Presentation on theme: "Executive Functions in the School Setting"— Presentation transcript:
1Executive Functions in the School Setting Stephen R. Hooper, Ph.D.Carolina Institute for Developmental DisabilitiesUniversity of North Carolina School of Medicine
2Learning ObjectivesIncrease participants’ knowledge base with respect to the various definition and models of EF.Provide exposure to the neurodevelopmental underpinnings for EF.Improve the participants’ familiarity with targeted assessment strategies for EF
3Learning ObjectivesIncrease the participants’ awareness of various conditions where executive dysfunction may be present.Autism Spectrum DisorderWritten LanguageTraumatic Brain InjuryProvide an overview of specific classroom management strategies for executive dysfunction.
5DefinitionsOf all of the neurocognitive constructs, this one is probably the most complex.Is it taught as part of an assessment class sequence?The complexity comes not only in its overall regulatory functions, but also in how executive functions interact with nearly every other neurocognitive function.Executive processes have been deemed critical to the integrity of many learning and social-behavioral functions.And likely represent processes that are not typically assessed in a routine psychoeducational evaluation.There are a number of definitions of executive functions, some extending back nearly 50 years.
6Executive Functions (Luria, 1966) Executive function is defined as the ability to maintain an appropriate problem-solving set for attainment of a future goal. This set can involve:an intention to inhibit a response or to defer it to a later, more appropriate time;a strategic plan of action sequences and/or;a mental representation of the task, including the relevant stimulus information encoded in memory and the desired future goal-state.
7Executive Functions (Welsh & Pennington, 1988) Executive function is primarily the set maintenance required to achieve a future goal. This set would include the requisite skills of planning, organization, inhibition of maladaptive responses, self-monitoring, and flexibility of strategies contingent on feedback.Goldman-Rakic (1990) would add to this definition the concept of working memory.
8Executive Functions (Zelazo & Mueller, 2002) Executive function (EF) describes the control processes that affect overall output. This collection of abilities involves:Regulatory control over thoughts and behaviors during goal-directed or intentional actionProblem solvingFlexible shifting between actions to meet task demands.
9Executive Functions (Stuss & Alexander, 2000) Noted that one important contribution of EF is the regulation of affect and social behaviorThis notion is supported by the finding that abstract reasoning has been linked to vulnerability to social anxiety during adolescence in typically developing children.
11Models of Executive Functioning As can be surmised from the above definitions, executive functions are generally viewed within a multidimensional framework of cognitive abilities that provide critical support for goal-directed, future-oriented behaviors.These behaviors typically include attention regulation, inhibitory control, working memory, set shifting/cognitive flexibility, planning, and cognitive efficiency.The multiple dimensions of executive functions have been embedded within conceptual and empirical models that comprise two, three, four, and six factors.
12Executive Functioning (Welsh et al., 1991) Speeded respondingVisual search - achieved at age 6Verbal fluency - > age 12Motor sequencing - > age 12Set maintenanceWisconsin Card Sort - achieved at age 10MFFT - achieved at age 10PlanningTower of Hanoi (3 disk) - achieved at age 6Tower of Hanoi (4 disk) - > age 12
13Executive Functions (Pennington, 1997) Implicated 4 empirical subcomponents of EF using Typicals and children with Reading Disabilities. Then applied to different disorders:Inhibition (ADHD< FXS, ASD; ADHD improves on medication)Set Shifting (ADHD>FXS>ASD)Working Memory (ADHD>ASD>FXS)Planning (ADHD>FXS>ASDBoth the level and pattern of executive abilities can discriminate across disorders.
14Executive Functioning (Denckla, 1993) Delay between stimulus and responseInternal representation of schemaInternal representation of action planResponse inhibitionEfficiency and consistency of responseActive strategies and deploymentFlexible strategies and deployment
15Executive Functioning (Denckla, 1993) Denckla utilized this conceptual framework to propose a 4-factor model of executive functions:InitiatingSustainingSet-ShiftingInhibitingHas been applied to 4th and 5th grade students with Written Language Disorder (Hooper et al., 2002).Poor writers were less proficient at initiation, set-shifting, and sustaining than Good writers.
