Presentation on theme: "Executive Functions Assessment and Intervention"— Presentation transcript:
1Executive Functions Assessment and Intervention Presented byGeorge McCloskey, Ph.D.Philadelphia College of Osteopathic Medicineorpresented by George McCloskey Ph.D.
2Brain/Mind Bulletin, 1988 Overly positive view of themselves Mentally healthy persons maintain many illusory beliefs, including:Overly positive view of themselvesConvenient “forgetting” of negative facts about themselvesPerceptions of having greater control over events than is actually the case“Unrealistic” optimism about themselves“Unrealistic” optimism about the future“Abnormal” cheerfulness
3Newberg’s Best Ways to Exercise Your Brain YawnConsciously RelaxStay Intellectually ActiveSmile
4Benefits of Yawning Stimulates alertness & concentration Optimizes brain activity and metabolismImproves cognitive functioningIncreases memory recallEnhances consciousness and introspectionLowers stressRelaxes every part of your bodyImproves voluntary muscle controlEnhances athletic skillsFine tunes your sense of timeIncreases empathy and social awarenessEnhances pleasure and sensuality
5Newberg’s Best Ways to Exercise Your Brain Maintain Faith (Positive Belief System)Dialogue with OthersEngage in Aerobic ExerciseMeditateYawnConsciously RelaxStay Intellectually ActiveSmile
6How God Changes Your Brain HHHow God Changes Your BrainAndrew Newberg & Mark Robert Waldman
10Key Concept Executive Functions: Directive capacities of the mind Multiple in nature, not a single capacityPart of neural circuits that are routed through the frontal lobesCue the use of other mental capacitiesDirect and control perceptions, thoughts, actions, and to some degree emotions
11Key ConceptAll Assessment of the Use or Disuse of Executive Functions Hinges on Careful Observation of Behavior.
12Behavior Observation and Inferences about Brain Function What’s the difference between a Similarities Scaled Score of 12 (75th percentile)……and a Similarities Scaled Score of 12 (75th percentile)?
13Key Concept Task Performance is directed by Executive Functions or an LD IdentificationKey ConceptTask Performance is directed by Executive Functions or anExecutive Functions substitute.The neural networks used toperform a task depend on perceptions about how the task should be done.presented by George McCloskey Ph.D.
14Key ConceptMost of what a teacher says to students is intended to activate specific areas of the students’ brains.
15Key ConceptThe more specific the language used by a teacher, the more likely it is that students will be activating the necessary brain areas.
16What Are Executive Functions? “Despite the frequency with which it is mentioned in the neuropsychological literature, the concept of executive functions is one that still awaits a formal definition. Research efforts aimed at exploring the different aspects of this construct have often yielded contradictory evidence, resulting in a lack of clarity and even controversy regarding the true nature of executive abilities.”Jurado & Rosselli, 2007, page 213.
17The Wisdom of Kurt Lewin “There is nothing more practical than a good theory.”Known for his field theory of behavior that posits that human behavior is a function of an individual’s psychological environment.
18Executive Functions Are Not a Unitary Trait LD IdentificationExecutive Functions Are Not a Unitary TraitFrequently referred to as “the CEO of the Brain” or the “Conductor of the OrchestraThese metaphorshint at the nature of EFs, but are far too general for effective understanding of the conceptcreate the impression of a central control center or a singular control capacitypresented by George McCloskey Ph.D.
19EF as the Conductor of the Brain’s Orchestra (i.e., EF as “g”)
20Executive Functions Are Not a Unitary Trait Appropriate Metaphors for Executive Functions:The conductor and section leaders of the mind’s OrchestraThe management structure of a multinational mind corporationThe coaching staff of team mind
21Emot ion Cognition Perception Action Domains of Functioning Directed by Executive FunctionsActionExecutive control of modes of output including behavior in the external world and storage and retrieval of internal representationsPerceptionCognitionActionEmotionCognitionExecutive control of thoughts and thought processingPerceptionExecutive control of modes of perceptual input including external sensory stimuli (visual, auditory, kinesthetic) and internal (representational) stimuliEmotionExecutive control of moods, feelings, and the processing of emotions
22Co-Conductors in a Holarchical Model of EF Activation
23EF Tiers within the Holarchical Model of Executive Functions PerceiveFocusSustainEnergizeInitiateInhibitStopInterruptFlexibleShiftModulatePlanEvaluate/CompareDecideSense TimePaceSequenceExecuteHoldManipulateStoreRetrieveTrans-Self IntegrationSelf-ActivationSelf-RealizationSelf-AwarenessOther-AwarenessSelf-AnalysisSelf-DeterminationGoal settingLong-range Planning &ForesightSelf-GenerationMonitorCorrectBalanceGaugeAnticipateEstimate TimeAnalyzeGenerateAssociateOrganizePrioritizeSelf-RegulationEFefActivation
24Key ConceptExecutive Functions cue and direct in different ways at different levels.
25Key Concept It is important to distinguish between Executive Skills andExecutiveFunctions.
26Self Regulation Executive Skills Executive Skills involve the use of neural networks routed throughout the brain to perform specific tasks (e.g., attending, inhibiting, modulating, planning, organizing, associating).
27Self Regulation Executive Functions LD IdentificationSelf Regulation Executive FunctionsExecutive Functions involve the part of the executive network that is routed through the frontal lobes and that is used to cue, direct, and coordinate the use of executive skills and other mental capacities.presented by George McCloskey Ph.D.
28Co-Conductors in a Holarchical Model of EF ExecutiveCapacitiesExecutiveFunctionsExecutiveSkills
29LD IdentificationSelf RegulationA set of control capacities that cue and direct functioning across the domains of perception, emotion, cognition, and actionThe current model posits 33 self-regulation executive functionspresented by George McCloskey Ph.D.
34Self Regulation Executive Function “Clusters” EnergizeInitiateInhibitStopPauseFlexibleShiftENGAGEMENTMonitorModulateBalanceCorrectOPTIMIZATIONPerceiveFocusSustainATTENTIONGenerateAssociatePrioritizePlanOrganizeDecideSOLUTIONAnticipateGaugeAnalyzeEstimate TimeEvaluateINQUIRYSense TimePaceSequence Use RoutineEFFICIENCYHoldManipulateStoreRetrieveMEMORY
35Key ConceptEffective use of Executive Functions can vary by Arena of Involvement as well as by Domain of Functioning.
36Arenas of Involvement Interpersonal Intrapersonal Control of Self in Relation to SelfInterpersonalControl of Self inRelation to OthersEnvironmentControl of Self inRelation to SurroundingsSymbol SystemControl of Self in Relation to Academics (Reading, Writing, Math)
37LD IdentificationKey ConceptExecutive Functions are developing form birth; maturational delays can cause difficulties.presented by George McCloskey Ph.D.
38Executive Function Development Some EF-based clinical syndromes, such as ADHD, demonstrate clear patterns of delayed developmental progression. Barkley (1998) estimates developmental delays of about 30% associated with various EF processes such as Inhibit, Manipulate, Shift, Sustain, Time, Monitor, Correct.
39Developmental Progression with a 30% Delay FAGQChronological Age
40EF Development does not progress by continuous equal intervals
41EF Development does not progress by continuous equal intervals
42Key ConceptVirtually all individuals who struggle with psychological disorders exhibit executive function difficulties.
43Executive Functions and Clinical Diagnoses “Deficits in PFC [prefrontal cortex, aka frontal lobes] function are evident in every neuropsychiatric disorder (indeed, the term “psychiatric problem” seems synonymous with PFC dysfunction).”Arnsten & Robbins 2002 in Principles of Frontal Lobe Function
44Executive Functions and Clinical Diagnoses Most of the clinical conditions described in the DSM-V reflect some form of Executive DysfunctionThe DSM-V can be thought of as “A User’s Guide to All the Things That Can Go Wrong With the Frontal Lobes”
45Executive Functions and Clinical Diagnoses A sampling of conditions involving EF deficits:Autism Asperger’s SyndromeADHD and ADDConduct DisorderOppositional Defiant DisorderDepression and/or AnxietyObsessive-Compulsive DisorderFetal Alcohol Syndrome
46Key ConceptAll individuals with ADHD exhibit EF deficits but not all individuals that exhibit EF deficits are ADHD.ADHDExecutive Function Deficits
47Executive Functions and ADHD? All individuals with ADHD have executive functions deficits…Executive Function DeficitsADHD…but not all individuals with executive functions deficits have ADHD.
48Executive Functions and ADHD EF and ADHD are not synonymous terms; rather ADHD is a condition involving EF deficits in:Focus/Select, Sustain, Inhibit, ModulateNearly all persons with ADHD also have additional self-regulation difficulties; the nature of these additional difficulties is what makes ADHD so variable from one person to the next and what causes confusion in diagnosis.
49Different Constellations PerceiveEnergizeShiftMonitorEst TimeOrganizeSense TimeHoldInitiateFlexibleCorrectAnticipateAnalyzePlanSequenceManipulateStopAssociateEvaluatePaceStoreInterruptBalanceGaugeGenerateDecideExecuteRetrieveSustainAlan Age 10FocusModulateInhibitSameCoreFocusSustainModulateInhibitKatie Age 11Sense TimeHoldPerceiveEnergizeShiftMonitorOrganizeEst TimeInitiateManipulateFlexibleCorrectAnticipateSequencePlanAnalyzeStopEvaluatePaceStoreAssociateInterruptBalanceGaugeDecideExecuteRetrieveGenerateDifferent Constellations
50Executive Functions and ADHD Pharmacological treatment of ADHD usually only addresses the problems associated with the EFs specific to ADHD (Inhibit, Modulate, Focus/Select, Sustain)Most persons with ADHD will require additional interventions to assist with the additional self-regulation difficulties that persist even when medication is being used effectively to treat the primary ADHD problems.
