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Supporting the Executive Functions of Older Adolescents:

Fostering Self-Regulation

Mary R.T. Kennedy, Ph.D., CCC-SLP

Professor, Chapman Universitywww.neurocognitvelab.com

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Supporting Executive Functions with Self-regulation

• Adolescents with TBI are at risk of executive dysfunction which impacts transition to college/community and success.

• Transition needs can be addressed by speech-language pathologists (SLPs) who ‘coach’ students to self-regulate their own learning, time management and self-advocacy.

• Assessing self-regulation is done using surveys & interviews.

• Functional treatment planning & intervention will be described using an evidence-based coaching approach that uses motivational interviewing and metacognitive strategy instruction.

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Clinical Researcher

EducatorAdvocate Self-Regulation

Metacognition

Cognitive Rehabilitation

College after TBI

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Time ordered agenda

9:00• Executive functions & Self-regulation

9:30• Preparing for post-secondary education

10:00• Coaching: What is it?

10:45• Assessing Self-regulation & Goal collaboration

11:00

• Coaching self-management, -studying & learning, advocacy

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TBI Non-Combat Stats

• >5 million living with disabilities from TBI in US

– 1.7 new injuries annually; most mild

• Leading cause of accidental death or disability worldwide– U.S. leading cause of

disability < 34 years old

– 57 million hospitalized http://www.cdc.gov/Features/dsTBI_BrainInjury/

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Post-concussion syndrome (PCS)

Physical

• Fatigue

• Visual

• Headaches

• Balance, tinnitus

• Nausea

• ‘Foggy’ feeling

Cognitive

• Attention

• Word finding

• Slow processing (reading, listening)

• Memory

• Executive functions & self-regulation

Psychosocial

• Adjustment to lifestyle change

• Injury & symptom validation

• Irritability, short fuse

• Depression

• Anxiety, stress

• Frustration

• Feeling alone

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Post-concussion syndrome: A cluster

Physical

Cognitive

Psychosocial

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http://www.cdc.gov/headsup/basics/concussion_recovery.html

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Young Adulthood: A Critical Time

• Brain development

o Blooming & pruning

• Context: School & Community

o Peers, social

o Higher executive functions

o Game changes, less support

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• Injured before collegeoLower graduation rates (National

Longitudinal Transition Study, Wagner et al., 2005)

o IEPs & transition teams are important to successful college entry (Glang et al., 2008)

oAbout half are linked to campus disability services (Tobis & Glang, 2008)

What happens when students with TBI go to college?

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High school & college students

o More strategies, more effort

o Decreased GPA, outside activities & relationships with peers

o Worse concentration, memory, problem-solving

What happens when students with TBI go to college?

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Model of Cognitive Processing

Sense of Self

Anticipation Goal Selection Preplanning Monitoring

Drive

Attention Visual-Spatial Memory Alertness

Autonomic-Emotional Sensory/Perceptional Language

Motor Cognition

Sequencing

Executive Functions

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Stuss & Benson, 1986

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The Widening Gap of Executive Functions

Pre-K Elementary Secondary Post-secondary

Executive functions

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• integrative cognitive processes that determine goal-directed and purposeful behavior in daily life– formulate goals;

– initiate behavior;

– anticipate the consequences of actions;

– plan and organize behavior in logical sequences

– “to monitor and adapt behavior to fit a particular task or context.” (Cicerone et al., 2000, p. 1605).

Executive Functions are…

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Executive Functions (Dawson & Guare, 2012)

1) Response inhibition

2) Working memory

3) Emotional control

4) Sustained attention

5) Task initiation

6) Planning/prioritizing

7) Organization

8) Time management

9) Goal-directed persistence

10) Flexibility

11) Metacognition

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Examples of Cognitive ImpairmentsCognitive Process College students with disabilities may…

Attention: Focusing on a specified activity, behavior, or task. Levels from basic to complex include: focused, sustained, alternating, divided.

• Be distractible during class, while studying, or during conversation

• Talk out of turn• Have a low tolerance for frustration• Not follow through on assignments or personal

commitments

Memory: Gathering information so that it can be stored and then recalled at a later time.

• Have difficulty recalling facts, new information for tests• Forget what they read• Be unable to connect information; draw inferences when

reading• Not know when assignments are due • Rely on poor memory strategies when studying, such as

repetition

Receptive language: comprehending and decoding meaning – both explicit & implicit language.

