Good morning!!! - Flota.org · Good morning!!! 11/4/2015 2 ... developmental milestones and environmental influences ... • Prefrontal cortex –late adolescence to

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Understanding Executive Functioning Applications for occupational therapists in and out of

the classroom

11/4/2015

Megan Hyman, M.S., OT/LOutpatient Pediatric Program Coordinator1

Good morning!!!

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Objectives

• Define executive functioning (EF) and the brain structures involved

• Identify the developmental processes that encompass EF

• Compare EF deficits associated with common diagnoses seen in pediatric population

• Examine impact of EF deficits on daily functional skills in pediatric population

• Acquire functional and practical strategies/accommodations for use in clinic/home environment

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The BIG picture…..

We worry about what a child will become tomorrow, yet we forget that he is someone today.

~Stacia Tauscher

How one handles success or failure is determined by their early childhood.

~ Harold Ramis

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Behavior

• Merriam-Webster– the manner of conducting oneself

– anything that an organism does involving action and response to stimulation

– the response of an individual/group/species to its environment

• Behavior is purposeful

– Requires interpretation of signals from our CNS

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Motivation

• Oxford dictionary– the general desire or willingness of someone to do

something

– the condition of being eager to act or work

• Can be intrinsic/extrinsic

• Motivation impacted by experience, drive, curiosity

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Executive Functioning (EF)

• A set of cognitive abilities that control and regulate behavior

• Necessary for goal-directed behavior (execution)

• EF skills develop over time – we are NOT born with them

• Process of processing and interpretation

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• Involves:

– Inhibitory Control

– Working Memory

– Cognitive Flexibility

• EF skills emerge in combination with developmental milestones and environmental influences

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• Response inhibition

• Working memory

• Emotional control

• Sustained attention

• Planning/prioritization

• Flexibility

• Task initiation

• Organization

• Time management

• Goal-directed persistence

• Metacognition

11/4/2015 Dawon,P. & Guare,R. (2009) 9

Response inhibition

• Stop & think before you act

• Resist urges, delay gratification

• Learning to “wait”

• Accept decisions without arguing

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Working memory

• Hold information while performing tasks

• Manipulate information internally

• Draw on past experiences and apply to current/future

• Affects sense of time

• Baddley’s psychological model

– Visuo-spatial “sketchpad”

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Emotional control

• Self-soothe, self-regulate

• Recover from disappointment

• Manage anxiety in order to perform challenging task

• Learn to be assertive, not aggressive

• Sharing & compromise

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Sustained attention

• Maintain a consistent behavioral response during continuous and repetitive activity

• Keep attention to a task despite distractibility, boredom, fatigue

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Task initiation

• To begin a project in a timely fashion (without procrastination)

• Necessary for new challenges and goal setting

• Do not confuse difficulties with task initiation for “lazy”

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Planning/prioritization

• Creating a roadmap to reach a goal/complete a task

• Making decisions about what’s important and not

• Setting deadlines, breaking down long term projects

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Organization

• Create and maintain systems to keep track of information

• Routines, checklists, reminders, compartmentalization

• Everything has its place, order, structure

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Time management

• Estimate and anticipate the amount of time, either available or needed

• Stay within time lines/deadlines

• Planning for interference/obstacles/ challenges and remaining on task

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Goal directed persistance

• To have a goal, follow through, and not get distracted by competing interests

• Important for the child to acknowledge and understand the goal

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Flexibility

• Adapt to new information, routines

• Handle unexpected changes or imposed transitions

• See things from another’s perspective

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Metacognition

• Self-monitoring

• Evaluating one’s own behavior

• “Take a step back”

• Reflecting on one’s behavior/choices either from feedback or from self-observation

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Neurophysiology of EF

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• White matter = bundles of axons that connect and communicate with different regions of the brain (Composed of nerve fibers)

– Subcortical; contains myelin sheath for fast transmission

• Grey matter = cortical tissue on surface of brain– Composed of nerve cells; receives & interprets

signals from sensory channels

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• The “pruning effect”