51Executive Functions and School Although executive functions are used to guide cognitive processing involved in new learning, many new learning situations are structured in ways that reduce the need for strong executive direction.In contrast, demonstrating what has been learned usually requires significant involvement of executive control processes.
52Key ConceptExecutive Functions activation can be internally or externally driven; EFs can cue the use of learned strategies.
53Internal versus External Control The neural circuits for executive function activation are routed differently depending on whether the activation is based on an internally driven desire or command versus an external demand.
54Internal versus External Control Because internally driven production is much easier to accomplish than externally demanded production for children with “producing difficulties” their lack of production on demand often stands in stark contrast to their seemingly effortless production “when the spirit moves them.”
55Internal versus External Control The on-demand deficiencies observed by others are often attributed to negative personal characteristics such as lack of responsibility, apathy, passive aggressive stance, or oppositional defiance.
56??? Engagement of Self-Regulation External Demand Pathway Teach how to self-regulate in a way that increases the desire to self-regulateExecutiveFunctionsExternalDemandInternalCommand???ExtrinsicRewards &PunishmentsNucleusAccumbensInternal Command Pathway:Intrinsically Rewarding
57Production based on External Demand: Internal Command:
58Key ConceptProducing difficulties are different from learning difficulties; producing difficulties reflect poor use of EFs.
59Producing versus Learning Executive Function difficulties of a severe nature (especially in the Symbol System Arena) do not result in Learning Difficulties; they result in Producing Difficulties.
60A General Model for Conceptualizing Learning and Producing DifficultiesLearningDifficultiesOnlyOften NOT recognized as a Learning Disability, even when severe, unless an evaluation involving process assessment is doneLearningDifficultiesAndProducingRecognized fairly quickly as a Learning DisabilityWhen severe, typically attributed to lack of motivation, character flaws, or behavior/personality problemsProducingDifficultiesOnly
61Executive Functions and Intelligence The concept of executive functions is not synonymous with the traditional concepts of intelligence or “IQ”Executive functions often are not directly assessed with standard intelligence tests
62Measuring Executive Functions with a Reasoning Task Directions for the Wisconsin Card Sorting Test (WCST):I can’t tell you much about how to do this task. Which of these do you think this one goes with? I’ll tell you if your answer is right or wrong.
63Executive Functions and School The more classroom instruction resembles tests of executive functions like the Wisconsin Card Sorting Test (figure out what we’re learning, I’ll tell you whether you are right or wrong), the more executive difficulties are going to impact classroom learning and performance.
64Executive Functions and Assessment Test taking can be exceptionally difficult for a student with executive function difficulties if the test format emphasizes executive function demands over content knowledge.
65The Multidimensional Nature of Executive Functions Use of Executive Functions varies depending on:the arena(s) of involvement in which the EF(s) are operating,the domain(s) being directed by the EF(s)
66The Multidimensional Nature of EF Assessment The Multidimensional Nature of the use of Executive Functions necessitates a Multidimensional approach to their assessment.Assessment of Executive Functions needs to address the use of Efs within all four domains of functioning and across all four arenas of involvement
67Key ConceptEffective EF assessment is multidimensional in nature and addresses the use of Efs within all four domains of functioning and across all four arenas of involvement.
69EF Assessment Perspective x Method Assessment MethodFormal Methods –Using interviews, records reviews, and observation and interpretation methods that make use of standards established through normative comparisonsInformal Methods –Using interviews, records reviews, and observation and interpretation methods that do not make use of standards established through normative comparisonsIndirect Perspective –Collecting information in a manner that does not require direct contact with, or observation of, the clientBehavior Rating ScalesParent & Teacher Behavior Rating ScalesSelf-Report Rating Scales(e.g., BRIEF or MEFS Parent, Teacher and Self Rating forms)Interviews of Parents, Teachers (e.g., use of the EFSO)Review of School RecordsProcess-oriented Interpretation of Parent and Teacher Ratings and Self ReportsDirect Perspective –Collecting information through direct interactions with, or through direct observations of, the clientIndividually-AdministeredStandardized Tests(e.g., D-KEFS,NEPSY-II, WCST,BADS, BADS-C)Child InterviewSystematic and Nonsystematic Behavioral Observations (e.g., use of the EFSO and EFCO)Process-oriented Interpretation ofStandardized Test Performance and Classroom Work Samples
70Intrapersonal Interpersonal Environment Symbol System Cognitive AcademicCognitiveAcademicMotorMotorSocial-EmotionalSocial-EmotionalAdaptiveAdaptiveCognitiveAcademicCognitiveAcademicMotorMotorSocial-EmotionalSocial-EmotionalAdaptiveAdaptiveEnvironmentSymbol System
71Assessment of Executive Functions Norm-referenced assessments of executive functions are currently available, including:Individually-administered testsBehavior rating scales
72Assessment of Executive Functions The limitations of the current methods available need to be understood and taken into account when conducting an assessment.
73Key ConceptStandardized, individually-administered measures of executive functions only assess the use of executive functions within the Symbol System Arena.
74X EF Assessment Using Individually Administered Tests Perception EmotionCognitionActionSelfOthersEnviron-mentSymbol SystemsX
75The Multidimensional Nature of EF Assessment The most frequently used EF behavior rating scale, the Behavior Rating Inventory of Executive Functions (BRIEF) covers a broader range of Arenas and Domains, but items are highly nonspecific, combining many arenas and domains at once.
76EF Assessment Using the BRIEF PerceptionEmotionCognitionActionSelfXOthersEnviron-mentSymbol Systems
77The Multidimensional Nature of EF Assessment The most effective approach to EF assessment involves:Conducting a thorough clinical interview(s)Using additional data collection methods to test hypotheses generated from the interview(s)
78The Multidimensional Nature of EF Assessment Conducting a thorough clinical interview:Identify arenas of involvement that are of concern, within the arenas of concern:Identify domains of functioning that are of concernIdentify the specific executive function levels that are of concernIdentify the specific executive functions that are of concern within the level
79The Multidimensional Nature of EF Assessment Use additional data collection methods to test hypotheses generated from the clinical interview:Parent, Teacher, Self Report InventoriesBackground information/Records reviewIndividually-administered standardized testing (for Symbol System arena concerns)
80Key Concept 1) Clinical interview(s) The most effective approach to EF assessment involves1) Clinical interview(s)2) Use of additional data collection methods to test hypotheses generated from the interview(s)
81BRIEF Parent, Teacher, Self-Report Inventories Behavior Rating Inventory of Executive Functions (BRIEF)Parent, Teacher and Self-Report FormsPreschool, School-Age, Adult formsNorm-referenced scores
82Parent, Teacher, Self-Report Inventories The BRIEF assesses self-regulation EFs under the following 8 headings:Inhibit, Shift,Emotional Control, Initiate,Working Memory,Plan/Organize,Org. of Materials, Monitor
84Likely to be Associated with Behaviors Executive FunctionsBRIEF INHIBIT SCALELikely to be Associated with BehaviorsItem DescriptionPTPRIMARY EFSECONDARY EfsWILDER than othersxMODULATEMONITORINTERRUPTS othersINHIBITOUT OF SEATOUT OF CONTROLBLURTS OUTTOO WILDTrouble STOPPINGSTOPTROUBLE when NOT SUPERVTOO SILLYTalks at WRONG TIMENO THOUGHT BEFORE ACTANTICIPATEIMPULSIVETOLD to STOP
85Likely to be Associated with Behaviors Executive FunctionsBRIEF SHIFT SCALELikely to be Associated with BehaviorsItem DescriptionsPTPRIMARY EFSECONDARY EfsRESISTS different waysxFLEXIBLEGETS UPSET with new situationsMODULATESAME THING OVER AND OVERSHIFTGERERATESTOPUPSET by change in plansDISTURBED by change of teacherRESISTS routine changesTROUBLE GETTING USED TO new situationsThinks too much about SAME TOPICGENERATEGETS STUCK ON ONE topic or activitySTAYS DISAPPOINTED
86Likely to be Associated with Behaviors BRIEF EMOTIONAL CONTROL SCALEExecutive FunctionsLikely to be Associated with BehaviorsItem DescriptionsPTPRIMARY EFSECONDARY EfsOVERREACTS to small problemsxMODULATEEXPLOSIVE angry OUTBURSTSINHIBITEASILY becomes tearfulOUTBURSTS for little reasonMood CHANGES FREQUENTLYReacts MORE STRONGLYMood EASILY INFLUENCEDINTENSE OUTBURSTS over quicklyBIG REACTION to small eventsGets UPSET TOO EASILY
