5/9/2019 1 Accelerating Student Outcomes in Your School-Based Occupational Therapy Practice Mother to two children with autism. Advisor for OT and contributing author for Autism Asperger’s Digest Magazine, Asperkids, Autism Parent Speaker across the US for Universities, Future Horizons Autism Conferences, state and local organizations Co-Founder of Aspire Pediatric Therapy, Founder of Route2Greatness, LLC, & Owner of The Pocket Occupational Therapist, and OT2OT Program Executive Vice President of Content for www.myHana.org (c) The Pocket Occupational Therapist, 2019 (c) The Pocket Occupational Therapist, 2019 1 2 3
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Speaker across the US for Universities, Future Horizons Autism
Conferences, state and local organizations
Co-Founder of Aspire Pediatric Therapy, Founder of
Route2Greatness, LLC, & Owner of The Pocket Occupational
Therapist, and OT2OT Program
Executive Vice President of Content for www.myHana.org
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• Examine evidence-based treatment strategies to increase your effectiveness and efficiency as a school-based therapist.
• Utilize fresh, new, & innovative ideas for your therapy toolbox – including accommodations, interventions, and adaptations for better goal achievement.
• Set SMART goals using AOTA’s framework terminology outlining the distinct value of OT in your treatment plans.
• Develop effective treatment plans and interventions that address foundational skills for improving function in school.
• Select specific strategies to help students increase participation and independence with attention and focus in the classroom.
Course Objectives
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Course Objectives
• Demonstrate the best uses of technology in the process of written language while considering apps and assistive technology.
• Utilize interventions to boost students’ focus, attention, working memory, and organization.
• Describe evidence-based strategies to better manage executive function deficits.
• Incorporate sensory and brain-based treatments for difficult sensory and behavioral issues affecting classroom performance.
• Identify proven interventions to boost postural support and upper extremity stability to improve functional outcomes.
Write a Facebook, Instagram post, or tweet about a concept
Pictionary to draw a concept
Cartoons or comic strips
Post three images and ask student to choose the correct or best one
Find an image that best relates to the concept.
Write or show the correct way and wrong way and ask someone to choose which is right.
Art gallery
Flip book
Greeting cards
Scrapbook
Collage
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Aural (Auditory) Learning Strategies
Listen to music and write feelings down
Chanting or making songs out of rules, letters, etc.
OddCast.com provides a song to text the student enters in
Write a commercial
Puppet show
News report
Game show
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Read/Write Multimedia Ideas
Go Animate
Toon Doo
Show Me iPad App
Edu creations
Photo Story
Power Point
Dragon Dictation
Virtual Whiteboards
Padlet
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Tagxedo
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Kinesthetic Learning Strategies
Signal response cards
Dry erase boards
Stand up if yes or true
Cross your arms if something is true
Touch your toes while spelling…….
Hold up a red bean bag for yes/no
Chant ________ while touching your tummy, etc.
Make up a song or rap while dancing
Models
Costume
Scavenger Hunt
Mask
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Professional Development
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Caseload Vs. Workload – Why Should OTs Care?
Advocate for additional occupational therapy staff positions.
Clearly define the role of occupational therapy in your school.
Facilitate discussions to address therapy roles and responsibilities.
Determine occupational therapy service needs and program capacity.
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Caseload Vs. Workload
IDEA services support access to the general education curriculum
Evidence-based shows limited generalization with caseload in school settings.
To meet the needs of children, teachers, parents, and school a workload approach helps in the development of work patterns (workflow) that optimize effectiveness and impact.
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Caseload
Direct work with students
Traditional thinking
Counts number of students
Pull-out services built around clinical model of predictable, routine “appointments”
Limited support in the educational literature
Do not promote generalization of skills to classroom or other settings.
Workload
Direct AND Indirect Services
Includes collaborative teamwork and data collection
Can be done in bus line, cafeteria, recess, etc.
