1. EXECUTIVE FUNCTIONING: A HOME VISITOR PERSPECTIVE Luke Quinn, MSW

2. Learning Objectives  Understand basics of Executive Functioning as it applies to infants and toddlers  Learn practical activities to enhance Executive Functioning in early childhood  Develop ideas for supporting Executive Function development with families

3. First: our own Executive Functioning Instructions: circle numerical answers and total each section Strongly Disagree Disagree Tend to Disagree Tend to Agree Agree Strongly Agree I don't jump to conclusions 123456 I think before I speak 123456 I make sure I have all the facts before I take action 123456 Section A Total: 13 Adapted from Executive Skills Questionnaire for Adults by Peg Dawson & Richard Guare

4. Executive Skills Questionnaire  Your EF Strengths (highest totals)  Your EF Challenges (lowest totals)  Any Surprises?  Thoughts?  Implications for our work with families and children?

5. Executive Function Our very own air traffic control system

6. Executive Function Skills Working Memory - the ability to hold and manipulate information in our heads over short periods of time Marshmallow Experiment Inhibitory Control- the ability to master and filter our thoughts and impulses to resist temptations and distractions Mental Flexibility – the ability to switch gears and adjust to changing demands, priorities, or perspectives

7. Working Memory (to hold) 7-9 MONTHS Develops ability to remember that unseen objects are still there and learns to put two actions together in a sequence 9-10 MONTHS Can execute simple means-to-ends tasks and two- step plans; also able to integrate looking one place and acting at another place 3 YEARS Can hold in mind two rules and act on those rules ADULT Can remember multiple tasks, rules, and strategies that vary by situation from Center on Developing Child, Working Paper 11

8. Inhibitory Control (to wait) 6 MONTHS Rudimentary response inhibition 8-11 MONTHS Begins to maintain focus despite distractions during brief delays in a task; also able to inhibit reaching immediately for a visible but inaccessible object 4-5 YEARS Can delay eating a treat; also can begin to hold an arbitrary rule in mind and follow it ADULT Consistent self-control; situationally appropriate responses from Center on Developing Child, Working Paper 11

9. Mental Flexibility (to switch) from Center on Developing Child, Working Paper 11 9-11 MONTHS Develops ability to seek alternate methods to retrieve objects beyond directly reaching for what’s in view 2-5 YEARS Succeeds at shifting according to changing rules based on different settings or circumstances ADULT Able to revise actions and plans in response to changing circumstances

10. The Opportunity: Circuits for Executive Function Skills Are Located in Brain Regions that Exhibit an Extended Period of Plasticity Weintraub, et al., (2011) Birth Age (Years) 507080 EF Skill proficiency 3515253010 Slide courtesy of the Center on the Developing Child at Harvard University

11. How to share this with families?  How could you start the conversation?  How to continue the conversation?  Questions you might ask  Observations you could make  How to make it practical?  How do you feel about the term “Executive Function” – do you have a better term for parents?

12. Activities to build EF Skills http://developingchild.harvard.edu/resources/

13. Working Memory (to hold)  For INFANTS (birth to 18 months)  Peekaboo  Hide-and-Find  Rhymes, Songs, Fingerplays  Imitation Games  For TODDLERS (18 to 36 months)  Matching and Sorting  Conversations and Storytelling

14. Inhibitory Control (to wait)  For INFANTS (birth to 18 months)  Back and Forth Activities  Peekaboo  Naming for your baby  For TODDLERS (18 to 36 months)  Freeze Dance  Active Songs  Talking about Feelings

15. Mental Flexibility (to switch)  For INFANTS (birth to 18 months)  Rattle Play  Symbolic Play  For TODDLERS (18 to 36 months)  Pretend Play  Silly Sorting

16. Spotlight on Game Play  A Game has at least one rule to remember (Working Memory) and requires waiting and/or turn-taking (Inhibitory Control). As they play, children may need to try new tactics (Mental Flexibility) to be successful.  All sorts of games  Home-made, Songs, Imitation, Active  Support parents to support their children

17. ThinkFun Games Ages: 18 months and up

18. ThinkFun Games Ages: 18 months and up

19. Improvement on test of Mental Flexibility Average for normed sample NIH toolbox Card Sort Test

20. How to encourage EF activities?  What are families already doing?  Where could this fit into your home visit?  Does this fit with other models you are using?  Will parents care?

21. Resources  Activity Cards  Android and iPhone App  Online Resources http://www.joinvroom.org/tools-and-activities *scroll to bottom of page for link to printable cards in Spanish and English

22. Resources  Activities Guide  Working Papers and InBriefs  Videos  A few in Spanish and Portuguese  Online Training Modules  EF and Building Brain Architecture (WA DEL) http://developingchild.harvard.edu/resources/

23. Resources  Videos  Brain Architecture, EF, Serve and Return, Toxic Stress  Learning Cards  PowerPoint Presentations http://www.albertafamilywellness.org/building-better-brains

24. Thank You! Luke Quinn, MSW Children’s Home Society of WA lukeq@chs-wa.org