1. Diane La Bomme, Program Specialist Beverly Murata, Program Specialist June 9, 2015 1

2. The participants will: Define Executive Function Discuss the concept of “surrogate frontal lobe” Evidence based strategies to support students with Executive Function impairments in the school environment How to objectively describe behaviors The ABC’s of Behavior Antecedent Behavior Consequences 2

3. PUSD’s Six Essentials 3

4. Definition of Executive Function Executive Function/Skills are: Elements of cognition that allow for the self- regulation and self-direction of our day-to-day and longer term functioning. https://www.youtube.com/watch?feature=player_embedded&v=efCq_vHUMqs 4

5. 5 Working Memory Inhibitory Control Mental Flexibility Definition of Executive Function

6. 6 The Executive Skills The Metacognitive Strand Goal Setting Planning/strategizing Sequencing Organization of materials Time management Task initiation Executive/goal-directed attention Task persistence Working Memory Set Shifting The Social/Emotional Regulation Strand Response inhibition (Impulse Control) Emotional Control Adaptability

7. Executive Function – Components & Processes Behavioral Inhibition - putting brakes on your behavior. Working Memory- “Remembering so as to do”. (Barkley, 2005) Initiation – the skill of actually getting started. 7

8. Executive Function Self talk – the ability to talk to ourselves. Foresight/Prioritization – predicting and planning for the future. Hindsight – remembering past experiences. Sense of time 8

9. Executive Function Organization is the skill to To create structure or order. Flexibility is the skill to alter plans mid-stream as the circumstances change. Shifting from Agenda A to Agenda B. 9

10. Executive Function Sustaining focus, alertness, and effort Goal-directed persistence 10

11. Executive Function Self-regulation of emotions & motivation Separating emotion from fact requires time to reflect. Adding emotion to fact is an important part of motivation. Self-monitoring, metacognition 11

12. Executive Function & ADHD Students with ADHD are approximately 30 percent delayed in their development of executive functions. Students with ADHD are on average, about 30 percent delayed in their ability to organize and follow directions compared their classmates. 12

13. The Classical Definition of EFD/ADHD is just the tip of the iceberg. (Kutscher, MD 2008) 13

14. Neurological Basis of EFD/ADHD: Frontal Lobes Asleep on the job. EFD/ADHD is a real biological condition: The frontal and pre-frontal lobes are the home of our executive and inhibitory functions of these frontal and pre-frontal lobes. The neurotransmitters dopamine and norepinephrine play a major role in the inhibitory functions of these frontal and pre-frontal lobes. In EFD/ADHD, there is insufficient action by these neurotransmitters. People with EFD/ADHD show poor executive and inhibitory behaviors. 14

15. Executive Function & ADHD In the school setting we do not “diagnose” ADHD We assess in the areas affected by ADHD Language, social skills, cognitive skills, behavior, developmental history 15

16. SYMPTOMS OF EXECUTIVE DYSFUNCTION Act like moths: Students with EFD/ADHD are like moths: they are always with the brightest light. The brightest light could be a video game, or a shiny pen, or the fascinating paperclip on the desk. Rarely will the brightest light be a book report that is due in two weeks. 16

17. SYMPTOMS OF EXECUTIVE DYSFUNCTION Able to focus on videogames forever: EFD/ADHD doesn’t mean that you can’t pay attention. It means you can’t pay attention to anything that isn’t the most fascinating. Trouble actually executing a task: Most students with EFD/ADHD intend to do the task, however their executive dysfunction in the area of actually initiating tasks prevents the execution of the job. Poor organization: Disorganization is a cardinal symptom of EFD/ADHD. It often looks like lack of motivation. 17

18. SYMPTOMS OF EXECUTIVE DYSFUNCTION Inconsistent work and behavior: With 100% of their energy, students with EFD/ADHD may be able to control the task that most of us can do with 50% of our focus. But who can continually muster 100% effort? (As the joke goes: Children with ADHD do something right once, and we hold it against them for the rest of their lives (Barkley 2000). Trouble returning to task: Students with EFD/ADHD often can get through the major aspects of a project in a burst of energy, but have trouble returning to the task to mop up the less-intriguing finishing details. Poor sense of time: May take a long time to do a small part of an assignment. Time moves too slowly: May complain that an activity is taking forever. 18

19. SYMPTOMS OF EXECUTIVE DYSFUNCTION Lack of foresight!!!: Foresight-the ability to predict the results of our behaviors-is a major adaptive ability of humans. We can run imaginary simulations of possible future outcomes on our brain’s computer. Lack of use of this ability can be the most devastating part of EFD/ADHD. It’s not that the student doesn’t care about the future; it is just that the future doesn’t even exist in his/her working memory. (Kutscher MD 2008) 19

20. SYMPTOMS OF EXECUTIVE DYSFUNCTION Lack of foresight!!!: 20

21. SYMPTOMS OF EXECUTIVE DYSFUNCTION Poor hindsight/trouble learning from mistakes: Unable to inhibit the present, student cannot stop to consider lessons from the past. Poor hindsight is one of the reasons why punishment rarely solves the problems for students with EFD/ADHD. They can’t keep past repercussions in mind as they fact the present. Live at the “mercy of the moment.”: All your student can do is react to whatever is happening to him right then and there. EFD/ADHD behaviors make sense once we realize that they are based on reactions taking only the present moment into account. The future and the past don’t even exist. Such is the nature of the disability. Poor ability to utilize “self-talk” to work through a problem. Poor sense of self-awareness: Impulsivity (defined as acting quickly and without thought) in EFD/ADHD comes from two reasons: the students aren’t good at stopping (therefore, they act quickly), nor or at self-talk (there, they act without thought). 21

