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EXECUTIVE FUNCTIONS Using Language To Think Shelly Wier, MS, CCC-SLP Easter Seals Outreach Program

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Presentation on theme: "EXECUTIVE FUNCTIONS Using Language To Think Shelly Wier, MS, CCC-SLP Easter Seals Outreach Program"— Presentation transcript:

1 EXECUTIVE FUNCTIONS Using Language To Think Shelly Wier, MS, CCC-SLP Easter Seals Outreach Program

2 Orchestra Analogy

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5 Language & Communication Prerequisite Subtle, Unspoken Flexible

6 Operational Definition A cluster of brain functions/skills that allows us to... Anticipate consequences Generate novel solutions Initiate appropriate actions/responses to situations Monitor the ongoing success/failure of ones behavior Modify performance based on unexpected changes.

7 Tertiary Processing Conscious Independent Purposeful Goal-Oriented Self-Serving Monitored Evaluated Flexible Adaptive

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10 Underlying Cognitive Functions AttentionInhibition Working Memory

11 Five Levels of Attention Focused Focused Sustained Sustained Selective Selective Alternating Alternating Divided Divided

12 Inhibition Allows for sufficient planning and organization Allows for sufficient planning and organization Prevents disruptive, unwanted, unintentional and irrelevant impulses Prevents disruptive, unwanted, unintentional and irrelevant impulses Delays appropriate actions until the appropriate time Delays appropriate actions until the appropriate time Basis for delayed gratification and optimal results at a later time Basis for delayed gratification and optimal results at a later time

13 Working Memory Memory ChalkboardMemory Chalkboard Mental Storage Space Mental Storage Space Immediate Comparison Immediate Comparison Used Repeatedly Used Repeatedly Reliant on Sustained Attention Reliant on Sustained Attention

14 Six Components of Executive Function Goal Selection Planning & Organization Initiation & Persistence Flexibility Execution & Goal Attainment Self-Regulation

15 Goal Selection Behavioral determination Behavioral determination Predict and anticipate Predict and anticipate Externally-controlled at first Externally-controlled at first Increasingly internally-controlled Increasingly internally-controlled Requires sophisticated language!! Requires sophisticated language!!

16 Planning & Organization Recognize the need to act Recognize the need to act Determine what is necessary Determine what is necessary Seek relevant materials & information Seek relevant materials & informationOR Make do with what is availableMake do with what is available Develop relevant strategies Develop relevant strategies Sequence plans, information, materials Sequence plans, information, materials Account for time, expectations, requirements Account for time, expectations, requirements

17 Initiation & Persistence Self-selected start Self-selected startOR Time-sensitive initiation Time-sensitive initiation Persist with efforts to completion Persist with efforts to completion Continually re-start efforts as needed Continually re-start efforts as needed Terminate efforts as appropriate Terminate efforts as appropriate

18 Flexibility Adapt! Adapt! Adapt! Success requires change Success requires change Allow for unexpected parameters Allow for unexpected parameters React strategically React strategically Depends on divergent thinking and verbal reasoning Depends on divergent thinking and verbal reasoning

19 Execution & Goal Attainment Relies on... Relies on... Initiation & Persistence Attention & Vigilance Adaptability & Flexibility Self-Evaluation Manage time constraints and pacing Manage time constraints and pacing Poorly developed EF = more supervision Poorly developed EF = more supervision

20 Self-Regulation Observation Observation Judgment Judgment Monitoring Monitoring Reaction Reaction Recognizing Recognizing Relies on... Making comparisons Drawing conclusions

21 SUMMARYSUMMARYSUMMARYSUMMARY COMMENTSCOMMENTSCOMMENTSCOMMENTS

22 Pop Quiz 1 1.Define executive function. 2.Give 3 behavioral adjectives to describe tertiary processing. 3.Name 3 underlying cognitive functions that are prerequisite to EF development. 4.Name 5 levels of attention. 5.Name 3 of the 6 components of EF. 6.Which component requires sophisticated language? 7.Which component is syntactically complex?