– 20 weeks � 100 billion neurons (adult size)

– Early childhood � 1 quadrillion synapses (exceeds adult brain)

• Growth of grey matter peaks before age 5 and then follows a gradual reduction

• “Pruning” allows for consolidation and refinement of mental skills

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• Increase in overall grey matter �

– By 5 years

– 11-12 years

• “Use it or lose it” concept

• Frontal lobe development � growth spurt prior to adolescence

• Prefrontal cortex – late adolescence to young adulthood

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Frontal lobe

• The most dopamine-sensitive neurons– Dopamine system associated with reward, attention,

long term memory, planning/drive

• Receives & interprets communication from neighboring cortexes

• Responsible for “conscious” function

• “Air traffic control” system (Center on the

developing child, Harvard University, 2011)

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Frontal lobe

• Directs/”mediates” behavior

– Attend

– Control emotions/regulate

– Reflect & adapt

• Cognitive “choices” = BEHAVIOR

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Prefrontal cortex

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• Feedback-feedforward loop

• Last to develop �late adolescence to young adult

• Interplay with amygdala, cingulate gyrus, hippocampus

Prefrontal cortex

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• Amygdala = memories associated with emotion

• Cingulate gyrus = emotional formation, processing, learning, memory

• Hippocampus = long term memory

Development of EF

• EF develop over time

• Impacted by

– Biology & genetics

– Interactions & supports

– Environmental stress

• Postnatal development impacts refinement & interpretation of prenatal skills

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Development of (EF)

• Response inhibition

• Working memory

• Emotional control

• Sustained attention

• Planning/prioritization

• Flexibility

6-12 months **

6-12 months

6-12 months

6-12 months

6-18 months

12-24 months

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• Task initiation

• Organization

• Time management

• Goal-directed persistence

• Metacognition

Preschool-elementary school

10-11 years

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Central Nervous system (CNS)

• Sensory fibers = “circuits/tracks”

• Humans all contain the same number of sensory fibers

• Sensory information is processed involuntarily = PRE-COGNITIVE

• Sensory signals are filtered and interpreted in the frontal lobe

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• Input � CNS

• Output � Motor function

– Act, think, feel, analyze, judge

• Early sensory “experiences” are foundational for purposeful behavior

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Data source: Charles A. Nelson (2000). Credit: Center on the Developing Child 38


• Vestibular/spinal tracks

– Myelination at term/birth

• Midbrain cortical tracks (visual pathways)

– Myelination at 2-3 months

• Lateral cortical tracks

– Myelination by 12 months

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Data source: www.vivaling.com

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Environment/stress

• Chronic stress

– Poverty

– Severe/life threatening illness

– Suboptimal parent/child interactions

– Neglect/abuse

– Sensory processing/modulation???

• Repeated cortisol release

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Environment/stress

• Chronic stress impacts brain development

– Children growing up in poverty have elevated chronic stress levels (Evans et al., 2013)

– Prefrontal cortical & hippocampal disruptions (Evans & Schamberg, 2009)

– Working memory & language were the most sensitive neurocognitive system to early deprivation (Noble et al., 2007)

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Environment/stress

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Environment/stress

• Self-regulation may aid in reducing harmful effects of chronic stress– “Maintain emotional and behavioral self-

control necessary for goal directed behavior in the face of competing social and physical demands” (Evans & Fuller-Rowell, 2013)

– Children with better self-regulatory skills develop more flexible and efficient coping strategies � delaying gratification into middle age

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Interactions/supports

• Interactions between infants & adults help build skills related to EF

– Focused attention

– Working memory

– Self-regulation (reactions to stimulating experiences)

• Match and support the child at their level

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Interactions/supports

• For children, practice the process - talk,

monitor, reflect, hypothesize, evaluate

• EF continues to develop as adults serve to “scaffold”

– Assist with completion of challenging tasks and then fading back on support

• Scaffolding can come from a person or the environment

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Enhancing and practicing executive function skills with children from infancy to adolescence

