Helping Students Cultivate Their Executive Functioning Donna Thiele, Psy.D., Lic., BCBA-D Donna Thiele Psychological Consulting the Institute for Children with Autism

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Building Independence: Helping students cultivate their executive functioning Donna Thiele, Psy.D., Lic., BCBA-D Donna Thiele Psychological Consulting The Institute for Children with Autism

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©2020 Donna Thiele Psychological Consulting 1. Executive functioning challenges are only found in those with disabilities 2. Social narratives, behavioral skills training, and Pre- environmental arrangement are interventions that have proven benefits to those with executive Assessment: functioning challenges. True or False 3. Executive functioning challenges are permanent and cannot be remediated. 4. Executive functioning is not as good as IQ when it comes to predicting school success. 5. Executive functioning challenges can affect many dimensions of an individual’s life, including their job, marital status, and mental health.

Define executive functioning skills and list behavioral manifestations of executive functions Learn the connection between executive functions and independent behavior Describe assessment of executive functions

Explore evidence-based practices for enhancing executive functions –assimilations and accommodations Goal development for executive functions and progress monitoring

• You are enrolled in a college and feeling the pressure of the end of the semester. Several things are due at once and the pressure is ON! What do you do first and why? Can you do everything? How do you decide? • 10- page double-spaced essay on the French Revolution due in 4 days worth 40% of your grade • Quiz tomorrow on concepts of physics worth 10% of your grade • Class presentation on a topic of your choice in psychology worth 30% of your grade and requiring you to speak and have a powerpoint for 15 minutes • You promised your roommate you would drive her to the train station so she could get home for the holiday weekend • You work for the school yearbook and they need those pictures from the last football game ASAP This Photo by Unknown Author is licensed under CC BY-SA

This Photo by Unknown Author is licensed under CC BY independence [ in-di-pen-duhns ]

Noun freedom from the control, influence, support, aid, or the like, of others.

• Independence is not defined as never needing help. Instead, it is knowing how to find help and information in a variety of contexts with novel people, places, and materials. • Use of naturally occurring supports to complete activities. These include use of teacher and peers (not overuse), use of visual supports

This Photo by Unknown Author is licensed under CC BY-SA

• a set of cognitive processes that are necessary for the cognitive control of behavior: selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals. • Executive functions gradually develop and change across the lifespan of an individual and can be improved at any time over the course of a person's life. • EF takes effort, it is not automatic and in fact is meant to counteract those responses that would otherwise be automatic and typically ill- advised. (Diamond, 2013) This Photo by Unknown Author is licensed under CC BY

This Photo by prefrontal cortex Unknown Author is licensed under CC BY

• Self-awareness centers on self-directed action—an awareness of what you are doing. • Inhibition is impulse control and self-restraint. It acts to stop thinking and behavior and redirects not working successfully or acting harmfully. • Nonverbal working memory centers on self-directed sensing, mental imagery, and the awareness of time. It guides behavior by memory and anticipation—a map to orient thought and action toward future goals. • Verbal working memory allows for the preservation of a limited amount of speech-related information for use. It can show up as talking to oneself either out loud or silently. • Emotional regulation involves modulating feelings that arise when evoked by notable events. • Motivational regulation involves self-directed motivation. Internal stimulation, not needing constant guidance from others, is the driving force. • Planning and problem-solving: This executive function innovates a plan that can be refined, reformulated, and updated, so that trial This Photo by Unknown Author is licensed under CC BY and error sharpen it toward efficacy.

©2020 Donna Thiele Psychological Consulting (Ninivaggi, F. 2020) Behavioral manifestations of executive function Easier to measure (behavioral Hard to measure manifestations) • Attention • Completed work, participation • Planning • Use of planner, copying down • Emotional regulation homework, use of agenda book • Displaying a reaction appropriate to the “size” of the problem, decreased recovery time in tantrum behavior

This Photo by Unknown Author is licensed under CC BY-SA Hot and Cold EF

Framework of executive function processes, adapted from Chan et al. (2008) and McDonald (2013) in (Zimmerman, Ownsworth, O'Donovan, Roberts, & Gullo, 2016)©2020 Donna Thiele Psychological Consulting Hot EF example- The marshmallow twist

• The “marshmallow” test is a classic test of inhibition and delay of gratification for a larger reward. • (Zelazo, 2019)- decision when marshmallow was for someone else (not affected by emotion), or themselves

