1. 1 for Rock Fish River Elementary 10/13/10 What, Where & How & Who Executive Function & Behavior Management By Judy Ritchie, P.R.E.P.

2. 2 Executive Dysfunction often leads to Behavior Causes of Behavior Problems Confusion Expectation (inaccurate) Stimulation (over/under) Lack of order Communication (receptive/expressive) Driven behaviors

3. 3 Behavior Serves a Purpose Compensates for a deficit Comforts Communicates Utilizes a strength

4. 4 Most common Referrals Boys with ADHD (usually un-medicated) Students with Autism Spectrum Disorders Both likely students with Executive Dysfunction

5. 5 What are some behaviors that you are concerned with Not completing work Not paying attention Focused on wrong stuff Overflow of body/hands/mouth Forgetting needed materials Poor organization Social issues Poor impulse control

6. 6 Discipline Issues There is growing evidence that: Problems associated with Executive Dysfunction contribute to most disruptive behavior that result in removal from the learning environment. There is increased demands on executive function skills. Children are exposed to fewer activities that build executive function skills.

7. 7 Could the problem be…. Not that the person is doing the WRONG thing but that they don’t know (hidden agenda) or can’t (lack of impulse control) do the RIGHT thing Is it related to a deficit? Is it related to unrealistic expectations? Is it related to an antecedent or lack of?

8. 8 Executive Function or Hard Work, Discipline and Persistence Evidence indicates that self discipline accounts for over twice as much variance in final grades as does IQ, even in college. Duckworth & Seligman( 2005) EF skills are important for school readiness and are more strongly associated with school readiness than IQ or entry reading or math ( Blair, 2002, 2203, Blair & Razza, 2007; Normandeau & Guay, 1998)

9. 9 ED impact on Academics Writing Comprehension Mental Arithmetic Completing work Turning in work Consistent performance Having necessary material

10. 10 So what is Executive Function?

11. 11 Executive Function The way people monitor and control their thoughts and actions ( Carlson & Moses, 2001 ) We need EF whenever we are presented with the unexpected, need to concentrate particularly hard, or need to adapt or change

12. 12 Function of Executive Functioning Executive Functioning is the brain's ability to absorb information interpret information, and make decisions based upon this information. Like: Picking the correct clothes based on the weather Allowing enough time to complete a task Understanding the unspoken expectations, goals or rules of a situation.

13. 13 Major areas of impairment in Executive Dysfunction Inhibitory Control Working Memory Cognitive Flexibility

14. 14 EXECUTIVE FUNCTION JOBS Inhibition - The ability to stop one's own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; Shift - The ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation.

15. 15 EXECUTIVE FUNCTION JOBS cont Emotional Control - The ability to modulate emotional responses by bringing rational thought to bear on feelings. Initiation - The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies.

16. 16 EXECUTIVE FUNCTION JOBS cont Working memory - The capacity to hold information in mind for the purpose of completing a task. Planning/Organization - The ability to manage current and future- oriented task demands.

17. 17 EXECUTIVE FUNCTION JOBS cont Organization of Materials - The ability to impose order on work, play, and storage spaces. Self-Monitoring - The ability to monitor one's own performance and to measure it against some standard of what is needed or expected.

18. 18 Executive Dysfunction Core Deficits Inhibitory control Cognitive flexibility Working memory Contributing to the ability to Plan Organize Predict Self Monitor

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20. 20 Which students have Executive Dysfunction For many students, the executive functioning system of their brain is not working properly. Executive Dysfunctions are intimately connected with Asperger's Disorder High Functioning Autistic ADHD (Most common) Also been found in adults with OCD, depression, to name but some of the conditions. Is starting to turn up as a stand alone diagnosis

21. 21 Executive Dysfunction occurs during typical brain development twice Around the age of two=the awful twos Around the age of thirteen=alien invasion It is also apparent during high levels of stress

22. 22 Inhibitory Control Self Control (Discipline) This is the ability to resist a strong inclination to do one thing instead of doing what is most appropriate or needed.

