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Throughout this series, we’ve explored how executive functions develop from the toddler years through adolescence. We’ve seen that these skills don’t appear overnight. They grow gradually through relationships, play, meaningful occupations and repeated opportunities to participate in everyday life.

But what happens when executive functions don’t follow the developmental pathway we might expect?

What if your child seems incredibly capable in one situation and completely overwhelmed in another? What if they can spend hours building an intricate Lego model but can’t remember to brush their teeth? What if they desperately want to be organised but lose everything? What if getting started on a simple homework task ends in tears?

For many families of neurodivergent children and young people, these experiences are part of everyday life.

As occupational therapists, one of the most important messages we share with families is this:

Executive function differences are not a reflection of intelligence, motivation or character. They are differences in how the brain organises, plans, initiates, regulates and manages everyday life.

When we understand executive functioning through this lens, we stop asking:

“What’s wrong with my child?”

And begin asking:

“What is making participation difficult, and how can we help?”

That shift in thinking changes everything.

Executive Functions Are Different—Not Broken

Over the years, we’ve become much better at recognising that children experience and engage with the world in different ways. We understand that every child has unique strengths, interests and challenges. The same is true for executive functioning.

Neurodivergent children—including many autistic children, children with ADHD, Developmental Coordination Disorder (DCD), Developmental Language Disorder (DLD), intellectual disability, learning differences and other neurodevelopmental conditions—often experience executive functioning differently from their neurotypical peers (Diamond, 2013; Dawson & Guare, 2018; Barkley, 2012).

That doesn’t mean their executive functions are “wrong.” It means they develop differently, are influenced by different factors, and often require different supports.

As occupational therapists, we don’t view executive functioning as a checklist of skills that every child must master in exactly the same way. Instead, we recognise that executive functions develop within the interaction between the child, the occupations they participate in, and the environments in which they live, learn and play (Law et al., 1996; American Occupational Therapy Association [AOTA], 2020).

This is one of the reasons why a child may appear highly organised in one setting and completely overwhelmed in another. The demands have changed. The environment has changed. The supports have changed. And so has the child’s ability to access their executive function skills.

Looking Beneath the Behaviour

One of the most valuable things occupational therapists do is look beyond what we can immediately see. Behaviour is communication. It tells us that something is happening beneath the surface. When we only respond to the behaviour itself, we risk missing the reason behind it.

The table below illustrates how executive function differences may present in everyday life:

This doesn’t mean behaviour should be ignored or that children shouldn’t learn appropriate expectations. Rather, it reminds us that effective support begins with understanding. When we understand why something is happening, we are much more likely to choose strategies that actually help.

The OT Lens

Occupational therapists rarely ask,

“How can we stop this behaviour?”

Instead, we ask questions like:

• What occupation is the child trying to participate in?
• What barriers are making participation difficult?
• What strengths does the child already have?
• Which executive function skills are being challenged?
• How do the environment, sensory experiences, emotional demands and task expectations influence success?
• What adaptations might allow the child to participate more independently?

This approach reflects the Person–Environment–Occupation (PEO) Model, one of the core models used in occupational therapy (Law et al., 1996). Rather than placing all the responsibility on the child, we recognise that successful participation depends on the fit between the person, the environment and the occupation.

Sometimes the child needs support to develop a skill. Sometimes the environment needs to change. Often, both are true.

Executive Functions Don’t Exist in Isolation

One of the biggest misconceptions about executive functioning is that it can be understood separately from everything else. In reality, executive functions interact constantly with many other areas of development.

A child who is overwhelmed by sensory input may struggle to plan or organise. A child experiencing anxiety may find it almost impossible to initiate a task. A young person with motor planning difficulties may appear disorganised because simply carrying out the physical steps of a task requires enormous effort. A child with language processing differences may miss important instructions, making it appear as though they are forgetful.

Interoception—the ability to notice and interpret signals from within the body—also plays an important role. Children who have difficulty recognising hunger, thirst, fatigue, the need to use the toilet or rising emotional arousal may struggle to regulate themselves before these sensations become overwhelming. In turn, this can significantly affect planning, attention, flexible thinking and emotional regulation.

Executive functioning is rarely influenced by just one factor. Instead, it reflects the interaction of cognitive processes, sensory experiences, emotional wellbeing, physical health, communication, motor skills and environmental demands (Diamond, 2013; Schaaf & Mailloux, 2015). This is why there is no single strategy that works for every child.

Understanding the Invisible Load

Imagine carrying a backpack every day. Now imagine that every time you encountered a challenge, someone quietly added another weight.

A noisy classroom. Bright fluorescent lights. Unexpected changes. Remembering verbal instructions. Trying to understand social cues. Ignoring uncomfortable clothing. Managing anxiety about making mistakes. Planning what to do next. Trying to remember where you left your lunchbox.

