PLAY & EXECUTIVE FUNCTIONS INTERCONNECTED IN YOUNG CHILDREN STEPHANIE ADAMS DHS, OTR/L

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1 PLAY & EXECUTIVE FUNCTIONS INTERCONNECTED IN YOUNG CHILDREN STEPHANIE ADAMS DHS, OTR/L

2 Objectives Learn about Executive Functions. Learn about developmental Play skills. Learn how EF & Play are interconnected. Learn how these areas impact a child s occupation. Learn about a pilot study on Play and EF.

3 Play in Children Have you ever watched children play on a playground? If so maybe you have wondered. Why is this particular child not able to engage with their peers? Are they having trouble with social, cognitive, or language skills that make it challenging to play with friends? Well It could be that the child is struggling with Executive Functions. We will discuss the connection of Executive Functions & Play which may be why these children are struggling with this important childhood occupation.

4 Introduction Preschoolers are expected to have readiness skills upon entering kindergarten. Readiness = Academic + Physical + Motor + Emotional + Social Executive Functions help us Make Plans Use Reasoning Integrate Thoughts & Actions

5 Problem More children being diagnosed with medical conditions at a young age. These various diagnoses tend to have EF deficits. Children with these challenges may not be ready to enter formal education settings. Children demonstrate EF as early as 2 years old. It is vital for early educational experiences to prepare preschoolers for higher cognitive thinking.

6 Diagnoses & Executive Functions Childhood Conditions Intellectual Disabilities Attention Deficit Hyperactivity Disorder Prematurity Autism Spectrum Disorder Abuse/Trauma Hypertension Fetal Alcohol Syndrome Brain Injured

7 Research Trends on EF Diagnoses-ADHD, Autism, & ODD Low Birth Weight Fine Motor Emotional Eating Language Academic Readiness Low Socio-Economic Populations Social-Self-Concept Play Google Search locates thousands of hits on the topic of Executive Functions Adults Adolescents Early Childhood

8 Early Research on EF Field of psychology and education is the forerunner with published studies. Experimental-psychology use techniques in imaging, neurophysiology, and brain stimulation to determine EF deficits. Mapping of EF processing is in the prefrontal cortex. There has been an increase in research in the topic of EF and preschoolers over the last decade.

9 Where Does EF Originate?

10 EF from a Neuro-Developmental Perspective Skills develop over time through combination of brain maturation and exposure to different opportunities and experiences. Pre-frontal cortex is among the last to develop. Brain synapses reach peak density between ages 1-2 years old. The more the brain grows & learns, the more branches or synapses develop, allowing for increased complexity of thought.

11 EF Progression of Stages

12 Hierarchy of Learning

13 EF Skills in Academics The teacher assigns a book to read. Due date is placed on the board. Student determines where to get the book. How long it will take to read it? A specific book report format is required after reading. Enough time needs to be planned to write a rough draft of the paper. If need help, seek out teacher to answer questions. Write a final draft by due date. Turn in the assignment on time.

14 Academic Task Initiation

15 Manifestations of Weak EF Difficulty beginning tasks. May begin a task but not see it through. Loses or forgets where homework is; doesn t get things turned in on time. In one ear, out the other or here one day, gone the next. Inability to follow full set of directions (verbal or written). Struggles with organizing thoughts, language, and belongings. Challenges with managing longer term projects or papers. Hard time managing emotional and attention states.

Academic Implications & EF Cuevas, Hubble, & Bell (2012) measured EF after kindergarten to provide evidence of how preschoolage children have emerging EF that are related to elementary education.

16 Academic Implications & EF Cuevas, Hubble, & Bell (2012) measured EF after kindergarten to provide evidence of how preschoolage children have emerging EF that are related to elementary education. Measures included were: EEG, Child Behavior Questionnaire (CBQ), and the BRIEF-P. During this two year span children exhibited improvements in EF that were related to the maturation of frontal lobe areas of the brain. Higher post-kindergarten EF were associated with higher pre-k levels of inhibitory control and working memory.

17 What is Executive Functions Anyway? Shift Inhibit Emotional Control Metacognition Working Memory Plan & Organize

18 Inhibition Being able to control your impulses so you can: Think before you act. Stop and modulate behavior at the right time. Resist peer pressure. Make good choices.

19 Shift Move from one situation to another, make transitions, solves problems Flexibility-when things are not as you expect.

20 Emotional Control Being able to manage your feelings so they don t get in the way of getting work done or meeting goals. Appropriate emotional responses in the moment reactions.

21 Working Memory Being able to keep in mind everything you have to remember to complete a task & remembering what worked the last time.

22 Planning Planning is your road map-gps. When you have a good plan. You know all the turns you have to make. How to get past the roadblocks along the way. You also can focus on what s important. And let the little things go.

23 Organization Having a system for keeping track of information and materials. Especially the things you need every day (phone, keys, homework, sports gear). Putting everything in its place so when you look for it, it s there.

