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Executive Function: Effective Strategies and Interventions

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Executive Function: Effective Strategies and Interventions
is a workshop I'll be offering at Assumption College in Worcester, Mass. on Friday 12/5/2014. Contact me if you think a workshop like this would be a good fit for your organization - David@DrNowell.com

Executive Function: Effective Strategies and Interventions

  1. 1. David D Nowell PhD www.DrNowell.com Executive Function: Effective Strategies and Interventions
  2. 2. www.DrNowell.com DavidNowellSeminars DavidNowell
  3. 3. Overview • Brain Overview in 27 Slides • Models of EF • Strategic Behavioral Inquiry (HËDŸDT?) • Disorders Which Impact EF • Real Life Implications of EF Deficits • Assessment of EF • Strategies and Case Studies • Q&A&D
  4. 4. www.slideshare.net/dnowell
  5. 5. BRAIN OVERVIEW IN 27 SLIDES
  6. 6. What does dopamine feeeel like?
  7. 7. Ways of thinking about the brain • Left to right • Top to bottom • Front to back • Top-down and bottom-up
  8. 8. what IS… 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 28
  9. 9. …what COULD BE 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 29
  10. 10. What’s wrong with this brain model?
  11. 11. What’s wrong with this brain model?
  12. 12. What’s wrong with this brain model?
  13. 13. MODELS OF EXECUTIVE DYSFUNCTION
  14. 14. • McCloskey’s model • Barkley’s model • BRIEF model
  15. 15. McCloskey’s Clusters • Attentional cluster • Engagement cluster • Optimize cluster • Evaluation cluster • Efficiency cluster • Memory cluster
  16. 16. McCloskey’s Clusters • Attentional cluster – Becoming aware – Focusing attention – Sustaining attention
  17. 17. Sleep hygiene • Strict bedtime • Use bed only for sleep • No caffeine after mid-afternoon • No activating media after 7pm
  18. 18. Establish bedtime routine
  19. 19. Fidget supports
  20. 20. McCloskey’s Clusters • Engagement cluster – Initiating – Putting in effort – Inhibiting – Stopping – Interrupting
  21. 21. Reward small units of effort
  22. 22. There’s no such thing as “disinhibited”
  23. 23. The “talking stick”
  24. 24. DRO Differential Reinforcement of Other
  25. 25. McCloskey’s Clusters • Optimize cluster – Modulating – Monitoring – Correcting
  26. 26. Sam rode her new blue bicycle down the steep hill, enjoying the crisp Autumn air and bright late-afternoon sun.
  27. 27. Sam rode her new blue bicycle down the steep hill, enjoying the crisp Autumn air and bright late-afternoon sun.
  28. 28. GREEN
  29. 29. Voice Modulation • 5 – football game • 4 – large clasroom • 3 – small group • 2 – talking quietly with a friend • 1 - whisper
  30. 30. • Give multi-step directions while playing catch • Play mindfulness “freeze tag” • Quiz do-over • Make use of rhythm and music (508) 579-7958
  31. 31. Don’t stealth bomb inattentive students • “Pete in about a minute I’ll ask you about..”
