Executive Functioning: The Basics - School of St. Mary

Executive Functioning: The Basics

Lisa Novak, Psy.D.

Noelle Pontarelli, Ph.D.

Illuminate Psychological Assessments, LLC

Agenda

u What is executive functioning?

u How does executive functioning develop over time?

u How do we assess executive functioning?

u What interventions can help improve executive functioning?

u Questions & Resources

Broadly, executive functions are…

u What we use to control and regulate ourselves to accomplish goal-directed tasks.

uinitiate uplan and organize uset goals uflexibly solve problems uregulate emotionsumonitor behavior

Variability in EF Development

u Frontal lobe: last area of brain development

u Fluid vs. stepwise development

u Wide range of “normal” functioning

u Adverse impact on functioning

u Social, academic, behavioral challenges

Preschool Expectations

u Follow 1-step directions

u Perform simple chores with some assistance/reminders

u Inhibit simple behaviors (hitting/biting, touching hot stove)

KindergartenExpectations

u Follow 2-3 step directions

u Inhibit more complex behaviors with reminders (e.g., look both ways before crossing a street)

1st/2nd Grade Expectations

u Tidy bedroom/playroom with minimal assistance

u Bring papers & materials to/from school

u Complete simple homework assignments with minimal assistance

u Decide how to spend money

u e.g., save allowance for future goal

u Independently inhibit specific behaviors

u e.g., raise hand before speaking in class

3rd - 5th Grade Expectations

u Complete 1h of homework with minimal assistance (and one to two breaks)

u Keep trach of changing daily schedule

u Plan how to earn money and save it for desired objects

u Keep track of belongings when away from home

u More complex behavioral inhibition: continue to behave when teacher leaves room, don’t make rude comments, inhibition of outbursts

6th – 8th Grade Expectations

u Independently use system for organizing schoolwork

u Follow more complex & flexible school schedules

u Plan & execute steps to complete long-term projects

u Minimal assistance in time management for juggling demands & activities

u e.g., homework, chores, extracurriculars

High School Expectations

u Establish long-term goal & continuously monitor plan for achieving goal

u Identify & synthesize main ideas from grade-level text

u Organize thoughts coherently in writing

u Inhibit reckless or dangerous behavior

u e.g., succumbing to peer pressure, unsafe decisions while driving

Examples of EF Challenges at different stages

u Forgetting to turn in completed homework

u Messy backpack, locker, bedroom

u Losing materials for school & extracurriculars

u Blurting out in class; interrupting others’ conversations

u Motor restlessness & excessive energy/activity level

u Conflicts with peers due to rigidity or poor self-monitoring

u Limited ability to sustain effort on non-preferred tasks

Assessment of EF

u Importance of multiple sources of data

u Review of relevant developmental history

u Teacher & parent reports

u Clinical observation

u Comprehensive evaluation

u Performance on standardized measures to directly compare to same-age peers

Assessment of EF

Assessment of EF

Why pursue an evaluation?

u Identifying underlying causes

u Other issues can masquerade as poor EF (e.g., learning disorders, anxiety)

u Determine magnitude of concern

u Is there a diagnosable disorder?

u Would medication be helpful?

u What other interventions/supports might be necessary?

EF Interventions

u Home-based strategies

u Visual schedules/family organizers

u Visual timers

u Manage expectations

u Games to encourage flexibility, working memory, inhibition

u Scaffolding of support to encourage increasing independence

EF Interventions

u Private providers

u EF coaches

u Occupational therapists

u CBT therapists

u Psychiatrists/pediatricians

u Tutors for reading comprehension/writing

EF Interventions

u School-based supports

u Interventions (RtI & IEPs)

u Accommodations (504 Plan)

u Functional Behavioral Analysis (FBA) & Behavior Intervention Plan (BIP)

Questions?

Lisa Novak, Psy.D. & Noelle Pontarelli, Ph.D.

www.illuminateneuropsych.com