The Executive Brain: Support Strategies For Autism Spectrum Disorder And ADHD

Editor's note: This text-based course is a transcript of the webinar, The Executive Brain: Support Strategies for Autism Spectrum Disorder and ADHD, presented by Cara Koscinski, OTD, OTR/L, CAS.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

After this course, participants will be able to:

• Analyze the relationship between interoceptive awareness, nervous system state, and executive function access, using the Executive Function Express model to determine when executive demands exceed regulatory capacity.
• Differentiate between neurological up regulation and down regulation states and differentiate the use of Move the Train to Build the Brain movement strategies to support executive readiness across varying states.
• Analyze executive function challenges through a strengths based, neurodiversity affirming lens, distinguishing state based access needs from behavior based interpretations in order to design supportive, capacity building interventions.

Introduction

I am so glad to be back with all of you, and I have to tell you, this topic means a great deal to me. As an occupational therapist with almost 30 years of clinical experience, and as a parent of two adult autistic sons, I have lived this material from both sides of the table. I want you to think about one student or patient you have struggled with, someone whose behavior referral just did not resolve, no matter how many strategies you tried. Keep that person in mind as we go, because by the end of this course, I hope you will have a new way to understand what is going on for them, and a plan you can put into practice starting tomorrow.

I know many of you are seeing a flood of behavior referrals right now. I own one of the large pediatric occupational therapy groups on Facebook, and I read the questions our members post every single day. We are not behavior therapists, yet we are constantly asked to fix behavior. Most of us have already tried behavior charts and executive function supports, the planners, the checklists, the reward systems, and often none of it sticks. Today I want to offer a different lens, one that starts in the body rather than on paper. This shift has shaped my own clinical practice for years, and I believe it will change how you understand every child on your caseload who struggles with attention, initiation, or follow-through.

I also want to name something before we go further. None of what I am about to say is a judgment of anyone who has used behavior charts, planners, or reward systems. We are all doing the best we can with the training we were given, and so are the educators and parents we work alongside. The goal today is not to feel guilty about strategies that have not worked. It is to understand why they have not worked, so that we can choose differently going forward.

What Actually Builds Executive Function

Here is a question I like to open with. If you had thirty minutes to support a preschooler's executive function, would you choose a pencil or a jump rope? Almost everyone, when they really think about it, chooses the jump rope. That instinct is correct and backed by research. Executive function is not built on paper. It is built through movement and embodied experience.

Think about which child is building stronger foundational executive function skills: the one completing a behavior chart, or the one navigating an obstacle course. I am not a fan of behavior charts, and I want to be clear that this is not a judgment on anyone who uses them. We are all doing our best with the tools we were taught. But when a child struggles with organization or focus, our first instinct is often to hand them a planner or a checklist. If the brain and body are not working together efficiently, those tools only address the surface. They do not touch the source.

Before a child can plan anything, they need to be able to attend, regulate, and sequence, and those capacities are built through motor play, not worksheets. Once we understand this, an entire category of "the strategy stopped working after a few weeks" cases starts to make sense. We were never addressing the body in the first place.

What We Often Call "Behavior"

Let's talk honestly about what gets reported to us. Look at the language on your referrals: not paying attention, impulsive, won't start work, easily distracted, has emotional outbursts, and doesn't follow directions. This is what gets seen, because behavior is the most visible part of a much larger system.

Then look at how that behavior tends to get interpreted. Doesn't care. Lack of discipline. Lack of motivation. Noncompliance. Choosing not to try. I have heard every one of those said about my own children, especially my younger son, who has significant support needs. He has been called negative things by educators and therapists who meant well but were only looking at the surface. He is not lacking will. He is lacking access to a skill, and if he had the skill available to him in that moment, he would already be using it.

When we focus only on behavior, three things happen. We address what we can see rather than what is driving it. We assume the skill is available in the moment, when it may not be. And we respond by increasing prompts, consequences, and expectations, which usually makes things worse. What gets missed is the nervous system state, interoceptive access, regulation, and readiness, and the mismatch between what we are demanding and what the child can actually deliver right now. When we stay at the level of behavior, we work harder without working more effectively, because we are not touching what is actually limiting access.

This is the shift I want you to make today. The old lens asks, "How do we change this behavior?" It focuses on compliance and performance, assuming the skill is available. It responds with prompts and consequences. The new lens asks, "What is happening in the system?" It focuses on state, access, and capacity. It supports the system and lets skills emerge. It matches support to what the child actually needs in that moment.

