Build your brain and health with motor movement and thinking skills ~ 2013
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Lynne Kenney, PsyDwww.lynnekenney.com
@drlynnekenney
Brain-Based Interventions 2013
Becoming A Brain-Based Clinician
What is a Brain-Based Intervention?
An intervention that engages cognitive or motor parts of the brain
One that increases neuronal communication
One that builds skill sets One that increases collaborative parenting
strategies
Neuroscience in Psychology
Books on Brain Development
Brain Facts – Society for Neuroscience The Brain That Changes Itself ~ Norman
Doidge, MD The Woman Who Changed Her Brain ~
Barbara Arrowsmith-Young Brain School ~ Howard Eaton The Whole Brain Child ~ Dan Siegel, MD How To Reach and Teach Children with
Challenging Behavior ~ Otten & Tuttle Smart But Scattered ~ Dawson & Guare
Neuroscience + Cognitive/Dev Psych + OT + PE
Today’s Landscape ADHD and EF Learning Disabilities and EF Social Skills and EF Teaching skills sets across diagnoses Play Math (STM, WM, VSM, M2T) Motor Intelligence Therapy
What does executive dysfunction “look like”
Child completes work but “forgets” to hand it in Child has difficulty transitioning from one
situation or task to another Child doesn’t seem to catch “careless” errors Child needs more external support and
reminders than peers Child can’t seem to keep track of directions,
possessions, and assignments Child is very inconsistent in her performance
What is Executive Functioning (EF)? An umbrella term covering related yet
distinct skills Refers to mental control/self-
regulatory processes Can be understood as Cognitive and
Limbic
McCloskey 23 Self-Regulation Executive Functions
Perceive
Initiate
Modulate
Gauge
Focus/Select
Sustain
Stop/Interrupt
Flexible/Shift
Inhibit
Hold
Manipulate
Organize
Foresee
Generate
Associate
Balance
Store
Retrieve
Pace
Time
Execute
Monitor
Correct
EF Domains (Kenney, 2012)
Attention, focus, distractibility Cognitive control, shift and flexibility Memory, input, manipulation, output Emotional regulation and modulation Problem solving, decision making Impulse control and management Organization, planning, and time management Motor management planning, pacing, initiation,
maintaining, stopping
I. Executive Functions include the ability to: Survey and preview Plan, organize, sequence, initiate and
execute tasks Hold, manipulate and retrieve
memory Shift focus, sustain attention, tolerate
and adapt to changes in expectations Stop, think, decide, respond
II. Executive Functions include the ability to: Conduct visual-spatial mental operations Track information and activities in working
memory Perceive, read, interpret and respond to social
situations Regulate and manage emotions Evaluate, plan and manage time Use language to facilitate communication
within relationships Reason, evaluate choices and make decisions
Don’t All Kids have Executive Dysfunction? EF follows a developmental course as
do all cognitive and social-emotional skills
We all have domains in which we could improve
EFD interferes with daily adaptive living skills
Good Books on EF
Twitter ~ The Research Playground BRAIN DEVELOPMENT
@davidnowell @drbethkids @all4mychild @braininsights @viviensabel @drmarty01 @DrEscotet @TheTeenDoc
Enhancing Executive Function with skill set development
Where we are heading:Improving Neuronal ConnectionsKnowing the different between a skill deficit and willful non-complianceStrategies to build brain connections
Your Brain is Like A Placemat Insulted?
Don’t be.A placemat is
a good thing.Connect the
dots.
