the role of attention & executive functioning in the ... · executive functioning in the...

Executive Functioning In the Process of Learning: Assessment Results and Intervention Tactics

Adam Scheller, Ph.D., NCSP

Copyright 2012. Pearson Education and/or its affiliates. All rights reserved. 1

Disclosure

This free session is sponsored by Pearson Clinical Assessment.

Dr. Scheller is an employee of Pearson. Several examples of assessments and interventions mentioned in this presentation are either published or distributed by Pearson Clinical Assessment.

Let’s Revisit Executive Functioning In the Process of Learning:

Assessment Results and Intervention Tactics

Adam Scheller, PhD, NCSP

3 | Copyright 2012. Pearson Education and its Affiliates. All rights reserved

Agenda

• Overview of executive functioning

– What is it?

• Patterns of executive functioning weakness

– Reading

– Math

– Writing

– Behavior…

• EF assessment

• EF intervention tactics

• Case study





What is Executive Functioning?

• A.R. Luria (1973)

• Russ Barkley

• Andrewes (2001)

• Miyake et al. (2000)

• Evolving definitions

– Micro level: e.g., Cognitive flexibility, Attentional control, Updating, Sequencing, Abstracting

– Macro level: e.g., Inhibitory control, Problem solving, Organization, Planning, Concept Formation


Executive Functioning (EF) Taxonomy

• Executive Control – Inhibition or Disinhibition of behavior,

emotions, speech, cognition, attention, etc.

– Flexibility

• Seeing another point of view

• Metacognition

– Working Memory

– Directly affects processing speed

• Control the ―gate‖ of information


EF Taxonomy (cont.)

• Problem Solving – Plan, sequence, and self-monitor

– Feedback loop, from which we can change the process to be either correct (if incorrect) or more efficient (faster).

• Organization – Ability to order, sort, categorize

• Concept Formation – Categorize – Abstracting

– Situation based judgments.





…with Executive Dysfunction

• Attention-Deficit/Hyperactivity Disorder

• Bipolar Disorder

• Depression

• Autism/Asperger’s Disorder

• Traumatic Brain Injury


…with Executive Difficulties


Development of Executive Functions

• Build-upon, layering, hierarchical

• Earliest executive abilities observed at 12

months

• Three major ―growth spurts‖

• Adolescent ―flat(er) trajectory‖

• Continued improvement (refinement) into adulthood





HOW DO EXECUTIVE FUNCTIONS AFFECT LEARNING?


Grey Matter White Matter


Effects of EF Deficits on Learning

• Average or better IQ, but still having difficulties?

• Interrelated to other aspects of cognition

• Inhibition and…

– School Readiness (Blair & Diamond, 2008; Blair & Razza, 2007; Diamond, et al., 2007)

– Academic achievement (St Clair-Thompson & Gathercole, 2006)

• Working Memory* (www.cogmed.com) • Multiple simultaneous tasks • Dysfluency

http://www.cogmed.com/





Age WM is crucial for… Indicators that WM needs

improvement

Pre-school -Learning the alphabet

-Completing a puzzle independently

-Unwillingness to learn

Elementary

School

-Understanding textual content

(reading comprehension) -Mental arithmetic

-Inability to understand what is read

-Problems memorizing the multiplication table

Middle

School

-Completing homework

independently -Complex math problems, especially word problems

-Can’t complete homework without

parental supervision and direction -Inability to grasp/break down word problems

High

School -Writing essays

-Difficulty writing neat, coherent

essays

College

-Studying for an exam

-Participation in group projects -Keeping focus/interest during a lecture

-Constantly procrastinates; panics the

night before an exam -Doesn’t listen or participate during a group project

-Difficulty remaining attentive during lectures

WM Implications for Learning


EF and Reading

• Reading – Difficulty with Reading Comprehension/Inferring

meaning/Abstraction

– Dyslexics often have affected Inhibition, Working Memory, and design and verbal Fluency (Reiter, Tucha, & Lange, 2005)

• Fluency

– Link to executive functioning and attention

– Difference from Word Identification and Word Attack (WRMT-III)

– Link to comprehension


EF and Math

• Math – Difficulties with multiple steps, algebraic

equations, word problems

– ―Careless Errors‖ – Fluency





EF and Writing

• Writing – Difficulties organizing written output, including

format of arguments, and grammatical and spelling errors • Dysfluent writing, doesn’t transition well within

text • Bullet-point writing

– ―Slow‖ writing


Learning Behavior

OLAI-2 (Gentile, 2011)


HOW DO WE ASSESS EXECUTIVE FUNCTIONS?