16Executive Function Summary There are notable differences between these models, but there does appear to be a number of specific executive functions that appear across the models.Planning and problem solving, inhibitory control, set shifting, and set maintenance usually are included in some fashion in many of these models.Speeded responding and working memory also have been discussed as subcomponents of executive function.Most of these functions are linked to the dorsolateral prefrontal cortex and associated brain regions, but it is important to remember that the emotional control functions associated with the ventromedial prefrontal cortex also should be included in a larger executive function model.This will be especially important for increasing our understanding of the childhood neurobehavioral difficulties.
18Neurodevelopmental Underpinnings Lesion, neuroimaging, and brain function (e.g., EEG) studies suggest that the prefrontal cortex (PFC) is primarily involved in executive processing.Based upon anatomical connectivity, two major regions of PFC:Dorsolateral PFC (DlPFC)Ventromedial PFC (VmPFC).
19Neurodevelopmental Underpinnings The so called “cool functions of dorsolateral prefrontal cortex represent the executive functions of motor planning and regulation, integration of sensory and mnemonic information, working memory, and attention regulationThe ventromedial regions of the orbitofrontal cortex are involved in planning and decision-making, but they also mediate affective regulatory functions, or the so called “hot” functions.
20Neurodevelopmental Underpinnings Dorsolateral Prefrontal Cortex (DlPFC)Regions within DlPFC influence:The selection of behaviorsRecognition of context-dependent changes between stimuli and behaviorPotentiation of sets of stimulus-response contingencies related to behaviors in contextFlexible, goal-driven control of behavior
21Neurodevelopmental Underpinnings Varying levels of damage to the DlPFC are associated with:Lack of motivation, creativity, or goal-following.Difficulty in initiating or flexibly modifying actions, resulting in stereotyped responses.Loss of affect.Inability to assess others’ mental states – Theory of Mind.Perseveration and more random-choice errors than age-matched controls.Increased distractibility and problems with sustained attention.Impaired working memory.Understanding of complex task rules.
22Neurodevelopmental Underpinnings Ventromedial Prefrontal Cortex (VmPFC)The VmPFC is critical for elucidating the relation between stimuli and reinforcers, and for explaining the inability of individuals with vmPFC damage to learn reward contingencies.Important for affective regulation.
23Neurodevelopmental Underpinnings Varying levels of damage to the vmPFC are associated with:ImpulsivitySensitivity to immediate rewardsLack of self-controlDisruption of both affective and nonaffective stimuliTendency to select behaviors with the highest perceived reward, not the highest perceived utility.
25Neurodevelopmental Underpinnings All of the various executive functions have a developmental basis that will have differential effects on learning and behavior over time.There is a sequential unfolding of various executive functions over the course of development.Contemporary findings from typical developmental studies, lesion studies, and primate studies suggest that the PFC is operational, at a basic level, by the end of infancy (i.e., ~24 months), with some evidence of even earlier emergence.While executive functions appear to develop from infancy into early adulthood, it appears that the period of most rapid development occurs between the ages of 6 and 8 years of age, followed by more modest gains between the ages of 9 and 12.Continued, but differential development continues through adolescence into early adulthood depending on the specific task or behavior of interest.Consequently, an injury during any of these periods of developmental ascendancy will have an effect on specific functions along with the developmental trajectories of these functions.
26Neurodevelopmental Underpinnings Disruption to the neurological underpinnings of any of these brain regions of the prefrontal cortex could trigger specific executive dysfunctions in cognitive and/or behavioral-emotional functioning.Given the developmental trajectories of many of these functions, it also is possible for an earlier injury to “lie silent” until they are developmentally required, and a specific executive dysfunction could emerge at a later developmental epoch (e.g., during middle school).This can create the apparent emergence of a “new” learning or behavior problem, and requires that evaluators routinely inquire about brain injuries in their developmental history for any given case.
