Executive Functioning Disorder

1. Executive Functioning Disorder Presented by: Jennifer Wright & Barb Simeone

2. LET’S DANCE!

3. Why Dance? • Dancing develops Executive Functioning skills by helping with concentration, sequencing, timing, by engaging your brain to do several tasks at the same time.

4. What is EFD? • Executive functions have been likened to an orchestra conductor. The conductor doesn’t play the instruments, but he decides which instruments are needed, cues them, and integrates the sound to produce Beethoven’s 9th Symphony. Let’s Listen! • In cognitive terms, executive functions include the ability to initiate work, plan and organize, set goals, generate problem-solving strategies, and demonstrate cognitive flexibility, emotional self-regulation, and self-monitoring. • The “instruments” in the “orchestra” include skills such as reading, spelling, math, language and visual-spatial processing, verbal and non-verbal reasoning, visual-motor skills, sequencing, memory, etc. If there are deficits in underlying skills, executive functions will be impaired. On the other hand, all the “instruments” or underlying skills may be working, but the “conductor” may not be able to do his job. • By Marcia Eckerd, Ph.D.

5. Measuring Executive Function • Why Measure? • Standard tests in schools correlate poorly with Executive Functions, because the tasks on tests are structured and don’t require the initiation ongoing effort and organization needed for independent work. In real life information must be prioritized and multiple demands must be integrated simultaneously sustained in memory and managed over time. • How to Measure? • Woodcock-Johnson III Cognitive Test or NEPSY (for younger children). As we know these tests measure concept formation and cognitive shifting (WC-Jll), impulsivity and impulse control (NEPSY) which is specific to EF. These tests do have limitations since the students may not be able to perform same functions in real life time-frame and they don’t capture organization functions reliably. • www.smartkidswithld.org

6. Comprehensive Executive Functioning Inventory (CEFI) • The CEFITM is a comprehensive evaluation of Executive Function strengths and weaknesses in youth aged 5 to 18 years. The CEFI is an effective and reliable tool for evaluating executive function.The Purpose of the CEFIThe CEFI is a versatile instrument that can be used to evaluate an individual, using standard scores to compare the youth to a nationally representative norm group. This information can ultimately be used to guide assessment, diagnosis, and treatment planning.in turn guiding the success of an intervention program. • In addition to a Full Scale Score calculated by adding responses to 90 of the items, the CEFI utilizes nine rationally-derived scales to pinpoint targets for intervention:Attention; Emotion Regulation; Flexibility; Inhibitory Control; Initiation; Organization ;Planning- Self-Monitoring and Working Memory • (Cost is approx. $300.00 for complete online kit; Scoring kit is approx. $550.00). • Must be administered by professionals such as psychologists, school psychologists, clinical social workers, physicians, counselors, psychiatric workers, and pediatric/psychiatric nurses • www.mhs.com (Multi Health Systems Inc.)

7. We use our Executive Functioning Skills for these tasks: • Shifting • Planning • Organizing • Strategizing • Sustaining Attention • Remembering Details • Managing Time and Space • Regulating Thoughts and Actions

8. What does EFD look like in the Classroom? • difficulty planning and completing projects • problems understanding how long a project will take to complete • struggling with telling a story in the right sequence with important details and minimal irrelevant details • trouble communicating details in an organized, sequential manner • problems initiating activities or tasks, or generating ideas independently • difficulty retaining information while doing something with it such as remembering a phone number while dialing

9. What a Student with EFD mightlook like to others? Unmotivated Lazy Disorganized Having a bad attitude Unmotivated Apathetic Irresponsible Stubborn Undisciplined More and more however, neuroscientists are saying that these underachievers may suffer from neurological abnormalities, particularly in the Frontal Lobe. www.aboutkidshealth.ca www.teachadhd.ca

10. EFD: The ‘Hidden Disability’ The DSM-IV can be thought of as “A User’s Guide to All the Things That Can Go Wrong With the Frontal Lobes” (www.caddac.ca) • LD in math may just be an LD in math • EF’s present difficulties across all subjects, possibly including problems with starting work, staying focused on work, completing work, and remembering to do the work. • Executive function deficits are associated with a number of psychiatric and developmental disorders, including: Obsessive-compulsive disorder Tourette's syndrome Depression Schizophrenia Attention-deficit/hyperactivity disorder Autism Executive Function deficits also appear to play a role in: Antisocial behavior. Chronic heavy users of drugs and alcohol ↔ (EFD may contribute to developing Substance Abuse Disorder) www.minddisorders.com; www.caddac.ca; www.teachadhd.ca