EF Assessment is Difficult

• Process vs. singular construct

• Assessment challenges (Dawson & Guare, 2010)

– Ecological Validity?

– Initiation and sustained attention

– Adult monitoring vs. self-monitoring

– Close-ended tasks limit creativity/problem solving

– Real world EF vs. Lab EF


Assessment of EF

• Assess outcomes to uncover the process.

– Skill deficit vs. EF

– Congruence vs. incongruence

• Observation of functional performance to verify process.

– How does weakness affect functional outcome?

– What outcomes are affected…in what areas?

• Look for Patterns

– Behavior to validate assessment findings

– Behavior to understand real world executive functioning


Formal Norm-Referenced Assessment

• NEPSY-2

• D-KEFS

• CVLT-C

• WISC-IV Integrated

• WPPSI-IV

• KABC-II

• WRAML2

• TEA-Ch

• Rey CFT

• BADS-C

• Achievement measures





EF Assessment Process

• Rating Forms • Broad vs. Narrow • D-REF

• Brown ADD • Conners 3

• BASC-2 • BRIEF

• Observations • Do test findings present in-situ?

• Qualitative and quantitative data • Evaluate congruence of test data with the

observed


HOW DO WE DEVELOP EFFECTIVE INTERVENTIONS FOR EXECUTIVE FUNCTIONING

WEAKNESSES?

…LET’S BREAK…THIS…DOWN…


Think of all things that have multiple

steps… …require understanding the main idea

…require us to use multiple skills at once …require us to process multiple factors

simultaneously





The goal of EF interventions

• One at a time…OK, but three at a time…

• Make tasks less complex

• High expectations, but attainable

• ―Retrain the Brain‖

• Build skills!


Brain-based interventions

• Behavioral

• Cogmed • Researchers posit that Cogmed training transfers

to executive functioning, supporting link with executive control and WM. (Diamond et al., 2011; Thorell et al. 2009)

• For more information on Cogmed research, free webinars and demonstrations go to: www.cogmed.com


Behavioral EF Interventions

•Two-pronged Interventions:

– Internally focused

•Skill acquisition, development, refinement

– Externally focused

•Modification of environment or tasks

http://www.cogmed.com/





Externally-Focused Interventions

• Reinforce skill development through focus on learning skills – Interventions can become THE skill

– Reliance on adaptations and modifications

• Examples of Externally-Focused Interventions


Internally-Focused Interventions

• ―Internalize‖ rather than use of external structure or modification.

• Rely less on outside assistance over time

• Examples of Internally-Focused Interventions


Social Problem Solving

• Process of problem solving in the ―natural‖ environment

• Cognitive-behavioral

• Concepts

– Problem Solving

– Problem

– Solution

• Problem Solving vs. Solution Implementation

(Chang, D’Zurilla, & Sanna, 2004)





Remember…

• Give them time, don’t give up

• Implement in multiple settings

• Start basic, then move to more complex


Laura 12 years old

Grade 7, Private Middle School

See NEPSY-II Case Study

www.pearsonassessments.com


Referral Concerns

• Laura was referred for a neuropsychological

evaluation due to her mother’s concern over

Laura’s consistently poor grades in

Mathematics and Science and her recent

retention in the 7th grade.

• Laura received a failing grade in Mathematics

and a D minus in Science at the conclusion of

her 7th grade year.

http://www.pearsonassessments.com/





Referral Concerns

• Her primary physician requested an ADHD

evaluation due to Laura’s apparent attentional

difficulties.

• In addition to general ability, the evaluation

focused on processing speed, impulse control,

and working memory, all factors associated

with ADHD.