24 Sustained Attention Staying on task. Getting things done in the time you ve given yourself even if you re tired, bored, or have more appealing distractions.

25 Task Initiation Being able to make yourself start a task. This is a tough skill to learn, so if you ve seen yourself getting closer to your goal this is the first step on that path.

26 Time Management Time management allows you to manage the tug of war between: What you want to do. What you need to do. What others ask you to do. A key piece of time management is the ability to estimate how long it takes you to do something.

27 Goal-Directed Persistence This is a giant version of sustained attention (with some response inhibition thrown in there, too). This involves making a goal. Being determined to get there. Keeping the goal in mind as you make decisions about how you spend your time.

28 Metacognition This is your brain s life lesson machine. It allows you to reflect on past actions and behaviors and make informed decisions about how you will act in the future. The formula: What did I do + Why did I do it = What will I do the next time?

29 Here s something else we understand about Executive Functions: Kids and adults seem to have both executive function strengths &weaknesses. Some executive skills come more easily and naturally than others. Individuals vary in their executive skills profile.

30 Research on Play & EF Davis-Unger & Carlson Expected to learn directions, rules, and teach the game. 5 year olds were able to teach longer, explain rules, use various strategies when teaching. Volckaert & Noel Commercial games with characters having symbolic meaning. Improvement in their behaviors of attention and WM after engaging in the game. Halperin, et al. Created a game called TEAMS. Designed to enhance inhibitory control, WM, and motor combined. A positive outcome with parent satisfaction and continued participation past the 3 months of intervention. Tamm & Nukonezny Utilized memory card & search activities. The games were intended to be fun but use metacognitive strategies with EF. They found that a play-based intervention improved BRIEF-P ratings on shift and emotional control.

31 A Child s Occupation-Play Play Any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion. Play Exploration Identifying appropriate play activities, including exploration play, practice play, pretend play, games with rules, constuctive play, and symbolic play. Play Participation Participating in play, maintaining a balance of play with other occupations; obtaining, using, and maintaining, toys, equipment, and supplies appropriately. AOTA, 2014

32 What Does the Research Say? AOTA Statement on Play The act of playing is an important tool that influences a child s life. The primary goals of childhood are to grow, learn, and play. It is often through play that children learn to make sense of the world around them. It is a child s "job" or "occupation" to play to develop physical coordination, emotional maturity, social skills to interact with other children, and self-confidence to try new experiences and explore new environments. Play as the primary occupation of childhood.

33 Play Skills Builds self-esteem and self-worth. Develops sense of competency. Having a variety of leisure skills helps to reduce or eliminate highrisk behaviors at later ages.

34 Stages of Typical Play Development Early Social Play. Solitary. (object play, imaginary play, imitative play) Spectator Play. Parallel Play. Associative Play. Cooperative Play.

35 Impact of Pretend Play Singer (1961) completed a study with 6-9 year olds, they were asked to stand still for 15 minutes and pretend that they were going up in a space flight. Children with high fantasy and imagination skills were able to stand still for twice as long. Manuilenko (1975) designed a study with children ages 3-6 years old. The children were asked to play a game and pretend to be a factory worker and a guard. The guard was to stand motionless. Children ages 4 and up were successful with this task. Reasoning Social Language Cognitive PLAY Executive Function Creativity Problem Solving o These particular studies suggest that pretend play content can motivate and strengthen behavior for children.

Mental + Physical Tools help a children to grow with responsibility for becoming a

36 Theory-Tools of the Mind Vygotsky-inspired preschool program with many tools to assist children with self-regulation skills. Mental + Physical Tools help a children to grow with responsibility for becoming a self-directed learner. Children learn to understand roles and rules by learning gestures and language that may match a role. Ex. Mom goes to work with a briefcase.

38 Development of EF through Play in Preschoolers The purpose of the pilot study was to determine the effectiveness of a play-performance game that incorporates various components of executive functions with preschoolers.

39 Method: Study Design & Procedures Pilot study using a single group, pre-post test design. A day care center in Missouri. Game was designed and implemented by the researcher. Intervention was two times a week for eight weeks.

Teach job skill to friends as everyone joins in.

40 Going to Work Game Pretend play-dress up as a community worker. Stop at various job sites along the way to work. Teach job skill to friends as everyone joins in. Drive along the road in a car until you reach the work site. When you arrive to work on time you win the game!