Behavior is only what we can see. It is information, not the starting point. The system underneath is what we have to understand if we want to know what is driving behavior, gauge readiness, and figure out what to do next. That is exactly what the model I am about to walk you through is designed to do.

The Roots to Fruit Tree Model

I developed the Roots to Fruit model, an integrated interoception tree, based on years of clinical practice, my doctoral capstone research, and studies of child development. I want you to picture a child as a tree.

Think about how a tree grows. We plant a seed, and its roots begin to develop underground long before we see anything above the surface. In utero, a baby's senses, tactile, proprioceptive, auditory, visual, vestibular, olfactory, and gustatory, are already coming online at different points in development. Some, like vision, will keep refining with use well after birth. The ground the tree sits in represents nature, nurture, the environment, and co-regulation. Predictability and safety matter enormously here. Evidence on early intervention and neonatal care indicates that skin-to-skin contact and a responsive caregiver lay the foundation for healthy attachment. When that ground is nourished, access begins to take root.

Interoception is the trunk, the thickest and most central part of the tree. I want to be clear that this model is meant purely for visualization, not as a replacement for other interoception frameworks. But I want it used widely, because it shows how central interoception really is. It is not simply an eighth sense. It bridges safety and sensation to meaning in a child's life, and once you see it that way, you understand why it matters so much for executive function.

The canopy is where executive function lives. This is regulation, the ability to be alert or calm and to act accordingly. It is also a sense of self and identity, and participation in everyday activities where children thrive, play, and learn. Many kids who struggle with executive function access are also bullied, because on some level, they know there is something happening that makes certain tasks harder for them than for their peers. That awareness can chip away at self-esteem and increase anxiety, and that in turn affects the whole system.

Behavior is the fruit. I remember sitting in a business conference once and hearing someone talk about "low-hanging fruit," meaning the easiest, most visible thing to go after first. That is exactly what behavior is for us clinically. It is bright, attention-grabbing, and easy to respond to, like a dollar bin at the front of a store that pulls you in. It is the thing we are trained to notice and to think we can fix.

So when a child is not participating or cannot complete a task, we tend to say they have attention, planning, or organization issues, and we treat those as fixed, available, or not available. But executive function is not a yes-or-no switch. Access depends on emotion, mood, and state of being, and it is not consistently available. That inconsistency is exactly why kids seem to succeed one day and struggle the next with the identical task. It is an access issue, not a character issue.

When we treat executive function purely as a thinking skill, we teach it, prompt it, and expect performance, and in doing so, we are only touching the canopy. If the leaves of a tree are wilting and the fruit is rotting, you do not fix the canopy. You water the roots. Thinking is only available when the roots and trunk are supported. This is the foundation for everything else in this course.

The Executive Function Express: A Train Model

Understanding the tree model gives us clarity, but understanding alone does not change a child's state in the moment. It does not build access on its own, nor does it tell us what to do next. We need a way to support the system in real time, and that is what the Executive Function Express gives us.

Picture the child as a train. The engine represents the nervous system state, or regulation. When the engine is fueled and running at the right speed, the child can be flexible, responsive, and able to sustain attention and regulate emotion. A fueled, regulated train can transition more smoothly, recover from setbacks more quickly, and actually use the strategies we have taught.

The tracks represent the environment and the supports we put in place: routines and schedules, visual supports, task structure, clear expectations, environmental setup around noise and space, demand, and adult support through co-regulation. The core idea of this model is simple. We do not push the train. We support the system that moves it.

Fuel matters too. What motivates the child? Have their basic needs been met: water, sleep, and use of the restroom? A child's interests should be built into therapy as genuine motivation, not simply offered as a reward for compliance, because when we ask a child to work on something that is hard for them, they need real motivation to sustain the effort, the same way adults need motivation to keep a New Year's resolution going.

Periods of high fuel use are the difficult or unfamiliar tasks, the ones that take the train uphill. During those periods, energy depletes faster, and access to executive function drops. That is when the train needs a trip to the station.

The station represents interoceptive support. The brain is built for survival and craves efficiency. It will use whatever strategy is quickest to keep the system going, which is part of why habits are so hard to change. When a train's engine is worn out, it needs a station for repair: a drink of water, a trip to the restroom, a calm-down space. Until the system reaches a felt sense of safety, we cannot expect access to higher-level thinking. What looks like behavior is often the system trying to survive.

