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Executive Capacities: Model and Implications for Intervention

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1 Executive Capacities: Model and Implications for Intervention
Executive Functions Presented by George McCloskey, Ph.D. Philadelphia College of Osteopathic Medicine or presented by George McCloskey Ph.D.

2 EF as the Conductor of the Brain’s Orchestra or CEO of the brain (i. e
EF as the Conductor of the Brain’s Orchestra or CEO of the brain (i.e., EF as “g”) EF

3 Are these Executive Functions?
Inhibition Working Memory Focusing/Sustaining Attention Flexibility Shifting Planning Organization Problem-solving Reasoning Creativity Not Really

4 What are Executive Functions? Part 1
Executive Functions enable the brain to answer the questions of What? and When?

5 What are Executive Skills? Part 1
Executive Skills enable the brain to answer the question of How?

6 Accommodation Plans When specially designed instructional strategies are implemented, or when parents carefully guide their children through assignments, whose executive functions are engaged?

7 Externally Controlled Change
Typical plans and strategies for behavior change are forms of external control; far too often, the individual passively follows directions that are provided to them instead of actively changing their brains and developing a greater capacity for self-regulation.

8 Functional 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).

9 Functional 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.

10 FBA: Is A-B-C Enough? Since the antecedent does not trigger the same undesirable behaviors in ALL students in the same situation, there must be something about the client that differs in an important way. Functional behavior assessment ignores internal considerations (i.e., perceptions, emotions, thoughts) and focuses on applying external control to effect change in behavior.

11 The EF Driven FBA Informed by knowledge of executive functions, the functional behavior assessment model can be revised as follows: EF A B C EF Behavior Response Antecedents Consequences Perception Emotion Cognition Action

12 A Key Concept An EF-Driven FBA enables problems to be clearly stated in terms of perceptions, emotions, thoughts or actions that can be changed through intervention. B C

13 EF- Driven FBA The goals of an EF-driven FBA are:
to help the client, family and significant others, and professionals to understand the nature of the deficit and to assist the client in changing the behavior from a negative to positive through implementation of the intervention plan.

14 External Control Strategies
EF Intervention Continuum Orienting Strategies External Control Strategies Bridging Strategies Internal Control Strategies

15 EF Intervention Continuum
Interventions always start with an orienting phase during which goals are established, awareness of current difficulties is established, and strategies for positive change are developed. Interventions are implemented at the phase most compatible with the client’s current capabilities. Many interventions start with external control and then shift to bridging during which the client learns to take greater control over the change process and receives feedback about the effectiveness of change efforts. Practice during the bridging phase eventually leads to internally driven self-regulation.

16 The 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.

17 EF as the Conductor of the Brain’s Orchestra or CEO of the brain (i. e
EF as the Conductor of the Brain’s Orchestra or CEO of the brain (i.e., EF as “g”) EF

18 Executive Functions Are Not a Unitary Trait
Appropriate Metaphors for Executive Functions: The management structure of a multinational mind corporation The conductor and section leaders of the mind’s Orchestra The coaching staff of team mind

19 Thoughts EFs Perceptions Actions Emotions

20 The Management Structure within a Holarchical Model of EF
Activation ef/es ef Trans-Self Integration Self-Generation Self- Determination Self- Realization Self-Regulation Self-Activation

21 EF ES Management Structure within a Holarchical Model of EF Executive
Function: What, When? Executive Functions + Evecutive Skills = Capacities ES ExecutiveSkill: How?

22 Key Concept It is important to distinguish between Executive Functions
and Executive Skills.

23 Self Regulation Executive Functions
Executive Functions are the parts of the executive network that are used to become aware of what to do and when to do it (e.g., knowing when to make a plan, when to inhibit)

24 Self Regulation Executive Skills
Executive Skills are the “how” parts of the executive network that are used to cue the rest of the neural network needed to perceive, feel, think and act effectively (e.g., knowing the parts of the brain to activate to make a plan.

