Executive Functioning Activities At Home

Many kids have difficulty mastering skills such as problem-solving, organization, sequencing, initiation, memory, attention, and breaking downgirl with homework books tasks.  These skills (and many more) fall under the category of executive functioning.  As children get older and begin middle school, these skills are expected to advance quickly.  It is usually in about 5th grade where teachers and parents start to notice their child may be having more difficulty than her peers in executive functioning skills. Academic specialists, occupational therapists, and neuropsychologists are just a few of the professionals who address challenges in these areas, but there are also a variety of activities that can be done at home that are both fun and target the development of certain executive functioning skills.

Here is a list of activities that build certain aspects of executive functioning and are fairly easy to orchestrate in the home:

  • Using Playdoh, blocks, or Tinkertoys, build a figurine and have your child build an exact replica in size and color.  This works on multiple skills, including initiation, breaking down tasks, sequencing, organization, and attention.  If you are unable to build an example, or if you have an older child who enjoys playing independently, there are often pictures of structures to build that come along with block sets or images online that can be printed.
  • Have your child go through a magazine and make a list of all the toys/items wanted. Then, have her organize the list in some sort of order (most wanted at the top, alphabetical, price, etc.).  For older kids, you could also have them write a description of the item, cut the pictures out, and type up a list with descriptions and pasted pictures, or even plan a presentation.
  • There are many board games that target executive functioning skill development.  A few of the games used in the therapeutic setting that would be easy and fun options for home use include: Rush Hour (a problem-solving and sequencing game involving getting a specific car out of a traffic jam when the other vehicles can only move in straight lines), Mastermind (trying to determine what the secret code is by process of elimination), and Connect 4 Stackers (a game of attention, organization, and planning to be the first to get four in a row, like the original, but this game involves different dimensions).
  • There are many resources that can be printed from the internet. Logic puzzles come in many different levels of difficulty and involve taking given clues, making inferences from those clues, and eventually solving some sort of problem through the use of the clues. There are often charts that accompany these puzzles and require attention, organization, sequencing and problem-solving.
  • Have your child choose a recipe from a magazine. After verifying that it is a realistic recipe that can be made in your home, have her write a grocery list containing everything needed to prepare that dish, create a list of the necessary cooking supplies, and for older children, have them look up the price of each item at the store and create an estimated budget. If possible, let them be part of the entire process, and take them with you to the grocery store. Again, with older children, you could even put them in charge of pushing the cart and finding the items in the store. For older kids, they may also act as the “head chef” and be responsible for completing most of the cooking. For younger kids, if there are safety concerns, assign specific tasks as their job in the cooking process.

One of the most important aspects of doing therapeutic activities at home is that your child is having fun. These are just a few of the many activities that can be done at home to develop executive functioning skills and are also engaging and enjoyable for school age kids.

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What Is Tourettes Syndrome

The Diagnostic and Statistical Manual, Fourth Edition, Text Revised (DSM-IV-TR), which is the diagnostic guide book published by the American tourettes childPsychiatric Association, indicates that Tourettes Syndrome is characterized by multiple motor tics and one, or more, vocal tic.  (APA XX).  Tics are sudden, repetitive motor movements or phonic productions (Leckman & Cohen, 1988).  These tics are considered to be either simple or complex.  Simple motor tics include eye blinking, eye movements, grimacing, and nose twitching and simple vocal tics include throat clearing, coughing, sniffling, spitting, barking, grunting, growling, hissing, and sucking.  Complex motor tics include facial gestures, biting, touching objects, thrusting arms, gestures with hands and complex vocal tics include phrases, speech atypicalities (unusual rhythms, tone, accents), and echoing words (Evans et. al., 1996).

Tics typically begin to occur when the child is between two to fourteen years old.  Initially, research has indicated that the first tics are simple motor tics.  The course of the expression of tics is difficult to predict but usually progresses from simple to complex tics (Leckman et. al., 1988).  Typically, vocal tics have a later age of onset and usually appear in children when they are approximately nine years old (Evans et. al., 1996).

Tourette’s Syndrome often coexists with other neurodevelopmental disorders and conditions, including Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder, and Learning Disorders.  As a result, it is always important to attain a comprehensive evaluation of a child’s cognitive, academic, attentional, and social/emotional functioning in order to ensure that all possible areas of concern are addressed through academic and social interventions.

The Centers for Disease Control and Prevention reported that current prevalence rates of Tourette’s Syndrome are approximately 3 out of every 1,000 children between the ages of six and seventeen living in the United States (CDC, 2010).

