Dr. Caren Baruch-Feldman Westchester Day School Parents and Professionals Advocating for Students (PAPAS) Presents: The Disorganized Student: Strategies for Parents and Teachers Presented by: Dr. Caren Baruch-Feldman drcarenfeldman@msn.com Dr. Helene Walisever hwalisev@optonline.net Westchester Day School January 26, 2009

What Are Executive Functions and How is it Related to Disorganization? A student’s ability to manage their time, organize their paperwork, and numerous other day to day classroom activities are impacted by their executive functions. This presentation will explain the role of executive functions and offer practical strategies for parents and teachers to help the disorganized student.

What Is Executive Functioning? Executive Functioning refers to our ability to be able to make and carry out plans, direct our attention, focus and also control our internal states: our impulses and emotions and to be able to switch from one task to another. It is involved in processes such as planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting actions, and selecting relevant information.

People with Executive Functioning Problems have Difficulties in 6 Major Domains: Activation, Focus, Effort, Emotions, Memory, and Action

Children with ADHD Have the Following Executive Functioning Impairment

On Demand Deficiencies Because internally driven production is much easier to accomplish than externally demanded production for children who have these difficulties their lack of production on demand often stands in stark contrast to their seemingly effortless production “when the spirit moves them”. The on-demand deficiencies observed by others are often attributed to negative personal characteristics such as being UNMOTIVATED, WILLFULLY LAZY and DISORGANIZED, POSSESSING A BAD ATTITUDE, DOING THIS ON PURPOSE. More and more however, neuroscientists are saying that these underachievers may suffer from neurological abnormalities, particularly in the FRONTAL LOBE.

Executive Functioning and the Brain

Can’t Versus Won’t “We are encouraging people to become involved in their own rescue.” Remember rewards will not work if the child does not have the skill. Reward programs imply that a child can do it if he/she wants to or is motivated enough to. This often leads away from the realization that many children who do want to change their behavior don’t know what to do to change it.

Kids Do Well If They Can… Behind every challenging behavior is an unsolved problem or lagging skill. Challenging behavior often occurs when the demands being placed on a kid exceed his capacity to respond adaptively. One needs to determine what thinking skill the child is lacking so that the thinking skill can be taught. One needs to determine the triggers/antecedents: the what, who, when, and where. The goal is to develop a plan with the child that resolves the problem in a realistic and mutually satisfactory manner.

Executive Function and Development Because EFs are developmental in nature, natural maturational delays and lags are observed. Inter-individually, there is also great variation relative to chronological age. The developmental progression is from external to internal.

A Developmental Perspective for Interventions for Children with Executive Skills Deficits Children with developmental executive skill deficits also fit this developmental progression from external to internal. Children with underdeveloped executive skills can be supported in one of two ways: 1. By Intervening at the Level of the Environment. 2. By Intervening at the Level of the Person.

Intervening at the Level of the Environment Changing the Physical or Social Environment to Reduce Problems Changing the Way Cues are Provided To Prompt the Child to Perform Tasks or Behave in Certain Ways Changing the Nature of the Task

Intervening at the Level of the Environment: Changing the Physical or Social Environment to Reduce Problems Are there impediments to smooth executive functioning that can be removed or added to the environment? Front versus back of the class. Moving them away from a window or near their friends or talkative students. Placing a student with weak skills with a very structured teacher. For impulsive children, placing them in smaller settings or under more adult supervision.

Intervening at the Level of the Environment: Changing the Way Cues are Provided To Prompt the Child to Perform Tasks or Behave in Certain Ways Verbal prompts or reminders, Visual Cues Schedules, Lists, Pager Systems or Alarms Provide time management aids such as calendars, clocks, timers, schedules Audio-taped cues that increase self monitoring. When the tape sounds the child is instructed to answer the question, “Was I paying attention?”

Intervening at the Level of the Environment: Changing the Nature of the Task Make the task shorter Make the steps explicit Make the task close ended instead of open ended (e.g., fill in the blanks, T/F, rather than essays, providing word banks) Build in variety or choice with respect to the tasks to be done or the order in which the tasks are to be done Offer bonus points for handing in homework and assignments on time instead of taking points away Offer feedback and opportunities to revise writing assignments before grading them Offer students choices for ways to demonstrate content knowledge Offer credit for all efforts to correct work Offer opportunities to retake failed tests Deduct no more than 5-10% of total points for minor detail errors Teach note-taking, memory strategies, and study skills when necessary

Changing the Way Teachers Interact with Children With Executive Skill Deficits Changing the way adults interact with them can often ameliorate the negative impact of weak skills. Remembering that you are the biggest vehicle of change and a model of good executive functioning. Increasing the level of supervision, support, and cueing are the easiest way to impact executive functioning. Increasing children’s involvement in the decision making process. Creating a balance between support and acting as the child’s frontal lobe with the ultimate goal of having the child develop their own executive skills sufficiently so they can function independently.

Intervening at the Level of the Person The goal of this strategy is to change the child’s capacity for using his/her own executive skills. 1. Teaching him/her ways to develop or fine tune executive skills that he/she needs. 2. Motivating him/her to use the executive skills that he/she has but is reluctant to employ.

Teaching Children Executive Skills: Teaching Thinking and Organizational Skills in Addition to Content Knowledge Initially teachers become the frontal lobes for the child. After having walked the child through the process many times the teacher can then begin to reduce the level of supervision and support. The next step might be to begin to transfer the responsibility to the child by asking a more general question (e.g. “What do you need to do?”) The transfer is complete when the child reaches the point when he/she asks himself/herself “What do I need to do”? and either refers to the list independently without prompting from the parent or remembers the steps on the list and can perform the task without referring to the list itself.

Motivating Children to Use Executive Skills Aligning External Demands with Internal Commands. Using natural self-generated sources of motivation whenever possible. Motivating May Include: Praise and Recognition or Incentive Systems

Last Thoughts Your child is not lazy. You need to teach students the importance of responsibility, time management, attention to detail and other important qualities. State the problem in behavioral terms that indicate a behavior that can then be changed. Learning is a process. As much as possible try to align external demands with internal desires to maximize motivation. Think Win-Win:

Tips for Organizing Paper and Time A coach teaches skills, keeps the child focused, offers encouragement Form the team: your spouse; your child Who should coach? You, spouse, or professional organizer

Help Your Child Accept Help Middle-schoolers want more independence but need more supervision. Don’t fall for “I don’t care” attitude. Motivate your child to be open to help: Use mild natural consequences Use small incentives

Collaborate With Your Child Child should help choose the goal. Goal should be small, short-term, likely to yield success. Goal should improve child’s quality of life Prioritize, choose top 3 goals. Do something fun with your child.

Develop A Plan The devil is in the details Review the plan nightly for a few minutes If the daily goal was not met, ask what got in the way. What helped it work on successful days? Don’t give up too soon, but revise plan if needed. It takes 3 weeks for new habits to form. Your child didn’t fail, the strategy failed.