1 The Organ Shortage Demands Change Inser

1
The Organ Shortage Demands Change
Insert your information
General Purpose: To persuade
Specific Purpose: At the end of my speech I hope that The
Organ Transplant Act of 1984
be changed so that compensation in some form be allowed to
donors

which would increase donations and reduce the number of
people still
waiting for organs.
2
Central Idea: The Organ Transplant Act of 1984 is a U.S.
federal legislation that
prohibits the sale or any type of payment to the donors of
organs. This Act
applies to every situation no matter the case. I believe that the
Act should be
changed to allow donors to be compensated in some way that is
regulated by
the Government which would likely reduce the number of
people still waiting
for someone to donate. There is a shortage of donors and the
current system
is failing to provide the necessary things needed to the people
waiting for
organs and to the donors themselves.
I. Introduction

a. A quote from the United Network for Organ Sharing says
“without the
organ donor, there is no story, no hope, no transplant. But when
there is
an organ donor, life springs from death, sorrow turns to hope,
and a
terrible loss becomes a gift.”
b. Give the audience a reason to listen: Some of you may have
experienced
or known someone who has needed an organ transplant, and if
not, I
know that you can still recognize that it is something that
people deal
with in their daily lives.
c. Establish your credibility: As someone who is aspiring to be
in the
medical field one day and has also seen a person pretty close to
me go
through the experience and process, I feel that this is a topic
worth
thinking about and seeing if change to the current legislation
would be
better for society.

3
d. Reveal the law: The legislation is called the Organ Transplant
Act of 1984
and it prohibits the sale or compensation of organs from donors.
e. Preview the speech: So today, I will explain more about the
Organ
Transplant Act, I will propose the changes that should be
implemented
within the Act and the benefits that it can bring to society, I
will explain
some of the opposing viewpoints which prevent the Act from
being
changed, and finally, I will be giving the audience a certain plan
that they
can do to help change this Legislation.
II. Body
a. According to Barbara Mantel’s article (2011, April 15)
“Organ Donations”
written for CQ Researcher, more than 110,000 Americans are on
the

waitlist for organ-transplants. She states that kidneys account
for about
60 percent of those on the waitlist but can take up to 5 years
until they
find one.
i. Not only that but since 2000 the waiting list has doubled and
will
only continue to do so unless things change.
b. Some organs are given based off of a score patients receive
depending on
their chance of survival but for kidneys it’s determined by how
long you
wait.
i. This system does not help diminish the shortage that is
occurring
c. In 2012, Alex Tabarrok wrote in his article “Around the
World, Innovative
Programs Boost Organ Donations” that Iran is the only country
that has
4

eliminated the shortage of transplant organs, but they do have a
legal
system of paying for donations.
i. They began in 1988 and stopped the shortage by 1999
d. In another article called the “Great Debate: Should Organ
Donors Be
Paid?” (2009, August 10) written by Rachael Rettner, it says
that keeping
a patient on dialysis is expensive and can cost around $65000 to
$75000
per year and it would benefit the government to just pay for the
transplant and incentive for the donors.
e. According to the article “Step One in Solving the Organ
Shortage: Become
an Organ Donor”, 95 percent of people support the concept of
organ
donation but only 54 percent sign up to donate when they die
Transition: These statistics and facts show that many people in
the united states are in
need of a transplant, but the shortage stops that from happening
while the number continues
to grow. This shortage and the unnecessary death of people can
be prevented but, in order to

do this, the legislation must be changed.
f. Thus, I propose that there should be some form of
compensation for
those who are willing to donate so that they can also benefit
from this
procedure and potentially increase the amount of people willing
to give.
g. If the Organ Transplant Act can be changed, the amount of
people that
could be helped would increase and there would be no shortage
because
of an increase in donors.
i. According to Amy L Friedman (2006), an associate professor
of
surgery, wrote in her article “Payment for living organ donation
5
should be legalized” that donors not only have to pay for
transportation to the site of surgery, but they get no
compensation

for lost wages at work either. She believes that these reasons
might be stopping many from donating.
1. Compensating would allow everyone from the donor to the
patient to receive something and be treated equally.
ii. In Alex Tabarrok’s article (2012), Nobel Laureate economist
Gary
Becker and Julio Elias estimated that if only 15000 were given
to
donors, there would be no shortage of kidneys in the U.S but the
Federal Gov would have to pay so there would be no inequality.
iii. The National Kidney Foundation (2017) also agreed that
compensation should be given to donors to make it cost neutral
and pay for things like travel expense, wages, medical care, and
follow up care for donors.
1. Giving to the families of those who donate in some form
could also work.
iv. The US could even save up to $46 billion a year according
to
Robert Gebelhoff in his article, “Compensation for organ
donors: A

