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Executive Skills in Children and Adolescents

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Executive Skills in Children and Adolescents
Executive Skills in Children and Adolescents:
Assessment and Intervention
Peg Dawson, Ed.D.
[email protected]
Center for Learning and Attention Disorders
1149 Sagamore Ave.
Portsmouth, NH 03801
The Cookie Problem
Problem to be solved: Which girl wore which color?
 Rachel, Linda, and Eve were friends sitting in a circle on the
grass.
 Rachel passed three chocolate chip cookies to the person in
blue.
 Eve passed three macaroons to the person who passed her
cookies to the person wearing green.
 Each person passed three cookies to the friend on her left.
 Rachel, Linda, and Eve were dressed in red, blue, and green,
but not necessarily in that order.
 The person who was wearing green did not get a macaroon.
The person wearing red passed along three oatmeal cookies.
 Who wore which color?
Taken from: Get It Together: Math Problems for Groups Grades 4-12, published by
EQUALS, Berkeley, CA, 1989.
RED BLUE PURPLE BLACK
GREEN YELLOW ORANGE RED
BLUE PURPLE BLACK GREEN
YELLOW ORANGE RED BLUE
PURPLE BLACK GREEN YELLOW
RED BLUE PURPLE BLACK
GREEN YELLOW ORANGE RED
BLUE PURPLE BLACK GREEN
YELLOW ORANGE RED BLUE
PURPLE BLACK GREEN YELLOW
Executive Skills: Definitions
 Response Inhibition: The capacity to think
before you act – this ability to resist the
urge to say or do something allows us the
time to evaluate a situation and how our
behavior might impact it.
 Working Memory: The ability to hold
information in memory while performing
complex tasks. . It incorporates the ability
to draw on past learning or experience to
apply to the situation at hand or to project
into the future.
Executive Skills: Definitions
 Emotional Control: The ability to manage
emotions in order to achieve goals,
complete tasks, or control and direct
behavior.
 Sustained Attention: The capacity to
maintain attention to a situation or task in
spite of distractibility, fatigue, or boredom.
 Task Initiation: The ability to begin projects
without undue procrastination, in an
efficient or timely fashion.
Executive Skills: Definitions
 Planning/Prioritization: The ability to create a
roadmap to reach a goal or to complete a task. It
also involves being able to make decisions about
what’s important to focus on and what’s not
important.
 Organization: The ability to create and maintain
systems to keep track of information or materials.
 Time Management: The capacity to estimate how
much time one has, how to allocate it, and how to
stay within time limits and deadlines. It also involves
a sense that time is important.
Executive Skills: Definitions
 Flexibility: The ability to revise plans in the face
of obstacles, setbacks, new information or
mistakes. It relates to an adaptability to
changing conditions.
 Goal-directed persistence: The capacity to
have a goal, follow through to the completion
of the goal, and not be put off by or distracted
by competing interests.
 Metacognition: The ability to stand back and
take a birds-eye view of oneself in a situation. It
is an ability to observe how you problem solve. It
also includes self-monitoring and self-evaluative
skills (e.g., asking yourself, “How am I doing? or
How did I do?”).
What Do Executive Skill
Weaknesses Look Like in Students?
 Acts without thinking
 Interrupts others
 Overreacts to small
problems
 Upset by changes in plans
 Talks or plays too loudly
 Resists change of routine
 Acts wild or out of control
 Easily overstimulated and
has trouble calming down
 Gets stuck on one topic or
activity
 Gets overly upset about
“little things”
 Out of control more than
peers
 Low tolerance for frustration
 Overwhelmed by large
assignments
 Can’t come up with more
than one way to solve a
problem
 Doesn’t notice impact of
behavior on others
What Do Executive Skill
Weaknesses Look Like in Students?
