assessment and intervention for executive function difficulties part 3

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Presented by

George McCloskey, Ph.D.Philadelphia College of Osteopathic Medicine

[email protected] or [email protected]

Assessment and Intervention for Executive Function Difficulties Part 3

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Workshop ObjectivesDescribe general strategies for

mediating ef difficulties through external control and improving ef capacities through strategies for self-regulation.

Describe specific intervention methods that address executive function difficulties.

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The neural circuits for executive function activation are routed differently depending on whether the activation is based on an internally driven desire or command versus an external demand.

Internal versus External Control

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Because internally driven production is much easier to accomplish than externally demanded production for children with “producing difficulties” their lack of production on demand often stands in stark contrast to their seemingly effortless production “when the spirit moves them.”


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The on-demand deficiencies observed by others are often attributed to negative personal characteristics such as lack of responsibility, apathy, passive aggressive stance, or oppositional defiance.


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As Martha Denckla has pointed out, Executive Function difficulties of a severe nature (especially in the Symbol System Arena) do not result in Learning Disabilities; they result in “Producing Disabilities.”

Producing versusLearning Difficulties

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Learning Difficulties

Only

Learning Difficulties

AndProducing Difficulties

Producing Difficulties

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Often NOT recognized as a Learning Disability, even when severe, unless an evaluation involving process assessment is doneRecognized fairly quickly as a Learning DisabilityWhen severe, typically attributed to lack of motivation, character flaws, or behavior/personality problems

A General Model for Conceptualizing Learning and Producing

Difficulties

Functional Behavior Assessment

The focus of a traditional FBA:“Behavior support plans are designed to alter patterns of problem behavior. The process by which this is done, however, involves change in the behavior of family, teachers, staff, or managers in various settings. Plans of behavior support define what we will do differently. It is the change in our behavior that will result in improved behavior of the focus person.” (O’Neill, Horner, Albin, Sprague, Storey, & Newon, 1997, p. 65).

Functional Behavior Assessment

A B CIn traditional functional behavior

assessments antecedents are said to TRIGGER the behavior that results in the consequences, but the reasons WHY the

antecedents trigger the behavior is not really addressed.

FBA: Is A-B-C Enough?Since the antecedent does not trigger the

same undesirable behaviors in ALL students in the same situation, there must be something about the students that differs in an important way.

Functional behavior assessment ignores internal considerations (i.e., perceptions, emotions, thought) and focuses on applying external control to effect change in behavior.

FBA: Is A-B-C Enough?Because of their strong emphasis on

observable behaviors, functional assessments typically do not provide a conceptual basis for understanding the root causes of why setting events and antecedent conditions result in problem behaviors even when the negative consequences associated with the problem behaviors are completely undesirable from the student’s perspective as well as everyone else’s.

While some strict behaviorists might argue that it is unnecessary to speculate on such causal issues, parents, teachers, and students themselves find such explanations to be central to their attempts to make sense of things.

FBA: Is A-B-C Enough?

The EF Driven FBAInformed by knowledge of executive functions, the functional behavior assessment model can be revised as follows:

Antecedents Behavior Response Consequences

Perception Emotion Cognition Action

EF

A B C

While it might appear that the child is consciously choosing how to perceive, feel, think and act when a lack of production is observed, proper conceptualization of executive function difficulties requires an acknowledgement that the source of the executive function problem is most likely a result of less than optimal nonconscious brain function rather than a conscious choice to act in a contrary manner.

Most importantly, clinicians must help parents and teachers, as well as themselves, realize that the executive difficulties that are so exasperating to them are just as exasperating to the child, with the only difference being in the nature of the reactions that are expressed.

EF-Driven FBA

With a good understanding of executive functions, problems can be clearly stated in terms of perceptions, emotions, thoughts or actions that can be changed through intervention. The goal here is twofold: 1) to help the child, the parents, and professionals to understand the nature of the deficit and 2) through proper intervention, to assist the child or adolescent in changing the behavior from a negative to positive.

EF-Driven FBA

An Executive Function-driven FBA can identify the executive function difficulties that are the source of the behavior problems.

Subsequently, part of the intervention plan would be to help parents and teachers understand the nature of these executive function difficulties, their impact on the student’s behavior, and the reasons why external control strategies are required.

Additionally, understanding the executive function difficulties producing the problem behaviors will help those charged with delivering the intervention adopt an appropriate perspective during implementation.

EF-Driven FBA

Executive Function Difficulties

Are they the result of:Disuse through Conscious

ChoiceInnate DeficiencyMaturational DelayDisuse through Nonconscious

Choice

Executive Function Intervention

For intervention purposes, it is bestto assume that EF deficiencies arethe result of disuse throughnonconscious choice. The generalintervention goal then becomeseducation to make the child consciousof the EFs needed and how to engagethem.