Bridges and tunnels are the scaffolds and supports that stay in place even after a child is performing well. If a train travels smoothly because of a bridge or tunnel, we do not remove that structure once performance improves. The same is true clinically. Some supports are meant to last a lifetime, the way many of us depend permanently on a planner or a calendar app. That dependency is not a failure. It simply reflects how brains conserve energy.

Understand the System, Then Support the System

Putting the two models together gives us a workflow. The Roots to Fruit tree helps us understand the system: what is happening underneath, where the breakdown is occurring, and why the behavior is showing up. The Executive Function Express helps us support the system: what the child needs right now, how to respond in real time, and how to build access before we expect performance.

Here is how I want you to apply this with a real student. Think of a child who is not starting work, appears disengaged, and needs frequent prompting. Using the tree, the fruit is "not starting." The canopy is the executive skill affected, which here is task initiation. The trunk shows low interoceptive awareness or activation. The roots reflect an underactivated system.

Then move to the train. The engine needs activation, so the support is a brief, alerting movement break. The tracks need a clear starting point, reduced task size, and a guided start. When we apply this, tasks begin more consistently, engagement increases, and the need for prompting decreases.

Section 2: State Determines Access

Let's slow down and talk about what "state" actually means, because I do not want it confused with personality. Regulation is not the same thing as being calm. Regulation is the ability to flexibly modulate behavior, cognition, emotion, and physiological state in response to environmental demands (Khalsa et al., 2023). We can be regulated while excited watching a football game, and we can be regulated while calm at our desk. Regulation is not stillness. It is flexibility.

The autonomic nervous system coordinates heart rate, respiration, smooth muscle activity, pupil dilation, and organ function through a dynamic interaction between sympathetic activation, which mobilizes us, and parasympathetic influence, which restores us (Chen et al., 2024; Uddin, 2023). Healthy regulation depends on the ability to shift flexibly between these two systems rather than getting locked into either. It ebbs and flows throughout the day, like a wave.

Nervous system state is the body's level of activation at a given moment, how ready the system is to engage. It is shaped by environment, demand, sensory input, and internal signals, and it determines attention, regulation, and the ability to think and respond. I like to use the images of the alligator brain and the eagle brain here. When we feel threatened or overwhelmed, we chomp, react, and survive. That is alligator brain, and it includes fight, flight, freeze, and fawn responses. When we are soaring, meeting goals, and thinking clearly, that is eagle brain, the higher-level access that lives in the prefrontal cortex.

Dan Siegel's hand model of the brain captures this well. When something threatens us, we can flip our lid, moving from higher-level thinking to a reactive, survival state. If I told you there was a snake in the room right now and you were afraid of snakes, you would stop listening to anything else I said. You would have flipped your lid into alligator brain, and no amount of executive function coaching would reach you in that moment.

State is always shifting to meet changing demands. Think about driving to work exhausted with your radio turned all the way up just to stay alert, then driving home at the end of a long day with the radio blaring because your system has shifted so much over the course of the day. Same person, same radio, completely different state.

When a child's system is supported and regulated, access opens up. Attention, thinking, and responding become available. When the system is not supported, thinking is simply not available, no matter how many times we ask for it. This inconsistency is not a character flaw. It is the nature of access. The same child, with the same skill, can look completely different on any given day.

Overactivation and Underactivation

When the nervous system is too high, the body moves fast, the brain prioritizes safety, and access to higher-level thinking drops. You might see fast movements, a loud voice, big emotional reactions, difficulty slowing down, and being easily overwhelmed. In terms of executive function, inhibition drops, so the child struggles to pause or stop. Attention narrows or scatters. Flexibility disappears, and emotional regulation becomes intense and reactive. This shows up as blurting out, interrupting, difficulty waiting, and quick escalation. Executive function is not absent here. It is inaccessible because the child has dropped from the eagle brain to the alligator brain.

When the nervous system is too low, the body is slow and underfueled. You might see low energy, slow movements, limited response, and what appears to be disengagement, though it is not disinterest. In terms of executive function, initiation drops, and this is often the first clinical breakdown we notice. Attention drifts, working memory falters, and persistence fades quickly. This shows up as not starting tasks, appearing unmotivated, slow responses, incomplete work, and a need for repeated prompting. Again, executive function is not absent. It is not yet activated. The child is not refusing. Their system simply does not have enough energy online to engage.

