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Diamonsd 2018 2/27/18 Diamonds March 10, 2018 Unstuck and On Target: Improving Executive Function, On-Task and Flexible Behavior Lauren Kenworthy, PhD I receive royalties for Professor, Pediatrics, GW Medical School sale of Unstuck Director, Center for Autism Spectrum Disorders Children’s National Medical Center manuals and BRIEF forms. [email protected] Unstuck Team Ivymount Model Asperger Program/Take2 Summer Camp • Katie Alexander • Lynn Cannon • Monica Werner Children’s National Center for Autism Spectrum Disorders • Laura Anthony • Lauren Kenworthy • John Strang • Cara Pugliese Copyright 2011, 2014 Brookes 1 2/27/18 GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Functions (EF)? Ø EFs are fractionated and plastic 2. Why do they matter? Ø EFs are necessary for effective everyday functioning 3. Specific components of EF & accommodations Ø Flexibility, Organization, Planning/Working Memory problems 4. How can we treat EF problems in autism? Ø In everyday settings, with self regulatory scripts “The Unity and Diversity of Executive Functions” Initiate Working Memory PlanningInitiate Organization/IntegrationWorking Memory Plan/OrganizeTask Monitor Task Monitor Inhibit Flexibility Self-Monitor Emotional Control Inhibit Flexibility Self-Monitor Emotional Control Teuber, 1972; Gioia, et al 2002; 2016; Friedman & Miyake, 2017 2 2/27/18 GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Functions (EF)? Ø EFs are fractionated and plastic 2. Why do they matter? Ø EFs are necessary for effective everyday functioning Executive Dysfunction (Teuber, 1964): “The curious dissociation between knowing & doing” EF problems relate to: • Adaptive daily living skills • Academic learning • Locus of Control • Family stress • Adult outcomes 3 2/27/18 Adaptive Skills by Age Group (ASD n=421; Mean IQ =103) 105 100 95 90 4-5.99 85 6-7.99 80 8-9.99 75 10-11.99 12-13.99 70 Vineland Standard Score Standard Vineland 14-20 65 60 55 Communication Daily Living Skills Socialization Pugliese et al, Mean Domain Scores in Each Age Group 2015 Adaptive Skills by Age Group (ASD n=327) IQ 105 100 Age Adap9ve EF Behavior 95 90 4-5.99 85 6-7.99 80 8-9.99 75 10-11.99 12-13.99 70 Vineland Standard Score Standard Vineland 14-20 65 Age, IQ, Initiate IQ, Age, Initiate Age, Initiate and and Working and Working 60 Flexibility Memory Memory 55 Communication Daily Living Skills Socialization Pugliese et al, Mean Domain Scores in Each Age Group 2015, JADD 4 2/27/18 EF relates to autism sx & supports social learning • Joint attention: “early developing self-organizing facility” (Mundy, 2003) • Prolonged visual fixation in infants later dx’d with ASD, coincides with emergence of ASD behaviors (Zwaigenbaum et al, 2005) • EF predicts change in ToM (independent of age, language, NVIQ) (Pellicano, 2010) • Indirect “trickle-down” effect of EF training on TOM performance (Fisher and Happé 2005) and social skills (Kenworthy & Anthony et al, 2014) Looks Like Won’t… Could be Can’t Difficulty shifting Oppositional, Stubborn Avoiding overload Difficulty shifting Can do it if he wants to Lack of salience Impaired social cogni@on Self Centered Poor self monitoring Won’t put good ideas on Poor fine motor paper Disorganization Poor self monitoring Sloppy, erratic Overloaded Overloaded Won’t control outbursts Disinhibition Doesn’t care what others Impaired social cogni@on think Poor self monitoring Greene, 1998; Bernstein, 2000 5 2/27/18 GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Functions (EF)? Ø EFs are fractionated and plastic 2. Why do they matter? Ø EFs are necessary for effective everyday functioning 3. Specific components of EF & accommodations Ø FlexiBility, Organization, Planning/Working Memory proBlems Unstuck Philosophy: Accommodate, then Remediate Neurodiversity is a civil Overwhelmed people right people can’t learn can’t learn • Can’t vs Won’t • Predictability and structure • Make Big Picture Explicit • Talk Less, Write More (continued from front flap) Praise for $24.00 “An essential guidebook that will help all the creative, quirky, geeky, and Every person, Aspergian or not, has something diff be unique to offer the world, and every person has the be different wonderfully different kids to become successful in life.” —TEMPLE GRANDIN “I believe those of us with Asperger’s are here capacity to create strong, loving bonds with their for a reason, and we have much to offer. This friends and family. Be Different will help readers “For anyone who has difficulty fitting in, this book is fantastic.” • book will help you bring out those gifts.” Avoid Overload and those they love find their path to success. —TEMPLE GRANDIN, author of Thinking in Pictures Adventures of a Free-Range Aspergian n his bestselling memoir, Look Me in the Eye, JOHN ELDER ROBISON is “In a love poem to his wife, Pedro Salinas, the Spanish poet, wrote, John Elder Robison described growing up an author and frequent lecturer ‘Glory to the differences / between you and me.’ John Robison teaches us to with Asperger’s syndrome at a time when the about his life with Asperger’s. I celebrate differences like Salinas did, but also offers clear insight and valuable diagnosis didn’t exist. He was intelligent but so- He blogs for Psychology Today advice on how to cope with the challenges that being different can create. cially isolated; his talents won him jobs with toy and is an adjunct faculty mem- makers and rock bands but did little to endear him ber at Elms College in Chicopee, This book transcends the specific case of Asperger’s syndrome and be different to authority figures and classmates, who were put • Keep it Positive Massachusetts. John serves on is a lesson in humanity and the human condition.” e off by his inclination to blurt out non sequiturs committees and review boards —ALVARO PASCUAL-LEONE, M.D., Ph.D., Harvard Medical School and avoid eye contact. for the Centers for Disease Control and the National and Beth Israel Deaconess Medical Center By the time he was diagnosed at age forty, John Institutes of Health. He is currently involved in au- rent had already developed a myriad of coping strategies tism research and therapy programs at Harvard’s “Anyone with Asperger’s, if not everyone else, will derive knowledge and that helped him achieve a seemingly normal, even Beth Israel Deaconess Medical Center and Massachu- pleasure from the wonderful stories told in John Elder Robison’s newest book, highly successful, life. In Be Different, Robison shares setts General Hospital. John also sits on the science a new batch of endearing stories about his child- and treatment boards of Autism Speaks. His previous Be Different. Clearly, John is one of our community’s leading voices.” hood, adolescence, and young adult years, giving book, Look Me in the Eye, was a New York Times best- —MICHAEL JOHN CARLEY, author of Asperger’s from the Inside Out Adventures of a the reader a rare window into the Aspergian mind. seller and has been translated into ten languages. He and executive director of GRASP and ASTEP In each story, he offers practical advice—for Asper- lives in Amherst, Massachusetts. gians and indeed for anyone who feels “different”— Copyright © 2011 by Crown Archetype Copyright © 2011 by Crown Free-Range Aspergian “Be Different is a fascinating and unique guide for young people on how to improve the weak communication and Visit him at www.johnrobison.com. who may be struggling with autism and feel ‘out of sync’ with the social skills that keep so many people from taking Also available as an eBook world around them. John shares personal insights about growing up, full advantage of their often remarkable gifts. and on audio from Random House feeling apart from his peers, and learning to modify his socializing skills With his trademark honesty and unapologetic eccentricity, Robison addresses questions like: and harness his gifts to discover his path to a successful life.” • How to read others and follow their behaviors —MARK ROITHMAYR, president of Autism Speaks WITH PRACTICAL ADVICE when in uncertain social situations for Aspergians, Misfits, Families & Teachers • Why manners matter Jacket design: WHITNEY G. COOKMAN • How to harness your powers of concentration to Jacket photograph: COURTESY OF THE AUTHOR master difficult skills Author photograph: AUGUSTEN BURROUGHS JOHN • How to deal with bullies ELDER • When to make an effort to fit in, and when to U.S. $24.00 ROBISON PSYCHOLOGY—AUTISM/FAMILY & RELATIONSHIPS John Elder Robison embrace eccentricity Crown Archetype I SBN 978-0-307-88481-7 • How to identify special gifts and use them to New York 52400 3/11 author of the New York Times bestselling LOOK ME IN THE EYE your advantage www.crownpublishing.com Printed in the U.S.A. 9 780307 884817 (continued on back flap) 6 2/27/18 Ini$ate Working Memory Planning Organiza$on Task Monitor Inhibit Flexibility Self-Monitor Emotional Control Asperger’s is like a vise on your brain. And each unexpected event is like another turn on the vise…it just keeps building until you feel like you’re going to explode. Sometimes when you explode, it comes out the wrong way. - A young student with ASD (Rumsey, 1985; Hill, 2004, Kenworthy et al, 2008) 7 2/27/18 What does cognitive inflexibility look like? Can’t or Won’t? • Accept feedback, different opinions, ideas • Transition • Handle frustration • Start something they don’t want to do • Stop meltdowns • Stop doing something even they have
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