EF Intervention Strategies

Orienting StrategiesExternal Control StrategiesBridging StrategiesInternal Control Strategies

EF Intervention Continuum

Orienting Strategies

External Control Strategies

Bridging Strategies

Internal Control Strategies

EF Intervention LevelsInterventions will vary

depending on the EF level or levels at which difficulties are occurring and will be constrained by the level of development attained by the person.

EF Intervention LevelsIndividuals with little self-activation

capacity need classical conditioning interventions that do not require any EF involvement

Individuals with little or no self-regulation or self-realization capacities will require strict behavior modification treatment regimens

EF Intervention LevelsIndividuals with some self-

regulation capacity may respond well to cognitive behavior therapy

Individuals with some self-regulation and self-realization capacities may respond to mindfulness-based cognitive behavior therapy

Development of Interventions for EF Difficulties

Requires keeping in mind:The need to increase awareness and

provide goals.The need to move from external control to

internal control through bridging strategies.The environment in which intervention is

happening: Requires those close to child to have reasonable EF capacities and be able to model those capacities.

EF Self-regulation skills eventually need to be just that—Self-regulated.

During classroom instruction, it is necessary to find the balance between providing enough EF SR cueing to help students function, but not too much to prevent EF skill-development.

It is easy to underestimate the multiplicity of Efs required and focus only on those related to attention and organization.

Development of Interventions for EF Difficulties

General Literature Sources for Intervention Information

Executive Function ReferencesADHD InterventionsTBI InterventionsDynamic Assessment/ Instrumental

Enrichment ProgramsI Can Problem Solve (ICPS) programMetacognition applied to academics skill

areas; especially readingCognitive Behavior TherapyOT/PT Motor Planning and Motor Praxis

Executive Function References

Promoting Executive Functions in the Classroom– Lynn Meltzer (2010)

Executive Function Skills in Children and Adolescents 2nd Edition – Dawson & Guare (2009)

Smart but Scattered – Dawson & Guare (2009)Late, Lost, and Unprepared – Cooper Kahn &

Deitzel (2008)Assessment & Intervention for Executive Function

Difficulties – McCloskey, Perkins & VanDivner (2009)

Executive Functions in the Classroom – Chris Kaufman (2010)

Orienting Strategy

Increase student awareness of:self-regulation expectationspersonal self-regulation

strengths and weaknesses

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Increase Awareness of EF Difficulties; raise consciousness of the specific difficulties that result from EF deficiencies in order to clearly define the problems; when possible, use videotaping for reality testing.

Orienting Strategy

STATING GOALSTo assure that executive function capacities

are used to their fullest potential, it is important to state goals for both achievement and self-regulation. Stating goals enables executive function capacities, either consciously or nonconsciously, to engage the perceptions, emotions, thoughts, and actions, needed to achieve the goals.

Orienting Strategy


Provide predictable, consistent structure to classroom environments and routines:

Post and discuss class rules and schedules

Review and rehearse routinesMaintain basic room arrangement

Marzano & Pickering (2003) identified four components of effective classroom management:Classroom Rules and ProceduresDisciplinary InterventionsTeacher-Student RelationshipsMental Set

Classroom Managementthat Works (Marzano)

Design and Implementation of Classroom Rules and Procedures involves clearly stating general expectations and standards (rules) for behavior and providing specific behavior routines (procedures) that enable the students to meet the general expectations.

Classroom Rules should address Self-Regulation expectations, thereby increasing awareness of the need for self-regulation.



Provide external prompts and cues as a substitute for self-regulation.

In preschool, kindergarten and early elementary years, in many ways, teachers ARE their student‘s frontal lobes.

Providing executive prompts and cues are important to assure that children are engaged appropriately in the instructional process.

Modeling good executive functions helps children see how they can self-regulate their own perceptions, emotions, thoughts and actions.


In late elementary, junior-senior high school, college, and even graduate school and work places, effective teachers/supervisors provide executive function prompts and model good executive function use.


An Observation Form (McCloskey, Perkins & VanDivner) has been developed for use to help structure observations and assist in providing effective feedback to teachers.

Assessing the Use of EF Prompts in the Classroom

The form has two componentsA definition and sample sheet to

help you focus on the types of prompts that you are observing.

The observation form, that lists all 33 SREFs, has a space for taking notes and keeping track prompts that are observed.

Executive Function Classroom Observation Form (EFCO)

Example Prompts

The definitions & sample prompts are used to prepare for the observation

For each self-regulation EF, examples of positive and specific prompts and negative, vague and/or poorly timed prompts are provided.

EFCO Example Prompts

Each self-regulation EF has sample prompts for each of the four domains of function:

P =Perceiving;F = Feeling;T = Thinking A = Acting

33 Self-Regulation EFsPerceiveFocusSustainEnergizeInitiateInhibitStopInterruptFlexibleShiftModulate

MonitorCorrectBalanceGaugeAnticipateEstimate TimeAnalyzeCompare/EvalGenerateAssociatePlan

AnalyzeCompareChoose

OrganizePrioritizeDecideSense TimePaceSequenceExecuteHoldManipulateStoreRetrieve

Strategies for Becoming Familiar with SREFs and Prompts

To effectively use the observation form, you will have to build familiarity with each of the 33 self-regulation areas.

