About the Executive Function Clinic

The EXCEL Clinic (Executive Function Consultation, Education and Skills Clinic) within CHOP’s Cancer Center provides services for children and adolescents who are at risk for executive function (EF) weakness.

Executive functions are a group of cognitive skills that guide how we complete daily tasks in efficient and effective ways. Children at particular risk for weak EF skills include those who have been diagnosed with, or treated for, brain tumors, leukemia/lymphoma, neurofibromatosis type 1 and other cancer conditions. In these cases, either the cancer or the treatment may have impacted the child's executive functions.

The EXCEL Clinic primarily supports children who have undergone cranial surgery, cranial radiation, intrathecal chemotherapy, intensive cancer treatment at a young age, or who have a cancer predisposition syndrome.

How EF skills work

Executive functions are essentially the brain’s “how” skills — how a child thinks and performs tasks. These skills include attention, initiation, inhibition, working memory, processing speed, planning, organization, flexibility, self-monitoring and time management.

When EF skills are working properly, they allow a child to perform these functions:

  • Attention: Focus on the most important information and ignore the rest.
  • Initiation: Independently get started on something; motivation and planning are required.
  • Inhibition: “Stop and think” before making a decision. Act, rather than react impulsively.
  • Working memory: Keep information actively “on line” and use it to guide actions.
  • Processing speed: Quickly and efficiently take in information and respond with similar efficiency.
  • Planning: Create a logical set of action steps to accomplish a task. The planning skill includes both conceiving and managing the goal and materials needed to accomplish the goal.
  • Organization: Keep track of ideas, action plans and materials.
  • Flexibility: Adjust to expected and unexpected changes.
  • Self-monitoring: Evaluate personal effectiveness. Recognize what is going well and what needs to change.
  • Time management: Accurately estimate how long a task will take.
  • Emotional control: Manage emotions competently. Express an emotional response based on what is socially acceptable in a specific circumstance.

When “how” skills aren’t in sync with “what” skills — as in what a child knows — the result can be multiple challenges at home, in school and in the community. These challenges often become most obvious with increased demands placed on a child, such as when he or she enters a new grade or takes on more responsibilities or independence. We understand how incredibly stressful this can be for everyone in the family and we are here to help. The EXCEL Clinic will help you devise and implement solutions to manage these struggles.

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What to Expect

You and your child or adolescent will meet with a pediatric neuropsychologist for approximately one hour. 

Teenage boy smiling

Executive Function Interventions

These interventions aim to create new habits that can sidestep or override a child’s cognitive challenges.