primer” written in 2015.
1. All of these reasons would likely increase the amount of
donations and reduce the shortage of organs.
6
Transition: A change in the federal legislation that includes the
modifications I have
proposed, can save the lives of those who are still waiting for a
donor and a transplant.
However, there are still some people who oppose this change of
legislation.
h. Some of the opposing views to changing the legislation
includes the belief
that doing this would in turn exploit the poor.
i. But there are many ways to prevent this from happening
ii. In the article written by Dr. Joseph Fins (2009, February 9)
called
“Should Organ Donors Be Compensated?”, another Dr. Sally
Satel,
an organ donor herself, states within that same article that to

protect the poor and desperate there should be compensation
that
would not appeal to these groups, specifically, no cash for
kidneys.
1. However, instead they could compensate in the form of a
401k contribution, or even a Medicare voucher which
would stop them from making any hasty decisions.
2. Or they could prevent the poor from contributing at all
unless they were completely healthy and checked by
doctors first.
3. Also, everything would need to be regulated and
compensated by the Gov. to keep everything equal from
paying to who ends up receiving the donation.
iii. Another opposition is that altruistic or religious giving
would stop.
1. According to the article “Financial Incentives for Or gan
Donation” written for the US department of Health and
7

Human Services, altruistic giving has been going on for
about 30 years, but it might be time for a new approach,
and it would be ethical because of concern for patients and
saving lives.
a. The current altruistic system of donations is just not
providing enough.
2. Barbara Mantel’s article for CQ Researcher, says that a
study found that poor people were more willing to donate
with no payment than people who were wealthier.
Introducing payments to that did nothing to change the
outcome.
a. It also concluded that altruistic donation would not
be affected either.
III. Signpost: As you can see, there are many views regarding
this topic and legislation. Those
who oppose it, oppose it due to their fear of problems and
implications that could arise;
however, we must also think about those that are suffering and
have waited for such a long

time and think about more ways to help them.
IV. Plan of action:
a. In order to reduce the amount of people still on the waitlist
for those
organs, I believe that a change to the legislation could be a
possible way
to make it work.
b. All of us can aid in this by doing different things.
8
c. The National Kidney Foundation (2017) states that a way to
help is to
educate families, friends, and patients on how to find donors
when they are
struggling to do so.
i. Not only that but learning more about the issue in general
ii. They also state that peer mentoring from a donor to potential
donors could be beneficial
d. Another step is to educate yourself and consider, even if only
a little bit,

to become a donor yourself.
i. When you renew your license, you can also put that you
would be
an organ donor if anything happens as well.
ii. Whether we are compensated or not the act itself is still
something
that takes a lot of courage from all who donate.
e. These are just some things we can think about and do in our
own lives to
help the issue at hand. But we still need to try to get the
legislation
changed to see more of an impact.
V. Conclusion
a. To reiterate, I propose that the Organ Transplant Act be
changed and
should include compensation for anyone that is willing to
donate any
organ at any point in their lives whether it be money or even
just paying
for their expenses which would raise donation rate and reduce
the
shortage over time.

9
i. Research shows that not only could this raise donation rate
and
finally stop the shortage, but it saves the US a lot of money as
well
and everyone would benefit.
ii. Although there are those who oppose the Act from changing,
there
are many ways that the US Government could regulate the
compensations in a way that is safe and would benefit all.
iii. Finally, I discussed a plan of action that I hope can be
accomplished and something we can all do to bring awareness to
the issue.
b. If we do this many more people who die unnecessarily and
suffer from
this could live, and finally be free from hoping that one day,
they will be
able to receive what they desperately needed. All we need to do
is to take

the first step and see where it can take us.
References
Financial Incentives for Organ Donation (n.d.). U.S Department
of Health & Human Services.
Retrieved from
https://optn.transplant.hrsa.gov/resources/ethics/financial -
incentives-for-organ-donation/
Fins, Dr. J. (2009, February 9). Should Organ Donors Be
Compensated? Weill Cornell
Medicine. Retrieved from
https://news.weill.cornell.edu/news/2009/02/should-
organ-donors-be-compensated
Friedman, A. L. (2006). Payment for living organ donation
should be legalised. BMJ (Clinical
research ed.), 333(7571), 746–748.
https://doi.org/10.1136/bmj.38961.475718.68
https://news.weill.cornell.edu/news/2009/02/should-organ-
donors-be-compensated
https://news.weill.cornell.edu/news/2009/02/should-organ-
donors-be-compensated

https://doi.org/10.1136/bmj.38961.475718.68
10
Gebelhoff, R. (2015, December 28). Compensation for organ
donors: A primer. Retrieved
from https://www.washingtonpost.com/news/in-
theory/wp/2015/12/28/compensation-for-organ-donors-a-primer/
Mantel, B. (2011, April 15). Organ donations. CQ Researcher,
21,337-360. Retrieved from
http://library.cqpress.com.ezproxy.barry.edu/cqresearcher/cqres
rre2011041500
National Kidney Foundation Position on Increasing Organ
Donation and Transplantation.
(2017, May 25). Retrieved from
https://www.kidney.org/news/national-kidney-
foundation-position-increasing-organ-donation-and-
transplantation
Rettner, R. (2009, August 10). Great Debate: Should Organ
Donors Be Paid? Retrieved from
https://www.livescience.com/5606-great-debate-organ-donors-
paid.html
Step One in Solving the Organ Shortage: Become an Organ