By the end of the day, that backpack has become incredibly heavy. Many neurodivergent children carry an invisible cognitive, sensory and emotional load that others cannot see.

Parents often tell us,

“They’re fine at school, but they fall apart as soon as they get home.”

This experience is particularly common among children who spend significant energy masking, suppressing sensory discomfort, consciously interpreting social situations or working much harder than their peers to meet everyday expectations (Cage & Troxell-Whitman, 2019).

From the outside, it may look as though the child is “overreacting.” From the inside, they may simply have reached the limit of what their nervous system can manage. When we understand the invisible load children are carrying, we begin to see after-school meltdowns, emotional outbursts or withdrawal in a very different light.

Rather than asking,

“Why are they behaving like this?”

We can begin asking,

“How much have they been holding together all day?”

That small change in perspective often transforms not only our response, but our relationship with the child.

The OT Lens

One of the core principles of occupational therapy is that participation should never come at the expense of wellbeing. If a child is using every ounce of energy simply to “get through” the school day, we need to ask whether the demands being placed upon them are sustainable.

Our role is not only to build skills, but also to reduce unnecessary barriers so that children can participate in ways that support both their development and their quality of life. Successful participation isn’t about appearing neurotypical. It’s about enabling children and young people to engage meaningfully in the occupations that matter to them while respecting who they are.

Building Skills Without Changing Who They Are

One of the most important shifts in occupational therapy over the past decade has been moving away from asking,

“How can we make this child look more like everyone else?”

Towards asking,

“How can we help this child participate successfully while respecting who they are?”

This distinction matters. Every child deserves opportunities to develop planning, organisation, emotional regulation and independence. But those skills do not have to look identical for every child.

Some children naturally develop routines without much support. Others benefit from visual schedules, reminders or predictable structure. Some may always rely on external supports to organise their day. That isn’t a sign that intervention has failed. It is an example of successful adaptation.

Occupational therapy has always recognised that independence does not necessarily mean doing everything without support. Instead, independence means having the tools, strategies and confidence to participate as fully as possible in the occupations that matter.

For one young person, that may mean using a digital calendar. For another, it may mean setting multiple alarms on their phone. Someone else may benefit from a smartwatch that provides discreet reminders, colour-coded folders, visual planners or a written checklist on the fridge. These supports do not make a child less independent. They make participation possible.

Research consistently demonstrates that environmental adaptations and scaffolding can improve participation and functional outcomes for children and young people with executive functioning differences (Dawson & Guare, 2018; AOTA, 2020).

The OT Lens

As occupational therapists, we don’t aim to remove every support. We aim to identify which supports enable meaningful participation while fostering increasing confidence and autonomy. Sometimes the most successful intervention isn’t teaching a child to remember everything. It’s helping them develop a system that means they don’t have to.

Just as an adult might use a calendar, shopping list or navigation app, children and young people can benefit from external supports that reduce cognitive load and allow them to direct their energy towards participation rather than simply remembering.

There Is No “One Size Fits All”

Parents are often searching for the strategy. The visual timetable. The reward chart. The organisational app. The perfect planner. The reality is that no single strategy works for every child.

Executive functioning develops within the interaction of the child, their strengths, their interests, their sensory profile, their environment and the occupations they are being asked to complete.

A strategy that transforms one child’s morning routine may increase anxiety for another. A visual checklist may help one young person become independent while overwhelming someone else who already feels overloaded by information. This is why occupational therapists spend time understanding the whole child rather than focusing on isolated behaviours.

We consider:

• What motivates this child?
• What environments support success?
• When do executive functioning difficulties become most noticeable?
• What sensory, emotional or social demands are also present?
• What strengths can we build upon?

When intervention is individualised, children are far more likely to experience success.

Strengths Are Just as Important as Challenges

Families often come to therapy worried about what their child cannot do.

As occupational therapists, we spend just as much time discovering what they can do. Many neurodivergent children demonstrate remarkable strengths that can support executive functioning when recognised and nurtured.

These may include:

• Exceptional attention to detail
• Creativity
• Honesty
• Persistence in areas of interest
• Innovative problem-solving
• Visual thinking
• Deep knowledge of favourite topics
• Empathy
• Humour
• Curiosity
• Strong memory for specific information

Rather than trying to separate strengths from challenges, occupational therapists often use strengths to support areas of difficulty.

A child who loves technology might successfully use digital reminders. A visual thinker may benefit from mind maps rather than written lists. A child who enjoys routines may create highly effective organisational systems when those routines are meaningful to them. By building on strengths, we increase motivation, confidence and participation.