Utilize interventions at the
POINT of
PERFORMANCE
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Eat the FROG
“If it’s your job to eat a frog, it’s best to do it first thing in the morning.
And if it’s your job to eat two frogs, it’s best to eat the biggest one first.”
~Mark Twain
Workload Responsibilities
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TIME MONDAY TUESDAY WEDNES THURS FRIDAY
8-8:30 Team Meeting Evaluation Billy in Language Arts
Documentation Handwriting in-service
Bobby in PE
8:30-9:00 Sensory Group Evaluation Training/supervision of Billy’s aide
Handwriting in-service
Case management
9:00-9:15 Documentation Set up for next preschool motor group
Travel to next site
Early intervening services in Mrs. Smith’s class
Parent Consult
9:15-9:45 Travel to Next Site
Consult with kindergarten teachers on fine-motor centers
IEP meeting Katie Tx. Collect data on Katie’s progress
Services to the child, hands-on services (individual and small groups)
Activities that support child/student programming (e.g., collaborating with team, planning meetings)
Activities that support children/students in natural environments or general education curriculum (e.g., in-service to kindergarten teachers on fine-motor centers)
Activities that support other federal, state, and local requirements (e.g., documentation, data collection).
For each category, calculate the percentage of your time spent per week performing each activity. Once you have calculated your time allocations, put the information in a chart or table so that you have a visual record of your workload. (c) The Pocket Occupational Therapist, 2019
Step 3: Analyze Results
The information you collect represents the current demand for occupational therapy services in your program or district.
If you are unable to meet all of the demands of your workload, use this information to collaborate with your team, administrators, or supervisors to determine solutions.
Some suggestions include:
Varying the frequency of services provided (many students may not need weekly services)
Determining services based on individual criteria instead of
Over 83 percent of school children sit at chair-desk combinations that are not suitable for their body height. The researchers also purport that most school furniture is out of date and doesn’t confirm to minimum orthopedic-physiological requirements. Collmer, 2016
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Helpful Downloads www.PocketOT.com
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Writing Strategies
Place prompt at midline
Alternate colors on the board
Book rests/props
Paper tents
Slant boardsHARMON ANGLE is 20°
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Harmon in 1938 The Coordinated Classroom
9 years and over 60,000 students
Dr. Harmon discovered, among many shocking results:
53.3% of the children had visual difficulties
30.2% of the children had postural difficulties
20.9% had chronic fatigue
Harmon concluded that “posture relates not only to spatial judgments, but also to performing visual tasks.”
“Eyes are not cameras…meaningful vision is learned – learning like
every other learning – by doing, by the constructive use of bodily stress.”(c) The Pocket Occupational Therapist, 2019
Dyscalculia Difficulty with math Problems doing math problems, understanding time,
using money
Dysgraphia Difficulty with writing Problems with handwriting, spelling, organizing ideas
Dyspraxia
(Sensory Integration Disorder)
Difficulty with fine motor skills Problems with hand–eye coordination, balance, manual
dexterity
Dysphasia/Aphasia Difficulty with language Problems understanding spoken language, poor
reading comprehension
Auditory Processing Disorder Difficulty hearing differences between
sounds
Problems with reading, comprehension, language
Visual Processing Disorder Difficulty interpreting visual information Problems with reading, math, maps, charts, symbols,
pictures
*resource - http://www.helpguide.org/mental/learning_disabilities.htm(c) The Pocket Occupational Therapist, 2019
What is NOT Considered a Learning Disability
Anxiety
Depression
Emotional trauma
Stressful events
ADHD
Autism
NOT Considered a Learning Disability
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Signs of Dysgraphia
Generally illegible writing
Unfinished words or letters
Inconsistent spaces between words and letters
Misuse of lines and margins
Mixed upper case and lower case letters
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Types of Dysgraphia
Dyslexic Dysgraphia – written work is illegible, spelling is bad.
Motor Dysgraphia – insufficient fine motor skills, poor muscle tone and poor dexterity.
