smaller steps

For each step, you’ll help the patient figure out the details of how it’ll get done. They’ll decide:

  • When they’ll do each step
  • What they’ll need to do it
  • Where the step is and how they’ll get there (if appropriate)
  • What might get in the way of each step (potential obstacles)
  • How they’ll handle these obstacles

For example, your patient wants to cook dinner 3 times this week. You can help them break it down into the following steps:

  1. First, I will choose 3 things to cook. I’ll do it on Saturday night. I’ll need my notepad, pen, and the supermarket ad that comes in the mail. What might get in the way is I may not have the ad or I may forget to choose my meals. If I don’t have the ad, I’ll look it up online. In order to not forget to choose my meals, I’ll set an alarm on my phone.

  2. Then, I will go to the nearby supermarket. I will do it on Sunday morning. I’ll need my notepad and pen. I’ll put them in my pocket. I will take the bus. I might forget my notepad. In order to not forget my notepad, I will set a reminder on my phone.

  3. Lastly, I will cook the meals on Monday, Wednesday, and Friday. I’ll need my notepad and a calendar. I may forget that it’s my day to cook dinner. In order to not forget, I will set an alarm on my phone for 5:00 pm.

3. Do The Task

executive functioning strategies for adults pdf

Executive Functioning Skills Being Practiced

Task Initiation (begin tasks efficiently and on time)
Response Inhibition (think before acting)
Time Management
(estimating and allocating time to meet deadlines)
Attention
Working Memory (holding information in memory while doing a task)
Organization (creating and using systems to keep track of things)
Persistence (following through on a goal)
Stress Tolerance (handling stress, demands, and uncertainty well)
Emotional Control (manage emotions)
Flexibility (adaptability, ability to revise plans)

The third step is to teach your patient how to stay motivated and on track as they do the task.

This step can be a lot. There are many moving parts, which means distractions—both internal and external—that can derail goal-directed behavior.

Help your patient set up the supports they need to stay on task. Refer to My Plan for ideas they’ve already come up with. Supports may be:

  • Support people. For example, ask a spouse to help with a task
  • Reminders. For example, set reminders on their phone
  • Why is this goal Important? Have your patient jot down why this goal is important to them, to help them stay motivated
  • What will help me avoid distractions? For example, being in a quiet room

For example, your patient successfully cooked dinner 3 times a week for the first few weeks. However, he only cooked dinner twice the week before and once this week. He reports that he’s tired and maybe it wasn’t a good goal to begin with. You bring out his reminders.

  1. My support people: my wife and daughter. They will remind me that my tiredness goes away while I’m cooking because I love it so much.

  2. My reminders: my phone alarm, phone reminders app, and monthly calendar.

  3. Reminder–why is this goal important to me? I love cooking, and I miss working as a chef. Cooking makes me feel lively. My wife loves my meals.

  4. What will help me avoid distractions: I’ll stop watching TV 30 minutes before I need to go to the supermarket and before I cook on Monday, Wednesday, and Friday. I will set an alarm to remind me to turn off the TV.

4. How Did I Do?

executive functioning strategies for adults pdf

Executive Functioning Skills Being Practiced

Metacognition (self-awareness and self-evaluation)
Working Memory
(holding information in memory while doing a task)
Flexibility
(adaptability, ability to revise plans)

Finally, you’ll guide your patient to review how they did on the task.

With this step, they can learn what parts of their plan worked or didn’t work. And they can identify obstacles they hadn’t considered before.

Using these insights, patients can update their plan and maybe even change their goal (if it’s not meaningful, doable, specific, or the right level of challenge).

Use each Goal Plan Worksheet as stepping stones to greater independence in the goals that matter to your patient!

For example, your patient is back on track and cooked 3 meals this week.

  1. What went well? The alarms to remind me to stop watching TV really helped.

  2. What didn’t go well? I misplaced my monthly calendar so my wife had to remind me that it was my day to cook dinner. I found the calendar later.

