ri o ts presentation slideshare

Games and Apps to Improve

Executive Functioning

RI OT Pediatric Special Interest Group

RandyKulman. Ph. D.

randy@learningworksforkids.com

@lw4k

learningworksforkids.com

pinterest.com/lw4k

What are executive functions?

The cognitive command and control systems of the brain.

The CEO of the brain

The manager, organizer, and coordinator of internal and

external information.

A collection of brain processes that guide thought and

behavior.

Capacities that enable independent, purposeful, goal-

directed behaviors.

Critical thinking and self-regulatory skills

Dawson and Guare 2004 (Model of executive functions)

Identifies 11 component executive skills that are consistent

with major theories of executive functioning by Brown and

Barkley.

The specific skills are also easily assessed by the best measures

of executive functioning {the Brown ADD Scales and Behavior

Rating Inventory of Executive Functioning (BRIEF)}.

The division of skills into 11 specific executive functions also

helps in developing clear interventions strategies.

LearningWorksforKids has modified the Dawson and Guare

model and has added a twelfth skill, social thinking.

Current Neuroscience

Executive functions are not located simply in the prefrontal cortex.

Executive functions involve neural networks involved with coordinating and processing internal and external information.

The prefrontal cortex sends reciprocal connections to many other areas of the brain involving executive functions.

It is best to view executive functions as an interconnected coordination process across wide ranges of areas of the central nervous system (including, but not restricted to, the parietal, temporal, and occipital cortex, basal ganglia, cerebellum, amygdala, and hippocampus).

http://learningworksforkids.com/executive-functions/

Development of Executive Functions

The growth of executive function skills in children and adolescents parallels the

maturity and development of the frontal lobes and the prefrontal cortex in particular.

Executive functions are observed as early as 8 months old, where infants are seen as

keeping an object in mind (while playing hide-and-seek).

Preschoolers learn to inhibit behaviors (eg. not touch a hot stove) and develop basic

social skills in peer play.

Growth patterns ages 5-7, 9-12, and adolescence.

Adolescents, in particular, are known to engage in risky behavior, often failing to

consider the consequences, plan effectively, or regulate emotional displays.

Slowly-developing executive skills are also seen across a wide range of psychiatric

disorders, and in particular Attention Deficit Disorders. Recent brain imaging studies

indicates slower development of the cortex in ADHD kids.

Executive Functions and Academic

Performance

Goal-directed persistence

Ability to set a reachable goal and display ongoing effort.

Sustain effort when a task becomes boring or interrupted.

Necessary for activities that require sustained practice for

improvement.

Willingness to delay gratification and be able to visualize or

imagine the future.

Executive Dysfunctions and Psychiatric Diagnosis

Disorders of executive function cut across a range of psychiatric diagnoses in children and adults.

Many individuals with significant executive dysfunctions do not readily fit into a diagnostic category. (For example, individuals may be very disorganized and have difficulty planning, but may not meet the criteria for an attention or learning diagnosis.)

Most often associated with Attention Deficit Hyperactivity Disorder and Learning Disabilities.

Also observed in Autism Spectrum Disorders, Nonverbal Learning Disabilities, Tourette’s Disorder, and Anxiety and Mood Disorders.

Sustained Attention

Maintain one’s focus in the presence of distractions and other activities.

Return to an activity when interrupted.

Persist in tedious and boring tasks.

Select the most important sources of information when confronted with multiple stimuli.

Developmental in nature; all children tend to focus longer as they mature.

http://learningworksforkids.com/playbooks/the-legend-of-zelda-skyward-sword/

Task initiation (getting started)

Get started directly on a task.

Understand what is expected.

Redirect one’s attention from a previous involvement.

Get activated even with non-preferred tasks.

Goal-directed persistence

Ability to set a reachable goal and display

ongoing effort.

Sustain effort when a task becomes boring or

interrupted.

Necessary for activities that require sustained

practice for improvement.

Willingness to delay gratification and be able to

visualize or imagine the future.

http://learningworksforkids.com/apps/story-builder/

Planning

Display sequencing and foresight.

Develop short- and long-term goals.

Respond to environmental and social cues.

Estimate and anticipate possible outcomes.

http://learningworksforkids.com/playbooks/minecraft/

Working Memory

Keep information in mind and perform an activity on this information.

Involve verbal and visual processes for memory.

Display cognitive function that holds information “on line” for a short

period.

Used for following instructions, paying attention, and problem solving.

http://learningworksforkids.com/apps/cogmed-working-memory-

training/

Organization

Arrange elements in a functional manner.

Utilize a systematic approach that facilitates goal-

directed behavior.

May involve sequencing and anticipation of the future

Ordering thoughts and communication with others

http://learningworksforkids.com/apps/first-then-visual-

schedule/

Flexibility

Improvise and shift approaches.

Adapt to the demands of a new situation.

Develop novel strategies.

Shift attention from one task to another.

Recognize the need to utilize different problem-solving strategies.

http://learningworksforkids.com/playbooks/portal-2/

Regulation of Affect

Manage one’s feelings effectively to make decisions.