23 Remediate Deficit Skills Improve Awareness of Deficits Teach Compensatory Strategies Remediate Deficit Skills Improve Awareness of Deficits Remediate Deficit Skills Teach Compensatory Strategies Improve Awareness of Deficits

24 Longest Developmental Phase Frontal lobe development is prolonged Frontal lobe development is prolonged Slowest maturational phase of all the developmental progressions Slowest maturational phase of all the developmental progressions Not completed until mid-20s Not completed until mid-20s Normal, age-related changes in mid-40s Normal, age-related changes in mid-40s Slow decline in synaptic density with age Slow decline in synaptic density with age

25 Emerging Foundations First Two Years Reflexive at first Reflexive at first Inhibition and simple, focused attention emerges between 6-12 months Inhibition and simple, focused attention emerges between 6-12 months Simple shifting of attention emerges between 1-2 years Simple shifting of attention emerges between 1-2 years

26 Two Year Olds Life is here-and-now Life is here-and-now Impulse-driven Impulse-driven Distractible Distractible Perseverative Perseverative No flexibility No flexibility No self-correction No self-correction Immature, but developing attention Immature, but developing attention

27 Three Year Olds Attention, environmental awareness, and language continue to develop Attention, environmental awareness, and language continue to develop Verbal fluency and impulse control improves Verbal fluency and impulse control improves Able to process 1 simple rule Able to process 1 simple rule Shift between tasks 1 at a time Shift between tasks 1 at a time Use inefficient strategies Use inefficient strategies

28 Four Year Olds Language is really starting to help Language is really starting to help Follows simple rules Follows simple rules Generates new ideas and makes simple plans Generates new ideas and makes simple plans Shifts btw simple tasks Shifts btw simple tasks Better task completion Better task completion Delays first choice Delays first choice Complex demands still troublesome Complex demands still troublesome

29 Five Year Olds Impulsivity is declining Impulsivity is declining Language, verbal fluency, and now processing, is increasing Language, verbal fluency, and now processing, is increasing Better balance btw internal needs & external demands Better balance btw internal needs & external demands Follow simple, multi- step directions Follow simple, multi- step directions

30 Six Year Olds More self-controlled; less other-controlled More self-controlled; less other-controlled Attention much better; span is longer Attention much better; span is longer Language processing is of great help Language processing is of great help Begin to use silent, verbal mediation!!! Simple problem solving appears Simple problem solving appears

31 7 - 9 Year Olds Typically, language is well-developed Typically, language is well-developed Attention skills more selective and deliberate Attention skills more selective and deliberate Better at switching between rules and sets of conditions Better at switching between rules and sets of conditions

32 Ten Year Olds Nearing maturity in ability to selectively attend and identify relevant information Nearing maturity in ability to selectively attend and identify relevant information Significant increase in complex reasoning and strategic behavior Significant increase in complex reasoning and strategic behavior Able to consider task requirements over personal impulses Able to consider task requirements over personal impulses

33 11 – 12 Year Olds Ability to learn from mistakes Ability to generate alternate strategies Goal-setting for complex issues Problem solving, and planning & organization complexity Language abstraction significantly increases: Language abstraction significantly increases:

34 Adolescents Significant increases in all skills and relative maturity of: Significant increases in all skills and relative maturity of: Attention & inhibition Working memory Language processing Cognitive flexibility Decision-making Deliberate behaviors Multi-goal oriented efforts Multi-strategy development

35 Early 20s Executive function skills come into full maturity! Self-control Adaptive to change Goal-directed behaviors Avoid sabotaging efforts Ethical, moral, legal decisions Behave within parameters of society

36 Brocas Wernickes 3

37 Prefrontal Cortex (PFC) 1. Integrates relevant prior learning and internal states 2. Makes premotor cognitive decisions 3. Mediates the temporal sequence of behaviors 4. Produces context-dependent, relevant behavior

38 PFC Components Orbitofrontal = STOPS Ventromedial = DECIDES Dorsolateral = ACTS

39 Lets take a break! Please return in minutes.

40 Dx: Executive Function Disorder? So what happens to self-guided behaviors and mature independence when development of EF is atypical or something else goes wrong?