Center on the Developing Child, Harvard University 47

Executive Dysfunction

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Executive dysfunction

• Poor self-control

• Impulsivity

• Distractibility

• Decreased initiation

• Inflexibility/can’t shift gears

• Perseveration

• Apathetic/lack of self-advocacy

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• Needs directions repeated often

• Slow to start tasks

• Takes a long time to complete tasks

• Rushes through work despite parameters

• Difficulty recalling a sequence of events

• Repeats same mistakes over and over

• Easily misplaces items

• Forgets books, personal effects

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At home…….• Cannot adhere to limit

setting

• Frequent & intense tantrums/reactions

• Immature coping skills

• Difficulty asking for help

• Unable to adapt to transitions/changes in routines

• Resistant to imposed routines/requests

• Poor time management (ADL’s, morning routines)

• Difficulty following through with routine sequences (chores)

• Misplaces belongings

• Disorganization of personal space

• Forgets homework supplies/assignments

• Waits till last minute to begin/finish an assignment

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At school…..• Difficulty recognizing limits

• Difficulty establishing social relationships

• Aggressive behavior or prone to outbursts

• Resistant to transitions/stopping what they are doing

• Hard to wait their turn/”share”

• Misinterpret peers/overly sensitive or judgmental

• Misplaces supplies

• Forgets assignments

• Difficulty conceptualizing, organizing, & writing ideas down on paper

• Frequent careless errors in writing

• Takes more time for completion of work

• Appears lethargic/apathetic

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• Sensory processing disorder (SPD)– Sensory modulation/discrimination

• Fetal alcohol syndrome

• Tourette’s syndrome

• Down syndrome

• Cochlear implants

• ADHD

• Autism spectrum disorder (ASD)

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Sensory processing disorder

= “Impaired responses to, processing of, and/or organization of sensory information” (Miller et al., 2009)

• Inefficient functioning of the central nervous system

• Involves primary sensory cortical areas & higher order cortical regions

• High co-morbidity with ADHD, ASD, premature birth, Fragile X syndrome

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• Quantifiable differences in brain structure

– Reduction of posterior white matter microstructure primarily affecting posterior cerebral tracts

– Differs from microstructural integrity of ASD (frontal and temporal tracks) and ADHD (prefrontal

tracks)

(Owen et al., 2013)

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• Prenatal environmental factors (non-humans)

– Non-human primates exposed to prenatal alcohol or stress

– Significantly lower muscle tone/righting reactions at birth, significantly greater cortisol levels upon maternal separation (6 months), impaired cognitive function at 32 months

– Hypothesized SOR associated with altered dopamine function � needed for inhibitory control (filtering)

(Schneider et al., 2007)

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Fetal alcohol syndrome

= a group of conditions involving neurological,

physical, behavioral, and learning problems as a result of alcohol consumption during pregnancy

• Wozniak,J.R., 2013

– White matter may be disproportionately impacted

– Abnormalities in para-central cortical regions connected by posterior callosal fibers

• Rasmussen et al.,2013

– Impairments in shifting attention, inhibition, visual spatial processing, memory, social perception

11/4/2015 58www.CDC.gov

Fetal alcohol syndrome

• Selective inhibition, verbal/non-verbal fluency, arousal/attention, planning/organization, working memory (Wells et al., 2012)

• Jirikowic et al., 2008

– “Disruptive behaviors” & “uncooperative behaviors” were reported among the majority of children in study

– Functioned significantly more poorly on clusters of adaptive behaviors

– Acquired fewer age appropriate ADL skills (dressing, mealtime, toileting)

11/4/2015 59www.CDC.gov

Tourette’s syndrome

= a neurological disorder characterized by

repetitive, stereotyped, involuntary movements and vocalizations called tics

• Functional limitations suggest inhibitory deficits

• Research hypothesizes potential disruption of fronto-subcortical circuits (basal ganglia & anterior cingulate)