Donor. (2018, August 17).
Retrieved June 22, 2020, from https://biolife4d.com/step-one-
solving-organ-
shortage/
Tabarrok, A. (2012). Around the World, Innovative Programs
Boost Organ Donations. In D.
A. Henningfeld (Ed.), At Issue. Organ Transplants. Detroit, MI:
Greenhaven Press.
(Reprinted from The Meat Market, Wall Street Journal, 2010,
January 8) Retrieved
from https://link-gale-
com.ezproxy.barry.edu/apps/doc/EJ3010483233/OVIC?u=miam
50083&sid=OVIC&
xid=18576079
What is UNOS?: About United Network for Organ Sharing.
(2019, December 23). Retrieved
June 22, 2020, from https://unos.org/about/
https://www.washingtonpost.com/news/in-
https://www.washingtonpost.com/news/in-
http://library.cqpress.com.ezproxy.barry.edu/cqresearcher/cqres
rre2011041500

https://www.kidney.org/news/national-kidney-foundation-
position-increasing-organ-donation-and-transplantation
https://www.kidney.org/news/national-kidney-foundation-
position-increasing-organ-donation-and-transplantation
https://www.livescience.com/5606-great-debate-organ-donors-
paid.html
https://biolife4d.com/step-one-solving-organ-shortage/
https://biolife4d.com/step-one-solving-organ-shortage/
https://link-gale-
50083&sid=OVIC&xid=18576079
https://link-gale-
50083&sid=OVIC&xid=18576079
https://link-gale-
50083&sid=OVIC&xid=18576079
https://unos.org/about/
372 CounCil for ExCEptional ChildrEn
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From Frazzled to
Focused
Supporting Students With
Executive Function Deficits
Corinne Gist
Executive Function
http://crossmark.crossref.org/dialog/?doi=10.1177%2F00400599
19836990&domain=pdf&date_stamp=2019-04-10
TEACHING ExCEptional ChildrEn | May/JunE 2019 373
Ms. Miller is an experienced special
education teacher at Huntley Middle
School. This year, she has several
students on her caseload demonstrating

difficulties that she did not notice
during her first year of teaching.
Students are losing assignments,
turning in homework late, missing
scheduled practices, and continuing to
exhibit ineffective problem-solving
strategies, even after receiving feedback.
Verbal reminders and loss of points on
late assignments have not been
effective. Ms. Miller is at a loss for how
to help these students.
The struggles these students are
experiencing are not unique to Ms.
Miller’s classroom. Special and general
education teachers experience similar
challenges on a daily basis. As any
teacher will tell you, reminders and
lectures to stay focused or to apply
oneself are not enough for many
children who have deficits in their
executive functioning skills. Executive
functions are often referred to as the
chief operating system of the brain.
Currently, there is no one agreed-upon
definition for the term executive
functions, but it is most often used as
an umbrella term for a set of processes
or subskills needed for higher-level
cognitive functioning (Suchy, 2009).
Executive function subskills include
task initiation, sustained attention,
working memory, and inhibition. These
skills are often referred to as self-
discipline or self-control by the general
public. Additionally, executive

functions are related to subskills
necessary for higher-order thinking
skills, such as planning, organizing,
goal setting, and problem solving. All
of these skills develop most rapidly
during the preschool years but
continue to develop during adolescence
and beyond (Zelazo & Carlson, 2012).
Students with diagnoses of autism
spectrum disorder (ASD), emotional
and behavioral disorders, specific
learning disabilities (LD), and attention
deficit hyperactivity disorder (ADHD)
commonly demonstrate deficits in
executive function skills (Cole, Usher,
& Cargo, 1993; Martinussen & Tannock,
2006; Mattison & Mayes, 2012). In fact,
Barkley (2012), a leading expert on
ADHD, states that, at its base, ADHD is
an executive functioning disorder.
Deficits in executive functions can
lead to many difficulties for students
with disabilities. Research has shown a
strong correlation between deficits in
executive functions and deficits in
academic performance and social-
emotional functioning (e.g., Best, Miller,
& Naglieri, 2011; Clark, Prior, & Kinsella,
2002). In addition, results of a
longitudinal study reported that a
self-control assessment given to children
3 to 11 years old predicted physical
health, substance dependence,
socioeconomic status, and the likelihood

