The document discusses executive function and strategies for assessment and intervention. It provides an overview of executive function models and domains. Assessment methods are described, including formal tests, record reviews, and interviews. Challenges in various life domains are reviewed, with strategies for the classroom, homework, social skills, and accommodations for deficits. Sample IEP goals target self-awareness, goal setting, planning, organizing, and problem solving.
Behavioral Intervention for ADHD, ASD, ODD and General Behavior IssuesTuesday's Child
Meg Kincaid, PhD, Clinical Director of Tuesday's Child presents at the Illinois Chapter of the American Academy of Pediatrics Annual Conference on September 20, 2014.
Behavioral Intervention for ADHD, ASD, ODD and General Behavior IssuesTuesday's Child
Meg Kincaid, PhD, Clinical Director of Tuesday's Child presents at the Illinois Chapter of the American Academy of Pediatrics Annual Conference on September 20, 2014.
The executive function (EF) system located in the prefrontal cortex provides top-down bias signals to other brain structures to guide the flow of activity along neural pathways. The four categories of the executive control system are cognitive flexibility, attentional control, goal setting, and information processing. The EF construct is composed of multiple inter-related high functioning cognitive skill such as formulating goals, planning, and carrying out planned goals. The key elements of the EF system including initiation of activity, working memory, attention, mental flexibility, self-regulation, and monitoring of performance. Nonverbal disabilities such as visuospatial and visuomotor deficits are on the same continuum with attention and EF disorders. In adults, the most active cortical area while performing tasks requiring attention for cognition are the left premotor and supplementary motor areas (BA 6).
The frontal lobe is functional during both fluid intelligence and executive function activities. The left thalamus is activated by verbal working memory tasks which is also controlled by the EF system. The dorsolateral prefrontal (Guenon BA 9), Broca’s area BA 45 and BA 46, angular cingulate, and the left thalamus are components of the EF system’s verbal working memory model. Fluid intelligence encompasses problem solving, pattern recognition, abstract thinking, reasoning skills, and ability to draw inferences and understand relationships. Fluid intelligence is also influenced by the EF system. There is a relationship between fluid intelligence and executive functions. Frontal lobe deficits are entirely explained by fluid intelligence (g) when using some classical executive tasks such as verbal fluency, Trail Making Test B, and the Wisconsin Card Sorting Test. However, multitasking, decision making, and social deficits are EF tasks that exceed those predicted by fluid intelligence loss.
This is a powerpoint, I created, with help from a Developmental Specialist named Becky Parker (M. Ed.) who is in the Early Childhood Education/Early Childhood Special Education Program at BYU-Idaho. It talks about the causes and some helpful tips for parents, teachers, and specialists who may work with these amazing people who suffer from Sensory Disorders.
ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development.
PubMed Health
این پاورپوینت در کارگاه توانبخشی عملکردهای اجرایی توسط دکتر فرهنگ دوست ارائه شده است. برای مشاهده دیگر مطالب ارائه شده در این زمینه به وب سایت فروردین مراجعه فرمایید.
www.farvardin-group.com
This is a Bully reform program that has been designed to TEACH the Bully How it feels to be Bullied a reform the behavior.
This is alternative method that can be adapted into a School's existing program. Instead of an out of school suspension where the bully learns nothing about their behavior. An in school suspension where the Bully must attend a Bully Reform course with different classes to learn about Empathy, The Victim and their struggles they have. This program gives the Victim a chance to Self Advocate and tell the Bully exactly how they feel and Take back their Power. There is a ROLE PLAY activity and a Role reversal and a Common ground class, where the Bully and the Victim must find something in common with each other and have a real conversation about something they both like. This is a Positive learning approach to reforming Bully Culture in our schools.
The executive function (EF) system located in the prefrontal cortex provides top-down bias signals to other brain structures to guide the flow of activity along neural pathways. The four categories of the executive control system are cognitive flexibility, attentional control, goal setting, and information processing. The EF construct is composed of multiple inter-related high functioning cognitive skill such as formulating goals, planning, and carrying out planned goals. The key elements of the EF system including initiation of activity, working memory, attention, mental flexibility, self-regulation, and monitoring of performance. Nonverbal disabilities such as visuospatial and visuomotor deficits are on the same continuum with attention and EF disorders. In adults, the most active cortical area while performing tasks requiring attention for cognition are the left premotor and supplementary motor areas (BA 6).
The frontal lobe is functional during both fluid intelligence and executive function activities. The left thalamus is activated by verbal working memory tasks which is also controlled by the EF system. The dorsolateral prefrontal (Guenon BA 9), Broca’s area BA 45 and BA 46, angular cingulate, and the left thalamus are components of the EF system’s verbal working memory model. Fluid intelligence encompasses problem solving, pattern recognition, abstract thinking, reasoning skills, and ability to draw inferences and understand relationships. Fluid intelligence is also influenced by the EF system. There is a relationship between fluid intelligence and executive functions. Frontal lobe deficits are entirely explained by fluid intelligence (g) when using some classical executive tasks such as verbal fluency, Trail Making Test B, and the Wisconsin Card Sorting Test. However, multitasking, decision making, and social deficits are EF tasks that exceed those predicted by fluid intelligence loss.