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• Record review of grades, observations, Informal behavior rating scales, interviews,

• IQ testing Formal • Normed EF scales

This Photo by Unknown Author is licensed under CC BY-SA-NC Formal Assessments

• Behavioural Assessment of Dysexecutive Syndrome (BADS) • Iowa gambling task • Behavior Rating Inventory of Executive Function(BRIEF). Ages 2- • Jansari assessment of Executive Functions (JEF)[77] 90 covered by different versions of the scale.[71][unreliable medical source?] • Kaplan Baycrest Neurocognitive Assessment (KBNA) • Barkley Deficits in Executive Functioning Scales (BDEFS)[72] • Kaufman Short Neuropsychological Assessment • Behavioral Dyscontrol Scale (BDS)[73] • Paced Auditory Serial Addition Test (PASAT) • Comprehensive Executive Function Inventory (CEFI) • Pediatric Attention Disorders Diagnostic Screener(PADDS) • CogScreen[74][unreliable medical source?] • Rey-Osterrieth Complex Figure • Continuous Performance Task (CPT) • Ruff Figural Fluency Test • Controlled Oral Word Association Test (COWAT) • Stroop task • d2 Test of Attention • Tasks of Executive Control • Delis-Kaplan Executive Function System (D-KEFS) • Test of Variables of Attention (T.O.V.A.) • Digit Vigilance Test • Tower of London Test • Figural Fluency Test • Trail-Making Test (TMT) or Trails A & B • Halstead Category Test • Wisconsin Card Sorting Test (WCST) • Hayling and Brixton tests[75][76] • Symbol Digit Modalities Test

▪ Acquisition/Skill deficit – Skills the client cannot perform. ▪ The client lacks the knowledge for executing the skill ▪ The client may be missing a step in a sequence ▪ ~ Can’t do

Assessment ▪ Performance deficit – Skills the student can, but does not perform as a result of: ▪ not knowing when to use skill ▪ inability to adjust skill to specific social situations ▪ lack of proficiency with skill ▪ competing inappropriate behaviors: skill is not as efficient or effective as problem behaviors ▪ ~ Won’t do

Non-verbal Core functions working memory Working Memory Verbal working of EF memory

Planning and Cognitive problem solving Flexibility Self-awareness Self-motivation

Inhibition is impulse control and self-restraint. It acts to stop thinking and behavior and redirects not working successfully or acting harmfully.

Positive example: Sara’s ball rolls down the driveway into the street, she stops and looks both ways. What does it look like? Negative example: Arthur’s friends laugh when he accidentally drops a French fry, he shakes all the rest of his French fries out onto the floor.

How is it connected to independent functioning? If an individual cannot delay gratification or put aside temporary pleasure for long term gain, that individual will continue to come into contact with negative consequences in the school and adult system that hinder their liberty. Some children may speed through schoolwork

Emotional regulation involves modulating feelings that arise when evoked by notable events.

Positive example: Gianna decides not to send an angry text to her boyfriend What does it look like? Negative example: Janet has a size “8” reaction to a size “2” problem (breaking a favorite pencil)

How is it connected to independent functioning? Children and adults who do not display appropriate self-control will require others to help them formulate and maintain friendships. They are at risk for mental health diagnoses and school and community contingencies that may hinder liberty.

©2020 Donna Thiele Psychological Consulting • Nonverbal working memory centers on self-directed sensing, mental imagery, and the awareness of time. It guides behavior by memory and anticipation—a map to orient thought and action toward future goals. Executive • What does it look like? Functions- • Positive example: Remembering where you left your keys Nonverbal • Negative example: Forgetting how to get to your working colleague’s house

memory • How is it connected to independent functioning? Students may require an aide or use of more restrictions to help them navigate the school day, parents may limit independence due to fears of “making it” in the world

Verbal working memory allows for the preservation of a limited amount of speech-related information for use. It can show up as talking to oneself either out loud or silently.

What does it look like?

• Positive example: Karen is the best waitress in the restaurant, she never needs to write down orders. • Negative example- When Javier is given multiple directives by the teacher, he tends to shut down and not complete them. How is it connected to independent functioning? Future education and career opportunities may be limited by inability remember verbal directions and information, students can be stigmatized and left out because they forget names, game rules, etc.

