• Presenters: • Carol Roberts-Hassen, Occupational Therapist • Kim Greer, SELF 10 teacher

Practical Solutions to Supporting Executive Function Development

Outline

• What are the skills of executive function. • Explore what does typical development look

like. • What are some strategies to support skill

development.

Executive Function Because executive function develops so slowly and is associated with a part of the brain (the prefrontal cortex) that continues to develop into adulthood, it is not surprising that impairments in executive function are associated with so many different disorders with childhood onset. Executive function appears to be a fragile, complex developmental achievement that is vulnerable to disruption from a variety of sources, ranging from genetic abnormalities to environmental stressors.

Philip David Zelazo, PhD

Neo-cortical systems of executive function

• JEM Judgment (foresight and hindsight) Emotional Tone Memory Motivation • APES Appreciates and Anticipates Plans, Programs Executes Skills and Survival Strategiums

• Response Inhibition: The capacity to think before acting. • Working Memory: The ability to hold information in memory while

performing complex tasks. • Self-regulation of affect: The ability to manage emotions in order to achieve

goals, complete tasks, control behavior, or direct behavior. • Sustained Attention: The capacity to maintain attention to a situation or

task in spite of boredom, distractibility, or fatigue. • Task Initiation: The ability to begin projects without undue procrastination,

in an efficient or timely fashion. • Planning/Prioritization: The ability to create a roadmap to reach a goal or

to complete a task. • Organization: The ability to arrange or place things according to a system. • Time Management: The capacity to establish how much time one has, how

to allocate it, and how to stay with time limits and deadlines. • Goal-directed Persistence: The capacity to have a goal, follow through to

the completion of the goal, and not be put off by or distracted by competing interest.

• Flexibility: The ability to revise plans in the face of obstacles, setbacks, new information, or mistakes; it relates to adaptability to changing conditions.

• Metacognition: The ability to stand back and take a bird’s-eye view of oneself in a situation; the ability to self-monitor and self-evaluate.

Executive Skills in normal developing Children and Adolescents: A Practical Guide to assessment and Intervention by Peg Dawson and Richard Guare

• Pre School: Run simple 1-step errands such as “Get your shoes from the bedroom.” Tidy living environments with assistance. Perform basic self-help skills with reminders.

• Inhibit behaviors: don’t touch a hot stove, don’t run in the street, don’t grab another child’s toy, don’t hit, bite, push, etc.

• Kindergarten—2nd Grade: Run 2-3 step simple concrete errands.

Tidy routine living environments. Perform simple chores. Bring papers to and from school. Complete homework of 20 minutes duration. Decide how to spend allowance.

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

Executive Skills in normal developing Children and Adolescents: A Practical Guide to assessment and Intervention by Peg Dawson and Richard Guare

• Grades 3-5: Run simple concrete errands that may require a time delay or remembering to perform after school. Complete chores taking 15 to 30 minutes. Bring books, papers, and assignments to and from school. Homework completion can last 1 hour. Plan simple school projects such as book reports, e.g. select, read, report on a book. Keep track of changing after school activities. Save personal money for desired objects, plan how to earn money.

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

• Grades 6-8: Help with daily and weekly chores. Task may take 60-90 minutes to

complete. Baby-sit younger siblings. Use system to organize homework including agenda book, notebooks, etc. Follow complex changing school schedules keeping up with subjects and teachers. Plan and carry out long-term projects, including task to be completed and timelines. Plan time to manage after school activities, homework, and family responsibilities. Adjust schedule to fit varies task completions.

• Inhibit rule breaking in the absence of visible authority.

Executive Skills in normal developing Children and Adolescents: A Practical Guide to assessment and Intervention by Peg Dawson and Richard Guare

• 9th-12 grade: Manage schoolwork effectively on a day-to-day basis, including completing and handing in assignments on time, studying for test, creating and following timelines for long-term projects, and making adjustments in effort and quality of work in response to feedback from teachers and others (e.g. grades on test, papers). Establish and refine long-term goal and make plans for meeting that goal. If the goal beyond HS is college, the youngster selects appropriate courses, pre-college exams (SAT/ACT), and maintains grades to ensure acceptance into college. The young adult can show employability skills if on a vocational track. Makes good use of leisure time including school organizations, homework, household chores, and part time job.

• Inhibits reckless and dangerous behaviors (e.g. use of illegal drugs, shop lifting, sexual acting out, or vandalism.

Complex/Concrete Problem Solving • You have a busy day ahead. You have a doctor’s appointment. You

must also go to the party store to buy decorations for a party, fill up the car with gas, go to the post office to mail a package, and go to the bank to get enough money to pay the doctor’s fee. (He demands cash on visits.) You must order and pick up a special ice cream cake for a relative’s birthday, bring your prescription to the drugstore, and meet a friend for lunch.

