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Defining Executive Functioning CAN’T vs. WON’T:

■ There is no universal definition of Executive Executive Functioning and Functioning. It’s Effect on Behavior: ■ These aspects of behavior are not easy or straightforward to observe, measure, or Assessment and Treatment define. ■ Disability Categories you may see used: Theory and Practice  Neurological  Learning Disability David Gotthelf, Ph.D., NCSP  Emotional  Health (ADHD)

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Why look at Executive Functioning? Executive Functioning is Critical to Human Development ■ Children we see with various disorders also exhibit executive dysfunction, which may ■ “Crowning achievement of human help define and explain problematic development” behaviors. ■ Separates us from animals ■ Is there a behavioral component that might suggest an attention or some other ■ Allows us to think about ourselves, social disorder? relationships, and what future may bring ■ Allows for planning and delayed ■ Executive Functioning may explain behavior not easily measurable. gratification

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Executive Functioning: Developmental Aspects

■ Executive functioning unfolds as we ASPECTS OF EXECUTIVE mature, (Denckla), resulting in: FUNCTIONING

❑ Increasing Independence

❑ Maturation of Self-Regulation

❑ Development of Self-Generated Productivity

❑ Managing Emotional Influences

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Executive Functioning: Memory

• Short term • Simple • Working • Complex • Delayed • Semantic • Long term • Contextual • Recognition • Conceptual

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Managing, Storing, Retrieving Memories Executive Functioning:

Our Two Memory Systems Processing Speed & Effortful Control ■ Visual-motor speed ■ Short-term visual memory ■ Visual scanning ■ Effortful control: The ability to avoid distraction while working quickly on a task.

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Executive Functioning: Attention Executive Functioning: Behavior Regulation ■ Effortful Control There is a strong connection between ■ Auditory response control the frontal cortex and the amygdala. ■ Visual response control ■ Ability to inhibit behaviors ■ Sustained auditory attention ■ Ability to shift easily from one task to ■ Sustained visual attention another ■ Impulse control ■ Emotional control

❑ Anxiety management

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Executive Functioning: What conditions may be at risk for Metacognition Executive Dysfunction?

■ Ability to initiate tasks independently ■ ADD/ADHD ■ Working memory ■ Anxiety Disorders ■ Planning and organization of assignments ■ Autism Spectrum Disorders (ASD) ■ Organization of Materials ■ Traumatic Brain Injury ■ Self-monitoring of progress on a task ■ Central Auditory Processing Disorder ■ Language Processing Disorder ■ Specific Learning Disability

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And what situations often result in Computer and Phone Usage

Executive Dysfunction? ■ We need to address this as a major problem in its own right. ■ Computer and Computer/Phone Usage ■ The challenge is the novelty of computer ■ Gaming games and social media overwhelms tasks ■ Poor Sleep Hygiene and activities that require sustained attention ■ Substance use: marijuana to fewer stimuli and stimuli that do not ■ Multitasking change frequently, e.g. Reading vs. YouTube ■ The screen itself Let’s look at each of these: ❑ The blue underlying color of screens ❑ All color as a stimulating factor.

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Computer Usage and Screen Time Computer Addiction as Defined by (APA Monitor on Psychology, May 2020) the World Health Organization Average use per day, other than schoolwork or homework: ■ 8 to 12-year-olds: 4 hours 44 minutes ■ The WHO (World Health Organization) has ■ 13 to 18-year-olds: 7 hours 22 minutes put “Gaming Disorder” in its latest diagnostic manual. Other key findings: ■ ■ Children under 2 don’t learn from screens as well as It’s important to note that the existence of a from live interactions. gaming disorder does not mean doctors are ■ Co-viewing with parents protects young kids from many saying games are inherently bad or of the downsides of screen time. dangerous. ■ Meeting sleep, screentime, and physical activity guidelines is associated with the best mental health ■ Video games can be an effective learning outcomes, but few teens meet all three. tool, and they can also just be fun.