Capable of sustaining one’s effort in the face of frustration.

Accept criticism without defensiveness

Able to regulate emotional displays

http://learningworksforkids.com/playbooks/if/

Response Inhibition

Use reflective rather than impulsive behaviors.

Demonstrate Self- Control in social situations

Stop or delay an action

Demonstrate appropriate caution in dangerous activities

http://learningworksforkids.com/playbooks/fruit-ninja/

Time Management

Respond to things in a timely fashion.

Follow a schedule.

Display skills at estimating the time necessary to

complete tasks.

http://learningworksforkids.com/playbooks/the-

blockheads/

Metacognition

Display self-monitoring and self-observation.

Check on one’s efforts and assess success and failure.

Provide perspective on decision making and understand the impact of one’s actions on others.

http://learningworksforkids.com/playbooks/the-legend-of-zelda-ocarina-of-time-3d/

Social Thinking

Label and describe one’s feelings.

Understand the needs of others.

Display perspective-taking skills.

Understand social conventions.

http://learningworksforkids.com/playbooks/draw-

something-2/

Assessment of Executive Functioning

Performance of complex everyday tasks are the best data.

Parent interviews :

Problems with homework and chores,

Frequent displays of frustration,

Anger, problems getting started and finishing tasks,

Difficulties following directions.

Assessment of Executive Functioning (Cont.)

Teacher interviews:

Difficulties in understanding social and classroom expectations

problems in sustaining attention and effort on independent classroom

assignments

difficulties in following complex directions

requires frequent prompting to get started or maintain effort.

Difficulties with organizing essays and written materials.

Performance of complex everyday tasks are the best data.

Assessment of Executive Functioning

(Rating Scales)

Behavior Rating Inventory of Executive Functioning (BRIEF) –

Scales include Initiate, Plan/Organize, Working Memory, Shift, Inhibition,

Monitor, Emotional Control

Brown ADD Scales – More of a measure of executive functioning than

specifically of Attention Deficit Disorder

Scales include Activation, Focus, Memory, Emotion, Effort, action

Executive Functioning Questionnaire (LearningWorksforKids)

Processing Speed Questionnaire (LearningWorksforKids) - face valid

methods for collecting observations of executive functioning and

processing speed concerns with children

Executive Dysfunctions in ADHD

DSM-V (2011) proposed criteria for ADHD describe six of the nine major symptoms as executive dysfunctions (Barkley 2007).

Problems in following directions, keeping things in mind, and getting started on tasks.

Difficulties sustaining attention and effort.

Problems in regulating feelings and becoming easily frustrated.

http://learningworksforkids.com/alternative-learners/adhd/

Autism Spectrum Disorders

Difficulties with social thinking and picking up on nonverbal cues.

Inflexibility and rigidity.

Metacognitive problems and difficulties in self-observation and perspective taking.

Difficulties in emotional regulation and controlling frustration and anger.

http://learningworksforkids.com/alternative-learners/autistic-spectrum-disorders/

Anxiety and Mood Disorders

Difficulties in regulating emotions.

Become overwhelmed by minor inconveniences and stress.

Lack of self-confidence and problems in getting started on tasks and sustaining effort.

Unable to complete homework.

Perfectionism or rigidity that may lead to inflexible problem solving.

http://learningworksforkids.com/alternative-learners/anxiety/

Executive Functions and Academic Performance

Goal-directed persistence

Ability to set a reachable goal and display ongoing effort.

Sustain effort when a task becomes boring or interrupted.

Necessary for activities that require sustained practice for improvement.

Willingness to delay gratification and be able to visualize or imagine the future.

http://learningworksforkids.com/wp-content/uploads/AcademicChartExecutiveFunctionsThinkingSkillsConnections.pdf

Reading

Phonological Awareness

Working Memory - keeping different sounds in mind while decoding

Fluency

Focus - ability to sustain attention to the task, keep going without getting distracted, not give up.

Comprehension

Planning - ability to form/plan comprehension goals before reading, use organizers, think about prompts

Organization - Have to be able to organize information that was read in order to make sense of it. Sequencing events, most important info.

Working memory - keep track of pieces of info to complete understanding

Writing

Vocabulary

Working memory - Recalling previous vocab learned and being able to use it when appropriate

Fluency

Focus - sustain attention to the task without being distracted or giving up, goal directed. Writing as a problem and step by step process, writing in stages.

Task initiation - Being able to define the first step and begin organizing thoughts with minimal hesitation and self - doubt, getting something on the page

Working memory - keeping multiple ideas in mind at once, recalling grammar/spelling rules

Organization

Working memory - Ability to pull spelling rules from long term memory and use when writing

Mathematics

Computation

Working memory - Keeping different steps to solving a problem in mind, recalling which formulas to use to solve which problems, keeping parts to a multi-step problem in mind

Focus - Sustaining attention to the task, not getting distracted in the middle of completing a problem, setting goals and working to meet them

Fluency

Working memory - Keeping all of the different components to a problem in mind while solving it, thinking about previous steps while doing the current one, retrieving previously learned information to apply it to the current problems/task, applying math rules.