At first, this can seem overwhelming, but if you use your own EF’s effectively, it can be accomplished!

Organize according to the 7 clusters, perhaps study one a day. In less than 2 months, you can have them mastered.

SREF “Clusters”The 33 self-regulation

executive functions can be grouped based on “Clusters” in which several srefs are used in an integrative manner.

There are seven primary clusters to consider.

SREF “Clusters”AttentionEngagementOptimizationInquirySolutionEfficiencyMemory

Attention Cluster“What’s going on out there?”Includes: Perceive,

Focus/Select, Sustain

Engagement Cluster “Get to it – or not” Includes: [Attention Cluster],

Energize, Initiate, Inhibit, Stop/Interrupt, Flexible, Shift, [Optimization Cluster]

Optimization Cluster “How am I doing?”Includes: [Attention

Cluster], Monitor, Modulate, Balance, Correct

Efficiency Cluster“The Smooth Operator.” Includes: Sense Time,

Pace, Sequence, Execute, [Optimization Cluster]

Memory Cluster “You CAN get there from

here.”Includes: [Attention Cluster],

Hold, Manipulate, Store, Retrieve, [Efficiency Cluster]

Inquiry Cluster“Inquiring minds need to know.” Includes: Anticipate, Gauge,

Estimate Time, Analyze, [Memory Cluster], Evaluate/Compare, [Solution Cluster]

Solution Cluster“I’m the Decider.” Includes: Generate, Associate,

Prioritize, Plan, Organize, [Memory Cluster], Choose/ Decide, [Optimization Cluster]

PerceiveThe Perceive function cues the use of

sensory and perception processes to take information in from the external environment or “inner awareness” to tune into perceptions, emotions, thoughts, or actions as they are occurring.

Prompt examples: “Listen to this.” “Look up at the board.”

“How are you feeling right now?”

FocusThe Focus function cues the direction of

attention and effort to the most relevant specifics (perceptions, emotions, thoughts, and/or actions) of a given environment, situation, or content while downgrading or ignoring the less relevant elements.

Prompt example: “Pay attention to what happens to the baking soda after the vinegar is added.”

SustainThe Sustain function cues sustained

attention to the most relevant specifics (perceptions, emotions, thoughts, and/or actions) of a given environment, situation, or content.

Prompt example: “You will need to watch the computer screen carefully for the entire 10 minutes.”

EnergizeThe Energize function cues the

investment of energy to the level needed to achieve the desired results

Prompt example: “This will require a lot of effort.” “You’ll need to focus all of your energy on task if you want to finish.”

InitiateThe Initiate function cues the

initial engagement of perceiving, feeling, thinking, or acting .

Prompt example: “Start walking now.” “Begin work on the count of five.”

InhibitThe Inhibit function cues resistance to,

or suppression of, urges to perceive, feel, think, or act on first impulse.

Prompts direct capacities to an alternate source rather than drawing attention to the perception, emotion, thought, or action that should be inhibited.

Prompt example: “Don’t start until I tell you to go.”

StopThe Stop function cues the sudden,

immediate discontinuation of perceiving, feeling, thinking, or acting.

The Stop cue always precedes the Shift cue when altering problem-solving based on changing conditions, and switching or alternating attention.

Prompt example: “Stop writing now.”

InterruptThe Interrupt function cues the brief

cessation of, and the return to perceiving, feeling, thinking or acting.

Efficient use of the interrupt cue enables a quicker return to a previous mental state or activity.

Prompt example: “Stop for a moment and listen, then I want you to go back to what you were doing.”

FlexibleThe Flexible function cues a

willingness to alter the frame of reference for the direction and engagement of perceptions, emotions, thoughts or actions in reaction to what is occurring in the internal or external environments.

Prompt example: “It doesn’t need to be done exactly the same way each time.”

ShiftThe Shift function cues a relatively

quick change in the direction and engagement of perceptions, emotions, thoughts or actions in reaction to what is occurring in the internal or external environments.

Prompt example: “The museum is closed for emergency repairs, so we won’t be able to go on the field trip.”

MonitorThe Monitor function cues the

activation of appropriate routines for checking the accuracy of perceptions, emotions, thoughts or actions.

Prompt example: “Periodically check the task directions to see if you are following all of them.”

Modulate/AdjustThe Modulate function cues the

regulation of the amount and intensity of mental energy invested in perceiving, feeling, thinking, and acting.

Prompt example: “Let’s all use our indoor voices now.”“Please tone it down a bit.”

BalanceThe Balance function cues the

regulation of the trade-off between opposing processes or states (e.g., pattern vs detail; speed vs accuracy; humor vs seriousness) to enhance or improve experiencing, learning, or performing.

Prompt example: “Work as quickly as you can, but be careful not to make any mistakes.”