Spatial Dysgraphia – lack of understanding of space. Illegible work, but may have normal spelling.
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Signs of Dyscalculia
Difficulty learning math concepts beyond basic math
Trouble with mental math calculations
Difficulty with finding different approaches to one problem
Confuses similar numbers; reads numbers out of sequence
Inability to measure—telling time, using money
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Specially Designed Instructions
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Specially Designed Instructions (SDIs)
Universally required for all students through IDEA.
Actions by the TEACHER or THERAPIST not the STUDENT.
Directly address IEP goals and not 1:1 correspondence between goal and SDI.
Spans ANY domain on the IEP including: academic, social, behavioral, communication, and functional.
NOR lower standard but enables student to reach the highest standards.
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Specially Designed Instructions
Accommodations Modifications
Methods used to determine our approach to achieve student’s
goals.
DO NOT change the content. Supports to help students access general curriculum.
Change in expectations and content.
Graphic organizers with titles, words, labels, pictures.
Graph paper to help organize math facts.
Outline in place of essay for test.
Executive function and behavior support. Use of social stories and peer buddies.
Token reinforcement for behavior.
Projects substituted for written reports.
Breaking down tasks into manageable parts, step by step checklists
Tape record lectures Turning in film or video assignments instead of essay.
Use of mnemonics, visual supports
Ability to use computer for writing.
Questions on exam re-worded or word bank of choices given.
Specially Designed Instructions (SDIs)
Highlighter Tape
Rewordify.com (makes reading easier)
Textcompactor.com (shortens sentences)
Wiki Stix
Sticky Arrows
Personal Strategy List
Clear Plastic Covers
Pre-reading Guides
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Rewordify.com
Specially Designed Instructions (SDIs)
Offer digital options such as comic strips,
Infographics
Word banks on post-its
Cut up problems for scavenger hunt
Personal common error list
Timeline for completion (self-check)
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COLLABORATION
Establishing goals as a team Working toward common goals
Sharing expertise
Improving student outcomes
Griffin, 2017 suggests establishing collaborative student goals and data collection methods benefit students
Collaboration brings a holistic view of the student (Phillippo & Stone, 2006).
Synthesize different perspectives
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Meaningful Collaboration Through 2 Lenses
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TEACHERLearning Specialist
THERAPISTSpecialist in Activity Analysis
STUDENTAccess to LearningSupported
Wilson and Harris, 2018
Strategies Examples
Identify unique skill sets Joint projects based on professional interests and student needs (developing adapted materials)AAC, visual supports, activity analysis, positioning.
Find areas of common ground Professional skills and interests audit.
Strengths-based approach with both colleagues and students
Acknowledge the positive contributions others make to the team; recognize successes
DANCE rather than WRESTLE(Rollnick et al., 2008).
Use empathy to understand different perspectives. What motivates others?
Collaborate outside the ‘work’ of service delivery
Journal club, one time monthly have lunch. Community projects.
Address disagreements EARLY, OPENLY, with RESPECT
Communication, trauma-informed practices, parity. Where is tension?
ONE student at a time.Re-assess constantly
Start with likely successes. Alliances that lead to student outcome improvement.
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Big Change:
STRATEGIES EXAMPLES
Consider coaching and collaborative team approaches as effective alternatives todirect service delivery
Systems-wide andworkload approach
**next slide
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Systems-Wide Workload Approaches
UDL: Universal Design for Learning
Designed Leadership are defined by a true modeling of the UDL
framework, a call on leaders to be expert learners, engaging all
stakeholders, leveraging UDL as a district-wide decision-making
tool, and focusing on student outcomes.
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Degner, 2018
Massachusetts Educator Evaluation Framework
Designed to support and promote educators' continuous growth and professional learning.
The framework, which apply to both administrators and teachers throughout the state, is designed to:
Promote growth and developmentPlace student learning at the centerRecognize excellenceSet a high bar for professional teacher statusShorten timelines for improvement
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PARITY …… the Magic Word
Is there PARITY in the school budget?
