executive functioning for students
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Executive Functioning
Alan Babcock, M.Ed.
School Psychologist
Disability Services Coordinator
Penn State Harrisburg
Executive Functioning
“I don’t think of myself as a poor deprived ghetto girl who made good. I think of myself as someone who, from an early age, knew I was responsible for myself and I had to make good.”
Oprah Winfrey
Executive Functioning
“My will shall shape my future. Whether I fail or succeed shall be no man’s doing but my own. I am the force; I can clear any obstacle before me or I can be lost in the maze. My choice; my responsibility; win or lose, only I hold the key to my destiny.”
Elaine Maxwell
Executive Functioning
It matters not how straight the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.
William Ernest Henley
Executive Functioning
“You can be anything you want to be, if you want it badly enough and if you are willing to work for it.”
Charles Babcock
Executive Functioning
• We are in control of our lives.
• We can do anything we want to do.
• If we do not do something, we did not want to do it.
• If we do not do something we want to do, we are LAZY.
Executive Functioning
This point of view is only part of the truth.
Our behavior is the end product of numerous factors interacting with each other.
One of those factors is Executive Functioning.
Executive Functioning
THE STORIES
OF TWO MEN
PHINEAS GAGE
• Construction foreman
• Efficient and capable
• Smart, shrewd businessman
• Treated women with respect
• Well liked by his superiors and the men he supervised
ELLIOT
• Good husband and father
• Competent businessman
• Enviable personal, professional, and social status
• Successful
THE CHANGE
Phineas’ Accident
Phineas’ Accident
THE CHANGE
Immediately following the accident– A few convulsions– Walked to a wagon to take him to the doctor– Spoke with his men on the way– Said to the doctor, “Well I guess this is work
enough for you”– Appeared completely normal with the
exception that he had a hole in his head
AFTER THE ACCIDENT
• Fitful, irreverent, indulging in the grossest profanity
• Little deference for his fellow man
• Generated many plans No follow through
• Good at finding something which did not suit him
• Egocentric
Gage was no longer Gage
THE CHANGE
Elliot’s tumor
and operation
AFTER THE OPERATION
• Needed prompting to get up• Distracted and did not return to the task at hand
• Focused on unimportant details• Poor business decisions• Two divorces• Disregarded good advice from friends
• Turned down for Supplemental Social Security Income
• The doctors thought he was malingering
• His intelligence was intact
• Virtually all of the testing that was done with him was within normal limits
Executive Functioning
What did Phineas and Elliot have in common?
Executive Functioning
An Executive Functioning Disorder
Executive Functioning
Executive Functioning is a hypothetical construct
Executive Functioning
Executive Functioning is on a continuum
No Problem – Slight – Mild – Moderate – Severe Problem
Definition
• Overview– The Executive Functions are the parts of the
brain that work together to direct cognitive activity, including the ability to engage in purposeful, organized, strategic, self-regulated, goal directed behavior
– Conductor of the orchestra – Goal Plan Implement Monitor
Definition
• Behavior Regulation:
–Involves the ability to shift cognitive set and modulate emotions and behavior via appropriate inhibitory control
BEHAVIOR REGULATION
• The ability to inhibit, resist, or not act on an impulse and the ability to stop one’s own behavior at the appropriate time (Inhibit)
• The ability to move freely from one situation, activity, or aspect of a problem to another as the circumstances demand -- key aspects of shifting include the ability to make transitions, problem solve flexibly, switch or alternate attention, and change focus from one mindset or topic to another (Shift)
• The ability to modulate emotional responses (Emotional Control)
Definition
• Metacognition (Thinking):–Involves the ability to initiate, plan
and organize, and sustain future-oriented problem-solving in working memory -- this skill is necessary to self-manage tasks and to monitor one’s performance
METACOGNITION
• To begin a task or activity, as well as independently generate ideas, responses, or problem-solving strategies (Initiate)
• To hold information in mind for the purpose of completing a task -- working memory is essential to carry out multi-step activities, complete mental arithmetic, or follow complex instructions (Working Memory)
• To anticipate future events, set goals, and develop appropriate steps ahead of time to carry out a task or activity (Plan)
METACOGNITION
• To bring order to information and to appreciate main ideas or key concepts when learning or communicating information (Organize)
• To organize work, play, and storage spaces (Organization of Materials)
• To evaluate one’s performance during or shortly after finishing a task to ensure appropriate attainment of a goal (Monitor)
ASSESSMENT
Assessment
Importance of assessment
To intervene effectively:
• You have to identify the problem accurately
• You need to know what aspects of Executive Functioning have to be ameliorated
Assessment
Assessment techniques
• Standardized tests
• Behavior questionnaires
• Work samples
• Observations
Assessment
Problems with standardized tests
• During testing, the evaluator is providing the executive functioning needed to complete the tasks
• Executive skills are in demand during complex open-ended tasks requiring problem solving or unique solutions
• Absence of evidence is not evidence of absence
Assessment
TESTS
• Wisconsin Card Sorting Test
• Delis-Kaplan Executive Function System
• Stroop test
• Rey Complex Figure Test and Recognition Trial
• The Awareness of Social Inference Test, (TASIT)
Assessment
– BEHAVIOR RATING SCALES• Behavior Rating Inventory of Executive Function
--Adult version
--School-age
--Preschool version
• Frontal Systems Behavior Scale™ (FrSBe™)
IMPLICATIONS
OF
DYSFUNCTION
Implications of Dysfunction
• Cognitive– Hypothesis Testing– Abstract Reasoning– Memory Disorders– Attention Deficits– Impaired initiation of cognitive activity
Implications of Dysfunction
• Behavior– Need prompting to start an activity– Failure to follow through– Continue activities without stopping– Impaired attention– Impulsive– Poor planning
Implications of Dysfunction
• Language– Reduction of language production– Difficulty initiating speech– Struggle to maintain a complex, spontaneous
conversation– Indifferent to communication– Trouble ending a conversation
Implications of Dysfunction
• Social Behavior–Social misperceptions–Simplistic thinking–Behavior based on concrete, simple
motivations–Cannot handle the complexity of social
interaction–Underdeveloped “Theory of Mind”
INTERVENTION
Intervention
• Individual
• Support System– Therapist
– Friends
– Parents
– Family members
Intervention
The Process:
AwarenessAcceptanceInstructionPracticeAccountability
Awareness
• Individual
–Executive functioning
–Strengths and challenges
–How the intervention process works
–Benefits of intervention
Awareness
• Support system
–Executive functioning
–Specific problems with which the individual is dealing
Acceptance
• Individual
–“I'm not perfect.”