©2020 Donna Thiele Psychological Consulting • Planning and problem-solving: This executive function innovates a plan that can be refined, reformulated, and updated, so that trial and error sharpen it toward efficacy. Executive Functions- • What does it look like? Planning and • Positive example: Brian takes into account potential school problem closures and changes his work schedule to be with his kids • Negative example: Alexei waits until the last minute to send solving out Christmas cards and they don’t get there in time

• How is it connected to independent functioning? Those who cannot plan and solve problems require the use of supports to help them do so which constricts liberty and independence, career and education options may be limited

Self-awareness centers on self-directed action—an awareness of what you are doing.

Positive example: When Nancy plays tennis, her concentration is entirely on the game and never on the stress of work What does it look like? Negative example: Kevin tends to overeat at lunch, he wolfs down his food and doesn’t even remember tasting it.

How is it connected to independent functioning? Those with self-awareness are dependent on others for feedback and progress, goals will need to be set by outside entities.

This Photo by Unknown Author is licensed under CC BY-SA-NC

Motivational regulation involves self-directed motivation. Internal stimulation, not needing constant guidance from others, is the driving force.

Positive example: Cynthia gets up every day to train for the 5K What does it look like? Negative example: Maxine is only now finding out that she has to start studying because she is failing

How is it connected to independent functioning? Students who display decreased ambition and “drive” are given less opportunities (and thus less practice) and so they may require future training and support to make up ground with their peers.

What exactly DOES “Evidence- based Practice (EBP)” mean?

Staff training EBP’s- In addition Student seminars (Dawson, n.d.) Peer coaching

Outside presentation/consultation by experts to school systems

Modeling

Rehearsal

Feedback

Behavioral Skills Training

Describe the skill Why is it important to use this skill? When is it important to use this skill? With whom is it important to use this skill? Where is it important to use this skill? What conditions should you NOT use this skill?

Demonstrate how the skill looks when it is performed correctly.

Make the conditions match the conditions that the skill should be performed in as closely as possible.

Allow the learner to practice the skill and build fluency.

Take data or detailed notes as to how the skill progresses with practice.

Deliver positive and constructive feedback

Focus on one item at a time so as not to overwhelm or punish the learner

Time management: How Planning Problem: You Organization Problem: long do you think it would have a lot of homework What are three ways you take you to read 2 and soccer practice at can stay organized when chapters in a book? How 6pm. What can you do? you do your homework? do you know?

Emotional regulation: The Non-Verbal memory: How Verbal memory: How can lunchroom is too loud and could you remember the you remember the name you are afraid you are place where you parked of the host at a party? going to lose control- what your car? can you do?

©2020 Donna Thiele Psychological Consulting • Visual supports • Power cards EBP- • BST • Environmental modification (e.g. Inhibition “blackout” time for hw and test taking) and • Teach in times of non-crisis regulation • Teach flexibility skills • Exposure and Response Prevention for anxiety

• Self-monitoring of behavior • Check in/Check out • Social Thinking. (2016). Socialthinking.Com. https://www.socialthinking.com/Product s/superflex-superhero-social-thinking- curriculum • Everyday speech

©2020 Donna Thiele Psychological Consulting • ● Go-Ahead-Forget-It-Glitch, who lurks in our memory, preventing us from remembering things like writing down our assignments, or keeping track Mastermind of important dates • ● Go-Ahead-Lose-It-Glitch, who tricks us into “Organization misplacing things and messing up our backpack. • ● Time Bandit, who tries to convince us to ignore Glitches” (Gallagher clocks and calendars or any tool to help us keep et al., 2018) track of when things are due. • ● Go-Ahead-Don’t-Plan-It Glitch, who tells us it’s okay to wait until the last minute to start on that assignment

©2020 Donna Thiele Psychological Consulting ©2020 Donna Thiele Psychological Consulting • Memory • Mneumonics EBP- • Reduce multi-tasking Nonverbal • Engage in memory task practice working (next slide) memory • Use accommodations (e.g. apps)

• How many boats are in the picture? • How many kids have their mouths open? • Is the structure on the land (A) a house, (B) a church, (C) a tent, or (D) a water tower? • How many ducklings are in the picture? • Is anyone wearing a green shirt? • Is the shape on the foremost boy’s shirt (A) a circle, (B) a square, (D) a crescent, (E) a star, or (F) a pentagon? • Is there any blue sky showing in the picture?

