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Executive functioning SLP’s Will Want To Know About This!

Cindy A. Young, MSE, CCC-SLP, NDT, CAMT

ArkSHA Convention October 16, 2015

What is Executive Functioning

•  An umbrella term for all the complex cognitive processes that control: •  Response Inhibition •  Emotional Control •  Sustained Attention •  Task Initiation •  Time management •  Goal Setting •  Planning •  Organizing •  Prioritizing •  Shifting •  Flexibility •  Holding/manipulating information in working memory •  Self-monitoring/Self Checking •  Metacognition

•  Executive Function is controlled by the Frontal and Prefrontal Cortex

The human brain

Dawson, P., & Guare, R. (2010). Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention. Second Edition.

Executive Skill Definition Examples

Response Inhibition The capacity to think before you act.

A young child can wait for a short period without being disruptive. An adolescent can accept a referee’s call without an argument.

Working Memory The ability to hold information in memory while performing complex tasks.

A young child can hold in mind and follow one- or two-step directions. The middle school child can remember the expectations of multiple teachers.

Emotional Control The ability to manage emotions to achieve goals, complete talks, or control and direct behavior.

A young child can recover from a disappointment in a short time A teenager can manage the anxiety of a game or test and still perform.

Sustained Attention The capacity to keep paying attention to a situation or task in spite of distractibility, fatigue, or boredom.

A young child can complete a 5 minute chore with occasional supervision. A teenager can pay attention to 1-2 hours of homework.

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Executive Skill Definition Examples

Task Initiation The ability to begin projects without undue procrastination, in an efficient or timely fashion.

A young child can start a chore or assignment right after instructions are given. A teenager does not wait until the last minute to begin a project

Planning/prioritization The ability to create a roadmap to reach a goal or to complete a task.

A young child with coaching can think of options to settle a peer conflict. A teenager can formulate a plan to get a job.

Organization The ability to create and maintain systems to keep track of information or materials.

A young child can with reminder put toys in a designated place. A teenager can organize and locate sports equipment.

Time Management The capacity to estimate how much time one has, how to allocate it, and how to stay within time limits and deadlines.

A young child can complete a short job within a time limit set by adult. A teenager can establish a schedule to meet task deadlines.

Executive Skill Definition Examples

Goal-directed persistence The ability to have a goal, follow through to completion and not be distracted by competing interests.

A first grader can complete a job to get to recess. A teenager can earn and save money over time to buy something of importance.

Flexibility The ability to revise plans in the face of obstacles, setbacks, new information, or mistakes

A young child can adjust to a change in plans without major distress. A teenager can accept an alternative when the first choice is not available.

Metacognition The ability to stand back and take a bird’s-eye view of yourself in a situation to observe how you problem solve

A young child can change behavior in reasons to feed back from an adult. A teenager can monitor and critique her performance and improve it by observing others who are more skilled.

Who are these students?

•  Act without thinking

•  Interrupts others

•  Overreacts to small problems

•  Upset by changes in plans

•  Overwhelmed by large assignments

•  Talks or plays too loudly

•  Resists change of routine

•  Doesn’t notice impact of behavior on others

•  Doesn’t see their behavior as part of the issue.

•  Forgets to bring materials back and forth between home and school

•  Easily over stimulated and has trouble calming down

•  Gets stuck on one topic or activity

•  Gets overly upset about “little things”

•  Out of control more than peers

•  Can’t come up with more than one way to solve a problem

•  Low tolerance for frustration

•  Acts wild or out of control

•  Leaves a trail of belongings wherever he/she goes

•  Messy desk/cubby areas/backpack

•  Loses or misplaces tings (books, papers, mittens, lunch money, etc.)

Who are these students?

•  Doesn’t bother to write down assignment

•  Forgets directions

•  Forgets to bring materials home

•  Keeps putting off homework

•  Passive study methods or doesn’t study

•  Forgets homework/forgets to pass it in

•  Leaves long-term assignments or chores until last minute

•  Cant break down long-term assignments

•  Sloppy work messy notebooks

•  Can’t find things in backpack

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Developmental tasks requiring executive

skills

Preschool

•  Run simple errands (one step)

•  Tidy bedroom or playroom with assistance

•  Perform simple chores and self-help tasks with reminders

•  Inhibit behaviors: don’t touch a hot stove, run into the street, grab a toy from another child, hit, bite, push

Kindergarten – Grade 2

•  Run errands (2-3 step directions)

•  Tidy bedroom or playroom

•  Perform simple chores, self-help tasks; may need reminders

•  Bring papers to and from school

•  Complete homework assignments (20 min max)Decide how to spend money (allowance)

•  Decide how to spend money

•  Inhibit behaviors: follow safety rules, don’t swear, raise hand before speaking in class, keep hands to self.

Grades 3 - 5 •  Run errands that involve time delay or great distance

•  Tidy bedroom or playroom that includes vacuuming, dusting

•  Perform chores that take 15-30 minutes

•  Bring books, papers, assignments to and from school

•  Compete homework assignments (1 hour max)

•  Keep track of belongings when away from home

•  Plan simple school project such as book report

•  Keep track of changing daily schedule

•  Save money for desired objects, plan how to earn money

•  Inhibit/self-regulate: behave when teacher is out of the classroom, refrain from rude comments, temper tantrums, bad manners.

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Grades 6 - 8 •  Help with chores around the home including daily and occasional tasks that

require 60-90 minutes to complete

•  Babysit younger sibling or for pay

•  Use system for organizing schoolwork; including assignment book, notebooks

•  Follow complex school schedule involving changing teacher and changing schedules.

