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Effects of Executive Functioning Deficits on Behavior

Jennifer Carvalho, M.Ed., BCBA

Mt. Diablo Unified School District

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  1. What Is Executive Functioning?

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“The Brain’s CEO”

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  • Most researchers agree that the term executive function (EF) is exceedingly broad, and there is little consensus on a definition.
  • Hypothesized brain processes that control other brain process.
  • The behaviors that fall under executive function skills are a means of controlling and organizing our own behavior, and they are key to success in everyday life.

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  • Thinking skills that help :
  • Select and achieve goals
  • Problem Solve

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Executive Skills and the Brain

  • Brain-based skills, managed out of the frontal lobes of the brain

  • Takes 25 years for our brains to reach full maturation

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Why are executive Functioning Skills Important?

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“Thoughtful, considerate, mature, self-disciplines, organized……”

  • Allow us to organize our behavior overtime and override immediate demands in favor of long term goals…..Help one regulate our behavior

  • EF skills help increase self-determination and personal freedom for an individual because, by definition, they help one become the master of their own environment.

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  • Allows us to problem solve

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  • Important for success in inclusive settings

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Executive Functioning Skills:

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  1. Picture a goal, path to achieve goal and resources

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  • Planning: The ability to create a roadmap to reach a goal or to complete a task.
    • Ability to make decisions about what’s important to focus on and what’s not important.
  • Organization: The ability to design and maintain systems for keeping track of information and materials
  • Time Management: The capacity to estimate how much time one has, how to allocate it, and how to stay within time limits and deadlines.
    • Sense that time is important
  • Working Memory: The ability to hold information in mind while performing complex tasks.
    • Ability to draw on the past learning or experience to apply to the situation at hand or to project into the future.
  • Metacognition: The ability to stand back and take a birds-eye view of oneself in a situation
    • Ability to observe how to problem solve
    • Self monitoring and self-evaluation

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Executive Functioning Skills:

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2. Skills to guide behavior to achieve goal

  • Response Inhibition: The capacity to think before you act.
    • Resist the urge to say or do something
    • Ability to evaluate a situation and how our behavior may impact it
  • Emotional Control (self-regulation): The ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior
  • Sustained Attention: The capacity to attend to a situation or task in spite of distractibility, fatigue, or boredom
  • Task Initiation:: The ability to begin a task without undue procrastination, in a timely fashion
  • Flexibility: The ability to revise plans in the face of obstacles, setbacks, new information, or mistakes,
    • Involves adaptability to changing conditions
  • Goal Directed Persistence: The capacity or drive to follow through to the completion of a goal and not put it off by other demands or competing interests.

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Response Inhibition

  • Resist the urge to say or do something
  • Ability to evaluate a situation and how our behavior may impact it.
  • Talks without raising hand
  • Interrupts
  • Talks back
  • Has difficulty waiting turn
  • Has physical contact with peers

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  • The capacity to think before you act.

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Learning

Behavior

Starts assignment without reading directions

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Blurts out negative comments about peers/classmates

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Response Inhibition

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Strategies to Support Skill Development

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Environmental Modifications

Teaching the Skill

  • Increase external Controls: Prompting and defined boundaries (P.E., group activities, circle time)
  • Increase Supervision:

Proximity acts as a cue for the child

  • Visuals and Reminders:

Expectations/rules posted and reviewed and student specific goals reviewed before setting

  1. Identify a replacement skill
  2. Teach steps/practice
  3. With cues and prompts practice in natural environment
  4. Reinforce immediately for using replacement skill
  5. Ignore disinhibited response
  6. Gradually fade cuing and reinforcement

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Expected Behaviors vs. Unexpected Behaviors

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  • Emotional Control (Self-Regulation)
  • Getting really irritated when a homework assignment is hard or confusing
  • Lashes out on peers when something doesn’t go their way, when disappointed, or feel situation is unjust
  • May have big emotional reactions to small events/problem, relative to developmental age
  • Engage in verbal/physical outburst not considering setting/audience

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  • The ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior

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Emotional Control (Self-Regulation)

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  • The ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior

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Learning

Behavior

Shuts down when get frustrated with work

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Yells at peer when is out during a recess

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Possible Accommodations

  • Social Narratives
  • Visual Supports: coping strategies, scripts, scales
  • Break tasks into smaller steps
  • Access to break/break area for self-regulation
  • Access to calm-down tools (fidgets, music, quiet area, etc.)