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Gaming Disorder (ICD-11 June Zoom Fatigue: the latest challenge 2018) Defined Behaviors: ◼ Videoconferencing does not show us the whole picture of what is going on in our conversations. We ■ Impaired control over the onset, frequency, miss nonverbal cues given by other parts of the body. intensity, duration, termination, or context of gaming ◼ Pressure is increased because the camera is always on you. This means paying attention for longer ■ Increasing priority given to gaming to the periods of time; mentally exhausting. extent that gaming takes precedence over ◼ Digital eye strain contributes to feelings of exhaustion. other life interests and daily activities ◼ Physical surroundings may contribute to screen ■ The continuation or escalation of gaming exhaustion, e.g. needing to maintain a fixed position despite the occurrence of negative to stay in view of the camera leads to physical consequences soreness.

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Fighting Zoom Fatigue: 5 Ideas Sleep Hygiene

◼ Make small adjustments on how we sit to keep ■ Sleep hygiene is a major problem for young blood pumping but not distracting others. adults, teens and younger students. ◼ Try not to schedule back-to-back meetings or ■ Lack of sleep significantly affects executive include breaks within a meeting so that there is functioning and learning. an opportunity to get up and move around. ■ Causes: ◼ Take our eyes off the screen for a moment and ❑ Computer usage and Texting: Going to bed with focus on an object further away. one’s phone is a major problem. ❑ Longer and more demanding schedules of ◼ Take notes using pen & paper, which gives an students: academic day, sports, and other excuse to look elsewhere to reduce eye strain. activities are affecting sleep. ◼ Join meetings just by phone, eliminating camera. ❑ And now: The lack of structure during the day.

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Marijuana Use The Newest Challenge: Executive Functioning and COVID-19 ■ Now that marijuana is legal for recreational ■ Major challenges given that more students use, we must give this additional concern. may be struggling with the organizational ■ Research indicates that marijuana has a demands of learning at home. significant negative effect on working ■ Many students are in fact doing well given the memory/executive functioning, particularly lack of structure and greater time flexibility. in growing brains. ■ Many others are struggling due to the numerous distractions at home and chances ■ This means anyone under 25 should to engage in multi-tasking: trying to do NOT use marijuana. several things at once.

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Multitasking: Is it possible? Multitask Test, Step 1: One at a time

■ Most neuroscience research notes the brain ■ Draw two horizontal lines on a piece of paper doesn’t really do tasks simultaneously but and then have someone time you as you carry rather switches quickly between tasks. out the two tasks that follow: ■ There is some validity to multitasking ■ On the first line, write:

regarding doing an automatic and an explicit ❑ I am a great multitasker task, e.g. walking and talking. ■ On the second line: write out the numbers 1- ■ But doing two school related tasks, e.g. using 20 sequentially, like those below:

the computer and listening to the teacher at ❑ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 the same time is for all practical purposes ■ How much time did it take you? impossible.

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Multitask Test, Step 2: Multitasking

1. Draw two more horizontal lines. 2. Write a letter on one line, then a number on Assessing Executive Functioning the line below, then the next letter in the sentence on the upper line, then the next number in the sequence, changing from line to line. So: you write the letter "I" then the number "1" and then the letter "a" and then the number "2", completing both lines. 3. Have someone time you. How fast were you?

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How should we assess Executive Classroom Observation Functioning? ■ Only required for determining SLD eligibility ■ Classroom Observations but… ■ Parent and Teacher Questionnaires ■ Behavior Rating Scales ■ It can be an important component for assessing Executive Functioning. ■ Standardized Diagnostic Testing

■ Even if you don’t have to do the classroom Let’s look at each of these: observation, you should do it anyway.

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Questionnaires Examples of Items from Teacher and Parent Questionnaires: ■ Teachers are required to complete a student questionnaire as part of a special ■ Resists or has trouble accepting a different education evaluation. The state has a form way to solve a problem with schoolwork, to use, but it can be revised and made friends, chores, etc. more comprehensive. ■ Becomes upset with new situations. ■ Parent questionnaires can be very helpful, ■ Acts upset by a change in plans. but they are not legally mandatory. ■ Is disturbed by a change of teacher or class. ■ Resists change of routine, food, places, etc.

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More Examples of Items from Teacher More Examples from Teacher and and Parent Questionnaires: Parent Questionnaires:

■ Does not think before doing. ■ Does not bring home homework assignments ■ Interrupts others. sheets, materials, etc. ■ Is impulsive. ■ Has good ideas but cannot get them on ■ Gets out of seat at wrong times. paper. ■ Gets out of control more than friends. ■ Forgets to hand in homework, even when ■ Acts too wild or “out of control.” completed. ■ Has trouble stopping or attenuating his/her ■ Gets caught up in details and misses the big actions. picture.

