A backpack stuffed with crumpled papers—old and new—tossed in without a folder. A locker
harboring last month’s lunch, buried beneath a flood of missed assignments and forgotten
homework.
Screaming and crying between activities, paired with impulsive behavior. These are
just a few signs that a child may be struggling to develop their executive function skills.
Executive function skills, as defined by Harvard University’s Center on the Developing Child,
“act like an air traffic control system in the brain, helping us manage information, make
decisions, and plan ahead.” While these skills may naturally develop over time for some
children, others may experience difficulties that interfere with their ability to navigate daily life.
For adults, multitasking is an ingrained part of everyday living. Beyond managing multiple tasks,
self-control and self-regulation form the foundation of how we interact with the world. Yelling at
your boss or laying on the horn when someone cuts you off might feel justified in the
moment—but executive function gives us the tools to respond appropriately instead of
impulsively. These skills are essential, yet they are not innate.
According to a working paper by Harvard University’s Center on the Developing Child, “We are
born with the potential to develop these capacities—or not—depending on our experiences
during infancy, throughout childhood, and into adolescence.” The paper continues, “These skills
develop through practice and are strengthened by the experiences through which they are
applied and honed.” In other words, while we aren’t born with executive function skills, they can
be cultivated—especially with consistent support at home and in therapeutic settings.
1) Creating structure and Routine
One important aspect of pediatric therapy—whether occupational, speech, or
physical—is the consistent routine it establishes. When therapy sessions occur on the
same days each week and are attended regularly, they provide a predictable structure
that supports the child’s sense of security and promotes steady progress over time.
Additionally, occupational therapy often features the use of a visual schedule, breaking
a child’s daily routine into easily digestible, visually descriptive pieces in order to reduce
stress and confusion.
2) Inhibitory Control
Many children—especially those with ADHD—struggle with impulsivity and a lack of
self-regulation, making it difficult to stop a behavior they know is inappropriate.
Occupational therapy can help strengthen inhibitory control through structured,
engaging activities such as:
● Simon Says
● Collaborative board games
● Waiting for their turn on playground equipment like swings or monkey bars
● Popcorn reading
Each of these activities emphasizes the importance of listening, waiting, and thinking
before acting. By practicing these skills in a playful, supportive environment, children
begin to internalize the foundations of self-control.
3) Building Focus and Attention
One common occupational therapy approach is the use of the “first… then” strategy. For
example, saying “First we will clean up, then we will go outside” can help children stay
on task by providing structure, offering clear expectations, and using motivation to
encourage follow-through. This approach not only incentivizes the initial behavior but
also gives the child a sense of predictability and control.
In addition to this, occupational therapy incorporates a wide range of activities designed
to strengthen focus and attention. Some examples include:
● Walking on a balance beam
● Memory games
● Target games using weighted bean bags or tennis balls
● Fine and gross motor activities such as beading, cutting, and drawing
These activities engage the brain and body simultaneously, helping children develop the
sustained attention and concentration needed for daily tasks.
4) Social Skills
A lack of executive function skills can also affect a child’s social interactions and ability
to form meaningful relationships. Outbursts, impulsivity, and agitation may interfere with
their capacity to engage with peers, understand social cues, or maintain friendships.
Occupational therapy addresses these challenges through structured play, which
creates opportunities for children to interact, practice social skills, and build confidence
in a supportive environment.
Another key tool used in OT is social storytelling. Social stories, as defined by the
Vanderbilt Kennedy Center, are “used to describe social situations specific to individuals
and circumstances while promoting self-awareness.” These personalized narratives
help children understand expected behaviors, navigate tricky social scenarios, and
reflect on their own actions in a constructive, non-judgmental way.
Executive function skills are vital to a child’s ability to thrive—academically, socially, and
emotionally. While these skills don’t come automatically, they can be nurtured through
consistent support, structure, and intentional practice. Pediatric occupational therapy
offers a wide range of tools and strategies to help children develop self-regulation,
focus, flexibility, and social awareness. From visual schedules and sensory play to
social stories and games that promote impulse control, therapy creates a safe and
supportive space for children to grow.
By understanding and addressing executive function challenges early on, caregivers,
educators, and therapists can empower children to navigate their world with greater
independence and confidence. With the right interventions and encouragement, every
child has the potential to build the skills they need to succeed.
