1. Andrea Ogonosky, PhD. ESC XV June 11, 2012 www.ogonoskylearning.com
ADHD: Executive Function Dysfunction (I meant to behave…..but I forgot!)
Andrea Ogonosky, PhD.
ESC XV June 11, 2012
6/11/12

2. Core Symptoms Poor sustained attention (inattention, distractibility)
ADHD Strategies
Core Symptoms
Poor sustained attention (inattention, distractibility)
Impulsivity (behavioral inhibition)
Hyperactivity
Attention is a multidimensional construct that can refer to alertness, arousal, selectivity, sustained attention, distractibility, orspan of apprehension (Barkley, 1988).
The problem appears consistently to be one of the diminished persistence of effort or sustained responding to tasks that have little intrinsic appeal or minimal immediate consequences for completion.
Impulsiveness or behavioral disinhibition in response to situational demands is frequently associated with ADHD. Like attention, impulsivity can be viewed as multidimensional in nature. Evidence of behavioral disinhibition is the hallmark of this disorder.
Hyperactivity can be defined as the excessive or developmentally inappropriate levels of activity, whether motor or vocal. Restlessness, fidgeting, and generally unnecessary gross bodily movements are common.
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Andrea Ogonosky, Ph.D. May 2002

3. Co-morbid Conditions Psychiatric Disorders
ADHD Strategies
Co-morbid Conditions
Psychiatric Disorders
Oppositional Defiant Disorder (ODD)
Conduct Disorder
Antisocial/Delinquency
Anxiety Disorders
Major Depression
Somatization Disorder
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Andrea Ogonosky, Ph.D. May 2002

4. Associated Problems (School)
ADHD Strategies
Associated Problems (School)
Lagging in intellectual development over time (10-15 points)
Underperforming in school
Excessive variability in work produced
Low average achievement
Learning disabilities (25-35%)
56% of ADHD children may require academic tutoring, approximately 30% may repeat a grade in school, and 30-40% may be placed in one or more special education programs.
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Andrea Ogonosky, Ph.D. May 2002

5. Associated Problems (Emotional)
ADHD Strategies
Associated Problems (Emotional)
Poor rule-governed behavior
Immaturity
Irritable, hostile, excitable
Hyper-responsiveness toward others
Low frustration tolerance
Demoralization
Dysthymia
ADHD children have difficulties with adherence to rules and instructions. ADHD children has been observed to be less compliant with directions and commands given by their mothers than are normal children.
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Andrea Ogonosky, Ph.D. May 2002

6. Associated Problems (Social)
ADHD Strategies
Associated Problems (Social)
Increased parent/child conflicts
Selfish/self-centered
More interpersonal problems
Peer rejection due to intrusive behavior(s)
Little regard for social consequences
Immature play
Fewer close friendships
Shorter duration of dating
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Andrea Ogonosky, Ph.D. May 2002

7. Associated Problems (Medical)
ADHD Strategies
Associated Problems (Medical)
More allergies, colds, otitis
Enuresis (43%)
Increased minor injuries due to accidents
Motor coordination problems (affects handwriting)
Sleep disturbances
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Andrea Ogonosky, Ph.D. May 2002

8. ADHD and Self-Control Behavioral Inhibition (Barkley et al.)
ADHD Strategies
ADHD and Self-Control
Behavioral Inhibition (Barkley et al.)
Behavioral control shifts from external to internal
Greater motor control
Behavior focuses on time and future
Need to understand normal development of self-regulation.
First year of life--develop ability to wait; to inhibit initial reactions to environment
Executive system gives us self-control--requires self-regulation
4 executive functions--each started out as observable, public behavior; then gets turned on to control selves and make our self-directed behavior cover (disappears from public view as observable) As the functions mature, behaviors become private, internalized, covert
Humans act to maximize the future over the moment--very effective way of dealing with environment. We delay consequences.
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Andrea Ogonosky, Ph.D. May 2002