28Disorders with Executive Dysfunction The presence of executive deficits can appear in a variety of disorders and conditions.Chronic illness (e.g., diabetes, chronic kidney disease)Pediatric neurological conditions (e.g., traumatic brain injury, stroke)Psychiatric disorders (e.g., bipolar disorder, schizophrenia, substance abuse)Developmental disabilities (e.g., Autism Spectrum Disorder, learning disabilities, ADHD)Childhood maltreatment (e.g., abuse, neglect)
29Autism Spectrum Disorder Individuals with Autism—both low and high functioning—appear to manifest significant impairments when compared to various comparison groups.These deficits included:Planning and organizationSet-Shifting and perseverative tendenciesAbstract thinkingExecutive dysfunction has been correlated with both the quality of joint attention and social interactions.
30Autism Spectrum Disorder In contrast, individuals with brain injuries to the frontal region are not “autistic.”Neuroimaging studies have not documented clear frontal lobe brain injuries, but neurological abnormalities have been reported (e.g., early white matter tracts).Neurocognitive findings have not been universally supportive of a global executive dysfunction in Autism.
31Autism Spectrum Disorder Studies of older children have converged to suggest that working memory is not a deficit in Autism, and this is the only EF domain with consistent results.Several research groups reported deficits in problem solving and self-monitoring, perhaps secondary to a lack of verbal self-regulation, but his has been contested.Deficits in cognitive flexibility were documented in some studies but, again, not in others.Independent of verbal IQ or present even after controlling for verbal IQ.Intact cognitive flexibility also has been linked to improvements in social competence.
32Autism Spectrum Disorder Several research groups have reported deficits in inhibition, while others reported no deficits.Could they be related to poor verbal abilities or are they unrelated?Regarding attention, children with Autism performed similarly to children with developmental language delays matched on nonverbal IQ on a sustained attention task, although their modulation of arousal levels has been implicated.This was not consistent with the high prevalence of ADHD symptoms in individuals with Autism.Individuals with Autism also seem to experience less encroachment on their functioning during divided attention tasks.
33Autism Spectrum Disorder A model of executive functioning may prove to be useful in linking selected executive functions to core and associated symptoms. For example,Working memory, cognitive flexibility, and response inhibition have been variably related to restrictive and repetitive symptoms, but planning and fluency were not.Verbal fluency difficulties could be another contributor to communication impediments in individuals with Autism.Organizational deficits have been noted, but not thoroughly studied.
34Autism Spectrum Disorder While this theory can explain some aspect of each of the core problems with Autism, they are not universally supported and account for small amounts of the variance of the core symptoms.Executive dysfunction also is not exclusive to Autism and, consequently, is not the sole cause of autistic behaviors.These deficits also cannot explain some of the assets that many children with Autism can manifest (e.g., savant skills).
35Autism Spectrum Disorder Current theorizing indicates that while executive dysfunction can be present early in development, it also can surface as a secondary deficit as children with Autism increase in age.There also may be environmental contributors to the executive dysfunctions, such as a caregiver unintentionally reinforcing cognitive rigidity in an interaction.Further, given the prolonged developmental trajectory of many executive functions, might an extended window for neurorehabilitation be present?
36Traumatic Brain Injury Along with attention impairments, one of the most common findings in pediatric traumatic brain injury is the presence of various types of executive dysfunction.This is not unexpected given that many cases of TBI will evidence some degree of frontal lobe involvement.
37Traumatic Brain Injury Empirical studies have documented the presence of impairments in:Planning and problem solvingAbstract thinking and analogical reasoningSet-shifting and cognitive flexibilityInhibitory controlMetacognitive capabilitiesProcessing speedWorking memory
38Traumatic Brain Injury Given the regulatory role of the ventromedial prefrontal cortex in social and affective functions, a number of studies have documented the difficulties of self-regulation and social cognition in children following a traumatic brain injury.These impairments have been documented in moderate to severe brain injuries up to five years post injury.Self-regulatory abilities also can serve as mediators of the effects of traumatic brain injury and the emergence of social-behavioral difficulties in this population.