87Likely to be Associated with Behaviors BRIEF INITIATE SCALEExecutive FunctionsLikely to be Associated with BehaviorsItem DescriptionsPTPRIMARY EFSECONDARY EfsNOT A SELF STARTERxINITIATEGENERATEENERGIZEMUST BE TOLD TO BEGINTROUBLE THINKING OF THINGS TO DOTROUBLE GETTING STARTEDTROUBLE ORGANIZING ActivitiesORGANIZEDECIDEDOESN'T TAKE INITIATIVEComplains NOTHING TO DOLIES AROUNDDOESN'T SHOW CREATIVITYTrouble finding NEW WAYS TO SOLVE PROBLEMS
88Likely to be Associated with Behaviors BRIEF WORKING MEMORY SCALEExecutive FunctionsLikely to be Associated with BehaviorsItem DescriptionsPTPRIMARY EFSECONDARY EfsHOLDS ONTO only first or lastxHOLDSUSTAINSHORT ATTENTION SPANFOCUS/SELTROUBLE CONCENTRATINGEASILY DISTRACTEDTROUBLE with tasks having MORE THAN ONE STEPNEEDS HELP TO STAY ON TASKENERGIZEDOESN'T HOLD ONTO what their doingDOESN'T HOLD ON TO multi-step directionsTROUBLE FINISHING TASKSPACEEST TIMETROUBLE HOLDING INFORMATION for a few minutes
89Likely to be Associated with Behaviors BRIEF PLAN/ORGANIZE SCALEExecutive FunctionsLikely to be Associated with BehaviorsItem DescriptionPTPRIMARY EFSECONDARY EfsDOESN'T REMEMBER to brxRETRIEVEMONITORCAN'T GET IDEAS ONTO PAMANIPULATEHOLDEXECUTEDOESN’T ASSOCIATE homeANTICIPATEASSOCIATEDOESN'T REMEMBER to haMISSES BIG PICTURE - OVEBALANCEDOESN'T GET JOB DONESUSTAINENERGIZEOVERWHELMED by largeMODULATEORGANIZEFOCUS/SELUNDERESTIMATES TIME foESTTIMEGAUGESTARTS tasks AT LAST MINSENSE TINITIDOESN'T PLAN AHEADPLANPOORLY ORGANIZED writSEQUENCEDOESN'T COMPLETE ACT
90Likely to be Associated with Behaviors BRIEF ORGANIZATION OF MATERIALS SCALEExecutive FunctionsLikely to be Associated with BehaviorsItem DescriptionsPTPRIMARY EFSECONDARY EfsLeaves room a MESSxORGANIZEKeeps a MESSY roomCAN'T FIND THINGSRETRIEVEMONITORLEAVES THINGS lyingCORRECTLeaves MESSES for others to cleanMESSY closetLOSES THINGSDISORGANIZED backpack
91Likely to be Associated with Behaviors BRIEF MONITOR SCALEExecutive FunctionsLikely to be Associated with BehaviorsItem DescriptionPTPRIMARY EFSECONDARY EfsDOESN'T CHECK FOR MISTAxMONITORMAKES CARELESS ERRORSPOOR HANDWRITINGEXECUTEUNWARE OF EFFECT ON OTSR-AWAREUNAWARE OF EFFECT ONPOOR UNDERSTANDINGSR-ANALYSISSLOPPY WORKMODULATELEAVES WORK INCOMPLETECORRECTEST TIMEUNAWARE OF SELF IN A GRTalks or plays TOO LOUDLY
92Parent, Teacher, Self-Report Inventories BRIEF Interpretive Cautions:Identical BRIEF Scale T-scores can result from very different response patterns.Critical EF difficulties may be masked by low T-scores based on aggregation of multiple items.
93Parent, Teacher, Self-Report Inventories BRIEF Interpretive Cautions:An elevated T-score can result from a rating of “Sometimes” for all, or nearly all, items on a Scale, or from a rating of “Often” for a smaller subset of items on a Scale.
94Parent, Teacher, Self-Report Inventories BRIEF Interpretive Cautions:Because each BRIEF Scale is an amalgam of multiple EFs, certain areas of deficit may not be reflected in the T-score.
95Parent, Teacher, Self-Report Inventories BRIEF Interpretive Cautions:Example: The BRIEF Inhibit Scale combines items assessing Inhibit, Modulate, and Stop. If a client only exhibits Modulate problems, the T-score may not be clinically elevated. The low T-score will be masking the Modulate difficulties.
96Parent, Teacher, Self-Report Inventories Recently, 3 additional EF Rating Scales have been published:D-REFS (Delis Rating of Executive Function; 2012)BDEFS-CA (Barkley Deficits in Executive Functioning Scale; 2012)CEFI (Comprehensive Executive Functions Inventory; 2013)
97Parent, Teacher, Self-Report Inventories Ideally, behavior rating inventories would offer coverage of a broad array of executive functions across all 4 domains within all 4 arenas of involvement.
98Parent, Teacher, Self-Report Inventories The McCloskey Executive Function Scales are being developed to assess 33 self-regulation executive functions across multiple domains of function within multiple arenas of involvement.
99Parent, Teacher, Self-Report Inventories 5AAAlways or almost always does this on his or her own. Does not need to be prompted or reminded (cued) to do it.4FFrequently does this on own without prompting3SSeldom does this on own without being prompted, reminded, or cued to do so.2APDoes this only after being prompted, reminded, or cued to do it.1DAOnly does it with direct assistance. Requires much more than a simple prompt or cue to be able to get it done in situations that require it.UAUnable to do this, even when direct assistance is provided.
100Key ConceptAlthough limited in scope, individually-administered assessment of executive functions can provide valuable information about the child’s capacities to self-regulate perception, cognition and action within the Symbol System arena, especially in school.
102Identifying Task Construct Processes An Information Processing Model provides a theoretical framework for understanding task component cognitive capacities and their role in learning and production.An information processing model represents a dynamic model of cognition rather than a taxonomy of cognitive abilities.SI- changed scoring to 2,1,0 on initial items b/c got better discrimination between mild and mod disabilitiesGeorge McCloskey, Ph.D.
103Copyright 2007 George McCloskey, Ph.D. indicateExecutiveFunctionsat workMotor OutputLong-TermMemoryLexiconsMentalRepresentationActiveWorkingMemoryProcessingpatterndetailAttentionInitialRegistrationkinestheticvisualauditorySensoryMemoryCopyright 2007 George McCloskey, Ph.D.Sensory Input
104Key ConceptAssessment of Executive Functions does not occur “in a vacuum.” In order to evaluate how EFs cue and direct, they must have something (i.e., specific perceptions, emotions, thoughts, or actions) to cue and direct.
105Individually-administered Assessments of EF Executive Functions must be assessed in tandem with other mental constructs.Specific measures of Executive Functions always involve the assessment, to some degree, of a construct other than executive functions.For the most accurate observation or measurement of EFs, the contributions of other constructs need to be minimized, controlled for, or acknowledged.
106Key ConceptEFs in the Symbol System arena are best assessed by using methods that can reveal Cascading Production Decrements or Cascading Production Increments
107Cascading Production Decrement ConstructStart hereConstruct + EFConstruct + + EFProgressive deteriorationof performance is observedas executive function demands (+ EF) become greater.Construct+ + + EF
108Individually-administered Assessments of EF Identify a specific cognitive construct baseline using a measure that minimizes EF involvement.Select and use a measure that adds executive function demands to the baseline construct and observe the results.Continue to add additional EF demands and observe results.
109Increment Production Cascading ConstructConstruct+ EFCascading production increment: Progressive improvementof performance is observedas task embedded executive function demands (+ EF)are lessened.Construct+ + EFConstruct+ + + EFStart here
110Cascading Production Decrement Reasoning Ability:Matrix ReasoningStart hereReasoningAbility+ + + EF:WCSTProgressive deteriorationof performance is observedas executive function demands (+ EF) become greater.
111Cascading Production Decrement Visuo-motorAbility:Design CopyingAbility + EF:BVMGTStart hereAbility + + EFAbility EF:RCFTProgressive deteriorationof performance is observedas executive function demands (+ EF) become greater.
112Assessing Retrieval Fluency Examples:Naming animals in 60 secondsNaming foods in 60 secondsNaming words that begin with the letter “s” in 60 secondsNaming words that begin with the letter “f” in 60 seconds
113Assessing Retrieval Fluency Examples of response patterns:Semantic “Flooding” – Retrieval with minimal executive direction; uncontrolled flow of wordsControlled Access – Executive Functions used to organize retrieval of words by semantic clusters
114Assessing Retrieval Fluency Examples of response patterns:Semantic “Flooding” results in uneven performance across a 60 second interval with decreased production in each successive 15 second interval.
115Assessing Retrieval Fluency 1” – 15”Largest number of responses15 responses16” – 30”Reduced number of responses4 responses31” – 45”Reduced number of responses1 response46” – 60”Few, if any, responses0 responses
116Assessing Retrieval Fluency Examples of response patterns:Controlled Access typically results in a more even distribution of responses across a 60 second interval. Responses are often reflect organized, sequential access of various subcategories (e.g., water animals; flying animals; farm animals; forest animals; jungle animals;
118Cascading Production Decrement Retrieval Ability:Semantic FluencyStart hereRetrievalAbility + EF:Initial Letter FluencyProgressive deteriorationof performance is observedas executive function demands (+ EF) become greater.
119Key ConceptExecutive Functions are inextricably interwoven with all forms of academic production.
120Executive Functions and Reading Executive Functions are inextricably interwoven into the act of reading.