CorrectThe Correct function cues the use

of appropriate routines for correcting errors of perception, emotion, thought, or action based on feedback from internal or external sources.

Prompt example: “Correct any errors you find.”

Sense TimeThe Sense Time function cues the

monitoring of the passage of time (e.g., cueing the engagement of the mental functions that enable a person to have an internal sense of how long they have been perceiving, feeling, thinking or acting).

Prompt example: “How long have you been working on that?”

PaceThe Pace function cues the

awareness of, and the regulation of, the rate at which perceptions, emotions, cognitions, and actions are experienced or performed.

Prompt example: “You will need to work quickly as there is not much time left.”

SequenceThe Sequence function cues the

orchestrating of the proper syntax of a series of perceptions, feelings, thoughts, and/or actions, especially in cases where automated routines are being accessed or are initially being developed.

Prompt example: “Remember the order of the steps needed for completion.”

ExecuteThe Execute function cues the

engagement of a well-known series of perceptions, feelings, thoughts, and/or actions, especially in cases where automated routines have been practiced and used frequently.

Prompt example: “Use the routine you learned to do these.”

HoldThe Hold function cues activation of the

necessary cognitive processes required to maintain information in working memory and continues cueing these processes until the information is manipulated, stored, or acted on as desired.

Prompt example: “Hold that thought while we hear a reaction from the other group.”

ManipulateThe Manipulate function cues the use

of working memory and other cognitive processes for the manipulation of perceptions, feelings, thoughts or actions as they are being held in mind or being accessed in the environment.

Prompt example: “Visualize what it would look like if you turned it upside down.”

StoreThe Store function cues the

movement of information about perceptions, feelings, thoughts and actions from the mental processing environment of the present moment into “storage” for possible retrieval at a later time.

Prompt example: “This is important; it will be on Friday’s quiz.”

RetrieveThe Retrieve function cues the activation of

cognitive processes responsible for finding and retrieving previously stored information about perceptions, feelings, thoughts and actions.

The more specific the demands or constraints placed on the retrieval task, the greater the requirements for precision of retrieval cues.

Prompt example: “To answer the question correctly, you will probably need to recall all that we learned about photosynthesis.”

GaugeThe Gauge function cues one to

identify the demands (perceptual, emotional, mental, physical) of a task or situation and cues the activation of the resources needed to effectively engage the task or situation.

Prompt example: “Consider what it’s going to take to get this job done right.”

AnticipateThe Foresee/Plan function cues

the anticipation of conditions or events in the very near future, such as the consequences of one’s own perceptions, feelings, thoughts and/or actions.

Prompt example: “If you keep erasing in that same spot, what do you think will happen to the paper?”

Estimate TimeThe Estimate Time function cues the

use of time estimation routines (e.g., cueing the engagement of mental functions that enable a person to have an internal sense of how long something will take to complete, or how much time is still left in a specific period of time).

Prompt example: “Tell me how long you think this will take you to do.”

AnalyzeThe Analyze function cues the realization of

the need to examine more closely perceptions, feelings, thoughts or actions to obtain a greater understanding of a problem or situation.

Prompt examples:“Make a list of the positives and negatives and then compare them.”

“Are there additional factors that need to be considered?”

Compare/EvaluateThe Compare/Evaluate function cues the

realization of the need to make comparisons among, or evaluate the adequacy of, perceptions, feelings, thoughts or actions.

Prompt examples:“Is that the best you can do?”

“Are you sure you are finished?” “Does yours look like the model?” “Are you sure that what you said was a good

explanation?”

PrioritizeThe Prioritize function cues the use of

routines for ordering perceptions, feelings, thoughts, and/or actions, according to their relevance, importance, or urgency.

Prompt example: “Think about how important each of these tasks is, and then list them in order of importance so the most important ones get done first.”

GenerateThe Generate function cues the realization

that novel, fluid problem-solving efforts are required and cues the activation of the resources needed to carry out problem-solving routines.

Prompt example: “We haven’t tried to solve a problem like this one before.”“This problem will require some novel thinking if you are going to find a solution.”

AssociateThe Associate function cues the realization

that associations need to be made, and cues the activation of the resources needed to attempt to make the necessary associations.

Prompt examples: “Have you heard anything like that before?”“This problem is very similar to one you worked on last week.”

OrganizeThe Organize function cues the use of

routines for sorting, sequencing, or otherwise arranging perceptions, feelings, thoughts, and/or actions, to enhance or improve the efficiency of experience, learning, or performance.

Prompt example: “Let’s establish the order in which you need to do things to get this task done.”

Plan (Short-term)The Plan function cues the engagement of

the capacities required to identify a series of perception, feelings, thoughts, and/or actions that, if carried out, would be most likely to produce a desired outcome in the very near future (within minutes to within several hours).

Prompt example: “Write down what you will do over the weekend and when you will do it so that you will be ready for the test on Monday.”

Choose/DecideThe Choose function cues the need to

achieve closure, i.e., to make a choice among alternatives now.