How do Neurons Connect?The electrical signals (nerve impulses) carried by neurons are passed on to other neurons at junctions called synapses. The signal may be directly transferred at electrical synapses or, if there is no physical link between adjacent neurons, the signal is carried across the gap by chemicals called neurotransmitters. By using neurotransmitters, the nervous system can alter the way a message is passed on. Each neuron communicates with many others and this contributes to the amazing complexity of the brain. www.sciencemuseum.org.uk
What is The Synapse? When a nerve impulse reaches the synapse at
the end of a neuron, it cannot pass directly to the next one. Instead, it triggers the neuron to release a chemical neurotransmitter. The neurotransmitter drifts across the gap between the two neurons. On reaching the other side, it fits into a tailor-made receptor on the surface of the target neuron, like a key in a lock. This docking process converts the chemical signal back into an electrical nerve impulse. www.sciencemuseum.org.uk
Neurotransmitters Your brain uses over 50 different
neurotransmitter chemicals. Although electrical signaling between neurons is quicker and more energy efficient, chemical signaling is far more versatile. The signals carried by some neurotransmitters excite the target cell while others dampen down their activity, depending on the type of neurotransmitter released at the synapse and the receptors they reach. This is what sharpens the contrast between light and dark in the eye, for example. www.sciencemuseum.org.uk
Connections Neurons can connect with up
to a hundred thousand other cells. This number of connections is a truly enormous number: 10 thousand trillion.
One neuron can have as many as 100,000 dendrites.
In a human, there are more than 125 trillion synapses just in the cerebral cortex alone
How Do We Build Brain Connections? Exposure Experience Doing, thinking,
mirroring Practice ~ and a
lot of it
www.unc.edu
Pruning In a human fetus, almost a trillion
neurons are produced. During the last month, they are produced at the unbelievable rate of 250,000 per second. Eighty-to-hundred billion of these neurons will be utilized by experience and become permanent, while the other 900 billion will be pruned – that is, carefully dismantled with the material recycled by the brain’s unique immune system. jonlieffmd.com
Brain Training Some programs include Luminosity, Captain’s Log,
COGMED, MC2, Brain Gym and Brain Builder. If the child or adult has not had a neuropsychological or executive function evaluation that may be a first step.
Exercise is brain training. Activities that involve motor control and thinking at the same time build brain connections. Some activities to consider include: XBox Dance Dance Revolution, karate, double dutch jump rope, yoga, hacky sac, swimming and tennis. Getting up, out and moving in any way possible is good for everyone.
Preventing brain loss: Cognitive-motor exercises, working memory, nutrition, exercise
Executive Function and Education EF and intelligence Twice Gifted Disorganized students Homework interventions Task Analysis Skill-set development Multi-sensory interventions (MIT)
NOVELTY Only four to eight minutes of pure
factual lecture can be tolerated before the brain seeks other stimuli, either internal (e.g., daydreaming) or external (Who is that walking down the hall?). If the teacher is not providing that novelty, the brain will go elsewhere. Bruce Perry, PhD
Teaching with Visual Aides and Movement 50 % of children are kinesthetic learners so
why not begin with touch? Visual learners learn by watching. 40% of
learners are in this category. Only 10 percent of secondary students learn
best auditorily, but 80 percent of instructional delivery is auditory.
JP Das Prep & Cogent
EF and IntelligenceDeveloped by Frederic Perez-Alvarez & Carme Timoneda-Gallart, neuroscientists and authors of A Better Look at Intelligence from Girona Spain, FUNDI is designed to teach children, parents and their teachers about critical aspects of meta-cognition and executive function. Applying PASS theory developed by JP DAS, the producers of these valuable films seek to help children learn about their cognitive processes in a manner to which children understand and relate.
Television
Flashlight
Parrot
Conductor
Evidence That Enhances Learning 1. Frequency and recency of neuron synapses increase memory Increase
frequency through practice and maintain fluency through use 2. Emotions strengthen memory Appeal to and engage emotions while
learning 3. Learning causes changes to the physical structure of the brain Allowing
children to teach increases their ability to learn throughout their lives 4. Memories are stored in multiple parts of the brain Engage all senses
when learning 5. Our brains are programmed to focus on new and unusual inputs Learning
should tap into the brain’s natural curiosity and intrinsic motivation
Sources: Donald J. Ford, Ph.D., C.P.T., Carl Haywood, PhD
Hello Remembering… Most people forget newly learned concepts after
a day. Re-learning forgotten concepts is easier than
learning new ones. This is even true years after something is forgotten.
Over-learning typically occurs during motor learning this repetitive form of learning reinforces information and requires high levels of brain organization.