121An Integrative Model Specifying Processes, Abilities, Knowledge Bases, Skills, and Memory in Reading indicateExecutiveFunctionprocessingat workGeneral & SpecificKnowledge LexiconsSemantic LexiconWord & Phrase KnowledgeLanguageReasoningVisuospatialInitialRegistration(ImmediateMemory)Comprehending Words and Text+ Prosody =Reading Rateaka“Fluency”SpeedDecodingUnfamiliarand/orNonsenseWordsReadingFamiliar(Sight)WordsWorkingMemoryRetrievalfrom LongTerm StorageOrthographic ProcessingOral Motor ProcessingPhonological Processing
122Assessing Executive Functions Related to Reading Example of D-KEFS Color-Word Interference Word Reading task:“Look at this page…read these words as quickly as you can without making any mistakes.”
123Assessing Executive Functions Related to Reading Example of D-KEFS Color-Word Interference Inhibition task:“Look at this page…the color names are printed in a different colored ink. You are to name the color of the ink that the letters are printed in not read the word.”
124Assessing Executive Functions Related to Reading Example of D-KEFS Color-Word Interference Inhibition-Switching task:“This time, for many of the words you are to name the color of the ink and not read the words. But if a word is inside a little box, you should read the word and not name the ink color.”
125Cascading Production Decrement Process:D-KEFSColor &Word NamingProcess + EF:D-KEFS CWIInhibitionProgressivedeteriorationof performance is observedas executive function demands (+ EF) become greater.Process + + EF:D-KEFS Inhibition/Switching
126Executive Functions and Academic Production In the classroom, the task most frequently impacted by executive function-driven producing difficulties is written expression.
128Writing as a Holarchically Organized Process PLANPLANORGANIZEReviewing/RevisingText GenerationText TranscriptionLanguage RepresentationIdea Generation
129Executive Functions and Writing What Evan wrote for me:My favorite game is … “mabulroling it isfun I like makingthe box to role into. Iam prety gode aswell. It is rell intersing. It is so fun
130Executive Functions and Writing What Evan told me:“My favorite game is rolling marbles. I think it is fun. I just learned it yesterday. It can be pretty hard at times. It can be fun and it’s interesting if you make it challenging. I like making the boxes to roll the marbles into. You probably need to be pretty skilled with eye hand coordination to do it. To get up the ramp you need to roll it really fast.”
131Cascading Production Decrement PAL-II AlphabetWriting & PAL-IICopying A & BWIAT-III Sentence Composition and/orPAL-II Sentence WritingProgressivedeteriorationof performance is observedas executive function demands (+ EF) become greater.WIAT-IIIEssayComposition
132Process Approach to Cognitive Assessment The Process Approach can be applied effectively to assess a client’s use of executive functions when performing individually-administered symbol system measures.SI- changed scoring to 2,1,0 on initial items b/c got better discrimination between mild and mod disabilitiesGeorge McCloskey, Ph.D.
133Process Approach to Cognitive Assessment The basic principles of the Process Approach can be applied effectively at the subtest, item and task construct levels of the Interpretive Levels Framework.SI- changed scoring to 2,1,0 on initial items b/c got better discrimination between mild and mod disabilitiesGeorge McCloskey, Ph.D.
134Process Approach to Cognitive Assessment The Process Approach to cognitive assessment requires a clear understanding of what a cognitive task measures so that performance can be effectively task analyzed to characterize a child’s cognitive capacities as accurately as possible.
135Process Approach to Assessment The Process Approach to assessment represents a different way of thinking about test content, assessment procedures, test session behavior, and test performance interpretation.
136Process Approach to Assessment Accurate and effective characterization of a child’s cognitive capacities almost always requires effective application of a process approach to test administration and interpretation employed by a clinician skilled in process-oriented testing techniques.
137Process Approach to Assessment Academic Skills Assessment4/14/2017Process Approach to AssessmentComplex, multi-faceted tasks, such as those represented by subtests from Cognitive and Academic assessments, must be process-analyzed to identify how underlying task component processes might be affecting performance.prepared by George McCloskey, Ph.D.
138Process Approach to Assessment The input format, the internal processing demands, and the output requirements of a task all impact on performance and can produce highly variable results for any given child, even those from the “general” population.
139Process Approach to Assessment The cognitive capacities required to perform a task can change:across different items of the same task.the age of the child attempting to perform the task.the ability level of the child attempting to perform the task.
140Process Approach to Assessment Careful, systematic observations of problem solving strategies (process) en route to a solution, whether correct or incorrect, can yield more useful information about cognitive functioning than simple right-wrong scoring of the final solution (product or achievement).
141Process Approach to Assessment Knowing what an individual does wrong is as important as knowing what they do right; it is important to examine the nature of the particular errors made and the particular context in which they were made.
142Process Approach to Assessment Specific observations can lead to enhanced hypothesis generation and confirmation (or refutation).
144Process Approach to Assessing EFs What Does WISC-IVBlock Design Measure?Consider the following quote from John Carroll (Human Cognitive Abilities, 1993, page 309) :
145Process Approach to Assessing EFs What Does WISC-IV Block Design Measure?“…difficulty in factorial classification arises from the fact that most spatial test tasks, even the “simplest,” are actually quite complex, requiring apprehension and encoding of spatial forms, consideration and possibly mental manipulations of these forms, decisions about comparisons of other aspects of the stimuli, and making a response – often under the pressure of being required to respond quickly.”
146Process Approach to Assessing EFs From Carroll’s description, Block Design can be measuring at least 5 distinct cognitive processes:Visual perception and discriminationReasoning with visual stimuliVisualization (optional)Motor dexteritySpeed of motor response
147Process Approach to Assessing EFs From Carroll’s description of Block Design, which of the 5 distinct cognitive processes do you think Subject 3 lacked?Visual perception and discriminationReasoning with visual stimuliVisualization (optional)Motor dexteritySpeed of motor response
148Process Approach to Assessing EFs Consider the following quote from Carroll (1993, p. 309):…considerable confusion exists about the identification of factors in the domain of visual perception… Some sources of confusion are very real, and difficult to deal with. This is particularly true of confusion arising from the fact that test takers apparently can arrive at answers and solutions – either correct or incorrect ones – by a variety of different strategies. French (1965) demonstrated that different “cognitive styles” can cause wide variation in factor loadings; some of his most dramatic cases had to do with spatial tests, as where a sample of subjects who reported “systematizing” their approach to the Cubes test yielded a large decrease of the loading of this test on a Visualization factor (that is, decreased correlations of Cubes with other spatial tests), as compared to a sample where subjects did not report systematizing. It has been shown (Kyllonen, Lohman, & Woltz, 1984), that subjects can employ different strategies even for different items within the same test. Lohman et al. (1987) have discussed this problem of solution strategies, even rendering the judgment that factor-analytic methodology is hardly up to the task of dealing with it because a basic assumption of factor analysis is that factorial equations are consistent over subjects.
149Process Approach to Assessing EFs Carroll’s description leaves out a critical 6th cognitive process, or group of processes, essential for effective performance of Block Design – the ability to initiate, focus, sustain, coordinate/balance, and monitor the use of the other cognitive processes – i.e., Executive Function processes.
150Process Approach to Assessing EFs Coding requires multitasking requiring continuous motor production while processing associations from a code key.This multi-tasking effort must be coordinated by executive functions involving focusing and sustaining attention and effort, pacing and balancing work effort (speed vs accuracy) and monitoring for accuracy.Coding has predictable elements that can help to improve performance.
151Process Approach to Assessing EFs Symbol Search assesses processing speed applied to a series of unique visual discrimination tasks with only a minor motor response component.Every symbol search item is a unique task requiring attention to new visual details.Executive functions are required to direct focusing and sustaining attention and effort, pacing and balancing work effort (speed vs accuracy) and monitoring for accuracy.
152Process Approach to Assessing EFs An effective way to assess the use of executive functions in directing the focusing and sustaining of attention and effort is through the use of 15 or 30 second interval task performance recording.
153Process Approach to Assessing EFs Interval Recording:0 – – – – 120Typical performance on both Coding and Symbol Search reflects steady, consistent attention and effort, with only slight improvements or declines in the final 30 seconds.
154Process Approach to Assessing EFs Interval Recording:Patterns that deviate substantially are often indicative of difficulties with executive direction of attention and effort, regardless of level of scaled score performance.
155Process Approach to Assessing EFs Interval Recording:Examples of clinically relevant patterns of performance:0 – – – – 120
156Process Approach to Assessing EFs Memory processes are not required to perform either Coding or Symbol Search, but memory processes can be recruited for the performance of both of these tasks if the persons chooses to engage them.
157Process Approach to Assessing EFs Memory processes can be used to learn the code associations in Coding and to hold visual images during comparisons on Symbol Search. Choosing to use memory processes to help perform these tasks reflects the use of executive functions to alter test taking strategy.Use of memory processes for these tasks does not, however, guarantee improvement in performance.
158Process Approach to Assessing EFs Executive Functions Session IProcess Approach to Assessing EFsThe child scans 11 x 17 visual fields with structured and unstructured arrays of pictures and marks all pictures that match a specific target picture within a specified time.Involves:Visual Perception and DiscriminationProcessing SpeedProcessing AccuracyExecutive Coordination of Visual Skills, Speed, and AccuracyVisual Search Efficiency can be assessed with process-oriented technique (search behavior checklist)George McCloskey, Ph.D.