Prompt example: “Make a choice now.” “Pick one now.” “Choose now.”

The Choose cue often must be preceded by the Stop/Interrupt cue.

Prompt example: “You need to stop thinking about it and make a choice now.”


Provide time management aids, such as calendars, clocks, timers, schedules, peer leaders and coaches, work teams, etc.


Rewards can be a tremendous benefit to a child who has difficulty aligning internal desires with external demands. Use rewards, but heed the following cautions:

Using Rewards to Increase Production

Rewards do not teach the child how to reflect on and alter perceptions, emotions, thoughts or actions, they simply reward the presence of desired behaviors.

Reward programs imply that a child can do it if he/she wants to or is motivated enough. This often leads away from the realization that many children who are motivated and do want to change their behavior don’t know what to do to change it.


Punishment in mild form can be an effective means of obtaining compliance with external demands. When choosing to use punishment, heed the following cautions:

Using Punishment to Increase Production

Punishment does not teach the child how to reflect on and alter perceptions, emotions, thoughts or actions, they simply punish the presence of undesired behaviors.

Punishment implies that a child can do it if he/she wants to or is motivated enough. This often leads away from the realization that many children who are motivated and do want to change their behavior don’t know what to do to change it.

Bridging Strategies

Encourage the engagement of executive functions through the use of reflective questioning.

Reflective Questioning

Repeat the child’s question back to the child instead of providing an answer. In situations where the child seems unaware of the need to be asking questions for adequate engagement, reflective questioning involves the mediator asking the child a question that is intended to make the child aware of the need to engage executive functions.

Bridging Strategies

Provide immediate and frequent feedback about the effectiveness of attempts to engage self-regulation executive functions. Providing students with feedback about their performance enables them to engage executive capacities more effectively to learn from their mistakes and improve future performance.

Feedback About Accuracy

When providing feedback, be sure to emphasize the importance of effort; make sure the child realizes that self-regulation is not simply something you have or don’t have – it can be increased by applying techniques and strategies; the more effort placed into applying the techniques, the more likely the improvements.

Bridging Strategies

Model appropriate use of self-regulation executive function capacities

Bridging Strategies

Teach self-regulation capacities as specific skill routines using Cognitive Strategy Instruction approaches (e.g. Graham & Harris Self-Regulated Strategy Development approach for Written Expression).

Bridging Strategies

Strategy Example – CC3 Method:Carefully CONSIDER (accurately

perceive) and COPY the word.COVER and COMPOSE the word.COMPARE your spelling with the

word and CORRECT any errors you see.

Bridging Strategies

Develop a common vocabulary and set of nonverbal symbols for describing or signifying self-regulation capacities and signaling their use (e.g., cueing flexibility with “The Coconut Story”)

Based on assessment of EF difficulties, school psychologist and 9 year-old student established cue vocabulary that staff and parents used:“Read the room”—to increase perceive

and monitor capacity“Start”—to increase initiation“Wait”—to increase inhibition“Check”—to monitor work or behavior“Correct”—to edit/fix errors

Bridging Strategies

Bridging Strategies

Practice and rehearsal of the use of executive functions. This is the single best way to increase engagement and efficiency of the use of executive functions.

Bridging Strategies

Align external demands with internal desires to maximize motivation.

Allow self-selection or choice of assignments whenever possible

Use high interest material to illustrate application of new knowledge and skills

Internal Control Strategy

Once learned, the child can use internalized “self-talk” as a means of increasing awareness of executive functions and of when and how to use them (e.g., modified Berninger mantra for writing: “What I can think I can say. What I can say I can write. What I can write I can revise.”)


Model and teach the use of self-administered reward routines to increase the use of self-regulation executive functions (e.g., teach the child how to “bargain with yourself” to get homework accomplished).


Teach the use self-monitoring routines. These routines can be used to monitor and correct perceptions, feelings, thoughts and actions.

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Specific Programs and Approaches to

Improving Clients’ Executive Functions include the following:

Executive Functions Interventions

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Teaching self-control in Preschool and Kindergarten; programs such as Tools of the Mind (Bodrova and Leong) are being used to increase the self-regulation capacities of young children.


Early Childhood Evidenced Based Interventions: Tools of the Mind

Teachers can have a positive effect on children’s self-regulatory capacities (e.g., Burchinal, Peisner-Feinberg, Bryant, & Clifford, 2000).

Interventions that include self-regulatory components are more likely to improve achievement (Blair & Raza, 2007).

Early Childhood Evidenced Based Interventions: Tools of the Mind

Children who participated in Tools of the Mind classrooms had higher rates of self-regulation than matched controls and self-regulation levels correlated with achievement in literacy and mathematics (Diamond, Barnett, Thomas, & Munroe, 2007).

Early self-regulation has a stronger association with school readiness than IQ or entry-level pre-reading or pre-math skills (Blair, 2002. 2003; Normandeau & Guay, 1998).

