What Are Executive Functioning Skills? A Practical Breakdown for Speech Therapists

This post is all about what are executive functioning skills.

Over the past few weeks, we've explored executive functioning deficits, strategies for executive functioning in adults, and memory interventions. Now let's get specific: What exactly ARE executive functioning skills, and how do you recognize each one in your clients?

Understanding these individual components will transform how you assess, treat, and document therapy outcomes.

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The Core Executive Functioning Skills

Executive functioning isn't one skill. It's a collection of interconnected cognitive processes. Think of them as different departments in a company, all managed by the CEO (your frontal lobe).

Let's break down each skill with practical, observable examples you'll see in therapy.

1. Working Memory

What it is: The ability to hold and manipulate information in your mind temporarily.

What it looks like in therapy:

• Client can repeat a 3-word list immediately but can't recall it 30 seconds later

• Forgets the beginning of your sentence by the time you reach the end

• Can't follow multi-step directions without you repeating them

• Loses track of what they were saying mid-sentence

Why it matters for communication: Following directions, staying on topic, formulating complex sentences, and word retrieval all depend heavily on working memory.

How to target it:

• Use strategies from our speech therapy memory for adults post

• Start with 2-item sequences and gradually increase

• Provide visual supports to reduce working memory load

• Teach rehearsal strategies (repeating information aloud)

2. Cognitive Flexibility (Mental Flexibility)

What it is: The ability to switch between different tasks, ideas, or strategies. Adapting when situations change.

What it looks like in therapy:

• Gets stuck talking about one topic and can't transition to another

• Perseverates on the same word or idea

• Can't shift strategies when one approach isn't working

• Struggles with "changing the rules" in games or activities

• Takes things literally and can't understand alternative interpretations

Why it matters for communication: Conversations require constant flexibility—shifting topics, adjusting language for different listeners, understanding figurative language, and problem-solving when communication breaks down.

How to target it:

• Practice category switching ("Name an animal... now name a food... now another animal")

• Change game rules mid-activity and discuss the adjustment

• Role-play conversations where topics shift naturally

• Teach problem-solving: "That didn't work, what else could we try?"

3. Inhibitory Control (Impulse Control)

What it is: The ability to stop automatic responses and think before acting. Resisting distractions and impulses.

What it looks like in therapy:

• Blurts out answers before you finish the question

• Interrupts constantly during conversation

• Can't wait their turn in activities

• Says socially inappropriate things without filtering

• Gets distracted by every sound or movement in the room

Why it matters for communication: Turn-taking, maintaining conversational boundaries, filtering inappropriate comments, and staying focused during therapy all require inhibitory control.

How to target it:

• Practice "wait time" with visual cues (hand up = wait)

• Use games that require turn-taking

• Teach self-talk strategies ("Stop and think before I speak")

• Role-play situations requiring filtering (e.g., not commenting on someone's appearance)

4. Planning and Organization

What it is: The ability to create a roadmap to reach a goal. Thinking ahead and organizing steps logically.

What it looks like in therapy:

• Stories have no logical sequence—jumps around randomly

• Can't explain how to complete a familiar task in order

• Struggles to organize therapy materials

• Doesn't know where to start on open-ended tasks

• Can't anticipate what will happen next in a scenario

Why it matters for communication: Narratives require planning (beginning, middle, end). Explaining procedures requires logical sequencing. Problem-solving requires thinking through steps.

How to target it:

• Use graphic organizers for story retell

• Practice procedural discourse ("How do you make a sandwich?")

• Teach explicit planning strategies before tasks

• Break every activity into visible, numbered steps

5. Task Initiation

What it is: The ability to begin a task without procrastination. Getting started independently.

What it looks like in therapy:

• Sits and stares at materials without starting

• Needs repeated prompts to begin activities

• Says "I don't know what to do" even after clear instructions

• Avoids starting challenging tasks

• Waits for you to start every single activity

Why it matters for communication: Initiating conversation, starting homework, beginning to use compensatory strategies—all require task initiation.