•  Plan and carry out long term projects, tasks to be accomplished and reasonable timeline to follow; may require planning multiple large projects simultaneously.

•  Plan time, including after-school activities, homework, family responsibilities; estimate how long it takes to complete individual tasks and adjust schedule to fit

•  Inhibit rule breaking in the absence of visible authority

High school •  Manage school work effectively on a day to day basis, including

completing and handling in assignment on time, studying for tests, creating and following timelines for long-term projects, and making adjustments in effort and quality of work in reasons to feedback from teachers and others.

•  Establish and refine a long-term goal and make plans for meeting that goal. Participates in extracurricular activities, signs up for ACT at appropriate time and carries out the college application process. If not college then pursues vocational courses and/or employment outside of school to ensure the training and experience necessary to obtain employment after graduation.

•  Make good use of leisure time, including employment or pursuing recreational activities during the summer

•  Inhibit reckless and dangerous behaviors (illegal substances, sexual acting out, shoplifting, vandalism

Examples of six Key executive Function

Processes

Organizing

•  Definition •  Arranging information, systematizing •  Moving and sorting information

•  Example •  Using charts and graphic organizer for writing •  Using maps and webs for reading and writing

•  Difficulties •  Organizing ideas, such as summarizing key ideas on strategy cards

rather than rereading the text over •  Organizing materials such as class notes, textbooks, and study

guides •  Organizing workspace (reducing distractions and clutter

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Prioritizing

•  Definition: •  Ordering based on relative importance

•  Figuring out what’s most important

•  Example: •  Ordering information from written work, projects, and tests

•  Separating main ideas from details on reading and writing tasks

•  Difficulties •  Prioritizing by allocating more time and effort to major project and tests

•  Figuring out which details are critical and which entails can be ignored when reading, taking notes, or writing an essay

•  Estimating how much time to spend on reading and research versus output

Planning

•  Definition: •  Proposed or intended course of action •  Orderly or step-by-step proposal for accomplishing an objective

•  Example: •  Trying out for the football team •  Signing up to go on a mission trip and having to raise you own

money to go

•  Difficulties •  Allocating time to the many steps involved in different assignments •  Writing papers •  Taking notes for history or science •  Completing long-term projects

Shifting •  Definition

•  Switching easily between approaches •  Looking again, in a brand-new way

•  Example •  Predicting different endings for novels •  Understanding different word meanings in text •  Applying different problem-solving approaches to word problems

•  Difficulties •  Shifting flexibly from the major themes to relevant details to meet the

demands of the reading, writing, or studying task. •  Using outlines such as graphic organizers or linear outlines to get unstuck

when writing papers or projects •  Shifting between operations and between words and numbers for math

computation or word problem

Using Working Memory •  Definition

•  Manipulating information mentally •  Juggling information in the brain

•  Example •  Taking notes; completing multistep projects; completing math calculations

mentally; thinking about themes while reading

•  Difficulties •  Studying strategically so that complex information is retained over time

•  Students remember facts and spelling for quizzes and tests, but do not connect concepts and cannot juggle the information mentally so they can access this information on a long-term basis

•  Remembering to hand in completed assignments on time •  Remembering to bring necessary books and materials from school to home and back

again •  Keeping in mind the importance of remembering to check and correct careless errors

when writing papers, taking tests, or doing homework •  Performing consistently across situations, content areas, and tasks.

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Self-monitoring self-checking

•  Definition •  Reviewing work for common errors

•  Recognizing and fixing the most common kinds of mistakes

•  Example •  Using personalized checklists

•  Shifting to checking mindset and back

•  Difficulties •  Using a sequential way to review school work and find mistakes

•  Unable to intrinsically

assessment

•  Behavioral Checklists •  Behavior Rating Inventory of

Executive Functions (BRIEF)

•  Child Behavior Checklist/Teacher Report Form

•  Brown Attention-Deficit Disorder Scales for Children and Adolescents

•  Behavior Assessment System for Children-2 (BASC-2)

•  Executive Skills Questionnaire for Parents/Teachers and Students

•  Formal Assessments •  Nepsy-II •  Porteus Mazes

•  Trailmaking Tests •  Wisconsin Card Sorting Test •  Mesulam Tests of Directed

Attention •  Connors Continuous

Performance Test-II •  Test of Everyday Attention for

Children

•  Delis-Kaplan Executive Function Scale

•  Cognitive Assessment System

•  Detailed case history with interview questions designed to elicit the presence or absence of executive skills in everyday activities

•  Classroom observations and work samples

10 Principles to Improve Executive Functioning

1.  Explicitly teach skills rather than expecting the child to acquire them through observation or osmosis

2.  Consider your child’s developmental level

3.  Move from the external to the internal

4.  External includes changes in the environment , the task, or the way you interact with the child.

5.  Use rather than fight the child’s innate drive of mastery and control.

6.  Modify tasks to match your child’s capacity to exert effort

7.  Use incentive to augment instruction

8.  Provide just enough support for success.

9.  Keep supports and supervision in place until the child achieves mastery or success

10.  Fade supports, supervision and incentives gradually NEVER abruptly

  References   Dawson, P., & Guare, R. (2010). Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention. Second Edition.   Dawson, P. (2012, December 11). Smart but Scattered: Executive Dysfunction at Home & at School. Lecture, Little Rock, AR.   Dawson, P., & Guare, R. (2009). Smart but scattered: The revolutionary "executive skills" approach to helping kids reach their potential. New York: Guilford Press.   Meltzer, L. (2010). Promoting executive function in the classroom. New York: Guilford Press.