Transcript Executive Function - Special Education Services

Executive Function & Behavior
Management
By Judy Ritchie, P.R.E.P.
for Rock Fish River Elementary
10/13/10
What, Where & How & Who
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Executive Dysfunction often
leads to Behavior
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Causes of Behavior Problems
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Confusion
Expectation (inaccurate)
Stimulation (over/under)
Lack of order
Communication (receptive/expressive)
Driven behaviors
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Behavior Serves a Purpose
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Compensates for a deficit
Comforts
Communicates
Utilizes a strength
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Most common Referrals
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Boys with ADHD (usually un-medicated)
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Students with Autism Spectrum Disorders
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Both likely students with Executive
Dysfunction
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What are some behaviors that
you are concerned with
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Not completing work
Not paying attention
Focused on wrong stuff
Overflow of body/hands/mouth
Forgetting needed materials
Poor organization
Social issues
Poor impulse control
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Discipline Issues
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There is growing evidence that:
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Problems associated with Executive Dysfunction
contribute to most disruptive behavior that
result in removal from the learning environment.
There is increased demands on executive
function skills.
Children are exposed to fewer activities that
build executive function skills.
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Could the problem be….
Not that the person is doing the WRONG
thing but that they don’t know (hidden
agenda) or can’t (lack of impulse control)
do the RIGHT thing
 Is it related to a deficit?
 Is it related to unrealistic expectations?
 Is it related to an antecedent or lack of?
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Executive Function or Hard Work,
Discipline and Persistence
Evidence indicates that self discipline accounts
for over twice as much variance in final
grades as does IQ, even in college.
Duckworth & Seligman( 2005)
EF skills are important for school readiness and
are more strongly associated with school
readiness than IQ or entry reading or math
(Blair, 2002, 2203, Blair & Razza, 2007; Normandeau & Guay,
1998)
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ED impact on Academics
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Writing
Comprehension
Mental Arithmetic
Completing work
Turning in work
Consistent performance
Having necessary material
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So what is Executive Function?
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Executive Function
The way people monitor and control their
thoughts and actions (Carlson & Moses, 2001)
We need EF whenever we are presented with
the unexpected, need to concentrate
particularly hard, or need to adapt or change
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Function of Executive Functioning
Executive Functioning is the brain's ability to
absorb information
interpret information, and
make decisions based upon this information.
Like:
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Picking the correct clothes based on the weather
Allowing enough time to complete a task
Understanding the unspoken expectations, goals or
rules of a situation.
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Major areas of impairment in
Executive Dysfunction
Inhibitory
Control
Cognitive Flexibility
Working Memory
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EXECUTIVE FUNCTION JOBS
Inhibition - The ability to stop one's
own behavior at the appropriate time,
including stopping actions and thoughts.
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The flip side of inhibition is impulsivity;
Shift - The ability to move freely from
one situation to another and to think
flexibly in order to respond appropriately
to the situation.
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EXECUTIVE FUNCTION JOBS cont
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Emotional Control - The ability to
modulate emotional responses by
bringing rational thought to bear on
feelings.
Initiation - The ability to begin a task or
activity and to independently generate
ideas, responses, or problem-solving
strategies.
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EXECUTIVE FUNCTION JOBS cont
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Working memory - The capacity to hold
information in mind for the purpose of
completing a task.
Planning/Organization - The ability to
manage current and future- oriented task
demands.
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EXECUTIVE FUNCTION JOBS cont
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Organization of Materials - The ability
to impose order on work, play, and storage
spaces.
Self-Monitoring - The ability to monitor
one's own performance and to measure it
against some standard of what is needed
or expected.
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Executive Dysfunction
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Core Deficits
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Inhibitory control
Cognitive flexibility
Working memory
Contributing to the ability to
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Plan
Organize
Predict
Self Monitor
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Which students have
Executive Dysfunction
For many students, the executive functioning system of
their brain is not working properly.
Executive Dysfunctions are intimately connected with
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Asperger's Disorder
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High Functioning Autistic
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ADHD (Most common)
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Also been found in adults with OCD, depression,
to name but some of the conditions.
 Is starting to turn up as a stand alone diagnosis
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Executive Dysfunction occurs during
typical brain development twice
Around the age of two=the awful twos
Around the age of thirteen=alien invasion
It is also apparent during high levels of stress
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Inhibitory Control
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Self Control (Discipline) This is the ability to
resist a strong inclination to do one thing
instead of doing what is most appropriate or
needed.
