Learning disability and ADHD are very frequent in childhood periods , lately Executive Function is well proved to be a cause of these disorders and knowing what is EF and how to improve it and increase attention and working memory

1. EXECUTIVE FUNCTION IN
ADHD:
DEFICIT AND INTERVENTION
Prof Heba Essawy
MD psychiatry Prof of Psychiatry , Ain Shams
University

2. Executive Functions (EF) : Definition
EF is a neuropsychological concept referring to
the cognitive processes required
to plan and direct activities,
including task initiation and follow through
working memory, sustained attention,
performance monitoring, inhibition of impulses,
and goal-directed persistence.”
(Dawson & Guare,
2004, )

3. Executive Functions : Importance
 Organize our behavior over time and override
immediate demands in longer-term goals”
 Management of emotions and effective thought
monitoring.
 Allow the child to perform correctly .
Annie Shave 2011

4. Subtypes Of Executive
Function
 1-Response
Inhibition
 2- Working Memory
 3-Self-Regulation
Of Affect
 4- Sustained
Attention
 5- Task Initiation
 6- Planning
 7- Organization
 8-Time
Management
 9-Goal-Directed
Persistence
 10- Flexibility
 11- Metacognition

5. 1-Response Inhibition RI
 Is “the capacity to think before you act”
 The deficit tend to be impulsive.
Impulsive behavior
Saying words without thinking .

6. 2- Working Memory WM
 WM is the ability to hold information mind
while performing complex tasks
 This deficit tend
Forget easily.
Forget their homework or books at
school .

7. 3-Self-Regulation Of Affect
 SR is the ability to manage emotions in order
to achieve goals, accomplish tasks, or control
and direct behavior”.
 This deficit tend
upset quickly with situations, unable
to control their emotions.
to have outbursts that disrupt daily
functioning.

8. 4- Sustained Attention
 SA is the capacity to maintain attention to a
situation or task in spite of distractibility, fatigue, or
boredom”
.
 Deficit tend
to have a hard time getting started on a task.
talk when they shouldn’t.
attention is on everything in the room other
than their work.

9. 5- TaskInitiation
 TI is the ability to begin a task without undue
procrastination, in a timely fashion
 Deficit tend
Put off doing work that they need to
complete.
Lack the processes to start the task.

10. 6- Planning
 Planning is the ability to create a roadmap to reach
a goal or to complete a task.
It also involves being able to make decisions
to focus on and what’s not important.
 Deficit tend
to wait till the last minute to complete tasks
don t know what to do when they have to
complete them.

11. 7- Organization
 Organization is the ability to arrange or place
things according to a system .
 Deficit tend
to have messy desks .
lose papers and books instead of putting it in
its proper places

12. 8-Time Management
 Time management is the capacity to estimate,
allocate, and execute within time constraints
 Deficit tends to
Get work done at the last minute
Frequently ask for assignment
extensions.
Use excuses for not having work.

13. 9-Goal-Directed Persistence
 Goal – Directed is the capacity to have a goal,
follow through to the completion of the goal, and not
be put off by or distracted by competing interests.
 Deficit tends to
create goals for themselves but are not able to
achieve them.
not understand the best steps to reach a goal
always distracted impacting their task
completion.

14. 10- Flexibility
 Flexibility is the ability to revise plans in the face of
obstacles, setbacks, new information, or mistakes.
 Deficit tends to
have difficulty in transitions and new situations.
struggle longer at the beginning of each year.
have limited problem solving strategies.

15. 11- Metacognition
 Metacognition is the ability to observe how you problem
solve. It also includes self-monitoring and self-evaluative
skills.
 Deficit tends to
make careless mistakes frequently.
complete one step then stop instead of finishing the
series of steps.
not reflecting on the whole process needed to complete
the task.

16. Methods Of Intervention
 Executive Functioning Deficits
 Classroom Interventions
 Skill Training

17. Response
Inhibition:Intervention
 ClassroomIntervention:
Reduce situations where the child can get into
trouble
Increase supervision of the child
 Skills training:
Discussion situations to use the skill
Explore the skill and behaviors
Model behaviors
Reinforce positively the skill
Ignore bad behavior
Dawson & Guare, (2004).

