1. Implementing Strategies to increase Executive Function Skills in Young Children Patricia M Blasco, PhD Teaching Research Institute Western Oregon University Presentation at the Division for Early Childhood Conference St. Louis, MO 2014

2. Learner Objectives ▪ Participants will gain knowledge of executive function as cognitive capacity and how to improve skills for children who were born LBW or have developmental delays impacted by EF. ▪ Participants will learn how intervention strategies on components of executive function may help to strengthen EF skills and buffer or ameliorate learning difficulties in young children prior to school-age.

3. He’s the CEO of his brain

5. Executive Functioning Birth to 3 ▪ Refers to a group of neurocognitive processes in the brain that direct, connect, and organize information that is manifested in planned behavior.

6. Perception Emotion Cognition Action Co-Conductors in a Holarchical Model of EF =Domains Of Functioning EF =Executive Function Capacity EF ef Activation

8. Neurocognitive Processes ▪ Self Regulation ▪ Inhibition ▪ Working Memory ▪ Cognitive Flexibility ▪ Goal Selection ▪ Planning and Organization

9. Early Childhood and EF ▪ Components follow their own developmental trajectory ▪ growth spurts in the last half of the first year and then from 3 to 6 years of age Diamond, 2006

10. Why are these so important in Early Childhood? ▪ Inability to plan and organize actions, maintain attention to tasks, and recall past experience to apply to new learning experiences lead to: ▪ Learning disabilities (LD) as well as problems with Attention-deficit/hyperactivity disorder (ADHD)

11. Model of Early Indicators and Later Learning Disabilities Cognitive Problem-Solving Self-Regulation Early Language LanguageMemory Attention Concentration Self – Regulation (Social Mastery Motivation ) Visual Spatial/Motor Executive Processes Blasco & Saxton, 2010

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13. First Year of Life ▪ By 12 months, infants should be able to: ▪ Engage in a simple problem-solving task requiring working memory of an item (find a hidden toy under a cloth when it is changed) ▪ A not B task (Shift) ▪ Regulate behaviors (inhibit actions, waking, sleeping, eating, etc)

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15. Self-Regulation Self-regulation functions are developing from the first years of life on throughout a person’s entire lifetime.

16. Toddler (24 months) ▪ Spatial Reversal Concealed behind screen, reward under one of two cups, side of hiding reversed ▪ Multilocation Search (A not B) Object hidden at one of three or more locations

17. Three years and up ▪ Dimensional Card Category Sort (DCCS) Cards depicting colored shapes Child sorts cards by 1 dimension then another ▪ Knock tap Child knocks when Examiner taps

18. Dimensional Change Card Sort- Separated Task Rule: Sort by Shape Rule: Sort by Color

19. What about children born LBW ▪ Major medical conditions, such as cerebral palsy and other severe disabilities, are well known outcomes of low birth weight (LBW) (≤ 2500 grams) and preterm birth (≤ 37 weeks).

20. Research on LBW ▪ Longitudinal research has shown that, although a large portion of this population did not have major disabilities, many had lasting cognitive impairments, particularly in executive functions (EF) Anderson & Boyle, 2004; Vohr, Wright, Poole, & McDonald, 2005

21. Research on LBW ▪ Very preterm infants ( ≤2500 g, ≤37 weeks gestation) scored lower on tasks of executive functioning than full- term infants. ▪ Outcomes include poor cognitive function, learning difficulties, and behavior problems. Aarnoudse- Moens et. al., 2009; Sun, Mohay, & O’Hallahan, 2008

22. National Early Intervention Longitudinal Study (NEILS) National longitudinal study that followed children and families from the time they entered Part C Early Intervention through kindergarten. ▪ LBW data from CDC in 2002: ▪ 7.8% of all births are LBW ▪ Of those, 1.5% were ELBW (< 1,000 grams) ▪ NEILS LBW data ▪ n = 19,000 were ELBW (< 1,000 grams) ▪ Conclusion: Far fewer ELBW infants are in EI than in the general population.

