Executive functioning for students


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  • These quotes only represent part of the truth Today another piece of the puzzle
  • Development of rules that guide future behavior Application of rules taught Actions are motivated by concrete, superficial goals such as immediate gratification
  • Executive functioning for students

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