  32. 32. McCloskey’s Clusters • Evaluation cluster – Sizing up – Anticipating – Estimating time – Making associations – Generating solutions – Organizing – Comparing
  33. 33. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 66
  34. 34. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 67
  35. 35. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 68
  36. 36. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 69
  37. 37. Time Horizon 1 hour 1 day 1 week 1 month 1 year
  38. 38. 10-Minute Morning Review
  39. 39. Using your phone’s navigator as a time-management tool
  40. 40. McCloskey’s Clusters • Efficiency cluster – Sensing time – Pacing – Sequencing – Using routines / executing
  41. 41. Distraction delay training
  42. 42. McCloskey’s Clusters • Memory cluster – Holding – Manipulating – Storing – Retrieving
  43. 43. Prospective Memory
  44. 44. The Executive Functions • Sensing to the self • Speech to the self • Emotion to the self • Play to the self
  45. 45. The Executive Functions • Sensing to the self • Speech to the self • Emotion to the self • Play to the self Barkley, RA, (2012)
  46. 46. BRIEF (Behavioral Rating Inventory of Executive Functioning) • Inhibiting • Shifting • Controlling emotions • Initiating • Working memory • Planning • Organizing materials • Monitoring • Metacognition • Behavioral regulation
  47. 47. Self-control
  48. 48. The Executive Functions • Sensing to the self (HËDŸDT) • Speech to the self • Emotion to the self • Play to the self Barkley, RA, (2012)
  49. 49. BRIEF • Inhibiting (HËDŸDT) • Shifting • Controlling emotions • Initiating • Working memory • Planning • Organizing materials • Monitoring • Metacognition • Behavioral regulation
  50. 50. STRATEGIC BEHAVIORAL INQUIRY
  51. 51. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 106
  52. 52. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 107
  53. 53. Objectives of SBI • Specific behavioral strategy • What was the feeling-goal? • Motivational level on a scale from 1-10
  54. 54. Benefits of SBI • Affirms the value of clients’ unique internal experience • Emphasizes the culture of self-regulation • Encourages metacognition
  55. 55. Assumptions of SBI • Everybody’s doing the best they can • Behavior is not incomprehensible or random • Behavior follows patterns which reveal themselves to the curious observer free of prejudice or blame or theory
  56. 56. Personal Application
  57. 57. …and How Exactly Did You Do That?
  58. 58. …and How Exactly Did You Do That?
  59. 59. Personal Application • What bad habit persists? And How Exactly Do You Do That?
  60. 60. Learn from your To-Do list • Which things are not getting completed? • How – exactly – are these not getting completed? How do you do that?
  61. 61. Clinical Application • Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that?
  62. 62. Clinical Application • Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that? • What recurring behavioral problem is showing up in your clinic or classroom?
  63. 63. Clinical Application • Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that? • What recurring behavioral problem is showing up in your clinic or classroom? • Note: we aren’t asking “why did you do that,” but rather “how exactly did you do that.”
  64. 64. How to do SBI “How exactly did you do that?” “How did you know it was time to _____?” “How long had you been thinking about ____?”
  65. 65. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 123
  66. 66. DISORDERS WHICH IMPACT EXECUTIVE FUNCTIONS
  67. 67. • ADHD • Schizophrenia • Bipolar Disorder • Anxiety Disorder • Autistic Spectrum Disorders • Sensory Processing Disorder • Specific Learning Disorders • Tourette’s Syndrome • Sleep Disorders
  68. 68. 20%–60% of the variance in functional outcome (Sabhesan & Parthasarathy 2005)
  69. 69. Gur RE, Turetsky BI, Loughead J, et al. (2007)
  70. 70. (Clark, Iversen & Goodwin 2001)
  71. 71. (Rubinsztein, Fletcher, et al. 2001)
  72. 72. Fujii, Kitagawa, et al 2013
  73. 73. (Airaksinen, Larsson, & Forsell 2005)
  74. 74. Appendix A
  75. 75. (Brosnan, Demetre, et al 2002)
  76. 76. Appendix B
  77. 77. ADHD OCD Tourette
  78. 78. (Rechtschaffen & Siegel 2000)
  79. 79. ADHD and Brain Development
  80. 80. Sluggish Cognitive Tempo • Daydreaming • Easily confused • Staring • Easily fatigued • Sluggish • Withdrawn • Slow to complete tasks • Lower levels of parent stress • Less situation-specific than hyperactive type
  81. 81. REAL LIFE IMPACT OF EF DEFICITS
  82. 82. Preschool 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 157 1. 1-step errands 2. Chores with cues 3. Basic inhibition