41 Poor Attention Poor Working Memory Poor Inhibition Poor Goal Selection Poor Planning Poor Initiation Poor Flexibility Poor Execution Poor Self- Regulation

42 EF Deficits and SLI Syntax-Based Impaired attention Impaired attention Impaired inhibition Impaired inhibition Poor organization for sentences, narratives Poor organization for sentences, narratives Poor strategy development and planning Poor strategy development and planning Decreased flexibility Decreased flexibility Difficulties intensify as academic demands increase!

43 EF Deficits and SLI Semantics/Pragmatics-Based Failure to readily develop social relationships Failure to readily develop social relationships Impaired emotional perceptions Impaired emotional perceptions Impaired social play Impaired social play Poor or no interpretation of facial expressions Poor or no interpretation of facial expressions Difficulties intensify as social demands increase!

44 Associated Impairments Communication Disorganized discourse Disorganized discourse Tangential, wandering narratives Tangential, wandering narratives Failure to comprehend main theme or idea Failure to comprehend main theme or idea Reduced ability to use self-talk to mediate Reduced ability to use self-talk to mediate Inattentive, impulsive listening Inattentive, impulsive listening Lack of initiation Lack of initiation

45 Associated Impairments Pragmatics & Social Interaction Poor ability to take others perspective Poor ability to take others perspective Inability to transition Inability to transition Impaired recognition of nonverbal cues Impaired recognition of nonverbal cues Poor inhibition of impulsivity Poor inhibition of impulsivity Inaccurate judgment Inaccurate judgment Inappropriate behavior Inappropriate behavior

46 Associated Impairments Processing & Reasoning Limited abstract reasoning Limited abstract reasoning Difficulty recognizing relevant versus irrelevant input Difficulty recognizing relevant versus irrelevant input Difficulty drawing conclusions Difficulty drawing conclusions Difficulty making inferences Difficulty making inferences Limited divergent thinking Limited divergent thinking Limited ability to predict Limited ability to predict

47 Associated Impairments Problem-Solving & Learning Impaired strategic thinking Impaired strategic thinking Limited ability to generate multiple solutions Limited ability to generate multiple solutions Difficulty generalizing Difficulty generalizing Trouble learning from consequences Trouble learning from consequences Impaired ability to complete tasks Impaired ability to complete tasks Impulsive attempts Impulsive attempts Unable to recognize failure Unable to recognize failure

48 Associated Impairments Memory Difficulty retaining information Difficulty retaining information Forget to execute tasks or be where necessary at a given time Forget to execute tasks or be where necessary at a given time Recall information out of sequence Recall information out of sequence Failure to integrate long-term memories Failure to integrate long-term memories

49 Conceptual Differences Traditional Tests: Control for every variable Control for every variable Provide scripted instructions Provide scripted instructions Eliminate distractions Eliminate distractions Allow for very little novel thinking Allow for very little novel thinking Eliminate opportunities for errors in planning or sequencing Eliminate opportunities for errors in planning or sequencing Examiner controls order of things and establishes goals and objectives Examiner controls order of things and establishes goals and objectives

50 Crystallized vs. Fluid Verbal Verbal Vocabulary Verbal reasoning Syntax, semantics Knowledge base Static demo of knowledge Detail analysis Performance Performance Use of knowledge Use of language to develop strats Flexible, applied Nonverbal Perceptions Intuitions Gestalt analysis

51 Assessment Options Formal Assessment Tools Formal Assessment Tools Informal Assessment Tools Informal Assessment Tools Observations Interviews Rating Scales

52 A Quick Experiment TREE

53 STROOP Task green red brown white white brown green red red white green brown brown green white red white brown red green green white brown red red brown green white

54 Best Buy: BRIEF Behavior Rating Inventory of EF Inhibition Inhibition Shifting Shifting Emotional control Emotional control Initiation Initiation Working memory Working memory Planning Planning Organization Organization Self-monitoring Self-monitoring

55 Informal Tools: Observations, Interviews, and Rating Scales Observation Opportunities There are opportunities for informal observation of EF skills within problem solving tasks and social interactions.