39Traumatic Brain Injury Additionally, children sustaining a TBI have evidenced problems in:Identifying emotionsLabeling emotionsExtracting meaning from non-literal social communicationEvaluating problem solving outcomesHigher-order language impairments also have been reported such that both expressive and receptive language pragmatic skills (e.g., understanding proverbs, figurative sayings).
40Traumatic Brain Injury In general, following a TBI, nearly all of these executive functioning components will evidence some degree of impairment that is dictated, in part, by the severity of the brain injury.These findings have been reported for children with a mild TBI, although results were not as striking.These deficits also have been reported to be persistent in some fashion seven to ten years post injury.
41Traumatic Brain Injury Executive function ratings have been associated with:Psychiatric statusFamily burdenGeneral family functioningAdolescents with severe TBI tended to report fewer problems in executive functioning, when compared to their parents, particularly in their metacognitive abilities.Assessment and treatment issues?
42Written Language Disorder A number of studies have begun to document the importance of executive functions to the writing process.Hooper et al. (2002) showed that fourth and fifth grade students with and without writing problems manifested specific differences in their executive functions, with the poor writers being less proficient at initiation, set-shifting, and sustaining.From a developmental perspective, it would seem that executive functions will carry more variance with respect to written language production as students move into their middle school years, perhaps serving as moderators to specific types of writing interventions.
43Executive Functions of Good Writers vs. Poor Writers Z-scoresExecutive Functions of Good Writers vs. Poor Writers
44Written Language Disorder One key executive function that has been the target of scientific investigations is working memory.The cognitive workspace, or working memory, is important to written expression because it is the function that underlies the active maintenance of multiple ideas, the retrieval of grammatical rules from long-term memory, and the recursive self-monitoring that is required during the act of writing.Working memory contributes to the management of these simultaneous processes, and a breakdown may lead to problems with written output.
45Written Language Disorder Reduced working memory capacity has been reported in poor writers when compared to good writers, and it appears to have both general and domain-specific contributions to the writing process.Recent work by our group with fourth and fifth grade students with and without writing problems has documented not only working memory deficits, particularly in verbal working memory and its development, but also broader memory problems that could undermine the entire writing process.
46Written Language Disorder A contemporary model of written expression, the Not-So-Simple View of Writing, incorporates three major components:Transcription (handwriting or letter production and spelling or word production)Executive functions (planning, monitoring, revising)Text generation (i.e., the main writing goal of the beginning writer)Text generation occurs at the word, sentence, and text levels; consequently, automatic production of letters is necessary, but not sufficient, as spelling words via the alphabetic principle and related orthographic elements are necessary for writing proficiency. Working memory provides a mechanism for linking all of the components.The Not-So-Simple View of Writing Model postulates that neuropsychological, linguistic, and related cognitive functions will be recursive throughout the development of the writing process, but that each of these functions will exert relatively more influence at different points in the developmental process.
47Written Language Disorder According to this model, early elementary school students will be constrained by factors related to fine-motor output (e.g., letter formation), memory for letters and words, emergent working memory capacity, and linguistic capabilities. By middle school, many but not all children have sufficient transcription skills, and their writing skills will progress with increased emphasis being placed on the development of their executive functions.We have demonstrated the general utility of this model, particularly with respect to the stability of the cognitive components over time, with the impact of executive functions being noted even in first grade.
48Neurocognitive Components Fine MotorAttention/ Executive FunctionLanguageWIAT IIWrittenExpressionand SpellingPAL Finger Succession DominantPAL Finger Succession Non-DominantElision/PAL PhonemesPALLettersPAL Word ChoiceVisual Working MemoryVerbal Working MemoryWJ-III Retrieval FluencyWJ-III PlanningVIGIL OmissionsVIGILCommissions
49Written Language Disorder In the cognitive literature, the concept of self-regulation also has been employed in the study of the writing process.This has contributed to the development of empirically-based treatment strategies based on a larger executive function model.One example is the Self-Regulated Strategy Development (SRSD) model.Such models enables students to develop their skills in composing, improve automatic, but reflective writing strategies, understand the parameters of “good” writing, and finally to increase positive attitudes about their abilities to communicate via writingOther research groups also have demonstrated significant writing gains of elementary school students following a metacognitive intervention for planning, organizing, and self-regulation.The findings point to the importance of various executive functions from both assessment and intervention perspectives.