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EF Rating Scales: The BRIEF2 BRIEF2 Indexes and Scales ■ Behavior Regulation ■ Rates executive functions at home and in ❑ Inhibit school. ❑ Self-Monitoring of behaviors ■ Specific versions for parents, teachers, ■ Emotion Regulation and students. ❑ Ability to shift from one activity to another ❑ Emotional Control ■ Very helpful in breaking down EF into clear and understandable groupings. ■ Cognitive Regulation ❑ Initiate ■ Be aware: The BRIEF2 doesn’t cover all ❑ Working Memory possible factors that may result in ❑ Plan/Organize

behaviors resembling EF. ❑ Organization of Materials

❑ Task-Monitoring

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Rating Scales Specific to ADHD BASC-3: Another scale to use.

■ Addresses a greater number of clinical ■ Connors ADHD Scale behaviors, including attention and ■ Brown ADD Scale hyperactivity. ■ ADHD IV Scale ■ Covers a broader range of behavioral functioning than the BRIEF and other scales. These scales focus on behaviors associated ■ Not as comprehensive as the BRIEF in with ADHD, although the first two also cover covering executive functioning, but: behaviors associated with executive ■ The BASC-3 may uncover emotional factors functioning. influencing executive functioning.

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Questions to consider: Standardized Testing: Necessary?

■ Classroom observation? Who will do it? ■ If questionnaires and rating scales are completed, is there a need for diagnostic standardized testing? “No” vs. “Yes” : ■ Which scales should be given to parents, to teachers, and to para-professionals; And how ❑ No: Testing is redundant and may not always many scales should be given? identify reasons for behaviors. ❑ Yes: Rating scales are subjective, while standardized tests give a more accurate ■ Will school staff and parents complete rating diagnostic profile, and schools may want it for questionnaires and rating scales in a timely legal coverage.

manner? ❑ Yes but: How much is really needed?

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COVID-19 and Testing: Some options Testing Considerations ■ Suspend testing: Denying testing unethical? ■ Online Tele-testing; several problems: ■ Standardized tests are done in a ❑ Technical issues structured situation, arguably not a high ❑ Clinical &Ethical issues: Validity, confidentiality demand environment for executive ■ But is bad data worse than no data? functions, so behavioral problems related ❑ Legal issues: copyright laws, legal credibility to E.F. may not be observed. ■ Plastic shield between the tester and testee. ■ There is no singular disorder of Executive ❑ But tester and testee still breathing the same air. Dysfunction, so the tests may not ■ Social distancing: Use of iPads. Wear masks. specifically determine this. ■ The 2-office model. Can schools do this?

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Standardized Testing: More issues

❑ Neuropsychological Evaluation: Considered necessary by many parents & professionals EXECUTIVE for the assessment of executive functioning. FUNCTIONING WITHIN ❑ Not all neuropsychological tests are highly correlated to executive functioning. Some SPECIFIC CONDITIONS tests are better than others. Examples: ❑ Rey-Osterrieth Complex Figure (ROCF) ❑ Wisconsin Card Sort Test (WCST) ❑ D-KEFS: Trails; Verbal Fluency; Color-Word; Twenty Questions; Tower

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ADHD: Attention Deficit Attention Deficit Hyperactivity Hyperactivity Disorder Disorder-Inattentive Type ■ May sometimes be overlooked when there ■ Longstanding history of attentional and is not a high activity level, at least early behavioral control difficulties including on. hyperactivity, impulsivity, and problems ■ Difficulty sustaining attention. sustaining attention in school. ■ Working Memory problems resulting in ■ Problems may be first noted in kindergarten, what may appear at first as becoming more pronounced in second grade, Comprehension problems. including difficulties with peer relationships. ■ Historically has been overlooked in girls, but this has improved.