23. Results for Yes EI vs. No EI N = 375 Attends EI by BWYesNo LBW41 %59% VLBW60 %40% ELBW54%46% For the purpose of this analysis, Group 1 are labeled LBW ( 1500 grams), Group 2 VLBW ( 1000grams); Group 3 ELBW (<1000 grams). The percentages demonstrate that there were more children born LBW who were not in EI than those who were in EI. The percentages in EI are slightly higher for the VLBW and ELBW groups. However, there remain significant percentages of children not in EI in all groups. Blasco & Saxton, 2014

24. So why are some of these children who are at risk not in EI? This question remains unanswered at present. However, we know this population is highly at risk not only because of LBW but many of these children are from low SES and high poverty communities with limited resources (Blasco, Spiken, & Shaw, 2013).

25. National Children’s Study “There are no standardized tests that assess these specific abilities in infants, there are tests of attention, memory, and executive function that have been well-researched and replicated, yielding robust and consistent findings.”

26. Need for Measurement tools ▪ Executive functioning is important to cognitive development during the birth to three years. ▪ Comprehensive measures of executive functioning are needed for infants and toddlers.

27. Lowe, MacLean, Shaffer, & Watterberg, (2009) completed a study of object permanence as an indicator of early working memory on 18 to 22 months olds using scores extrapolated from the Bayley Scales of Infant and Toddler Development III (Bayley, 2005). Duvall, Blasco, Dolata, Atkins, & Saxton (2014) replicated this research in a pilot study with LBW toddlers and found gender differences favoring females on these Bayley tasks.

28. We will further examine the influence of each individual category of a measure of self-regulation and mastery behavior, the Dimensions of Mastery Questionnaire ( DMQ 17) Bayley III items to see if we can extrapolate indicators of Executive Function for children who were born LBW from 6 months to 3 years.

29. Researchers have demonstrated that aspects of executive functioning can be improved in infants and toddlers with intervention.

30. The Behavior Rating Scale of Executive Functioning – Preschool version (BRIEF-P) ▪ A 63 item rating form for parents or caregivers to rate a child's executive functions within the context of his or her daily environments ▪ Gioia, Espy & Isquith, 2002

31. How can we help? Inhibit ▪ Stop, redirect activity Inability to inhibit ▪ does not notice when his/her behaviors cause negative reactions ▪ talks in places too loudly ▪ Engages in inappropriate behavior

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33. Cognitive Flexibility (Shift) ▪ Moving from one idea/activity to another ▪ Difficulty: ▪ becomes upset in new situations ▪ has trouble changing activities ▪ resist changes in routine, foods, places ▪ acts overwhelmed or overstimulated in crowded and/or noisy environments

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35. Emotional Control Ability to control frustration, think before acting ▪ Difficulty with: ▪ overreacts to small problems ▪ after having a problem will stay disappointed for a long time ▪ has outbursts for little reason ▪ small events trigger big reactions

36. Working Memory Holding information in mind and recalling it Difficulty with: ▪ has trouble with activities or tasks that have more than one step ▪ cannot stay on the same topic when talking ▪ has a short attention span ▪ unable to finish describing an event, person, or story

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38. Planning and Organizing ▪ Mastery Motivationi ▪ Difficulty with: ▪ does not complete tasks even after given directions ▪ when instructed to clean up put things away in a disorganized/random fashion ▪ trouble following established routines for sleeping, eating, and/or play activity

39. ACTIVITY BASED TASKS ▪ Verbal Working Memory Tasks ▪ Questions “I eat bamboo?” “What am I?” ▪ Simon Says ▪ Red Light/ Green Light ▪ Dot to Dot pictures

40. Let’s Try It

41. Name the Ink Color Outloud…. ▪ Red ▪ Green ▪ Yellow ▪ Red ▪ Green ▪ Blue ▪ Yellow ▪ Red ▪ Green ▪ Blue ▪ Red ▪ Blue ▪ Yellow ▪ Red ▪ Blue ▪ Green

