Executive Functioning Deficits: What You Need To Know As A Speech Language Pathologist
- 1 day ago
- 3 min read
This post is all about executive functioning deficits
Executive functioning deficits are showing up more and more on our caseloads ... whether we're working with stroke survivors, individuals with TBI, people with dementia, or even clients with developmental disorders that persist into adulthood. But what exactly are executive functioning deficits, and how do they impact the communication goals we're targeting?
Let's break it down in practical terms.
What Are Executive Functioning Deficits?
Executive functioning deficits occur when the brain's "management system" isn't working properly. These are problems with the mental processes that help us plan, organize, focus attention, remember instructions, and manage multiple tasks.
Think of it like a company where the CEO has stepped down. Employees (different brain functions) are still working, but there's no one coordinating efforts, setting priorities, or keeping everything running smoothly.
Common Executive Functioning Deficits Speech Therapists Treat
M.A.R.V. Poster
Working Memory Problems: Can't hold information long enough to use it. A client might understand your instructions but forget them seconds later.
Planning and Organization Issues: Struggles to break tasks into steps or sequence activities logically. You might see this in disorganized narratives or inability to plan daily schedules.
Cognitive Inflexibility: Gets stuck on one idea or approach and can't shift thinking. This shows up as perseveration in conversation or inability to problem-solve when Plan A doesn't work.
Poor Impulse Control: Blurts out responses, interrupts constantly, or acts without thinking. This impacts conversational turn-taking and social communication.
Task Initiation Difficulties: Knows what to do but can't get started. They might sit and stare at homework or therapy materials without beginning.
Self-Monitoring Deficits: Doesn't catch their own errors or recognize when communication has broken down. They continue talking even when the listener is confused.
How Executive Functioning Deficits Impact Communication
Here's where it gets real for SLPs:
Conversation Tangents: Without executive control, people lose track of topics, go off on tangents, or can't find their way back to the main point.
Following directions is nearly impossible: Multi-step instructions require working memory and sequencing are both executive functions.
Word-finding gets difficult: Even when language skills are intact, poor executive functioning makes it harder to search for and retrieve words efficiently.
Social skills Impacted: Reading social cues, adjusting behavior based on context, and managing emotions all require executive functioning.
Carryover is difficult: Learning a strategy in therapy requires planning, self-monitoring, and cognitive flexibility to apply it in real-life situations.
What Causes Executive Functioning Deficits?
Multiple conditions can damage the brain systems responsible for executive functioning:
Traumatic brain injury (TBI): Especially frontal lobe injuries
Stroke: Particularly left hemisphere or frontal strokes
Dementia: Executive functions often decline early
ADHD: A lifelong executive functioning disorder
Autism spectrum disorder: Many individuals have co-occurring executive challenges
Mental health conditions: Depression and anxiety can temporarily impair executive functioning
Normal aging: Some decline is expected, though not to a debilitating degree (we do not treat this as an SLP!) There needs to be a legitimate rhyme and reason
Red Flags in Therapy Sessions
Watch for these signs that executive functioning deficits might be impacting your client's progress:
Needs constant redirection to stay on task
Can't remember what you just worked on five minutes ago
Gets "stuck" and can't generate alternative solutions
Difficulty notice their own errors
Struggles to start activities even with all materials ready
Can answer questions but can't organize information into a coherent story
Shows inconsistent performance.
Why This Matters for Treatment Planning
If you're treating language or speech without considering executive functioning deficits, you're missing a huge piece of the puzzle.
Example: You're working on word-finding strategies with a stroke survivor. You teach them semantic cueing and they use it perfectly in therapy. But at home? They never use it. Why? Because remembering to use the strategy, recognizing when they need it, and inhibiting the impulse to give up all require executive functioning.
Understanding executive functioning deficits helps you:
Set realistic goals
Provide appropriate scaffolding
Choose effective treatment approaches
Collaborate better with other disciplines
Educate families about what they're really seeing
Moving Forward
Executive functioning deficits aren't just "cognitive issues" that someone else deals with. They're directly impacting our clients' ability to communicate, learn, and function independently.
The good news? Executive functioning can be supported, scaffolded, and in some cases improved with the right interventions. (Check out our upcoming posts on executive functioning for adults and specific memory strategies!)
What executive functioning deficits do you see most often in your practice?
Thanks for reading about executive functioning deficits
Speech therapy tips are served with a side of sarcasm
