Executive Function Is Hiding in Plain Sight
- Cara Koscinski
- 5 days ago
- 5 min read
When clinicians hear the words executive function, it is easy to think about the skills we traditionally associate with it: planning, organization, working memory, and time management.
But executive function is much bigger than keeping track of homework or remembering what comes next. It is woven throughout a child's day. Executive function can influence how a child gets started, responds when something changes, keeps track of information, organizes actions, persists when something becomes difficult, manages an impulse, solves a problem, participates in play, reflects on an experience, and tries a different strategy.
Once we begin looking for executive function in everyday moments, we often realize it has been hiding in plain sight.
Start With What You Observe
Imagine a child who sits in front of an assignment but doesn't begin. What do we see?
A child who isn't starting. But that observation doesn't tell us why.
Perhaps the child doesn't understand the first step. Maybe they are having difficulty organizing the information in front of them. They may be holding too many directions in working memory. They may be uncertain about what is expected. The task may feel overwhelming. Their internal state may be making it harder to access skills that are usually available.
Or there may be another explanation we haven't considered yet.
This is why observable behavior should be the beginning of our clinical reasoning, not the end.
One Behavior Can Have Many Explanations
Consider some concerns clinicians like you hear every day:
“They need constant reminders.”
“She falls apart when the plan changes.”
“He gives up as soon as something gets hard.”
“They rush through everything.”
“She can never find her things.”
“He knows how to do this. I've seen him do it before.”
It can be tempting to quickly attach an executive function label to each one.
But even that requires caution. A child who needs repeated reminders might be experiencing difficulty with working memory. But attention, regulation, task complexity, environmental distractions, comprehension, or the way information was presented could also be contributing.
A child who struggles when plans change may need support with flexibility. But predictability, interoceptive experiences, regulation, previous experiences, communication, or uncertainty may also be important. A child who gives up when work becomes difficult may need support with persistence. But we should also wonder whether the task feels manageable, whether the child knows what to do next, whether support is available, and what their body is telling them during the experience.
Executive function gives us another lens through which to get curious. It doesn't give us permission to stop being curious.
Executive Function Is More Than a List of Skills
Another important piece of the puzzle is that executive function doesn't operate separately from the rest of the child. A child brings their body, sensory experiences, emotions, relationships, environment, communication, strengths, interests, previous experiences, and current state into every situation.
Executive function operates within that larger system. That is why the same child can look very different across settings, activities, people, and even different moments of the same day. Sometimes a child needs to learn a skill. Sometimes a child has developed the skill but needs additional support to access or use it in a particular situation. Very often, both are happening at the same time. Recognizing that difference can change the questions we ask and the interventions we choose.
Executive Function Shows Up in Play, Too
Play is a wonderful example.
Think about everything that can happen during even a simple play experience.
A child may need to generate an idea, begin an activity, remember a rule, follow another child's idea, shift when the story changes, organize materials, wait, respond to something unexpected, solve a disagreement, persist when something doesn't work, and reflect on what to try next.
That's a tremendous amount of executive function. Difficulty during play doesn't automatically mean an executive function skill is responsible. But executive function deserves a place in our clinical reasoning when we're trying to understand what may be making play easier or harder for a particular child.
The same is true for classroom routines, self-care, communication, transitions, community activities, learning, and relationships.
Executive function is everywhere.
You see what the child is doing. What comes next?
The EFX-TB™ Treatment Builder helps clinicians move from an everyday concern to individualized clinical reasoning, supports, treatment ideas, present-level language, and meaningful goals.
Less time staring at a blank page. More confidence in what to do next.
From “What Is the Child Doing?” to “What Might Be Happening?”
This is one of the most useful shifts we can make in clinical practice.
Instead of stopping with: What is the child doing? We can delve further and ask:
What does this observation tell me?
What executive function skills might this situation require?
What other factors might be influencing what I'm seeing?
What strengths does this child bring to the situation?
Does the child need support accessing a skill, explicit teaching of a skill, or both?
Notice that these questions don't assume we already know the answer. They help us reason toward one. And sometimes the answer will be that executive function isn't the primary factor at all. That's good clinical reasoning, too.
FREE CLINICAL QUICK GUIDE: Where Is Executive Function Hiding?
I created a simple one-page clinical reference to help you begin making these connections in everyday practice.
Where Is Executive Function Hiding? Our One-Page Clinical Quick Guide pairs common observations with executive function areas to consider. Use it as a quick reference during treatment planning, keep it near your desk, share it during team discussions, or use it as a reminder to pause before jumping from an observable behavior to an explanation.
Executive function is invisible.
Interoception is internal.
Behavior has many causes.
Regulation is complex.
...We Make It Visible.
Our job isn't to assume we know what is happening beneath the surface. It's to become better observers, ask better clinical questions, and find ways to make those invisible processes easier to recognize and understand. When we can connect what we observe with what may be happening beneath the surface, we have a better foundation for deciding what to support, what to teach, and what to try next.
That's how we begin to make the invisible visible.
Need help identifying the executive function pattern first? The EFX-AP™ helps clinicians assess executive function skills and understand the patterns that can guide intervention.
Dr. Cara Koscinski, OTD, MOT, OTR/L, CAS, is a seasoned pediatric occupational therapist, certified autism specialist, author of seven books, and founder of the Executive Function Institute. Known for her practical, strengths-based approach to neurodiversity, she specializes in helping children build executive function through sensory-aware, visual, and body-based strategies. Creator of The Executive Function Express program and a frequent speaker at national conferences, Dr. Koscinski brings warmth, clarity, and decades of clinical expertise to every tool she creates.
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