Treatment of Tourette’s Syndrome needs to focus on four factors:  working with the child to develop coping strategies, parent and family education, school accommodations, and peer education.  It is vital that the child receive specific intervention and strategies to help develop strategies to deal with anxiety associated with a tic disorder.  Parents and family members need to be educated about the disorder, as well as the course and treatment of the condition.  Teachers and faculty need to be educated about the condition in order to ensure that any academic staff member is aware that possible negative behaviors are tics as opposed to volitional oppositional and defiant behaviors.  In addition, peers need to be educated about tics in order to ensure social acceptance.  If a child with Tourette’s Syndrome continues to exhibit debilitating tics after the above four interventions have been addressed, it would be warranted that he or she have a consultation with a pediatric neurologist in order to determine if he or she would benefit from pharmacological intervention.

If you suspect that your child may be suffering from Tourette’s Syndrome, it would be warranted that a comprehensive evaluation take place in order to help ascertain the current level of functioning as well as any possible co-existing conditions such as learning disorders, attention deficit hyperactivity disorder, and social/emotional concerns.


Differential Diagnosis: Autism versus Aspergers

Autism and Asperger’s Disorder are diagnoses which both present with a hallmark feature of social impairment. There are several differences between Asperger's Childthe two diagnoses which help classify the two disorders.

Autism Diagnosis:

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR), which is the diagnostic guidebook published by the American Psychiatric Association, indicates that there are three domains of diagnostic criteria for a diagnosis of Autism. Impairment with social relationships is the first domain which includes impaired nonverbal communication (poor eye contact and lack of gestures), poor peer relationships (lack of social interest when young to one-sided social interactions when older), poor joint attention (lack of pointing to show interest, not bringing items to show parents), and a lack of emotional reciprocity (failure of the child to notice parents and peers emotions). The second area is impairment in language which includes: language delay (not speaking at a year, or not speaking in sentences at two years), inability to carry on a give-and-take conversation, perseverative and repetitive language (repeating lines from television shows or the same thing over and over), and absent or delayed pretend play. The final area of Autism is repetitive behaviors which include: preoccupations or over-interest with favorite objects or topics that are unusual for the child’s age, routines and rituals that cause distress if interrupted, stereotypical movements (rocking, hand flapping, spinning), and interest in parts of objects (playing with only the wheels on a car). According to the DSM-IV, the main differential between the diagnoses of Autism (as described above) versus Asperger’s Disorder is that children with a diagnosis of Aspergers do not evidence impairment in language.

Asperger’s Diagnosis:

Neuropsychological studies have documented that children with Asperger’s Disorder often exhibit relative strength with regard to their verbal skills with deficits in their visual spatial and visual motor ability. Whereas children with Autism will often exhibit the opposite profile; strength with visual spatial and visual motor ability and weakness with verbal skills (Wolf, Fein, Akshoomoff, 2007).

Overall, the diagnoses of Autism and Asperger’s Disorder are quite similar in that they both feature impairment with social relationships and repetitive behaviors. The main exception between the two diagnoses is that children with Asperger’s do not exhibit the concern with language functioning.

If you believe your child would benefit from an evaluation from an expert, please click here.


7 Reasons to Attend NSPT’s New Bucktown Clinic Open house!

The Chicago Clinic has recently expanded to a new and improved space! We would like to celebrate and introduce ourselves by opening the doors to the community. We are so excited to share our new space with both our existing families and also hope to meet some new faces!

New Clinic Open House

  1. It is hard to find fun for the whole family, without paying a high price in the city. The open house is a FREE event that you can bring your family and friends to!
  2. There will be endless entertaining fun for your children of all ages, including a magician, face painter, balloon maker, and games.
  3. Kids will have an opportunity to explore their creative side by making various crafts!
  4. A sensory table will provide an outlet for the children to explore their senses while engaging with other kids and having a blast. There will also be Occupational Therapists to answer any questions regarding various sensory strategies and tools.
  5. Parents will have an opportunity to speak with experts in fields such as speech therapy, physical therapy and occupational therapy, as well as counselors, academic specialists, and more.
  6. Learn more about North Shore Pediatric Therapy’s multidisciplinary approach to treatment.
  7. Check out the new state- of- the- art facility, with over 4,000 square feet of therapy rooms and equipment.