23. 23 Inhibitory Control The ability to keep attention focused despite visual displays noises novel information boredom initial failure interesting digressions

24. 24 Discipline (Self-Control) The ability to resist your first impulse and give a more considered response instead

25. 25 Attention Deficits Can affect motor, visual or auditory activities Too short Wrong stuff Inconsistent Too late I never moved but lost it anyway Relocation experts I have no idea, no really I have no idea Often it doesn’t affect all so the student may be better focused if an unaffected area is required

26. 26 La Différence ADHD Probably know the rule Often don’t know or can’t tell why it happened Won’t benefit from strategies to inform There may be an ego component (failure is a poor learning tool) Try and determine area of better focus (hands on,visual, auditory) ASD Probably don’t know the rule Can (if language) explain sometimes Will benefit from informing strategies Probably don’t realize impact Most are have superior visual and perceptual skills (never argue perception)

27. 27 Benefits of Inhibition Allows a measure of control over attention and actions Lessons control of external stimuli, emotions, old habits (of mind and behavior) Inhibition helps make change possible

28. 28 Cognitive Flexibility This allows us to flexibly switch our perspectives or our focus of attention as needed for task demands It allows us to be flexible and adjust to changes in demands, priorities, schedules, expectations It allows us to be able to think outside the box

29. 29 La Différence ADHD Often described as having greater ability to attend to self chosen activities Can be resistant to change but also easily distracted ASD Transition issues Ending Beginning Perspective issues Routine Issues Concrete/Rule issues Hidden Agenda Theory of Mind

30. 30 Cognitive Flexibility and Behavior CF allows us to change the focus of our attention from what others are doing wrong to how we might be contributing to that situation or how we might make the best of what happened. It allows us to change our focus from ourselves and our own needs to focusing on the needs of others.

31. 31 Cognitive Flexibility It is critical to creative problem solving It allows us to think of other ways of reacting to what is happening It allows us to think about or conceptualize a problem in other ways It allows us to try other ways to overcome obstacles

32. 32 Working Memory Holding information in mind and working with it.

33. 33 Working Memory Relating one idea to another The beginning of a story to the end Mental arithmetic Holding information in mind while working on something else Mentally holding onto information during an interruption or while you have to do something else first Making judgments or analyzing info to determine where it fits into existing knowledge or categories

34. 34 Other contributors

35. 35 Gender Issues Boys are more likely to be sensitive and at times over-reactive Boys have 30 % more muscle mass, are stronger and inclined to action Growth spurts for boys can result in temporary hearing loss (the ear canal stretches) Testosterone influences the brain and makes boys more concerned with rank and competition

36. 36 Gender Issues Boys Need structure to feel safe and answer questions Who’s in charge What are the rules Will the rules be fairly enforced Ambiguity may heighten their anxiety or increase their acting out or over activity Math and perceptual skills kick in before verbal and writing

37. 37 Girls Tend to be more eager to please It can be more about relationship than boys Verbal and writing skills kick in at an earlier age than math and perceptual skills

38. 38 Human Nature Issues Why anyone may avoid or give up Type of task Frustration tolerance Hopelessness Emotional/health factors Prior experience Expectation of success

39. 39 Emotional Sense It is not rational…it seems counterintuitive It is self-serving emotionally It is protective in nature It is less purposeful than you think It will be repeated if it works

40. 40 So what works? Visual Strategies External Structure Using Their Strengths Novelty for ADHD and sometimes for ASD Routine for some ADHD and most ASD

41. 41 So what works cont.? Preferred interests or desired topics Smaller segments, fewer numbers, tasks broken down Frequent feedback Technology

42. 42 So what works cont.? Breaks Switching gears before review or editing Success Protecting self-esteem Avoid using success punitively

43. 43 So what works? Avoid tracking or measuring disability Gentle, positive self-monitoring Avoiding why questions when they know the rules (generally not a deficit of knowledge for the ADHD student but can be a deficit for the ASD student) Vs. Explain why to address tendency to think impulsively Meaningful frustration is easier to bare than meaningless frustration

44. 44 More of what works Wait and think strategies (Ditty intervention) Change color for reversals Cognitive cues (strategies that help you remember the sequence of steps as well as the content or steps themselves) mnemonic (ROYGBIV) Can be visual (take a walk) Positive or neutral reframing of characteristics

45. 45 More of what works Back up plans, materials, opportunities Technology Give them 5 Second set of books Materials to use or borrow Coach vs lecture or parent (remember they may know) Address one dimensional problem solving Lets look at the options or result of choice brainstorm

46. 46 Addressing Executive Function Challenges Why Use Visual Strategies Visuals are not transient and compensate inattention, poor working memory, inability to prioritize/organizenot transient Visuals help sort out or point out what is importantsort out or point Visuals lesson demands on working memory and other executive functionslesson demands

