EXECUTIVE FUNCTION IN ADHD : DEFICIT AND INTERVENTION

Prof Heba Essawy

MD psychiatry Prof of Psychiatry , Ain Shams University

Executive Functions (EF) : Definition

EF is a neuropsychological concept referring to the cognitive processes required

to plan and direct activities, including task initiation and follow

through working memory, sustained

attention, performance monitoring, inhibition of impulses, and goal-directed persistence.”

(Dawson & Guare,

2004, )

Executive Functions : Importance

Organize our behavior over time and override immediate demands in longer-term goals”

Management of emotions and effective thought monitoring.

Allow the child to perform correctly .

Annie Shave 2011

Subtypes Of Executive Function 1-Response

Inhibition 2- Working

Memory 3-Self-Regulation

Of Affect 4- Sustained

Attention 5- Task Initiation

6- Planning 7- Organization 8-Time

Management 9-Goal-Directed

Persistence 10- Flexibility 11-

Metacognition

1-Response Inhibition RI

Is “the capacity to think before you act”

The deficit tend to be impulsive. Impulsive behavior Saying words without thinking .

2- Working Memory WM

WM is the ability to hold information mind while performing complex tasks

This deficit tend Forget easily. Forget their homework or

books at school .

3-Self-Regulation Of Affect

SR is the ability to manage emotions in order to achieve goals, accomplish tasks, or control and direct behavior”.

This deficit tend upset quickly with situations,

unable to control their emotions. to have outbursts that disrupt

daily functioning.

4- Sustained Attention

SA is the capacity to maintain attention to a situation or task in spite of distractibility, fatigue, or boredom”

. Deficit tend

to have a hard time getting started on a task.

talk when they shouldn’t.

attention is on everything in the room other than their work.

5- Task Initiation

TI is the ability to begin a task without undue procrastination, in a timely fashion

Deficit tend Put off doing work that they need

to complete. Lack the processes to start the

task.

6- Planning

Planning is the ability to create a roadmap to reach a goal or to complete a task.

It also involves being able to make decisions

to focus on and what’s not important. Deficit tend

to wait till the last minute to complete tasks

don t know what to do when they have to complete them.

7- Organization

Organization is the ability to arrange or place things according to a system .

Deficit tend to have messy desks . lose papers and books instead of

putting it in its proper places

8-Time Management

Time management is the capacity to estimate, allocate, and execute within time constraints

Deficit tends to Get work done at the last minute Frequently ask for assignment

extensions. Use excuses for not having work.

9-Goal-Directed Persistence

Goal – Directed is the capacity to have a goal, follow through to the completion of the goal, and not be put off by or distracted by competing interests.

Deficit tends to create goals for themselves but are not

able to achieve them. not understand the best steps to reach a

goal always distracted impacting their task

completion.

10- Flexibility

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

Deficit tends to have difficulty in transitions and new

situations. struggle longer at the beginning of each

year. have limited problem solving strategies.

11- Metacognition

Metacognition is the ability to observe how you problem solve. It also includes self-monitoring and self-evaluative skills.

Deficit tends to make careless mistakes frequently. complete one step then stop instead of finishing

the series of steps. not reflecting on the whole process needed to

complete the task.

Methods Of Intervention

Executive Functioning Deficits Classroom Interventions Skill Training

Response Inhibition:Intervention

Classroom Intervention : Reduce situations where the child can

get into trouble Increase supervision of the child

Skills training : Discussion situations to use the skill Explore the skill and behaviors Model behaviors Reinforce positively the skill Ignore bad behavior

Dawson & Guare, (2004).

Working Memory: Intervention Classroom Intervention: Enforce use of assignment books

consistently Utilize checklists and to-do lists Use cue as verbal reminders, alarm

clocks. Skills training :

Explain the skill Give different cues and checklists to the child Make a monitoring system for the child to monitor

their own skill

Dawson & Guare, (2004).

Self-Regulation Of Affect: Intervention

Classroom Intervention Prepare child for problem situations Give child scripts for problem situations and practice

regularly Structure environment to avoid situations that can

lead to problems Break tasks down into small steps Give breaks to child during tasks as needed Use social stories that teach emotional control Skills training :

Explain the skill Provide coping strategies Practice with the child Reinforce child when strategies are used Discuss real life situations of using the strategy

Dawson & Guare, (2004).

A.Sustained Attention: Intervention Classroom Intervention Write start and finish times on assignments Use incentive systems Break down tasks into steps Make tasks interesting for students Give child something fun to do when task is completed Provide attention and praise when student is remaining

on task Skills training:

Discuss attention time with the student Teach them to break down tasks on their own Help them make work plans for completing tasks Reinforce them when they use the plan

Dawson & Guare, (2004).

B.Task Initiation: Intervention

Classroom Intervention Use verbal cues to get child started Create a visual cue to prompt child to get started, as a

note on their desk Walk through the first part of the task to help child get

started Have child tell you when they will begin the task and cue

them when the time arrives

Skills training : Teach the child to create a written plan for starting the task

including time and type of task Teach child to break down the task if needed Teach child to use cue such as alarm clock to start task Reinforce child when no additional cues are needed

Dawson & Guare, (2004).

C.Planning: Intervention

Classroom Intervention Plan a schedule for the child Use rubrics Break long assignments into smaller pieces with

deadlines for each piece Create planning sheets with due dates Use assignment planners Skills training :

Walk through the planning process with the child Have child model the planning process Tell student to create roadmaps for tasks Ask questions such as “What do you have to do first?”

Dawson & Guare, (2004).

D.Organization: Intervention Classroom Intervention Maintain an organized classroom Create schemes for organizing backpacks

and folders Color-code folders, notebooks, and

papers for classes Skills training :

Teach child to separate papers and categorize them Have them create their own organization plan

Get the plan in writing Have them implement the plan

Dawson & Guare, (2004).

E.Time Management:Intervention Classroom Intervention Give child a schedule to follow Prompt student with each step of a task Impose time limits for assignments Provide frequent reminders for remaining time to

complete task Use cueing devices such as alarm clocks Skills training :

Help child understand what the task involves Have child think of distractions that may be present when

completing task Create an estimated time for completion; compare

estimated time to actual time Find strategies to decrease distractions

Dawson & Guare, (2004).

F.Goal-Directed Persistence:Intervention Classroom Intervention Give students goals and have them keep track of

their progress Goals need to have motivational interest to the

student Include students in establishing goals Create reasonable goals Skills training :

Follow a coaching process: Hold a goal setting session where a goal is set, obstacles are

discussed and a plan is written Hold daily coaching sessions where goal is re-discussed and

progress is assessed by asking questions

Dawson & Guare, (2004).

G.Flexibility:Intervention

Classroom Intervention Give advance warning for new schedules or activities Allow student to practice new schedules or activities Provide rubrics to follow Read social stories to teach coping strategies in

problem situations Offer positive reinforcement and step by step

assistance Skills training :

Teach students what inflexibility is and how to recognize it Teach and model coping strategies with plans and cues Create strategies to fall back on Teach relaxation strategies

Dawson & Guare, (2004).

Metacognition: Intervention Classroom Intervention Ask child to explain how they solved the problem . Give assignments where students can evaluate their

work and give grade. Use rubrics. Skills training :

Define the skill and what is needed to use the skill appropriately

Practice the skill Create error-monitoring checklists Teach children to ask themselves self-monitoring

questions while tasks are being completed

Dawson & Guare, (2004).