11/4/2015www.CDC.gov

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Tourette’s syndrome

• Channon et al. (2003)– Inhibition process was found to be single factor in EF

dysfunction

– Co-morbid ADHD was biggest contributor to any deficits experienced

11/4/2015www.CDC.gov

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Down syndrome

• Daunhauer et al., 2014

– School age children with DS & their teachers

– Teachers reported less assistance and adaptations needed for physical tasks versus cognitive-behavioral tasks

– Moderate difficulty reported for self-care, hygiene, memory and understanding

– Greatest challenges identified by teachers/parents in the areas of safety, behavior regulation, following social conventions, positive interactions

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Cochlear implants

• Beer et al., (2014)– Early auditory experiences and activities with

sound patterns promotes the development of EF by providing opportunities to engage in controlled information-processing

– Preschool children with severe to profound pre-lingual deafness who use cochlear implants were significantly delayed in attention and inhibitory control, and parent reported working memory

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ADHD

= neurodevelopmental disorder that includes deficits of attention, inhibition (impulsivity), and motor activity control (Crippa et al., 2015)

• Excessive slow brainwave activity – indicates a lack of control in the cortex

• Microstructural abnormalities in white matter, decreased functional connectivity

• Exhibit impairments in inhibition, working memory, and planning (Willcutt et al, 2005)

• Hyperactive children who were dx with ADHD in young adulthood showed significant impairments in attention & inhibition (Fisher et al., 2005)

11/4/2015 64www.CDC.gov

ADHD

• Written expression has been identified as the most common learning problem for children dx with ADHD (65%)

• Simultaneous processing, organization, and interpretation of information internally – Formulate an idea/string of ideas

– Hold onto ideas to sequence

– Retain information while writing (thinking while doing)

– Retrieve proper spelling, grammar, punctuation (LTM)

– Organize into a logical sequence

– Review and correct errors

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Autism spectrum disorder

= Persistent deficits in social communication and social interaction; restricted, repetitive patterns of behavior, interests, or activities

• Research suggests poor mental flexibility and regulation/modulation of motor acts

• Possible links between EF and joint attention

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• Prefrontal and temporal regions (anterior cingulate) show neuroanatomic differences (Schultz et al., 2000)

• School aged and adult individuals with autism showed impairments in planning and mental flexibility (perservative behaviors) (Hill,

E.L., 2004)

• Children with ASD exhibited more difficulty on tasks that required cognitive flexibility (Semrud-Clikeman et al., 2014)

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Diagnostics

&

Intervention

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Evaluation

Occupational therapy Physical therapy

Speech/language pathology

Teachers/Parents

Psychologist

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Assessments

• No one measure of EF

• Multiple measures used to identify various executive skills

• Evaluation of EF dysfunction uses standardized measures, rating scales, & functional observations

– Many standardized tools are normed for 7 y/o+

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Treatment team

• Student/child

• Family

• Teachers

• Psychologist

• Psychiatrist

• OT’s/PT’s/SLP’s

• ABA

• Educational support specialists

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Intervention

• Medication

• Psychological support

– Child & family

• Individual therapies

• Educational supports

– IEP, 504 plan, tutoring, remediation

• Environmental supports

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Intervention

• Consistent implementation

– Across all functional environments

• Intervention usually involves both the child & the environment

– Strengthen individual skills

– Establish appropriate expectations

– Develop supports & strategies

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What does this all mean?

What can we do?

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What does this all mean??

