1. Milton J. Dehn, Ed.D. NYASP Conference Fall 2017
Identifying Specific Executive Function Deficits That Guide Intervention
Milton J. Dehn, Ed.D.
NYASP Conference
Fall 2017

2. 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,

3. Workshop Topics An In-Depth EF Assessment EFs and Academics
How the MEFS Depth Guides Interventions
Case study
Interventions for the Classroom

4. New Directions for EF Assessment
More than just an ADHD assessment component
Should be part of all youth psychological evaluations, including SLD and Autism
Depth of assessment should match the depth of executive functions
Differentiate between academic and social-emotional EFs
Identify EF production deficits
Link more directly to specific EF interventions

5. Executive Functions A complex construct There are many different EFs
Different theories
Different from intelligence (correlate )
Cues and controls cognition, emotion, social functioning, and behavior
Have a neurological basis
Conscious and unconscious
Important for academic learning and production

6. EF Definitions Directive capacities
Supervisory system with multiple parts
Cue the use of other mental capacities such as cognitive abilities but are not those capacities themselves
“Purposeful, organized, strategic, self-regulated, goal-directed processing of emotions, thoughts, and actions”

7. 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
From a neuropsych perspective, these are prefrontal cortex abilities

8. WM: Both Executive and Cognitive
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 supports cognitive processes such as fluid reasoning
The executive aspect of WM cues the use of an executive skill/strategy, such as rehearsal

9. Is There a “g” of EF?
Factor analysis does not prove that EF is one “thing” in the brain or one function
Rather, “Co-conductors” that collaborate
Thus, the development of EF’s can vary; can be specific strengths and weaknesses
Domain’s have their own EFs; e.g. language
Efs also differ by environment or “arena”
Saying that EF in general is weak is not especially helpful in understanding the problem, child, or developing an intervention

10. EF Self-Awareness How self/mind functions Self-analysis
Appraisal of self is accurate
How one is perceived by others
Self-monitoring
Knowing one’s strengths and weaknesses
Setting goals: short- and long-term
Strategic knowledge

11. Awareness of Others & Environment
Is attentive to others and environment
Perceives cues from others
Perceives cues from the environment
Interprets cues correctly
When cues are perceived, higher level executive functions select and directs EF skills, such as planning

12. 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)

13. 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

14. 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)

15. Higher Level EFs (McCloskey)
These develop later, adolescence typically
Have low correlations with self-regulation
Self-Realization is a sense of self and others
Theory of mind
Self-awareness
Sense of personal strengths and weaknesses
Can enhance self-regulation, but not always
Self-Determination
Goal setting and long-term planning

16. 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

17. Neurological Basis of EF
Control center in prefrontal cortex (PFC)
Each EF has its own pathway through the frontal lobes and with other parts of brain
Connectivity is important for EFs functioning
Executive working memory, attentional control, and fluid reasoning also located in PFC
Inhibition is a fundamental function of the PFC; it underlies attention and WM

18. Prefrontal Cortex Image

19. Development of EFs Begin to develop in early infancy
E.g., choosing where to look
Control of actions
The different EFs are on different developmental tracks and rates
Major developmental advances in adolescence
Development is not under the child’s control

20. Development of EFs Initially cued by external demand
Then become more internally driven
Complying with external EF demands requires more mental effort and greater control capacity than internal (ADHD)
Females more advanced than males in most EFs at all ages except elementary years (MEFS study)

21. EFs and Misattributions
Misattributions: Laziness, apathy, irresponsible, lack of motivation, lack of respect for authority
Poor study skills
Low intelligence

22. EFs and Other Disorders
Executive deficits are evident in every neuropsychiatric disorder (does not mean they are the cause)
Examples: ADHD, Anxiety, ODD, CD, SLD autism
Can have executive deficits without having a disorder

23. EF and Academic Learning
EFs are good predictors of achievement
EF deficits 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
Influence skill development in math and wr. language
EF demands increase in middle & high school
In middle school, there is a mismatch between demands and students’ EFs developmental level

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

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

26. 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

27. 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) includes EF scores and statistically determines PSW

28. 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

29. EF Assessment Challenges
Assessments focus primarily on EF with symbolic material (academic learning arena)
Direct assessments provide much EF support
Each scale structures the EFs differently
Scales don’t assess for different arenas
Rating items are mostly general, not specific
E.g., the BRIEF Working Memory subscale has other EFs: Focus, Select, Modulate, Organize, Monitor, Execute, Direct

30. 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

31. 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
Rating scales can be just as valid and reliable if they pass validity scale criteria, e.g., consistency and negativity

32. 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

33. 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

34. Directive EFs vs EF Skills
Directive EFs: Becoming aware of the need to cue and then cuing and directing its executive skill counterpart, such as planning
Equivalent to construct of metacognitive awareness
Expressive Executive Skills: The actual expression of the EF skill, such as planning
Having the EF skill, but not expressing it because it has not been cued is an “EF production deficit”

35. Working Memory (WM) Example
WM Directive Cues
Noticing you just forgot something
Recognizing it will be difficult to remember
EF Skills
Review your previous thoughts
Write it down
Rehearsal
Chunking
Visualizing

36. 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)

37. Gender Differences on MEFS
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

38. 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

39. MEFS SLD Profile (n = 48)
Percentages of SLD students rated as having EF deficits in Academic EFs ranged from 8% (Engagement) to 42% (Solution)
Percentages of SLD students rated as having Academic EF strengths ranged from 33% (Attention) to 3% (Memory)
Compared with non-SLD were significantly weaker on all 7 MEFS clusters, both academic and Self/Social (about a standard deviation weaker on most clusters)