41 Going to Work Game Army Sergeant Astronaut Baker Bus Driver Carpenter Chef Computer Specialist Construction Worker Doctor Farmer Fire Fighter Fisherman Mechanic Painter Pilot Police Officer Scientist Teacher Weather Forecaster Zoo Keeper

42 Going to Work Game Hair Dresser Zoo Keeper Baker

43 Relationship of EF & Game Components Executive Functions Inhibit Description of the EF Area Impulse control; stopping/modulating behavior Task that Connects with the Executive Function Area Waiting to take a turn during the game. Staying at your car while another friend takes their turn. Ending turn by taking off the dress-up clothes. Uses an inside voice while talking. Using positive reactions during the turn taking. Engaging in the (movement pattern) job skill. Engages in changing clothes at a normal pace. Laughs appropriately and smiles during game. Has fun but not tool silly during game. Shift Ability to shift from one activity to another or solve problems Selecting a player piece. Rolling the dice. Does not display emotions of getting upset while changing tasks. Moving the player piece the amount of spaces. Looking at the card to see what job is on it. Going to the card pile to see what items are needed to dress-up. Put the dress-up clothes items on. Noise level during game doesn t bother them. Take items back to their place to use for dressing up. Teach friends the movement pattern/job skill. Is not overwhelmed during the busy game. Emotional Control The ability to modulate emotional responses Having fun while playing the game. Demonstrating a positive response when rolling the dice. Moving the player piece the amount of spaces appropriately. Presents a happy consistent mood during game. Is able to move forward after a problem arises. Is not overwhelmed or overstimulated during game Working Memory The process of holding information in the mind for the purposes of completing a task; staying with an activity Understanding directions to complete a turn. Will roll the dice and then move the player piece. Remembering what space was landed on and then going to the dress-up box. Can complete more than one step at a time. Retains the information on the card to act the movement of the job skill while teaching friends. Can engage in the game without many cues from an adult to stay on task. Concentrates on the game while it is another child s turn. Able to complete the game from start to finish. Plan/ Organize The ability to anticipate future events, to set goals, and to develop steps ahead of time to complete tasks Complete entire turn from start to finish in proper sequence. Rolling dice and moving player on a space. Goes to dress-up box and picks out community worker items. After given directions from leader will complete the tasks of the game. Follows game steps and routine that is demonstrated during game. Will clean up items and put away as expected during game.

44 Instrument & Data Collected Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Screen, assess, and monitor EF behaviors. 2-5 years old. Home and preschool environment. Pilot Study Data Pre-BRIEF-P and post-brief-p of the Teacher and parents. BRIEF-P Clinical Scales of EF: Inhibit Shift Emotional Control Working Memory Plan/ Organize

45 Findings Sample size n=8. Average attendance of 12.8 days. 5 (62.5%) males, 3(37.5%) females. All participants were Caucasian. Mean age was 4.3 years.

46 70.0 Teacher Scores Pre Post Inhibit Shift EC WM PO GEC Identified Trends. Teacher ratings of the children showed improvement in WM and PO.

47 70.0 Parent Scores Pre Post Inhibit Shift EC WM PO GEC Identified Trends. Parents rated their children as having improvement in the clinical scales of Inhibit, Shift, EC, WM, and GEC. PO was the same.

48 Limitations and Future Research Children at-risk. Sample size. One preschool. No control group. Summer schedule. Going to Work Game. BRIEF-P.

49 References American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3 rd ed.). American Journal of Occupational Therapy, 68 (Suppl.1). S1-S Aron, A. (2008). Progress in executive-function research: from tasks to functions to regions to networks. Current Directions in Psychological Science, 17, (2), Carlson, S. (2009). Social origins of executive function development. In C. Lewis & J. I. M. Carpendale (Eds.), Social interaction and the development of executive function. New Directions in Child and Adolescent Development, 123, Davis-Unger, A. & Carlson, S. (2008). Children s teaching skills: The role of theory of mind and executive function. Mind, Brain, and Education, 2, (3), Nader-Graosbois, N., & Vieillevoye, S. (2012). Variability of self-regulatory strategies in children with intellectual disability and typically developing children in pretend play situations. Journal of Intellectual Disability Research, 56, (2), Schoemaker, K., Bunte, T., Wiebe, S.,Andrews, K., Dekovic, M., Matthys, W. Executive functions deficits in preschool children with ADHS and DBD. The Journal of Child Psychology and Psychiatry, 53, (2), Sherman, E. & Brooks, B. (2010). Behavior rating inventory of executive function-preschool version (BRIEF-P): Test review and clinical guidelines for use. Child Neuropsychology, 16, Toplak, M. West, R., & Stanovich, K. (2013). Practitioner review: Do performance-based measures and rating of executive function assess the same construct? The Journal of Child Psychology and Psychiatry, 54, (2), Willoughby, M., Kupersmidt, J., & Voegler-Lee, M. (2012). Is preschool executive function causally related to academic achievement? Child Neuropsychology, 18 (1),

50 Thank you! Q & A.

Beyond Lazy and Unmotivated

Beyond Lazy and Unmotivated Why Parents and Teachers Need to Know About Executive Skills Peg Dawson Center for Learning and Attention Disorders Portsmouth, NH dawson.peg@gmail.com smartbutscatteredkids.com