159Process Approach to Assessing EFs Executive Functions Session IProcess Approach to Assessing EFsThe Cancellation Subtest has two separate items.Cancellation Random (CAR) offers a random array of pictures; the child must use executive capacities to generate and direct a search pattern.Cancellation Structured (CAS) offers rows of objects that provide a cue for a search pattern of row-by-row scanning.George McCloskey, Ph.D.
160Process Approach to Assessing EFs Executive Functions Session IProcess Approach to Assessing EFsCompare performance on CAR and CAS to assess efficiency of using search cues to improve performance.Observe and record the child’s search pattern for both items to qualitatively assess the effectiveness of executive direction of search patternsGeorge McCloskey, Ph.D.
161Process Approach to Assessing EFs Executive Functions Session IProcess Approach to Assessing EFsThe Picture Concepts Subtest requires the use of executive functions to cue the organization and comparison of multiple associative hypothesesA process approach to re-testing can reveal the difference between incorrect resposnes due to lack of associative reasoning or due to lack of use of executive functionsGeorge McCloskey, Ph.D.
162Functional Behavior Assessment The focus of a traditional FBA:“Behavior support plans are designed to alter patterns of problem behavior. The process by which this is done, however, involves change in the behavior of family, teachers, staff, or managers in various settings. Plans of behavior support define what we will do differently. It is the change in our behavior that will result in improved behavior of the focus person.” (O’Neill, Horner, Albin, Sprague, Storey, & Newon, 1997, p. 65).
163Functional Behavior Assessment In traditional functional behavior assessments antecedents are said to TRIGGER the behavior that results in the consequences, but the reasons WHY the antecedents trigger the behavior is not really addressed.
164FBA: A-B-C Is Not Enough Since the antecedent does not trigger the same undesirable behaviors in ALL students in the same situation, there must be something about the students that differs in an important way.Functional behavior assessment ignores internal considerations (i.e., perceptions, emotions, thought) and focuses on applying external control to effect change in behavior.
165The EF Driven FBAInformed by knowledge of executive functions, the functional behavior assessment model can be revised as follows:ABCEFBehaviorResponseAntecedentsConsequencesPerceptionEmotionCognitionAction
166Key ConceptAn EF-Driven FBA enables problems to be clearly stated in terms of perceptions, emotions, thoughts or actions that can be changed through intervention.
167EF- Driven FBA The goals of an EF-driven FBA are: to help the child, the parents, and professionals to understand the nature of the deficit andthrough proper intervention, to assist the child or adolescent in changing the behavior from a negative to positive.
168Progress MonitoringExecutive FunctionsProgress monitoring techniques for interventions targeting the improvement of the use of executive functions.Prepared and presented by George McCloskey, Ph.D.
169EF Assessment Using the MEFS-SRAV Effectiveness RatingsRate the students use (or disuse) of the 23 Self-Regulation Executive Functions using the following criteria:Internally Self-RegulatedExternally GuidedExternally ControlledTypically self-regulates this executive function.Typically does not self-regulate this executive function but demonstrates the capacity to use this executive function when external guidance is provided.Does not self-regulate; use of this executive function is minimal or non-existent even when external guidance is provided; External control is required as a substitute to maintain adequate functioning.7654321Extremely effective; does not require any external guidance; highly independent with self-regulation.Effective; usually does not require any external guidance; often independent with self-regulation; may occasionally require some external guidance.Requires only minimal external guidance to maintain the effective use of this executive function.Requires frequent external guidance to maintain the effective use of this executive function.Requires very frequent external guidance to demonstrate the use of this executive function; use is not maintained even when guidance is provided.External control can be used to effectively substitute for the absence of this executive function; the lack of this executive function is apparent when external control is not present.External control is only marginally effective or not effective at all as a substitute for the absence of this executive function; a lack of this executive function is apparent even when external control is present.
170EF Assessment Using the MEFS MODULATECues the regulation of the amount and intensity of mental energy invested in perceiving, feeling, thinking, and acting.InternallyRegulatedExternallyGuidedControlledPerceivingSelfOthersEnvironsAcademics3Feeling2-35Thinking2Acting6Notes: very negative about self and others; has a hard time returning to a calm state once agitated; finds academic work extremely frustrating; cannot modulate attitude toward schoolwork.
171Self Regulation Capacity: Focusing and sustaining attention when working independently on tasks. DurationFrequency1Never0% of the time.2OccasionallyApproximately10% of the time.3Sometimes20%-40% of the time.4Often50%-70% of the time.5Very Often80% of the time.6Almost Always90% of the time.7Always100% of the time.Unable to focus and sustain attention for more than a few seconds when independently working on tasks.Able to focus and sustain attention for about 1 minute when working independently on tasks.Able to focus and sustain attention for about 2-3 minutes when working independently on tasks.Able to focus and sustain attention for about 5 minutes when working independently on tasks.Able to focus and sustain attention for about 10 minutes when working independently on tasks.Able to focus and sustain attention for about 15 minutes when working independently on tasks.Able to focus and sustain attention for 20 or more minutes when working independently on tasks.
172Goal 1: Managing Frustration and Engagement Progress Monitoring Form for Zach Date: __________________Goal 1: Managing Frustration and Engagement3Fully engagedwithout frustrationMaintained positive engagement throughout class and no frustration was apparent.2Frustration managed withself cued strategyFrustration was apparent but was effectively managed and positive engagement occurred likely due to self-cued use of strategies.1teacher cue or ResetFrustration was apparent but was effectively managed and positive engagement occurred after teacher provided a cue for strategy useOr Zach returned after using the Reset strategy.Frustration not managedFrustration was apparent and strategy use was cued by teacher but positive engagement did not occur and student left class.
173Goal 2: Focusing and Sustaining Attention During Class Progress Monitoring Form for Zach Date: __________________Goal 2: Focusing and Sustaining Attention During Class3Attended the entire timeAttention was focused and sustained during the entire class period2Attended most of the timeAttention was focused and sustained often during the class period.1Attended some of the timeAttention focused and sustained occasionally during the class period, or focused often after returning from a Reset.Attended none of the timeAttention was never focused or sustained during the class period.
174Goal 3: Completing Assigned School Work Progress Monitoring Form for Zach Date: __________________Goal 3: Completing Assigned School Work3All work completedAll assigned class work is completed during class time.2Most work completedMost assigned class work is completed during class time.1Some work completedSome assigned school work is completed during class time or after returning from a Reset.No work completedNo assigned school work is completed during class time.
175Class ________________ Frustration Management 3 2 1 Work Modified: Progress Monitoring Form for Zach Date: __________________Class ________________Frustration Management321Work Modified:Yes NoComments/Work not completed:AttentionWork completed with extended time?Work Completion
176Executive Function Difficulties Are they the result of:Disuse through Nononscious ChoiceInnate DeficiencyMaturational DelayDisuse through Conscious Choice
177Executive Function Intervention For intervention purposes, it is bestto assume that EF deficiencies arethe result of disuse throughnonconscious choice. The generalintervention goal then becomeseducation to make the child consciousof the EFs needed and how to engagethem.
178Key ConceptIntervention efforts require a therapeutic perspective that emphasizes a Growth Mindset over a Fixed Mindset and a patient belief in the idea that EF difficulties “won’t last forever; but probably longer than you would like.”
179Interventions for EF Difficulties EF Self-regulation skills eventually need to be just that—Self-regulated.During classroom instruction, it is necessary to find the balance between providing enough EF SR cueing to help students function, but not too much to prevent EF skill-development.It is easy to underestimate the multiplicity of EFs required and focus only on those related to attention and organization.
180Executive Function References Promoting Executive Functions in the Classroom– Lynn Meltzer (2010)Executive Function Skills in Children and Adolescents 2nd Edition – Dawson & Guare (2009)Smart but Scattered – Dawson & Guare (2009)Late, Lost, and Unprepared – Cooper Kahn & Deitzel (2008)Assessment & Intervention for Executive Function Difficulties – McCloskey, Perkins & VanDivner (2009)Executive Functions in the Classroom – Chris Kaufman (2010)
181External Control Strategies EF Intervention ContinuumOrienting StrategiesExternal Control StrategiesBridging StrategiesInternal ControlStrategies
182Interventions for EF Difficulties Requires keeping in mind:The need to increase awareness and provide goals.The need to move from external control to internal control through bridging strategies.The environment in which intervention is happening: Requires those close to child to have reasonable EF capacities and be able to model those capacities.
183Key ConceptImproving students’ executive functions starts with increased awareness and goal setting and progresses from external control to internal self-regulation
184Key ConceptOrienting Strategies increase awareness of executive functions and expectations for their use and provide self-regulation goals for students.
185Engagement of Self-Determination Executive FunctionsSelf-RegulationExecutiveFunctionsNucleusAccumbensInternal Command Pathway:Intrinsically Rewarding
186Chapter 21Motivational Interviewing with Adolescentsand Young AdultsJohn S. Baer and Peggy L. Peterson
187Key ConceptExternal Control strategies enable students to perform more effectively but do not necessarily help to improve students’ capacity for self-regulated performance.