25 The Management Structure within a Holarchical Model of EF
Activation ef/es ef Trans-Self Integration Self-Generation Self- Determination Self- Realization Self-Regulation Self-Activation

26 Emot ion Cognition Perception Action
LD Identification Domains of Functioning Directed by Executive Functions Action Executive control of modes of output including behavior in the external world and storage and retrieval of internal representations Perception Cognition Action Emot ion Cognition Executive control of thoughts and thought processing Perception Executive control of modes of perceptual input including external sensory stimuli (visual, auditory, kinesthetic) and internal (representational) stimuli Emotion Executive control of moods, feelings, and the processing of emotions presented by George McCloskey Ph.D.

27 Key Concept Executive Functions: Directive capacities of the mind
Multiple in nature, not a single capacity Part of neural circuits that are routed through the frontal lobes Cue the use of other mental capacities Direct and control perceptions, thoughts, actions, and to some degree emotions

28 The Management Structure within a Holarchical Model of EF
Activation ef/es ef Trans-Self Integration Self-Generation Self- Determination Self- Realization Self-Regulation Self-Activation

29 EF Tiers within the Holarchical Model of Executive Functions
Activation ef/es ef Trans-Self Integration Self-Generation Self-Realization Self-Awareness Other-Awareness Self-Analysis Self-Determination Goal setting Long-range Planning & Foresight Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve Self-Activation

30 LD Identification Self Regulation A set of control capacities that cue and direct functioning across the domains of perception, emotion, cognition, and action The current model posits 33 self-regulation executive functions ef/es presented by George McCloskey Ph.D.

31 33 Self-Regulation EFs Perceive Balance Prioritize Focus Monitor
Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Balance Monitor Correct Gauge Anticipate Est Time Analyze Generate Associate Plan Organize Compare Choose Prioritize Compare/Eval Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve

32 Key Concept Self-regulation Executive Functions can be organized
into 7 basic clusters.

33 Self Regulation Executive Function “Clusters”
Energize Initiate Inhibit Stop Pause Flexible Shift ENGAGEMENT Sense Time Pace Sequence Execute EFFICIENCY Monitor Modulate Balance Correct OPTIMIZATION Perceive Focus Sustain ATTENTION Generate Associate Prioritize Plan Organize Decide SOLUTION Anticipate Gauge Analyze Estimate Time Compare INQUIRY Hold Manipulate Store Retrieve MEMORY

34 Executive Functions Interventions
LD Identification Executive Functions Interventions Practice and rehearsal are best suited to strengthen executive skills in the Attention, Engagement, Optimization and some Efficiency Cluster EFs Cognitive Strategy Instruction is best suited to enhance executive skills in the Memory, Inquiry, Solution and some Efficiency Cluster EFs presented by George McCloskey Ph.D.

35 Self Regulation Executive Function “Clusters”
Energize Initiate Inhibit Stop Pause Flexible Shift ENGAGEMENT Sense Time Pace Sequence Execute EFFICIENCY Monitor Modulate Balance Correct OPTIMIZATION Perceive Focus Sustain ATTENTION Generate Associate Prioritize Plan Organize Decide SOLUTION Anticipate Gauge Analyze Estimate Time Compare INQUIRY Hold Manipulate Store Retrieve MEMORY

36 Key Concept Most of what a teacher, therapist, or work supervisor says to a student, client, or worker is intended to activate specific neural networks within that person’s brain.

37 Key Concept The more specific the language used by a teacher, therapist or supervisor the more likely it is that the student, client or worker will be activating the brain networks needed for effective performance.

38 The Language of External Control
Pay attention! Can you be more specific?

39 Self Regulation Executive Function “Clusters”
Energize Initiate Inhibit Stop Pause Flexible Shift ENGAGEMENT Sense Time Pace Sequence Execute EFFICIENCY Monitor Modulate Balance Correct OPTIMIZATION Perceive Focus Sustain ATTENTION Generate Associate Prioritize Plan Organize Decide SOLUTION Anticipate Gauge Analyze Estimate Time Compare INQUIRY Hold Manipulate Store Retrieve MEMORY

40 Pay Attention, specificly speaking
Prompts for attention should include a call to Perception, as well as a cue for Focusing and a cue for Sustaining: Listen (P) to me (F) until I’m finished talking (S). Look (P) at the board (F) until we are done with this problem (S). Touch (P) the blocks (F) while you are solving this one (S).

41 Key Concept Bridging strategies effect the gradual transition from external control to self-regulated internal control.