51AssessmentMost psychoeducational measures do not assess executive functions.These deficits can appear in a myriad of medical conditions and disorders and can impact both learning and social-behavioral functioning.In this regard, the inclusion of executive functions measures should be considered in any assessment of neurocognitive abilities.In the past, there were few instruments available to clinicians—even neuropsychologists—for the assessment of executive functions.This was accentuated by the lack of training in these types of assessments.
52AssessmentOver the past 20 years or so, however, the assessment of executive functions has seen the development of a number of tools, many of which are normatively based, standardized, and span a wide age range—including the preschool years.In fact, assessment tools even have been developed to assess executive functioning using qualitative approaches and rating scales in an effort to have these tasks be more ecologically valid.The value added aspects may be critical to treatment planning and developmental surveillance.
53AssessmentThere are a number of more standardized measures that provide estimates of selected executive functions, and more recently, executive function batteries and ratings scales have been developed.When one considers the various subcomponents of executive functions, there are measures ofInhibitory control (e.g., errors of commission on the Continuous Performance Tests, Matching Familiar Figures Test, Go No-Go tasks. Stop Signal Test)Speeded responding (e.g., Rapid Naming tasks, motor sequencing tasks, verbal fluency tasks such as Controlled Oral Word Association Test, nonverbal fluency tasks such as the Ruff Nonverbal Fluency Test)Planning and problem solving (e.g., Wisconsin Card Sorting Test Categories Correct, Tower of Hanoi, Tower of London, Porteus Mazes)Set maintenance and perseveration (e.g., Wisconsin Card Sorting Test Perseveration Score)Set-shifting (e.g., Stroop Color and Word Test, Wisconsin Card Sorting Test)Working memory (e.g., Digit Span, Spatial Span)Attention regulation (e.g., CPT Variability Scores).
54Assessment Wisconsin Card Sorting Test Test of Problem Solving Skills-RevisedHRNB Category Test (Booklet version)Tower Tasks (Hanoi, London, Montreal)Fluency tasks (verbal and nonverbal)WJ-III Processing Speed ClusterWJ-III Fluid Reasoning ClusterWorking Memory Battery for ChildrenDelis-Kaplan Executive Function SystemBehavioural Assessment of the Dysexecutive Syndrome for Children
64Delis-Kaplan Executive Function System (D-KEFS) 9 Subtests tapping major dimensions of EFTrail-Making Test (set-shifting)Verbal Fluency Test (verbal efficiency)Design Fluency Test (nonverbal efficiency)Color-Word Interference Test (inhibition)Sorting Test (cognitive flexibility)Twenty Questions Test (problem solving)Word Context Test (abstract problem solving)Tower Test (problem solving)Proverb Test (abstract thinking)
66D-KEF Sorting Test Solutions Small vs. large cardsAnimals vs. transportationStraight edges vs. curvedOne-syllable vs. two-syllableBlue vs. yellow cardsAir vs. land thingsRed vs. white labelUppercase vs. lower case letters
67AssessmentAdditionally, there are relatively new measures becoming available to assess selected executive functions in the preschool population, with tasks going down to two years of age.Several of these tasks includeThe Shape School, which assesses inhibitory controlThe IS Task, which measures set-shiftingWorking memory span tasksThe Tower Task, which assesses planning and problem solvingContinuous performance tests (e.g., Kiddie Conners CPT) also are available for use for children ages 3 to 5
68AssessmentTo assess affective regulation, there are emergent tasks that extend from the laboratory into the clinical arena:Reading the Mind in the Eyes TestBenton Facial Recognition TestThe Awareness of Social Inference TestNEPSY-II Social Perception DomainAffect RecognitionTheory of Mind
69AssessmentA number of the measures to assess affective regulation are now computerized.The Penn Neuropsychological BatteryEmotional Recognition TaskThe Affective Go No-Go task from the Cambridge Neuropsychological Automated BatteryThe individual is asked to inhibit responses to selected targetsThe Diagnostic Assessment of Nonverbal Abilities (DANVA)Provides estimates of emotional regulation and control via visual and auditory pathways. Scores provide an indication of both receptive and expressive affective regulation.