Flexibility - Shifting between different representations-written in sentences, computation, etc. Being able to switch your approach/strategy when it is not working.

Concepts

Self-awareness - being able to explain and communicate your own reasoning in writing or to others, being able to think about and explain the steps you use to solve different kinds of problems, being able to explain the reasoning behind completing a math problem a certain way.

Improving Executive Functioning

Support and Scaffolding

Providing a child with external assistance that leads to the use of an executive skill

Training wheels on a bicycle

Often referred to as a parent or teacher taking on the role of the temporal lobe

The opportunity repeatedly to rehearse an executive skill

May require teaching or modeling of the skills

Sustained practice often requires salient rewards, reminders, recognition, and accomplishment

Improving Executive Functioning (Cont.)

Development

Teaches a child to use executive skills and apply them in new situations

Requires a teacher, mentor, parent

Understanding and ownership of the goal of developing a new skill on the

part of the child

Understanding of how this new skill will help the child

Generalization strategies to help apply it to new situations

Reasons to use video games and digital

media to improve EFs

Engaged kids

Catch them with what they are already doing

Willing practice

Sustained attention and effort

Uses skills (Efs) that are crucial to 21st century success

Research support for games and learning

Research -video games have positive

effects on children.

Improve processing speed (Green and Bavelier, 2009)

Improve working memory (Klingberg, et al, 2007)

Increase pro-social behaviors (Gentile et al, 2009) in children.

Improve social involvement (Ferguson, 2010)

Build brain regions Kühn and her colleagues study of Tetris

Improve Brain Flexibility with StarCraft

Rayman Raving Rabbids and Reading Fluency

Research-Negative impact of video games

on children

Increasing levels of obesity with screen-based time- primarily television

Poor psychological adjustment in kids who play more than 3 hours per day-

Pediatrics report

Violence and video games- Bushman data

7 hours 38 minutes per day of digital media time- Ignoring other activities-

Kaiser Foundation data

Video game addiction 3- 8% cited-DSM-V category Internet gaming

disorder

Generalization, Motivation and

Metacognition

The key Ingredient- Making game-based learning into

real world skills

Games are play, Play=Learning

Games (Traditional, think chess) require problem solving

Games are motivational

Games sustain attention and effort

Games require a variety of executive skills

Games promote extended practice

Generalization, Motivation, Metacognition- 2

Games are social and learning occurs with others

Games foster communication amongst kids

Games get special needs kids to participate

Games get kids to think about what they are doing

Flow and engamement

Games promote academic knowledge (eg history, geology)

Games promote digital literacy skills

How to Use Digital Technologies to Teach Executive Functions

Educational and Psychological Principles That Enhance

Effective Learning with Digital Technologies

Develop a partnership with the child for learning executive skills

Have the child identify areas that she wishes to improve

Practice skills in an interesting and reinforcing manner

Preview and review strategies -child "detect” use of executive skills with digital tech

Teaching strategies that help a child "reflect" on use of executive skills and her game play

Point of performance strategies-"connect" executive functions from games to real world

How Do Digital Technologies Teach

Executive Skills? (THEY DON’T)

Many do, however, require the use of executive skills throughout the game.

There is some evidence to suggest that the simple act of game play that

requires executive skills produces new neural connections in the brain.

Brain-training websites for adults such as Cognifit, Happy Neuron, and Fit

Brains report improved memory and attention skills.

Cogmed Working Memory Training has strong data including FMRI's of brain

change.

Wealth of anectodal evidence that children learn from electronic media

(television research, simulation-game research, and electronic toy-makers)

How Do Digital Technologies Teach Executive Skills? (Cont.)

The LearningWorks for Kids model:

Tailored interventions .Assess a child’s executive skills and weaknesses

Games as a vehicle for "engaging the gears" of a child's brain, as a teaching tool

Opportunities for children to practice an executive skill in a fun and engaging fashion

A teaching opportunity for parents, teachers, and clinicians

An opportunity to detect, reflect, and connect on the use of executive skills, Provide practice opportunities for real-world use of executive skills

Why Would OTs, SLPs, Clinicians Become Digital Play Therapists?

To become the most popular clinician on the block

To relate to kids where they are

To use "clinical play time" to do more than build relationships

To engage in an activity in which children often feel a sense of accomplishment

To provide a child with an opportunity to teach you, rather than you teach her

To engage in an activity in which homework assignments and ongoing practice are likely to be completed

What Does an OT, SLP, Clinician Need to

Learn?

"But I don't know how to play video games." (for parents, teachers, and

clinicians)

It's important to have some knowledge

Start learning

An opportunity to communicate with kids on their turf

It's good to know what the kids are up to.

Kids can learn from digital technologies, but they still need parents and

teachers to help them reflect, apply, and connect their knowledge.

Thank you

Contact info:

Learningworksforkids.com

www.facebook.com/LearningWorksForKids

Twitter- @lw4k

Pinterest.com/lw4k

@rkulman

401-515-2006