9. Executive Functions Directive capacities of the mind
Multiple in nature, not a single capacity
Cue the use of other mental abilities
Direct and control perceptions, thoughts,
actions, and to some degree emotions
Part of neural circuits that are routed
through the frontal lobes
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10. Executive Functions Frequently referred to as “the CEO of the
Brain” or the “Conductor of the Orchestra
Better to think of Executive Functions as:
A Team of Conductors and Co-Conductors of a Mental Ability Orchestra or …
The Coaching Staff of a Mental Ability Football Team
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11. Executive Functions Direct and control perceptions, thoughts,
actions, and to some degree emotions
Part of neural circuits that are routed
through the frontal lobes
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12. Executive functions Diverse group of cognitive processes
Acts in a coordinated way to direct perception, emotion, thought and action
Set of multiple cognitive capacities
Act in a coordinated way to engage in purposeful, organized, strategic, self-regulated, goal-directed behavior.
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13. Development of EF
Self-regulation executive functions are developing from the first years of life well into adulthood, and possibly throughout a person’s entire lifetime.
Large developmental shifts are
noticeable, especially around a
adolescence.
Because EFs are developmental in nature, natural maturational delays and lags are observed.
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14. Development of EF
All EFs do not develop evenly. For any given individual, one EF can be more or less developed than any other EF at any given point in time.
There is also great variation relative to chronological age. At the same age, different individuals will naturally vary considerably in their level of development of various EFs.
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15. Development of EF
Some EF-based clinical syndromes, such as ADHD, demonstrate clear patterns of delayed developmental progression. Barkley (1998) estimates developmental delays of about 30% associated with various EF processes such as Inhibit, Manipulate, Shift, Sustain, Time, Monitor, Correct.
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16. Executive Functions are involved with cueing and directing :
Inhibiting impulsive responding;
Stopping, or interrupting, and returning to, an ongoing activity;
Directing and focusing attention, screening out interference and distractions, and sustaining attention
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17. Executive Functions are involved with cueing and directing :
The initiation of effort
Judging about the amount of effort required to complete a task ….
Sustaining of a sufficient amount of effort
to effectively complete the task
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18. Executive Functions
Shifts cognitive resources to focus on new demands , new conditions or new information
Directs the efficient use of pattern and detail processing :
Knowing when to focus on the “big picture”, when to concentrate on the details, and when to switch between the two).
Monitors and regulates speed of information processing
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19. Executive Functions
Monitors and corrects task performance for accuracy and efficiency
Oversees the selection of verbal-nonverbal and abstract-concrete processing mechanisms
Directs motor output
Directs the ability to mentally manipulate information (working memory)
Directs the integration of multiple abilities to produce oral or written responses
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20. Executive Functions
Direct the efficient placement of information in long-term storage
Direct the retrieval of information from long-term storage
Regulates social behavior
Regulates emotional control
Enables self-observation and self-analysis
Makes use of hindsight and foresight
Enables the capacity to “take the perspective of the other”
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21. Executive Functions and School
Acquiring Knowledge
Demonstrating Knowledge
Many new learning situations are structured in ways that reduce the need for strong executive direction
Requires significant involvement of executive control processes.
Because executive control is heavily involved in demonstrating learning, executive difficulties usually manifest as “Producing Disabilities” much more so than “Learning Disabilities.”
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22. Learning Difficulties and Producing Difficulties
Learning Difficulties Only
Often NOT recognized
as a Learning Disability,
even when severe
Learning Difficulties
And
Producing Difficulties
Recognized as a
Learning Disability
most of the time
Producing Difficulties Only
When severe, typically
attributed to motivation
or personality problems
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23. Impact of EF and Learning
Although executive functions are used to guide cognitive processing involved in new learning, many new learning situations are structured in ways that reduce the need for strong executive direction.
In direct contrast, demonstrating what has been learned usually requires significant involvement of executive control processes
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24. Nonverbal Working Memory
ADHD Strategies
Nonverbal Working Memory
Imitation and vicarious learning
Anticipation and preparation to act
Awareness of self across time
Spatial location
Organization & reproduction of
complex designs
Less proficient at imitating sequences of simple motor gestures
Psychological awareness of time
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Andrea Ogonosky, Ph.D. May 2002

25. Verbal Working Memory Internalization of speech
ADHD Strategies
Verbal Working Memory
Internalization of speech
self-description and self-reflection
rule governed behavior (self-instruction)
digit span
mental computation
the basis for verbal thought
memory tasks
hindsight, forethought, and planning
In combination with NVM systems it gives us: reading comprehension and moral reasoning and guidance of behavior
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Andrea Ogonosky, Ph.D. May 2002