47. 47 Types of Visual supports Color Coding (like science folder, books, notebooks etc. all blue, even what bin to place work into) Strips that contain steps in the editing process such as checking punctuation, checking for capitalization, etc. Visual thought or idea organization (inspiration.com) Highlighting tape

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49. 49 Tools of the Mind An early childhood education curriculum based on the work of Vygotsky. A curriculum taught in regular classrooms with regular teachers shown to improve cognitive control (executive function) in preschool-age through kindergarten age children from disadvantaged backgrounds. ( Adele Diamond, W. Steven Barnett, Jessica Thomas, Sarah Munro November 30, 2007, Science, vol. 317 )

50. 50 Play Imaginative play, involving some adult participation and direction Research shows that when imaginative play is facilitated by a skilled teacher, it helps build executive function (EF), a critical cognitive skill that helps children learn to self-regulate. In turn, self-regulation helps children learn how to self-discipline and control impulses

51. 51 Children performed better in academics, after exercising with improvement in accuracy as well as attention. Reading comprehension, sometimes by as much as a full grade level Math and spelling also improved, however, the margins were not as great Recess is an Important Part of School Day

52. 52 The study monitored twenty 9-year old children and measured their attention and academic achievement after 20 minutes of exercise and compared to their responses from the previous day when they were tested after a resting period. (University of Illinois at Urbana-Champaign (2009, April 1). Physical Activity May Strengthen Children's Ability To Pay Attention. ScienceDaily. Retrieved April 2, 2009, from http://www.sciencedaily.com­ releases/2009/03/090331183800.htm) Recess is an Important Part of School Day

53. 53 Other Interventions Address Executive Dysfunction challenges Provide external structure by Organize or reorganize the child's environment Set clear goals (e.g., "Get dressed by 8:00 a.m.). Help the child keep his or her belongings (e.g., school books, toys, clothing) in the same place

54. 54 Addressing deficits in EF Give clear instructions (avoid multiple and complex) Use lists or check off opportunities to help them keep track Allow for movement when needed Teach self-monitoring strategies

55. 55 Some specifics to ASD

56. 56 Characteristics of Autism & Structured Teaching Approach Wiring Differences Focus on details vs. difficulty with whole Difficulty knowing how things fit together Difficulty extracting meaning Difficulty knowing which are relevant details Structured Teaching Intervention Highlights beginning and endings Establish routines and ways to approach tasks and materials Highlights relevant details

57. 57 Characteristics of Autism & Structured Teaching Approach Learning style: Strong visual learner Difficulty with language Sensory Sensitive to sensory input and modulating stimulation Support for learning Visual supports Visual schedules Visual routines Modifications Environment is modified to reduce stimulation (beware of loud confusing spaces)

58. 58 Characteristics of Autism & Structured Teaching Approach ASD characteristics Difficulty with transitions Difficulty with generalizing Can be compulsive ST intervention Transitions routines are taught visually Need to disengage and reengage is analyzed and addressed Flexibility is taught through visual manipulation of routines and clear expectations.

59. 59 Structured Teaching Antecedent based Uses competence motivation rather than consequence motivation Levels of Structured Teaching: Physical Structure Schedules Work Systems Routines and Strategies Task

60. 60 Swiss Cheese While students share characteristics Each child is unique Some need a distraction free environment Some need background noise Some need to stand

61. 61 Get support for yourself Un-medicated ADHD students are challenging Need for novelty Low self esteem Poor impulse control Inconsistency Co-morbid complications Some of most common are Oppositional Defiant Anxiety

62. 62 Get support for yourself The best laid plans may work once The fix is a process, try to make a positive contribution and know that they are likely equally discouraged but may be using cover-up strategies Use their motivations and interests whenever possible Design behavior plans to track what you are looking or hoping for not what they are doing wrong

63. 63 Other Treatment Medications Stimulants usually are the first-line medications prescribed. If two or three stimulants are tried and found to be ineffective, antidepressants may be used. Stimulants do not cure ADHD, but they can help control symptoms. Studies have shown that these medications can improve symptoms in 70–90% of children who have ADHD. We often note dramatic improvements in writing

64. 64 Medication Issues If parents disagree When parents don’t see benefit Complications of cost, pick up etc. Forgotten morning pill Lack of accurate information

65. 65 Meds diets and other treatments for ASD Some remarkable case studies Research has not sorted out who will benefit from what Usually focused on improving focus, behavior, sleep issues

66. 66 Questions, concerns? Judy Ritchie PREP jritchie@k12albemarle.org 540-421 3088