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Executive Functioning Paraprofessional Conference
Transcript of Executive Functioning Paraprofessional Conference
Ryan Ackerman M.A. LPC
James Whitehead M.A.
Definition of Executive Skills
Executive Functioning refers to our ability to:
Goal Directed Persistence
What Are Executive Functions and How Does IT Pertain to Success or Failure in School?
A student's ability to manage their time, organize their paperwork, and numerous other day to day classroom activities are impacted by their executive functions.
This presentation will explain what executive functioning skills are, what the dysfunction of these look like, how they may be manifested in students with disabilities, and interventions that have positively impacted the development of these skills
The Brain Continued
White Matter vs Gray Matter
Bundles of axons that allow communication throughout the brain
Myelination (increase in the fatty sheath that allows for faster communication)
Starts in early development and continues to young adulthood (parallel to executives skills development)
Cycles: large increase then pruning, large increase in 11-12 years of age and then pruning occurs
How do they impact executive skills?
What Are Executive Skills?
Develop a question about today's presentation that you want answered
Create a possible answer to that question
Share your thoughts with a person near you
What Do Dysfunctions Of Executive Skills Look Like?
Response Inhibition (Thinking before doing or saying)
Talks without raising hand
Makes insensitive comments
Difficulty waiting turn
Physical contact with peers
Can't wait while staff is doing things (on phone, helping another student
Working Memory (Remembering things learned)
Forgets assignments, parts of assignments, materials, homework, classroom procedures, verbal directions
Emotional Control (Managing feelings, perceptions, anxiety, etc...)
Frequent mood changes
Temper flares quickly and slow to recover from disappointments
What Do Dysfunctions Look Like? Continued
Sustained Attention (Ability to focus for long periods of time)
Fails to complete work
Switches frequently between activities
Difficulty listening to stories
Task Initiation (Self Starter)
Frequent reminders to stay on task
Slow to start new tasks
Needs cues to begin over-learned routines
Planning (Being able to set goals and or determine what's important)
Struggles carrying out long term projects and deciding what happens 1st, 2nd, 3rd, etc...
Can't make or follow timelines or complete tasks in order of priority
Doesn't offer useful suggestions in groups or organize groups
Can't take notes during lecture
Organization (Ability to place related items together; thoughts, ideas, events, etc...)
Messy desks, locker, backpack, notebook, etc...
Can't find belongings
Can't produce organized piece of writing
What Dysfunctions Looks Like Continued
Time Management (Understanding time and the amount of time needed)
Struggles completing tasks on time or misses deadlines
Struggles to estimate how long it takes to do something
Can't adjust schedule to fit new tasks
Can't complete routines on time
Goal-Directed Persistence ( Creating goals and seeing them through)
Doesn't stick with challenges
Doesn't return to task when interrupted
Can't sustain attention to intrinsically interesting things
Flexibility (Rolling with the punches)
Easily upset to changes in plans or routines
Struggles with open ended tasks or questions
Doesn't try multiple approaches to solving problems
Excessively rule-bound sometimes their rules or plans
Metacognition (Thinking about thinking; awareness or analysis of one's own learning or thinking processes)
Asks for help instead of trying on their own
Doesn't notice how others react to their behavior
Doesn't like games or tasks that involve problem solving
What Dysfunction does he demonstrate?
Manifested In Students With Disabilities
Categories of Special Education
Other Health Impairments (OHI) Examples: ADD, ADHD, etc...
Learning Disability (LD) Examples: LD in Math, Reading, Writing, etc...
Traumatic Brain Injury (TBI)
Autism (Autistic and Asperger)
Other Diagnosis That Are Not Identified Under IDEA or IDEIA For Special Education
Post Traumatic Stress Disorder (PTSD)
Mood Disorders (Depression, Bipolar, Cyclothymic, etc...)
ADHD and Bipolar
ADHD and Schizophrenia
Schizophrenia and Bipolar (aka Schizoaffective)
And all other combinations
How Does Executive Functions Impact a disability or disabilities?
Having a executive skills deficit does not mean a person has a disability
Executive skills deficits impact or can manifest into disabilities.