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  • Emotional Control (Self-Regulation)

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Strategies to Support Skill Development

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Environmental Modifications

Teaching the Skill

  1. Anticipate problems and prepare student
  2. Teach coping strategies
  3. Give scripts
  4. Break tasks into smaller steps
  5. Model and practice making positive statements
  6. Use 5-point scales

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  • Explain the skill
  • Have the child practice the skill
  • Reinforce the child for practicing
  • Cue the child to use the skill in real-life situations
  • Reinforce the child for using the skill successfully

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Visual with choice of strategies

Visual Scale with coping strategies

Social script

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  • Sustained Attention

Identifying Attention Deficits:

  • Easily distracted when more than one activity or task is presented, if multiple stimuli are presented, or if interruption occurs during task or activity. (disengagement, shifting attention, determining saliency)
  • Difficulty maintaining attention to one task or activity for more than a few minutes (sustained attention)
  • Lack of attention or response to typical social cues unless specifically called upon, especially when engaged in a preferred activity (orienting, disengagement, shifting attention, determining saliency)
  • Difficulty relaying information to others. (paraphrasing, summarizing, and determining saliency)

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  • The capacity to attend to a situation or task in spite of distractibility, fatigue, or boredom

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Response Inhibition

  • Resist the urge to say or do something
  • Ability to evaluate a situation and how our behavior may impact it.
  • Talks without raising hand
  • Interrupts
  • Talks back
  • Has difficulty waiting turn
  • Has physical contact with peers

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  • The capacity to think before you act.

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Learnng

Behavior

Starts assignment without reading directions

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Blurts out negative comments about peers/classmates

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Response Inhibition

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Strategies to Support Skill Development

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Environmental Modifications

Teaching the Skill

  • Increase external Controls: Prompting and defined boundaries (P.E., group activities, circle time)
  • Increase Supervision:

Proximity acts as a cue for the child

  • Visuals and Reminders:

Expectations/rules posted and reviewed and student specific goals reviewed before setting

  • Identify a replacement skill
  • Teach steps/practice
  • With cues and prompts practice in natural environment
  • Reinforce immediately for using replacement skill
  • Ignore disinhibited response
  • Gradually fade cuing and reinforcement

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Expected Behaviors vs. Unexpected Behaviors

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  • Emotional Control (Self-Regulation)
  • Getting really irritated when a homework assignment is hard or confusing
  • Lashes out on peers when something doesn’t go their way, when disappointed, or feel situation is unjust
  • May have big emotional reactions to small events/problem, relative to developmental age
  • Engage in verbal/physical outburst not considering setting/audience

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  • The ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior

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Learning

Behavior

Shuts down when get frustrated with work

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Yells at peer when is out during a recess

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  • Sustained Attention

Strategies to Teach the Skill

Environmental Modifications

Teaching the Skill

  1. Write start and stop times on assigned tasks
  2. Use incentive system
  3. Break tasks down
  4. Use a self-monitoring system
  5. Consider time of day for difficult task/class
  6. Give child something to look forward to. (text friend, access to phone, etc).
  7. Attention and praise when on task
  1. Be aware of threshold for attention and allow a break
  2. Teach how to break down tasks
  3. Help make a work plan
  4. Cue to follow their plan
  5. Reinforce for following the plan
  6. Gradually transfer responsibility to the child

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Sustained Attention:

  • The capacity to attend to a situation or task in spite of distractibility, fatigue, or boredom

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Learning

Behavior

Gets distracted before starting work, starts thinking about video game and missed instructions. Doesn’t get classwork completed

Doesn’t listen to instructions or gets distracted on the field and misses a play.