Techniques Used in Tools of the MindSelf-Regulation Activities Children practice self-regulated learning throughout the day by

engaging in a variety of specifically designed developmentally appropriate self-regulation activities.

Children learn to regulate their own behaviors as well as the behaviors of their friends as they enact increasingly more complex scenarios during imaginary play activities.

Briefer activities are also used. For example, children practice inhibitory control during an activity called Graphics Practice. Children draw different kinds of marks to music and must stop and start on cue.

Techniques Used in Tools of the MindDramatic Play

The cornerstone of Vygotsky’s theory of cognitive development on which the curriculum is based. Structured dramatic play involves role-playing scenarios that are planned and agreed upon in advance. Engaging in sustained role-playing requires the inhibition of role-inappropriate behaviors, as well as the use of working memory to sustain attention and effort to the imaginative enactment of the selected role.

Techniques Used in Tools of the MindScaffolding

The strategy of providing, and gradually removing, external support during learning and producing activities. During scaffolding the task itself is not changed but what the learner initially does is made easier with support. As the learner takes more responsibility for performance of the task, less assistance is provided.

Scaffolding attempts to move the child further along the continuum of self-regulation from being externally regulated by others to engaging in "shared" regulation to eventually becoming self-regulated.

Techniques Used in Tools of the MindExample of the Use of Scaffolding:

If a child needs support to approach writing as a task that is performed from left to right, the teacher may begin shaping the behavior by explaining to the child that writing begins on the left and progresses across the page. Verbal prompts may be used several times, then a mediator (a visual prompt such as an asterisk) is placed on the left side of the page to remind the child of where to start writing. Once the child follows the visual prompt without difficulty or hesitation, the asterisk is no longer placed on the page.

Techniques Used in Tools of the MindReflective Thinking

Refers to thinking about how you arrived at an answer or how you are thinking about something. Reflective thinking involves the use of metacognition (the ability to think about thinking).

During activities, children are asked to think about how they arrived at an answer or how/what/why they are thinking about something. Teachers model their use of reflective thinking by explaining to children what/how they are thinking about something.

Techniques Used in Tools of the MindUsing Props to Enhance Attention and

Working MemoryPhysical props are used as reminders of what

the child should be doing during an activity.For example, during an activity where children

read to each other. The reader holds a picture of lips and the listener holds a picture of an ear. The pictures are exchanged when the roles are switched.

Techniques Used in Tools of the MindUsing Props to Enhance Attention and Working

Memory: Continuum of OutcomesThe children learn to transition from both wanting to

read and neither wanting to listen, to one listening while holding the ear and one reading while holding the lips, to not needing the physical props to engage in the reciprocal roles, to changing the passive role of listening into an active role of listening and asking questions of the reader to a final state where active listening becomes an internalized process for enhancing the listener’s comprehension.

Techniques Used in Tools of the MindSelf-Regulatory Speech

Activities involve teaching children how to internally regulate speech and use internal speech to monitor external events.

For example, children pair off and collaborate in counting objects; one child counts aloud, and the other monitors the oral counting of the first child. The child doing the monitoring learns to inhibit the desire to count for themselves and instead to listen to the counting of the other child and to think metacognitively about the accuracy of the other child’s counting.

Evidence Based Intervention: Cognitive Strategy Instruction

Cognitive Strategy Instruction (CSI) emphasizes the development of thinking skills to increase learning and production. CSIs help students to become more strategic, self-reliant, flexible, and productive in their learning endeavors (Scheid, 1993). Use of these strategies have been associated with increased academic production (Borkowski, Carr, & Pressley, 1987; Garner, 1990).

Evidence Based Intervention:Cognitive Strategy Instruction

CSI techniques employ metacognition and focus on modeling and teaching students strategies for completing tasks and routines and then modeling and teaching methods for self-cueing the use of the strategies.


CSI techniques have been used effectively to improve written expression, reading comprehension, math calculation and problem-solving, study skills, test-taking, and project completion.


Lynn Meltzer (2010) employs CSI techniques in the Drive to Thrive classroom program and the BrainCogs and Essay Express software programs.


Drive to Thrive and BrainCogs both address five general areas of self-regulation:

Goal Setting, Planning and PrioritizingOrganizingRememberingShifting and Flexible Problem-SolvingSelf-Monitoring and Self-Checking

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Cognitive Behavior Therapy (CBT).CBT teaches strategies for improving the use of executive functions to cue and direct effective perceiving, feeling, thinking and acting. Techniques have shown good results at the adult and adolescent levels and some early indications that the techniques can be applied effectively with children in the elementary grades.


Evidence Based Intervention:Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) emphasizes collaborative reality-testing and the monitoring and modification of automatic perceptions, feelings, thoughts, and actions that cause difficulties for the child.