  83. 83. Kindergarten - 2nd Grade 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 158 1. 2-3 step directions 2. 20-30 minute assignments 3. Follow rules/inhibit/no grabbing
  84. 84. 3rd-5th Grade 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 159 1. Simple shopping list 2. Keep track of variable daily schedule 3. Inhibit and regulate even without teacher present 4. Simple delayed gratification (phone)
  85. 85. 6th – 8th Grade 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 160 1. Complex chores 2. Organizing system 3. Time management 4. Self soothe 5. Manage conflict
  86. 86. Teenage-mid 20’s 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 161 1. Independent with assignments 2. Make adjustments based on feedback 3. Inhibit reckless behavior 4. Say “no” to fun activity if other plans already made 5. Take others’ perspective
  87. 87. Knock 3 years off his age
  88. 88. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 163 Lending Your Brain
  89. 89. Arenas of Involvement • Intrapersonal • Interpersonal • Environmental • Academic / symbol system (McCloskey & Perkins, 2013)
  90. 90. Executive Functions and Math • Verbal strategies – Please excuse my dear Aunt Sallly (PEMDAS)
  91. 91. Executive Functions and Math • Verbal strategies – Please excuse my dear aunt sally (PEMDAS) – KNOW • Key words, numbers, operation, work it out
  92. 92. Key words Numbers I need Operations Work it out
  93. 93. Executive Functions and Math • Visual strategies
  94. 94. Executive Functions and Math • Hands-on strategies
  95. 95. Executive Functions and Reading
  96. 96. EZ-C Reader
  97. 97. Executive Functions and Writing
  98. 98. Executive Functions and Writing
  99. 99. Executive Functions and Writing
  100. 100. Executive Functions and Writing
  101. 101. Executive Functions and Writing
  102. 102. Executive Functions and Study Skills
  103. 103. Cornell note-taking system
  104. 104. Cornell note-taking system Class and date
  105. 105. Cornell note-taking system Class and date Notes
  106. 106. Cornell note-taking system Class and date Notes Notes Notes
  107. 107. Cornell note-taking system Class and date Notes Notes Notes
  108. 108. Cornell note-taking system Class and date Notes Notes Notes
  109. 109. Cornell note-taking system Class and date Notes Notes Notes SUMMARY
  110. 110. Cornell note-taking system Class and date Notes Notes Notes SUMMARY
  111. 111. Cornell note-taking system Class and date
  112. 112. Cornell note-taking system Class and date Notes
  113. 113. Cornell note-taking system Class and date Notes Notes Notes
  114. 114. Cornell note-taking system Class and date Notes Notes Notes
  115. 115. Cornell note-taking system Class and date Notes Notes Notes
  116. 116. Cornell note-taking system Class and date Notes Notes Notes SUMMARY
  117. 117. Cornell note-taking system Class and date Notes Notes Notes SUMMARY
  118. 118. Chunk Chew and Check • Grades K-2: about 5 minute chunks • Grades 3-6: about 10 minute chunks • Grades 7-12: about 15 minute chunks
  119. 119. Executive Functions and Homework
  120. 120. Executive Functions and Homework
  121. 121. Homework Considerations for Teachers • Target productivity first, then accuracy • Reduce homework – Overall correlation of homework with achievement is just .15-.25 across all grades and weaker in elementary grades* – For high school, best amount was 1.5-2.5 hrs/night; more time had no further benefits* *Cooper, Robinson, & Patall (2006). Review of Educational Research, 76(1), 1-62.
  122. 122. Executive Functions and Social Skills
  123. 123. Accommodations for EF Deficits • Preferential seating • Extra set of textbooks at home • Quiet test environment • Time off the clock during testing (schedule breaks) • Pre- and post-class 1:1 review of content • Visual schedule • Movement breaks • Fidget/sensory interventions • Verbal cues • External time cues (Time Timers products, or kitchen timer) • Teacher check-off on homework binder • “Locker” is in guidance counselor’s office • Attention coach (10-15 minutes)
  124. 124. Examples of IEP Goals for EF Deficits 1. Self Awareness a. Student will identify tasks that are easy or difficult for him/her. b Student will accurately explain why some tasks are easy or difficult d.Student will offer help to another when he/she is more capable than another child 2. Goal setting a. Student will participate with teachers in setting academic goals. 3. Planning a.Given a selection of 6 activities for an instructional session, student will select 3, indicate their order, create a plan on paper and stick to the plan. c. Having failed to accurately predict his/her grade on a test, student will create a plan for improving performance on the next test.