42 Bridging Strategies Encourage the engagement of executive functions through the use of reflective questioning

43 Reflective Questioning
Repeat the individual’s question back to them instead of providing an answer. In situations where the client seems unaware of the need to be asking questions for adequate engagement, reflective questioning involves the mediator asking the client a question that is intended to make the client aware of the need to engage executive functions.

44 Bridging Strategies Provide immediate and frequent feedback about the effectiveness of attempts to engage self-regulation executive functions. Providing individuals with feedback about their performance enables them to engage executive capacities more effectively to learn from their mistakes and improve future performance.

45 Feedback About Accuracy
When providing feedback, be sure to emphasize the importance of effort; make sure the individual 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.

46 Collaborative Problem-Solving
Ross Greene’s Collaborative & Proactive Solutions approach is featured in his books. Although Greene does not specifically use the concept of executive functions, his intervention approach teaches techniques for improving behavior through the use collaborative problem-solving as a bridging strategy.

47 Ross Greene’s Collaborative & Proactive Solutions

48 Bridging Strategies Teach self-regulation capacities with specific skill routines using Cognitive Strategy Instruction approaches (e.g. Graham & Harris Self-Regulated Strategy Development approach for Written Expression).

49 Model appropriate use of self-regulation executive function capacities
Bridging Strategies Model appropriate use of self-regulation executive function capacities

50 Cognitive Strategy Instruction
Case Example: Teaching Study Skills Through Cognitive Strategy Modeling

51 Bridging Strategies Practice 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.

52 Bridging Strategies Whenever possible, use game formats and game strategies to practice the use of executive functions.

53 Simon Says Pay Attention: Help for Children with ADHD
Daniel Yeager & Marcie Yeager

54 Bridging Strategies Align external demands with internal desires to maximize motivation. Allow self-selection or choice of assignments whenever possible Use high interest material to illustrate application of new knowledge and skills

55 Bridging Strategies Develop 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”)

56 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.

57

58 Evidence 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.

59 Evidence Based Intervention: Cognitive Behavior Therapy
Outcomes of CBT with children and adolescents: Increased ability to monitor perceptions, feelings, thoughts and actions Increased engagement in positive problem-solving strategies Increased capacity for self-regulating perceptions, feelings, thoughts and actions

60 CBT Variants 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.

61 Dialectical Behavior Therapy (DBT)
“Dialectical behavior therapy (DBT) focuses on the treatment mood disorders and on changing patterns of behavior that are not helpful, such as suicidal ideation and substance abuse. DBT improves modulation of perceptions, feelings, thoughts and actions by helping clients learn about the triggers that lead to reactive states and learn coping skills in order to avoid undesired reactions. DBT is a modified form of CBT developed by Marsha Linehan to treat individuals diagnosed with borderline personality disorder and chronically suicidal individuals. DBT use has expanded to the treatment of traumatic brain injuries (TBI), eating disorders, and mood disorders, self-injury, sexual abuse survivors, and chemical dependency. DBT combines standard cognitive behavioral techniques for emotion regulation (modulation) and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from meditative practice.

62

63 Bridging Strategies Develop 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”)

64 Key Concept Motivation energizes and integrates with Executive Capacities. Both motivation and Executive Capacities can be activated by internal command or external demand.

65 ??? Engagement of Self-Regulation External Demand Pathway Executive
Functions External Demand Internal Command ??? Extrinsic Rewards & Punishments Nucleus Accumbens Internal Command Pathway: Intrinsically Rewarding

66

67 ??? Engagement of Self-Regulation External Demand Self-Determination
Pathway Self-Determination Teach how to self-regulate in a way that increases the desire to self-regulate Executive Functions External Demand Internal Command ??? Extrinsic Rewards & Punishments Nucleus Accumbens Internal Command Pathway: Intrinsically Rewarding

68 Key Concept Executive Functions cue and direct in different ways at different levels.

69 EF ES Management Structure within a Holarchical Model of EF Executive
Functions Executive Capacities ES ExecutiveSkills

70 Holarchy vs Hierarchy Hierarchy Holarchy

71 Holoarchy vs Hierarchy
Within a hierarchy, the next stage of development does not begin until the stage preceding it is complete. Within a holarchy, additional stages of development can begin before earlier stages are completed; earlier stages can continue to develop after later stages begin; multiple stages may be developing at the same time; later stages may be better developed than earlier stages.