40. MEFS ADHD Profile (n = 47)
ADHD sample had significantly lower scores on MEFS clusters in both academic and self/social arenas, except for the Memory cluster
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
Better on EF clusters than SLD sample

41. MEFS Autism Profile (n = 38)
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

42. 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

43. 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 some self-regulation EFs when prompted and thus has the capacity/skill for these EFs
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

44. EF Assessment to Intervention
Identify MEFS strengths and weaknesses
At the cluster level
At the cluster level by arena: Academic vs Self-Social
At the specific self-regulation executive function level
At the item level within each specific self-regulation Report
The items suggest specific skills to teach or to teach self-cueing of

45. MEFS Autism Case Study
The items identify specific skills that need teaching or available skills that need to be self-cued
Quick Gains: develop more self-cueing for skills that are already there
Talk about situations, stimuli that mean it’s time to engage the skill, e.g., someone says, “Hello” means it time to focus on what the other person is saying and respond
Practice responding to cues

46. Autism Case Continued
Some Executive Skills that are deficient may also be prioritized
These skills need to be taught
Assess whether they are being cued; if not, also train the self-cueing
Sometimes the child is aware of the need (is being cued) and has the directive capacity but does not have the skill; does not know how to do it
Review examples in MEFS report

47. Autism Case Continued
Review number of responses under Strengths, EF Deficits, and Exec Skills Deficit columns while contrasting Academic and Self/Social arenas
Engagement stronger socially than academically
Inquiry and Solution stronger socially than academically
What is the priority arena: Academic or Self/Social

48. Autism Case Continued
Decide to focus on Solution in the Academic arena
Thus, needs skills training in Generating (ideas), Associating (seeing connections between ideas), Organizing (thoughts), Planning, Prioritizing, and Deciding
Then look at item responses under these self-regulation EFs

49. Autism Case Continued
Examples of specific items that identify the specific executive skills that need to taught
Examples of specific items the identify the type of self-cuing and self-directing that needs to be taught

50. Self-Realization & Self-Determination
Different rating system than self-reg. items
Frequency only
Begin to emerge at age 10
Fairly well developed at age 14
Strengths below age 14 are advanced development

51. Case Study Self-Realization and Self-Determination
Awareness and goal setting is emerging
Percentiles are higher than for self-regulation skills
Not a priority at this time

52. 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

53. EF Intervention Considerations
Don’t assume the child has conscious control over the EFs in question
Directive EF deficits: Skill is present; needs to be taught how to recognize cues
If EF skills are lacking, then they need to be taught before cuing is taught
When skills taught, metacognitive (awareness) component needs to be embedded

54. Metacognitive (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

55. General EF Intervention Guidelines
Model effective EF use (think aloud)
Focus on making child aware of the EF’s needed to accomplish a task
Begin with external control when there are directive EF deficits
Gains may be minimal and progress slow
Have reasonable expectations
Teach specific executive functions as skills routines
The end goal is the internalization of directive capacities and skills that can be accessed

56. Environmental Modifications for Poor Inhibition
Increase external controls
Restrict access to things that cause problems
Increase supervision
Create ways to cue child to control impulses
“What should you do when this happens?”
Teach child to ask himself specific questions in problem situations
“Did I get too close?”

57. Executive Functioning: Planning
Developing planning improves math performance (Naglieri’s study; ATI)
Discuss benefits of plans
Learn how to plan step-by-step
Develop plans
Verbalize them
Implement them and evaluate
Practicing planning steps with a variety of materials and situations

58. Problem-Solving Steps
Define the problem
Brainstorm solutions
Pick a solution
Implement the solution
Review the results

59. Questions to Ask Self When Planning and Problem Solving
What prior knowledge do I have than can help with this task?
What strategies should I use?
What should I do first?
How am I doing?
What adjustments to I need to make?
How did I do?
What could I have done differently?

60. Attention Self-Monitoring
Research documents efficacy of this method
Works because it increases the EF Directive (self-cuing) aspect
Increasing self-monitoring increases on-task behavior, extends sustaining attention
Assumes the EF skill is adequate

61. Attention: Self-Monitoring
Teacher, or device carried by student, cues student at variable intervals, minutes
When cued, student marks monitoring sheet regarding behavior when cue occurred or behavior since last cue
When teacher is cueing, she also provides her rating alongside student’s; student receives bonus point when ratings match
Set a points goal that student is working for, easy at first, then keep adjusting upward Link
Reinforcement system is helpful

62. EF Strategies for the Whole Class (Meltzer): Metacognitive Instruction
Recognize the purpose of a strategy (basically an EF Skill)
Recognize the benefits of a strategy
Teach conditional strategy knowledge: how, when, where, why to use the strategy
When students understand the above, they personalize and generalize strategies and persist at using them

63. 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

64. 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

65. 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

66. 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

67. 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

68. Increasing Homework Completion
Organizing materials
Using an assignment notebook
Time Management
Getting started on homework
Don’t provide too much help; guide student through the processes needed
Routinely preview and review upcoming tasks

69. EF Strategies Working Memory
Learn how to self-manage cognitive load
Using rehearsal
Visualizing

70. Free Recorded Webinar on the MEFS
An hour in length
Can be accessed at:
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)