 Slow to initiate tasks
 Runs out of steam before
finishing work
 Doesn’t bother to write
down assignment
 Loses books, papers,
notebooks
 Forgets directions
 Lack of time sense/urgency
 Forgets to bring materials
home
 Keeps putting off homework
 Chooses “fun stuff” over
homework
 Forgets homework/forgets
to pass it in
 Leaves long-term
assignments until last
minute
 Can’t break down longterm assignments
 Sloppy work
 Messy notebooks Can’t find
things in backpack
 Passive study methods (or
doesn’t study)
What Do Executive Skill Weaknesses Look
Like in Students
What Do Executive Skill Weaknesses Look
Like in Students’ Environment?
What Do Executive Skill Weaknesses Look
Like in Students’ Environment?
Why is it important to help kids
develop executive skills?
14
INFORMAL ASSESSMENTS
 Parent and Teacher Interviews
Parent interview (look for specific examples of
problems in areas likely to be affected by
executive skill deficits, including problems with
homework, chores, following directions, social
interactions, organizational skills, etc.).
Teacher interviews (again, look for specificity of
examples in relevant areas, e.g., following
complex directions, task initiation, handling
long-term assignments, response to openended tasks, social interactions, responses to
classroom/school rules, etc.).
 Behavior Observation
FORMAL ASSESSMENTS
Provide the context for examining other variables
such as cognitive abilities, emotional status, and
academic skills that can affect or be affected by
executive skills.
 Behavior rating scales
 Be aware that parents and teachers do not
always see the same executive skill deficits
Until they are fully developed in children,
parents and teachers act as “surrogate” frontal
lobes for children.
17
Intervening
As we get older the world demands greater
internalization of executive skills
We must
1. Intervene at the level of the
environment and
2. Intervene at the level of the child
Intervening at the Level of the
Environment
1. Change the physical or social environment
2. Change the nature of the tasks we expect
children to perform
3. Change the way cues are provided to
prompt the child to perform tasks or behave in
a certain way
4. Change the way parents, teachers,
caregivers interact with children
Change the physical or social
environment
 Seat students where distractions are less
 Classroom engineering; materials,
homework bins, routines, procedures –
reduce working memory demands
 Grouping/seating students to promote
attention and impulse/emotional control.
Environmental Modifications
 Establish classroom routines to address executive
skills such as organization, working memory,
planning, time management.
 Teach classroom rules to address executive skills
such as response inhibition, emotional control,
flexibility--post prominently, review frequently, and
practice following the rules.
 Establish class-wide and school-wide monitoring
and feedback systems (e.g., Power School,
TeacherEase).
 Embed metacognitive questions into instruction.
Metacognitive Questions
“Good question! How do you suppose you could find the
answer?”
“How do you think you will do on your math assignment.
Why?”
“What could you do to get a higher grade?”
“Tell me how you figured out your answer to that question.”
“This is a big assignment. What will you do 1st? Then what?”
“How long do you think it will take you to finish this? Let’s see
if you’re right.”
“Tell me your homework plan. What will you do first? When
will you do it?”
Metacognitive Questions
“Sometimes it’s hard to get started on homework. What
can you do to make it easier?”
“What can you do to make sure you keep working until
the assignment is done?”
“How can you keep from becoming distracted while
you’re trying to work?”
“Tell me how you came to that conclusion, made that
decision, etc. What would be another choice you
could have made?”
“What can you do to learn the material that will be on
the test?”
“Let me show you how I thought about the problem
when I tried to solve it.”
Modify the Tasks We Expect
Youngsters to Perform





Make the task shorter--reduce the amount of
work required or divide it into pieces with
breaks built in along the way.
Make the steps more explicit.
Create a schedule.
Build in variety or choice with respect to the
tasks to be done or the order in which the
tasks are to be done.
Make the task closed-ended (fill in the blank,
true/false, word banks, practicing spelling with
magnetic letters rather than sentences,
identifying starting and stopping points. )
Change the Way Cues are
Provided
 Verbal Prompts
 Visual Cues
 Schedules
 Lists
 Audiotaped Cues
 Alarm Reminders.