What Needs To Change? 1. We move to learn, we play to behave
(provide opportunity for creativity and critical thinking)
2. Multi-modal sensory learning strategies
3. Rhythmic daily movement 4. Make children the teachers/mentors 5. Instruct less, interact more
Disorganized Students
Thinking Skill Domains Organization Planning Systems and methods (Parrot) Initiation Attention to detail Finding the data Problem solving Explaining one’s answer
What every student needs to know ~ How to…
Plan InitiateExecuteReviewReviseTurn In
SOAR ~ Susan Kruger Reading comprehension Critical thinking Active learning Written expression Time management Organization Active listening Attention to detail Learning strategies Independence
Handwriting Without Tears
EF Management Calendars, planners and schedules Routines and daily activities Task Lists Project Management
SYSTEMS: Digital, paper, post-it notes, planners, mobiles tools Cozi.com, myjobchart.com, famzoo.com
IN CLASS Listening alone is not enough (Columbia,
Stanford, Cornell) Note Taking Skills Matter
Modified Cornell Method Remaining alert Remaining active
Transferring information Summarizing
Modified Cornell Method
AT HOME Actively use a planner Thrive in your homework setting
(snacks, distractions, tools) Initiate, execute and complete one
task at a time Establish time-frames for discrete
tasks (chunking) Review, revise, summarize
Tips For Parents Check the website Check the backpack Support the homework system Talk about the homework process for
today Help child manage time and tasks Be available to help
Test Preparation Be visual (Cornell, notecards,
teaching content to others) Sleep, eat and have a + mindset Arrive early Bring all needed materials Stress relievers Read questions carefully, show your
work
Calendars and Planners
Weekly and daily calendars Reviewing next weeks assignments
on Sunday Transferring working onto a marker
board or EF action plan
Planning/Time Management Use timers (auditory, visual) Use alarms Estimate amount of time needed for a
task and then write down actual time Sarah Ward ~
cognitiveconnectionstherapy.com
Manage The Work Space What does your space look like?
How functional is it? How organized is your study space? Does your student have all the items he needs? Does your student have the ability to use multi-sensory transfer
skills? Describe the study space setting, could you work there? Is there an adult near-by? Do you have a time set aside? Are you working in 15 min increments or those suitable to your
child? Do you have prompts or cues? Is your workspace portable or stationary?
Go Multi-Sensory Encourage transfer skills Use video, audio and tactile strategies Use marker boards Use quad bulletin board Draw and doodle Vary the types of paper available Plain, graph, wide ruled, narrow ruled
Building Routines and Habits Overlearning and automaticity Motor movement Systems and routines Habit replacement Visual cues Secret signals
Talking with Students about their Study Styles Emphasize strengths Keep it short and simple! Use visuals Discuss weaknesses as hypotheses (it
seems that you lose track of your ideas when you are writing...is that true?)
Instill hope as you describe interventions
Collaborate, collaborate more…
There are no BUT’s here Help the student feel valued Let the student have some control in
the discussion and plan Ask questions without making
assumptions The relationship is the agent of
change
Organizing The Disorganized Student Determine “Help Me” domain
listening, attending, focus, note taking, impulse control, transferring data, input, output, audition, vision, organization, previewing, planning, execution, time-management
Identify needed skill-set Make a plan Execute, monitor, review plan
Skill Set Tracking
PrioritizationThe modified Sullivan technique
for prioritizing, planning and execution
A B C
48 hrs
Cognitive Flexibility Social stories
Social skills training (individual, dyad, group)
Positive reinforcement for managing a change or generating a new way of responding (reinforce new habits)
Gifted Talented ~ 2 E
EF and Reading Efficient EF is essential to reading
comprehension- need to adjust reading rate to level of difficulty of material and monitor as one reads
EF and Math Word problems require the ability to
ignore extraneous information, sequence steps, and monitor one’s work
Many kids with executive dysfunction make “careless” computation errors and use inefficient procedures
EF and Writing Writing is the most complex task we
ask students to master. It involves: keeping track of directions physical act of writing using correct mechanics (spelling,
punctuation, and capitalization) creating complex sentences transferring ideas into written form deciding on main ideas, details, flow of
ideas
Proper diagnosis Behavioral skill building Academic support Medication Brain Training An organized home environment Access to competent parental figures Nourishment
Interventions
Data Based Treatment Planning Do you have a brief neuropsych eval to assess
IQ and executive function? Do you see an OT for sensory issues? Do you improve food and nutrition? Do you look into amino acids to impact
neurotransmitters? Do you do brain training? What behavioral interventions do you consider? Is it time for a medication trial?