70AssessmentThere are several ratings scales available to assess executive functioning in children and adolescents.The Dysexecutive Questionnaire for Children (DEX-C), which is part of the larger Behavioural Assessment of the Dysexecutive Syndrome for Children, and the Behavior Rating Inventory of Executive Function (BRIEF).These measures are not direct assessment batteries per se, but rather comprehensive rating scale that provides estimates of both cognitive and affective regulatory functions in a multi-rater, multi-setting framework.
71AssessmentFor the BRIEF, there is a preschool version, a school-age version, and an adult self-report version, thus providing a mechanism to assess executive functions across the age span from preschool into adulthood.Like all ratings scales, the BRIEF and the DEX-C are subject to attribution bias and responder acquiescence, but they can provide useful information on the application of executive functions in the child’s ecology.Such approaches provide a time effective alternative to direct assessment, and they also may provide a different type of (ecological) information pertaining to executive functioning in children with TBI.
73Assessment The BRIEF: Three overall summary indices Metacognitive IndexBehavioral Regulation IndexGlobal Executive CompositeEight different empirically derived scales:InhibitShiftEmotional ControlInitiateWorking MemoryPlan/OrganizeOrganization of MaterialsSelf-Monitor
74AssessmentQualitative tasks that involve real-life simulations include:Video-taped vignettes of social situationsThe Party Planning TaskThe Child-Kitchen TaskThe School Assessment of Motor and Process SkillsFrom a school-based perspective, this task provides an appraisal of skills that children need to function in the classroom setting.The Children’s Cooking TaskAn adaptation of an adult task that was designed to determine the child’s ability to follow a checklist without being distracted, evaluate the outcomes with respect to the initial goals for cooking, and make adjustments for any errors.The task was comprised of actually making a chocolate cake and a fruit cocktail, and the task is performed in a kitchen.Variables of interest from this task include the number of errors and an overall qualitative analysis of the task.Children with TBI made more errors in the cooking process as compared to aged matched controls.
76Management Strategies Problem SolvingDevelop a guide to help student through the stages of problem solvingIdentifying the problemAcquire relevant informationGenerate several possible solutionsList pros and cons for each solutionIdentify best solutionCreate a plan of actionEvaluate the effectiveness of the planEncourage generalization
77Management Strategies Problem SolvingRaise questions about alternatives and consequences (Can they predict outcomes?)Allow the student to bring up relevant real-life problems that are appropriate for group discussions, and promote brainstormingIntroduce roadblocks and complications to encourage flexibilityProvide ongoing, non-judgmental feedback
78Management Strategies Problem SolvingComputerized intervention for problem solving have received some supportTeen Online Problem Solving Program for pediatric traumatic brain injuryComputerized interventions for attention regulation have been mixed.
79Management Strategies Organizational ProcessesLimit the number of steps in a taskProvide part of a sequence and have the student finish itGive cues such as, “Correct, but what do you think will happen next?Structure thinking processes graphically (e.g., time lines, outlines, flow charts, graphs, etc.)