• EF skills are a set of cognitive skills that are learned over time– Developmental milestones & environmental

influences

• EF progresses in stages consistent with growth spurts within the CNS

• EF skills require environmental scaffolding to ensure proper development

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EF & Occupational therapy

Occupational therapy……– is concerned with the end result of

participation and thus enable engagement through adaptations and modifications to the environment or objects within the environment when needed

– services are provided for habilitation, rehabilitation, and promotion of health and wellness for clients with disability- and non–disability-related needs

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Scope of practice, American Occupational Therapy Association, 2014 77


Occupational therapists……– are experts at analyzing the client factors,

performance skills, performance patterns, and contexts and environments necessary for people to engage in their everyday activities and occupations

– use their knowledge of the transactional relationship among the person, his/her engagement in valuable occupations, and the context to design occupation-based intervention plans that facilitate change or growth in client factors (body functions, body structures, values, beliefs, and spirituality) and skills (motor, process, and social interaction) needed for successful participation

11/4/2015Scope of practice, American Occupational

Therapy Association, 2014 78

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• Sensory integration therapy

“Techniques use sensory stimuli and

cognitive strategies to assist the child in attaining and maintaining a regulated state, sustaining attention, controlling emotions and behaviors, as well as completing complex motor skills.” (Miller et al.,

2009)

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• Evaluate and interpret

– Sensory input

– Is there a behavior??

– Define the behavior??

– Identify environmental strategies

** Always acknowledge motivation

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• Support the child– In all functional environments (school/home)

– Identify strengths/weaknesses

• Educate about appropriate expectations

– Family & teachers

• Identify environmental supports & strategies

• Encourage consistency across environments

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• Individual therapies

– Address sensory, motor, processing limitations

– Increase awareness

• Educational supports

– IEP, 504 plan, tutoring, remediation

• Environmental supports

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Supporting

Executive Functioning

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Strategies & Supports

Sensory input

Frontal lobe

Behavior

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Strategies & Supports

• SUCCESS is the goal

• Adults have better developed skills than children

• Recognize individuals strengths & weaknesses

• TIME, TIME, TIME

• Do-over’s encourage learning through repetition

• Make the environment work for you

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To change a behavior…

It takes at least 30 days to build a new habit

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Response inhibition

�Self-regulation, sensory orientation/ modulation/discrimination, graded force/control

• Recognize the state of the environment– Remove excess distractions or provide the child a break from

stimuli

• Set predictable waiting cues/periods

– Use visual cues/gestures, counting, repetitive verbal

reminders

• Use tangible objects to help with waiting

• Establish appropriate waiting actions

– Raising hand, hands in pockets

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Response inhibition

�Self-regulation, sensory orientation/ modulation/discrimination, graded force/control

• Review social scenarios & use social stories

• Earn allowance/cumulative reinforcers

• Encourage rules for sharing/taking turns/compromise

• Intervene in social situations with young children– provide a sounding board but try not to solve the problem for

them

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Working memory

�Visual-spatial processing (visual memory,

sequential memory, spatial relations, discrimination)

• Establish eye contact before giving auditory information

• Use visual/written reminders (lists, notes, symbols, pictures)

• Rehearse what you want children to remember

• Teach with MEANING (gestures, affect, intonation)

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Working memory

�Visual-spatial processing (visual memory,

sequential memory, spatial relations, discrimination)

• Provide reinforcements for key information remembered

• Use timers for sense of time, calendars, timelines

• Color code information

• Use familiar and predictable environmental locations for personal effects

• Involve the child in the development of strategies

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Emotional control

�Self-regulation, sensory modulation for self-soothing, empathy

• Establish routines and stick to routines

• Provide verbal and visual preparation to changes in routines

• Label emotions

• Predictable consequences

• Set expectations but avoid “do” and “don’t” statements– Provide choices, negotiate, actively listen to children’s wants

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Emotional control

�Self-regulation, sensory modulation for self-soothing, empathy

• Provide explanations to reasons as opposed to just “NO”

• Establish appropriate behaviors to express emotion– Stomping feet, saying “NO”, squeezing hands

• Teach acceptable coping strategies

• Use scripts for problem solving

• Model emotional control

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Sustained attention

�Sensory modulation/discrimination, motor planning/problem solving

• Remove external distractions– Calming environment, headphones, other students, desk position

• Provide alternative positions/changes to position during work (sitting, standing, laying down, desk, couch)