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Severe Executive Dysfunction Asperger’s Syndrome

■ Academic performance declines over ■ Difficulty with social skills. time, starting in middle school, and ■ Student may have characteristics of ADHD. worsening in high school. ■ Anxiety is another concern, e.g. OCD. ■ Average to above average intellectual ■ May not always respond to medication. ability, but poor completion of ■ Difficulties appear early in life. assignments. ■ Overly focused on certain subjects. ■ Loses or forgets homework. ■ May be strong in reading and spelling. ■ Easily overwhelmed.

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Mood Dysregulation

■ Often overreacts to change in routine. ■ May have characteristics of ADHD. INTERVENTION AND ■ Anxiety is often another concern. MANAGEMENT ■ Overly focused on certain subjects. ■ May have strong intellectual and academic skills: The “2E” student.

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Two Underlying Assumptions: The Ultimate Goal: 1. Many students would rather be ■ To establish regular behavioral and seen as “bad” rather than “dumb.” cognitive routines to maximize This takes the focus off their independent, goal-oriented problem inability to do the work. solving and performance. 2. The idea underlying being a “coach” is to help students be successful rather than thinking that they are just lazy.

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EF: Changing Curriculum Demands Dimensions of Intervention

■ Personal: ■ EF processes underlying most academic work ❑ Understand student strengths and weaknesses. generally begin in the 4th grade. ❑ Teach strategies in small groups and progress th ■ At 4 grade on up, there is an increasing need to large groups. to coordinate multiple sub-processes: ■ Environmental: ❑ Planning time. ❑ Structure situations and assignments, using ❑ Organizing and prioritizing information. lists, schedules, visual cues, educational aids. ❑ Distinguishing main from subordinate ideas. ■ Activity: ❑ Monitoring one’s progress. ❑ Design assignments and activities so that they ❑ Ability to reflect one’s schoolwork. have a clear organization and structure.

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Basic Principles of Intervention Fixed Mindset vs. Growth Mindset Two ways of thinking: (Carol Dweck) ■ Proposed Outcomes: Fixed Mindset: Growth Mindset: Intelligence can’t change Intelligence is developed ❑ Demonstrate purposeful, goal-directed activity. ■ Challenges: Avoid them. ■ Challenges: Embrace change. ■ Obstacles: Give up easily. ■ Obstacles: Persist in the face ❑ Display an active problem-solving approach. ■ Effort: See effort as fruitless of of obstacles. worse. ■ Effort: See effort as the path to ❑ Exert self control. ■ Criticism: Ignore useful mastery. ❑ Demonstrate reliable and consistent negative feedback. ■ Criticism: Learn from criticism. behavior and thinking. ■ Success of others: Threatened ■ Success of others: Find by success of others. lessons and inspiration. ❑ Demonstrate positive self-efficacy. The result: We may plateau The result: We may reach ❑ Exhibit an internal locus of control. early and achieve less. It means higher levels of achievement. It we can’t change. means we have much greater free will.

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The Power of Habit: Creating Good Habits The Eisenhower Box Duhigg’s 4 Step Framework URGENT NOT URGENT DO DECIDE ■ Identify the routine: IMPOR- Do it now. Schedule a time to do it. TANT • Exercising ❑ Cue→ Routine → Reward • Assignments due today or • Calling family and friends tomorrow • Researching articles ■ Experiment with rewards (Timing is everything) • Getting to class on time • Long-term assignments • Social activities ■ Identify and isolate the cue POSTPONE DELETE ❑ 1. Location 2. Time 3. Emotional State Who can do it for you? Eliminate it.

❑ 4. Immediately preceding action(s) NOT • Answering certain emails or texts • Watching television or You- IMPOR- ■ Have a plan to make this automatic: Tube TANT • Checking social media ❑ When I see a CUE, I will do a ROUTINE, in order • Playing computer games • Playing or watching video to get a REWARD. games

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Accommodations vs. Modifications IEP/504 EF Interventions

■ Accommodation: Change in course, ■ Rather than specific academic curriculum standard, or test (prep, location, timing, “content,” these goals focus on the development scheduling, expectations, responses) of a learning and/or problem solving “process” that allow participation without lowering designed to enhance the efficient learning and performance standards. memory of academic information. ■ Emphasis of support is on teaching, modeling, and cueing an approach to self-management ■ Modification: A change that does lower through active planning, organization, and standards or expectations. monitoring of work.