188External Control Strategies Rewards can be a tremendous benefit to a child who has difficulty aligning internal desires with external demands. Use rewards, but heed the following cautions:
189Using Rewards to Increase Production Rewards do not teach the child how to reflect on and alter perceptions, emotions, thoughts or actions, they simply reward the presence of desired behaviors.Reward programs imply that a child can do it if he/she wants to or is motivated enough. This often leads away from the realization that many children who are motivated and do want to change their behavior don’t know what to do to change it.
190External Control Strategies Punishment in mild form can be an effective means of obtaining compliance with external demands. When choosing to use punishment, heed the following cautions:
191Using Punishment to Increase Production Punishment does not teach the child how to reflect on and alter perceptions, emotions, thoughts or actions, they simply punish the presence of undesired behaviors.Punishment implies that a child can do it if he/she wants to or is motivated enough. This often leads away from the realization that many children who are motivated and do want to change their behavior don’t know what to do to change it.
192External Control Strategies Provide predictable, consistent structure to classroom environments and routines:Post and discuss class rules and schedulesReview and rehearse routinesMaintain basic room arrangement
193External Control Strategies Provide external prompts and cues as a substitute for self-regulation.
194PerceivePerceive cues the use of sensory and perception processes to take information in from the external environment or “inner awareness” to tune into perceptions, emotions, thoughts, or actions as they are occurring.Prompt examples: “Listen to this.” “Look up at the board.”“How are you feeling right now?”
195FocusFocus cues the direction of attention and effort to the most relevant specifics (perceptions, emotions, thoughts, and/or actions) of a given environment, situation, or content while downgrading or ignoring the less relevant elements.Prompt example: “Pay attention to what happens to the baking soda after the vinegar is added.”
196SustainSustain cues sustained attention to the most relevant specifics (perceptions, emotions, thoughts, and/or actions) of a given environment, situation, or content.Prompt example: “You will need to watch the computer screen carefully for the entire 10 minutes.”
197EnergizeEnergize cues the investment of energy to the level needed to achieve the desired resultsPrompt example: “This will require a lot of effort.” “You’ll need to focus all of your energy on task if you want to finish.”
198InitiateInitiate cues the initial engagement of perceiving, feeling, thinking, or acting.Prompt example: “Start walking now.” “Begin work on the count of five.”
199InhibitInhibit cues resistance to, or suppression of, urges to perceive, feel, think, or act on first impulse.Inhibit prompts direct capacities to an alternate source rather than drawing attention to the perception, emotion, thought, or action that should be inhibited.Prompt example: “Don’t start until I tell you to go.”
200StopStop cues the sudden, immediate discontinuation of perceiving, feeling, thinking, or acting.The Stop cue always precedes the Shift cue when altering problem-solving based on changing conditions, and switching or alternating attention.Prompt example: “Stop writing now.”
201PausePause cues the brief cessation of, and the return to perceiving, feeling, thinking or acting.Efficient use of the Pause cue enables a quicker return to a previous mental state or activity.Prompt example: “Pause for a moment and listen, then I want you to go back to what you were doing.”
202FlexibleFlexible cues a willingness to alter the frame of reference for the direction and engagement of perceptions, emotions, thoughts or actions in reaction to what is occurring in the internal or external environments.Prompt example: “It doesn’t need to be done exactly the same way each time.”
203ShiftShift cues a relatively quick change in the direction and engagement of perceptions, emotions, thoughts or actions in reaction to what is occurring in the internal or external environments.Prompt example: “The museum is closed for emergency repairs, so we won’t be able to go on the field trip.”
204MonitorMonitor cues the activation of appropriate routines for checking the accuracy of perceptions, emotions, thoughts or actions.Prompt example: “Periodically check the task directions to see if you are following all of them.”
205Modulate/AdjustModulate cues the regulation of the amount and intensity of mental energy invested in perceiving, feeling, thinking, and acting.Prompt example: “Let’s all use our indoor voices now.”“Please tone it down a bit.”
206BalanceBalance cues the regulation of the trade-off between opposing processes or states (e.g., pattern vs detail; speed vs accuracy; humor vs seriousness) to enhance or improve experiencing, learning, or performing.Prompt example: “Work as quickly as you can, but be careful not to make any mistakes.”
207CorrectCorrect cues the use of appropriate routines for correcting errors of perception, emotion, thought, or action based on feedback from internal or external sources.Prompt example: “Correct any errors you find.”
208Sense TimeSense Time cues the monitoring of the passage of time (e.g., cueing the engagement of the mental functions that enable a person to have an internal sense of how long they have been perceiving, feeling, thinking or acting).Prompt example: “How long have you been working on that?”
209PacePace cues the awareness of, and the regulation of, the rate at which perceptions, emotions, cognitions, and actions are experienced or performed.Prompt example: “You will need to work quickly as there is not much time left.”
210SequenceSequence cues the orchestrating of the proper syntax of a series of perceptions, feelings, thoughts, and/or actions, especially in cases where automated routines are being accessed or are initially being developed.Prompt example: “Remember the order of the steps needed for completion.”
211Using Routines (Execute) Using Routines (Execute) cues the engagement of a well-known series of perceptions, feelings, thoughts, and/or actions, especially in cases where automated routines have been practiced and used frequently.Prompt example: “Use the routine you learned to do these.”
212HoldHold cues activation of the necessary cognitive processes required to maintain information in working memory and continues cueing these processes until the information is manipulated, stored, or acted on as desired.Prompt example: “Hold that thought while we hear a reaction from the other group.”
213ManipulateManipulate cues the use of working memory and other cognitive processes for the manipulation of perceptions, feelings, thoughts or actions as they are being held in mind or being accessed in the environment.Prompt example: “Visualize what it would look like if you turned it upside down.”
214StoreStore cues the movement of information about perceptions, feelings, thoughts and actions from the mental processing environment of the present moment into “storage” for possible retrieval at a later time.Prompt example: “This is important; it will be on Friday’s quiz.”
215RetrieveRetrieve cues the activation of cognitive processes responsible for finding and retrieving previously stored information about perceptions, feelings, thoughts and actions.The more specific the demands or constraints placed on the retrieval task, the greater the requirements for precision of retrieval cues.Prompt example: “To answer the question correctly, you will probably need to recall all that we learned about photosynthesis.”
216GaugeGauge cues one to identify the demands (perceptual, emotional, mental, physical) of a task or situation and cues the activation of the resources needed to effectively engage the task or situation.Prompt example: “Consider what it’s going to take to get this job done right.”
217AnticipateForesee/Plan cues the anticipation of conditions or events in the very near future, such as the consequences of one’s own perceptions, feelings, thoughts and/or actions.Prompt example: “If you keep erasing in that same spot, what do you think will happen to the paper?”
218Estimate TimeEstimate Time cues the use of time estimation routines (e.g., cueing the engagement of mental functions that enable a person to have an internal sense of how long something will take to complete, or how much time is still left in a specific period of time).Prompt example: “Tell me how long you think this will take you to do.”
219AnalyzeAnalyze cues the realization of the need to examine more closely perceptions, feelings, thoughts or actions to obtain a greater understanding of a problem or situation.Prompt examples: “Make a list of the positives and negatives and then compare them.”“Are there additional factors that need to be considered?”
220Compare/EvaluateCompare/Evaluate cues the realization of the need to make comparisons among, or evaluate the adequacy of, perceptions, feelings, thoughts or actions.Prompt examples: “Did you complete all the steps?”“Does yours look like the model?”“Why do you think what you said was a good explanation?”
221PrioritizePrioritize cues the use of routines for ordering perceptions, feelings, thoughts, and/or actions, according to their relevance, importance, or urgency.Prompt example: “Think about how important each of these tasks is, and then list them in order of importance so the most important ones get done first.”
222GenerateGenerate cues the realization that novel, fluid problem-solving efforts are required and cues the activation of the resources needed to carry out problem-solving routines.Prompt example: “We haven’t tried to solve a problem like this one before.”“This problem will require some novel thinking if you are going to find a solution.”
223AssociateAssociate cues the realization that associations need to be made, and cues the activation of the resources needed to attempt to make the necessary associations.Prompt examples: “Have you heard anything like that before?”“This problem is very similar to one you worked on last week.”
224OrganizeOrganize cues the use of routines for sorting, sequencing, or otherwise arranging perceptions, feelings, thoughts, and/or actions, to enhance or improve the efficiency of experience, learning, or performance.Prompt example: “Let’s establish the order in which you need to do things to get this task done.”
225Plan (Short-term)Plan cues the engagement of the capacities required to identify a series of perception, feelings, thoughts, and/or actions that, if carried out, would be most likely to produce a desired outcome in the very near future (within minutes to within several hours).Prompt example: “Write down what you will do over the weekend and when you will do it so that you will be ready for the test on Monday.”
226Choose/DecideChoose cues the need to achieve closure, i.e., to make a choice among alternatives now.Prompt example: “Make a choice now.” “Pick one now.” “Choose now.”The Choose cue often must be preceded by the Stop/Interrupt cue.Prompt example: “You need to stop thinking about it and make a choice now.”
227External Control Strategies Provide time management aids, such as calendars, clocks, timers, schedules, peer leaders and coaches, work teams, etc.
228Key ConceptBridging strategies effect the gradual transition from external control to self-regulated internal control.
229Bridging StrategiesEncourage the engagement of executive functions through the use of reflective questioning
230Reflective Questioning Repeat the child’s question back to the child instead of providing an answer. In situations where the child seems unaware of the need to be asking questions for adequate engagement, reflective questioning involves the mediator asking the child a question that is intended to make the child aware of the need to engage executive functions.