This reframing matters enormously for how we talk about specific behaviors. Not starting a task is not a refusal; it is a state issue. Difficulty with transitions does not reveal who a child is; it reveals what they can access in that moment. As the parent of two autistic sons, transitions have been a lifelong challenge in our house, and I can tell you it has never once been about defiance. Impulsivity is not a lack of discipline; it reflects overactivation and a decreased ability to pause and think because the nervous system is in a fast, reactive mode. Disengagement is not a lack of understanding; it often reflects underactivation, where the interest may genuinely be there, but the system lacks the energy to access it.

Interoception Changes With State

Interoception, our ability to notice and interpret internal body signals, is not constant. It shifts along with state. When everything feels equally intense, a child cannot connect a sensation to its meaning, and without that connection, the brain cannot adjust, regulate, or respond effectively. What we see on the outside is often big reactions without a clear apparent cause, difficulty identifying needs, and behavior that looks unpredictable. The child is not missing the information. They are missing access to that information in the moment.

This has real implications for how we approach interoception work. We should not simply ask a child to memorize or label emotions from a worksheet. That builds recall, not access. Instead, check in at the start of sessions. Ask how their body feels right now. Practice a breath together and notice what changes. Building this kind of felt, moment-to-moment awareness is what actually strengthens the connection between sensation and action, which is the real work of interoception.

If State Limits Access, Movement Changes State

If everything we have discussed hinges on state, the natural next question is: what changes state? Movement is the single biggest lever we have, and the research strongly supports this. Movement directly shifts nervous system activation, improves access to body signals, and prepares the system for executive function. When we support a child's engine through movement, their state shifts; when state shifts, access opens; and when access opens, performance follows. We are not pushing through a difficult state. We are changing it.

Section 3: Movement Is the Mechanism

The brain does not operate in isolation from the body. Thinking is shaped by body state, sensory input, and movement, which means executive function is grounded in the body rather than separate from it. We do not build thinking apart from the body. We build it through the body.

This idea is not new. Embodied cognition has been around for a long time and shows up frequently in everyday language. We say something is "as heavy as a stone," borrowing a physical experience to describe an abstract feeling. These idioms reflect just how tightly our thinking is bound up with our bodies, which is also part of why literal thinkers, including many autistic individuals, may find idioms confusing rather than intuitive.

In embodied cognition terms, movement changes state, state changes access, and access changes thinking (Chen et al., 2021; Glenberg & Hayes, 2023). When the body changes, thinking changes.

Unfortunately, movement is widely misunderstood in educational settings. It is treated as a break rather than part of learning, something to be earned rather than something built in. It is interpreted as distraction or avoidance rather than as a regulation tool, and it assumes skills are always accessible when they clearly are not. Our systems tend to prioritize stillness over regulation, and adults are trained to respond to what they can see: sitting still, being quiet, following directions. So when a child moves, it is often read as distraction or noncompliance rather than as a system trying to regulate itself.

The clinical shift I want you to make is this. Movement is a regulation tool, not a reward. It changes state, and state determines access to executive function. It should be used proactively, not reactively, and matched to whether the system is over- or underactivated. It supports the tree's roots and trunk, which in turn enable the canopy to function. A break implies that learning has stopped, but for many children, movement is precisely what makes learning possible in the first place. Removing movement can actually reduce access to executive function rather than protect instructional time.

Instead of saying, "Finish your work, then you can move," try, "Let's support your system so you can do the work." That single reframe changes the entire relationship between movement and learning.

How Specific Types of Movement Support Executive Function

Research on movement and executive function is expanding rapidly, and several areas are worth knowing well.

Rhythmic, patterned movement, such as marching or drumming, helps children calm their nervous systems and build inhibitory control and emotional regulation (Chen et al., 2021; Zhao et al., 2022).

Purposeful play and motor planning, structured and playful activities with a clear sequence, build goal setting and problem solving by strengthening sequencing, planning, and multi-step execution (Chen et al., 2021; Zhao et al., 2022; Glenberg & Hayes, 2023).