How to target it:

• Use "first-then" visual supports

• Provide a clear starting cue ("When I say go, you'll...")

• Break tasks into tiny first steps that feel manageable

• Teach self-talk: "Just do the first one"

• Set timers to create urgency

6. Self-Monitoring (Self-Awareness)

What it is: The ability to observe and evaluate your own performance. Recognizing and correcting errors.

What it looks like in therapy:

• Doesn't notice articulation errors even when they're obvious

• Continues talking when listener looks confused

• Thinks performance was perfect when it was inaccurate

• Can't identify what was hard or easy about a task

• Doesn't recognize when communication has broken down

Why it matters for communication: Carryover of therapy strategies depends entirely on self-monitoring. If clients can't catch their own errors, they can't fix them independently.

How to target it:

• Teach explicit self-checking strategies

• Video record and review performance together

• Use error detection tasks

• Ask "How do you think you did?" after every activity

• Teach rating scales (1-5: How clear was my speech?)

7. Emotional Regulation

What it is: The ability to manage emotions and reactions appropriately.

What it looks like in speech therapy:

• Melts down when tasks are challenging

• Gets frustrated easily and gives up

• Overreacts to minor mistakes

• Can't handle constructive feedback

• Mood shifts dramatically during sessions

• May need a referral to Psychology***

Why it matters for communication: Communication is emotional. Dealing with aphasia, apraxia, or cognitive-communication disorders is frustrating. Emotional regulation allows clients to persist through challenges.

How to target it:

• Acknowledge emotions validly ("This is hard, I see you're frustrated")

• Teach coping strategies (deep breaths, taking breaks)

• Build in success to maintain motivation

• Use scaling ("How frustrated are you, 1-10?")

• Collaborate on adjusting difficulty level

8. Attention and Focus

What it is: The ability to sustain attention on a task and resist distractions.

What it looks like in therapy:

• Looks away constantly during activities

• Loses focus after 2-3 minutes

• Easily distracted by background noise or visual stimuli

• Daydreams or zones out mid-task

• Needs frequent redirection

Why it matters for communication: You can't process language, follow conversations, or learn new strategies without sustained attention.

How to target it:

• Minimize environmental distractions

• Start with short tasks and gradually increase duration

• Use engaging, meaningful activities

• Incorporate movement breaks

• Teach self-monitoring: "Am I paying attention right now?"

How These Skills Work Together

Here's the critical point: These skills don't operate in isolation.

Example: Retelling a story requires:

• Working memory to hold story details

• Planning to organize it logically

• Cognitive flexibility to adjust if you forget something

• Inhibitory control to not jump ahead

• Self-monitoring to ensure it makes sense

• Attention to stay focused on the task

When one skill is weak, it impacts everything else.

Assessment Tips

Standard speech-language tests often miss executive functioning deficits. You need to observe HOW clients approach tasks, not just WHETHER they get the right answer.

Watch for:

• Do they plan before starting or dive in randomly?

• Do they notice and correct errors?

• Can they shift strategies when stuck?

• Do they need constant redirection?

• How do they handle frustration?

Document specifically: "Client required maximum cues for self-monitoring of articulation accuracy" tells a much richer story than "client has articulation errors."

Bringing It All Together

Now that you understand what executive functioning skills actually are, you can:

• Identify specific deficits more precisely

• Choose targeted interventions

• Write better, more functional goals

• Collaborate more effectively with other professionals

• Help families understand what they're seeing at home

Review the Series

This completes our 4-week series on executive functioning:

1. Executive Functioning Deficits – Understanding what they are and why they matter

2. Executive Functioning for Adults – Practical intervention strategies

3. Speech Therapy Memory for Adults – Specific memory techniques

4. What Are Executive Functioning Skills – Breaking down each component (you are here!)

Which executive functioning skill do you find most challenging to address in therapy?

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