It can sometimes be difficult to understand how best to help the person with executive functioning impairments. Below are a few ideas that may be helpful. However, it is important to remember that people with executive functioning impairment can vary widely in their degrees of ability and presentation. They may also have other cognitive, psychological or physical difficulties that can impact on their ability to benefit from the ideas below (e.g. language or memory impairment, visual problems, depression and anxiety). It may be necessary to seek support from other professionals who are experienced in the assessment and management of executive functioning impairment to ensure an individualised approach to the rehabilitation and management of these difficulties. Help may be sought from appropriately experienced Neuropsychiatrist, Neuropsychologist, Occupational Therapist and Speech and Language Therapist.

  • Those supporting people with executive functioning impairment should understand the impact of these difficulties upon the person’s abilities.
  • Try to put in place a clear daily structure and routine for the person.
  • Ensure expectations of behaviour and levels of co-operation are clearly understood by the person. Try to support the person to remember these.
  • A calm environment is helpful. The person with executive functioning difficulties will often manage better where noise and levels of stimulation are kept to a minimum.
  • It is important that those supporting the person with executive functioning impairments are consistent in their approach. As much as is possible, everyone should try to provide support in the same way.
  • Maintaining a warm and understanding approach, but also being clear and appropriately assertive when necessary, is important.
  • Give support to carry out tasks by prompting (visual and/or verbal dependent on ability).
  • Break down tasks into smaller, more manageable steps.
  • Use checklists or clear written instructions to help the person manage daily tasks.
  • Help structure the person’s time with functional, easy daily activities e.g. support them to fold clothes, pair socks, weed the garden, clean the car, wash dishes. Many people with executive functioning impairment will struggle to think of things to do and may become irritable and bored.
  • Support access to appropriate leisure and social activities.
  • For some people, a programme of education and awareness about their brain injury may be helpful. The more understanding they have of their problems and the impact of these problems upon themselves and others, the more likely they are to try and compensate for and adapt to them.
  • Training in anger management strategies and relaxation techniques may be helpful for some people.
  • Support the person to manage situations that they may find overwhelming e.g. a person with poor organisational skills and reduced insight may struggle to cope and become increasingly anxious if they are expected to be responsible for shopping, organising menus and cooking, sorting out clothes, deciding what to wear and washing them etc. The environmental demands on them to manage these things should be reduced and as much support as needed given. Support can be reduced as the person improves or if successful management strategies are found.
  • If the person has problems with disinhibition, it may be helpful to monitor what is on the T.V., access to internet etc if these are potential triggers for disinhibited behaviours.
  • Use of distraction techniques and playing down any unhelpful behaviours arising from executive functioning impairment can be helpful, especially if the person lacks insight and does not understand the impact of their impairment. Some people, because of the extent of their impairment, may not be responsive to guidance and prompting etc.
  • Humour can be a useful tool to help diffuse difficult situations or distract from an escalating situation.
  • A confrontational style to managing executive functioning problems is always unhelpful and may even make things worse.
  • Support to work through problems and to think through consequences of decisions/actions can be helpful for some people.
  • One of the most helpful tools to support people with executive functioning impairments is providing them with reinforcement when they:
    • Engage in appropriate, helpful and co-operative behaviours.
    • Demonstrate some insight into and understanding of their difficulties.
    • Manage to avoid engaging in unhelpful behaviours.
    • Manage to stop unhelpful behaviours spontaneously when requested to do so.

Unfortunately, in some cases, people with executive functioning impairments may demonstrate challenging behaviours.