This is a powerpoint, I created, with help from a Developmental Specialist named Becky Parker (M. Ed.) who is in the Early Childhood Education/Early Childhood Special Education Program at BYU-Idaho. It talks about the causes and some helpful tips for parents, teachers, and specialists who may work with these amazing people who suffer from Sensory Disorders.
ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development.
PubMed Health
این پاورپوینت در کارگاه توانبخشی عملکردهای اجرایی توسط دکتر فرهنگ دوست ارائه شده است. برای مشاهده دیگر مطالب ارائه شده در این زمینه به وب سایت فروردین مراجعه فرمایید.
www.farvardin-group.com
This is a Bully reform program that has been designed to TEACH the Bully How it feels to be Bullied a reform the behavior.
This is alternative method that can be adapted into a School's existing program. Instead of an out of school suspension where the bully learns nothing about their behavior. An in school suspension where the Bully must attend a Bully Reform course with different classes to learn about Empathy, The Victim and their struggles they have. This program gives the Victim a chance to Self Advocate and tell the Bully exactly how they feel and Take back their Power. There is a ROLE PLAY activity and a Role reversal and a Common ground class, where the Bully and the Victim must find something in common with each other and have a real conversation about something they both like. This is a Positive learning approach to reforming Bully Culture in our schools.
Executive Functioning Assessment in Psychoeducational Domainspsychoed
My CPA 2006 workshop on assessing within these domains. Item content has been removed for test security purposes. Slides have been put in place to indicate where test content was removed (for clarification and continuities sake).
This is the slide set accompanying my PESI workshop of the same title. Email me with questions or to set up a training for your staff! David@DrNowell.com
Lend Me Your Brain: Supporting TBI Survivors around Executive FunctioningDavid Nowell
Parents, counselors, case managers, and physicians are frequently called upon to support TBI survivors as they navigate decision-making, planning, and self-regulation. These key features of executive functioning are often areas of weakness for brain injury survivors, because of frontal lobe involvement. This workshop provides professionals and non-professionals alike with a model for thinking about executive functioning and strategies for providing the best supports – at the right points – for their clients and loved ones who have survived a brain injury.
Understanding and Supporting Clients with Attention Deficit Hyperactivity Di...David Nowell
Slides for a presentation to vocational rehabilitation counselors with Massachusetts Rehabilitation Commission on 12/12/2014. This is a workshop I've presented to various audiences - including professionals, parents, and adults and their partners - for 1-hour to 3-hour to all-day trainings. Contact me to consider a similar workshop for your group at David@DrNowell.com.
Workshop focuses on describing social skills, highlighting key/critical ones to focus on, describes how to teach skills, and provides examples of ways to integrate it into existing curriculum
Fall social work institute 2018 morning how exactly did you do that David Nowell
Developing an awareness and understanding of one’s own thought process is the essence of Metacognition. Executive functions are a group of cognitive “daily living” problem solving skills which typically improve with age, maturity and life experience. they distinguish high-functioning individuals from those who struggle with deadlines and goal management. Students and adults with aDHD often present clinically with frustration regarding procrastination, difficulty following through on important daily living tasks, and shame regarding not meeting the expectations of others. they need support developing “executive functions”.
In this workshop, you will learn a curious and compassionate approach to facilitate inquiry into our clients’ own experiences for the purpose of supporting their development of executive functioning skills. rather than learning how to teach executive functions to clients, we will learn how to support our clients in teaching themselves, and in learning from their own experiences.
Learning Objectives:
• Define Metacognition & Executive functioning
• be able to describe a thorough process of ADHD evaluation
• Identify the most common co-occurring conditions with ADHD • list the core executive functions required to function well as an independent adult
• How to put aside labels such as “lazy” or “unmotivated” in order to identify the functions that even undesirable behaviors serve, or the skills deficits which those behaviors highlight
Fall social work institute 2018 afternoon big 5David Nowell
In this workshop, we will explore in detail 5 keystone lifestyle practices which support the neurochemistry behind good sleep, mood, cognitive clarity, and reduction of ADHD symptomology and behaviors.
Learning Objectives: • learn what clinical research reveals about the impact of physical exercise on brain function and ADHD
•Identify the remarkable impact of even moderate sleep deprivation on cognitive functioning
• List the most common food additives which are known to exacerbate inattention and distractibility
• Summarize the current literature on the value of omega documentation for clients with ADHD
• Describe a 4-pronged system for deep engagement with our calendars
• Identify additional potential supports for our clients with ADHD, including alternative low cost or no cost resources
These slides were provided as a handout for a series of 1-hour programs provided at local (central Massachusetts) libraries by David Nowell, Ph.D. Similar talks are still being scheduled. Questions? contact David@DrNowell.com
Nowell des personality disorders october 2014David Nowell
Overview of the personality disorders, including the DSM5 alternative model, with particular focus on how these disorders impact the disability review process.