56 When Problem Solving... Watch for Watch for Overall independence and success Novelty of problem Planning, organization, and reasoning used Adaptation Correction Self-monitoring

57 Possible Activities Tasks from PBSKids.org and ZOOM Tasks from PBSKids.org and ZOOM Experiments Cooking Building Designing

58 When Interacting Socially... Watch for Watch for Types of behaviors Normalness of interaction Use of social conventions Awareness of... Rule-following Overall self-awareness

59 Possible Activities Games Games Group crafts Group crafts Running errands Running errands Making purchases Making purchases

60 Informal Assessment PROVIDE ultimate outcome (end product) requirements PROVIDE ultimate outcome (end product) requirements DO NOT provide plans or point out errors DO NOT provide plans or point out errors RESIST the urge to help RESIST the urge to help ALLOW natural consequences ALLOW natural consequences WATCH for spontaneous use WATCH for spontaneous use PROMPT only if... PROMPT only if...

61 Bottom Line for Assessment Language Tools Problem Solving Social Skills EFs Self-talkReasoningIntent Making meaning Playground success Friends, Connections Emotional development Academic success Pre-vocational skills Self-help skills Where will student be in 10 years?

62 How Do I Capture Behavior? Build or borrow an observational worksheet that uses... Build or borrow an observational worksheet that uses... Yes/No format Continuity format Context format Degree of independence format

63 Got Lunch? Please return in no more than one hour.

64 Concepts for Intervention EF Deficit Educate Expecta- tions Teach EF Skill Lang. Therapy Environ- ment Compen- sate Self D T T DD DD

65 Did you note? Presence or absence of... Competing background noise Competing background noise Overwhelming visual stimuli Overwhelming visual stimuli Physical constraints Physical constraints Other students Other students Posted lists, reminders, organizational bins, or storage units Posted lists, reminders, organizational bins, or storage units

66 Modify the Environment In the Classroom Balance white space with visual stimuli Balance white space with visual stimuli Create quiet areas and loud areas Create quiet areas and loud areas Provide all necessary materials Provide all necessary materials Group similar items together Group similar items together Explain organizational system Explain organizational system Use labels, lists, and simple signs Use labels, lists, and simple signs

67 Modify the Environment At Home Eliminate clutter, trash, unused items Eliminate clutter, trash, unused items Maintain routine and consistency Maintain routine and consistency Monitor visual stimulation Monitor visual stimulation Provide visual schedules and chore lists Provide visual schedules and chore lists Impose external barriers Impose external barriers

68 Improving Self... -Awareness -Monitoring -Evaluation -Regulation

69 Three Phases of Self... Intellectual Awareness Emergent Awareness Anticipatory Awareness

70 Compensatory Strategies

71 Self-Talk Externalized thought or thinking out loud Externalized thought or thinking out loud Model! Model! Model! Model! Model! Model! Provide: Provide: Verbal strategies Visual strategies Communication strategies Physical cues

72 Language for Thinking Infuse EF into language Tx and language into EF Tx Infuse EF into language Tx and language into EF Tx Make language use meaningful Make language use meaningful Build metacognitive vocabulary Build metacognitive vocabulary Generate the idea that thinking is deliberate and useful Generate the idea that thinking is deliberate and useful Reinforce thru consequences Reinforce thru consequences Model thought bubbles and self-talk Model thought bubbles and self-talk

73 Syntax for Prediction Cannot predict without logic Cannot predict without logic Cannot comprehend logic without an if-then construction Cannot comprehend logic without an if-then construction Cannot refer to past or think about future without tense Cannot refer to past or think about future without tense Cannot reverse thinking without active and passive verbs Cannot reverse thinking without active and passive verbs Cannot separate self from others without morphology Cannot separate self from others without morphology