Looking Beneath the Behaviour

Sometimes what appears to be “poor organisation” is actually a child using enormous effort simply to manage everyday demands.

Instead of asking,

“Why can’t they just…?”

Try asking,

“What is making this difficult?”

That one question opens the door to curiosity, collaboration and problem-solving. Children rarely choose to struggle. Most are doing the very best they can with the skills, supports and energy they have available in that moment.

Preparing for Adulthood Looks Different for Everyone

As children grow, parents naturally begin thinking about the future. Will they cope at secondary school? Will they manage college? Will they live independently? Will they be able to keep a job? These questions are understandable.

The reassuring news is that executive functions continue developing into early adulthood, particularly when young people are given opportunities to practise meaningful life skills with appropriate support (Best & Miller, 2010; Luna et al., 2015).

At the same time, we also need to broaden our understanding of what successful adulthood looks like. Some adults will always use planners. Others will rely on reminders, digital calendars or smart technology. Many successful professionals use body doubling, written checklists, meal planners or structured routines every single day. These are not signs of failure. They are examples of effective self-management.

The ultimate goal is not independence without support. The goal is interdependence—knowing when to seek support, how to use helpful tools and how to participate confidently in everyday life.

Everyday Occupations Continue to Build Executive Functions

Executive functioning grows through participation in meaningful occupations across the lifespan.

For neurodivergent children and young people, these opportunities might include:

• Planning and preparing a favourite meal
• Organising materials for a hobby
• Caring for a pet
• Volunteering in the community
• Managing pocket money or a bank account
• Using a calendar to plan appointments
• Packing for a family holiday
• Organising school assignments
• Travelling independently
• Contributing to household routines in ways that match their strengths and abilities

The occupation itself is often less important than the opportunity to participate, problem-solve, reflect and learn. Everyday life remains the most powerful classroom.

When Families Change the Question

One of the most rewarding moments in occupational therapy is hearing a parent say,

“I see them differently now.”

Not because the child has changed. But because understanding has changed.

Families often move from asking:

“How do I make them more organised?”

To asking:

“How can I support them to succeed?”

That shift transforms relationships. Children feel understood. Parents feel less frustrated.Expectations become more realistic. Success becomes more achievable.

Remember…

Throughout this series, we’ve explored executive functions from the toddler years through adolescence. We’ve seen that these skills are not fixed. They develop gradually through relationships, meaningful occupations and opportunities to participate in everyday life. For neurodivergent children and young people, that journey may look different.

It may involve different strategies. Different timelines. Different supports. And that is okay. Progress should never be measured by how closely a child resembles someone else. It should be measured by whether they are becoming more confident, more engaged and more able to participate in the occupations that give their lives meaning.

As occupational therapists, we believe every child deserves the opportunity to develop the skills they need to thrive—not by changing who they are, but by recognising their strengths, understanding their challenges and creating environments where they can flourish. At its heart, occupational therapy is about enabling participation in everyday life.

Executive functions are not an end in themselves—they are the skills that help children and young people engage in the occupations that bring meaning, connection and independence throughout life. That is a goal worth working towards for every child.

Evidence-Informed Practice

This article has been written from an occupational therapy perspective and is informed by current developmental neuroscience, neurodiversity-affirming practice, occupational therapy theory and peer-reviewed research. The references below represent a selection of the evidence underpinning the concepts discussed throughout this article.

References

American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Barkley, R. A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.

Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function. Child Development, 81(6), 1641–1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x

Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911. https://doi.org/10.1007/s10803-018-03878-x

Dawson, P., & Guare, R. (2018). Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention (3rd ed.). Guilford Press.

Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person–Environment–Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9–23. https://doi.org/10.1177/000841749606300103

Luna, B., Marek, S., Larsen, B., Tervo-Clemmens, B., & Chahal, R. (2015). An integrative model of the maturation of cognitive control. Annual Review of Neuroscience, 38, 151–170. https://doi.org/10.1146/annurev-neuro-071714-034054

Schaaf, R. C., & Mailloux, Z. (2015). Clinician’s guide for implementing Ayres Sensory Integration®: Promoting participation for children with autism. In R. C. Schaaf & Z. Mailloux (Eds.), Clinician’s Guide for Implementing Ayres Sensory Integration®. Bethesda, MD: AOTA Press.

World Federation of Occupational Therapists. (2019). Position Statement: Occupational Therapy with Children and Youth.

Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of ADHD: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346. https://doi.org/10.1016/j.biopsych.2005.02.006 Zelazo, P. D. (2015). Executive function: Reflection, iterative reprocessing, complexity and the developing brain. Developmental Review, 38, 55–68. https://doi.org/10.1016/j.dr.2015.07.001

by Nicola Van Zyl