Executive Functions Assessment and Interventions Milton J. Dehn, Ed.D. Summer 2017

Notice of Copyright 2017 These PowerPoint slides are copyrighted by Milton J. Dehn and Schoolhouse Educational Services, LLC. They are not to be reprinted, copied, or electronically disseminated without written permission. To obtain permission, email milt@psychprocesses.com.

Workshop Topics What are Executive Functions (EFs) EFs and Academics Using behavior rating scales The MEFS approach Some intervention ideas

What are Executive Functions? Directive, supervisory capacities Purposeful, organized, strategic, self-regulated, goal-directed processing of emotions, thoughts, and actions Self-awareness and self-regulation From a neuropsych perspective, these are prefrontal cortex abilities

Executive versus Cognitive Cue the use of other mental capacities such as cognitive abilities but are not those cognitive abilities themselves The executive dimension of WM supervises short-term memory (a cognitive process) The executive aspect of WM inhibits, shifts, and updates The executive aspect of WM cues the use of an executive skill/strategy, such as rehearsal

Executive vs Cognitive Executive includes both abilities and skills EF’s are measured in cognitive scales Directly: Working Memory, Planning, and Attention Indirectly during any cognitive testing task

Self-Regulation EFs These are what are typically considered EFs Cue and direct how we feel, think, and act Can self-regulate without being consciously aware McCloskey theory and McCloskey Executive Functions Scale (MEFS) has 31 specific self-regulation EFs (see image)

EF and Academic Learning EFs are good predictors of achievement EF deficits are more evident in production problems (homework) than acquiring academic skills Production deficit: has the academic skills, but does not demonstrate/apply them May be that teacher provides more executive controls during skill learning EF demands increase in middle & high school In middle school, there is a mismatch between demands and students’ EFs developmental level

EF and Reading Comprehension Important EFs: Focusing, Sustaining, Organizing, Planning, Shifting, Inhibiting, Monitoring, Holding/Working, Generating, Associating, Storing/Retrieving, Balancing

EF and Math EFs needed for math computation include: Focusing, inhibiting, storing/retrieving, monitoring, and correcting For math reasoning/problem solving, planning is important

EFs and Written Expression Of all academic skills, is the most impacted by EF difficulties EFs needed to integrate the various processes, abilities, and skills when writing. Such EFs include: Sustaining, gauging, holding/working, organizing, planning, balancing, monitoring, correcting, generating, associating

EF and SLD Identification A deficit in executive functioning (general or specific) is a “processing” deficit that can be used to document a processing deficit for SLD In Pattern of Strengths and Weaknesses (PSW) approach EF scores are compared with scores of other processes The Psychological Processing Analyzer (PPA; Dehn) statistically determines PSW

Assessment of EF Should be a component of every psychological/educational evaluation It determines success/failure; influences all aspects of functioning Provides insights into what underlies, behavior, social functioning, learning, etc. May be more informative than an FBA Kids with EF deficits are the ones who get referred first for every type of disability

Problem with Direct Standardized Testing of EFs Standardized tests provide structure, focus, short intervals; reduce need for EF functions May lack validity for the individual. Typically, overestimate the EF abilities and skills Multiple EFs are required by each task The tasks also require cognitive processes that are difficult to separate out The assessment task is not a real world task

Rating Scales vs Standardized Tests Some studies have found rating scales to be more valid assessment of EFs than direct testing for reasons on previous slide Rater is observing many aspects of EF; tests only sampling a few

Use of Rating Scales by Diagnosticians They are standardized, norm-referenced tests Avoid those that involve behavior, social-emotional (for LSSPs) Understand T-Scores Mean of 50; SD of 10 Often reverse scored: high scores mean a lack of ability skill Study manual about use and interpretation

Use of Rating Scales by Diagnosticians Raters can be biased Use more than one rater Look at validity scales Are responses consistent Are they overly negative Picks infrequent answers Interpret only the parts of the scales that apply to cognitive and academic

Rating Scale Results Expect scores to vary by informant May be due to different environments, executive function demands, experiences with the child, or bias by informant Parent vs teacher are usually more discrepant than between parents or between teachers

BRIEF2 Index/Composites Behavior Regulation Index (BRI) Emotion Regulation Index (ERI) Cognitive Regulation Index (CRI) Use only CRI for SLD identification purposes Global Executive Composite BRI and ERI should only be used by psychologists

BRIEF2 Cognitive Regulation Index CRI: “Ability to control and manage cognitive processes and problem solve effectively” Initiate Working Memory Plan/Organize Task-Monitor Organization of Materials

BRIEF2 Validity Study With both parent and teacher ratings, LD have elevated scores on all cognitive scales except Organization of Materials LD students have elevated scores mainly on the Cognitive Regulation Index, but not the Behavior and Emotion Indexes

McCloskey Executive Functions Scale (MEFS) Standardization and Norming 254 Teacher raters, 167 cities, 29 states Ages 5-19; N = 1,000; 5 age groups Matches U.S. demographics well 17% of norming sample: disability/disorder Online data collection 110 Items <15 minutes to complete

MEFS Structure 7 Self-Regulation Clusters 31 Self-Regulation EFs Also, Self-Realization and Self-Determination Two arenas: Academic and Self/Social Identifies strengths and deficits across self-regulation EFs by arena Individual item analysis

McCloskey (MEFS) Self-Regulation Clusters Attention Engagement (initiating, inhibiting, flexible) Optimization (monitoring, correcting) Efficiency (pacing, using routines) Memory (holding/working, storing/retrieving) Inquiry (anticipating, analyzing) Solution (organizing, planning, deciding)