Change the Way Adults Interact
With the Youngster
 Before the task:
Rehearse what will happen and how
student will handle it
Use verbal prompts or reminders to elicit
the executive skills
Arrange for other cues: lists, schedules,
alarm
Change the Way Adults Interact
With the Youngster
 During the task:
Coach the student to elicit the rehearsed
behaviors
Remind the student to check his or her list
or schedule
Monitor the situation to understand triggers
or other factors
Change the Way Adults Interact
With the Youngster
 After the task:
Provide positive reinforcement
Debrief
Consult with others (gened teachers)
Intervene at the Level of the
Student
The ultimate goal is to teach students to
develop their own executive skills
sufficiently so they can function
independently.
 Teach the skill
 Motivate student to use the skill
Goal: A Clean Room
 Directive from parent:
 Clean your room
 Response from child with executive skill
deficits:
 Nothing
Intervention Plan for Clean
Room
 Step 1: The parent acts as an external frontal
lobe that works with the child to perform the
following functions:
Develop a plan, an organizational scheme, and
a specific set of directions.
Develop a way to monitor performance.
Provide encouragement/motivation and
feedback about the success of the approach
 Problem solve when something doesn't work.
Determine when the task is completed
Step 1: Sample Statements:
 Let’s start.
 Put your dirty clothes in the hamper (praise).
 Hang your clean clothes in the closet (praise).
 Hang your hats/jewelry on the hooks (praise).
 Put your books on the shelf(praise).
 You have school papers under the bed. Put those in
a pile and we will go through them at the end
(praise).
 When you are finished you can hang out with your
friends.
 You’ve done a great job staying on task.
 Step 2: Provide the same information
without being the direct agent: create a list,
picture cues, audio tape, etc. to cue the
child.
Parent says to child: Look at your list.
 Step 3: Parent begins to transfer
responsibility to child:
Parent says to child: What do you need
to do?
 Step 4: Transfer complete.
Child now asks himself/herself. What do
I need to do?
Goal: Helping a Child Learn
to Control His/Her Temper
 Together with the child, make a list of the things that
happen that cause the child to lose his/her temper
(these are called “triggers”).
 Manage or eliminate the triggers.
 Talk about what “losing your temper ‘looks’ or ‘sounds
like’ (e.g., yells, swears, throws things, kicks things or
people, etc.). Decide which ones of these should go
on a “can’t do” list. Keep this list short and work on
only 1-2 behaviors at a time.
Goal: Helping a Child Learn
to Control His/Her Temper
 Now make a list of things the child can do instead
(called “replacement behaviors”). These should be 34 different things the child can do instead of the
“can’t do” behaviors you’ve selected.
 Put these on a “Hard Times Board.”
HARD TIMES BOARD
Triggers: What Makes Me Mad—
1. When I have to stop listening to my ipod.
2. When it’s time to do an assignment I don’t like.
3. When my plans don’t work out.
“Can’t Do’s”
1. Hit Somebody
2. Break or Throw Anything
When I’m Having a Hard Time, I Can
1. Talk to the teacher
2. Count to 10
3. Close my eyes and take a deep breath
Helping A Child Learn to Control
His/Her Temper
 Practice. Say to the student, “Let’s say you’re upset
because Jared was sitting in your desk in math.”
Which strategy do you want to use?”
 After practicing for a couple of weeks, start using the
process “for real,” but initially use it for minor irritants.
 After using it successfully with minor irritants, move on
to the more challenging triggers.
 Connect the process to a reward. For best results, use
two levels of rewards: a “big reward” for never getting
to the point where the Hard Times Board needs to be
used, and a “small reward” for successfully using a
strategy on the Hard Time Board to deal with the
trigger situation.
TEACH deficient skills
Don’t expect the youngster to acquire
executive skills through observation or
osmosis.
Seven Steps to teaching
Executive Functioning
Skills.
7 steps to teaching executive skills
1. Identify specific problem behaviors
2. Set a goal.
 They direct behavior (toward task relevant
and away from task irrelevant behavior)
 They energize
 They encourage persistence
 They motivate people to discover and use
task- relevant knowledge and skills.
7 steps to teaching executive skills
3. Outline the steps that need to be
followed in order for the youngster to
achieve the goal.