Most students with disabilities in ED, LD, TBI, and OHI (ADD and ADHD) have executive skills deficits
Examples: A student with poor executive skills in...
planning, attention, organization, behavior inhibitions, tasks initiation, and time management could have a label of ADD or ADHD
behavior inhibitions, emotional control, and flexibility could have the special education label of ED
working memory, planning, and metacognition could have the label of intellectual disability or LD
What executive skills deficits would a student with a Traumatic Brain Injury or Autism have?
So why are executive skills deficit not a diagnosed disability under IDEA or IDEIA?
No one test to determine
Multiple tests are needed
WISC (IQ tests)
WCJ III (Functioning Test)
Staff, Parent, and student Interviews
BASC (Behavior Rating Test)
Behavior Tracking System (Point sheet, Daily Behavior Log, etc...)
Specific Executive Skills Tests (only look at one or two areas but not all of the areas at once)
Only after all of these tests have been completed can a determination be made that a student has a executive skills deficit
What to Do?
•Bilateral stimulation (Dr. Perry)
Stop, Think, Plan, Do
Focusing on specific skill
CPS Model ( Dr. Ross Greene)
Baskets A, B, C
Plan A, B, C
Collaborative Problem Solving (CPS)
ALSUPs (Assessment of Lagging Skills and Unsolved Problems)
If they could they would
Brain Mapping and Bilateral Stimulation (Dr. Bruce Perry)
What does brain mapping tell us about cognitive function or more importantly executive skills?
Brain Mapping and Bilateral Stimulation (Dr. Bruce Perry) Continued
Bilateral Stimulation: Helps students get to baseline
Stimulation of the hemispheres of the brain
EMDR (Eye Movement Desensitization and Reprocessing)
Walking with tactile object (ball, puddy, fidget, etc...
Think for the child when he/she cannot (initially)
Provide a plan/ organizational scheme with specific directions (we are not specific enough)
Verbal, sticky notes, planner, lists, etc...
Monitor performance (checking in)
Provide immediate feedback/ encouragement/ and motivation
Problem solve when something doesn't work (CPS model)
Set specific criteria for completion
Focusing On Specific Skill
Select one or two skills to work on
Working on multiple skills at once can cause a student to shut down/ become upset/ etc...
Determine as a team with the student what skill to focus on.
Develop plan to address skill
Scaffolding (Broken into smaller parts with tools or resources to help complete task) Example: review key vocab before student reads/ break essay into smaller parts (attention getter, background information, thesis statement, supporting paragraphs, etc...)
Differentiation (Different assignment or modified assignment)
Chunking (The breaking into smaller parts/ single steps/ small groups)
I do-we do-you do (Staff demonstrates, student and staff together, student does)
Providing Supports Cont
Graphic Organizer (Work sheet that organizes information for the student to fill out
Lowering of Adult Expectations (Used when the student is unable to perform task) Just because the student did it once does not mean he/ she can do again/ different variables
Crazy Phrases (make up wacky sentences to help students remember names, events, places, etc...)
Acronyms (real or made up word where each letter of the word is the first letter of word he/ she trying to remember
Cartoon (a drawing that helps the student remember key information)
Mapping/ Webbing (Visual way to organize ideas) Web
Red Flag (a way to mark a question that is to hard to answer right away)
Providing Supports Again
Context clues/ Shifty Images (Look for clues in surrounding text to help find meaning of the word)
Personal Checklist (Student, with help from staff, develops a personalized checklist for completing work or tests
BOTEC (Brainstorm, Organization, Thesis, Elaborate, and Conclusion
Note Taking (Develop a blank template for taking notes then overtime remove the template)
Drill not Grill (Keep asking questions or restate reword what the student says until the root of the problem is known)
Visualization (Draw a picture or story board of what the important ideas, events, scenes after student reads passage)
Think Aloud (Modeling thought process when reading)
Think, Pair, Share
Change seat/ location
Time and space
Changing the nature of the task:
Make the task shorter.
Make the steps explicit.
Make the task closed ended instead of opened ended (e.g., fill in the blank, T/F, rather than essays, providing word banks).
Offer bonus points for turning in homework and assignments on time instead of taking points away.
Offer feedback and revising opportunities.
Offer choices for ways to demonstrate content knowledge.
Teach note-taking, memory strategies and study skills.
Asking instead of telling
Kids Do Well If They Can….
Behind every challenging behavior is an unsolved problem or lagging skill.
Challenging behavior often occurs when the demands being placed on a student exceed his/her capacity to respond adaptively.
