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om: Therapy has been a great journey — both Sara and I have learned a lot. There’s still work to do but now we know what the goals are and how to get there and that’s what executive function is all about!

Teacher: I’m finally seeing what Sara is capable of and it’s wonderful.

Sara: I earned my own digital camera by keeping my room clean for four weeks straight! I used it to take a picture of the gemach box when it was organized so the girls will know where everything belongs.

Now that Sara “gets” what’s going on around her and has a better concept of time she has the background skills to start working on actually executing tasks.

The first step is for Sara to know what the end product will look like so I give her more photography homework: Take a picture of her prepared knapsack her clean room and herself fully dressed and ready for school.

Parents often assume that their kids know what it means to “set the table” or “get ready.” But kids need to be taught what the end result looks like before they can execute the task.

Pictures in hand I introduce Sara to a system called Ready-Do-Done. We start with the knapsack. The photograph shows Sara’s bag with all her school essentials neatly packed inside. With a permanent marker I write in bold letters “DONE.”

I hand Sara the picture. “This is how your knapsack looks when it’s done.”

Then I teach Sara to work backwards. “How do we get to ‘done’? The first step is ‘ready’. What do you need in order to be ready to pack your knapsack?”

Using the photo I help Sara list what belongs in her knapsack each day. At the top of the list I write the word READY. “Now that you have what you need you are ready … to actually do.” I drag out a box full of random essentials and school supplies. Now that she’s ready it takes Sara just a minute to do the work of packing her knapsack.

The “doing” step is where Sara always got stuck. But once she’s aware of what “done” looks like she knows how to get “ready” and the task becomes simple to “do.”

I turn to Sara’s mother. “When it comes to executive function skills there’s nothing more effective than practice. Use this method over and over at home. With practice it becomes second nature.

Therapy is great for teaching strategies but real change comes from implementing them in real life.

You can even look for creative fun ways to implement these strategies. Sara can help you plan your next vacation — I’m sure she’d love that!”

Mrs. Gelbwirth and Sara laugh.

“I have a better idea” Sara announces. “Me and Shaindy want to start a supplies gemach in school to lend pens and things to kids who don’t have theirs. It’s very hard when you don’t have what you need” she adds seriously and I’m amazed at how much she’s come to understand. “So ‘done’ would be all the supplies in one place and a notebook and pen to write down who borrowed what.”

She speaks crisply reminding me of her mother as she reaches for my marker and jots this down on a piece of paper. “‘Ready’ would be getting all the supplies together finding a big enough container figuring out where to keep it. Once I ‘do’ that we can start.” She looks up glancing from my proud grin to her mother’s amazed smile. “Shaindy said she’ll be the secretary and write down who takes what.”

“And what will your job be?” I ask.

Sara winks at her mother. “Me? I’ll be the CEO!”

Take It Home

If your child struggles with executive function try these strategies to improve their skills:

PICTURE IT Take pictures of completed tasks such as a clean room a set table or your child dressed and ready. When it’s time to do a task the child can use the picture as a guide.

BREAK IT DOWN Break down tasks into tiny steps so your child knows exactly how to get to “done.” Never assume that any step is obvious. Be specific: Instead of just saying “Get a pencil” specify where the pencils are kept.

PRACTICE IT Offer your child opportunities to take leading roles in activities that require executive functioning like cooking or baking or organizing a carnival or baseball game.

READ IT Teach your child to “read the room” so he remains aware of what’s going on around him and what may be expected of him. Give a visual cue such as a mezuzah. Each time he passes the mezuzah he should do a quick read on the environment.

PARK IT Designate parking spots for objects so the child knows where to find them and where to return them.

CLOCK IT Replace digital clocks with analog clocks which provide visual context for the concept of time. You can use a dry-erase marker to color “slices” of time to indicate specific activities.