22 Executive Functioning Activities for Adults

In this post, you’ll find executive functioning activities for adults—plus free PDF worksheets! Each functional, step-by-step activity is broken down by severity, to help you adapt each activity as your speech therapy patient improves.

Bookmark this page and open it during treatments. Or feel free to copy and print anything you find useful.

And for ready-made materials that will save you hours of time and stress, check out our bestselling 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.

In this post, we focus on problems solving.

How to Treat Problem Solving

1. Keep it Functional!

Keep treatment functional. It will be more motivating for patients, and it’s key to practicing person-centered care.

Functional tasks are commonly ADLs and IADLs. That said, always interview the patient (or their caregivers, if appropriate) to understand what their goals are and what matters to them.

How to Set Functional Problem Solving Goals

When setting goals, consider the following patient factors:

• The patient’s goals, wants, and needs
• Previous level of functioning
• Current level of functioning
• Amount of support available
• Motivation
• Awareness of deficits

When setting goals, identify what the patient was doing before the injury. If the patient always used a calculator pre-injury, for example, then provide a calculator during math tasks.

The goal isn’t to improve their math skills. The goal is to help them get back to the previous level of functioning—or as independent with the skill as possible.

2. Work on Awareness

Work on awareness if your patient isn’t aware of their problem-solving deficits.

This process is to gently point out the deficit, educate about the deficit, and then help patients improve awareness and/or compensate for a lack of awareness.

You’ll find a step-by-step guide to treating awareness below.

3. Teach a Problem Solving Strategy

Teach your patient a step-by-step process for how to solve problems.

Patients with mild to mild-moderate deficits will fill out a worksheet with the process broken down into steps. After lots of practice, your goal is for the patient to internalize this process as much as they can.

For moderate to severe deficits, you’ll modify the process to help them learn how to think in a structured way.

You’ll find free executive functioning worksheets and other problem solving strategies below.

How to Treat Awareness

Working on awareness can be challenging for both the patient and the therapist.

Be non-confrontational.

Validate their hard work.

Give hope.

Take breaks.

And allow both you and the patient however long it takes.

1. Point Out the Area of Concern

• Respectfully point out the difference between the patient’s point of view and reality
• Start with things important to the patient’s daily life. For example, grocery shopping or a meaningful relationship

2. Educate About Their Impairment

• Keep your patient education specific and functional
• Educate about what their specific type of brain damage may look like in daily life (for example, “After a head injury, many people forget what they wanted to buy at the grocery store or they lose their keys”)

3. Practice Being More Aware

• Use a self-assessment worksheet (below)
• Make self-assessment a regular part of treatment
• The goal is that—with practice—self-assessment becomes a habit

Self-Awareness Worksheet (Metacognition)

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.

Your Self-Awareness worksheet is included in the free Executive Functioning Worksheets download.

For more, read How To Improve Awareness.

Strategies to Treat Executive Functioning Deficits

Below are 7 strategies to treat executive functioning deficits.

You’ll find recommendations for when to use each in the activities section below.

1) Game Plan Worksheet

Download our Game Plan Worksheet to teach your patients a step-by-step process for how to solve problems. Read Executive Functioning Strategies for Adults for detailed instructions.

2) Self-Assessment Worksheet

Use the Self-Assessment Worksheet to help your patient become more aware of their problem-solving deficits.

3) Errorless Learning

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

4) 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, checking and deleting voicemails can be broken down into these steps:

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

5) Chaining

Use chaining to teach patients multi-step tasks. You can use forward or backward chaining.

Steps to Backward Chaining

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
   • For example, the key steps to filling a pillbox are:
     1. Place all bottles on the left side of the table
     2. Open all the compartments of the pillbox
     3. Take one bottle and fill in one week’s worth
     4. Double-check your work
     5. Place the bottle on the right side of the table
        
        
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
   • For example, you give the patient moderate visual cues with occasional modeling to complete steps 1 through 5 of filling a pillbox
     
     
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
   • For example, give only a visual cue for step 5 (place the bottle on the right side of the table) until independent
     
     
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
   • For example, model step 4 (double-check your work) until independent
     
     
5. KEEP FADING PROMPTS FOR THE ENTIRE TASK
   • Keep backward chaining until the patient does the entire task independently

6) High Number of Practice Trials

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

7) Make Modifications

Modifications to a patient’s environment or tasks can improve problem-solving skills. They can also help patients compensate for deficits.

