Strategies to Change the Brain and Behavior: Improving Executive Capacities

1. Improving Executive Capacities: Strategies to Change the Brain and Change Behavior Presented by George McCloskey, Ph.D. Philadelphia College of Osteopathic Medicine gmccloskz@aol.com or georgemcc@pcom.edu

2. EF EC as the Conductor of the Brain’s Orchestra or CEO of the brain (i.e., EF as “g”)

3. Executive Functions Are Not a Unitary Trait Appropriate Metaphors for Executive Functions: • The management structure of a multinational mind corporation • The brain’s supervisory system

4. Executive Capacities aren’t just the CEO They are the CEO and all the other managers in the company

5. Thoughts Perceptions Executive Capacities Actions Emotions

6. The Workers The Managers

7. The Management Structure of the Brain’s Executives EF/ES Trans-Self Integration Self-Generation EF/ES EF/ES EF/ES Self- Determination Self- Realization EF/ES EF/ES EF/ES EF/ES EF/ES ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Self-Regulation Self-Activation Activation

8. Are these Executive Functions? • Inhibition • Working Memory • Shifting • Planning • Organization • Problem-solving Not Really

9. EF EF EF EF EF Tiers within the Holarchical Model of Executive Capacities Trans-Self Integration Self-Generation Self-Realization Self-Awareness Other-Awareness Self-Analysis Self-Determination Goal setting Long-range Planning & Foresight ef ef ef ef ef ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve Self-Activation Activation

10. Key Concept Self-regulation Executive Capacities can be organized into 7 basic clusters.

11. Self Regulation Executive Capacity “Clusters” Monitor Modulate Balance Correct Perceive Focus Sustain Energize Initiate Inhibit Stop Pause Flexible Shift OPTIMIZATION ENGAGEMENT ATTENTION Sense Time Pace Sequence Execute Generate Associate Prioritize Plan Organize Decide SOLUTION INQUIRY EFFICIENCY Hold Manipulate Store Retrieve Anticipate Gauge Analyze Estimate Time Compare MEMORY

12. Management Structure within a Holarchical Model of EC Executive Capacities EF Executive Function ES Executive Skill

13. Key Concept It is important to distinguish between Executive Functions and Executive Skills.

14. Self Regulation Executive Functions Executive Functions are the parts of the executive network that are used to become aware of what to do and when to do it (e.g., knowing when to make a plan, when to inhibit)

15. Self Regulation Executive Skills Executive Skills are the “how” parts of the executive network that are used to cue the rest of the neural network needed to perceive, feel, think and act effectively (e.g., knowing the parts of the brain to activate to make a plan.

16. Executive Capacity Demands Increase Gradually by Cluster Across the Pre-K to Grade 12 Educational Program Solution Inquiry Memory Efficiency Optimization Engagement Attention Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12

17. Executive Skills Interventions • Practice and rehearsal are best suited to strengthen executive skills in the Attention, Engagement, Optimization and some Efficiency Cluster EFs • Cognitive Strategy Instruction is best suited to enhance executive skills in the Memory, Inquiry, Solution and some Efficiency Cluster EFs

18. 504 Accommodation Plans When specially designed instructional strategies are implemented, whose frontal lobes are engaged? Most accommodation plans engage the teacher’s executive capacities to guide the student through external control.

19. 504 Accommodation Plans External control does not challenge the student’s brain to grow. Also, in most cases, the student is unaware of the fact that an accommodation plan is being implemented. A lack of awareness of the need to change means that the brain is passively receiving instead of actively engaging.

20. EF Intervention Continuum Orienting Strategies External Control Strategies Bridging Strategies Internal Control Strategies

21. Key Concept Most of what a teacher, therapist, or work supervisor says to a student, client, or worker is intended to activate specific neural networks within that person’s brain.

22. Key Concept The more specific the language used by a teacher, therapist or supervisor the more likely it is that the student, client or worker will be activating the brain networks needed for effective performance.

23. The Language of External Control Pay attention! Can you be more specific?

24. Self Regulation Executive Capacity “Clusters” Monitor Modulate Balance Correct Perceive Focus Sustain Energize Initiate Inhibit Stop Pause Flexible Shift OPTIMIZATION ENGAGEMENT ATTENTION Sense Time Pace Sequence Execute Generate Associate Prioritize Plan Organize Decide SOLUTION INQUIRY EFFICIENCY Hold Manipulate Store Retrieve Anticipate Gauge Analyze Estimate Time Compare MEMORY

25. Pay Attention, specificly speaking Prompts for attention should include a call to Perception (P), as well as a cue for Focusing (F) and a cue for Sustaining (S): • Listen (P) to me (F) until I’m finished talking (S). • Look (P) at the board (F) until we are done with this problem (S). • Touch (P) the blocks (F) while you are solving this one (S).

