Executive Functioning for Adults: Practical Therapy Strategies That Actually Work From A Speech Therapist
- 1 day ago
- 4 min read
This post is all about executive functioning for adults
Last week we talked about what executive functioning deficits look like (if you missed it, check out Executive Functioning Deficits). Now let's get into the practical stuff: How do you actually address executive functioning challenges in adult clients?
Whether you're working with stroke survivors, TBI patients, individuals with dementia, or adults with ADHD, these strategies will help you target executive functioning alongside communication goals.
Strategy 1: External Supports Are Your Best Friend
When the brain's internal organization system is broken, provide external organization.
Visual Schedules and Checklists: Create step-by-step visual guides for therapy routines, home practice, or daily activities. A simple checklist for "steps to tell a story" (who, what, where, when, why) provides the structure their brain can't generate independently.
Timers and Alarms: Use phone alarms to cue task initiation or transitions. "Set an alarm for 3pm to practice your speech exercises" removes the executive burden of remembering.
Color Coding: Color-code materials, calendar categories, or therapy folders. The visual distinction reduces cognitive load when organizing information.
Practical example: A TBI patient struggling to organize medication schedules uses a color-coded pillbox with visual photos of each medication and clear timing labels. You can apply this same principle to communication goals.
Strategy 2: Task Analysis and Breaking Things Down
Adults with executive functioning deficits get overwhelmed by complex tasks. Your job? Make everything step-by-step.
How to do it:
Break every therapy task into the smallest possible steps
Teach one step at a time
Have them repeat steps back to you
Use backward chaining (teach the last step first, then add previous steps)
Example: Instead of "retell this story," break it into:
Who was in the story?
Where did it happen?
What was the problem?
How did it end?
Each question provides structure their executive system can't create alone.
Strategy 3: Errorless Learning Approaches
Traditional therapy often involves trial and error. But adults with executive functioning deficits struggle to self-monitor and learn from mistakes.
Errorless learning instead:
Provide the answer immediately before they can make an error
Gradually fade your support as they internalize the skill
Prevent frustration and the reinforcement of incorrect responses
Example: Teaching word-finding strategies? Don't wait for them to struggle. Model the strategy, do it together, then let them try with heavy cueing. Success builds confidence and creates correct neural pathways. I can't stress this one enough! This is a big mistake I see new people in the field making. The client doesn't know the answer and the clinician provides a BILLION of the EXACT same verbal cue thinking the client will magically come up with it.
Strategy 4: Metacognitive Training (Teaching Them to Think About Their Thinking)
Help clients become aware of their own thought processes and develop self-monitoring skills.
Practical techniques:
Think-Aloud Protocol: Model your own thinking process out loud. "Hmm, I need to remember three items. Let me repeat them to myself: milk, bread, eggs. Milk, bread, eggs."
Self-Questioning: Teach clients to ask themselves questions:
"What am I supposed to be doing right now?"
"Did that make sense?"
"What should I do next?"
Error Detection Practice: Intentionally make errors and have them catch you. Then reverse—they perform a task and evaluate their own accuracy.
Example: After retelling a story, ask: "Did you include all the important parts? What might be missing?" This builds self-monitoring, a critical executive function.
Strategy 5: Routine and Predictability
Executive functioning is exhausting. Reduce the cognitive load by making therapy (and life) predictable.
Create consistent routines:
Same therapy structure each session
Same time of day for home practice
Same location for materials
Why it works: Once routines become automatic, they require less executive control. The brain can save that energy for the actual learning.
With families: Help caregivers establish routines at home. Morning routines, mealtime routines, bedtime routines—all reduce daily executive demands.
Strategy 6: Working Memory Supports
Working memory deficits are perhaps the most common executive functioning challenge. (We'll dive deeper into memory strategies next week in Speech Therapy Memory for Adults, but here are quick interventions.)
Write it down: Have clients write down instructions, important information, or therapy targets. External storage = less working memory demand.
Repeat, repeat, repeat: Information needs multiple exposures. Don't assume they remember something from last week.
Chunking: Group information into meaningful chunks. Phone numbers are easier as 555-1234 than 5-5-5-1-2-3-4.
Reduce distractions: Close doors, turn off TVs, minimize visual clutter. Working memory is easily overloaded when attention is divided.
'Strategy 7: Goal Management Training
This evidence-based approach teaches clients to:
STOP – Pause and orient to the task
DEFINE – What am I trying to accomplish?
LIST – What are the steps?
LEARN – Execute the steps
CHECK – Did I accomplish the goal?
Apply it to communication tasks:
Organizing a narrative
Participating in conversation
Following complex directions
Using compensatory strategies
Post these steps visually in your therapy space. Reference them constantly until they become habitual.
Strategy 8: Collaborate with Other Disciplines
You're not alone in addressing executive functioning!
Occupational therapists work on executive functioning in daily living tasks—coordinate your language goals with their functional goals.
Neuropsychologists can provide detailed assessment of executive functioning profiles—use their data to inform your treatment.
Families are implementing (or struggling with) executive strategies at home—train them, support them, check in regularly.
Measuring Progress
Track improvements in:
Ability to complete tasks with less cueing
Improved self-monitoring (catching own errors)
Better initiation (starting tasks more independently)
Increased working memory capacity (holding more information)
Greater flexibility (trying alternative approaches when stuck)
Don't just measure speech/language outcomes—measure executive functioning gains too.
The Reality Check
Executive functioning interventions take time. Progress is slow. Some clients will always need external supports.
That's okay.
Your goal isn't to "fix" their executive functioning—it's to provide strategies and supports that allow them to function as independently as possible despite their deficits.
Coming up: Next week we'll tackle specific memory strategies for adults in speech therapy, and then we'll explore what executive functioning skills actually are in practical, observable terms.
What executive functioning strategy has been most effective with your adult clients? Let's share ideas in the comments!
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Thanks for reading about executive functioning for adults
Speech therapy tips are served with a side of sarcasm
