ADHD: Executive Function Dysfunction (I meant to behave…..but I forgot!)

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

2. Core Symptoms • Poor sustained attention (inattention, distractibility) • Impulsivity (behavioral inhibition) • Hyperactivity

3. Co-morbid Conditions Psychiatric Disorders • Oppositional Defiant Disorder (ODD) • Conduct Disorder • Antisocial/Delinquency • Anxiety Disorders • Major Depression • Somatization Disorder

4. 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%)

5. Associated Problems (Emotional) • Poor rule-governed behavior • Immaturity • Irritable, hostile, excitable • Hyper-responsiveness toward others • Low frustration tolerance • Demoralization • Dysthymia

6. 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

7. Associated Problems (Medical) • More allergies, colds, otitis • Enuresis (43%) • Increased minor injuries due to accidents • Motor coordination problems (affects handwriting) • Sleep disturbances

8. 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

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

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

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

12. Executive functions

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.

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.

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.

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

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

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

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

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”

21. Executive Functions and School Because executive control is heavily involved in demonstrating learning, executive difficulties usually manifest as “Producing Disabilities” much more so than “Learning Disabilities.”

22. Learning Difficulties and Producing Difficulties

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

24. 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

25. 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

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.

27. EF and School In the classroom, the task most frequently impacted by executive function-driven producing difficulties is written expression.

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).

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.

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).

31. Interventions General Two-Stage Approach to Intervention: • Attempt to Affect Internal Change • Apply External Control As Necessary

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

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

34. Tier 1: CoreFoundations

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

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.

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.

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.

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

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

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

42. Homework (Parental Responsibility) Set homework goals-reinforce achievement Motivation: praise, self-monitoring Organize assignments

43. STRIVE FOR FIVE! • Strong Positive Behavior Supports: School-wide, classroom, individual • Highly structured classroom

44. Foster Positive Teacher Student Relationships Pair and Share

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

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

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

48. How do you arrange a classroom to increase academic engagement?

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

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