  125. 125. Examples of IEP Goals for EF Deficits 4. Organizing a. To relate a story, student will place illustrations in order and then narrate the sequence of events B. Student will prepare an organized semantic map or outline before proceeding with writing projects 5. Self-initiating a. Without prompts, student will begin his/her assigned tasks 6. Self-monitoring & self evaluating a. Student will identify errors in his/her work without teacher assistance 7. Problem Solving a. When faced with obstacles to educational or social objectives, student will identify possible courses of action, identify pros and cons for each, choose a course of action, perform it and evaluate its effectiveness.
  126. 126. What are our data sources? • Record review • Interview • Collateral interview • Checklists • Mental status examination • Test scores
  127. 127. ASSESSMENT OF EXECUTIVE FUNCTIONING
  128. 128. Curious Compassionate Nonjudgmental Evaluation • Skillfully eliciting the chief complaint • HËDŸDT? • Forming a diagnostic impression • Defending your diagnosis / impression
  129. 129. Skillfully eliciting the chief complaint • Too much of what? Or too little of what? • Invoking the Pediatric Fairy (or the Psychiatric Genie)
  130. 130. HËDŸDT? • How exactly did you do that? – Everybody’s doing the best he/she can – Every behavior problem is either • Skills deficit • Contingency problem
  131. 131. Forming a diagnostic impression • Where do you see it the most? And where do you see it the least? • Two disorders = two stories
  132. 132. Forming a diagnostic impression • Where do you see it the most? And where do you see it the least? • Two disorders = two stories
  133. 133. Documenting and communicating your conclusions • The footprints in the butter • Defend your diagnosis
  134. 134. Approaches to Evaluation of EF • Formal direct • Informal direct • Formal indirect • Informal indirect
  135. 135. Evaluation of EF • Informal Indirect – Review of records – Collateral interviews (see McCloskey 2012)
  136. 136. Evaluation of EF • Formal Indirect – BRIEF (Behavior Rating Inventory of Executive Functioning) – BASC (Behavior Assessment for Children) – CBCL (Achenbach Child Behavior Checklist) – BDEFS-CA (Barkley Deficits in Executive Functioning Scale – Children and Adolescents)
  137. 137. Evaluation of EF • Informal Direct – Review of work samples – Process-approach to test performance – Mental Status Examination – Classroom observation
  138. 138. Evaluation of EF • Formal Direct – NEPSY – CAS (Cognitive Assessment System) – Delis-Kaplan Executive Function System – Continuous Performance Tests (Vigil; Connors CPT; IVA) – Wisconsin Card Sorting Test – Trail Making Test for Children – Rey-Osterreith – Functional Behavior Assessment
  139. 139. Avoiding the most common diagnostic error
  140. 140. STRATEGIES AND CASE STUDIES
  141. 141. Stimulant Treatment for ADHD
  142. 142. Image: wikimedia commons
  143. 143. Cortico-striatal loop
  144. 144. Increase salience
  145. 145. Two weeks from now, how will you know whether it’s working? Appendix D
  146. 146. Daily report card Appendix C
  147. 147. Antecedent Support for Executive Dysfunction
  148. 148. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 258 A ANTECEDENT B BEHAVIOR C CONSEQUENCES
  149. 149. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 259 A ANTECEDENTS B BEHAVIOR C CONSEQUENCES
  150. 150. “Modified Independence” • Chronic disability perspective • Time prosthetics • Problem-solving prosthetics (mind map) • Math prosthetics • Sequence prosthetics • Motivation prosthetics
  151. 151. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 262 A ANTECEDENTS Set them up for success
  152. 152. Clear boundaries
  153. 153. Clear (see-through) storage
  154. 154. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 270 A ANTECEDENTS Identify exceptions Where do you see it the most? Where do you see it the least?