of a criminal conviction by age 32, even
after controlling for social class of origin
and IQ score (Moffitt et al., 2011).
Deficits in self-control were correlated
with poorer outcomes later in life.
Difficulty with impulsivity, problem
solving, and planning also affect an
individual’s ability to make and
maintain friendships (Diamantopoulou,
Rydell, Thorell, & Bohlin, 2007). With
executive function skills affecting so
many aspects of a student’s life, it is
important for teachers to find ways to
mediate these deficits in the classroom.
With state testing requirements,
response to intervention (RTI), and
positive behavior interventions and
supports (PBIS), teachers have more
responsibilities than ever before.
Adding one more skill set for teachers
to address may seem overwhelming;
however, deficits in executive function
skills are often related to academic and
behavior problems that lead to
referrals to the RTI or PBIS team.
Improving executive function skills
also increases students’ abilities to
perform academic, social, and daily
living tasks and decreases off-task and
challenging behaviors (Best et al., 2011;
Clark et al., 2002). Executive function
skills can also be addressed on a
student’s individualized education

program. Data can be collected in the
same manner as data are collected on
academic goals. If students are able to
plan, organize, stay on task, and
problem solve, they may not need
additional interventions that would
otherwise be required.
Ms. Miller attended a teacher
preparation program that was known
for its strong application of applied
behavior analysis and prides herself on
her ability to apply behavioral
principles in her classroom. She runs a
well-structured classroom that includes
clear behavioral expectations, classwide
and individual reinforcement systems,
and individual supports for challenging
behaviors. Despite the structure Ms.
Miller provides for her students, she is
frustrated by her inability to help
students with executive function
deficits to stay organized, manage their
time, and problem solve in their daily
lives.
For example, one of Ms. Miller’s
students, Samantha, has difficulty
bringing the correct materials to math
class. She will often show up to class
without her calculator, protractor, or
graph paper. Samantha always appears
embarrassed and apologizes for
forgetting her materials, but her
behavior has not changed. Ms. Miller

allows Samantha to retrieve her items
from her locker, but, in turn, Samantha
misses the first 5 minutes of instruction.
After speaking with Samantha’s other
teachers, Ms. Miller learns that this a
common problem for Samantha. She is
also forgetting to bring her textbook,
homework, and materials to her
English, social studies, and physical
education (PE) classes. Samantha’s
grades are suffering due to her difficulty
with staying organized. She is failing
PE because she often forgets her gym
clothes at home or leaves them in her
locker.
Improving executive function skills also increases
students’ abilities to perform academic, social,
and daily living tasks and decreases off-task and
challenging behaviors.
Fortunately for Ms. Miller, she
already has the tools needed to help
Samantha and her other students
struggling with similar difficulties. The
behavioral principles she uses to
prevent and address challenging
behavior can also be applied to assist
students with executive function
deficits.
How Do I Teach Executive

Functioning Skills Using
Behavioral Principles?
From the behavioral perspective,
executive function skills involve
selecting, monitoring, and revising
behavioral strategies. These strategies
are then used to develop (and revise)
an appropriate plan (Borkowski &
Muthukrishna, 1992, as cited in Hayes,
Gifford, & Ruckstuhl, 1996). Executive
function skills allow students to (a) set
goals and engage in behaviors that lead
to achieving those goals, (b) engage in
behaviors that are consistent with the
chosen goals and avoid behaviors that
are not, and (c) self-evaluate behavior
and change course if the plan is not
leading to the desired outcome. All of
these behaviors are observable and
measurable and can be taught using
behavioral strategies.
Step 1: Define the Behavior
Before beginning the process of
teaching new skills, teachers must first
determine what it is they want to
teach—they must define the target
behavior. Defining the target behavior
simply means stating what the student
should do and describing the behavior
in observable and measurable terms.
For example, stating that Samantha
needs to be more organized is not an
observable or measurable statement.

What does it mean to be organized?
How can her teacher measure it? What
is meant by more? Instead of saying,
“Be more organized,” Samantha’s
teacher could state, “Samantha will
bring all her materials to class.” Her
teacher can create a list of the
materials needed and observe and
measure how often Samantha brings
those materials to class.
Step 2: Provide Reinforcement
One of the most important steps in
teaching a new behavior is providing
reinforcement. Reinforcement involves
adding or subtracting something from
the environment immediately after a
behavior that increases future
frequency of the behavior under similar
circumstances (Cooper, Heron, &
Heward, 2007). Therefore, if the
reinforcer does not increase the
student’s behavior, it is not a reinforcer
for that student. It is crucial that
reinforcers are individualized for each
student—what is reinforcing for one
student may not be for another. For
example, Amber’s behavior may be
reinforced by social praise, whereas
Russell’s behavior may be reinforced
by extra opportunities to play on the
computer. In addition, reinforcers may
change over time, especially for
younger students and students with
short attention spans. It is important to