CBT with children and adolescents: Reduces the use of thought logsFocuses on internal experiences such as

monitoring perceptions, feelings, thoughts and actions

Works toward affective shifts to illustrate the cognitive model

Summarizes session content frequentlyKeeps abstractions to a minimum, focusing

instead on concrete examples based on personal experience


Outcomes of CBT with children and adolescents: Increased ability to monitor perceptions,

feelings, thoughts and actionsIncreased engagement in positive

problem-solving strategiesIncreased capacity for self-regulating

perceptions, feelings, thoughts and actions


CBT has been used with children and adolescents to deal with: DepressionAnxietyBipolar DisorderEating Disorders


CBT has been used with children and adolescents to deal with: ADHDDisruptive Behavior ProblemsObsessive-Compulsive

DisorderSocial Skills Deficits

Evidence Based Intervention: CBT for Depression

“Since depression is most often an episodic disorder, it usually improves over time. With young children, CBT has been shown to be more effective than 'watchful waiting' and more effective than traditional school counseling as a treatment for depression. With adolescents, CBT has also been shown to be more effective than 'watchful waiting' and more effective than nondirective supportive therapy.” www.abct.org

Evidence Based Intervention: CBT for Depression

“For moderately to severely depressed adolescents, the most effective treatment at this time is the combination of CBT and an SSRI medication. In the NIMH-sponsored Treatment for Adolescents with Depression Study (TADS), this combination led to the best outcomes in terms of both reduced depression and reduced risk of suicidal events.” www.abct.org

Evidence Based Intervention: CBT for Substance Abuse

“Support for CBT was found in a recent review of the quality of evidence in support of outpatient interventions for adolescent substance abuse (Becker & Curry, 2008). Across 31 randomized controlled trials, CBT was the outpatient intervention supported by the highest proportion of methodologically stronger studies.” www.abct.org

Cognitive Behavior Therapy Resources for Practice

Friedburg, R. D., & McClure, J. M. (2002). Clinical practice of cognitive therapy with children and adolescents: the nuts and bolts. New York: Guilford Press.

Mennutti, R. B., Freeman, A., & Christner, R W. (Eds.) (2006). Cognitive-behavioral interventions in educational settings. New York: Routledge.

Cognitive Behavior Therapy Resources for Practice

Reinecke, M.A., Dattillo, F.M., & Freeman, A. (Eds) (2003). Cognitive Therapy with Children and Adolescents: A Casebook for Clinical Practice.

Kendall, Philip C. (Ed) (2005). Child and Adolescent Therapy: Cognitive-Behavioral Procedures (3rd ed.). Guilford Press.

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CBT variants such as Jeffrey Schwartz’s “Brain-Lock: Free Yourself from Obsessive-Compulsive Behavior; subtitled as “a four-step self-treatment method to change your brain chemistry.” This method uses CBT oriented techniques to strengthen self-regulation capacities and decrease unproductive perceptions, feelings, thoughts and actions.


133

Ross Greene’s Collaborative Problem-solving approach featured in his books on Treating Explosive Kids. Although Greene does not specifically use the concept of executive functions, his intervention approach teaches parents techniques for improving both external control and building internal self-regulation capacities.


134

Myrna B. Shure’s I Can Problem-Solve (ICPS) techniques for teaching young children increased self-control and improved cueing of appropriate problem-solving routines.


135

Rueven Feuerstein’s approach to improving cognitive functioning through instrumental enrichment, mediated learning and dynamic assessment, all focused on increasing self-regulation through increased self-awareness and strategy use.


136

Michelle Garcia Winner’s Social Thinking Curriculum Superflex. Uses cartoon characters to teach about self-regulation concepts (e.g., Rock Brain represents inflexible thinking). Intended for upper elementary age children diagnosed with Asperger’s, but the techniques and ideas appear to have wider application.


137

Computer-based cognitive training programs such as CogMed and neurofeedback programs are being closely studied to determine the extent

to which they can be used to improve self-regulation in

settings other than the “computer lab.”


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Mindfulness-based CBT improves Self-Awareness and Self-Analysis capacities through the incorporation of meditative techniques along with teaching strategies for regulating perceptions, feelings, thoughts and actions, making it more likely that learned CBT strategies will be cued when needed.


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Use of Meditation, especially witnessing meditation

techniques. Improving all forms of self-control, especially Self-Awareness, through “quieting of the mind.”


140

Fostering development of internal and external control mechanisms through “strengthening of the will”; Improving or Developing “Magnetic Center” therapeutic

techniques such as Roberto Assagioli’s Psychosynthesis.


141

Mindfulness-based Physical Exercise Programs such as Yoga and Thai Chi are likely to have generalized effects on a number of self-

regulation executive functions.


142

Time - Natural maturational processes affect executive functions at all levels; time-related expectations for EF development often need to be adjusted (e.g., recall the 30% developmental delay often found

with individuals with ADHD)


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Pharmacological - Medications help increase executive functions use in conditions such as ADHD, mood disorders, and OCD. In most cases, the medication does not directly enhance EFs but rather reduces the disrupting effect of less than optimal function of other neural circuitry.


