Executive Capacities: Model and Implications for Intervention

1. Executive Capacities: Model and Implications for Intervention Presented by George McCloskey, Ph.D. Philadelphia College of Osteopathic Medicine gmccloskz@aol.com or georgemcc@pcom.edu

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

3. Are these Executive Functions? • Inhibition • Working Memory • Focusing/Sustaining Attention • Flexibility • Shifting • Planning • Organization • Problem-solving • Reasoning • Creativity Not Really

4. What are Executive Functions? Part 1 Executive Functions enable the brain to answer the questions of What?and When?

5. What are Executive Skills? Part 1 Executive Skills enable the brain to answer the question of How?

6. Accommodation Plans When specially designed instructional strategies are implemented, or when parents carefully guide their children through assignments, whose executive functions are engaged?

7. Externally Controlled Change Typical plans and strategies for behavior change are forms of external control; far too often, the individual passively follows directions that are provided to them instead of actively changing their brains and developing a greater capacity for self-regulation.

8. Functional Behavior Assessment The focus of a traditional FBA: “Behavior support plans are designed to alter patterns of problem behavior. The process by which this is done, however, involves change in the behavior of family, teachers, staff, or managers in various settings. Plans of behavior support define what we will do differently. It is the change in our behavior that will result in improved behavior of the focus person.” (O’Neill, Horner, Albin, Sprague, Storey, & Newon, 1997, p. 65).

9. Functional Behavior Assessment B C A In traditional functional behavior assessments antecedents are said to TRIGGER the behavior that results in the consequences, but the reasons WHY the antecedents trigger the behavior is not really addressed.

10. FBA: Is A-B-C Enough? • Since the antecedent does not trigger the same undesirable behaviors in ALL students in the same situation, there must be something about the client that differs in an important way. • Functional behavior assessment ignores internal considerations (i.e., perceptions, emotions, thoughts) and focuses on applying external control to effect change in behavior.

11. EF Behavior Response Consequences Antecedents The EF Driven FBA Informed by knowledge of executive functions, the functional behavior assessment model can be revised as follows: EF A B C Perception Cognition Action Emotion

12. A Key Concept An EF-Driven FBA enables problems to be clearly stated in terms of perceptions, emotions, thoughts or actions that can be changed through intervention. B C

13. EF- Driven FBA The goals of an EF-driven FBA are: • to help the client, family and significant others, and professionals to understand the nature of the deficit and • to assist the client in changing the behavior from a negative to positive through implementation of the intervention plan.

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

15. EF Intervention Continuum • Interventions always start with an orienting phase during which goals are established, awareness of current difficulties is established, and strategies for positive change are developed. • Interventions are implemented at the phase most compatible with the client’s current capabilities. • Many interventions start with external control and then shift to bridging during which the client learns to take greater control over the change process and receives feedback about the effectiveness of change efforts. • Practice during the bridging phase eventually leads to internally driven self-regulation.

16. The Wisdom of Kurt Lewin “There is nothing more practical than a good theory.” Known for his field theory of behavior that posits that human behavior is a function of an individual’s psychological environment.

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

18. Executive Functions Are Not a Unitary Trait Appropriate Metaphors for Executive Functions: • The management structure of a multinational mind corporation • The conductor and section leaders of the mind’s Orchestra • The coaching staff of team mind

19. Thoughts Perceptions EFs Actions Emotions

20. EF EF EF EF The Management Structure within a Holarchical Model of EF Trans-Self Integration Self-Generation Self- Determination Self- Realization 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 Self-Activation Activation

21. Management Structure within a Holarchical Model of EF Executive Functions + Evecutive Skills = Executive Capacities EF Executive Function: What, When? ES ExecutiveSkill: How?

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

23. 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)

24. 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.

25. EF EF EF EF The Management Structure within a Holarchical Model of EF Trans-Self Integration Self-Generation Self- Determination Self- Realization 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 Self-Activation Activation

26. Domains of Functioning Directed by Executive Functions Action Executive control of modes of output including behavior in the external world and storage and retrieval of internal representations Action Emot ion Cognition Executive control of thoughts and thought processing Cognition Perception Executive control of modes of perceptual input including external sensory stimuli (visual, auditory, kinesthetic) and internal (representational) stimuli Perception Emotion Executive control of moods, feelings, and the processing of emotions

27. Executive Functions: Key Concept • Directive capacities of the mind • Multiple in nature, not a single capacity • Part of neural circuits that are routed through the frontal lobes • Cue the use of other mental capacities • Direct and control perceptions, thoughts, actions, and to some degree emotions

28. EF EF EF EF The Management Structure within a Holarchical Model of EF Trans-Self Integration Self-Generation Self- Determination Self- Realization 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 Self-Activation Activation

29. EF EF EF EF EF Tiers within the Holarchical Model of Executive Functions 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

30. Self Regulation • A set of control capacities that cue and direct functioning across the domains of perception, emotion, cognition, and action • The current model posits 33 self-regulation executive functions 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

31. Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate Balance Monitor Correct Gauge Anticipate Est Time Analyze Generate Associate Plan Organize Analyze Compare Choose 33 Self-Regulation EFs • Prioritize • Compare/Eval • Decide • Sense Time • Pace • Sequence • Execute • Hold • Manipulate • Store • Retrieve

32. Key Concept Self-regulation Executive Functions can be organized into 7 basic clusters.

33. Self Regulation Executive Function “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

34. Executive Functions 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

35. Self Regulation Executive Function “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

36. 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.

37. 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.

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

39. Self Regulation Executive Function “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

40. Pay Attention, specificly speaking Prompts for attention should include a call to Perception, as well as a cue for Focusing and a cue for Sustaining: • 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).

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

42. Bridging Strategies Encourage the engagement of executive functions through the use of reflective questioning

43. 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.

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

45. 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.

46. 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 functions, his intervention approach teaches techniques for improving behavior through the use collaborative problem-solving as a bridging strategy.

47. Ross Greene’s Collaborative & Proactive Solutions

48. 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).

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

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