80Management Strategies Organizational ProcessesUse categories to focus on one topic at a timeIdentify the main idea and supporting details, categorize them, and encourage student to do the sameHave the student practice organizational skills in other settings
81Management Strategies Speed of Information ProcessingRecognize as the student fatigues, speed of processing declinesRecognize speed of processing can be negatively affected by some medicationsEliminate timed measures to assess learningReduce the amount of work required
82Management Strategies Speed of Information ProcessingProvide a reader for text materials and testsPermit the student the use of an aide or peer tutor to take notes for them, or a computer for written languageLower difficulty level until speed of processing improves
83Management Strategies Speed of Information ProcessingAllow extra time for the completion of tests and assignmentsFrequent breaks allow the student to “recharge”When necessary, allow the student extra time to travel between classes
84Management Strategies Feeney & Ylvisaker (1995) employed this approach to reduce maladaptive behaviors and increase on-task efforts:Analysis and restructuring of the individual’s daily routine wherein the sequencing of the routine was negotiated (e.g., task analysis)Liberal use of visual cues to facilitate the sequencingLiberal rehearsal prior to each component, accompanied by a performance review
85Management Strategies Feeney & Ylvisaker found that this program:Promoted predictability and orderlinessGave the individuals a sense of controlPromoted goal settingLessened oppositionality and impulsivityIncreased decision-makingIncreased problem solving efforts
86Management Strategies Math Curriculum: Solve It!A research-based instructional program in which teachers explicitly teach the processes and strategies that underlie mathematical problem solving.It incorporates the cognitive processes critical to mathematical problem solving, with a particular focus on strategies:Reading the problem and developing math vocabularyParaphrasingVisualizingHypothesizing about problem solutions and their orderEstimating and predicting the answerComputing via procedures and calculationsChecking the problemStudents also learn a metacognitive strategy that they apply at each step:Say aloud or to themselves what the problem is asking them to doAsk themselves if they understand the problemCheck their progressData on children with math disabilities are encouraging
87Management Strategies Self-Regulated Strategy Development (SRSD) is a model wherein students are taught an overarching strategy to learn specific strategies.Written language is considered a problem solving process that involves planning, knowledge transfer, and various skills.SRSD comprises three major areas:Six stages of explicit writing instruction (i.e., Develop background knowledge; Discuss it; Model it; Memorize it; Support it; and Independent performance)Explicit instruction in self-regulation strategies including goal setting, self-monitoring, and self-instructionDevelopment of positive self-efficacy about writing
88Management Strategies The SRSD model distinguishes itself from alphabetic principle-based intervention strategies (e.g., PAL) as the focus is on advancing higher-order executive functions versus developing phonological processes, vocabulary, or other language functionsDevelopmentally, this is highly appropriate for middle school students.Significantly positive data for students with writing disabilities.Holds promise for teaching other self-regulatory skills (e.g., behavior).
90ConclusionsThere are numerous definitions and models of executive function to consider, but the available evidence clearly indicates that this a complex, multidimensional construct that evolves over the course of development.There is a clear linkage to underlying neurological integrity and neurodevelopmental processes that is critical to understanding executive functions and dysfunctions.
91ConclusionsThe assessment of executive functions has come a long way over the past two decades, with many measures moving out of the laboratory into the clinical settingAffective regulatory measuresEven with these advances, though, the assessment of executive functions typically is not conducted as part of a routine psychoeducational or psychological evaluation, or as part of other types of evaluation (e.g., speech and language, occupational therapy, etc.).Given the relatively high prevalence of frontal lobe involvement in children and adolescents with a wide variety of disorders, this oversight could leave a significant hole in the overall profile of the impact of a specific disorder or condition on cognitive functioning, adherence to care, response to treatment, and quality of life.
92ConclusionsGiven the regulatory aspects of many of the executive functions, it is not uncommon to see such isolated functions as expressive and receptive language, sensory-motor functions, or academic achievement skills appearing to be unaffected by a brain injury, yet the child is not able to access the preserved information accurately and/or efficiently secondary to executive dysfunction.Without the assessment of executive functions, those working with the child are left with other plausible, but incorrect assumptions about the nature of the child’s capabilities (e.g., lazy, unmotivated, uninterested, behavioral problems, etc.).Consequently, it is essential for the examiner to include executive function measures as part of any assessment of a child as part of a larger assessment.
93ConclusionsAs a final note, it is suspected that the administration, scoring, and interpretation of executive function measures are rarely taught across the various professional training programs (e.g., clinical psychology, school psychology, speech and language, occupational therapy, etc.), and it is time for these types of assessment procedures to become part of a training program.This is important not only from an assessment perspective, but also with respect to how executive dysfunctions can impact upon therapeutic activities of children and the understanding of how these deficits can emerge later in development.Field needs more evidence-based treatments!