Data Based Treatment Planning
HOW TO HELPAccommodations
Strategies
Skill Building
At Home ~ The Family Coach Method Stay out of The Discipline Trap Establish routines and rhythm Clarify the family culture Collaborate on behavioral expectations Build a pond for better behavior Focus on what works
Three Tiers For In-Home Interventions
Intervention Pyramid Medication Neurotransmitters Food/NutritionDevelopmental,
Behavioral, Learning Interventions
Damage Control Using Previewing Planning Problem Solving Collaborating And BLOOM LANGUAGE
Skill Deficits vs Willful Non-compliance The 80/20 rule A skill deficit is when the task
demands exceed the skill level Are the expectations clearly
understood? Chunk Be detailed Model role play, practice
Is this a skill deficit?
Can he do it?If yes, expect itIf no, teach it
Case Example
Sammy and his “falling off” chair.
Freedomland
EF and Behavioral Change Visualizing and verbalizing Role Play Social Stories The Beginning, Middle & End Going Full Circle See, say, play, touch, build Mentoring others Motor movement
Cognitive Skills
Let’s Start Building J.P Das Suzy Koontz suzykoontz.com Jean Blaydes Madigan abllab.com SparkPE Eric Jensen www.jensenlearning.com Gil Connell @movingsmartnow
Breaking Down Skill Sets IListening
I chose not to speak I established eye contact I listened to someone speaking I nodded my head to show I was listening I repeated back what I heard, when asked I asked a question when I did not understand I remembered instructions I followed the instructions
Breaking Down Skill Sets IIListening
I chose not to speak I established eye contact I listened to someone speaking I nodded my head to show I was listening I repeated back what I heard, when asked I asked a question when I did not understand I remembered instructions I followed the instructions
Breaking Down Skill Sets IIIFor The Parent I defined an expected behavior I named the expected behavior I chose my behavior, thinking it through I practiced ready, steady, act I practiced “I have a choice” I thought about the next step I spoke the sequence of my actions I wrote the sequence of my actions
Impulsivity Waiting one’s turn Refraining from touching others Keeping one’s hands to self Not grabbing without permission Keeping one’s body still Thinking before you act Managing oral-motor movements Verbalization, waiting one’s turn Speaking in turn
Helping children “do as expected” takes previewing and planning 1. Tell the children what is about to
happen. “We are going outside to play. We will quietly get in line, stand helicopter distance from one another and keep our voices quiet.”
2. Tell them what they can do with their hands and their bodies. “While you are on the playground, keep your hands to yourself as you run, jump and play.”
3. Tell them how they will know the activity is over. “When you hear our ‘secret signal’, you will line up at the red door and we will slowly walk back inside.”
Self-Regulation
Calming Resources SEL www.kimochis.com Physical Movement www.sparkpe.org Repetitive Movement balavisx.com Rhythmic Breathing Take Five Music/Stories Listening www.stressfreekids.com Art Drawing Mandalas Listen to a Raisin – Meditate Vision Therapy
Me Moves
Anger Mountain
Polyspot Stories
The Caveman and The Thinker
Your Child’s Two-Part BrainThe Defensive BrainCollaboration WorksCalm the caveman to engage the thinker
We Calm Down To Think Teach relaxation breathing and self-talk Allow for a break (including a physical
place to calm down) when child encounters a change
Provide warnings (signals) prior to transitions – they can be visual, touch, or verbal
@stressfreekids Lori Lite
Subcortical Structures Sensory Integration, Sensory
Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings Leonard F. Koziol & Deborah Ely Budding & Dana Chidekel Cerebellum. 2011 Dec;10(4):770-92.