4. Whenever possible, turn the steps into a
list, checklist, or short list of rules to be
followed.
7 steps to teaching executive skills
5. Supervise the youngster following the steps.



Prompt the youngster to perform each
step in the procedure.
Observe the youngster while s/he
performs each step, providing
feedback to help improve
performance.
Praise the youngster when s/he
successfully completes each step and
when the procedure is completed as a
whole.
7 steps to teaching executive skills
6. Evaluate the program’s success and
revise if necessary.
7. Fade the supervision.
Use Incentives to Augment
Instruction.
 Incentives make both the effort of learning
a skill and the effort of performing a task
less aversive.
 Furthermore, putting an incentive after a
task teaches delayed gratification.
7 Steps to Creating Incentive
Systems
Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
Step 6:
Step 7:
Describe the problem behaviors.
Set a goal.
Decide on possible rewards and
contingencies
Write a behavior contract.
Implement the contract.
Evaluate success and make
changes if necessary.
Fade the rewards.
Instructional Strategies
 Teach organizational skills.
 Teach the “study” skills necessary to meet
course requirements—how to study for tests,
how to break down long term assignments
into subtasks, how to develop timelines.
Instructional Strategies
 Teach homework skills—e.g., how to plan
homework sessions, strategies for getting
started, screening out distractions, sticking
with tasks long enough to get them done,
avoiding temptation (e.g., choosing to play
video games, etc.), and problem solving
(what to do when you forgot to write down
the assignment, don’t understand the
assignment, etc).
 Teach reciprocal coaching (both to work on
metacognitive skills such as organization and
behavioral control such as following the
rules)
Resources
Resources
Coming in May
Resources
Resources
Resources
Resources
Resources
Resources
 1. Strategies for Organization: Preparing for Homework
and the Real World. A $600 program I found copied
on the Internet.
http://gustiesgang.wikispaces.com/file/view/strategies
+for+organization+(2).pdf
 2. Speech Pathologist Blog with graphic organizers.
https://jillkuzma.wordpress.com/teaching-ideas-forexecutive-function-skills/
Resources
 3. Strategies to Make Homework Go More Smoothly.
Document to give to parents
http://www.childmind.org/en/posts/articles/2013-8-13strategies-make-homework-go-smoothly
 4. Great Website that leads to example lesson plans
and more information
http://understandingexecutivefunctioning.blogspot.c
om/p/what-are-executive-functions.html
Resources
 5. Lazy Kid or Executive Dysfunction?
http://www.ldonline.org/article/Lazy_Kid_or_Executive
_Dysfunction%3F
 6. Erica Warren’s site (Where I bought the $20 CD)
http://www.goodsensorylearning.com/home.html
What is coaching?
An intervention strategy in which a coach (either an
adult or a peer) works with a student to set goals
(long-term, short-term, or daily) designed to enhance
executive skills and lead to improved self-regulation.
Coaching Is a 2-Stage Process
Step 1: Help the student establish a longterm goal
Step 2: Link the long-term goal to
daily plans
In the first stage of coaching,
we ask students to set goals
 Goals may be academic, social, or
behavioral depending on individual
students’ needs.
 We may ask students to set long-term goals,
or we may focus on more short-term goals
(marking period goals, weekly goals, daily
goals).
 Throughout the coaching process, we
remind students of the goals they have set—
and we help them track their progress
toward achieving their goals.
Second stage: Linking Daily Plans to Goals
Basic Format: R.E.A.P.
 Review: go over the plans made at the previous
coaching session to determine if the plans were
carried out as intended.
 Evaluate: how well did it go? Did the student do
what he said he would do? If not, why not?
 Anticipate: Talk about what tasks the student plans
to accomplish today--be sure to review upcoming
tests, long-term assignments.
 Plan: Have the student identify when he plans to do
each task, and, when appropriate, how he plans to
do each task.