Is there PARITY in the school staff?
Is there PARITY among students?
How should you build PARITY?
Discuss with a partner.
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Suggestions for Parity
Both names are listed on the student schedule.
Both names are listed on everything that goes home for that subject area that is co-taught.
Both names are on the grade report.
Both names are on any paperwork related to that subject or class.
Materials are shared between both teachers, including answer keys.
In the first few years of life, more than 1 million new neural connections are formed every second. After this period of rapid proliferation, connections are reduced through a process called pruning, so that brain circuits become more efficient. Sensory pathways like those for basic vision and hearing are the first to develop, followed by early language skills and higher cognitive functions. Connections proliferate and prune in a prescribed order, with later, more complex brain circuits built upon earlier, simpler circuits.
Goals and objectives do not state the actual intervention but what are you trying to achieve.
______ will hold 2 prone Belly stretches for at least 10 seconds, with 1 cue, 2 of 3
consecutive therapy sessions, by the end of the 3rd quarter.
Given two different S’cool Moves posters, __ will scan with eyes only in a left to right, top to bottom approach, performing the movements in the proper sequential order, 4 of 5 attempts with 1 prompt.
By the end of the school year, ___ will replicate crossing midline/bilateral coordination asymmetrical movements with 80% accuracy 3 of 4 sessions.
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Example: Posture While Seated
Given a desktop activity, ___ will demonstrate the ability to maintain an upright posture during a fine motor/class activity for __ minutes with cues/prompts/independently, __ out of __ observations/sessions/trials, by ___quarter/end of annual IEP.
Intervention:
S’cool Moves Belly Focus positions 1 time with OT and 1-2 times in class
Measure: Informal records and observation
How long holding poses at baseline & then at end of month/interim/end quarter?
How long sitting upright at desk, at baseline & then after received intervention?
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Example: Participation in School Activities
Self-Regulation: By the end of the school year, ___ will independently utilize a calming strategy to regulate behavior when attempting a frustrating activity (writing, math) 3 of 4 observations.
Play
Transition
Intervention:
Collaborating with and training teachers to utilize multisensory methods to promote literacy skills:
tapping with sight words and spelling words
using manipulatives, adding movement or music while learning
Therabands to promote spelling and phonetic learning
▪Observe, assess, fine-tune so we ‘won’t do THAT again.’
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Teach Forethought – Predict outcome
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What will finished
work look like?
How will I feel?Look back and reflect
Accommodation strategies:
▪Make the learning process as concrete and visual as possible.
▪Allow a child to dictate information to a “scribe” or parents
▪Use graphic organizers to provide visual prompts and help a student to organize their thoughts.
▪Use post-it notes and word webs to brainstorm essay ideas
▪Social stories geared to specific students
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Accommodation strategies:
▪Paired learning (students make up their own problem, swap and discuss/correct answers)
▪Peer tutor
▪Mnemonics (memory tricks)
▪Visual Posting of key information on strips of poster board.
▪Use a scoring rubrics to define what is to be included in class assignments and what a quality end product includes. Rubric can be written as a checklist.
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Let’s Play!
Time Management
Flexibility
Attention
Perseverance
Apps
ORGANIZATION ❑Checklists ❑Real-Simple❑Paperless ❑My Homework ❑The Homework App❑Remember the Milk ❑Hi Future Self ❑Organize:Me Personal Task Manager❑GTD Manager
CEBM Levels of Evidence Chart for Critically Appraisal
Want the highest level of evidence for an article used in your classroom
Systemic reviews are much more desired than single case studies
Capstone for OTD does NOT do research, but looks at existing research to help with a problem
PhD is when you DO research.
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CPGs Through AOTA
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AOTA website http://www.aota.org/Practice.aspx .Go to your area of practice and click on the "evidence-based practice" tab. Look for a "Practice Guidelines," which is typically in the first list.