• Provide fading supervision

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Sustained attention

�Sensory modulation/discrimination, motor planning/problem solving

• Use timers for independent play/work

• Incorporate incentives/tangible reinforcers– Builds motivation, work towards a goal

• Get feedback from student on how long they need to complete task – set attainable goal– Encourage them to tell you when they need a break (self-

monitoring)

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Task initiation

�Praxis

• Establish routines – with repetition you should allow the child to initiate the routine

• Highlight and praise the first step of every task

• Use songs or predictable auditory/visual cues to signify start

• Visual cues to reinforce each step of sequence

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Task initiation

�Praxis

• Break down tasks in smaller chunks

• Ask your child for “play by play” when they want something (“what are you going to do?”, “what do you need?”)

• Have the child help in establishing their routines

• Set goals and be clear with expectations

• Praise the child’s attempts……………… LEARNING takes time!!!

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Planning/prioritization

�Praxis, problem solving

• Establish a “launching/landing pad” around their goals/ideas (Set goal, identify steps to achieve end goal)

• Break down process visually (lists, notes, outlines)

• Calendars, timelines/sticky notes

• Identify incentives/motivations with child

– What is most important to them + what is important to you

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Organization

�Visual perceptual skills (discrimination, scanning, figure ground), praxis

• Do you have an established routine??– Can your child execute any portion of that

• Walk through their process

• Minimize interruptions while completing a routine

• Child=manager, adult=oversight

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Organization

�Visual perceptual skills (discrimination, scanning, figure ground), praxis

• Establish communication with teachers/parents to check on assignments

• Plan ahead – packing bags, lunches, laying out clothes

• Visual cues for coding/sorting (colors, symbols)

• Extra set of pencils, crayons, notebooks, books

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Time management

• Follow a predictable daily routine

• Use timed periods for fun and challenging tasks

• Ask child to anticipate amount of time needed

• Timers, digital/analog clocks, songs

– During homework, ADL’s, play time, cleaning room

• Plan weekend activities that have set time frames or occur over a longer time frame

• Compare time amounts to familiar activities (movie, soccer game, favorite TV show)

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Goal-directed persistence

• Start with intrinsic motivators

• Support foundational weaknesses (skills)

• Help set realistic goals with child

– Timelines, to do lists, calendar planning

• Long term goals need to have easier attained smaller goals to hold motivation

– Visual deadlines and tracking points

• Use reinforcers/incentives for goals you value (cumulative)

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Flexibility

• Be clear with the “deal breakers”

• Advance notice of changes in routine

• Provide choices/options to situations

• Anticipate outcomes

• Plan A, Plan B

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Flexibility

• Teach coping strategies (breathing, predictable

statements, social outlets)

• Reducing demands initially (particularly novel)

• Active listening & sharing of perspective

• Social stories

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Metacognition

• Set a goal or desired outcome on which to measure success

• Reflect on key behavior using framing statements

• Ask child about their performance– How did you do? Did it work? Did you want that to happen?

• What’s the problem??

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Metacognition

• Provide changes in affect/tone of voice to convey different meaning in verbal information

• Hypothesize about someone else’s feelings, ideas, wants

• Balanced feedback

• Highlight directions, math symbols, important dates

• Review written work for a predictable number of “rules’

• Record/video tapes lessons/lectures

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References

• Anderson,V. (2001). Assessing executive function in children: biological, psychological, and developmental considerations. Pediatric Rehabilitation, 4(3), 119-136.

• Beer,J., Kronenberger,W., Castellanos.I, Colson,B., Henning,S., Pisoni,D. (2014). Executive Functioning skills in preschool age children with cochlear implants. Journal of Speech, Language, and Hearing Research, 57, 1521-1534.

• Building the brain’s “air traffic control” system: How early experiences shape the development of executive function (2011). Center on the Developing Child at Harvard University. Retrieved from the Center on the Developing Child at Harvard University website http://developingchild.harvard.edu/key_concepts/executive_function/

• Caesar,P. & Lagae,L (1991). Age specific approach to neurological assessment in the first year of life. Acta Pediatricia Japonica, 33, 125-138.