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Inhibitory Control
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The ability to keep attention focused despite
 visual displays
 noises
 novel information
 boredom
 initial failure
 interesting digressions
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Discipline (Self-Control)
The ability to resist your first impulse
and give a more considered response instead
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Attention Deficits Can affect
motor, visual or auditory activities
Too short
 Wrong stuff
 Inconsistent
 Too late
 I never moved but lost it anyway
 Relocation experts
 I have no idea, no really I have no idea
Often it doesn’t affect all so the student may be better
focused if an unaffected area is required
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La Différence
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ADHD
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Probably know the rule
Often don’t know or can’t
tell why it happened
Won’t benefit from
strategies to inform
There may be an ego
component (failure is a
poor learning tool)
Try and determine area
of better focus (hands
on,visual, auditory)
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ASD
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Probably don’t know the
rule
Can (if language) explain
sometimes
Will benefit from
informing strategies
Probably don’t realize
impact
Most are have superior
visual and perceptual
skills (never argue
perception)
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Benefits of Inhibition
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Allows a measure of control over attention
and actions
Lessons control of external stimuli,
emotions, old habits (of mind and behavior)
Inhibition helps make change possible
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Cognitive Flexibility
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This allows us to flexibly switch our
perspectives or our focus of attention as
needed for task demands
It allows us to be flexible and adjust to
changes in demands, priorities,
schedules, expectations
It allows us to be able to think outside
the box
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La Différence
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ADHD
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Often described as
having greater ability
to attend to self
chosen activities
Can be resistant to
change but also
easily distracted
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ASD
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Transition issues
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Ending
Beginning
Perspective issues
Routine Issues
Concrete/Rule issues
Hidden Agenda
Theory of Mind
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Cognitive Flexibility and
Behavior
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CF allows us to change the
focus of our attention from
what others are doing wrong
to how we might be
contributing to that situation
or how we might make the
best of what happened.
It allows us to change our
focus from ourselves and our
own needs to focusing on
the needs of others.
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Cognitive Flexibility
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It is critical to creative problem solving
It allows us to think of other ways of
reacting to what is happening
It allows us to think about or conceptualize
a problem in other ways
It allows us to try other ways to overcome
obstacles
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Working Memory
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Holding information in mind and working
with it.
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Working Memory
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Relating one idea to another
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The beginning of a story to the end
Mental arithmetic
Holding information in mind while working on
something else
Mentally holding onto information during an
interruption or while you have to do something
else first
Making judgments or analyzing info to determine
where it fits into existing knowledge or categories
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Other contributors
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Gender Issues
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Boys are more likely to be sensitive and at times
over-reactive
Boys have 30 % more muscle mass, are stronger
and inclined to action
Growth spurts for boys can result in temporary
hearing loss (the ear canal stretches)
Testosterone influences the brain and makes boys
more concerned with rank and competition
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Gender Issues
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Boys
Need structure to feel safe and answer
questions
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Who’s in charge
What are the rules
Will the rules be fairly enforced
Ambiguity may heighten their anxiety or increase
their acting out or over activity
Math and perceptual skills kick in before verbal
and writing
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Girls
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Tend to be more eager to please
It can be more about relationship than
boys
Verbal and writing skills kick in at an
earlier age than math and perceptual
skills
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Human Nature Issues
Why anyone may avoid or give up
 Type of task
 Frustration tolerance
 Hopelessness
 Emotional/health factors
 Prior experience
 Expectation of success
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Emotional Sense
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It
It
It
It
It
is not rational…it seems counterintuitive
is self-serving emotionally
is protective in nature
is less purposeful than you think
will be repeated if it works
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So what works?
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Visual Strategies
External Structure
Using Their Strengths
Novelty for ADHD and sometimes for ASD
Routine for some ADHD and most ASD
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So what works cont.?
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Preferred interests or desired topics
Smaller segments, fewer numbers, tasks
broken down
Frequent feedback
Technology
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So what works cont.?
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Breaks
Switching gears before review or editing
Success
Protecting self-esteem
Avoid using success punitively
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So what works?
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Avoid tracking or measuring disability
Gentle, positive self-monitoring
Avoiding why questions when they know the rules
(generally not a deficit of knowledge for the ADHD
student but can be a deficit for the ASD student)
Vs. Explain why to address tendency to think
impulsively
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Meaningful frustration is easier to bare than
meaningless frustration
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More of what works
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Wait and think strategies (Ditty intervention)
Change color for reversals
Cognitive cues (strategies that help you
remember the sequence of steps as well as
the content or steps themselves)
 mnemonic (ROYGBIV)
 Can be visual (take a walk)
Positive or neutral reframing of
characteristics
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More of what works
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Back up plans, materials, opportunities
 Technology
 Give them 5
 Second set of books
 Materials to use or borrow
Coach vs lecture or parent (remember they may
know)
Address one dimensional problem solving
 Lets look at the options or result of choice
 brainstorm
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Addressing Executive Function
Challenges
Why Use Visual Strategies
 Visuals are not transient and compensate
inattention, poor working memory, inability
to prioritize/organize
 Visuals help sort out or point out what is
important
 Visuals lesson demands on working
memory and other executive functions
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Types of Visual supports
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Color Coding (like science folder, books, notebooks
etc. all blue, even what bin to place work into)
Strips that contain steps in the editing process such
as checking punctuation, checking for capitalization,
etc.