Goal-Setting
Step 1: Define goal
Step 2: Specify steps to achieve goal
Step 3: Identify barriers to goal attainment
Step 4: Brainstorm ways to overcome
barriers
Step 5: Identify necessary environmental
supports will be needed to achieve goal
Daily Coaching Sessions
Build in mini-lessons where appropriate:
 How to study for tests
 How to organize a writing assignment
 How to break down a long-term assignments
 How to organize notebooks
 How to manage time (resist temptations)
Coaching Alternatives
 Group coaching--use during homeroom
period or in advisor groups
 Peer coaching--train honor students to
coach at-risk students
 Reciprocal coaching--have students work in
pairs to coach each other
 Train older students to coach younger
students
References
Anderson, V. A., Anderson, P., Northam, E., Jacobs, R., & Catroppa,
C. 2001) Development of executive functions through late
childhood in an Australian sample. Developmental
Neuropsychology, 20, 385-406.
Barkley, R. A. (1997). ADHD and the nature of self-control. New York:
The Guilford Press.
Buron, K. D. & Curtis, M. B. (2003). The incredible 5-point scale.
Shawnee Mission, KS: Autism Asperger Publishing Company.
Dawson, P. & Guare, R. (1998). Coaching the ADHD student. North
Tonawanda, NY: Multi-Health Systems.
References
Dawson, P. & Guare, R. (2004). Executive skills in children and
adolescents: A practical guide to assessment and intervention.
New York: The Guilford Press.
Dawson, P., & Guare, R. (in press). Smart but scattered: The
revolutionary ”executive skills" approach to helping kids reach
their potential. New York: The Guilford Press.
Goldberg, D. (2005). The organized student. New York: Simon &
Schuster.
Gray, C. (1993). The original social story book. Arlington, TX:
Future Horizons, Inc.
Goldberg, D. (2005). The organized student. New York: Simon &
Schuster.
References
Gray, C. (1993). The original social story book. Arlington, TX:
Future Horizons, Inc.
Hart, T. & Jacobs, H. E. (1993). Rehabilitation and management
of behavioral disturbances following frontal lobe injury. Journal
of Head Trauma Rehabilitation, 8. 1-12 .
Huebner, D. (2007). What to do when you grumble too much.
Washington, D.C.: Magination Press.
Huebner, D. (2006). What to do when you worry too much.
Washington, D.C.: Magination Press.
Huebner, D. (2007). What to do when your brain gets stuck.
Washington, D.C.: Magination Press.
Huebner, D. (2007). What to do when your temper flares.
Washington, D.C.: Magination Press.
References
Landry, S. H., Miller-Loncar, C. L., Smith, K. E., & Swank, P. R.
(2002). The role of early parenting in children’s executive
processes. Developmental Neuropsychology, 21, 15-41.
Margolis, H., & McCabe, P.P. (2004). Resolving struggling readers’
homework difficulties: A social cognitive perspective. Reading
Psychology, 25, 225-260
Paniagua, F. A. (1992). Verbal-nonverbal correspondence raining
with ADHD Children. Behavior Modification, 16, 226-252.
Plumer, P.J. & Stoner, G. (2005). The relative effects of classwide
peer tutoring and peer coaching on the positive social behaviors
of children with ADHD. Journal of Attention Disorders, 9, 290300.
References
Risley, T. R., & Hart, B. (1968). Developing
correspondence between the nonverbal and verbal
behavior of preschool children. Journal of Applied
Behavioral Analysis, 1, 267-281.
Sabbagh, L. (2006). The teen brain, hard at work.
Scientific American Mind, 17 (4), 20-25.
Weinberger, D. R., Elvevåg, B., & Giedd, J. N. (2005).
The adolescent brain: A work in progress. The National
Campaign to Prevent Teen Pregnancy
(teenpregnancy.org).
Smith Harvey, V., Chickie-Wolfe, L.A. (2007). Teaching to
learn: Practical strategies to empower independent
learning. New York: The Guilford Press.
Witt, J., LaFleur, L., Naquin, G., & Gilbertson, D. (1999).
Teaching effective classroom routines. Longmont, CA:
Sopris West.
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