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ADHD & Executive Functions

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Kip Childers

on 14 July 2014

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Transcript of ADHD & Executive Functions

"My 8-year old son, Mani, once asked me whether maybe the zombie is smarter than we think, a fact that is celebrated in both ancient marital arts and modern movies like Star Wars. When young Luke is struggling with his conscious awareness, Yoda advises, 'Use the force. Feel it. Yes,' and 'No. Try not! Do or Do Not. There is no Try."
From Phantoms in the Brain by
V.S. Ramachandran, M.D., Ph.D.
NOW? No...not now
Wait, yea do it
aaaahhh...what did she say
make it up, what? where?
uh, oh...don't sing pay attention
ADHD & Executive Functions
by Kip Childers, LSSP &
Crystal Hansen, LSSP
For ADHD, 3 Major Neural Systems
That means you should be looking for this
lack of social tact/restraint
demanding or self-centered behavior
impulsive speech
EF & the Social Realm
Prefrontal Cortex (PFC) is about cognitive control. Theories and assessment of EF traditionally look at cognitive control.
There are major social impairments that should be included in any assessment of EF.
"The executive functions consist of those capacities that enable a person to engage successfully in independent, purposive, self-serving behavior" (Lezak, 1995)

"The executive functions are a collection of processes that are responsible for guiding, directing, and managing cognitive, emotional and behavioral functions, particularly during active, novel problem solving." (Gioia, 2000)
It is...They are...
goal directed, goal oriented behavior
complex processing
cognitive control

most ideas are not useful, it is up to executive control areas (PFC) to keep looking

PFC process acts of recognition (with help from the anterior cingulate cortex (ACC) which is involved in the detection of errors

"Two hallmark functions attributed to the frontal lobes are cognitive flexibility (set shifting) and inhibition." -- Miller
But...where are they?
We are talking about the integrated neural circuitry involved in higher order cognitive processing.
dorsolateral PFC- regulates the more cognitive aspects (shifting set, sustaining attention)
lateral PFC- selective attention
orbitofrontal PFC- impulse control, maintenance of ongoing behavior, decision making
anterior cingulate circuit- initiation of motor movement, response monitoring, error detection
"Executive functions comprise a family of cognitive control processes that operate on lower-level processes to regulate and shape behavior." (Friedman et al., 2007)

"Executive functioning has been defined as a set of regulatory processes necessary for selecting, initiating, implementing and overseeing thought emotion, behavior and certain facets of motor and sensory functions." (Roth, Isquith & Gioia, 2005)

"In general, executive function can be thought of as the set of abilities required to effortfully guide behavior toward a goal, especially in nonroutine situation...these include prioritizing and sequencing behavior, inhibiting familiar and stereotyped behaviors, creating and maintaining an idea of what task or information is most relevant..." (Banich, 2009)
Zombie Routines...automatic processing
(Meltzer, Pollica & Barzillai, 2007)
Critical skills for the classroom setting inclue the ability to:
plan time
organize information
place information into priority relevant to topic
initiating tasks
shifting strategies for problem solving
"Students with weaknesses in these important processes often understand complex concepts easily but struggle to show what they know..."
Interventions (2)(Meltzer)
"Planning, organizing details ahead of time, is an important EF process not taught in schools even though it is a prerequisite for reading, writing and completing projects..."

Student with EF difficulties begin projects/tasks impulsively with no plan of action; result= stuck

Teach strategy of short term goal and long term goal;
Create a calendar with a time frame for completion;
Assist with visualizing steps of the task;
Check to see if student understands project/task
Use scaffolding
(Maricle, Johnson & Avirett, 2010)

1. Environmentally focused interventions
provide support, control & reinforcement
2. Person-focused interventions
CBT, increase motivation
direct re-training of of cognitive abilities
regulating behavior via self-talk
Consciousness is the CEO. As long as the zombie subroutines are running smoothly the CEO can sleep
When everything is going to according to needs and skills of zombie systems , you are not consiously
aware of what's in front of you; when suddenly aware, the CEO scambles to manage -- Eagleman
How we learn...hopefully
Zombie CEO
But really, how do zombie brains function...

Frontal Lobe
executive functions
frontal lobe most relevant to understanding zombie behavior is the control of "impulsivity"

Amygdala & Anterior Cingulate Cortex

amygdala primitive part of brain driving base emotions; crocodile brain is mostly driven by amygdala.
Balance between emotion (rage) is maintained by ACC which dampens the excitability of the amygdala

How zombie brains function...

Cerebellum & Basal Ganglia
Clearly, zombies suffer from cerebellar and basal ganglia dysfunction.

These areas are responsible for fluidity of motion and balance

How zombie brains function...

Mirror Neurons

Schlozman describes mirror neuron theory as a 'neurobiological model for empathy'

Regions of the brain are recruited in response to social interactions

How zombie brains function...

Ventromedical Hypothalamus

This region of the brain lets you know whether or not you have eaten enough...zombies are always hungry

Dysfunctional ventromedial hypothalamus results in hyperphagia

"EF can therefore be initially defined as those SELF-DIRECTED actions needed to choose goals and to create, enact and sustain actions toward those goals, or more simply as self-regulation to achieve goals: EF = SR."

--Russell A. Barkley
Alerting, associated with the neurotransmitter norepinephrine

Orienting- cholinergic

Conflict resolution- dopamine
Executive Functions As a Multidimensional Construct
work of George McCloskey
1. Executive functions do not represent a single unitary trait;
2. EF's cue and direct the use of other mental constructs
3. EF's coordinate aspects of perception, cognition, emotion and action
4. EF's use varies in different areanas of involvement: symbol system, interpersonal, intrapersonal & environment
5. EF's develop over a person's life span; most significant development within first 30 years
6. EF's use reflected in the activiation of areas of the frontal lobes
Observable Behaviors Likely to Be Indicating EF Difficulties
Attention Cluster
not listen carefully to directions
lack of focus essential details for either auditory or visual information
Lack of attention for entire task
Observable Behaviors Likely to Be Indicating EF Difficulties

trouble getting started
does no more than bare minimum
does not orient to task
does not re-orient to task
does not accept changes to what has been done or has difficulty accepting feedback
trouble shifting cognitive sets
Observable Behaviors Likely to Be Indicating EF Difficulties
Memory Cluster
(Hold, Manipulate, Store, Retrieve)

Does not briefly hold onto information
does not manipulate information that is being held in mind in order to perform task effectively
does not store information
does not recognize when information could be retireved to provide a response rather than trying to come up with novel solution
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