Presentation to parents at Grafton Public LibraryDavid Nowell
A Parent’s ADHD Overview: 11 Strategies for Common Home and School Challenges
Does your child have difficulty starting or completing homework? Does he seem “addicted” to video games?
Does she struggle with organization and focus? Has your child been diagnosed or treated for ADHD, or do you or his teachers strongly suspect that he might have symptoms?
Join neuropsychologist Dr. Nowell for this interactive, high-energy, and practical introduction to ADHD. Learn what current brain research tells us about medication as well as non-medication interventions. Discover practical solutions for managing some of the more common ADHD-related problems at home and school. And bring your specific questions to the program.
What parts of your job do you love? Is it possible to do even more of that? And what distracts you and pulls you off-task at work? Finally: what about your job is important but really boring or hard? Neuropsychologist Dr David Nowell speaks to the importance of loving what you do at work. Grounded in cutting-edge understanding of brain-behavior relationships but focused on practical take-away strategies, this is a fun and interactive workshop for new employees.
25 adhd strategies that just might change your life (Boston Area Adult ADHD C...David Nowell
This month we will have the privilege of hearing Dr. David Nowell, Clinical Neuropsychologist.
David Nowell, Ph.D. will facilitate a discussion that will engage you, make you laugh, and leave you with "25 ADHD Strategies That Just Might Change Your Life."
For those who have heard David speak, you know he is a spark plug. His energy is infectious, care credible, and expertise obvious.
Come to this meeting with a friend, partner, family member, or alone. Whether you have ADHD or not, you will walk away changed.
4. 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
108. Objectives of SBI
• Specific behavioral strategy
• What was the feeling-goal?
• Motivational level on a scale from 1-10
109. Benefits of SBI
• Affirms the value of clients’ unique internal
experience
• Emphasizes the culture of self-regulation
• Encourages metacognition
110. 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
117. Learn from your To-Do list
• Which things are not getting completed?
• How – exactly – are these not getting
completed? How do you do that?
118. Clinical Application
• Who in your clinic or classroom is
demonstrating remarkable “resilience” –
persistence despite significant obstacles? And
how, exactly, does he/she do that?
119. 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?
120. 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.”
121. 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 ____?”
221. 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.
223. 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)
224. 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.
225. 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.
226.
227. What are our data sources?
• Record review
• Interview
• Collateral interview
• Checklists
• Mental status examination
• Test scores
229. Curious Compassionate
Nonjudgmental Evaluation
• Skillfully eliciting the chief complaint
• HËDŸDT?
• Forming a diagnostic impression
• Defending your diagnosis / impression
230. Skillfully eliciting the chief complaint
• Too much of what? Or too little of what?
• Invoking the Pediatric Fairy (or the Psychiatric
Genie)
231. HËDŸDT?
• How exactly did you do that?
– Everybody’s doing the best he/she can
– Every behavior problem is either
• Skills deficit
• Contingency problem
232.
233.
234. Forming a diagnostic impression
• Where do you see it the most? And where do
you see it the least?
• Two disorders = two stories
235.
236.
237. Forming a diagnostic impression
• Where do you see it the most? And where do
you see it the least?
• Two disorders = two stories
240. Approaches to Evaluation of EF
• Formal direct
• Informal direct
• Formal indirect
• Informal indirect
241. Evaluation of EF
• Informal Indirect
– Review of records
– Collateral interviews (see McCloskey 2012)
242. 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)
243. Evaluation of EF
• Informal Direct
– Review of work samples
– Process-approach to test performance
– Mental Status Examination
– Classroom observation
244. 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
337. Determine what basic provisions are
unconditional…
• Love
• Respect
• Safety
• 3 meals
• Essential clothing
• Temperature-controlled environment
• 30 minutes of video games
338. …and which are contingent
• Special foods
• Expensive or trendy clothing
• Extra video game time
• WiFi password
339.
340. Clip and share horrible articles about
teens falling out of the back of pickup
trucks
• Review cause and effect
• Discuss consequences
• Emphasize behavioral agency
341. The “Big Five”
• Daily focus time
• Nutrition
• Movement
• Sleep
• Connection
366. The “Big Five”
• Daily focus time
• Nutrition
• Movement
• Sleep
• Connection
367. 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
368. The “Big Five”
• Daily focus time / Motivational clarity
• Nutrition
• Movement
• Sleep
• Connection
382. Let’s stay in touch!
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@davidnowell David Nowell Seminars
389. • Review expectations in
advance
• Teens and college
students may take more
initiative with this
390. 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
391. 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
392. 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
393. 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)
394. 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.
395. 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
396. 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
397. 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
398. 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.
399. 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)
403. Reverse Engineering the Carrot and
Stick
• Rey O versus VMI
• Carrot and stick
• Break down large projects
• scaffolding
404. • 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)
405. 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