144

Engage the Services of a Cognitive Coach (i.e., Rent-a-Lobe) Make extensive use of an external executive function substitutes where appropriate, e.g., ADHD and Life Coaches.


145

Encourage Symbiotic Relationships (e.g. “Marry-a-Lobe” and Support Networks. Enter into relationships where there is a mutual interdepend- ence that enables reduction of the effects of EF deficiencies.


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Progress monitoring of interventions targeting

the improvement of the use of executive functions.


EF Assessment Using the MEFS-SRAVEffectiveness RatingsRate the students use (or disuse) of the 23 Self-Regulation Executive Functions using the following criteria:

Internally Self-Regulated

Externally Guided Externally Controlled

Typically self-regulates this executive function.

Typically does not self-regulate this executive function but demonstrates the capacity to use this executive function when external guidance is provided.

Does not self-regulate; use of this executive function is minimal or non-existent even when external guidance is provided; External control is required as a substitute to maintain adequate functioning.

7 6 5 4 3 2 1

Extremely effective; does not require any external guidance; highly independent with self-regulation.

Effective; usually does not require any external guidance; often independent with self-regulation; may occasionally require some external guidance.

Requires only minimal external guidance to maintain the effective use of this executive function.

Requires frequent external guidance to maintain the effective use of this executive function.

Requires very frequent external guidance to demonstrate the use of this executive function; use is not maintained even when guidance is provided.

External control can be used to effectively substitute for the absence of this executive function; the lack of this executive function is apparent when external control is not present.

External control is only marginally effective or not effective at all as a substitute for the absence of this executive function; a lack of this executive function is apparent even when external control is present.

EF Assessment Using the MEFSMODULATECues the regulation of the amount and intensity of mental energy invested in perceiving, feeling, thinking, and acting.

InternallyRegulated

ExternallyGuided

ExternallyControlled

MODULATE

Perceiving

Self Others Environs Academics

3

7 6 5 4 3

2 1

Feeling 3 2-3 5 3Thinking 2 3 3 2

Acting 6 2 5 2

Notes: very negative about self and others; has a hard time returning to a calm state once agitated; finds academic work extremely frustrating; cannot modulate attitude toward schoolwork.

Self Regulation Capacity: Focusing and sustaining attention when working independently on tasks.

Duration Frequency

1Never

0% of the time.

2Occasionally

Approximately10% of the

time.

3Sometimes

Approximately20%-40% of the

time.

4Often

Approximately50%-70% of the

time.

5Very Often

Approximately80% of the time.

6Almost AlwaysApproximately

90% of the time.

7Always100% of the time.

1Unable to focus and sustain attention for more than a few seconds when independently working on tasks.

2 Able to focus and sustain attention for about 1 minute when working independently on tasks.

3Able to focus and sustain attention for about 2-3 minutes when working independently on tasks.

4Able to focus and sustain attention for about 5 minutes when working independently on tasks.



7Able to focus and sustain attention for 20 or more minutes when working independently on tasks.

Self Regulation Goals for Lauren A College-Age Student Diagnosed with Asperger’s Disorder

Self Regulation Goal: Effectiveness Rating

Use appropriate problem-solving routines to reduce excessive negative emotional reactions and resistance to engagement when routines are altered or unappealing tasks must be completed.

InternallyRegulated

ExternallyGuided


7 6 5 4 3 2 1


Work through and resolve difficult situations by use appropriate problem-solving routines to generate and compare alternate scenarios and selecting the most appropriate course of action.

InternallyRegulated

ExternallyGuided


7 6 5 4 3 2 1


Recognize the need to engage in self-advocacy and use an appropriate problem-solving routine to determine what to do and how to do it and then carry out the actions needed to effectively address the self-advocacy need.

InternallyRegulated

ExternallyGuided


7 6 5 4 3 2 1


Recognize the need to engage in good personal hygiene routines, learn the necessary routines, and perform the routines on a daily basis.

InternallyRegulated

ExternallyGuided


7 6 5 4 3 2 1

Strategies for Improving Assessment Methods

1) Offer bonus points for handing in homework and assignments on time instead of taking points away

2) Point out minor errors and offer students a chance to correct them before assigning a grade


3) Offer feedback and opportunities to revise writing assignments before grading them

4) Offer students choices for ways to demonstrate content knowledge


5) Offer credit for all efforts to correct work; offer opportunities to retake failed tests

6) Deduct no more than 5-10% of total points for minor detail errors


7) Offer multiple ways to participate in classroom activities, not just oral expression

8) Use pop quizzes only as a diagnostic tool rather than a graded performance measure


9) Offer response choices (word banks) for open-ended question formats

10) Provide guidelines and progress checks for long-term projects


11) Avoid placing constraints on response modes as much as possible

12) Teach note-taking, memory strategies, and study skills when necessary

assessment and intervention for executive function difficulties part 3

Documents

improved behavior

behavior of family

behavior support plans

plans of behavior support

external control

patterns of problem

external demand

versuslearning difficulties