231Bridging StrategiesProvide immediate and frequent feedback about the effectiveness of attempts to engage self-regulation executive functions. Providing students with feedback about their performance enables them to engage executive capacities more effectively to learn from their mistakes and improve future performance.
232Feedback About Accuracy When providing feedback, be sure to emphasize the importance of effort; make sure the child realizes that self-regulation is not simply something you have or don’t have – it can be increased by applying techniques and strategies; the more effort placed into applying the techniques, the more likely the improvements.
233Model appropriate use of self-regulation executive function capacities Bridging StrategiesModel appropriate use of self-regulation executive function capacities
234Bridging StrategiesTeach self-regulation capacities with specific skill routines using Cognitive Strategy Instruction approaches (e.g. Graham & Harris Self-Regulated Strategy Development approach for Written Expression).
235Five Stages of Strategy Instruction Explain the purpose of self-regulation strategies in general and describe and discuss the specific steps of the strategy that will be taught.Strategies
236Five Stages of Strategy Instruction 2. Model the use of the strategy using language and examples that connect with the students.Strategies
237Five Stages of Strategy Instruction 3. Students memorize the steps in the strategy as well as any mnemonics that are used as part of the strategy.Strategies
238Five Stages of Strategy Instruction 4. Teacher supports the implementation of the strategy by the students, scaffolding as necessary to help the students to master the use of the strategy.Strategies
239Five Stages of Strategy Instruction 5. Students independently apply the self-regulated strategy covertly (in their own minds). Students and teacher collaboratively evaluate the effectiveness of student self-directed strategy application.Strategies
240The Report Writing Strategy Select a topic.Brainstorm what you know and what you want to learn.Organize your information using a visual web.Review your visual web and identify any holes or disconnects.
241Web for what I know and what I want to learn HabitsLooksActive at night___________Large eyesLong tailsRings on tail___________LemursLiveEat?Pets?jungletreesCountry???zoosWhat do they eat?___________Can they be pets?___________
242The Report Writing Strategy Gather new information andrevise your visual web.6. Use the visual web to help construct an outline for the report or to begin writing.7. Review, plan and revise as you write.
243The Report Writing Strategy Check the visual web; did you write what you wanted to write?Add information that is missing; fix sentences that don’t say what you want to say.
244Read the sentence silently and/or aloud. Scaffolding Step 9Read the sentence silently and/or aloud.Does the sentence make sense to you? What does it mean?Is that what you meant to say?
2454. What’s missing? What doesn’t make sense? Scaffolding Step 94. What’s missing? What doesn’t make sense?5. Restate what you want to write. Repeat it to yourself.Write what you just said.Read what you wrote; go through steps 1-6 if needed.
246Bridging StrategiesDevelop a common vocabulary and set of nonverbal symbols for describing or signifying self-regulation capacities and signaling their use (e.g., cueing flexibility with “The Coconut Story”)
247Bridging StrategiesPractice and rehearsal of the use of executive functions. This is the single best way to increase engagement and efficiency of the use of executive functions.
248Bridging StrategiesAlign external demands with internal desires to maximize motivation.Allow self-selection or choice of assignments whenever possibleUse high interest material to illustrate application of new knowledge and skills
249Key ConceptOnce learned and practiced, Internal Control Strategies enable students to effectively “run their own shows.”
250Internal Control Strategy Once learned, the child can use internalized “self-talk” as a means of increasing awareness of executive functions and of when and how to use them (e.g., modified Berninger mantra for writing: “What I can think I can say. What I can say I can write What I can write I can revise.”)
251Internal Control Strategy Model and teach the use of self-administered reward routines to increase the use of self-regulation executive functions (e.g., teach the child how to “bargain with yourself” to get homework accomplished).
252Internal Control Strategy Teach the use self-monitoring routines. These routines can be used to monitor and correct perceptions, feelings, thoughts and actions.
254Motivational Interviews with Zeke “I’m here to help you get what you want, but in order to do that I need to know what it is that you want.”
255Zach’s self-selected long-term goals: Goal Setting with ZekeZach’s self-selected long-term goals:Pass all classes in 8th gradeGet promoted to 9th grade and attend 9th grade at the district Senior High School
256Collaborative Problem-Solving with Zeke “When I was observing you in Science class, I saw that you just put your head down on the desk and stayed that way for most of the class. What happened?”
257Collaborative Problem-Solving with Zeke When asked specifically about his refusal to do classwork that day in Science class (as observed by the psychologist), Zeke offered that he was not purposefully refusing to do the work, but that he was unable to get himself to do it, stating: “It feels like I am hitting a wall and the harder I try, the more it hurts.”
258Improve my mood; get engaged with class Pay attention in class Goal Setting with ZekeGoals developed through discussion with Zeke about how to achieve his long-term goals:Improve my mood; get engaged with classPay attention in classComplete class work and home work
259Cognitive Behavior Therapy It was also explained to Zeke that it is possible to improve the capacity to respond on demand, especially if he were to have a strategy worked out that he could use in situations where demands were being made of him, such as the demands for participating in class and doing homework.
260Cognitive Strategy Instruction The Psychologist met with Zeke and his mother to come up with strategies that he could use to achieve his immediate goals. After the strategies were developed, the psychologist summarized them in a powerpoint file.
261Cognitive Strategy Instruction The Powerpoint file was used to teach Zeke how to use the strategies and used with school staff to help them understand how Zeke was going to work on improving his behavior.
263Get passing grades in all subjects Get promoted to 9th grade Long-term GoalsGet passing grades in all subjectsGet promoted to 9th gradeImmediate GoalsImprove my mood; get engaged with classPay attention in classComplete class work and home work
264Ask: How am I doing right now? Am I doing what I need to do for class? Do I feel good?Am I doing what I need to do for class?
265Purple Elephants Strategy Say: I need to use thePurple Elephants Strategy
266Take a deep breath and relax. Say: I need to adjust my attitudeso I can have a good day.Say: Looking at my Purple Elephants filewill help me feel better.
267Say: I am in control now!Say: I feel better.I’m ready to do whatI need to do for class.
268Ask: What should I be doing for class? Say: OK, I’m on it.orSay: I’m not sure.I will ask for help.
269Am I doing what I need to do for class? How am I doing right now?Do I feel good?Am I doing what I need to do for class?I need to use thePurple Elephants StrategyI need to adjust my attitudeso I can have a good day.Looking at my Purple Elephants filewill help me feel better.I am in control now!OK, I feel better.I’m ready to do whatI need to do for class.What should I be doing for class?I’m not sure.I will ask for help.OK, I’m on it.
273Say: I am energized and ready Say: I am in control now!Say: I am energized and readyto pay attention!
274Say: What should I be doing for class? Say: OK, I’m on it.orSay: I’m not sure.I will ask for help.
275Am I paying attention right now? I need to use the Focus StrategyYawn and Stretch.I am in control now!I am energized and readyTo pay attention!What should I be doing for class?I’m not sure.I will ask for help.OK, I’m on it.
278Say: I need to do my class work so I can earn a passing grade and go on to 9th grade next year.
279Say: I am in control now!Say: I am energized andready to work!
280Ask: Do I know how to do this work?” Say: I can complete my class work if I know what I need to do and how to do it.Ask: Do I know how to do this work?”Say: OK, I’m on it.orSay: I’m not sure.I will ask for help.
281I need to do my class work so I can earn a passing grade Am I doing my class work?I need to use theJust Do It StrategyI need to do my class workso I can earn a passing gradeand go on to 9th grade next year.I am in control now!I am energized andready to work!I can complete my class work if I know what I need to do and how to do it.Do I know how to do this work?”I’m not sure.I will ask for help.OK, I’m on it.
282Cognitive Behavior Therapy The psychologist created a list of cognitive distortions and related cognitive corrections that was used with Zeke to discuss how he could change his thinking about school and academic tasks. The list was shared with Zach’s counselor who also worked with Zeke on cognitive corrections.
283Cognitive DistortionCognitive CorrectionDichotomous Thinking:“I’m either a good student or a failure.”Contextual Thinking:“Sometimes I perform poorly but many times I perform well.”Overgeneralizing:“I hit the wall in class today and couldn’t find the door. I have no control over my emotions.”Specifying:“I hit the wall today and couldn’t find the door. The next time I hit the wall, I will use my Purple Elephant strategy and find the door.Mindreading:“I didn’t do all of the assigned work. I know the teacher is disappointed with me.”Mindsharing:“I didn’t do all my work. I’ll let the teacher know that I plan to finish all of it if that is ok with him/her.”
284Cognitive Distortions and YOU ARE IN CONTROL!Cognitive Distortions andCounteracting Cognitive Corrections WorksheetDeveloped by George McCloskey, Ph.D. Philadelphia College of Osteopathic MedicineCognitive DistortionCognitive Correction
285Teacher TrainingZach’s teacher’s met with the psychologist for 90 minutes to receive training on how to use a series of prompts to cue Zeke to use the strategies he was learning to improve his engagement, attention and work completion during classes.
286Deliver 1-3 prompts during class Teacher TrainingDeliver 1-3 prompts during classProvide daily ratings of engagement, attention and work completion based on need for and response to prompts
287Prompt 2: Zeke, you need to use your _ strategy. Teacher TrainingPrompt 1: Self-awareness cueing (Zeke, you seem to be having some trouble with…)Prompt 2: Zeke, you need to use your _ strategy.Prompt 3: Zeke you need to use your reset strategy.