Core and postural movement supports working memory and attention. Strengthening stability and balance helps children sustain attention and hold information while performing a task. I want you to try this yourself. Lean back in your chair right now, and notice how much more tired you feel almost immediately. Now sit up straight, feet flat on the floor, and notice the difference in your breathing and your alertness. Posture is not a small detail. It changes oxygen flow to the brain and directly affects access.

Cross-lateral and bilateral movement supports cognitive flexibility. Crossing midline activates communication between the brain's hemispheres, which supports flexible thinking, task switching, and adaptation to change.

Movement is not extra, and it is not optional. It changes nervous system state, builds access to interoception, and prepares the system for executive function. It supports the roots by strengthening sensory and regulatory foundations and building body awareness. It supports the trunk by helping a child notice heart rate, posture, and breathing, the building blocks of interoceptive awareness. And because the roots and trunk are supported, the canopy, executive function itself, can finally bloom. That is the whole chain: movement supports the roots, the roots support the trunk, and the trunk supports the canopy.

One Strategy Does Not Fit All

The same strategy will not work for every child, and it will not work for the same child in every moment, because state is constantly shifting and needs vary by time of day, task, and setting. A useful sequence to walk through is this: notice what you see (not starting, impulsive, disengaged, escalating), identify the likely state (overactivated or underactivated), check whether access is currently available, determine what the system needs (calming and organizing if too high, activating and engaging if too low), apply a matched movement strategy, and reassess whether access has improved. We are not searching for the one right strategy. We are searching for the right match at this moment for this child and adjusting in real time.

This is also where neurodiversity affirming practice becomes concrete rather than theoretical. Meeting a child where they are, rather than forcing them toward a fixed idea of what "regulated" or "on task" should look like, is the practical application of that value. When we stop trying to force every child into the same "just right" state and instead look at their actual access in the moment, we stop pathologizing normal human variability and start building support that fits the individual in front of us. That shift respects the child's strengths and their differences at the same time, and it tends to produce far more durable change than compliance-based approaches ever did.

Strategies for an Overactivated System

When the system is too high, the goal is to help it organize and calm. Slow, rhythmic input works well here: rocking at a steady pace, walking or marching rhythmically, bouncing a ball to a consistent beat, clapping or tapping patterns, and slow, repetitive, heavy work. This kind of input helps the nervous system slow down, follow a predictable pattern, and feel safer.

Deep pressure and heavy work are also valuable. This means proprioceptive input to the muscles and joints through pushing, pulling, lifting, or applying pressure. Carrying or pushing objects, wall pushes, animal walks, resistance band work, squeezing or compression input, and weighted or resistive activities all fit here. Deep pressure and heavy work can help regulate an overactivated system and, notably, help an underactivated system build body awareness, making this category useful in both directions.

Grounding brings the whole system back to a manageable, stable state when a child feels overwhelmed or reactive. Deep pressure, slow rhythmic movement, reducing sensory input, and connecting to the body through feet, hands, or breath all support grounding. When grounding works, we see a slower, more regulated state, an increased sense of control and safety, and improved access to thinking and response.

Strategies for an Underactivated System

When the system is too low, it needs energy, alertness, and increased activation. Fast, dynamic movement helps here, along with vestibular input like spinning, swinging, or jumping, plus novelty and variation, and quick, engaging activities. Novelty is something new, different, or unexpected, and engagement is something that captures attention and interest. The brain pays attention to what is new, which is why novelty helps "wake up" an underactivated system, while engagement helps the child connect emotionally to the activity. Together, novelty and engagement bring the system back online.

In practice, this might mean changing a worksheet into a whiteboard activity, turning a task into a "beat the timer" game, moving the work to a different space like the floor or a standing desk, or adding an unexpected twist like doing the task in reverse order. You might say, instead of simply asking a child to start, "Let's do three jumping jacks, then write the first answer on the board." Small, playful shifts like this activate the system before asking for performance.

A Real Life Example: Supporting a Child Who Will Not Start

Picture a child sitting at her desk, not starting the assigned work, appearing disengaged while the teacher repeats prompts. The instinct is usually to add more directions, more physical prompts, more pressure to "just start." That approach produces very little change because it does not address the actual barrier.

If we recognize this as an underactivated state, the support looks different. A brief, fast movement break, like jumping or a short obstacle course, paired with novelty and engagement, brings the system online. What changes are significant: the child begins the task, attention improves, less prompting is required, and independence increases over time.