72

73 Key Concept Between the ages of 10 and 14, most individuals begin the next level of EF development involving Self-Realization and Self-Determination

74 EF Tiers within the Holarchical Model of Executive Functions
Activation ef/es ef Trans-Self Integration Self-Generation Self-Realization Self-Awareness Other-Awareness Self-Analysis Self-Determination Goal setting Long-range Planning & Foresight Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve Self-Activation

75 EF Tiers within the Holarchical Model of Executive Functions
Activation ef/es ef Trans-Self Integration Self-Generation Self-Realization Self-Awareness Other-Awareness Self-Analysis Self-Determination Goal setting Long-range Planning & Foresight Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve Self-Activation

76 Self Realization (of self & others)
Directs cognitive processes that engage in awareness of self and others, reflection about self and others and self-analysis. Cues cognitive processes to access accumulated information about self and apply it in specific situations. EF

77 EF Self Determination Foresight/Long-Term Planning and Goal Generation
Directs the use of cognitive processes to construct visions of the future and plans for action over longer periods of time. Attempts to align daily self- regulation with long-term goals and strengthen delayed gratification.

78 Self Determination EF Interventions for developing Self-Determination involve reducing dependency on the Immediate Gratification circuit (Nucleus Accumbens – Self-Regulation EF connections) and increasing reliance on the Delayed Gratification circuit (Self-Determination – Self-Regulation EF connections)

79 Chapter 21 Motivational Interviewing with Adolescents and Young Adults John S. Baer and Peggy L. Peterson

80

81

82 EF Tiers within the Holarchical Model of Executive Functions
Activation ef/es ef Trans-Self Integration Self-Generation Self-Realization Self-Awareness Other-Awareness Self-Analysis Self-Determination Goal setting Long-range Planning & Foresight Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve Self-Activation

83 Self Generation EF Directs the posing of speculative questions related to the meaning and purpose of life and/or the ultimate source(s) of reality and physical existence, mind-body relationships, spirit, and soul; contemplates existence beyond the physical plane. Directs the generation of a philosophy of life used to guide self-awareness, self-realization and the other levels of executive function processes; serves as a basis for an ultimate source of intentional behavior direction.

84 EF Tiers within the Holarchical Model of Executive Functions
Activation ef/es ef Trans-Self Integration Self-Generation Self-Realization Self-Awareness Other-Awareness Self-Analysis Self-Determination Goal setting Long-range Planning & Foresight Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve Self-Activation

85

86 Trans-Self Integration
EF Directs the engagement of mental processes that enable realization and experiencing of a trans-self state of ultimate or unity consciousness. In most spiritual traditions, this state is considered the highest achievement of human consciousness and therefore very different from the maladaptive states characteristic of clinical diagnoses of dissociative states.

87 HH

88 Key Concept Executive Functions are developing from birth; maturational delays can cause difficulties.

89 Developmental Progression with a 30% Delay
F A G Chronological Age

90 EF Development does not progress by continuous equal intervals

91 EF Development EF development does not progress in a smooth, continuous upward slope; there are many peaks and valleys along the way. Periods of increased use may be followed by even longer periods of regression or lack of use. The goal of intervention therefore cannot be to “turn on” an EF that is “off”; but rather to strive for a cumulative effect of “more on than off” over a prolonged period of time.

92 EF Development does not progress by continuous equal intervals

93

94 Key Concept Producing difficulties are different from learning difficulties; producing difficulties reflect poor use of executive functions. vs

95 Producing 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. vs

96 A General Model for Conceptualizing
Learning and Producing Difficulties Learning Difficulties Only Often NOT recognized as a Learning Disability, even when severe, unless an evaluation involving process assessment is done Learning Difficulties And Producing Recognized fairly quickly as a Learning Disability When severe, typically attributed to lack of motivation, character flaws, or behavior/personality problems Producing Difficulties Only

97 Key Concept Effective use of Executive Functions can vary by Arena of Involvement as well as by Domain of Functioning.

98 Arenas of Involvement Interpersonal Intrapersonal Control of Self in
Relation to Self Interpersonal Control of Self in Relation to Others Environment Control of Self in Relation to Surroundings Symbol System Control of Self in Relation to Academics (Reading, Writing, Math)


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