Modify the Environment

• Reduce clutter: take down extraneous wall art, 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)

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

Executive Functioning Activities for Adults!

Below, you’ll find 22 executive functioning activities for your adult speech therapy patients!

These functional activities focus on problem-solving and are broken down by severity, from severe to mild deficits.

Activities for Severe Problem-Solving Deficits

You will teach patients with severe problem-solving deficits how to think in a structured way. The goal is often basic safety.

These patients likely can’t generate the steps to a goal by themselves. Or even plan ahead for simple tasks. But you can teach them how to think in a methodical way.

Problem-Solving Strategies To Use: Severe

1. Errorless Learning
2. Tasks Analysis
3. Chaining
4. High Number of Practice Trials
5. Make Modifications

1) Using the Call Light

Below are examples of how to use problem-solving strategies for the goal of using the call light.

Task Analysis: We break “using the call light” down into three steps: 1) Identify the goal to call the nurse 2) Find the call light and 3) Push the button.

Errorless Learning: Focus on accuracy by giving enough cues and emphasizing not guessing

High Number of Practice Trials: Practice the task many times

Make Modifications: Decrease clutter in the room. Caregivers always return the call light to the same location. Post a printed image of the call light next to the bed.

Chaining: Once the patient can call their nurse, expand the task. Teach them to call the nurse when they have pain, when they have a question, etc.

2) Follow Precautions

Turn any precautions that the patient has into problem-solving activities. For example, fall precautions, activity limitations, etc.

3) Manage Oxygen Tubing

For some patients on oxygen, a functional problem-solving task is how to manage the tubing without getting tangled.

Patient Instructions:

• If you use a walker, loop the tube around a finger to elevate the tube away from your feet. If you don’t use a walker, carry the tube with your non-dominant hand.
• When you want to sit down, hold the tube out in front of you to avoid it becoming tangled around you.
• Wrap small pieces of bright tape (e.g. neon-colored tape) every 12 to 18 inches along the length of the tubing to see it more easily.

4) Sequencing Tasks

Use simple, structured tasks to practice problem-solving strategies.

Patient Instructions:

Place the steps into the correct order, using the numbers 1 through 4.

BOILING WATER

☐ Put the pot on the stove.

☐ Wait for the water to boil.

☐ Fill up the pot with water.

☐ Turn on the stove.

TOASTING BREAD

☐ Put bread in the toaster.

☐ Open the bread bag.

☐ Add butter to the toast.

☐ Push the lever down on the toaster.

For print-and-go worksheets & handouts, visit our shop!

5) Simple Pen & Paper Math

Use simple addition to practice problem-solving strategies. The point isn’t math. The point is to practice the skills they need to problem solve, such as paying attention, task initiation, etc.

Activities for Moderate Problem-Solving Deficits

Patients with moderate problem-solving deficits are ready to expand beyond basic safety goals. They can now work on ADLs, increased independence, and setting and attain their own goals.

At the moderate level, they’re also ready to try self-awareness strategies.

At the mild-moderate level, you can introduce the Game Plan Worksheet.

Problem-Solving Strategies To Use: Moderate

1. Self-Awareness Worksheet
2. Game Plan Worksheet (Mild-moderate)
3. Errorless Learning
4. Tasks Analysis
5. Chaining
6. High Number of Practice Trials
7. Make Modifications

1) Avoiding Falls

At the moderate level, the patient can work on problem-solving several aspects of avoiding falls.

GET YOUR EYES & EARS CHECKED

IMPROVE YOUR STRENGTH

IMPROVE YOUR BALANCE

USE ASSISTIVE DEVICES

MODIFY YOUR ENVIRONMENT

2) Remembering Your Medications

Use the problem-solving strategies to help patients move towards greater independence with medication management. Create a worksheet to help teach the steps.

Patient Instructions:

KEEP A ROUTINE. Take your medications at the same time and place every day.

MAKE A LIST of all of your medications.

USE A PILLBOX. Have all of your medications ready.

PLACE REMINDER NOTES where you’ll see them

USE ALARMS. Program your phone or Alexa™ device to sound an alarm when it’s time to take your medications.