You can fade this support gradually. At first, you may need to provide the movement break in full and directly. Over time, the goal is for the child to recognize on their own that this is what their body needs before a difficult task, essentially learning to read their own engine and request or initiate the support themselves.

Preparing the Tracks Before the Task

Even a well-regulated engine needs tracks to run on. Preparing the tracks means setting up the environment for success: a clear starting point, visual supports, a structured task with the work broken into steps, reduced distractions, and predictable routines. Visual supports in particular are a well-documented strength-based approach for autistic learners, though it is important to get to know each individual and confirm what actually works best for them rather than assuming one approach fits everyone.

When the engine is supported, and the tracks are prepared, we see increased access to executive function, improved engagement and independence, and more consistent performance. State plus structure leads to access, and access leads to performance.

Section 4: From Behavior to Capacity

Behavior-based approaches fall short because they focus on what we can observe: compliance and performance, controlled from the outside through rewards and consequences. What gets missed is nervous system state, interoceptive access, regulation and readiness, and the mismatch between demand and capacity. When we ignore all of that, strategies work inconsistently, behavior escalates or shuts down, skills fail to generalize, and the child ends up seen as the problem.

I want to be honest about external control here. We do need some structure, and laws and expectations have their place. But when we lean too heavily on hand-over-hand correction, forced compliance, and labeling a child as "the problem," we are missing their nervous system needs and their actual capacity in that moment. Over time, that approach tends to hurt more than it helps.

The real shift is moving our attention from behavior to capacity. Capacity is the ability to use a skill in real time, and it is influenced by nervous system state, interoceptive access, environmental support (the tracks), and task demand. Capacity is not fixed. It changes moment to moment. A child may have a skill and simply not have access to it right now. Having a skill is not the same as being able to use it.

Understanding Demand and Capacity

Demand is what a task is asking of the child: the cognitive, physical, and emotional load involved. This includes executive function elements like initiation, attention, and planning; regulation elements like staying engaged and managing emotion; sensory processing; and environmental expectations. Demand can exceed capacity in any given moment, and when it does, access breaks down. The real clinical question is not simply what a child can do in general. It is whether the demand in front of them right now matches their capacity.

I like to use a seesaw as a visual for this. When demand and capacity are balanced, we see growth, and the child can engage in higher-level thinking and build new skills. When demand outweighs capacity, we get overwhelm, often triggered by fatigue, hunger, thirst, or simply being close to a transition like lunchtime. When capacity outweighs demand, we sometimes see boredom, low effort, or a child who has actually shut down or gone into freeze because the environment is overstimulating in a different way. Either mismatch, in either direction, disrupts performance.

Reframing a challenge as a mismatch between demand and capacity, rather than as a motivation or character problem, changes how we talk to families and educators. Instead of saying a child is choosing not to try, we can say the current demand does not match their current capacity, and that difference is not a character flaw. It is information we can act on.

This reframe also changes how we write goals and document progress. Rather than listing a long inventory of executive function deficits that feels overwhelming to address, ask what the actual barrier is in the specific moment a breakdown occurs. Is this happening right before lunch, during a transition, or during a particular type of task? Gathering that context lets you target the real access point rather than trying to treat 15 skills at once. It also provides language that meets documentation requirements while remaining accurate to what is really happening. Instead of writing that a child lacks organization or motivation, you can write that access to task initiation is reduced due to an underactivated nervous system state, and that the intervention plan addresses state and environmental support before expecting independent performance. That kind of language holds up clinically, and it reflects what is actually occurring in the child's system.

Case Study: Ethan

Let me walk you through a case that will likely feel familiar. Ethan is a nine-year-old student with diagnoses of ADHD and autism. His teacher describes him as bright, capable, and verbally expressive. Reported concerns include difficulty starting independent work, incomplete assignments, appearing disengaged during tasks, and inconsistent participation. As his teacher put it, "He just won't start. I am sure he knows what to do."

At home, his parents report long delays before beginning homework, frequent prompting, and frustration or shutdown when tasks feel too hard. Interestingly, he does well at school but "acts up" at home, which makes sense once you consider that home is where children often feel safe enough to let their guard and their regulation down.

Under the older behavior lens, Ethan gets described as unmotivated, avoidant, oppositional, or choosing not to try. The strategies typically attempted, repeated verbal prompts, reward systems, and increased expectations for independence, have had limited success. That lack of progress is itself useful data. If a strategy has not worked repeatedly, it is a signal to change our thinking rather than repeat the same approach with more intensity.