• Channon,S., Pratt,P., Robertson,M. (2003). Executive function, memory, and learning in Tourette’s syndrome. Neuropsychology, 17(3), 247-254.

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References

• Cramm, H, Krupa, T., Missiuna, C., Lysaght, R.M., Parker, K.C. (2013). Broadening the occupational therapy toolkit: an executive functioning lens for occupational therapy with children and youth. The American Journal of Occupational Therapy, 67(6), 139-147.

• Cramm, H.A., Krupa, T.M., Missiuna, C.A., Lysaght, R.M., Parker, K.H. (2013). Executive functioning: a scooping review of the occupational therapy literature. Canadian Journal of Occupational Therapy, 80(3), 131-140.

• Crippa,A., Marzocchi,G.M, Piroddi,C., Besana,D., Giribone,S., Vio,C., Maschietto,D., Fornaro,E., Repossi,S., Sora,M.L. (2015). An integrated model of executive functioning is helpful for understanding ADHD and associated disorders. Journal of Attention Disorders, 19(6), 455-467.

• Daunhauer,L., Fidler,D., Will,E. (2014). School function in students with Down syndrome. The American Journal of Occupational Therapy, 68(2), 167-176.

• Dawson, P. & Guare, R. (2009). Smart but Scattered. New York, NY: The Guilford Press.

• Dawson,P., Guare,R., & Guare,C. (2013). Smart but Scattered Teens. New York, NY: The Guilford Press.

• Deshpande,G., Libero,L.E., Sreenivasan,K.R., Deshpande,H.D., Kana, R.K. (2013). Identification of neural connectivity signatures of autism using machine learning. Frontiers in Human Neuroscience , 7, 1-15.

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References

• Enhancing and practicing executive function skills with children from infancy to adulthood (2015). Center on the Developing Child at Harvard University. Retrieved from Center on the Developing Child at Harvard University website http://developingchild.harvard.edu/key_concepts/executive_function/

• Evans,G., Fuller-Rowell,T. (2013). Childhood poverty, chronic stress, and young adult working memory: the protective role of self-regulatory capacity. Developmental Science, 16(5), 688-696.

• Evans, G.W. & Schamberg, M.A. (2009). Childhood poverty, chronic stress, and adult working memory. Proceedings of the National Academy of Sciences, USA, 106, 6545-6549.

• Executive Dysfunction: Effective strategies & interventions for children and adolescents. (2012). Presented for PESI by Dr. Susan Fralick-Ball, Psy.D., MSN.

• Fischer,M., Barkley,R.A., Smallish,L., Fletcher,K. (2005). Executive functioning in hyperactive children as young adults: attention, inhibition, response perseveration, and the impact of comorbidity. Developmental Neuropsychology, 27(1), 107-133.

• Hatch,B., Healey,D., Halperin,J. (2014). Associations between birth weight and attention deficit/hyperactivity disorder symptom severity: indirect effects via primary neuropsychological functions. Journal of Child Psychology and Psychiatry, 55(4), 384-392.

11/4/2015 110

References

• Hill, E.,L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8(1), 26-32.

• Jirikowic,T., Kartin, D., Olson,H.C. (2008). Children with fetal alcohol spectrum disorders: a descriptive profile of adaptive function. Canadian Journal of Occupational Therapy, 75(4), 238-248.

• Key concepts: executive function. Center for the Developing Child at Harvard University. Retrieved from Center for the Developing Child at Harvard University website http://developingchild.harvard.edu/key_concepts/executive_function/

• Kleinhans,N., Akshoomoff,N., Delis,D.C. (2005). Executive functions in autism and Asperger’s disorder: Flexibility, Fluency, and Inhibition. Developmental Neuropsychology, 27(3), 379-401.

• Late, lost, and unprepared: Executive dysfunction & the disorganized child/adolescent. (2012). Presented for PESI by Dr. Laurie Dietzel, Ph.D.