WISC-IV

General Ability Index (GAI) 107

Verbal Comprehension Index (VCI) 108

Perceptual Reasoning Index (PRI) 104

Working Memory Index (WMI) 97

Processing Speed Index (PSI) 80


NEPSY-II

Attention and Executive Functioning

–Auditory Attention and Response Set

Scaled Score

AA Combined Score 10

RS Combined Score 6

AA vs. RS Contrast Score 5





NEPSY-II


–Inhibition

Scaled Score

Naming Combined Score 9

Inhibition Combined Score 6

INN vs. INI Contrast Score 6

Switching Combined Score 3

INI vs. INS Contrast Score 4


NEPSY-II


–Animal Sorting and Clocks

Scaled Score

AS Combined Score 8

CL Score 8


Behavior Rating

D-REF

• Clinically significant Core Index Scores:

Behavioral Functioning T=62

Executive Functioning T=65

Total Composite T=61

• Clinically significant Clinical Index Scores:

Attention/Working Memory T=66

Abstract Thinking/Problem Solving T=64





Laura Conclusions

• Strengths

• Specific Weaknesses

– Link to referral concerns

• Diagnosis

• Recommendations


References…

• Anderson, P. (2002). Assessment and development of executive

function (EF) during childhood. Child Neuropsychology, 8(2), 71-82.

• Andrewes, D. (2001). Neuropsychology: From Theory to Practice.

Psychology Press, New York, NY.

• Blair, C. & Diamond, A. (2008). Biological processes in prevention

and intervention: The promotion of self-regulation as a means of preventing school failure. Developmental Psychology, 20, 899—911.

• Blair, C. & Razza, R. P. (2007). Relating effortful control, executive

function, and false-belief understanding to emerging math and literacy ability in kindergarten. Child Development, 78, 647-663.

• Chang, E.C., D’Zurilla, T.J., & Sanna, L.J. (2004). Social Problem Solving: Theory, Research, and Training. American Psychological

Association, Washington, DC.

• Davies, P.L., & Rose, J.D. (1999). Assessment of cognitive

development in adolescents by means of neuropsychological tasks.

Developmental Neuropsychology, 15(2), 227-248.


References…

• Dawson, P., & Guare, R. (2010). Executive Skills in Children and

Adolescents: A practical guide to assessment and intervention, Second Ed. The Guilford Press, New York, NY.

• Dean, R.D., Woodcock, R.W., Decker, S.L., & Schrank, F.A. (2003). A cognitive neuropsychological assessment system. In WJ III

Clinical Use and Interpretation. Elsevier Science, USA.

• Diamond, A., Barnett, W. S., Thomas, J., & Munro, S. (2007).

Preschool program improves cognitive control. Science, 318, 1387–

1388.

• Gentile, L.M. (2011). Oral Language Acquisition Inventory, Second

Ed. (OLAI-2) – Manual. NCS Pearson, Inc. Bloomington, MN.

• Gioia, G.A., Isquith, P.K., Guy, S.C., & Kenworthy, L. (2000).

Behavior Rating Inventory of Executive Function (BRIEF) – Manual.

Psychological Assessment Resources, Inc. Lutz, Fl.

• Luria, A.R. (1973). The working brain: An introduction to

neuropsychology. New York, NY: Basic Books, Inc.





References…

• Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., Wager, T. (2000). The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100

• Reiter, A. Tucha, O. Lange, KW. (2005). Executive functions in children with dyslexia. Dyslexia. 11:116–131.

• St Clair-Thompson, H., L., & Gathercole, S., E. (2006). Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. The Quarterly Journal of Experimental Psychology, 59, 745-759.

• Thorell L B, Lindqvist S, Bergman S, Bohlin G, Klingberg T (2009). Training and transfer effects of executive functions in preschool children. Developmental Science, 12(1): 106-113.

• Ylvisaker, M., Feeney, T., & Szekeres, F. (1998). Cognitive Rehabilitation: Executive Functions. In M. Ylvisaker (Ed.), Traumatic brain injury rehabilitation: Children and adolescents (2nd ed., pp. 244). Boston: Butterworth-Heinemann.

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