Visual thought or idea organization (inspiration.com)
Highlighting tape
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Socialization Toolbox
• Social Stories™, Gray,
Carol
• Comic Strip
Conversations, Gray,
Carol
• Video Modeling
• Power Cards, E. Gagnon
• Role Playing
• Peer partners
• Clubs
• Drama
• The Incredible Five Point
Scale, Dunn Buron, K.,
Curtis,M.
•VDOE
Incidental
Teaching
T/TAC at VCU
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Tools of the Mind
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An early childhood education curriculum
based on the work of Vygotsky.
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A curriculum taught in regular classrooms with
regular teachers shown to improve cognitive
control (executive function) in preschool-age
through kindergarten age children from
disadvantaged backgrounds.
(Adele Diamond, W. Steven Barnett, Jessica Thomas, Sarah
Munro November 30, 2007, Science, vol. 317 )
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Play
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Imaginative play, involving some adult
participation and direction
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Research shows that when imaginative play is
facilitated by a skilled teacher, it helps build
executive function (EF), a critical cognitive skill
that helps children learn to self-regulate.
In turn, self-regulation helps children learn how
to self-discipline and control impulses
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Recess is an Important Part of
School Day
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Children performed better in academics,
after exercising with improvement in
accuracy as well as attention.
 Reading comprehension, sometimes by
as much as a full grade level
 Math and spelling also improved,
however, the margins were not as great
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Recess is an Important Part of
School Day
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The study monitored twenty 9-year old children
and measured their attention and academic
achievement after 20 minutes of exercise and
compared to their responses from the previous
day when they were tested after a resting period.
(University of Illinois at Urbana-Champaign (2009, April 1).
Physical Activity May Strengthen Children's Ability To Pay
Attention. ScienceDaily. Retrieved April 2, 2009, from
http://www.sciencedaily.com
releases/2009/03/090331183800.htm)
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Other Interventions
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Address Executive Dysfunction
challenges
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Provide external structure by
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Organize or reorganize the child's
environment
Set clear goals (e.g., "Get dressed by 8:00
a.m.).
Help the child keep his or her belongings
(e.g., school books, toys, clothing) in the
same place
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Addressing deficits in EF
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Give clear instructions (avoid multiple and
complex)
Use lists or check off opportunities to help them
keep track
Allow for movement when needed
Teach self-monitoring strategies
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Some specifics to ASD
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Characteristics of Autism &
Structured Teaching Approach
Wiring Differences
 Focus on details vs.
difficulty with whole
 Difficulty knowing how
things fit together
 Difficulty extracting
meaning
 Difficulty knowing
which are relevant
details
Structured Teaching
Intervention
 Highlights beginning and
endings
 Establish routines and
ways to approach tasks
and materials
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Highlights relevant details
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Characteristics of Autism &
Structured Teaching Approach
Learning style:
 Strong visual learner
 Difficulty with
language
Sensory
 Sensitive to sensory
input and modulating
stimulation
Support for learning
 Visual supports
 Visual schedules
 Visual routines
Modifications
 Environment is
modified to reduce
stimulation
(beware of loud
confusing spaces)
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Characteristics of Autism &
Structured Teaching Approach
ASD characteristics
 Difficulty with
transitions
 Difficulty with
generalizing
 Can be compulsive
ST intervention
 Transitions routines are
taught visually
 Need to disengage and
reengage is analyzed and
addressed
 Flexibility is taught
through visual
manipulation of routines
and clear expectations.
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Structured Teaching
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Antecedent based
Uses competence motivation rather than
consequence motivation
Levels of Structured Teaching:
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Physical Structure
Schedules
Work Systems
Routines and Strategies
Task
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Swiss Cheese
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While students share characteristics
Each child is unique
Some need a distraction free environment
Some need background noise
Some need to stand
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Get support for yourself
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Un-medicated ADHD students are challenging
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Need for novelty
Low self esteem
Poor impulse control
Inconsistency
Co-morbid complications
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Some of most common are
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Oppositional Defiant
Anxiety
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Get support for yourself
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The best laid plans may work once
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The fix is a process, try to make a positive contribution
and know that they are likely equally discouraged but may
be using cover-up strategies
Use their motivations and interests whenever
possible
Design behavior plans to track what you are looking
or hoping for not what they are doing wrong
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Other Treatment
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Medications
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Stimulants usually are the first-line medications
prescribed. If two or three stimulants are tried and
found to be ineffective, antidepressants may be used.
Stimulants do not cure ADHD, but they can help
control symptoms.
Studies have shown that these medications can
improve symptoms in 70–90% of children
who have ADHD.
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We often note dramatic improvements in writing
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Medication Issues
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If parents disagree
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When parents don’t see benefit
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Complications of cost, pick up etc.
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Forgotten morning pill
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Lack of accurate information
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Meds diets and other
treatments for ASD
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Some remarkable case studies
Research has not sorted out who will
benefit from what
Usually focused on improving focus,
behavior, sleep issues
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Questions, concerns?
Judy Ritchie
PREP
[email protected]
540-421 3088
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