42. Name the Ink Color Outloud…. ▪ Red ▪ Green ▪ Yellow ▪ Red ▪ Green ▪ Blue ▪ Yellow ▪ Red ▪ Green ▪ Blue ▪ Red ▪ Blue ▪ Yellow ▪ Red ▪ Blue ▪ Green

43. Inhibit Interventions ▪ Frequent Breaks ▪ Environmental Structure ▪ Limit distractions ▪ Behavior programs ▪ Frequent Redirection and Limit Setting ▪ Smaller Student-Teacher Ratio

44. Shift Interventions ▪ Displaying a daily schedule ▪ Development of positive routines ▪ “Two minute warning” ▪ Working in small groups

45. Emotional Control Intervention ▪ Preview social situations ▪ Review rules ▪ Behavioral management techniques

46. Working Memory Interventions ▪ Establishing Eye Contact ▪ Frequent, brief, breaks ▪ Reduce distractions ▪ Increase Supervision/Aide ▪ Time of Day important ▪ Encourage verbalization, paraphrasing, repetition ▪ Memory, Number-Letter Sequencing, Songs

47. Planning and Organizing Interventions ▪ Increase external structure ▪ Parent/Teacher modeling ▪ Provide examples ▪ Present information in an organized fashion ▪ Book of common routines

48. “Get Ready for Outdoor Play” What do we need? Check the Weather Make a list / visuals ▪ Coat ▪ Hat ▪ Water bottle ▪ Boots

49. Organizational Skills ▪ Plastic containers are a great way to organize different toys, especially the smaller ones that can fit in one drawer.

50. Organizational Skills ▪ Picture/label the toys inside and have children return materials to the right drawer. ▪ Use a large picture calendar of daily routines or storyboard

51. Organizational Skills ▪ Teach the children how to place lunch plates or cups in a designated place after a meal ▪ Use a fun folder that the child picks out to pass notes back and forth with family

52. Organizational Skills ▪ Videotapes on cell phone to remind child of daily routines ▪ Talk about past and future events ▪ Use visual strips or book to help child with routines

53. Executive Function Intervention ▪ 12 months ▪ Use a shape sorter, show the child how to insert a simple shape circle, provide them the opportunity to place the same shape. Now ask them to place other shapes. Watch the child for signs of frustration or lack of interest. If the task is too challenging, reduce the number of shapes.

54. Executive Function intervention ▪ 24 Months ▪ Find six pair of socks and place them singularly in a basket. Ask the child to find the matching sock and put them together. To add a challenge use small and large socks so the child has to match both color and size. To add a fine motor component, have the child clip the matching socks together with a large clipper for snacks.

55. Executive Function Intervention ▪ 36 months ▪ Build a road with blocks and make an obstruction. Ask the child to rebuild the road without the obstruction. Let the child experiment with problem- solving as they try to rebuild the road.

56. Preschool Executive Functions Perform simple chores and self-help tasks with reminders (e.g., clear dishes from table, brush teeth, get dressed). ▪ Inhibit behaviors: knows not to touch a hot stove; knows not to run into the street; knows not to grab a toy from another child; hit, bite, or push, etc.

57. EF: Kindergarten – Grade 2 ▪ Kindergarten ▪ Complete errands (two to three step directions; more complex). ▪ Organize bedroom or playroom toys (put in bin, etc.). ▪ Perform simple chores, self-help tasks; may need reminders (e.g., throw tissue in trash).

58. EF: Kindergarten – Grade 2 ▪ Bring backpack to and from program. ▪ Complete simple assignments (20-minute maximum). ▪ Decide how to spend money (allowance). ▪ Inhibit Behaviors: follow safety rules, raise hand before speaking, keep hands to self.

59. Organization of Materials for K – 2 nd Grade ▪ Talk with child about goals, plan of approach, and provide appropriate guided approach ▪ Parents and teachers should help in reviewing materials needed ▪ Provide organization time at the end of the school day

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61. The End Patricia M Blasco, PhD blascop@wou.edu