collect data on each student’s behavior
and adjust the reinforcers as needed.
Ms. Miller and Samantha discuss
reinforcer options and decide that
Samantha will earn buckeye bucks to
spend at the school store. Samantha
will have the opportunity to shop at the
school store on Fridays. Ms. Miller
knows that for some students, it may be
best to make the exchange period
(when the students can spend their
money) indiscriminable. In other
words, students do not know which day
of the week they will get to visit the
school store. This approach is best for
students who may engage in the desired
behaviors only toward the end of the
week or right before they are able to
cash in for the terminal reinforcer.
Samantha is able to wait until Friday to
shop at the store. In addition, her
behavior is also reinforced by the
positive praise she receives when she
earns the buckeye bucks.
Step 3: Create a Task Analysis
After the target behavior is defined, the
teacher can begin teaching the new
behavior. The first step is to analyze
the behavior by creating a task
analysis. A task analysis involves
breaking down complex or multistep
skills into smaller, easier-to-learn

subtasks (Heward, Alber-Morgan, &
Konrad, 2017). The number of steps
required will be determined by each
student’s individual needs and skill set.
Task analysis can be used to teach a
variety of skills, from cleaning tables
(R. Smith, Collins, Schuster, & Kleinert,
1999) to training teachers to teach
literature (Browder, Trela, & Jimenez,
2007). For example, Bryan and Gast
(2000) taught students with high-
functioning autism on-task and
on-schedule behaviors using a task
analysis and picture schedule system.
Figure 1 provides an example of a
task analysis that could be used to teach
Samantha to bring her materials to
class. This task analysis was designed
specifically for Samantha and may need
to change if used with another student.
For example, a teacher may add
additional steps, combine steps, or
exclude steps that are not needed.
Step 4: Create a Chaining Plan
Once the task analysis is complete,
chaining can be used to teach the new
Figure 1. Task analysis for Samantha
Task: Samantha will bring her materials to class.
1. Go to locker after each period.

2. Take out checklist of needed materials for your next class
(hung on locker
door with magnetic clip).
3. Check off each item on checklist as you put them into your
book bag.
4. Put checklist back on top shelf of locker and close locker.
5. Walk directly to class with bookbag and materials.
set of behaviors. Chaining involves
individually teaching each step of the
task analysis to create a chain or set of
behaviors and has been used to teach
functional and academic skills to
individuals of all ages (Purrazzella &
Mechling, 2013; Rao & Kane, 2009; Test,
Spooner, Keul, & Grossi, 1990). Most, if
not all, higher-order thinking skills
involve multiple steps and, therefore,
will probably be taught using a chaining
procedure. Chaining can be useful for
students who do not know how to
complete some steps, miss or skip steps,
or complete some steps incorrectly.
There are three types of chaining
procedures that are commonly used: (a)
forward chaining, (b) backward
chaining, and (c) total task chaining
(Cooper et al., 2007). In forward

chaining, the student is required to
complete only the first step in the chain
before earning a reinforcer (e.g., prize,
reward, praise). Once the first step is
mastered, the student is required to
complete the first and second steps in
order to earn the reinforcer. This pattern
continues until the student has
completed the entire chain.
Backward chaining follows a similar
process; however, the teacher begins
with having the student complete only
the last step in the chain in order to
earn the reinforcer. Once the student
has mastered the last step, he or she is
required to complete the last two steps
in the chain to earn the reinforcer, and
so on. Last, total task chaining involves
working on the entire chain from the
start—the student receives training on
each behavior in the chain during each
session.
There are a few points for teachers
to consider when deciding which
chaining method is best for their
student (see Slocum & Tiger, 2011, for
an experimental comparison of forward
and backward chaining). First, if the
student can already complete the first
couple steps in the chain, the teacher
may want to begin with forward
chaining. For instance, if a student
completes the first few steps of the

classroom morning routine (e.g., hang
up coat, take lunch out of book bag,
hang up book bag) but consistently
forgets to take homework out of the
book bag and turn it in, the teacher
may want to begin with forward
chaining. However, if the last step must
be completed, for example, in
Samantha’s case (she must bring all
her materials to class), the teacher may
want to use backward chaining
(Najdowski, 2017). The student is
responsible for independently
completing only the last step, and the
teacher can prompt or assist the
student through the beginning of the
chain.
Last, total task chaining is best for
students who have the skills needed to
complete the entire behavior chain but
require additional motivation to do so.
For example, total task chaining may be
used with a high school student who
has the ability to fill out a planner every
day but needs some extra motivation (or
reinforcement) to do so. Total chaining
is not the best option for students who
are easily frustrated with long tasks
(Najdowski, 2017). See Figure 2 for a
summary of chaining options.
Ms. Miller sits down with her team
to create a plan to assist Samantha
with bringing her materials to class.
The plan includes the use of chaining,

prompting, reinforcement, fading
prompts, and self-management
strategies.
The first component involves
teaching Samantha the behavior chain
described in the task analysis in Figure
1. Ms. Miller’s teaching assistant, Ms.
Gebhardt, will walk Samantha through
Steps A, B, C, and D. In order to earn
the reinforcer, Samantha is responsible
only for independently walking to class
Figure 2. Forward, backward, and total task chaining
with her materials (Step D). After she
reaches some set criteria for
independently completing Step D (e.g.,
independently walks to class with
materials for 3 consecutive days), she
will be required to put her checklist
away (Step C) and walk to class with
her materials (Step D) to earn the
reinforcer.
Step 5: Select Prompts
Once the task analysis is complete and
the chaining procedure has been
selected, the teacher must determine
what types of prompts the student will
need in order to engage in the