• The post office, bakery, drugstore, and party store all close at 5:00 p.m. and the bank closes at 3:00 p.m. It is now 10:00 a.m. Your doctor’s appointment is at 2:00 p.m.

• At what time should you leave the house? Where will you go first, second, third, etc.?

Examples of Social Skills Department of Adult Rehabilitative Services (DARS)

• Introduce self to a stranger, manager, peer. • Looks up when spoken to. • Initiate social niceties such as saying, “Hi/Bye” • Can answer a question with more detail than just “yes/no”. • Can respond to a question within 5 seconds. • Stays on topic being discussed. • Can add, an on topic commit, or respond on topic. • If topic deviates, could be re-directed back to conversation. • Can make basic needs known to others. • Can follow directions. • Accepts feedback of performance and adjust accordingly. • Allows others to express thoughts and feelings. • When exposed to differing thoughts and feelings, can identify when to “agree to

disagree”. • Accepts new people within a short period of time.

Examples of Self-Regulation and Emotional Intelligence (DARS)

• Will not melt down when asked to wait for instructions or task to begin. • Accept “no” or “not now” from the person in charge. • When they have a persistent thought or obsession, can they let it go. • When upset, have appropriate work place strategies for self calming. • Identify when a co-worker or person in charge is upset, and what made

them upset. • Within work scenarios, identified when someone is joking, sarcastic,

exaggerating, or lying. • Within work scenarios, identify “small” verses “big” problems and how

to react accordingly • Within work scenarios, identified what to do if going to be late, absent,

or leave early • Appear to want to please the person in charge. • Arrive and come back from breaks on time.

Examples of Problem Solving and Executive Functioning (DARS)

• Worked through a frustrating task. • Asked for help or clarification. • When presented with a problem, was able to identify

multiple ways to resolve it. • Without notice, was able to have their “schedule” for the

day changed. • Without notice, was able to have their work interrupted. • Worked task to completion. • Worked at a reasonable pace. • Moved onto the next known task, or asked for a new task. • Make decisions in a reasonable time frame. • When faced with multiple tasks, was able to prioritize.

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Transition Decision-

Making Matrix

Participation low to moderate ID range

Individual is not able to generalize or transfer learning due to severe or profound mental impairments. Cognitive deficit is significant, perhaps in combination with severe physical or sensory deficits. His ability to perform activity-related tasks with any consistency is not reliable. His dependence on others for most, if not all, daily needs makes necessary an extensive ongoing support system. Therefore the individual needs an extensive ongoing support system requiring cooperative effort by home, school, and community. Executive Functions: Needs external support to identify problems and formulate goals. Needs all caregivers to consistently present supports in same fashion and format. Needs consistent monitoring to plan, sequence, and organize activities. Needs external support to self-monitor with dependent ability to internally structure new or changing events. Needs step by step guidance to initiate and maintain problem-solving activity. Needs external support to change in response to failure or feedback. Have generally dependent social skills due to poor inhibition of emotional response to any given situation. Has a short attention span and temporal awareness. Needs concrete guidance/assistance to use compensatory strategies, with repeated practice. Needs concrete guidance/modeling to modify behavior, with repeated practice to master. Frequently non-verbal or with pre-school based language skills. Needs frequent checks for understanding.

Supported Independence moderate to high ID range

The individual with supported independence has a moderate mental impairment and is expected to require ongoing support throughout adulthood. Performance expectations focus on task completion and activities of daily living, enhancing quality of life, and maximizing personal effectiveness for living in supervised living setting. They can perform previously learned routines and demonstrate some level of independent living skills. Academic team is aiming for this individual to live a productive and fulfilling life with as much independence and personal decision-making as possible. Executive Functions: Limited ability to internally structure, resulting in occasional disorganized thinking. Limited temporal awareness without external structure. With practice can change response from feedback. Doesn’t always recognize failure. Needs extensive repetitive learning opportunities. Limited ability to self-monitor. Modeling, visuals, and motor sequencing frequently best learning styles. Can perform simple concrete problem-solving task, with practice and life experience of hindsight learning. Needs concrete experience of failure to motivate for change. Functions best within planned/structured/routine activities. Has limited attention span. Has limited spatial visualization and spatial reasoning. Have inconsistent social skills, due to inconsistent emotional inhibition, e.g. speech impulsively, and social pragmatics. Needs concrete training on all levels of social skills. Needs repeated prompts and repeated opportunities to use compensatory strategies. Needs repeated prompts and repeated opportunities to modify behavior. Needs opportunity to relearn skill in new environmental settings