74 Semantics for Reasoning Need vocabulary to support concepts Need vocabulary to support concepts Need concept analysis to reason (compare, contrive, and deliberate) Need concept analysis to reason (compare, contrive, and deliberate) Need reasoning to strategize Need reasoning to strategize Need strategies to succeed Need strategies to succeed Words, language, thought Words, language, thought

75 Language and Discovery Learning

76 Treatment Planning

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78 Goals and Intervention Determine WHAT, WHY, and HOW Determine WHAT, WHY, and HOW Blend easily measurable, functional outcomes Blend easily measurable, functional outcomes with the underlying process being targeted Include type/amount of cueing Include type/amount of cueing Condition! Skill! Criteria! Condition! Skill! Criteria! Manipulate structured vs unstructured and distracting vs nondistracting environmental variables Manipulate structured vs unstructured and distracting vs nondistracting environmental variables

79 Example? The student will demonstrate attentive listening in structured environments by demonstrating adequate processing and comprehension of simple directions needed to complete academic tasks, given moderate amounts of verbal cues and prompts, with 80% accuracy.

80 Lets take a break! Please return in minutes.

81 Treatment for Attention Deficits Visual scanning tasks Visual scanning tasks Selective listening tasks Selective listening tasks Listening and repeating words Listening and repeating words Listening and repeating sentences Listening and repeating sentences Following directions Following directions Ignoring distractions Ignoring distractions

82 Treatment for Impulsivity Use negative consequences Use negative consequences Withhold necessary materials or information Withhold necessary materials or information Impose delays Impose delays Use barriers or other games Use barriers or other games Use gestural cues and questions to delay Use gestural cues and questions to delay

83 Treatment for Goal Selection Compare and contrast exercises Compare and contrast exercises Interpretation of if-then statements Interpretation of if-then statements Deductive and conclusive reasoning tasks Deductive and conclusive reasoning tasks Using hypothetical situations Using hypothetical situations Inference-making exercises Inference-making exercises Using written lists of prediction outcomes to support memory and comparison Using written lists of prediction outcomes to support memory and comparison Discriminating advantageous versus destructive plans Discriminating advantageous versus destructive plans

84 Treatment for Poor Initiation Turn chores into contests Turn chores into contests Hang simple step-by-step lists Hang simple step-by-step lists Use music and rhythm Use music and rhythm Use simple verb phrases Use simple verb phrases Give forced choices Give forced choices Use timers or time constraints Use timers or time constraints Give first steps and subtask directions Give first steps and subtask directions Divide tasks into smaller, more obvious steps Divide tasks into smaller, more obvious steps

85 Treatment for Planning & Organization Plan itself is outcome, not execution Plan itself is outcome, not execution Capitalize on the need for language Capitalize on the need for language Sorting and sequencing activities Sorting and sequencing activities Teach and use key phrases Teach and use key phrases Feature analysis Feature analysis Divide organization tasks into parts Divide organization tasks into parts

86 Treatment for Poor Flexibility Verbal fluency tasks Verbal fluency tasks Design fluency tasks Design fluency tasks Simple real life activities Simple real life activities Incorporate the unexpected Incorporate the unexpected Require plan shifting Require plan shifting Structured, closed to uncontrolled, unpredictable environments Structured, closed to uncontrolled, unpredictable environments Force sharing, joint effort, and common goals Force sharing, joint effort, and common goals

87 Treatment for Self-Skills Use video- and audio-taping Use video- and audio-taping Chart problems and success Chart problems and success Use a diary Use a diary Role play Role play Planned failure tasks Planned failure tasks Identify ineffective problem solving Identify ineffective problem solving Compare predicted w/ actual accuracy Compare predicted w/ actual accuracy Start in structured, nondistracting environments Start in structured, nondistracting environments Transition less structured environments with planned distractions Transition less structured environments with planned distractions Generalize to unpredictable and distracting environments Generalize to unpredictable and distracting environments

88 Questions? Comments? Please complete evaluation forms prior to exiting. Thanks for coming. Presentation and accompanying handouts will posted to Shellys Communication Board. Shelly Wier, MS, CCC-SLP,


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