behavior. Prompting involves providing
some type of assistance in order to
evoke a target behavior. For instance, if
the teacher asks the entire class to line
up and one student does not do so, the
additional verbal direction or gesture
given to that student is a prompt. As
with the other steps, the number and
types of prompts required will be
individualized for each student. Using
prompts in the classroom is a
successful strategy for assisting
students with LD, autism, and other
disabilities (Garfinkle, & Schwartz,
2002; Moore, Anderson, Glassenbury,
Lang, & Didden, 2013; Rouse, Alber-
Morgan, Cullen, & Sawyer, 2014).
Figure 3 provides examples of prompts
for a target behavior.
Ms. Miller has decided that Ms.
Gebhardt will use verbal and visual
prompts to assist Samantha in learning
to bring her materials to class. Ms.
Miller and Samantha will create a list
of the steps Samantha must follow to
assure she brings her materials to class
(i.e., task analysis). Additionally, they
will create lists of the materials she
needs for each class. These lists will be
posted in her locker. Last, Ms. Gebhardt
will meet Samantha at her locker and
provide verbal prompts as she learns
each step in the behavioral chain. Ms.
Gebhardt’s assistance will be faded as

Samantha becomes more independent.
Step 6: Create a System for Data
Collection
In addition to consistently providing
reinforcement, data must be collected
when teaching a new skill. Collecting
and analyzing data is the only way to
determine if the student is learning the
new skill. Data also help in making
decisions regarding when to add or
fade prompts, change the teaching
method (e.g., forward chaining vs. total
task chaining), or begin teaching a new
skill. Including the student in the data
collection and analysis can add extra
motivation for the student. Most
students enjoy seeing their progress in
graph form.
The task analysis created for
Samantha will also serve as the data
collection form (see Figure 4) Ms.
Gebhardt will use to collect data on
Samantha’s progress. Ms. Gebhardt will
circle the type of prompt needed for
each step in the chain. For example, if
Samantha forgets to walk to her locker
after class and needs a verbal prompt to
do so, Ms. Gebhardt will circle the V for
verbal prompt. If Samantha requires
only a gestural prompt for the next step,
Ms. Gebhardt will circle the G. Last, if
Samantha is able to complete a step

without any prompts, Ms. Gebhardt will
circle the I to indicate Samantha
completed the step independently. Once
Samantha has independently completed
the determined step(s) for 3 consecutive
days, the next step will be added to the
chain.
Step 7: Prevent Prompt
Dependency (Fading and
Self-Management)
The ultimate goal of teaching any
skill, whether it be academic, social,
or related to executive functions, is to
Figure 3. Example of prompts that may be used when teaching a
new skill
Target: Complete morning routine.
1. Hang up backpack.
2. Put lunch in bin.
3. Take out bell work, notebook, and pencil.
Prompt Type Definition Examples
Verbal Involves spoken or written words for
hints, cues, reminders
“Sheri, please take out your morning routine checklist.
Remember, your first step is to hang up your book bag.”
Visual Visual cue or reminder of desired
behavior
Sheri has a checklist on her desk that contains words

and/or pictures that represent each step in the chain.
Gestural Pointing or moving eye gaze towards
the item
The teacher points to the checklist to show Sheri which
step is next.
Modeling Demonstrating the behavior for the
student
The teacher hangs up Sheri’s book bag and then has
Sheri hang up the book bag herself.
Additional Auditory/
Tactile Prompts
Devices that can prompt the start of
a behavior or shorten/lengthen the
duration of a behavior
The teacher sets a timer and vibrating device (e.g.,
MotivAider®) and has Sheri complete all the steps before
the timer goes off.
have the student be able to complete
the task independently. Many times,
the steps are put into place, but
teachers forget to slowly fade the
prompts and thin the schedule of
reinforcement. Fading prompts
involves decreasing the number of

prompts given for a particular step or
set of steps. If prompts are withdrawn
too quickly, the student may regress in
his or her progress; however, if
prompts are not faded at all, the
student may become prompt
dependent and demonstrate the target
behaviors only when prompted.
Thinning the reinforcement schedule
means increasing the requirements for
receiving reinforcement. For example,
initially Samantha may earn a buckeye
buck for every class period she brings
her needed materials. The teacher
could thin her reinforcement schedule
by requiring her to bring her materials
to all of her classes in order to earn
the buckeye buck. The decision to
fade prompts and thin reinforcement
should be made based on the
student’s data.
As prompts are faded, teachers
should work with the student to create
a self-management plan. Self-
management is defined as “the
personal application of behavior
change tactics that produces a desired
change in behavior” (Cooper et al.,
2007, p. 578). Self-management is often
used as a blanket term to cover a group
of behaviors including self-monitoring
(self-recording), self-evaluation, and
self-delivered reinforcement (Cooper
et al., 2007). Self-management