Possible Accommodations

  • Preferential seating (close to teacher, away from frequent distractions)
  • Directions repeated/rephrased/written
  • Directions broken down into small parts
  • Frequent reminders of expectation
  • Visual supports (expectation, directions, etc)
  • Separate setting for test/quizzes (quiet with few distractions)
  • Extended time on test/assignments

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  • Task Initiation
  • Ability to begin task or activity without undue procrastination, drive and motivation to complete work

Identifying Deficits in Task Initiation:

  • Requires multiple prompts to get started on classwork/homework
  • Frequently does not complete chores or work in allotted time
  • Misses deadlines for projects with multiple parts
  • Informs parent that materials for project the night before it is due
  • Rushes through work

Two Kinds of task initiation:

  1. Beginning task right away when it is assigned
  2. Planning when a task will be done and starting it promptly at the predetermined time

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  • Task Initiation
  • Ability to begin task or activity without undue procrastination, drive and motivation to complete work

Ready…... Set …... Go!!!!

Learning

Behavior

Misses class starter/ warm-up, due speed of getting out materials

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May frustrate peers during group activities because fails to follow through on promised actions

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  • Task Initiation
  • Strategies to Teach the Skill

Environmental Modifications

Teaching the Skill

  1. Verbally cue the child to get started
  2. Visual cue to prompt student
  3. Walk the child through first portion on the the task
  4. Note start and stop times when task is started and completed
  5. Have the child specify when they will start the task-Hold them to it!
  1. Have the child contribute to/ make their own written plan
  2. Have the child determine what cue to use to remind them to start
  3. Provide reinforcement for starting tasks promptly
  4. Gradually fade supervision.

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Concrete expectations: broken down into manageable parts

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  • Flexibility
  • The ability to revise plans in the face of obstacles, setbacks, new information, or mistakes.

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Identifying Deficits in Task Initiation:

  • Easily upset by changes and plans, disruptions to routines, etc.
  • Struggles with open-ended tasks
  • Doesn’t try multiple approaches to solving problems
  • Excessively “rule bound”

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Flexibility

  • The ability to revise plans when faced with obstacles, setbacks, new information, or mistakes.

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Learning

Behavior

Significant problems with creative writing assignments or open ended tasks

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Gets upset with a change in schedule (fire drill, fun activity scheduled)

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Possible Accommodations

  • Dry runs, provide advance warning, preview materials, provide schedule ahead of time, give questions ahead of time
  • Decrease speed, complexity, adapt open ended to close ended questions, provide template or rubric
  • Social Narratives:Label problem situations to reduce uncertainty
  • Visual Schedules

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  • Flexibility
  • Strategies to teach the Skill

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Environmental Modifications

Teaching the Skill

  1. Reduce Novelty
  2. Modify nature of the task
  3. Help reframe the situation
  4. Increase level of support around task
  1. Teach to recognize inflexibility
  2. Teach coping strategies
  3. Give rules to manage specific situations and prompting them
  4. Help develop default strategies
  5. Provide scripts for problem solving

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Provide Warnings for changes in schedule

Provide visuals to teach expectations on new/novel events

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  • Goal Directed Persistence

The capacity or drive to follow through to the completion of a goal and not be put off by other demands or competing interests

  • Doesn’t stick with challenging tasks
  • Doesn’t return to a task if interrupted
  • Can’t sustain attention well to tasks that are intrinsically interesting

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Learning

Behavior

Doesn’t set goals for the future or connect with the present. (may want to go to college, but doesn’t invest the time/effort to get good grades)

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Lives in the moment Makes choices on how to spend time based on immediate needs

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  • Goal Directed Persistence

Strategies to Teach the Skill

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Environmental Modifications

Teaching the Skill

  1. Teachers give goals and prompt students to stay on track
  2. Make tasks real and visible, break down into achievable steps
  3. Give frequent feedback of progress (use visuals)
  4. Praise for effort

Coaching is the most effective way to teach:

  1. Setting a goal (daily, weekly, long-term)
  2. Identifying potential obstacles
  3. Writing a plan for achieving goal
  4. Reviewing plan and tracking progress frequently

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Organization:

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The ability to design and maintain systems for keeping of information or materials

Identifying Deficits in Organization

  • Missing assignments due to papers misfiled or lost
  • Messy desk
  • Papers out of order
  • Takes a long time to pack up or find materials for class’
  • May leave personal belongings behind
  • Backpack has crumpled papers in bottom

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