11. EFD, LD, and ADHD • If you look at the criteria used to diagnose ADD/ADHD, inattentive type, you could understand why an EFD child might be diagnosed as having ADHD. But it’s important to know that EFD can cause learning disabilities (LD). • “EFD can be a reflection of ADHD, but it might also indicate an LD.” When a professional evaluating a child or adult finds evidence of EFD, it is essential for him/her to clarify whether the disorder results in ADD/ADHD, LD, or both. Only then can the child or adult receive the appropriate treatment for his specific problem. • A child or an adult with Attention Deficit/Hyperactivity Disorder (ADD/ADHD) might be hyperactive, inattentive, and/or impulsive. Clinicians have always understood hyperactivity and impulsivity. The understanding of inattention, though, has shifted from primarily “the inability to stay on task” to a broader concept called Executive Function Disorder (EFD), which involves a pattern of chronic difficulties in executing daily tasks. • The DSM lV does not currently include impairments in emotional regulation when diagnosing ADHD. The DSM V criteria for diagnosing ADHD may be quite different, than the DSM lV. Martha Bridge Denckla, M.D www.additudemag.com www.drthomasebrown.com/pdfs/ef

12. The Brain Areas of EF Research shows that the frontal lobes of the brainplay a major role in executive function. The frontal lobes are the large portions of the brain cortex that lie near front of the brain. The cortex is the site in the brain where lower level processes like sensation and perception are processed and integrated into thoughts, memories and abilities, and actions are planned and initiated. People with frontal lobe injuries have difficulty with the higher level processing that underlies executive functions. Because of its complexity, the frontal cortex develops more slowly than other parts of the brain, and not surprisingly, many executive functions do not fully develop until adolescence. Some executive functions also appear to decline in old age, and some executive function deficits may be useful In early detection of mild dementia. www.minddisorders.com; www.caddac.ca; www.teachadhd.ca

13. ADHD and EF Impairment

15. EFD: Signs and Symptoms Is this your child or student? • Keeps a messy room and a disorganized desk • Has difficulty following sequential instructions • Has trouble sitting still when others don’t • Needs to be nagged repeatedly to get ready to catch the bus • Fails to complete assignments unless you’re standing over him • Forgets to turn in homework even when it’s completed • Loses things regularly, from jackets to permission slips • Has a meltdown when it’s time to clean her room • Has difficulty planning and managing time • Fails to control his impulse to lash out when frustrated • Forgets to pay attention to where she’s going when talking on her phone • Engages in risk-taking or thrill-seeking behaviors

16. How we can Help Student’s with EFD Recognizing Different Learning Styles: Visual Indirect Experience Tactile Direct Experience Reflective/Logical; Sequential Rhythmic/Melodic Verbal Simultaneous Interactive Auditory These learning styles are based on learning styles; cognitive styles; Howard Gardner’s Multiple Intelligences; and also considers an information processing model out of school psychology. The Eclectic Learning Profile by Dr. Erica Warren www.youtubeericawarren/eclecticlearningstyles

17. All Learners • Create a structured work schedule with clear goals and expectations • Break Complex Tasks down into manageable goals • Teach children how to plan, organize, and manage time • Prioritize tasks • Be consistent and plan a routine • Practice what you preach – set an example

18. Organizational Tools • Use organizational charts (hourly, daily, weekly) if this fits in with child's learning profile (helps to plan, organize and manage time). Visual Schedules! • Organize work spaces with necessary tools • Minimize Clutter • Scheduled weekly time to organize work areas (desks, stations, book bags, files, etc.) • Use labelled boxes, cubbies, clear boxes, or file cabinet with colour coded files

19. Visual Organizational Schedule Sample

20. Manage Behaviours & Incentive Programs • Don’t ignore the problem – define target/desired behaviours and set goals • Remember it is not their fault • Negative labels can cause damage • Use positive reinforcers over negative ones (define motivating rewards) • Use incentive programs in order to help • develop sound work ethic • help children value and take care of belongings • help children build good habits of appropriate behaviours that match goals

21. Sample Rewards Chart

22. What Else Can We Do? • Read, read, read: (www.learningworksforkids.com) This site offers a variety of leading edge ‘reads’ to help understand and improve executive functioning skills. • Understand each child’s Eclectic Learning Profile • Dance: Eg.: Dance, Dance Revolution helps children with concentration, sequencing and timing • Interactive Metronome is an assessment and treatment tool used in therapy to improve neurological processes of motor planning; sequencing; and executive functioning, and processing • Lumosity and Fit Brains – these are subscription, web-based applications that use a wide range of games and exercises all geared to improve cognitive abiliites (www.lumosity.com; www.fitbrains.com) • Other Online Games geared towards improving Executive Functioning Skills: www.learningworksforkids.com For Ipod; Ipad; PC, Mac, etc. • Games for the Brain – free internet games for the brain (:games that develop Executive Functioning Skills: Chess; Blokus; Mastermind