interventions can improve an
individual’s awareness of his or her
behavior, minimize the need for
external supports, and increase
maintenance and generalization of
behavior change (Cooper et al., 2007).
It is important to transfer the
responsibility of prompting and
reinforcing the behavior to the student,
as the student is the only one who is
always present when the behavior is
exhibited. In addition, learning
self-management skills will increase
independence and reduce reliance on
the teacher. A recent meta-analysis
(Lee, Simpson, & Shogren, 2007) found
that self-management interventions for
individuals with ASD successfully
increased appropriate behaviors across
several domains (e.g., problem
behavior, academic performance, daily
living skills). Additional research has
found similar results for students with
ADHD, LD, and emotional and
behavioral difficulties (Alsalamah,
2017; for a review, see Briesch, &
Briesch, 2016). For easy-to-use
self-management strategies, see Joseph
and Konrad (2009).
Once Samantha independently
completes the entire behavior chain, the
verbal prompts from her teacher will be
faded. Samantha will keep the list of
materials for each class in her locker

and independently use them when
needed. Additionally, Samantha will
need to bring all of her needed
materials to class in order to earn her
buckeye buck. As Samantha increases
her independence, the number of
consecutive days she is required to bring
her materials in order to earn the
buckeye buck will gradually increase.
Ms. Miller has helped Samantha and
her other students strengthen their
executive functioning skills by applying
behavioral procedures. She is confident
her students have learned the skills
needed to successfully transition into
high school. Ms. Miller’s students will
use their self-management plans to stay
organized, set goals, and problem solve
for years to come.
Putting It All Together
The steps for teaching executive
function skills are versatile—they can
be used to teach of range of skills to a
range of students. Here is an example
Figure 4. Data sheet for Samantha
Week of: Day:
Step Monday Tuesday Wednesday Thursday Friday Notes
Go to locker after class. I G V I G V I G V I G V I
G V

Take out checklist of
materials for your next class.
I G V I G V I G V I G V I G V
Check off each item on
checklist as you put them
into your book bag.
Hang checklist back on door
and close locker.
Walk directly to class. I G V I G V I G V I G V I G
V
Total
I_____
G____
V____
I_____
G____
V____
I_____
G____
V____
I_____
G____
V____

I_____
G____
V____
Prompt Key: I: Independent G: Gesture V: Verbal
of how to put all the steps together.
This scenario follows Nathan, a student
who is struggling with staying
organized and managing his time, as
he works with his guidance counselor
to develop a plan.
Nathan is an 11th grader who is
involved in many activities at school.
He is on the soccer team and hopes to
receive a scholarship to play soccer in
college. Nathan’s school counselor
advised him to become involved in
other school activities to increase his
chances of receiving a college
scholarship. This school year, Nathan
has joined the yearbook club, is active
in the gaming club, and volunteers at
the local food bank. In addition to these
activities, he receives academic tutoring
three times a week. Over the past
semester, Nathan has started missing
practices, meetings, and assignments.
Nathan and his teachers agree that he
needs to create a plan to assist him in

managing all of his responsibilities.
1. Define the target behavior. Nathan
will complete his planner checklist
at the end of each school day.
Although Nathan may have more to
work on than just writing in his
planner, this skill is currently the
top priority. Nathan admits that he
cannot remember when his
assignments are due, the dates of
his club meetings, or what time he
has practice. Completing his planner
each day will allow him to keep
track of all of his responsibilities.
Once he has mastered this skill, the
team can create a plan to work on
related skills.
2. Determine reinforcement plan. Mr.
James, Nathan’s guidance
counselor, will provide verbal praise
when Nathan independently
completes steps on his checklist.
Additionally, Nathan will receive
naturally occurring social
reinforcement from his coaches and
teachers when he decreases the
number of missing assignments and
practices. Additional tangible
reinforcement (e.g., snacks, school
store bucks, gift cards) can be added
if needed.
3. Create a task analysis (planner

checklist). Nathan and Mr. James
create a planner checklist for
Nathan to complete each day (see
Figure 5). Mr. James knows that if
Nathan writes down his meetings,
practices, and assignments, he will
be more likely to remember them
and, in turn, attend and complete
them. Nathan is responsible for
deciding which details he needs to
record for each activity (e.g., time of
event, materials needed, length of
activity).
4. Decide on a chaining plan. Mr.
James determines that total task
chaining will be used to assist
Nathan with completing this
checklist. Nathan has the skills to
complete each step but requires
additional prompts to write in his
planner each day.
5. Select a prompting procedure.
When the plan is first implemented,
Mr. James will sit with Nathan at
the end of each school day to
complete his checklist. Mr. James
will provide verbal prompts only for
the steps that Nathan does not
complete on his own. Verbal
prompts may include information
on the activity (e.g., due date,
practice start time) or reminding
him where to look for certain