288Cognitive Strategy Implementation Zeke self-cues engagement, attention and work completionIf prompt 1 is used: Zeke realizes the need to use his strategiesIf prompt 2 is used: Zeke, uses his strategy as suggested by teacherIf prompt 3 is used: Zeke leaves the room and uses his reset strategy.
289Frustration managed with self cued strategy Progress Monitoring Form for Zeke T Date: __________________Goal 1: Managing Frustration and Engagement3Fully engagedwithout frustrationMaintained positive engagement throughout class and no frustration was apparent.2Frustration managed with self cued strategyFrustration was apparent but was effectively managed and positive engagement occurred likely due to self-cued use of strategies.1Frustration managed with teacher cueFrustration was apparent but was effectively managed and positive engagement occurred after teacher provided a cue for strategy use.Frustration not managedFrustration was apparent and strategy use was cued by teacher but positive engagement did not occur and student left class.
292Staff Collaboration/Consultation Staff requested to have the psychologist meet with Zeke on a regular basis to reinforce the strategies and consult with teachers and staff.
293Progress MonitoringWeekly ratings were summarized to help school staff monitor progress and provide Zeke with feedback about his performance.
294END OF YEAR SUMMARY ALL CLASSES ENGAGEMENT%Rated 3, 2, or 178%Rated 022%ATTENTIONWORK COMPLETION70%30%
2958th Grade OutcomesZeke passed all of his classes.Zach’s progress toward behavior goals were judged as reflecting adequate improvementZeke was promoted to 9th grade at the high school instead of being transferred to an alternative program
296Key ConceptSome specific educational programs are designed, either explicitly or implicitly, to improve students’ executive functions.
297Executive Functions Interventions Specific Programs and Approaches to Improving Clients’ Executive Functions include the following:
298Key ConceptTools of the Mind (Bodrova & Leong) is an effective preschool /kindergarten curriculum that helps young children improve executive functions.
299Key ConceptCognitive Strategy Instruction is an evidence-based methodology that improves students’ use of executive functions to improve academic production.
300Evidence Based Intervention: Cognitive Strategy Instruction Cognitive Strategy Instruction (CSI) emphasizes the development of thinking skills to increase learning and production. CSIs help students to become more strategic, self-reliant, flexible, and productive in their learning endeavors (Scheid, 1993). Use of these strategies have been associated with increased academic production (Borkowski, Carr, & Pressley, 1987; Garner, 1990).
301Evidence Based Intervention: Cognitive Strategy Instruction CSI techniques employ metacognition and focus on modeling and teaching students strategies for completing tasks and routines and then modeling and teaching methods for self-cueing the use of the strategies.
302Evidence Based Intervention: Cognitive Strategy Instruction Lynn Meltzer (2010) employs CSI techniques in the Drive to Thrive classroom program and the BrainCogs and Essay Express software programs.
303Evidence Based Intervention: Cognitive Strategy Instruction Drive to Thrive and BrainCogs both address five general areas of self-regulation:Goal Setting, Planning and PrioritizingOrganizingRememberingShifting and Flexible Problem-SolvingSelf-Monitoring and Self-Checking
304Executive Functions Interventions Rueven Feuerstein’s approach to improving cognitive functioning through instrumental enrichment, mediated learning and dynamic assessment, all focused on increasing self-regulation through increased self-awareness and strategy use.
305Key ConceptThe language of Cognitive Behavior Therapy is being used to help teachers improve their ability to engage specific brains areas during classroom instruction.
306Executive Functions Interventions Cognitive Behavior Therapy (CBT).CBT teaches strategies for improving the use of executive functions to cue and direct effective perceiving, feeling, thinking and acting. Techniques have shown good results at the adult and adolescent levels and some early indications that the techniques can be applied effectively with children in the elementary grades.
307Evidence Based Intervention: Cognitive Behavior Therapy Cognitive Behavioral Therapy (CBT) emphasizes collaborative reality-testing and the monitoring and modification of automatic perceptions, feelings, thoughts, and actions that cause difficulties for the child.
308Evidence Based Intervention: Cognitive Behavior Therapy Outcomes of CBT with children and adolescents:Increased ability to monitor perceptions, feelings, thoughts and actionsIncreased engagement in positive problem-solving strategiesIncreased capacity for self-regulating perceptions, feelings, thoughts and actions
309Executive Functions Interventions CBT variants such as Jeffrey Schwartz’s “Brain-Lock: Free Yourself from Obsessive-Compulsive Behavior; subtitled as “a four-step self-treatment method to change your brain chemistry.” This method uses CBT oriented techniques to strengthen self-regulation capacities and decrease unproductive perceptions, feelings, thoughts and actions.
310Key ConceptProblem-solving approaches are intended to increase students’ use of executive functions to find better solutions to personal difficulties.
311Executive Functions Interventions Ross Greene’s Collaborative Problem-solving approach featured in his books on Treating Explosive Kids. Although Greene does not specifically use the concept of executive functions, his intervention approach teaches parents techniques for improving both external control and building internal self-regulation capacities.
312Executive Functions Interventions Myrna B. Shure’s I Can Problem-Solve techniques for teaching young children increased self-control and improved cueing of appropriate problem-solving routines.
313Executive Functions Interventions Michelle Garcia Winner’s Social Thinking Curriculum Superflex. Uses cartoon characters to teach about self-regulation concepts (e.g., Rock Brain represents inflexible thinking). Intended for upper elementary age children diagnosed with Asperger’s, but the techniques and ideas appear to have wider application.
314Key ConceptComputer-based technologies are beginning to show promise as techniques for improving students’ capacities for executive functions use.
315Executive Functions Interventions Computer-based cognitive training programs such as CogMed and neurofeedback programs are being closely studied to determine the extent to which they can be used to improve self-regulation in settings other than the “computer lab.”
316Key ConceptMeditation is one of the most effective ways to increase access to and use of executive functions.
317Executive Functions Interventions Mindfulness-based CBT improves Self-Awareness and Self-Analysis capacities through the incorporation of meditative techniques along with teaching strategies for regulating perceptions, feelings, thoughts and actions, making it more likely that learned CBT strategies will be cued when needed.
318Executive Functions Interventions Use of Meditation, especially witnessing meditation techniques. Improving all forms of self-control, especially Self-Awareness, through “quieting of the mind.”
320Executive Functions Interventions Fostering development of internal and external control mechanisms through “strengthening of the will”; Improving or Developing “Magnetic Center” therapeutic techniques such as Roberto Assagioli’s Psychosynthesis.
321Executive Functions Interventions Mindfulness-based Physical Exercise Programs such as Yoga and Thai Chi are likely to have generalized effects on a number of self-regulation executive functions.
322Key ConceptBecause so many executive functions problems are related to maturational delays, time is an effective intervention in itself.
323Executive Functions Interventions Time - Natural maturational processes affect executive functions at all levels; time-related expectations for EF development often need to be adjusted (e.g., recall the 30% developmental delay often found with individuals with ADHD)Prepared and presented by George McCloskey, Ph.D.
324Key ConceptSome medications help students with severe ADHD gain greater access to some specific executive functions.
325Executive Functions Interventions Pharmacological - Medications help increase executive functions use in conditions such as ADHD, mood disorders, and OCD. In most cases, the medication does not directly enhance EFs but rather reduces the disrupting effect of less than optimal function of other neural circuitry.Prepared and presented by George McCloskey, Ph.D.
326Key ConceptExecutive Skills coaching is a growing area. When done well, it can be used to implement all four strategies for improving executive functions.
327Executive Functions Interventions Engage the Services of a Cognitive Coach (i.e., Rent-a-Lobe) Make extensive use of an external executive function substitutes where appropriate, e.g., ADHD and Life Coaches.
328Executive Functions Interventions Encourage Symbiotic Relationships and Support Networks. Enter into relationships where there is a mutual interdependence that enables reduction of the effect of EF deficiencies.Prepared and presented by George McCloskey, Ph.D.
329Key ConceptTeachers can implement specific techniques to reduce the likelihood of executive functions difficulties affecting assessment of academic production.
330Key ConceptAlternately, teachers can take on the challenge of teaching students how to adjust to increased demands for the use of executive functions in assessment situations.
331Strategies for Improving Assessment Methods 1) Offer bonus points for handing in homework and assignments on time instead of taking points away2) Point out minor errors and offer students a chance to correct them before assigning a grade
332Strategies for Improving Assessment Methods 3) Offer feedback and opportunities to revise writing assignments before grading them4) Offer students choices forways to demonstrate content knowledge
333Strategies for Improving Assessment Methods 5) Offer credit for all efforts to correct work; offer opportunities to retake failed tests6) Deduct no more than 5-10% of total points for minor detail errors
334Strategies for Improving Assessment Methods 7) Offer multiple ways to participate in classroom activities, not just oral expression8) Use pop quizzes only as a diagnostic tool rather than a graded performance measure
335Strategies for Improving Assessment Methods 9) Offer response choices (word banks) for open-ended question formats10) Provide guidelines and progress checks for long-term projects
336Strategies for Improving Assessment Methods 11) Avoid placing constraints on response modes as much as possible12) Teach note-taking, memory strategies, and study skills when necessary