22. SYMPTOMS OF EXECUTIVE DYSFUNCTION Poor reading of social cues: Often the student with EFD/ADHD is too overwhelmed to note other people’s reactions. Trouble with transitions: Trouble shifting agenda at someone else’s time frame is a major cause of EFD/ADHD blowups. Hyper focused at times: It is often difficult getting a student to change from something they like doing, such as games on the computer. Poor frustration tolerance: Students with EFD/ADHD often times will not want help. Frequently overwhelmed and angry: (Ms. A, just stop. I can’t stand it. Just stop. Please!) Push away those whose help they need the most: Simply overwhelmed. 22

23. SYMPTOMS OF EXECUTIVE DYSFUNCTION Inflexible/explosive reactions. Feels calm only when in motion. Thrill seeking behavior. Student may crave stimulation at any cost. Trouble paying attention to others. Lying, cursing, stealing, and blaming others: These can become frequent components of EFD/ADHD, especially as the student gets older. 23

24. Common Behaviors of EFD & ADHD Many behaviors that are common for ADHD are also common in typically developing children and in children with other disabilities. You can effectively address these behaviors in a similar manner regardless of the cause of the behaviors. 24

25. Tips for Teaching Students with EFD/ADHD Four Basic Principles of Effective Approaches to improve the lives of students with ADHD 1. Keep it positive. 2. Keep it calm. 3. Keep it organized. 4. Keep it going (i.e., keep doing 1 to 3). 25

26. Disorganization is virtually built into the definition of EFD/ADHD Fails to give close attention; makes careless mistakes Difficulty sustaining attention Does not seem to listen when spoken to directly Easily distracted by extraneous stimuli 26

27. Disorganization is virtually built into the definition of EFD/ADHD Difficulty organizing tasks Fails to follow through (not volitional or incapable) Loses things needed for tasks Often forgetful in daily activities 27

28. Disorganization is virtually built into the definition of EFD/ADHD Do not confuse disorganization with “He/She doesn’t care”. “Sink or swim” does not work for students with disabilities 28

29. Disorganization is virtually built into the definition of EFD/ADHD Five Major components of an organizational system: An assignment pad A monthly planner A bi-folder for all papers coming from school (left side) and for all papers going back to school (right side). A single binder (or two) Most importantly, frontal lobes to supervise continued use of the above. 29

30. Disorganization is virtually built into the definition of EFD/ADHD Convert assignment pads into time schedules: A time schedule for today – a “To Do List.” Use of visual timer for specific tasks, to support the student’s on task behaviors. 30

31. Disorganization is virtually built into the definition of EFD/ADHD Ongoing skills support provided by teacher/resource specialist/instructional aide: Checks the assignment sheet Reviews the monthly calendar Reviews due dates Reviews the plan for breaking down larger projects into steps. 31

32. Disorganization is virtually built into the definition of EFD/ADHD Ongoing skills support provided by teacher/resource specialist/instructional aide: Reviews needed books. Checks for daily class notes/materials for each subject. Teachers provide appropriate information to the parents/other team members. 32

33. Disorganization is virtually built into the definition of EFD/ADHD Allow the student to expediently make up missed work. Teacher/parent communication in “real-time” is essential 33

34. EFD/ADHD Strategies: “ Students with EFD/ADHD typically already know what to do, they just can’t execute it this decade.” (Kutscher, 2005) Look for associated problems (70% will have some type of learning disability). Don’t take the EFD/ADHD behaviors as personal challenges. Provide help for deficits at the moment it is needed, not negative feedback when it is already to late. 34

35. Accommodations: Presentation Materials Provide “preferential seating”. “Present material in an animated fashion. Remember students with EFD/ADHD are like moths. They will pay attention to whatever is the brightest light. The teacher needs to be more interesting than the paperclip on the desk.” (Kutscher 2008) Establish good eye contact. 35

36. Accommodations: Presentation Materials Tap on the desk (or use another code) to bring the student back into focus. Alert the student’s attention with phrases such as “This is important.” Alert the students they are about to be called on. 36

37. Accommodations: Presentation Materials Break down longer directions into simpler chunks. Frequently check for understanding Encourage students to underline/circle/highlight the key words in directions. 37

38. Accommodations: Presentation Materials Allow physically hyperactive children out of their seats to hand out and pick up papers, maybe stand to do their work, etc. Keep students and parents apprised of their grades. Students with EFD/ADHD often have an inflated sense of how well they are doing. Two sets of textbooks might be useful. 38

39. Accommodations: Presentation Materials Use tangible methods to externalize problem areas: Explicitly state out loud the problem and consequences at the time of the event. Use timers and planners to break down tasks into manageable, concrete chunks. ( Timers and planners give a tangible face to nebulous concept of time). 39

40. Accommodations: Presentation Materials Use clear and simple directions. Have the student repeat the directions. Encourage use of a word processor. Keep it up. Don’t allow the success of organizational support to lead to its disuse. 40