One needs to determine what thinking skill the student is lacking so that the thinking skill can be taught.
One needs to determine the triggers: the what, who, when and where.
The goal is to develop a plan with the student that works to resolve the problem in a realistic and mutually satisfactory manner.
Strengthening Executive Functioning Skills
It all starts with a positive relationship.
Adults involved with a child with executive function difficulties must be careful not to attribute the particular production of deficits they observe to character flaws or consciously chosen states of mind, such as lack of motivation, apathy, irresponsibility or stubbornness.
Rather, these behaviors are the result of inadequate activation of executive function capacities that are necessary for regulating perceptions, feelings thoughts and actions.
Executive Functions and Clinical Diagnoses
Most of the conditions described in the DSM-5 reflect some form of Executive Dysfunction
The DSM-5 can be thought of as “A User’s Guide to All the Things That Can Go Wrong With the Frontal Lobes”
Intellectual Disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains.
Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience.
Deficits in adaptive functioning – limit functioning in one or more activities: communication, social participation, school, work, community
Typical IQ score of 65-75
Autism Spectrum Disorder
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:
Deficits in social-emotional reciprocity – failure of normal back and forth conversations, reduced sharing of interests, emotions, or affect, failure to respond to social interactions.
Deficits in nonverbal communicative behaviors used for social interactions – verbal, non-verbal communication, body language, eye contact, facial expressions
Deficits in developing, maintaining and understanding relationships.
Severity is based on social communication impairments and restricted , repetitive patterns of behavior
Repetitive motor movements – lining up toys, flipping objects, echolalia
Insistence on sameness, inflexible adherence to routines, extreme distress to small changes, rigid thinking, difficulty with transitions
Preoccupation with unusual objects
Hyper or hyporeactivity to sensory input – indifference to pain/temperature, adverse response to sound or texture
Typically identified between the ages of 1 and 2
Developmental gains typical in later childhood in some areas
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Inattention symptoms (6 required in the last 6 months)
Fails to give close attention/careless mistakes
Difficulty sustaining attention in tasks or play
Often does not listen when spoken to directly
Difficulty organizing tasks and activities
Often does not follow through, Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
Often loses things, easily distracted, forgetful
ADHD - Impulsivity
Often fidgets, leaves seat
Often unable to play or engage in leisure play
Often on the go, driven by a motor
Often talks excessively, blurts out comments
Difficulty waiting for their turn
Interrupts or Intrudes
Pharmacological treatment of ADHD usually only addresses the problems associated with EF’s specific to ADHD (inhibit, modulate, focus/select, sustain)
Most individuals with ADHD will require additional interventions to assist with the additional self-regulation difficulties/self-esteem and delayed academic progress.
Diagnostic Criteria: (two or more)
Disorganized Speech (incoherence)
Grossly disorganized or catatonic behavior
Negative Symptoms (diminished emotional expressions)
Involve a range of cognitive, behavioral and emotional dysfunctions
Dysphoric mood- Depression
Anxiety, Anger, disturbed sleeping pattern
Somatic Concerns, Phobias
Impairments in working memory, language, executive functions, slower processing
Unawareness of symptoms - psychosis
Inflated self-esteem or grandiosity
Decreased need for sleep
Flight of ideas (racing thoughts)
High risk behavior
Bipolar 1 Continued
Inflated self-esteem or grandiosity
Decreased need for sleep
Flight of ideas (racing thoughts)
High risk behavior
With Psychotic Features:
During Manic Episodes - grandiosity, invulnerability, paranoia
Post-Traumatic Stress Disorder
Exposure to actual or threatened death, serious injury, or sexual injury in one of the following ways:
Directly experiencing the event
Witnessing, in person the event
Learning that the traumatic event occurred to a close family member/friend
Experiencing repeated extreme exposure to aversive details of traumatic events
Recurrent, involuntary and intrusive distressing memories of the event
Dissociative reactions – flashbacks, loss of awareness
Psychological distress related to similar cues
Efforts to avoid external reminders that rouse disturbing thoughts or feelings
Feeling detached – depersonalization
Distorted sense of self/time/Dissociation
Increased negative emotional states (fear, guilt, sadness, shame, confusion)
Diminished interest or participation
Irritable, Angry, Hypervigilance
Problems with concentration
Draw This Picture
9 year old with Reading disorder
Draw Picture From Memory