  155. 155. Rules •Waking up •Bedtime •Chores •Homework •TV / internet A ANTECEDENTS
  156. 156. Launching Pad
  157. 157. Expectations •Specific •Behavioral •In advance A ANTECEDENTS
  158. 158. Communication •Get eye contact •Speak clearly •Provide behavioral info •Check for understanding A ANTECEDENTS
  159. 159. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 282 A ANTECEDENTS Provide prosthetic cues at the “point-of- performance” (Barkley)
  160. 160. If It’s Harder than a “3” Find Some Way to Make It Easier easy hard 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 284
  161. 161. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 286
  162. 162. Assign separate due dates for smaller parts of big projects
  163. 163. Appendix H
  164. 164. Increase salience
  165. 165. StayOnTask app
  166. 166. The “talking stick”
  167. 167. Provide multiple cues for transitions • Verbal “two minute warning” • Visual schedule • Changes in lighting • Nonverbal cues
  168. 168. Instant study carrel
  169. 169. Time “in”
  170. 170. Place the student with tactile defensiveness at the edge of the group
  171. 171. Heavy work
  172. 172. ADD Coaching
  173. 173. Movement Techniques • Exercise • Yoga • Martial arts
  174. 174. Bal-A-Vis-X
  175. 175. Balance screen time and “green time”
  176. 176. Balance screen time and “green time”
  177. 177. Supplements and Diet • Omegas • Food additives • Food allergies • Pesticides
  178. 178. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 311 A ANTECEDENT B BEHAVIOR C CONSEQUENCES Behavioral Support
  179. 179. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 313 B BEHAVIOR “A healthy high-functioning 26 year old”
  180. 180. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 314
  181. 181. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 315 B BEHAVIOR More • Behavioral control • Choices and options • Self-regulation • Arousal • Motivation • Mood • Attention
  182. 182. Mindfulness
  183. 183. Dr. Sara Lazar
  184. 184. Metacognition • How much effort am I giving this? • What has worked for me before? • When to shift from processing to maintenance
  185. 185. Hypnosis
  186. 186. Mnemonics Training
  187. 187. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 325 A ANTECEDENT B BEHAVIOR C CONSEQUENCES
  188. 188. Don’t reward them with stuff
  189. 189. Rotate rewards frequently
  190. 190. Use extrinsic reward creatively 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 332
  191. 191. Emphasize the sensory details of your desired outcome
  192. 192. Cortico-striatal loop
  193. 193. Determine what basic provisions are unconditional… • Love • Respect • Safety • 3 meals • Essential clothing • Temperature-controlled environment • 30 minutes of video games
  194. 194. …and which are contingent • Special foods • Expensive or trendy clothing • Extra video game time • WiFi password
  195. 195. Clip and share horrible articles about teens falling out of the back of pickup trucks • Review cause and effect • Discuss consequences • Emphasize behavioral agency
  196. 196. The “Big Five” • Daily focus time • Nutrition • Movement • Sleep • Connection
  197. 197. 10-Minute Morning Review
  198. 198. 12/3/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 343 …the most important 10 minutes of the day….
  199. 199. The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it. - E. Goldberg
  200. 200. Key features of a great planner system
  201. 201. Key features of a great planner system • 2 pages per day • Master to-do list • With the client at all times
  202. 202. Yoga / read Phone calls Staff meeting Planning session billing
  203. 203. Vh: jeff w/ puritan oil Vc: kate re: brimfield TC umass dermatology. Spoke w/ cindy 508 8564000
  204. 204. Key features of a great planner system • 2 pages per day • Master to-do list • With the client at all times
  205. 205. What’s a To-Do list for anyway?
