The Role of Attention & Executive Functioning In the...

The Role of Attention & The Role of Attention & Executive Functioning in the Executive Functioning in the

Process of LearningProcess of Learning

Adam Scheller, PhD, NCSP

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Disclosure

This free session is sponsored by Pearson Clinical Assessment.

Adam Scheller, PhD is an employee of Pearson. Several examples of assessments and interventions mentioned in this presentation are either published or distributed by Pearson Clinical Assessment.

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Outline

• Neuro-anatomy primer• Executive Functioning and Attention, what are

they?• Role of EF and Attention in Learning• How do we intervene?

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Phineas Gage

From the collection of Jack and Beverly Wilgus

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Gage Legacy

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Cafeteria Example

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What is Executive Functioning?

• A.R. Luria (1973)• Russ Barkley• Andrewes (2001)• Miyake et al. (2000)

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Evolving

• Evolving definitions– Micro level: e.g., Cognitive flexibility, Attentional

control, Updating, Sequencing, Abstracting– Macro level: e.g., Inhibitory control, Problem

solving, Organization, Planning, Concept Formation

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Executive Functioning (EF) Taxonomy

• Executive Control– Inhibition or Disinhibition of behavior,

emotions, speech, cognition, attention, etc. – Flexibility

• Metacognition– Working Memory– Directly affects processing speed

• Control the “gate” of information

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EF Taxonomy (cont.)

• Problem Solving– Plan, sequence, and self-monitor– Feedback loop, from which we can change the

process to be either correct (if incorrect) or more efficient (faster).

• Organization– Ability to order, sort, categorize

• Concept Formation– Categorize– Abstracting– Situation based judgments.

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How do I get there?

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Attention

• Sensory Distinction (Auditory/Visual)• “Executive” Attention• Attention must be online for other processes

to occur. • Inattention affects “higher order” cognition,

compared to language alone, per se

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…with Executive Dysfunction

• Attention-Deficit/Hyperactivity Disorder

• Bipolar Disorder

• Depression

• Autism/Asperger’s Disorder

• Traumatic Brain Injury

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Photo Credit: Patrick J. Lynch, medical illustrator

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Axon

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Grey Matter White Matter

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Processing Theory and Interconnectivity

• Luria (1973)• Reciprocal Interaction• Dean-Woodcock Neuropsychology Model

(2003)

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Development of Executive Functions

• Earliest executive abilities (Gioia, Isquith, Guy, & Kenworthy, 2000)• 12 month olds exhibit goal directed problem

solving behavior• 18 month olds exhibit self control to maintain an

action or inhibit a behavior

• Three major “growth spurts” (Anderson, 2002):– 0-5 years– 7-9 years– 11-13 years

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EF Related Grade Expectations

By Grade 2

• Perform simple chores (self-care, make bed) with reminders

• 2-3 step directions to run errands• Bring papers to/from school• Complete 20-minute homework assignments• Inhibit behaviors: follow safety rules, raise hand

to speak, keep hands to self

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EF Related Grade Expectations

By Grades 3-5

• Bring books, papers, assignments to/from school• Keep track of belongings• 1 hour of homework• Plan/execute simple school projects (e.g. book

report)• Keep track of changing daily schedule

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EF Related Grade Expectations

By Middle Grades 6-8

• Use system to organize schoolwork: assignment book, dividers/folders

• Follow complex school schedule: changing teachers

• Long-term projects, including creating time line to follow

• Inhibit rule-breaking in absence of visible authority

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EF in Adolescence

• Flat developmental trajectory– Compared to the significant spikes or spurts

(Anderson, 2002) evident during early and middle childhood.

• Information processing, cognitive flexibility, and goal setting are basically mature by 12 years old (Davies & Rose, 1999), but…

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EF into Adulthood

• Does not end in adolescence• Most potential is reached by early to mid 20’s

• Continued improvement into adulthood.• Refinement of strategies• Improved decision-making• Increased efficiency and fluency• Improved abstraction

(Anderson, 2002; Wang, 1987)

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MRI Scans (5-20 years)

http://www.loni.ucla.edu/~thompson/DEVEL/dynamic.html (9/14/09)

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ROLE OF EF AND ATTENTION IN LEARNING

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Grey Matter White Matter

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Effects of EF Deficits on Learning

• Average or better IQ, but still having difficulties?

• Interrelated to other aspects of cognition• Inhibition and…

– School Readiness (Blair & Diamond, 2008; Blair & Razza, 2007; Diamond, et al., 2007)

– Academic achievement (St Clair-Thompson & Gathercole, 2006)

• Working Memory• Multiple simultaneous tasks• Dysfluency

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EF and Reading

• Reading– Difficulty with Reading Comprehension/Inferring

meaning/Abstraction– Dyslexics often have affected Inhibition, Working

Memory, and design and verbal Fluency (Reiter, Tucha, & Lange, 2005)

• Fluency– Link to executive functioning and attention– Difference from Word Identification and Word

Attack (WRMT-III)– Link to comprehension

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EF and Math

• Math– Difficulties with multiple steps, algebraic

equations, word problems– “Careless Errors”– Fluency

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EF and Writing

• Writing– Difficulties organizing written output, including

format of arguments, and grammatical and spelling errors• Dysfluent writing, doesn’t transition well within

text• Bullet-point writing

– “Slow” writing

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Learning Behavior

OLAI-2 (Gentile, 2011)

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Assessment

• Standardized tests• NEPSY-2• D-KEFS• CVLT-C• WISC-IV• Rey CFT• Achievement measures

• Rating Scales• Brown ADD• BASC-2• BRIEF

• Observations• Do test findings present in-situ?