• Lee, K., Bull, R., Ho, R.M.H. (2013). Developmental changes in executive functioning. Child Development, 84(6), 1933-1953.

11/4/2015 111

References

• McAlister, A., Peterson,C. (2013). Siblings, theory of mind, and executive functioning in children ages 3-6 years: New longitudinal evidence. Child Development, 84(4), 1442-1458.

• Miller, L.J., Nielsen, D.M., Schoen,S.A., & Brett-Green, B.A. (2009). Perspectives on sensory processing disorder: a call for translational research. Frontiers in Integrative Neuroscience, 3(22), 1-12.

• Noble,K.G., McCandliss,B.D., & Farah,M.J. (2007). Socio-economic gradients predict individual differences in neuro-cognitive abilities. Developmental Science, 10, 464-480.

• Owen,J.P., Marco, E.J., Desai,S., Fourie,E., Harris, J., Hill,S., Arnett,A.B., Mukherjee,P. (2013). Abnormal white matter microstructure in children with sensory processing disorders. NeuroImage: Clinical 2, 844-853.

• Rasmussen,C., Tamana,S., Baugh,L, Andrew,G., Tough,S., Zwaigenbaum,L. (2013). Child Neuropsychology, 19(4), 337-349.

• Semrud-Clikeman,M., Fine,J.G., Bledsoe,J. (2014). Comparison among children with children with autism spectrum disorder, non verbal learning disorder and typically developing children on measures of executive functioning. Journal of Autism and Developmental Disorders, 44, 331-342.

11/4/2015 112

References

• Schneider,M.L., Moore,C.F., Gajewski,L.L, Laughlin,N.K., Larson,J.A., Gay,C.L., Roberts,A.D., Converse, A.K., DeJesus,O.T.. (2007). Sensory processing disorders in a nonhuman primate model: evidence for occupational therapy practice. American Journal of Occupational Therapy, 61, 247-253.

• Sjowall,D., Roth,L., Lindqvist,S., Thorelli,L.B. (2013). Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits. Journal of Child Psychology and Psychiatry, 54(6), 619-627.

• Toglia,J., Berg,C. (2013). Performance-based measure of executive function: comparison of community and at-risk youth. The American Journal of Occupational Therapy, 67(5), 515-523.

• Travers,B.G., Adluru,N., Ennis,C., et al. (2012). Diffusion tensor imaging in autism spectrum disorder: a review. Autism Research, 5, 289-313.

• Van der Donk, M., Hiemstra-Beernink, A.C., Tjeenk-Kalff, A.C., van der Leij, A.V., Lindauer, R. (2013). Interventions to improve executive functioning and working memory in school-aged children with AD(H)D: a randomized controlled trial and stepped-care approach. BMC Psychiatry, 13(23). Retrieved from http://www.biomedcentral.com/1471-244X/13/23

11/4/2015 113

References

• Verburgh,L., Konigs,M., Scherder,E., Oosterlaan,J. (2014). Physical exercise and executive functions in preadolescent children, adolescents, and young adults: a meta-analysis. British Journal of Sports Medicine, 48, 973-979.

• Vollebregt,M.A., vanDongen-Boomsma,M., Buitelaar,J.K., Slaats-Willemse,D. (2014). Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. Journal of Child Psychology and Psychiatry, 55(5), 460-472.

• Weiland,C., Yoshikawa,H. (2013). Impacts of a prekindergarten program on children’s mathematics, language, literacy, executive functions, and emotional skills. Child Development, 84(6), 2112-2130.

• Willcutt,E.G., Doyle,A.E., Nigg,J.T., Faraone,S.V., & Pennington,B.F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336-1346.

• Wozniak,J.R., Mueller,B.A., Bell,C.J., Muetzel,R.L, Hoecker,H.L, Boys,C.J., Lim,K.O. (2013). Global functional connectivity abnormalities in children with fetal alcohol spectrum disorders. Alcoholism: Clinical and Experimental Research, 37(5), 748-756.

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