• Remembering images | Master of Memory: Accelerated learning, education, memorization. (2020). Masterofmemory.com. https://masterofmemory.com/remembering-images/

©2020 Donna Thiele Psychological Consulting • Formal instruction in mneumonics, rehearsal, and study strategies EBP-Verbal • Repetition and shaping working • Talking “out loud” memory • Memory games • Use of a recording device or scribe

• Shaping is the differential reinforcement (one level of behavior is reinforced and others are not) of successive approximations (behaviors that are a part of or step towards the goal behavior) to a desired behavior. • We can “shape” verbal memory • Song lyrics • Phone numbers • Directions

©2020 Donna Thiele Psychological Consulting • Priming • Task analysis and chaining skills EBP-Planning • Cueing and environmental and problem arrangment solving • Conceptual development through repetition and generalization (e.g. solving the problem of a broken pencil is like the problem of a broken crayon)

• Task Analysis involves breaking a complex skill or series of behaviors into smaller, teachable units. (see example) • Task analyses can be used to teach self- help, language, social, and academic skills. • Check your task analyses by asking yourself the following: • Is it specific enough for someone unfamiliar with the program to review it and teach it accurately? • Is it sequenced in a logical and efficient manner? • Does it contain only those steps (as well as enough steps) necessary to complete the objective? • Is it individualized enough for the target student?

• Chaining is the linking together or component skills to comprise an entire, more complex skill. Self awareness is the ending of one response becoming the signal for the next response • We use chains to: • Foster independence skills • Teach students to combine behaviors and form more complex skills • Produce overall behavior change • This is “how” we do things

Theory of Mind and Perspective Taking

©2020 Donna Thiele Psychological Consulting • SMART goals • Estimation skills (how long will this EBP-Self- take me) motivation • Self monitoring- fitbit, weight and watchers, noom • Allow and encourage access to monitoring student grade portal for real-time feedback about perfromance

• Social Narratives (*note: NOT social stories!) • Narratives that describe a social situation by highlighting relevant cues and offer examples of appropriate responses. The narratives are individualized according to the student, are short, and may include visual / pictorial aides (Wong et al., 2014). • Evidence: 17 single case design studies • Social stories v. Social storiesTM • Lack of support for Social storiesTM and Social Thinking® (Leaf et al., 2012a)

• We feel the need to “earn our keep” and “do something” • Close bond with students • Don’t see road ahead • Control freaks • Don’t see the need • Routine (we get used to helping) • Hold our students to a higher standard (5 or more rule)

• Think of yourself as a “coach”, not a “personal assistant” (mindset first) • “Eyes on the prize”- know the payoffs for independence from the point of view of your child • Chaining and shaping • Activity schedules • Graduated guidance

• Peers are naturally occurring supports. Teach your student to use peers to foster their independence by setting up tasks and prompting your student to ask a peer for help. • Peers can provide positive reinforcement • “Here are some cheat codes for Minecraft” • Peers can provide negative reinforcement • “Your friend is here, you can do your homework later”

• Do NOT assume osmotic imitation

• 3 ring binder with pictures or words • A checklist • A calendar • A palm pilot • A datebook

The pictures or words prompt the activity instead of another person.

The materials within the activities themselves prompt the behavior (i.e., in the presence of a puzzle, the child learns to dump the pieces and put them back into the correct places).

©2020 Donna Thiele Psychological Consulting • Time on task • Number of opportunities for planning • Flexibility in difficult situations • Fluency (more correct responses and faster Activity reaction time) schedules • Structure for children who are more successful increase when life has predictability • Opportunities for choice making for children with limited language • A legacy of your teaching (something for them to rely on when you are not able to be there) A note on prompts…

• A prompt is an antecedent stimulus used to elicit a correct response when it is paired with the discriminative stimulus (Cooper, Heron, & Heward, 2007; Snell, & Brown, 2011). • A prompt is never meant to be the signal for the student to engage in a particular response. Rather, it is meant to increase the probability of the response, not occasion it. This Photo by Unknown Author is licensed under CC BY-SA-NC

• Organization and independence are closely linked together. By assisting your student organize, you can greatly increase independence. • First, look at what your student has been able to organize, praise! • Second, decide what area, if organized, would make the greatest difference. • Understand that “organized” and “neat” are not synonomous terms. Sometimes a system may not look pretty, but may be very functional for the child. • Organizing “on the fly” is almost never a good idea. Do a cost benefit analysis of how much time could be saved looking for materials if you just put aside time to focus on organization. • Make sure home and school are consistent with expectations for organization. • Functional can be defined as: • can the student get needed materials in a timely manner? • Can the student keep materials from being lost or damaged? • Is the system flexible enough to have room to grow?