Event Details:

Date: Saturday, September 15th
Time: 11:00-2:00
Location: 1657 W. Cortland St. (corner of Cortland and Paulina; 1 block south of Armitage)
Chicago, Il 60622

For more information regarding this event please contact Lauren at 877-486-4140 or

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Get your Child Ready for 1st Grade

For many children going to 1st grade is a huge milestone.  More hours spent in school, higher expectations for academic, behavior,  social skills, and more peer pressure.Child in First Grade

Here are some tips to parent these kids as “right” as you can before 1st grade:


  • Prepare your child with some online fun academics, flash cards, or any workbook for 1st grade readiness;  but make it fun!  10 minutes per day is enough! You can even try KUMON math and reading to get them strong in basics for math and reading.  This will also prepare them with homework.
  • Strengthen up any weaknesses your child may have in academics. If they need a little reading help, use the following tips in this blog. If they need some number work, try flashcards, or try a tutor, but even just 10 minutes a day can make a huge difference in their self esteem about academics.
  • Get your child tested now if you detect any challenges. Don’t wait for the teacher to say something at conferences!  Go get a good neuropsychological exam and you will know what strengths and challenges your child has and have an opportunity to grow them.
  • Use a daily schedule even in first grade for time management and learning appropriate skills.


  • Make sure your child knows how to follow rules, understands boundaries, and knows the expectations of first grade children.  This includes raising hands, taking turns, staying quiet and getting involved/participation, etc.
  • Get your child some support if behavior is an issue.  There are social groups, social workers, books, all kinds of tools to help out there!
  • Your child needs to know what YOU expect of him and what your consequences  are at home.
  • Make sure your family gets proper sleep and food daily.

Social skills/Peer Pressure

  • Make play dates for your child and help model proper 1st grade skills.
  • Join a community playgroup/social group at a local clinic, park district or religious organization.
  • If you suspect something is still off about his social skills, get him evaluated and he can practice his skills with the right support.
  • Make sure to keep your child engaged and talkative with you so you can help him through the tough and great times of 1st grade.

Good luck!

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How to Determine if a Child Has Executive Functioning Difficulties | Pediatric Therapy Tv

In today’s Webisode, a pediatric neuropsychologist explains ways to tell if a child struggles with executive functioning.  Click here to download a FREE checklist on Executive Functioning Signs by age!

In this video you will learn:

  • What factors the child struggles with daily
  • How executive functioning issues start at home
  • What a child needs help with when they suffer from executive functioning

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now, your host, here’s

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman, and today I’m sitting here with Dr. Greg Stasi, a Pediatric
Neuropsychologist. Doctor, can you give us some tips on how to identify if
a child needs help with executive functioning?

Dr. Greg: Of course. When we talk about executive functioning, we’re
talking about a child who struggles with organization, initiation on tasks,
problem solving, cognitive flexibility. This is a child where the morning
routine is going to be extremely difficult. They can’t follow through on
tasks. The parent has to follow through constantly to get them out the door
in the morning. It’s a child who starts projects at the last minute,
Sunday evening, when a project is due Monday morning. If we’re seeing the
child not be able to develop strategies on how to complete homework
assignments and if the child gets frustrated easily, those are all symptoms
and characteristics of what we’d expect in a child with an executive
functioning issue.

Robyn: All right. Well, thank you so much, and thank you to our viewers.
And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind
to your family with the best in educational programming. To subscribe to
our broadcast, read our blogs, or learn more, visit our website at That’s

What is the Difference Between Aspergers and Autism? | Pediatric Therapy Tv

In today’s Webisode, a pediatric neuropsychologist explains the difference between Aspergers and Autism.

In this video you will learn:

  • What are common symptoms of Aspergers and Autism
  • The main difference between Aspergers and Autism
  • What group Aspergers and Autism belong to

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn

Today I’m standing here with Dr. Greg Stasi, a pediatric
neuropsychologist. Greg, can you explain to our viewers what the
difference is between Aspergers and autism?

Greg: Sure. Aspergers and autism are both considered to be along the autism
spectrum. These are disorders with significant impairment in a
child’s social functioning, rigidity, and issues with
preoccupation or fixation on certain objects.

The main differential in a diagnostic formulation between autism
and Aspergers is that with Aspergers we have a child who has
normal language development, whereas in autism we have a child
who has significant impairments in their language development.

Robyn: Thank you so much for that explanation, and thank you to our
viewers for watching. And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of
mind to your family with the best in educational programming. To
subscribe to our broadcast, read our blogs, or learn more, visit
our website at That’s

Oppositional Defiant Disorder

Behavior problems in children are nothing new. Many children present with concerns regarding oppositional and defiant behavior. In fact, studies have indicated that the highest rates of referral for mental health services for children involve aggression, acting-out, and disruptive behavior patterns (Achenbach & Howell, 1993). Oppositional Defiant DisorderAggressive child (ODD) is a diagnostic condition that focuses on a pattern of negative, hostile, and defiant behaviors lasting at least six months. The Diagnostic Statistical Manual, Fourth Edition, Text Revised (American Psychiatric Association, 2000) indicates that four or more of the following behaviors must be present in the child to make the diagnosis: often loses temper, often argues with adults, often actively defies or refuses to comply with adult’s requests, often deliberately annoys others, often blames others for his or her own mistakes or misbehaviors, is often touchy or easily annoyed by others, is often angry or resentful, and/or is often spiteful or vindictive.