Sensory Integration Dysfunction There is considerable overlap
between executive and sensory processing
Both are related to self-regulation Many kids with sensory integration
difficulties also have trouble with cognitive flexibility
Oversensitivity Olfactory – “ewe it smells” Gustation – “It’s gritty mama” Tactile – “Ouch! That hurts” Visual – “There is still light” Sound – “I need to get out of this car!” Motor - “Inside I am just shaking”
A learning story ~ 9 year old Jason There is still light!
Twitter ~ The Research Playground INTERVENTION
@Inclusive_Class @marianne_russo @special-ism @movingsmartnow @micheleborba @talkingteenage @Kiboomu @kidlutions
5 Things About The Teen Brain You were afraid to ask, but need to know
Teen brain growth (neuronal connections) is in spurts and starts The Teen Years Explained: A Guide to Healthy Adolescent Development (Johns Hopkins University, 2009) by Clea McNeely and Jayne Blanchard
Go away! Wait, where are you going? (Separation and Independence)
Why so moody? The limbic interference relates to neuronal growth, hormonal changes and brain re-organization
Why so cliquey? Teens are herd animals… What? Your brakes aren’t working? (Impulsivity and risk
taking and the teenage brain)
Teens and Tweenies Teenage as a second language ~
Barbara R. Greenberg, & Jennifer A. Powell-Lunder
Get out of my life! But first will you take me and Cheryl to the mall ~ Anthony Wolf
Why do they act that way? ~ David Walsh
Food Rules
You are what you assimilate Get back to real whole food Consider amino acids
neurogistics.com
5 Food Rules1. 1 oz water per pound per day2. If it does not rot or sprout do without3. Consider 1-2 oz protein/fats every four hours for children 4. Consider 8-10 servings of color per day (1/2 cup per serving)5. Eat when you are hungry, mostly plants
SLEEPS = Similar bed-time schedule and
routine nightlyL = Light-off, dark, cool sleep
environmentE = Everything off, phone, TV, musicE = Exercise, regularly at least 45
mins dailyP = Preparation and planning
Twitter ~ The Research Playground NUTRITION
@NutritionBlogs @MelissaMcCreey @childobesity (nourish interactive) @ RMNutrition @eatingarainbow www.KidKritics.com www.pathways4health.org
Field Trip!
Play Math is a cortico-cerebellar math program that alternates fine and gross motor movement to teach children ages 6-12 fact families, factors and fractions (Kenney 2012)
Mirror or Skip Count (Balls) Slide and Glide (Blocks) Over and Up (Blocks) How do numbers fit together? What makes a family? Advanced techniques
The Method
Three things children taught me about how they learn math.We build brain connections
with: a. Rhythm b. Fine and Gross Motor
Movement c. Mentoring
Audition and Rhythm For younger kids who have trouble getting
started with the morning or evening routine at home, use a song they like to guide them through
Before starting a seated task, engage in some gross motor activity (quick walk, throw a koosh ball, etc.)
Alex Doman ~ Healing At The Speed of Sound @Kiboomu
The Importance of Play
We Teach EF Through Play Decision making Inhibition Cognitive Flexibility Attention Focus Shift Creativity/Imagination
Gill Connell ~ Play
PLAY: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul by Stuart Brown, M.D.
THE POWER OF PLAY: Learning What Comes Naturally by David Elkind, Ph.D.
PLAYFUL PARENTING by Lawrence J. Cohen, Ph.D. A CHILD'S WORK – The Importance of Fantasy Play by
Vivien Gussen Paley THE ART OF ROUGHHOUSING by Anthony T. DeBenedet,
M.D. and Lawrence J. Cohen, Ph.D.
The Power of Hopscotch HOPPING = MIDLINE DEVELOPMENT For children,
hopping signals sophisticated advances in both physical coordination, balance, AND cognitive development. You see, as your child refines her physical coordination, she is also building essential neural pathways in the brain. It's those exact same pathways which will one day become the conduits for left/right brain thinking tasks such as creativity, reasoning, and self-regulation.
DON'T STEP ON THE LINE = BODY CONTROL STOP & START = BODY RHYTHM LEAPING = MUSCLE STRENGTH SPACES = SPATIAL AWARENESS
movingsmartblog.blogspot.com
Neurodevelopmental Disorders and Special Population
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