Executive Functions 2023 PDF

EXECUTIVE FUNCTIONING SKILLS CATHERINE CAVALIERE, PHD OTR/L GRADUATE OCCUPATIONAL THERAPY PROGRAM DOMINICAN UNIVERSITY NEW YORK CEO OF SELF DEVELOPMENT OF EFS Planned and sequenced motor actions towards a goal Interconnected is the cognitive processes As we grow- cognitive processes becom...

EXECUTIVE FUNCTIONING SKILLS CATHERINE CAVALIERE, PHD OTR/L GRADUATE OCCUPATIONAL THERAPY PROGRAM DOMINICAN UNIVERSITY NEW YORK CEO OF SELF DEVELOPMENT OF EFS Planned and sequenced motor actions towards a goal Interconnected is the cognitive processes As we grow- cognitive processes become more complex  WHAT ARE EXECUTIVE FUNCTIONS? Organization Self Regulation Planning Inhibition Time Management Self monitoring Working memory Behavioral Regulation Attention – sustained and shifting Emotional regulation Task initiation Flexibility Task completion/execution Problem solving  DYSPRAXIA Dyspraxia – difficulty conceptualizing, planning and executing a non habitual/familiar motor task ( Ayres, 1979) https://youtu.be/ncnVYonMA5Y  EFS AND OCCUPATIONS OF ADOLESCENTS School Relationships Work Extracurriculars MYTHS ABOUT CHILDREN WITH DYSPRAXIA( AND ADHD) “SMART BUT SCATTERED” “LATE, LOST AND UNPREPARED” Lazy Unmotivated Need to work harder Need to focus Do not live up to potential Need to manage time better Will grow out of it EFS AND MENTAL HEALTH Fatigue Low self worth Low self efficacy Depression Anxiety  EFS SCHOOL RELATED CHALLENGES Forgets homework Looses personal belongings frequently- books, water bottles, hats Hands homework in late Forgets club meetings Trouble starting assignments Trouble finishing assignments Forgets important dates/deadlines Starts projects the night before Late for class on regular basis Trouble following directions Cannot keep up with peers academically even though very bright Trouble organizing personal belongings – locker, backpack Always playing catch up  EFS HOME/COMMUNITY RELATED CHALLENGES Reminders for self care Conflict with parents Takes a long time to perform self care Need repeated reminders to do simple tasks tasks Room always a mess Absent minded Constantly looses or misplaces things Frustrated easily Decision making is difficult – what to eat, wear etc..  EFS SOCIAL RELATED CHALLENGES Late to social outings Does not respond to texts Does not initiate plans Does not initiate and maintain conversations Constant catch up Limited extracurricular participation  DEVELOPMENTAL COORDINATION DISORDER (DYSPRAXIA) AND EFS Dyspraxia “disorder of sensory integration interfering with the ability to plan or execute skilled or non-habitual motor tasks” (Ayres, 1979) Clumsy Slow to learn new motor tasks- riding a bike, tying shoe laces; handwriting; sports Low muscle tone EFS challenges  ADD/ADHD AND EFS Ø ADHD/ADD have marked and well documented executive skills deficits Ø Can be diagnosed with ADHD based purely on EFS challenges Ø Research using the BREIF-ADHD andADD- impairments on all scales in working memory, shifting attention, planning or organizing and task completion Ø ADHD- also marked deficits in Inhibition – not ADD Ø Diminished activity in the cerebellum Ø Sensory Processing Challenges Ø Self Regulation challenges  AUTISM AND EFS Ø Children with ASD have been identified as having executive skills deficits – in particular planning, flexibility, initiation and working memory.These deficits have been correlated impairments in adaptive skills, socialization and independent living Ø Dyspraxia has been identified as a feature ofASD Ø Children with ASD demonstrate difficulties with Self Regulation –emotional regulation, sensory processing TRAUMA AND EFS  ASSESSMENT OF EFS Interviews- child, parent, teachers Observations- varied environments- task performance Standardized assessments- BREIF 2; Child Behavior Checklist ( CBCL); Behavior Assessment System for Children(BASC-2) Motor planning/praxis- BOT-2, COMPS, Miller Function and Participation Scales ( M- FUN) Performance based assessment- GOAL EFS INTERVENTION STRATEGIES Opportunities during play to practice praxis Obstacle courses Playground equipment Sports Playing board games Practice during routines- self care; chores ; cooking Scaffolding Reflection  Environment EFS INTERVENTION Task STRATEGIES Person factors  SUSTAINED ATTENTION & WORKING MEMORY § Adapting the environment – arousal and attention and organization Modifying the physical space- de clutter ; organize for ease of access; creating systems Sensory aspects of environment to support arousal and attention – lighting; music; fidgets; scents; snacks ; seating options Modifying the ways cues are given – visual, auditory, tactile; electronic Bite size pieces, planned breaks, anticipated rewards § Checking in § Study buddy or Note friend TASK INITIATION § The Main Ideas – Build a Positive Cycle § Motivate –Schedule –Budget- Reward – (repeat) § The Toolkit § Daily Planner § Reminder Apps/Alarms § Bite-Size Pieces § Planned Breaks § Anticipated Rewards § Do Something – Anything - Start Anywhere § Graphic Organizers § COOP Method(Case-Smith & O’Brien, 2015)  ORGANIZATION § What are you trying to organize? § Physical environment - room, locker § Portable environment – backpacks § Virtual environment – data, information § The Toolkit § Color coded systems § A place for everything and everything in its place § Filing systems - real & virtual § Routines that support order § Systems § A central command center -visibility https://www.charlotteparent.com/how-to-help-your-teen-get-organized/  The Issues Frustration tolerance Delayed gratification GOAL- The Toolkit DIRECTED Goal Attainment Scales (GAS) (Case-Smith & PERSISTENCE O’Brien, 2015) Anticipating Rewards Breaking down tasks – bite sized pieces Error analysis Resources for self-correction Reflection  Issues Tasks appear farther away than they really are Balancing multiple tasks The Toolkit PLANNING, Agendas, planners, calendars, apps, alarms PRIORITIZING & Color coded scheduling/time blocking Sequencing – First the pants, then the shoes TIME Breaking down large tasks into small ones- bite size MANAGEMENT Analyzing areas of need – I got this/ I don’t have that Big Rocks/Small Rocks/Sand (Covey, Merrill & Merrill, 1994) Time use logs and analysis (real time vs planned time) – pie charts and other graphics METACOGNITION § Issues § Develop insight and awareness § Learn about how you learn/create § Think about how you think § Toolkit § COOP method § Talk aloud method § Error analysis/Self correction support § Describe & name thinking processes § Modeling § Reflection SAFETY SUPPORTS EFS  QUESTIONS TO CONSIDER What are EFS skills at 1-3 years? 4-7 years? 10-14? 17-21 yrs? How might intervention differ at each stage? Do you think that early praxis issues can predict later EFS challenges? Why or why not? If yes- what can we as OT’s do to prevent this? Think about the role of affordances in the development of praxis and what this might mean for babies and children in underserved communities.