• Qualitative and quantitative data• Evaluate congruence of test data with the observed

• Assessment of outcomes to uncover the process

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HOW DO WE INTERVENE ON EF WEAKNESSES?

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Think of all things that have multiple steps…

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…require understanding the main idea

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…require us to use multiple skills at once

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…require us to process multiple factors simultaneously

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The goal of EF interventions

• One at a time…OK, but three at a time…

• Make tasks less complex

• High expectations, but attainable

• “Retrain the Brain”

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Brain-based interventions

• Behavioral• Cogmed

• Researchers posit that Cogmed training transfers to executive functioning, supporting link with executive control and WM. (Diamond et al., 2011; Thorell et al. 2009)

• For more information on Cogmed research, free webinars and demonstrations go to:

www.cogmed.com www.psychcorp.com

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Behavioral EF Interventions

•Two-pronged Interventions:

– Internally focused•Skill acquisition, development, refinement

– Externally focused•Modification of environment or tasks

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Externally-Focused Interventions

• Reinforce skill development through focus on learning skills– Interventions can become THE skill– Reliance on adaptations and modifications

• Examples of Externally-Focused Interventions

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Internally-Focused Interventions

• “Internalize” rather than use of external structure or modification.

• Rely less on outside assistance over time

• Examples of Internally-Focused Interventions

(Ylvisaker, Feeney, & Szekeres, 1998)

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Outcome Evaluation Overview

• Evaluate the outcome of the plan

1. Collect outcome data2. Determine if function has improved 3. Evaluate intervention integrity4. Evaluate intervention validity5. Maintain or modify the plan

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Maintain the Plan

• Improvement does not have to be absolute

• Look for reasonable improvements

• Continue if they are effective and necessary

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Modify the Plan

• Progress not acceptable

• Interventions– Consult literature or experts

• Are there any barriers for implementation?

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Remember…

• Give them time, don’t give up

• Implement in multiple settings

• Start basic, then move to more complex

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References…

• Anderson, P. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology, 8(2), 71-82.

• Andrewes, D. (2001). Neuropsychology: From Theory to Practice. Psychology Press, New York, NY.

• Blair, C. & Diamond, A. (2008). Biological processes in prevention and intervention: The promotion of self-regulation as a means of preventing school failure. Developmental Psychology, 20, 899—911.

• Blair, C. & Razza, R. P. (2007). Relating effortful control, executive function, and false-belief understanding to emerging math and literacy ability in kindergarten. Child Development, 78, 647-663.

• Davies, P.L., & Rose, J.D. (1999). Assessment of cognitive development in adolescents by means of neuropsychological tasks. Developmental Neuropsychology, 15(2), 227-248.

• Dean, R.D., Woodcock, R.W., Decker, S.L., & Schrank, F.A. (2003). A cognitive neuropsychological assessment system. In WJ III Clinical Use and Interpretation. Elsevier Science, USA.

• Diamond, A., Barnett, W. S., Thomas, J., & Munro, S. (2007). Preschool program improves cognitive control. Science, 318, 1387– 1388.

• Gentile, L.M. (2011). Oral Language Acquisition Inventory, Second Ed. (OLAI-2) – Manual. NCS Pearson, Inc. Bloomington, MN.

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References…

• Gioia, G.A., Isquith, P.K., Guy, S.C., & Kenworthy, L. (2000). Behavior Rating Inventory of Executive Function (BRIEF) – Manual. Psychological Assessment Resources, Inc. Lutz, Fl.

• Luria, A.R. (1973). The working brain: An introduction to neuropsychology. New York, NY: Basic Books, Inc.

• Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., Wager, T. (2000). The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100

• Reiter, A. Tucha, O. Lange, KW. (2005). Executive functions in children with dyslexia. Dyslexia. 11:116–131.

• St Clair-Thompson, H., L., & Gathercole, S., E. (2006). Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. The Quarterly Journal of Experimental Psychology, 59, 745-759.

• Thorell L B, Lindqvist S, Bergman S, Bohlin G, Klingberg T (2009). Training and transfer effects of executive functions in preschool children. Developmental Science, 12(1): 106-113.

• Ylvisaker, M., Feeney, T., & Szekeres, F. (1998). Cognitive Rehabilitation: Executive Functions. In M. Ylvisaker (Ed.), Trau-matic brain injury rehabilitation: Children and adolescents (2nd ed., pp. 244). Boston: But-terworth-Heinemann.

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Adam Scheller, PhD, NCSP Pearson Clinical Assessment adam.scheller@pearson.com