ODD is believed to be a fairly common disorder in children.  The condition is thought to occur in 5-16% of children under 18 years old (Burke, 2002). The majority of children who exhibit ODD show signs of behavioral dyscontrol prior to their ninth birthday. The condition is more common in boys than girls before puberty; however, it is thought that the rates are equivalent for children after puberty. Boys are more likely to engage in ‘direct aggression,’ in which the child actively engages in verbal or physical aggression towards another child. Girls, by contrast, are more likely to engage in ‘indirect aggression,’ in which third parties are used to get even (e.g. spreading rumors) (Hinshaw & Anderson, 1996). ODD is thought to highly co-exist with other mental health conditions including ADHD, Mood Disorders, and Learning Disorders. Thus, a comprehensive evaluation is often warranted for children who exhibit behavioral problems in order to ensure that the most appropriate intervention is applied.

The treatment of ODD focuses on behavior management. Behavioral therapy focuses on working not only with the child who exhibits the behavioral concerns, but also with parents and teachers, to help create appropriate behavioral reinforcement schedules across all environments. In addition, pharmacological intervention might be implemented for children who demonstrate co-existing ADHD, or academic tutoring might be in place for those with significant learning disorders.

In summary, ODD is a fairly common disorder of behavioral dysregulation in childhood. It is a condition that often presents simultaneously with other conditions, and as a result a comprehensive evaluation is often recommended to determine whether or not the child also has these conditions. Additionally, the treatment of choice is behavioral therapy, in which a therapist works with the child, parents, and teachers to discuss methods of increasing the frequency of positive behaviors while extinguishing the negative oppositional and defiant behaviors.

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Where To Go If Your Child Has Been Misdiagnosed

Parents come to professionals in order to ascertain what is going on with their child.  As a neuropsychologist, the two most common questions I hearmother upset with child are:What is wrong with my child? And How do I fix it?  

A diagnosis will help clarify the symptom characteristics that the child exhibits which in turn will lead to developing the most effective interventions and accommodations for that child within the home, school, and private clinic settings.

Many times parents question the appropriateness of a diagnosis that was given to their child.  It is important to understand that there are several factors that can lead a clinician towards an inappropriate diagnosis or a diagnosis that is not the best fitting based upon the child’s symptom characteristics.

How Assessments Are Conducted:

An evaluation constitutes several hours out of one day of your child’s life.  Many factors impact the child’s performance during the testing, including;

  • Lack of appropriate sleep the night before
  • Being hungry during the evaluation
  • Anxiety over the testing situation

How many of those factors contributed to the diagnosis that was handed to the child?  Second, did the diagnostician receive or ascertain all appropriate information.  Did that individual receive information from the school, past medical records, detailed information regarding the child’s early development?  You are your child’s best advocate.  As much as any diagnostician may know about the responses on the testing, the response to the testing as well as explanations for the testing has to gel with you.  If you are uncomfortable with a diagnosis, ask questions.  Explain to the diagnostician that the behaviors that were observed are not consistent with what is observed on a daily basis.  Work as a team to figure out what lead to the discrepancy between actual behavior and observed behavior/test scores.

If you do not feel that your questions were answered with a diagnosis or are hesitant to follow through with the interventions that were offered, it is then recommended to seek a second opinion.  Oftentimes a second set of eyes, even in the form of reviewing the report/test performance can help solidify the diagnosis that was given or help establish what additional testing/information would be needed.


Why Does My Child Need a Diagnosis?

-“I don’t want to label my child.”

-“Teachers are biased against diagnosed children.”

-“My son doesn’t act like most kids with _________ (particular diagnosis).”


These are statements that I hear on a routine basis, and they are all valid points. Any diagnosis that a child or adolescent may have carries a certain stigma to it. This is human nature. As a neuropsychologist, one of my biggest tasks is to develop the most appropriate and effective diagnosis for any child. My goal with writing this blog is to help identify the importance of an appropriate diagnosis.

How A Diagnosis Can Help Your Child:

First and foremost, an appropriate diagnosis will help explain and answer the “why” questions. Why does my child continue to struggle to read? Why is it impossible for my child to sit still? Why is it that my child cannot make friends? Once we identify the “whys,” we are on our way to solving the problems.  An appropriate diagnosis is intended to help develop the most effective means of intervention. If I diagnosis a child with Dyslexia, I know that traditional teaching of reading and phonics wouldn’t do much good. I would know instead to utilize an empirical approach consistent with the disorder at hand. Read more