Working through this with the model looks like a sequence of steps.

First, what is the demand? Many of the tasks that trigger difficulty for Ethan require initiation, sustained attention, working memory, organization, and frustration tolerance. These are all high executive function demand tasks, even though they might look like simple homework.

Second, what is Ethan's state? Observations during work time show him to be slow to begin, low energy, and to stare or look away, with minimal verbal engagement. This pattern suggests underactivation.

Third, is access available? Executive function depends on the state of the system, and at this moment, Ethan cannot reliably access the skills required for the task. This is not about what he knows. It is about what he can use right now.

Fourth, what support is needed? Rather than increasing demand, the plan is to support state first, reduce immediate task pressure, and build access before expecting performance.

The clinical reframe follows naturally from this process: Ethan is not refusing to start. He is currently unable to initiate in his current state.

Using the Roots to Fruit model, we look at each layer. At the roots, the sensory and regulation foundation, the system needs activation, so we add fast movement and novelty to build energy and readiness. At the trunk, interoception, his internal signals may be muted or not currently driving action, so movement is used again here to help bring those signals back online and improve access to internal cues. At the canopy, executive function and initiation are not yet accessible, so the task itself is reduced to a first step with a clear, doable starting point, making it approachable once access improves.

Additional support layers on top of this foundation. State support before the task might include brief, structured movement like jumping or wall push-ups, using fast, alerting input to increase activation. Task modification includes reducing the initial task size, providing a clear starting point, and using a visual or verbal cue to begin. Bridges make the path clear by reducing distractions and creating a predictable start routine. Tunnels support the child through the hardest part of a task, beginning with a co-regulated start and staying present as the child begins, then gradually fading that support as access improves. Stations provide interoceptive check-ins, pausing to notice body signals and connect sensation to what is needed, using simple prompts like "How does your body feel right now?" before or during a task.

After these supports are implemented, children like Ethan typically begin tasks more consistently, need fewer prompts, show increased engagement, and complete more of their assigned work. We are not simply expecting independence. We are building it.

I want to point out something important about Ethan's case that applies far beyond this one example. Before we shifted the lens, every strategy tried, repeated prompting, rewards, and raised expectations, was aimed at the fruit. None of it addressed the roots or the trunk, so none of it produced lasting change. Nothing about Ethan changed when we shifted our thinking. What changed was how we understood his situation, and that understanding is what led us to a completely different, and far more effective, kind of support. This is the same pattern you will see over and over with your own students once you start looking for it: a child whose "won't" is actually a "can't access right now," and a caseload of strategies that were all aimed at the wrong layer of the tree.

Key Teaching Point

The skill was present. The access was not. If we stay in a behavioral lens, we respond by increasing prompting, increasing consequences, or labeling the behavior as avoidance. If we shift to a capacity lens instead, we support state, adjust demand, and build access. When we change what we see, we change what we do, and that changes what the child is able to access.

Conclusion

Let's tie this back to where we started. The goal of this course has been to help you analyze the relationship between interoceptive awareness, nervous system state, and executive function access, using the Executive Function Express model to determine when demand exceeds capacity. We spent real time on the difference between upregulation and downregulation, and on matching movement strategies, from rhythmic input and deep pressure to fast, novel movement, to whatever state a child is actually in, rather than the state we wish they were in. And throughout, I have asked you to look at executive function challenges through a strengths-based, neurodiversity affirming lens that separates state-based access needs from behavior-based interpretations, so that the interventions you design build capacity rather than simply demanding compliance.

Behavior is what we see. It is not where the problem starts. When we look underneath, at the roots, trunk, and canopy of the tree, and at the engine and tracks of the train, we stop asking "How do I fix this behavior?" and start asking "What does this system need right now?" That single shift in question changes everything downstream: how we write goals, how we talk to families and educators, and how consistently our interventions actually work.

We are not fixing behavior. We are building access. When access improves, performance follows, and that is true for every child on your caseload, regardless of diagnosis. I encourage you to pick just one student, the one you thought of at the beginning of this course, and try shifting your lens with them this week. Notice their state before you address their skill. You do not need to change your entire caseload overnight. Start with one child, one small shift, and let the results build your confidence from there. You have the clinical skills already. You just needed a new way to see what was happening beneath the surface.

References

See additional handout.