  3. What did I learn? I realized that watching TV makes me feel tired. I should place my monthly calendar on the fridge because it’s easy to see and hard to misplace.

  4. What will I try next time to get a better result? I think I’ll take a walk around the block instead of watching TV sometimes so I don’t feel so tired. I feel more motivated to make dinner when I’m feeling awake.

  5. Does the goal still feel good? Why or why not? Yes, cooking makes me feel 20 years younger. Once I get in the habit, I’d love to make dinner more often or even start making lunch.

6 More Executive Functioning Strategies for Adults

problem solving strategies

Below are 6 more executive functioning strategies!

Self-Awareness Worksheet

Patients who lack awareness of their cognitive deficits can practice being more aware. The goal of your treatment will be for self-assessment to become a habit.

The 3-step process of improving awareness is to:

  1. Gently point out the deficit
  2. Educate about the deficit
  3. Help patients practice self-awareness and/or compensate for a lack of awareness.

You can use a worksheet to work on that 3rd step! Your Self-Awareness worksheet is included in the free Executive Functioning Worksheets download.

For more, read How To Improve Awareness.

Errorless Learning

  • Focus on accuracy
  • Emphasize not guessing
  • Minimize guessing by giving enough help. For example, give a verbal cue to double-check the medication labels.

Task Analysis

Task analysis helps patients learn new skills by breaking down a task into smaller steps. Task analysis is especially handy when working on more complex tasks.

For example, a goal to check and delete a voicemail can be broken down into these steps:

  1. Touch the phone icon
  2. Touch the voicemail button
  3. Touch play, etc.

You can use task analysis to help patients during step 2 of the Game Plan Worksheet, My Plan.

Chaining

chaining cognitive rehabilitation

Use chaining to teach patients multi-step tasks.

Teach the entire task first, then gradually decrease cues, step-by-step, until the patient can do the task independently. Be sure to use errorless learning and to give immediate feedback.

  1. BREAK DOWN THE TASK INTO KEY STEPS

  2. FULLY PROMPT THE PATIENT THROUGH EACH STEP
    • Give visual, verbal, and/or physical prompts and modeling as needed as they go through every step of the task

  3. FADE PROMPTS FOR THE LAST STEP ONLY
    • Go through the entire task, but decrease cues for the last step
    • Keep fading cues until the patient can do the last step independently

  4. FADE PROMPTS FOR THE 2ND-TO-LAST STEP
    • Go through the entire task, but decrease cues for the 2nd-to-last step
    • Keep fading cues until the patient can do the 2nd-to-last step independently

  5. KEEP FADING PROMPTS FOR THE ENTIRE TASK
    • Keep backward chaining until the patient does the entire task independently

You can use backward chaining during part 3, Do The Task.

High Number of Practice Trials

Have your patient complete the entire task over and over again.

Make Modifications

modifications executive functioning

Modifications to a patient’s environment or tasks can help patients during all steps of The Game Plan Worksheet.

Modify the Environment

  • Reduce clutter: extraneous wall art, stacks of papers, etc.
  • Remove distractions: reduce excess noise and visual distractions
  • Organize the space: assign specific places for specific things (e.g. a key rack by the door, mail organizer)

Modify the Task

  • Make tasks easier
  • Give cues and prompts
  • Use task analysis
  • Identify other factors that may be impacting the patient’s ability to problem solve
    • Physiological: issues with sleep, medication side effects, pain, etc.
    • Psychological: depression, anxiety, etc.
    • Refer out as appropriate

More Patients Worksheets

For everything you need to assess, treat, and document adult speech therapy, visit our shop!

References

  1. Cognitive Rehabilitation Manual; Translating Evidence-Based Recommendations into Practice by The American Congress of Rehabilitation Medicine
  2. Goal Plan Do Review/Revise by the Center on Budget and Policy Priorities and Global Learning Partners
  3. smartbutscatteredkids.com
  4. The Adult Speech Therapy Workbook by Chung Hwa Brewer
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