I Shouldn t Have to Tell em That. Executive Functioning Deficits that Create Behavioral Challenges for Children and Teens

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Shonda Stevens
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1 I Shouldn t Have to Tell em That Executive Functioning Deficits that Create Behavioral Challenges for Children and Teens

2 AGENDA Behavioral Challenges Challenges and Diagnostic Categories New Ways of Understanding: Why these behaviors occur How to help the child-teen change the behavior Discuss Examples Applying these Principles

3 Challenging Behaviors Procrastination Inattention Lack of Follow Through Poor Organizational Skills Oppositional-Defiance Lack of Flexibility Behavioral Meltdowns

5 Executive Functions Refers to the psychological processes that allow the person to develop 1) self-control, 2) problem solving skills, and 3) the capacity to maintain a future direction (planning). These executive functions are mental processes that direct a child s thought, action, and emotion, particularly during active problem solving.

6 Executive Functions Each of these mental abilities help the individual develop control over overt behavior and mental activity, i.e. Executive abilities or functions. These allow us to organize our behavior across time so we can develop and maintain a future (goal directed) orientation.

7 Executive Functioning Skills: 1) selecting appropriate goals for a particular task, 2) planning and organizing an approach to problem solving, 3) initiating a plan, 4) inhibiting (blocking out) distractions, 5) holding a goal and plan in mind, 6) flexibility trying a new approach when necessary, 7) checking to see that the goals are achieved, 8) controlling emotional responses, thereby allowing more effective problem solving.

8 Behavioral Categories describe behaviors based on what is known at the time Defect in Moral Control 1901 Post-encephalitic Syndrome Strauss-Leiten Syndrome Hyperkinetic Reaction to Childhood Attention Deficit Hyperactivity Disorder

10 Intelligent Behavior Measured Intelligence Adaptive Intelligence or Behavior Limbic System Responses (meltdowns)

11 Impact of Exe Functions on IQ Wechsler Intelligence Test for Children (WISC-IV) Verbal Comprehension Perceptual Organization Working Memory Processing Speed FULL SCALE IQ

12 Why do these behaviors occur? Psychodynamic Explanations Learned Behavior Reinforcement Punishment Underlying Motives Attention Power Revenge

13 New Perspective? Executive functions are learned skills. Deficits are skill deficits. Children and teens would do well if they thought they could We all want attention and to be rewarded Is the payoff worth the child or teen s investment? Behavioral meltdowns are not fun for anyone

14 Skill Deficit Perspective Understand the child is trying to do well. Figure out what is wrong from the child s perspective. (The influence of frontal lobe functioning on literacy and math skills is also being increasingly revealed.) Consider what executive functions are involved in performing the skill Use Collaborative Problem Solving Method (Ross Greene) to come up with a real solution

15 Executive Abilities and ADHD RESPONSE INHIBITION Switching Attention Initiation of Behavior (procrastination) WORKING MEMORY INTERNALIZED SPEECH Intrinsic Motivation EMOTIONAL CONTROL CREATIVE PROBLEM SOLVING

17 Executive Functions RESPONSE INHIBITION: Is a prerequisite for development of the executive functions Humans have a capacity to wait. Will take up to 20 years to completely develop, but is more developed in humans at 12 months of age than it will be during the lifetime of many other species.

18 Executive Fucntions: Inhibition Three Key Features of Inhibition: 1. Being able to resist the urge to act 2. Be able to stop responding midstream if the behavior is proving ineffective 3. Being able to withstand distractions while engaged in thoughtful actions

20 Executive Functions Wk Mem WORKING MEMORY Three elements that develop over time 1) Holding Information in Mind (Images, Sounds, Sensations, Perceptions) 2) Retrospection = Look back at information from the past 3) Prospection = sensing the future - what will happen next

22 Executive Functions: Internal Sprech INTERNALIZED SPEECH (the mind s voice) Initially children use language to describe and label things and to instruct and to question others. But as child gets older, language develops another very important function. Besides being directed outwardly, it is directed toward the self and becomes private. This process is typically complete by years of age.

23 Executive Functions: Internalized Speech This private speech provides the structuring and self-regulating functions. This internal dialog allows us to Reflect on what has happened Describe what has happened Question Instruct ourselves

24 Executive Functions: Combining Internal speech and working memory allows the creation of internal rules and the ability to regulate behavior over long periods of time. These rules are based on what has happened in the past and how we think things will go in the future.

26 Executive Functions: Emotional Control Over time develop the ability to express emotions internally in a controlled fashion. When internal emotional control can work with internalized speech and working memory, we can develop INTRINSIC MOTIVATION. toward the future.

27 Executive Functions and Motivation INTRINSIC MOTIVATION. (Persistence; stick-to-itness; determination etc. when behavior is guided by intrinsic motivation.) Immediate rewards and consequences become much less important as intrinsic motivation directed at long term goals takes over. Long term goals may represent the values of the person and other important parts of their personality. Emotional control helps the person direct behavior toward the future.

29 Executive Functions: Problem Solving PROBLEM SOLVING ANALYSIS Take old behavior patterns apart SYNTHESIS Recombine behaviors into novel patterns

30 Executive Functions: Problem Solving CREATIVE PROBLEM SOLVING Comes from child s play which teaches the child the way the world works, by taking it apart and putting it back together again. This becomes more internal and uses mental representations. This then allows the person to Adapt to new information Predict what may happen Invent strategies to deal with new events

31 Interventions Developing Skills Brain Development Predicting Behaviors On the Spot Interventions

32 Interventions Behavioral Inhibition Practice the skill Don t Do It procedure Distraction Zapper Mapping the Route Additional Cues and Self Monitoring

33 Interventions Working Memory Temporal Cues The Morning DJ Watches That s My Cue

34 Interventions Internalized Speech Internal Cues Stop Relax Focus Go Problem Solving Procedures MIWAE (Meeting; Important; What, When; Anyone Else; Extra SODA

35 Using internalization Of speech to guide Behavior by activating Working memory and Problem solving

36 Interventions Emotional control Cognitive Triad Internal Body Sensations Cognitions Behavior

37 Interventions Problem Solving SODA MIWAE

38 Interventions Collaborative problem solving (Ross Greene) Method A Must Do It Method B Postpone for Now or Drop Method C Find collaborative Solution

39 Resources Theraplay Simon Says, by Daniel and Marcie Yeager ADHD Warehouse Russell Barkley (Video New Look at ADHD) Ross Greene Explosive Child

41 Discussion

ADHD: MORE THAN ATTENTION PROBLEM JULIE STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP

ADHD: MORE THAN ATTENTION PROBLEM JULIE STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP WWW.CHILDRENSRESOURCEGROUP.COM UNDERSTANDING THE NATURE OF ADHD IS CRITICAL TO TREATING THE DISORDER HYPERACTIVITY