18. Working Memory: Intervention
 ClassroomIntervention:
Enforce use of assignment books consistently
Utilize checklists and to-do lists
Use cue as verbal reminders, alarm clocks.
 Skills training:
 Explain the skill
 Give different cues and checklists to the child
 Make a monitoring system for the child to monitor their own
skill
Dawson & Guare, (2004).

19. Self-Regulation Of Affect:
Intervention
 ClassroomIntervention
Prepare child for problem situations
Give child scripts for problem situations and practice regularly
Structure environment to avoid situations that can lead to
problems
Break tasks down into small steps
Give breaks to child during tasks as needed
Use social stories that teach emotional control
 Skills training:
 Explain the skill
 Provide coping strategies
 Practice with the child
 Reinforce child when strategies are used
 Discuss real life situations of using the strategy
Dawson & Guare, (2004).

20. A.Sustained Attention:
Intervention
 ClassroomIntervention
Write start and finish times on assignments
Use incentive systems
Break down tasks into steps
Make tasks interesting for students
Give child something fun to do when task is completed
Provide attention and praise when student is remaining on task
 Skills training:
 Discuss attention time with the student
 Teach them to break down tasks on their own
 Help them make work plans for completing tasks
 Reinforce them when they use the plan
Dawson & Guare, (2004).

21. B.TaskInitiation: Intervention
 ClassroomIntervention
Use verbal cues to get child started
Create a visual cue to prompt child to get started, as a note on
their desk
Walk through the first part of the task to help child get started
Have child tell you when they will begin the task and cue them
when the time arrives
 Skills training:
 Teach the child to create a written plan for starting the task including
time and type of task
 Teach child to break down the task if needed
 Teach child to use cue such as alarm clock to start task
 Reinforce child when no additional cues are needed
Dawson & Guare, (2004).

22. C.Planning: Intervention
 ClassroomIntervention
Plan a schedule for the child
Use rubrics
Break long assignments into smaller pieces with deadlines for
each piece
Create planning sheets with due dates
Use assignment planners
 Skills training:
 Walk through the planning process with the child
 Have child model the planning process
 Tell student to create roadmaps for tasks
 Ask questions such as “What do you have to do first?”
Dawson & Guare, (2004).

23. D.Organization: Intervention
 ClassroomIntervention
Maintain an organized classroom
Create schemes for organizing backpacks and
folders
Color-code folders, notebooks, and papers for
classes
 Skills training:
 Teach child to separate papers and categorize them
 Have them create their own organization plan
 Get the plan in writing
 Have them implement the plan
Dawson & Guare, (2004).

24. E.Time
Management:Intervention
 ClassroomIntervention
Give child a schedule to follow
Prompt student with each step of a task
Impose time limits for assignments
Provide frequent reminders for remaining time to complete task
Use cueing devices such as alarm clocks
 Skills training:
 Help child understand what the task involves
 Have child think of distractions that may be present when
completing task
 Create an estimated time for completion; compare estimated time to
actual time
 Find strategies to decrease distractions
Dawson & Guare, (2004).

25. F.Goal-Directed
Persistence:Intervention
 ClassroomIntervention
Give students goals and have them keep track of their
progress
Goals need to have motivational interest to the student
Include students in establishing goals
Create reasonable goals
 Skills training:
 Follow a coaching process:
 Hold a goal setting session where a goal is set, obstacles are
discussed and a plan is written
 Hold daily coaching sessions where goal is re-discussed and
progress is assessed by asking questions
Dawson & Guare, (2004).

26. G.Flexibility:Intervention
 ClassroomIntervention
Give advance warning for new schedules or activities
Allow student to practice new schedules or activities
Provide rubrics to follow
Read social stories to teach coping strategies in problem
situations
Offer positive reinforcement and step by step assistance
 Skills training:
 Teach students what inflexibility is and how to recognize it
 Teach and model coping strategies with plans and cues
 Create strategies to fall back on
 Teach relaxation strategies
Dawson & Guare, (2004).

27. Metacognition: Intervention
 ClassroomIntervention
Ask child to explain how they solved the problem .
Give assignments where students can evaluate their work
and give grade.
Use rubrics.
 Skills training:
 Define the skill and what is needed to use the skill appropriately
 Practice the skill
 Create error-monitoring checklists
 Teach children to ask themselves self-monitoring questions while
tasks are being completed
Dawson & Guare, (2004).