  206. 206. Key features of a great planner system • 2 pages per day • Master to-do list • With the client at all times
  207. 207. Key features of a great planner system • The “technology” • The “practice”
  208. 208. Key features of a great planner system • The “technology” • The “practice”
  209. 209. Weekly Overview
  210. 210. 10-Minute Morning Review
  211. 211. The “Big Five” • Daily focus time • Nutrition • Movement • Sleep • Connection
  212. 212. Nutrition essentials • Emphasize protein at every snack and meal • Eat fewer processed foods • Choose local • Pay close attention to patterns between food and focus/mood
  213. 213. The “Big Five” • Daily focus time / Motivational clarity • Nutrition • Movement • Sleep • Connection
  214. 214. “Exercise for focus” is different from "exercise for fitness”
  215. 215. The “Big Five” • Daily focus time / Motivational clarity • Nutrition • Movement • Sleep • Connection
  216. 216. The “Big Five” • Daily focus time / Motivational clarity • Nutrition • Movement • Sleep • Connection
  217. 217. Positive characteristics of many people with attentional / executive challenges Appendix G
  218. 218. Don’t do anything for your ADHD teenager which could be managed by a machine or an app
  219. 219. “Walk Me Up” app
  220. 220. www.slideshare.net/dnowell
  221. 221. Let’s stay in touch!  Join my e-newsletter list:  Fill out a card today and drop it in the box.  Sign up on my web site or Facebook page  Visit us on the web: www.DrNowell.com @davidnowell David Nowell Seminars
  222. 222. Q & A & D
  223. 223. Fail-proof desk activities Appendix A
  224. 224. Determine in Advance When You’ll Check Email and Facebook Tomorrow
  225. 225. • Review expectations in advance • Teens and college students may take more initiative with this
  226. 226. Generic Issues Associated with Transition to Adolescence • Increased physical size and neurological maturation • Increasing maturation of sexuality • Increasing desire to individuate from parents; decreasing influence of parents on teen behavior • Increasing time away from home & parents • Increasing number of domains of major life activities to which the teen must adapt – Sex, driving, peers, money & work, community activities, crime, drugs • Greater involvement with and influence of peers • Most of these are adversely affected by delay in self-regulation associated with ADHD
  227. 227. How do symptoms change by adolescence? • Hyperactivity declines more steeply than does inattention and related executive function (EF) deficits • Motor restlessness becomes a more internalized subjective sense of feeling a need to be busy all the time • Transition to middle school is associated with a transient increase (reversal of decline) in ADHD symptoms • The inattentive/EF symptoms have a greater impact on school functioning than HI symptoms; increases with age • Impulsivity is more related to impaired nonacademic domains: – development of ODD – drug experimentation – speeding while driving – risky sexual behavior, taking on dares from peers – impulsive verbal behavior – reactive aggression
  228. 228. Symptom Transitions (continued) • But inattention also has adverse impacts on non-academic functioning : – Poor attention to traffic density and speed while in community auto traffic settings – Greater risk for pedestrian/cycling accidents in traffic settings – Greater crash risk as drivers (in vehicle distractions are most contributory) – Accelerated use of nicotine after experimentation • Self-medication ??? – Poor follow through on chores and other home responsibilities – Poorer work performance in school – Poor work performance part-time employment settings – Inattention to others’ comments and needs in social activities
  229. 229. Emerging Impact of EF Deficits • Poor working memory (remembering to do things) – Less follow through on promises and commitments to others – Increasing adverse impact of reading-listening-viewing comprehension deficits, especially in school & work settings • Impaired planning, anticipation, and preparatory behavior; not ready for the future as it arrives – Reduced valuing of future rewards relative to peers – Consequently, don’t persist toward future goals and show poor delay of gratification • Deficient sense of time and time management – A restricted temporal window relative to peers • Poor emotion regulation (related to poor inhibition) – Deficient control of anger & frustration most impairing • Decreased fluency (rapid assembly of ideas into coherent verbal reports and behavior)
  230. 230. Basic Considerations • Don’t retain in grade! • Sept is to establish behavioral control • Decrease total workload, or • Give smaller quotas of work at a time • Target productivity first, accuracy later • Reduce homework – Overall correlation with achievement is just .15-.25 (just 2-6% of variance in achievement) across all grades and weaker in elementary grades* – For high school, best amount was 1.5-2.5 hrs/night; more hours had no further benefits* *Cooper, Robinson, & Patall (2006). Review of Educational Research, 76(1), 1-62.