• Does it conform to the class standard? This Photo by Unknown Author is licensed under CC BY-SA-NC

• Remember- you are looking to measure the product of executive functions in the context that you want them performed in to the extent to which they are functional.

• Objective #1 Identify situations that may lead to conflict (e.g.. hurtful teasing, name calling). • Better: When given a series of up to 20 flashcards, student will identify which contain 1 or 2 elements that may cause conflict based on a previously mastered list at 90% accuracy as measured over 5 occasions. • Objective #1 Arrive at class with all materials required for daily assignments (e.g. paper, pen, pencil, text, homework, evaluation sheet). • Better: Student will arrive at all core classes with a supplies pouch containing a complete list of supplies at 90% accuracy as measured over a two week period. • Objective #4 Work steadily with attention focused on task. • Student will complete teacher given assignments within a specified time period with no more than 3 prompts to remain on task for 9 out of 10 trials

©2020 Donna Thiele Psychological Consulting • Digital addiction effects- delay of reinforcement, other leisure skills- distress tolerance • World changes that affect exec function- Monitoring bottomless scrolling, background “noise”, • Our brain is assaulted by hundreds/ our Digital thousands of stimuli every second Consuming • Have children focus on one thing, eliminate background “white noise” 1. Executive functioning challenges are only found in those with disabilities 2. Social narratives, behavioral skills training, and Pre- environmental arrangement are interventions that have proven benefits to those with executive Assessment: functioning challenges. True or False 3. Executive functioning challenges are permanent and cannot be remediated. 4. Executive functioning is not as good as IQ when it comes to predicting school success. 5. Executive functioning challenges can affect many dimensions of an individual’s life, including their job, marital status, and mental health.

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• Duckworth, A. L., Quinn, P. D., & Tsukayama, E. (2012). What No Child Left Behind leaves behind: The roles of IQ and self-control in predicting standardized achievement test scores and report card grades. Journal of Educational Psychology, 104(2), 439–451. https://doi.org/10.1037/a0026280 • Dawson, P., & Guare, R. (n.d.). Executive Skills Questionnaire. https://nyspta.org/wp-content/uploads/2017/08/Conv17-305-dawson-executive-skills- questionnaire.pdf • Social Thinking. (2016). Socialthinking.Com. https://www.socialthinking.com/Products/superflex-superhero-social-thinking-curriculum • Flexible and Focused, Teaching Executive Function Skills to Individuals with Autism and Attention Disorder, Najdowski, 2017 • Executive Function and ASD: Evidence-Based Practices to Help ALL Learners Succeed. (2020). National Autism Resources. https://nationalautismresources.com/blog/executive-function-and-asd-evidencebased-practices-to-help-all-learners-succeed/ • Diamond, A., & Ling, D. S. (2016). Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Developmental Cognitive Neuroscience, 18, 34–48. https://doi.org/10.1016/j.dcn.2015.11.005 • Lightner, L. (2020, January 7). Executive Functioning | Measurable IEP Goals | Accommodations | Strategies. Don’t IEP Alone: A Day In Our Shoes; Don't IEP Alone: A Day In Our Shoes. https://adayinourshoes.com/executive-functioning-iep-goals-accommodations/ • Ninivaggi, F., (2020). Using the Mind’s “Executive Functions.”. Psychology Today. https://www.psychologytoday.com/us/blog/envy/202004/using-the- mind-s-executive-functions • Ramaci, T., Bellini, D., Presti, G., & Santisi, G. (2019). Psychological Flexibility and Mindfulness as Predictors of Individual Outcomes in Hospital Health Workers. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01302 • Research Round-Up: Psychological Flexibility in the Workplace. (2013, August 14). Newharbinger.Com. https://www.newharbinger.com/blog/research- ©2020 Donnaround Thiele-psychological Psychological Consulting-flexibility -workplace