26. Key Concept Bridging strategies effect the gradual transition from external control to self-regulated internal control.

27. Bridging Strategies Encourage the engagement of executive capacities through the use of reflective questioning

28. Reflective Questioning Repeat the individual’s question back to them instead of providing an answer. In situations where the client seems unaware of the need to be asking questions for adequate engagement, reflective questioning involves the mediator asking the client a question that is intended to make the client aware of the need to engage executive functions.

29. Bridging Strategies • Provide immediate and frequent feedback about the effectiveness of attempts to engage self-regulation executive capacities. Providing individuals with feedback about their performance enables them to engage executive capacities more effectively to learn from their mistakes and improve future performance.

30. Feedback About Accuracy • When providing feedback, be sure to emphasize the importance of effort; make sure the individual realizes that self-regulation is not simply something you have or don’t have – it can be increased by applying techniques and strategies; the more effort placed into applying the techniques, the more likely the improvements.

31. Collaborative Problem-Solving Ross Greene’s Collaborative & Proactive Solutions approach is featured in his books. Although Greene does not specifically use the concept of executive capacities, his intervention approach teaches techniques for improving behavior through the use collaborative problem-solving as a bridging strategy.

32. Ross Greene’s Collaborative & Proactive Solutions

33. Bridging Strategies Teach self-regulation capacities with specific skill routines using Cognitive Strategy Instruction approaches (e.g. Graham & Harris Self-Regulated Strategy Development approach for Written Expression).

34. Bridging Strategies • Model appropriate use of self-regulation executive capacities

35. Cognitive Strategy Instruction Case Example: Teaching Study Skills Through Cognitive Strategy Modeling

36. Bridging Strategies • Practice and rehearsal of the use of executive capacities. This is the single best way to increase engagement and efficiency of the use of executive capacities.

37. Bridging Strategies • Whenever possible, use game formats and game strategies to practice the use of executive capacities.

38. Simon Says Pay Attention: Help for Children with ADHD Daniel Yeager & Marcie Yeager

39. Bridging Strategies • Align external demands with internal desires to maximize motivation. • Allow self-selection or choice of assignments whenever possible • Use high interest material to illustrate application of new knowledge and skills

41. Bridging Strategies Develop a common vocabulary and set of nonverbal symbols for describing or signifying self-regulation capacities and signaling their use (e.g., cueing flexibility with “The Coconut Story”)

42. Cognitive Behavior Therapy (CBT) CBT teaches strategies for improving the use of executive functions to cue and direct effective perceiving, feeling, thinking and acting. Techniques have shown good results at the adult and adolescent levels and some early indications that the techniques can be applied effectively with children in the elementary grades.

44. Evidence Based Intervention: Cognitive Behavior Therapy Cognitive Behavioral Therapy (CBT) emphasizes collaborative reality-testing and the monitoring and modification of automatic perceptions, feelings, thoughts, and actions that cause difficulties for the child.

45. Evidence Based Intervention: Cognitive Behavior Therapy • Outcomes of CBT with children and adolescents: • Increased ability to monitor perceptions, feelings, thoughts and actions • Increased engagement in positive problem-solving strategies • Increased capacity for self-regulating perceptions, feelings, thoughts and actions

46. CBT Variants CBT variants such as Jeffrey Schwartz’s “Brain-Lock: Free Yourself from Obsessive-Compulsive Behavior; subtitled as “a four-step self-treatment method to change your brain chemistry.” This method uses CBT oriented techniques to strengthen self-regulation capacities and decrease unproductive perceptions, feelings, thoughts and actions.

47. Dialectical Behavior Therapy (DBT) “Dialectical behavior therapy (DBT) focuses on the treatment mood disorders and on changing patterns of behavior that are not helpful, such as suicidal ideation and substance abuse. DBT improves modulation of perceptions, feelings, thoughts and actions by helping clients learn about the triggers that lead to reactive states and learn coping skills in order to avoid undesired reactions. DBT is a modified form of CBT developed by Marsha Linehan to treat individuals diagnosed with borderline personality disorder and chronically suicidal individuals. DBT use has expanded to the treatment of traumatic brain injuries (TBI), eating disorders, and mood disorders, self-injury, sexual abuse survivors, and chemical dependency. DBT combines standard cognitive behavioral techniques for emotion regulation (modulation) and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from meditative practice.

49. Bridging Strategies Develop a common vocabulary and set of nonverbal symbols for describing or signifying self-regulation capacities and signaling their use (e.g., cueing flexibility with “The Coconut Story”)

50. Key Concept Executive capacity development unfolds in a holoarchical manner.