–“I have strengths and weaknesses.”
–“I need outside help.”
–“I am not to blame for my challenges; I am responsible for managing them.”
–“I have work to do.”
Acceptance
• Support system
–“I cannot expect the person to change without some outside help.”
–“The person is not to blame for his or her struggles.”
–“I may have to make changes.”
–“I have work to do.”
Action
• Individual–Making a commitment to make changes–Providing support personnel with honest
feedback about his or her difficulties –Taking direction from support personnel–Making an honest attempt to use
strategies–Explaining what works and what does
not work
Action
• Support system–Make a connection with the person–Be willing to monitor the individual–Teach specific management strategies–Help the individual to implement
management strategies–Evaluate effectiveness of management
strategies
GENERAL
• Name the problematic behavior
• Become aware of the problematic behavior– When does the behavior occur?– Where does the behavior occur?– With whom does the behavior occur?
GENERAL
• Set a goal
• Develop specific strategies to manage the behavior
• Generate external supports to help you manage the behavior
• Monitor progress
• Fade external supports
SPECIFIC INTERVENTIONS
INHIBITION
• Practice monitoring behavior• Ask others to point out your impulsivity• Before engaging in a new, exciting behavior,
“STOP” and consider the consequences• When engaging in a new, exciting behavior, ask
yourself if you could tell someone who cares about you what you are going to do
• After stopping and thinking, make a conscious decision about engaging in the behavior
SHIFTING
• Become aware of getting stuck• When you notice that you are stuck, engage in
relaxation techniques• Practice coming up with multiple solutions to
specific problems• Generate a specific problem-solving strategy
that considers your needs and the needs of other people involved
EMOTIONAL CONTROL
• Learn specific relaxation techniques and practice those techniques
• Identify when you are beginning to feel intensely
• Apply your relaxation techniques
• Identify problems that precipitate strong feelings
• Deal with that problem
SELF-MONITORING
• Identify a specific task that needs to be completed
• Determine how you will know the task has been accomplished
• Develop strategies that will be employed to complete the task
• Establish points during the process when your progress will be reviewed
INITIATE
• Set a specific time to start
• Have a visual reminder
• Tell someone when you plan to start
• Generate a step-by-step strategy for completing the task
• “Just get started”
WORKING MEMORY
• Externalize your working memory (sticky notes, write out steps for multi-step tasks)
• Write down a “to do” list and review it with another person
• Transfer the “to do” list to a calendar
• Review your calendar at specific times during the day
PLAN/ORGANIZE
• Identify tasks and goals
• Create templates for tasks that repeat
• Review your plan with someone you trust
• Establish time lines for completing the steps
• List then gather necessary materials
• Identify potential obstacles and techniques for managing them
ORGANIZATION of MATERIALS
• Identify specific locations for important materials
• If necessary, label those locations
• Designate a time each day to organize
• Complete the same task in the same location
• Be willing to start over on a regular basis
Resources
Books
• Attention, Memory and Executive Function, editors, G. Reid Lyon & Norman A. Krasnegor
• The Executive Brain, by Elkhonon Goldberg• Executive Skills in Children and Adolescents,
by Peg Dawson & Richard Guare• Descartes Error, by Antonio Damasio• ADHD and the Nature of Self-Control, by Russell Barkley
Resources
Web Sites• http://www.nldline.com/bonnie_singer_and_tony_bashir.htm• http://www.goertzel.org/dynapsyc/1999/morin.html• http://brain.oxfordjournals.org/cgi/content/abstract/
125/3/624?ijkey=8ccb9bde475d0cdc92b613e04e848b278429da7f&keytype2=tf_ipsecsha
• http://www.waiting.com/frontallobe.html#anchor266669• http://braincampus.learnpsychology.com/npsych/frontal.html• http://www.ect.org/effects/lobe.html• http://www.schoolbehavior.com/conditions_edfoverview3.htm