26. EF and School
Test taking can be exceptionally difficult for a student with executive difficulties if the test format emphasizes executive demands over content knowledge.
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27. EF and School
In the classroom, the task most frequently impacted by executive function-driven producing difficulties is written expression.
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28. EF and Written Language
Poor grapho-motor control and lack of automaticity for handwriting.
Poor organization of written material
Poor retrieval cueing or poor generate cueing for idea generation or idea fluency when writing.
Inability to use multiple self-regulation
EFs at one time (e.g. hold, manipulate, retrieve with generate and execute).
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29. Reading and EF Reading Decoding – poor use of one or more
self-regulation EFs (e.g., lack of attention to
specific letters in words; saying words that
“look” like the word on the page).
Rapid Automatic Naming – poor executive control of language fluency processes.
Reading Comprehension – poor direction of
one or more self-regulation EFs (e.g., Focus,
Sustain, Hold, Manipulate, Balance, Pace,
Time, etc.) when reading for meaning.
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30. Math and EF
Poor cueing of Focus/Select, Monitor, and Correct functions when doing calculation routines.
Poor cueing of hold, organize, manipulate and retrieve when setting up calculations or problems
Poor cueing of organize, store, retrieve, execute when learning or applying rote knowledge (e.g. storing and retrieving multiplication tables).
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31. Interventions General Two-Stage Approach to Intervention:
Attempt to Affect Internal Change
Apply External Control As Necessary
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32. Important Life Changes That Work! (Hallowell, 2005)
Positive human contact
Reduce electronics
Sleep (increase opportunities)
Diet: balanced - eat protein at breakfast
Exercise
Prayer or meditation
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33. Implications for Interventions
Intervene at “points of performance”
Externalize all information
Externalize sources of motivation
Arrange immediate consequences for task initiation and completion
Plan to provide interventions over the long-term
Take over the now!
Physically represent time--they have no sense of time!
Externalize--post it, print it, put it in front of them.
Externalize motivation--bring them into the now and keep it in place.
If you don’t externalize motivation, then externalizing information will fail!
Will probably always need something like token system.
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34. Tier 1: Core Foundations
Build a Culture of Acceptance and Safety
High performance expectations for all students
Clearly articulated rules and consequences
Strong student teacher relationships
High level of parent and student participation
Student connectedness to the school process
Multiple opportunities for success with academic
and social skill development
Conflict resolution strategies actively taught and
modeled (school-wide)
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35. Building Internal Strategies
Providing students with feedback about their performance enables them to engage executive capacities more effectively to learn from their mistakes and improve future performance
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36. Build Internal Strategies
Use IES guides to develop strategy instruction within Tiered interventions.
Align anchor activities within instructional groups for repeated practice of strategy use within intervention.
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37. Classroom Instruction (TIER 1)
To assure that executive function capacities are used to their fullest potential, it is important to state the goals of the learning process. Stating goals enables executive capacities, either consciously or nonconsciously, to engage the perceptions, emotions, thoughts, and actions, needed to achieve the goals.
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38. Tier 1 In many ways, teachers ARE their student ‘s frontal lobes.
Providing prompts and cues are important to assure that children are engaged appropriately in the instructional process.
Modeling good executive functions helps children see how they can self-regulate their own perceptions, emotions, thoughts and actions.
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39. Homework: 7 Skills Parents Can Help Children Learn
Insure assignments are copied correctly and get home with proper books/materials
Select work place at home
Start assignments by reading directions and following them carefully
Manages difficult or long-term assignments
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40. Homework: 7 Skills Parents Can Help Children Learn
Maintains attention to boring tasks
Checks work for accuracy and completeness
Gets homework to school when done
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41. Homework (Parental Responsibility)
Create Proper homework environment
Quiet place
Regular schedule
Necessary supplies
Teachers instructions and requirements are understood
Awareness of child’s difficulties-inform teacher
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42. Homework (Parental Responsibility)
Set homework goals-reinforce achievement
Motivation: praise, self-monitoring
Organize assignments
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43. STRIVE FOR FIVE!
Strong Positive Behavior Supports: School-wide, classroom, individual
Highly structured classroom
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44. Foster Positive Teacher Student Relationships
Pair and Share
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45. Classroom Strategies (Self-Discipline)
Adopt classroom management and disciplinary practices that are proactive, instructive, and corrective
Correct behavior fairly and consistently
Arrange physical environment to reduce congestion and facilitate smooth and quiet movement of students
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46. Classroom Strategies (Self-Discipline)
Use a variety of teaching methods to address various learning styles
Review and discuss acceptable behavior expectations throughout the year
Reinforce positive behaviors
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47. Characteristics of a Positive Classroom Environment
Create a welcome and inviting atmosphere:
Free from clutter
Highly organized