Find the “TABLE OF RECOMMENDATIONS”, which stems from the systematic reviews: this will be where your focus is when you implement a recommendation. Here is where the tables of recommendations are in the guidelines:
Productive Aging Community Dwelling Older Adults, p. 56.
Older Adults with Low Vision, p. 50.
Autism spectrum disorder, p. 67.
Early Childhood: Birth through 5 Years, pp. 52-56.
Home Modifications, p. 36.
Driving and Community Mobility for Older Adults, pp. 56-58.
Adults with stroke, pp. 63-65.
Adults with traumatic brain injury, pp. 25-26.
Mental health in children, pp. 66-69.
Adults with neurodegenerative disorders, pp. 44-45.
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AOTA Website
Framework III
Turn to page 102 in your conference booklet.
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Pages 102-118
Evaluation According To Framework III
Evaluate- Select evaluation measures to determine
Performance skills: fine motor, visual motor, visual perception, sensory processing, social emotional and self-regulation abilities, social interaction
Occupational Performance: Self-care, IADL’s, handwriting, academic and work tasks, play, social participation, rest, sleep, leisure/interests
Coordinates hands with eyes during visual tracking
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Signs of Complex SPD:
Sensory MODULATION disorder
Problem regulating in response to input
Results in withdrawal of/negative responses
Signs:Upset by noises and
sounds Easily distracted by visual
stimuliDifficulty falling/staying
asleepHypersensitivity to
clothing
Sensory DISCRIMINATION disorder
Problem in recognizing/interpreting differences or similarities in qualities of stimuli
Signs: uses too much forceCrashes/bumps into objectsDrops or knocks things overAfraid of heightsPoor balance
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Pages 74-75
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OTD Why??
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✓Leadership✓Health literacy, diversity, cultural
competence, occupational justice✓Community practice✓Evidence-based practice✓Critically appraising the evidence✓Looking deeper✓Contributing to OT with the capstone
Bastable, S.B., & Doody, J.A. (2011). Behavioral objectives. In S.B. Bastable, P. Gramet, K. Jacobs, & D.L. Sopczyk, Health Professional as Educator (pp. 377-418). Sudbury, MA: Jones & Bartlett Learning.
Carnegie Mellon. (n.d.). Design & teach a course. Retrieved from http://www.cmu.edu/teaching/designteach/design/learningobjectives.html
Cline, J. (2012). Creating successful learning objectives. Retrieved from http://youtu.be/_woMKwBxhwU
Clark, D. (2015) Bloom’s taxonomy of learning domains. Retrieved from http://www.nwlink.com/~donclark/hrd/bloom.html
Effron, S. (n.d.). Bloom’s revised taxonomy. Retrieved from http://saraeffron.files.wordpress.com/2012/10/blooms-revised-taxonomy.jpg
References
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Illinois Central College. (n.d.). Revised Blooms taxonomy- verbs, materials/situations that require this level of thing, potential activities and products. Retrieved from http://icc.edu/faculty-staff/files/2014/07/ICC-Assessment-Revised-Blooms-Taxonomy.pdf
Jahn, B. (2011). Blooms taxonomy (revised) and writing SMART goals. Retrieved from http://youtu.be/CXqm1gwuTKQ
Louisiana State University Center for Academic Success. (2012). Bloom’s taxonomy. Retrieved from http://www.youtube.com/watch?v=Qfp3x_qx5IM
Plack, M. & Driscoll, M. (2011). Systematic effective instruction: Keys to designing effective presentations. Teaching and learning in physical therapy: From classroom to clinic (pp. 65-115). Thorofare, NJ: SLACK Incorporated.