McCloskey (MEFS) Self-Regulation EFs Perceiving Focusing Sustaining Initiating Energizing Inhibiting Stopping Pausing Being Flexible Shifting Monitoring Modulating Correcting Balancing Sensing Time Pacing Using Routines Sequencing Holding/Working Storing/Retrieving Gauging Anticipating Estimating Time Analyzing Evaluating Generating Associating Organizing Planning Prioritizing Deciding Link to Item Examples

Gender Differences At all age levels, females significantly better EFs on Engagement and Optimization clusters Ages 5-6, females better on all self-regulation clusters except Memory Ages 7-8, females better only on Engagement and Optimization Ages 9-10, females better on all except Efficiency and Memory Ages 11-18, females better on all clusters

EF Correlation with Academic Skills Teachers rated student’s overall academic skill level Below average students had the lowest EF scores, and above average the highest Significant differences by academic skill level for all MEFS clusters, regardless of disability status

Autism Profile Autism sample had significantly lower scores on all MEFS clusters in both academic and self/social arenas The majority of the differences were around one standard deviation

ADHD Profile ADHD sample had significantly lower scores on MEFS clusters in both academic and self/social arenas, except for the Memory cluster and Self-Realization The majority of the differences were around one half of a standard deviation Those on medication did not have significant differences on Memory, Efficiency, and Self-Realization and self/social under Solution

Arenas of Involvement (McCloskey) EF’s vary greatly by situation, environment, and domain of functioning Intrapersonal (internal processes) and Interpersonal (social) (these two combined on MEFS) Autism has deficits in this arena Academic (symbol system) Language and academic learning LD often deficient in this arena

Awareness vs Skill Deficits Awareness of the need to cue and then cuing and directing its executive skill counterpart, such as planning Skill deficit: The actual expression of the EF skill, such as planning Having the EF skill, but not expressing it because it has not been cued because of lack of awareness is an “EF production deficit”

Unique Rating Structure Identifies Different Types of EF Deficits Rating Description Strengths or Deficits 5 – Almost always does on own without prompting 4 – Frequently does on own without prompting 3 – Seldom does it on own without prompting 2 – Does it, but only after prompting 1 – Only does it with direct assistance 0 – Unable to do even with assistance 5 and 4 – Executive Function Strength (has both directive function and expressive skill) 3 and 2 – Executive Function Deficit (directive EF lacking but has expressive skill) 1 and 0 Executive Skill Deficit (the executive skill is lacking; can’t do even when cued)

Case Study 12 year old, 6th grade female WJ IV GIA of 71; ST WM a strength (95) Academic skills 2nd to 4th grade level She is in unstructured charter school project-based regular ed. class; performance is poor No interest in learning Can shut down and become noncompliant Can be socially appropriate when she chooses to

Case Study MEFS Results MEFS completed by classroom teacher All cluster scores 1st percentile except Memory No EF strengths EF Deficits and Executive Skills Deficits are fairly even, meaning she can perform the EF when prompted and thus has the capacity/skill Has more EF deficits under academic than self/social, consistent with underachievement indicators on the WJ IV NEPSY-II EF scaled scores are 7-12, majority around 9 Why? See Report

EF Assessment to Intervention Prioritize; select EF’s to work on first based such considerations as: Safety of self and others Ability to function independently Social vs Academic Parent goals Self goals Environmental modifications necessary when EFs are very deficient

EF Intervention Considerations Don’t assume the child has conscious control over the EFs in question Awareness Deficits: Skill is present; needs to be taught how to recognize cues (yellow column on MEFS) If EF skills are lacking, then they need to be taught before cuing is taught When skills taught, awareness component needs to be included

Awareness Emphasis “Thinking about thinking” Applies to all EF Deficits and EF Interventions Teach child how EF works Inform child of strengths and weaknesses Teach how to control, apply, use the EF skills Emphasize personal efficacy of intervention Includes strategy knowledge and application Teach conditional strategy knowledge: how, when, where, why

Help Teachers Understand The extent of the EF demands they make on students and how these overwhelm students with slower EF development How EF deficits contribute to academic production problems Encourage them to have an EF focused class, such as a memory strategies focused classroom

EF Strategies for the Whole Class (Meltzer): Goal Setting Short-Term and Long-Term goals Makes students more motivated when they set goals themselves Identify the steps involved Visual the steps Breaking tasks into manageable parts Identify the strategies needed Includes planning and time management Example of a college class

EF Strategies for the Whole Class (Meltzer): Flexibility and Shifting Shifting examples: from one approach to another, from one process to another, from the main ideas to the details, from writing to editing, from reading to computing Flexibility examples: interpreting information in different ways, solving math problem in different ways, studying differently for different kinds of tests

EF Strategies for the Whole Class (Meltzer): Organizing and Prioritizing Prioritize based on level of importance Allocate time based on priority Teach them to impose their own structure on the task Organize concepts, such as semantically Organize materials and work space Graphic organizers Following a rubric for writing

EF Strategies for the Whole Class (Meltzer): Working Memory Learn how to manage cognitive load What is cognitive load? Using rehearsal Chunking and visualizing Using long-term memory mnemonics, such as keyword

EF Strategies for the Whole Class (Meltzer): Self-Monitoring & Checking Review progress towards goals Reflect on strategy use Develop and use personalized checklists Use self-cuing

Free Recorded Webinar on the MEFS An hour in length Can be accessed at: https://attendee.gotowebinar.com/recording/8207945938457043202 NOTE: An internet search for the MEFS will bring up the Minnesota Executive Functions Scale. This is NOT McCloskey’s Executive Functions Scale (the real MEFS)