Daily routines established
Rules visible and reinforced daily
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48. How do you arrange a classroom to increase academic engagement?
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49. Physical Arrangement of Classroom
Divide room into logical work areas:
All students can be easily seen by teacher
Maximize student personal space by arrangement of desks
Establish traffic patterns
Minimize areas of distractions
Maintain distance between students and supply/storage areas
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50. Principles for Managing EF
Externalize time, reduce delays
Externalize important information
Externalize motivation
Externalize problem solving (chore cards)
Immediate feedback
Increased frequency of consequences
Externalize time--bridging time
Example of book report--Read book (externalize event), write 2 sentences, get 10 tokens. Break into small daily doses. Consequences as immediate as you can.
Another example; page of math problems. Cut into strips (rows). Hand one row to child to complete. Child gets reinforced when completes row plus gets exercise and attention.
Act don’t yak--manage consequences and shut up--it’s not an “information-deficit disorder!”
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51. Principles for Managing EF
Increase accountability of others
Use more salient and artificial rewards
Change rewards periodically
Touch more, talk less
Act, don’t Yak
Keep sense of humor
Use positives before negatives--kids being punished enough!
Anticipate--kids have no sense of time/no forethought--we have to break it down for them and anticipate.
Keep perspective--”invisible but real”
Priorities--keep in mind developmental priorities
Forgiveness--formally teach forgiveness
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52. Principals for Managing EF
Use positives before negatives
Anticipate problems; have a plan
Maintain a sense of priorities
Practice forgiveness (child, self, others)
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53. Command Effectiveness
Use imperatives, not questions
Break down complex tasks to simpler ones
Bridge time delays in tasks (use external cues to bridge tasks)
Use single-step commands
Praise initiation of compliance and reinforce throughout task
Get attention before giving directions
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54. Tier 2 Strategic Interventions
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55. Conduct Functional Behavior Assessment
Tier 2: Informal data gathered through observations, consultations, review of teacher data and student products
Purpose:
To identify the function(s) maintaining problem behaviors
antecedent events = triggers occurrence of behaviors
consequences = maintains behavior episodes
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56. Tier 2: Common Principles of Strategic Interventions
Positive Behavior Supports are used to motivate students.
Corrective feedback is immediate.
Students master content before moving on to more difficult activities.
Professionals are trained to implement intervention with high level of fidelity:
Practice with all staff to ensure consistency
Meet weekly to problem solve and share ideas
These are some of the important aspects of any tutoring program. The tutoring program should include a point system for motivation and provide students with immediate corrective feedback. Students should master content before moving on to more difficult tutoring activities. Students work with their tutor to set goals and learn how to self-monitor their learning.
Training the tutors to implement the tutoring intervention effectively is a very important aspect of secondary prevention. When learning to implement the tutoring, tutors should be presented with demonstrations of each tutoring activity and have time to practice the tutoring strategies. Tutors should schedule practice time with one another before tutoring students in the schools. Tutors could also practice with age-appropriate students who are not the actual students to be tutored. Weekly meetings for the tutors should be arranged so tutors can share ideas, plan for upcoming tutoring sessions, and problem solve.
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57. Tier 2: Behavior Reduction Strategies to Monitor
Responding to misbehavior
Continuum of consequences established
Consider misbehavior as a behavioral error: treat like an academic skills error
Re-teach appropriate behavior
Respond consistently and efficiently
Observe the effects of behavior reduction strategy
Punishment??? Behavior increases??
Respond early: avoid escalation, prolonged existence
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58. RtI Team Roles in Tier 2
Ongoing progress monitoring of data (specifically ensuring fidelity of data collection)
Social Skills Training
Motivational Strategies
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59. Targeted Group Interventions ADHD
Small group instruction within the areas of self-monitoring for problem solving, social skills, behavioral regulation
Small group instruction for identified academic deficits.
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60. Tier 3 Team Role: Intervention Implementation
Assist with intervention
Fidelity checks at least weekly
Revise when needed regarding fidelity
Monitor progress
Design and implement
Provide feedback to teacher or parent
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61. Tier 3 Interventions Prevention (Make problem behaviors irrelevant):
Schedule
Curriculum (content, sequence)
Instruction
Skill Building (Teach desired behaviors)
Teaching = delivering events that change behavior, not just delivering curriculum
Replacement behaviors (maintain same function as problem behavior)
Adaptive skills
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62. Increase Behavioral Successes
Find the buried Treasures (Hallowell, 2005)
Connect
Play
Practice
Master
Recognition
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63. Determining Eligibility for OHI
Full and individual evaluation that is comprehensive
Meet three prongs
Eligible according to disability classification criteria
Eligible due to adverse impact of disability on attainment of an appropriate education (using RtI data collection)
Eligible due to need for special education (specially designed instruction and related services)
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64. Questions
Thank you for staying on task and engaged to a marked degree and for a long period of time!
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