USE A CALENDAR. Write reminders to take your medications. Cross them out only after you’ve taken them. Add to your calendar when to call for a prescription refill.

3) Using a Smart Speaker

Use problem-solving strategies when learning to use a smart speaker. Create a worksheet to help teach the steps.

SET AN ALARM

SET A TIMER

SET REMINDERS

ADD AN APPOINTMENT TO A CALENDAR “Set a speech therapy appointment for every Monday at 10 am”

CHECK A CALENDAR “When is Mother’s Day?”

SPELLING

CALCULATIONS

CONVERSIONS “How many tablespoons is 3 cups?”

4) Organize Bills

Use problem-solving strategies to help patients with the basics of financial management. Create a worksheet to help teach the steps. Modify the activities below for each patient.

GET ORGANIZED. Organize paper bills. Make a list of all bills, due dates, automatic payments, etc.

KEEP A PHONE/WEBSITE LIST. Create a list of important websites and phone numbers.

STICK TO A SCHEDULE. Make due dates on calendars. Decide when to pay monthly bills. Set up recurrent reminders.

SET UP AUTOMATIC PAYMENTS. Set up automatic payments for all recurring payments.

5) Practical Math Worksheets

Use simple but practical math problems to practice problem-solving strategies. Move beyond worksheets to real-life activities as soon as possible!

Patient Instructions:

Use a calculator and pen and paper as needed.

• Your one-week car rental is $400. How much does each day cost?
  
  
• Your bill for a meal is $30. How much would a 15% tip be?
  
  
• You buy 4 coffees at $1.80 each. How much is the total cost?
  
  
• You split a $50 meal between 2 people. How much does each meal cost?
  
  
• You buy two $18 shirts with a buy-one-get-one half-off sale. What’s the total cost?
  
  
• A 30-minute massage costs $45. How much does each minute cost?
  
  
• Your dentist is 15 minutes away. What time should you leave your house to be right on time for an 8:30 appointment?
  
  
• The movie is 2 hours and 15 minutes long. It started at 3:35 pm. What time does it end?

6) Math in Everyday Life

Use math in everyday life to practice problem-solving strategies. Create a worksheet to help teach the steps.

Patient Instructions:

Practice your math skills with the following tasks:

ROAD TRIPS. Choose a fun road trip destination. Use an atlas or Google Maps

• Calculate the total distance
• Plan a few stops
• Calculate how much you will spend on fuel

WEEKLY ADS. Open a weekly ad from a local grocery store

• Decide on a budget for a week’s worth of groceries
• Write a list of all the items you need
• Using the weekly ad, write down the price of all the items you need
• Calculate the total cost

7) Meal Planning

Use meal planning to practice problem-solving strategies. Create a worksheet to help teach the steps.

KEEP IT SIMPLE. Delicious, healthy, and time-saving meals can have 5 or fewer ingredients.

KEEP A LIST. Place a whiteboard or magnetic memory pad on the refrigerator and write down the grocery list throughout the week. Or use a Notes app on your cell phone.

PLAN ONE MEAL AT A TIME. Decide what you want to eat. After planning a meal, add the items you need to your grocery list and Move on to the next meal.

USE FROZEN OR CANNED INGREDIENTS. If preparing fresh produce is too challenging, canned or frozen produce can be a nutritious and easier option. Avoid added sugars and salt.

GROCERY SHOP AT THE SAME TIME EVERY WEEK. Get in a routine to avoid forgetting to shop.

USE A MEAL DELIVERY SERVICE. Meal delivery subscriptions such as Hello Fresh or Home Chef can cut down a lot of time spent on shopping, cooking, and cleaning. Some offer special diet options and oven or microwave-ready meals.

Make a schedule for choosing meals online. Set calendar reminders for dates you need to pause the subscription (for example, during a holiday week).

8) Set Goals

Once patients with moderate deficits are ready, begin working on goal-setting.

Create a goal-setting worksheet. Prep them with the following questions:

• What is your normal daily routine right now?
  
  
• What did a normal day use to look like (pre-injury)?
  
  
• What things are missing that you’d like to do again? These will become your goals.
  
  
• Given your new challenges, which goal would you like to get back to in the next 2 weeks?
  
  
• What could you do tomorrow to work towards reaching your goal?
  
  
• What 1-3 more steps can you take this week this reach your goal?
  
  
• How would your routine change?