Functional Independence low to average IQ range

Individual has mild cognitive limitations that impact his ability to transfer or generalize learning across all performance domains, or functions as if he had such impairment. He should be able to assess personal strengths and limitations, and to access resources and supports. Student may require content and instructional strategies focusing on a balance of functional academic skills and functional daily living skills. He is capable of meeting his needs and living successfully in the community without overt support from others. Student may require content and instructional strategies focusing on independent living skills. Instruction must be concrete and relevant to each setting, as ability to generalize is limited. Executive Functions: Needs concrete visuals to help learn the process of planning and organizing activities. Needs concrete practice in the steps to problem-solving and goal formulation. Needs external structure to initiate, maintain, and disengage from problem-solving activities. Needs external structure and training in self-monitoring techniques. Can develop sequential logic. Can develop ability to describe categorical qualities and see relationships. Ability to derive abstract meaning and form abstract intent can be limited. Has limited insight and ability to self evaluate. Has near normal spatial visualization, spatial reasoning, and non-verbal problem solving. Can generate and evaluate some alternative solutions to a problem, but will need concrete experience to find the best solutions. Needs external structure to develop the skill of self-monitoring. Needs external structure for the development of some social skills. Attention span and memory skills may need external structural supports in early years of maturation. May need verbal/visual reminders to use compensatory strategies. May need verbal reminders to modify behavior.

Full Independence Average to Above Average IQ range

An individual may have physical, emotional, or learning disabilities, but functions in the normal range of intelligence. His cognitive abilities allow him to transfer or generalize learning across all domains. Student is aware of cognitive processes, personal work characteristics, and interpersonal effectiveness. The fully independent person has developed a comprehensive set of skills, competencies, and orientations to complete tasks and activities encountered within the major performance contexts of adult life. Executive Functions: Due to the physical, emotional, or learning disability this student may be less mature than his school peers and need structural support similar to the functionally independent learner. It could be expected that this student might require less repeated opportunities to learn the models presented to him compared to the functionally independent learner. However, he might be noticed for needing support and structure due to his inability to keep up with his school age/cognitive age peers. Can modify behavior upon request or in different environments due to self-awareness of personal strengths and weakness. Can use compensatory strategies due to self-awareness of personal strengths and weakness. Could benefit from concrete visuals. Could benefit from concrete practice. Could benefit from external structure. Could benefit from guidance.

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Performance Expectations (PE)

• Performance oriented. • Drive program elements and assessment systems • Reflect empowerment • Aid in understanding criteria for an outcome

achievement. • Provide orientations that relate to the fulfillment of an

adult living role. • Based on cognitive ability within each performance

category. • Have a social behavioral component that may reflect

lower levels of performance than the cognitive ability.

Are:

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Moving Towards Reduced Behavioral Support

Independent No Supports

needed for that behavior

Good effort at ...

What are you suppose to be

doing?

Give concrete examples or

model . . .

Student Mastery

Unconscious Incompetent

Conscious Incompetent

Conscious Competent

Unconscious Competent

Situational Observational Tools • Management of homework, papers to and from school. • Play ground, social interaction skills • Idea generators of DMM. (adult living, Social/rec/leisure/LLL) • Weekly home chore chart. • Help the student learn to problem solve in teachable moments. • Direct teach with concrete practice, e.g. “How long do you think

this activity will take?”. “Can you list/name all the steps”. • “What is the hardest part for you?, Let’s do that first.” • Fade supervised, structured practice as student can answer

prompts such as • “What do you need to do next?”, or • What have you tried?”, or • What else could you do?”

National Center on Birth Defects and Developmental Disabilities (CDC)

www.cdc.gov/actearly • Has free handouts on developmental milestones.

Starts with 2 months progresses through teen years. Addresses

• Social/Emotional • Language Communication • Cognitive • Movement/Physical Development www.cdc.gov/ncbddd/childhooddevelopment/po

stiveparenting/middle2.html ;adolenscene.html;2

Observe Your Parent Talk Choose encouraging language “Please make a different choice.” “Please make a decision.” “I know you can handle it.”

Avoid discouraging statements “Let me do that for you.” “There you go again!” “Be careful or you’ll spill that!” www.cdc.gov/ncbddd/childhooddevelopment/postiveparenting/middle2.

html ;adolenscene.html;2

1-2-3 Magic! Dr. Thomas W. Philan

• http://www.hitinc.org/uploads/resources/880/1-2-3-magic.pdf

• He offers practical ways to help • Start new behaviors or • Stop old behaviors.

Any Questions Now?

• Contact information • Carol.Robertshassen@leanderisd.org • Denise.Geiger@leanderisd.org • Kimberly.Greer@leanderisd.org