University of Connecticut. (n.d.a.). Learning taxonomy- Krathwohl’s affective domain. Retrieved from http://assessment.uconn.edu/docs/LearningTaxonomy_Affective.pdf
University of Connecticut. (n.d.b.) Learning taxonomy- Simpson’s psychomotor domain. Retrieved from http://assessment.uconn.edu/docs/LearningTaxonomy_Psychomotor.pdf
Vanderbilt University. (n.d.) Bloom’s taxonomy. Retrieved from http://cft.vanderbilt.edu/teaching-guides/pedagogical/blooms-taxonomy/
Wilson, L.O. (2013). Anderson and Krathwohl: Bloom’s taxonomy revised. Retrieved from http://thesecondprinciple.com/teaching-essentials/beyond-bloom-cognitive-taxonomy-revised/
References
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CPG Resources
http://www.openclinical.org/guidelines.html#purposes - there is also a list of other websites at the end of the page for your consideration.
https://www.guidelinecentral.com/summary-intended-users/occupational-therapists (not all pertain to treatment in occupational therapy, but all refer to rehabilitative practices among either OTs or professional colleagues).
Australian clinical guidelines in OT http://www.clinicalguidelines.gov.au/browse.php?pageType=13&intendedUserCode=9&itemsPerPage=10&pageNumber=0&
Anderson, P.J. (2002). "Assessment and development of executive functioning (EF) in childhood". Child Neuropsychology 8 (2): 71–82
Anderson, R. Jacobs & P. Anderson (Eds). Executive functions and the frontal lobes: A lifespan perspective (24-48). New York:Psychology Press.
Balmer, K. (2012). Executive functioning activities at home. Retrieved from: http://nspt4kids.com/therapy/executivefunctioning- activities-at-home/
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21, 37–46.
Baron-Cohen, S., & Robertson, M. (1995). Children with either autism, Gilles de la Tourette syndrome or both: Mapping cognition to specific syndromes. Neurocase, 1, 101–104.
Baron-Cohen, S., Tager-Flusberg, H., & Cohen, D. J. (Eds.). (2000). Understanding other minds: Perspectives from developmental cognitive neuroscience (2nd ed.). Oxford, England: Oxford University Press.
Best, John R., and Patricia H. Miller. “A Developmental Perspective on Executive Function.” Child development 81.6 (2010): 1641–1660. PMC. Web. 2 July 2016.
Bock, Allison M.; Gallaway, Kristin C.; and Hund, Alycia M., "Specifying Links Between Executive Functioning and Theory of Mind during Middle Childhood: Cognitive Flexibility Predicts Social Understanding" (2015). Faculty Publications –Psychology. Paper 5. http://ir.library.illinoisstate.edu/fppsych/5
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for participation (241-261). Philadelphia: F.A. Davis Company
Brown, C. & Stoffel, V. C. (Eds.). (2011). Occupational therapy in mental health: A vision for participation. Philadelphia, PA:F.A. Davis Company.
Cantio, C., Jepsen, J. R. M., Madsen, G. F., Bilenberg, N. and White, S. J. (2016), Exploring ‘The autisms’ at a cognitive level. Autism Res. doi: 10.1002/aur.1630
Center on the Developing Child at Harvard University (2014). Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence. Retrieved fromwww.developingchild.harvard.edu.
Cramm HA, Krupa TM, Missiuna CA, Lysaght RM, Parker KH. (2013). Executive functioning: a scoping review of the occupational therapy literature. Canadian Journal of Occupational Therapy. 2013 Jun;80(3):131-40.
Clark, D. (2000). Learning styles & preferences. Retrieved from http://www.nwlink.com/~donclark/hrd/styles.html
Craig, F., Margari, F., Legrottaglie, A. R., Palumbi, R., de Giambattista, C., & Margari, L. (2016). A review of executive function deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 12, 1191–1202. http://doi.org/10.2147/NDT.S104620
Dawson, P. and Guare, R. (2010) “Executive Skills in Children and Adolescents, Second Edition”. New York: Guilford Press
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Learning Styles Online. (n.d.). Overview of learning styles. Retrieved from http://www.learning-styles-online.com/overview/
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