9) Real Life Problem-Solving

As the patient progresses, make the transition to real-life tasks.

These include their daily activities and the goals they have set:

• Planning their own schedule
• Making their own appointments
• Increased independence with ADLs and IADLs, etc.

Activities for Mild Problem-Solving Deficits

Patients with mild problem-solving deficits will work on tasks that further increase their independence, safety, and quality of life.

Do a more in-depth patient interview to better understand their needs and wants. What do they want their life to look like? And how can your problem-solving treatment sessions help them get there?

Problem-Solving Strategies To Use: Mild Deficits

1. Game Plan Worksheet
2. Self-Awareness Worksheet
3. Errorless Learning
4. Tasks Analysis
5. Chaining
6. High Number of Practice Trials
7. Make Modification

1) Math in Everyday Life: Road Trip

Patient Instructions:

1. Choose a road trip destination. Have fun with this! Maybe it’s to visit the grandkids in Atlanta or to the beach
2. Use an atlas or Google Maps to map out their journey
3. Calculate the total distance
4. Calculate how many days/hours the trip will take
5. Plan how many stops they’ll take
6. Calculate how much they’ll spend on gas or tickets
7. If appropriate for your patients, increase the challenge by adding in a second or third destination. Calculate the costs of lodging and food

2) Math in Everyday Life: Shopping

To keep this activity functional, choose weekly ads for a store that fits your patient’s interest. For example, if they love gardening, use a garden center’s weekly ad to plan next spring’s garden. Or if it’s around the holidays and they have young grandchildren, find a big-box store or toy store catalog to create a gift list.

Patient Instructions:

We’ll use the example of planning a holiday feast.

1. Get a copy of a weekly ad from a local grocery store
2. Have them decide on a budget for the holiday meal
3. Have them write a list of all the items they’ll need to make the meal. Don’t forget fun decor and dessert!
4. Using the weekly ad, have them write down the price of all the items they’ll need
5. Have them calculate what the total cost will be

3. Math in Everyday Life: Restaurant Menus

Patient Instructions:

1. Get a copy of the restaurant’s menu. You may pick up their take-out menu or print out the menu from their website.
2. Have the patient set a budget
3. Have them write a list of all the items they want
4. Have them calculate tax and tip
5. Then have them calculate how much their total will be

4) Math in Everyday Life: Reading a Receipt

Patient Instructions:

1. Ask the patient to review a receipt and then answer questions
2. Let them know that they can use the calculator and pen and paper as needed

Example Questions

1. How much is each mango?
2. How much is each avocado?
3. How much are apples per pound?
4. How much is whipped topping?
5. What is your grand total?

5) Remembering Your Medications

• Transition away from the medication management worksheet to problem-solve how to be more independent with this task
• Use the Game Plan Worksheet to have patients set their own goals and make their own plans for this task
• Help patients progress towards internalizing these steps
• Continue using the other strategies

Go to the medication management instructions.

6) Using a Smart Speaker

• Transition away from the smart speaker worksheet to problem-solve how to be more independent with this task.
• Use the Game Plan Worksheet to have patients set their own goals and make their own plans for this task
• Help patients move towards internalizing these steps
• Continue using the other strategies

Go to the smart speaker instructions.

7) Financial Management

• Transition away from worksheets to problem-solving how to be more independent with this task
• Use the Game Plan Worksheet to have patients set their own goals and make their own plans for this task
• Help patients move towards internalizing these steps
• Continue using the other strategies

Go to the financial management instructions.

8) Meal Planning

• Transition away from the meal planning worksheet to problem-solve how to be more and more independent with this task
• Use the Game Plan Worksheet to have patients set their own goals and make their own plans for this task
• Help patients move towards internalizing these steps
• Continue using the other strategies

Go to the meal planning instructions.

Worksheets & Handouts

For hundreds of ready-made handouts & worksheets check out our bestselling Adult Speech Therapy Starter Pack!

References

• Cognitive Rehabilitation Manual; Translating Evidence-Based Recommendations into Practice by The American Congress of Rehabilitation Medicine
• Goal Plan Do Review/Revise by the Center on Budget and Policy Priorities and Global Learning Partners
• Mild TBI Rehabilitation Toolkit by The Borden Institute
• The Adult Speech Therapy Workbook, by Chung Hwa Brewer