information. For example, if Nathan
does not have any after-school
activities listed, Mr. James may tell
Nathan to check his e-mail for his
volunteer schedule or to check his
Figure 5. Checklist for Nathan
Directions: Complete the checklist at the end of each school
day. Mark yes if the step is complete; mark no if
the step is not complete or if Nathan needs prompts to complete
the step. Total the yes and no responses at the
bottom of the checklist.
Task Yes No
1. Each academic subject is listed for today and tomorrow
2. Each subject has an assignment listed and includes the
following information
a. The name of the assignment
b. The due date of the assignment
c. The estimated amount of time needed to spend on the
assignment each night
3. Completed assignments are crossed off
4. After-school activities are listed and include the following
information
a. The time of the activity

b. The location of the activity
c. Supplies and equipment needed
Total
soccer team’s web site for his
practice and game schedule.
6. Collect data. Data will be collected
using the task analysis/checklist in
Figure 5. Each day, Mr. James and
Nathan will count the number of
responses of yes and no and graph
the totals. If either total stays
stagnant or moves opposite of the
desired direction, additional
interventions (e.g., additional
prompts or reinforcement) will be
introduced.
7. Fade prompts and develop self-
management plan. When Nathan
has completed all the steps on the
checklist, without prompts, for 3
consecutive days, Mr. James and
Nathan will decrease their meetings
from 5 to 4 days each week. The
number of meetings a week will
continue to decrease until Nathan is
able to independently complete the

checklist.
When Nathan becomes independent
with the checklist, the team may want to
create a new plan to assist Nathan in
managing his time. This plan could
include creating a daily schedule that
specifically indicates the time of day and
duration of time Nathan will spend on
each activity. For additional information
on teaching time management skills, see
the resources listed for Teaching
Executive Functions in Figure 6.
Conclusion
When students struggle with executive
function skills in the classroom, it
affects all aspects of their learning.
Fortunately, teachers can use behavioral
principles to teach their students the
skills they need to be successful. When
target behaviors are clearly defined, a
task analysis is created, appropriate
reinforcers are selected and delivered, a
chaining plan and prompt procedures
are put in place, data are collected, and
responsibility for implementing the plan
is slowly transferred to the student,
independence can be achieved. By
following the steps outlined in this
article, teachers can teach their students
to independently organize, plan, and
Figure 6. Additional resources
Topic Resource Description

Reinforcement
Perle, J. G. (2016). Teacher-provided positive attending to
improve student behavior. TEACHING Exceptional Children,
48, 250-257.
A practitioner paper with practical
strategies for implementing positive
attending in the classroom
Smith, K. (2016, December 2). Positive reinforcement in
the classroom: Tips for teachers. Retrieved from https://
cehdvision2020.umn.edu/blog/positive-reinforcement-
teacher-tips/
A teacher tip sheet for implementing
positive reinforcement in the classroom
National Center on Intensive Intervention (February, 2016).
Reinforcement strategies. Washington, DC: U.S. Department
of Education, Office of Special Education Programs,
National Center on Intensive Intervention. Retrieved from
https://intensiveintervention.org/sites/default/files/
Reinforcement_Strategies_508.pdf
A tip sheet describing positive
reinforcement strategies
Self-
management
Joseph, L. M., & Konrad, M. (2009). Have students self-
manage their academic performance. Intervention in Schools
and Clinic, 44, 246-249.

A practitioner paper with 10 easy to use
self-management tools
Schulze, M.A. (2016). Self-management strategies to support
students with ASD. TEACHING Exceptional Children, 48,
225-231.
A practitioner paper with strategies for
implementing self-management with
students with ASD.
Teaching
Executive
Functions
Najdowski, (2017) A. C. Flexible and focused: Teaching
Executive Function Skills to Individuals With Autism And
Attention Disorders
A manual that includes ready-to-
implement lessons for executive
functioning skills
Dawson, P., & Guare, R. (2009) Smart But Scattered: The
Revolutionary “Executive Skills” Approach to Helping Kids
Reach Their Potential
A book that provides information on
identifying, assessing and teaching
executive function skills to children
https://cehdvision2020.umn.edu/blog/positive-reinforcement-
teacher-tips/
teacher-tips/

teacher-tips/
https://intensiveintervention.org/sites/default/files/Reinforceme
nt_Strategies_508.pdf
https://intensiveintervention.org/sites/default/files/Reinforceme
nt_Strategies_508.pdf
manage their time. Mastering these
skills will allow students to succeed in
school and life.
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Corinne Gist, doctoral candidate,
Department of Special Education, The Ohio
State University, Columbus.
Address correspondence concerning this article
to Corinne Gist, The Ohio State University,
305 Annie and John Glen Ave, Columbus, OH
43201 (e-mail: [email protected]).
TEACHING Exceptional Children,
Vol. 51, No. 5, pp. 372–381.
Copyright 2019 The Author(s).
• Counseling and Psychotherapy
• Education
• Media and Communication

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