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Long Term Goals for an IEP One Behavioral Goal Example: Four questions students should ask daily

■ “The student will independently employ a systematic learning/problem solving method 1. What assignments do I need to work on (Goal-Plan-Do-Review system) for tasks that and in what order will I do them? involve multiple steps and/or require long-term 2. Where will I do those assignments? planning.” 3. When will I start work on those ■ Domain specific goals and objectives are then assignments? articulated. 4. About how much time will I need for each ■ For younger children, preface with “With directed assistance,…….will….. one?

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Non-Academic Interventions for Medications: Who prescribes? Who monitors? Executive Functioning and ADHD: Popular meds students may be taking:

■ Medication RConcerta Adderall ■ Stress and anxiety management Vyvanse Ritalin (Methylphenidate) ■ Exercise • These medications may be prescribed by a variety of ■ Neurofeedback practitioners: pediatrician, nurse practitioner, nurse practitioner trained specifically in the area of psychological ■ Working memory training medications; psychiatrist. • A major question is whether any of these practitioners have training and experience in working with children with ADHD ■ Should these be used in school? If so, and/or executive functioning issues. • Other questions: What about the side effects? Who when, how, and who is in charge? monitors this in school?

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Stress Management Meditation Helps in Several Ways

■ The idea is that if we help students with As little as 30 minutes a day of meditation: executive functioning challenges better manage their anxiety and stress, they will function better ■ Reduces mind wandering in school. ■ Decreases stress

■ Improves performance on tests ■ Examples: ■ Increases sense of happiness ❑ Mindfulness: Slow breathing, Yoga ■ Increases social closeness ❑ Apps: Calm; Breathe2Relax; HeadSpace; Smiling Mind

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Exercise Neurofeedback

■ Exercise benefits both executive functioning ■ The hypothesis: Students with executive and learning (Ratey, 2008). dysfunction and/or ADHD are not generating ■ Even short, moderate, regular exercise can appropriate brainwaves associated with be beneficial. sustained attention and other aspects of EF. ■ Consider: Working memory has a limited ■ Newton Public Schools pilot study completed capacity that can overload if too much at middle school level found improvement in information is given at once. executive functioning and attention following the use of neurofeedback.

■ Question: Whatever happened to recess?

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Working Memory Training The Latest Behavioral Strategy:

■ The premise is that improvement of working Virtual Reality memory will improve general executive ■ Virtual Reality can help kids learn attention functioning and behaviors related to ADHD. skills in a “real” environment. ■ Examples: ■ The immersive environment of Virtual Reality ❑ Cogmed can promote sustained focus and attention, ❑ Lumosity although some kids can get over immersed ❑ Cogni Fit and have difficulty leaving it. ❑ Dual N-Back (the best one): ■ Virtual Reality can create “game” scenarios http://brainworkshop.sourceforge.net/download.html to promote practice in sustaining attention. ■ The problem is that the research is not strong in terms of any of these approaches being effective. ■ Research is limited but seems positive.

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Thinking of the Future: Conclusions

Executive Functioning & College ■ We need to take a leadership role in both assessing and addressing issues related to ■ How would the issues presented today be executive functioning. manifested at the college level? ■ We can quantify certain behaviors. ■ What sort of services and support could and ■ We can determine how well teachers and should be offered to students? parents agree on how the student is viewed ■ What should professors know and do about and how the student views him/herself. executive functioning? ■ We can make concrete suggestions for management.

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References and Resources ■ Bones, Bobby (2018) Fail Until You Don’t: Fight, Grind, Repeat, Dei Street Books ■ Brown, P.C., Roediger, H.L., McDaniel, M.A. (2014) Make It Stick, The Science of Successful Learning, Harvard U. Press ■ Buron, Kari & Curtis, Mitzi (2012) The Incredible 5-Point Scale, AAPC Publishing, Shawnee Missin, KA ■ Dawson, Peg & Guare, Richard (2009) Smart but Scattered Guilford Press, New York ■ Duhigg, Charles (2014), The Power of Habit: Why We Do What We Do in Life and Business, Random House, New York ■ Dweck, Carol (2007) Mindset: The New Psychology of Success, Ballantine Books, New York ■ Minahan, Jessica and Rappaport, Nancy (2012) The Behavior Code, Harvard Education Press, Cambridge, MA

■ https://www.wikihow.com/Study-More-Effectively

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