  231. 231. Tips for Teens • As needed, use ADHD medications – have parents negotiate a contract with the teen if necessary • Find a “Coach” or “Mentor” (Just 15 min.) – The Coaches’ office is the student’s “locker” – Schedule in three 5-minute checkups across each day – Use behavior report card to monitor teen across classes – Use daily assignment sheets requiring teacher initials – Cross temporal accountability is the key to success • Identify a parent-school ADHD liaison – Serves as an intermediary on issues between parents & school
  232. 232. A Daily Behavior Card Each teacher rates each behavior at end of each class; 1=Excellent (+25), 2=Good (+15), 3=Fair (+5), 4=Poor (-15), 5=Terrible (-25) Subjects 1 2 3 4 5 6 7 Class Participation Performs assigned classwork Follows class rules Gets along well with others Completes home-work assignments Teacher’s Initials
  233. 233. More Tips for Teens • Use a daily school behavior card for self-evaluation after; move to weekly after 3+ good weeks • Keep extra set of books at home • Learn typing/keyboard skills for writing assignments • Require continuous note-taking to pay attention to lectures or during reading assignments • Tape record important lectures – check out the Smart Pen that digitally records lectures or other conversations at livescribe.com
  234. 234. More Tips for Teens • “Bucks for Bs” system – grades on each assignment = $ from parents • Get week-at-a glance calendar with journal or other organizing notebook system • Schedule hard classes in AM • Alternate required with elective classes • Extra time on timed tests (???) – no evidence it helps – Better to have distraction free test setting and intersperse breaks in testing to create shorter test periods (time off the clock) • Permit music during homework* • Get written syllabus as handouts *Soderlund et al. (2007). Journal of Child Psychology and Psychiatry, 48, 840-847.
  235. 235. Still More Tips for Teens • Learn SQ4R for reading comprehension – Survey material, draft questions, then: – Read, recite, write, review • Peer tutoring in class • “Study-with-a-buddy” after school • Find “fall-back” classmates (swap phone, e-mail, & fax numbers) for lost or missing assignment sheets • Attend after-school help-sessions • Schedule parent-teacher-teen review meetings every 6 weeks (not at 9 week grading period)
  236. 236. Teaching skills is inadequate
  237. 237. What and who is the “A”
  238. 238. Chronic disability perspective
  239. 239. Reverse Engineering the Carrot and Stick • Rey O versus VMI • Carrot and stick • Break down large projects • scaffolding
  240. 240. • Present various models of EF • Settle on 10-ish • Introduce HEDYDT? (disappearing ink, do you comment, hedydt) • Create more handouts (e.g. worksheet for determining contingencies)
  241. 241. Overview • Brain overview in 11 slides – Amygdala (mindfulness), hippocampi (exercise), PFC (screen time/green time, sleep), PFC regions, loops • Models of EF – Small group: what is EF – Hot and cold EFs – 10 Efs - consider dawson guare model – Barkley’s 4 – McCloskey’s 30-st • EF as Self-Regulation – Sensing to the self, etc – Central impairment is in self-regulation • Disorders which impact EF – ADHD – TBI – Schizophrenia – Bipolar Disorder – ASD – Anxiety Disorders – Leaning Disorders – Oppositional Defiant Disorder • Real life implications of EF deficits – EF and reading – EF and writing – EF and math – EF and test-taking – Metacognitive Awareness Inventory (Schraw & Dennison 1994) • Assessment of EF – Direct formal etc – Curious compassionate nonjudgmental evaluation • Strategic Behavioral Inquiry (HEDYDT?) • Asking 2 Questions • Case Studies and EF Strategies • School Accommodations and Supports • Big 5 EF Supports
  242. 242. • N-back with a deck of cards
  243. 243. Accomodations • Meltzer (kindle)
  244. 244. ADHD Inattentive Sluggish Cognitive Tempo Hyperactive Combined
  245. 245. 5-42 / (10-2)+3x6 P 5-42 / (8)+3x6 E 5-16 / (8)+3x6 MD 5-2+18 AS 21

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