• Be slow to respond to questions• Become frustrated by group interactions that require

listening and responding to multiple speakers• Have difficulty understanding implicit information when

reading texts• Focus on explicit information in texts while missing implicit

information

May 13, 2016Kennedy & O’Brien, 2016

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Examples of Executive Function Impairments

EF Process College students with disabilities may…

Attention control: Deciding what to pay attention to, what to ignore, how long to attend, & when to switch attention.

• Get too focused on one part of an assignment • Be easily distracted in class, during exams, & while studying• Become distracted when completing long assignments• Not recall or learn material

Memory Control (working memory): Holding information in one’s mind in order to manipulate it; retrieving details when needed; remembering to do something at a later time (i.e., prospective memory)

• Have trouble multi-tasking (e.g., listening & taking notes)• Make decisions based on limited information• Forget important details • Miss punch lines or story conclusions • Have difficulty weighing options

Cognitive self-regulation: Monitoring the need for strategies; selecting & implementing strategies.

• Underestimate the need to study & use strategies Underestimate the amount of time & effort studying takes

• Not adjust or change study strategies even when current ones are ineffective

• Know study strategies, but do not use them

Emotional self-regulation:Managing and bouncing back from everyday ups and downs without over-reacting.

• React in ways that are out of proportion to the situation • Get upset or overly discouraged when given feedback • Have fluctuating emotions or “mood swings” over a short

period of time• Get easily irritated if someone disagrees with them

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Impairments associated with TBILanguage & Cognition Executive

Functions

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COGNITIVE & EXECUTIVE FUNCTION IMPAIRMENTS

DUAL DISABILITIES

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Transition Planning

• Taxonomy of Transition Programming (Kohler, 1996)

– Student-focused planning

– Student development

– Interagency collaboration

– Family involvement

– Program structures

www.nsttaac.org

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What Do Students Need to Succeed after High School?

• SReg learning are the strongest predictors of learning at work and in college

1. Goal level

2. Persistence

3. Effort

4. Self-efficacy

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Sitzman & Ely, 2011

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Executive

FunctionsMetacognition

Awareness

Rehabilitation,

NeuropsychologyOther Fields of Psychology

Self-Regulation

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Self-regulation

Goal –

Self-monitor

Strategy decision – Self-control

Implement strategy

Compare (& adjust)

Metacognitive beliefs &

sense of self

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Revised from Flavell, 1979; Kennedy & Coelho, 2005

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Self-regulation is…• the ability to assess ones own (hence the

‘self’) cognitive and emotional states and to make decisions about what to do in light of that assessment. – a group of cognitive processes

– are the ‘meta’ manipulations that allow us to monitor and control our own emotions, thinking, and actions.

– goal- oriented behavior that is adjusted in a real world context.

Carver & Scheier, 1991; Kennedy & O’Brien, 2016; Sitzman & Ely, 2011

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SELF-AWARENESS

WHAT ARE YOU GOOD AT DOING?

List 5 things

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Adolescents & Young Adults with Executive Dysfunction: Sense of Self?

Developmental

ADD/ADHD

ASD

Intellectual Disabilities

Acquired

TBI

Concussion

Stroke, other

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Executive Functions

Sense of self

AcquiredDevelopmental

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College

Work

College

College

Work

Work

Context is Key

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Percentage by student group registered with Disability student services (DSS)

(NCES report, Raue & Lewis, 2011)May 13, 2016 27

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Percentages of colleges that document these groups of students

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Preparing Students with Executive Dysfunction for Post-secondary Education

• Transition teams before & after HS – Vocational rehabilitation

• Educate student & family– Role of Disability services &

cultural shift

– Emphasize independence

– Plan ahead: meet with DS, early course registration

• Translate executive functions

• Coach time-management, study & learning, self-advocacy

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Context: Role of Disability Services

• Maintain medical/psychological documentation in a confidential manner

• Determine if condition is a disability• Identify and assist with implementation or

reasonable accommodations– Modify accommodations as needed IN ORDER TO PROVIDE

EQUAL ACCESS

• Provide information and referral• Promote independence, self-advocacy, self-

expression, finding your own way• Provide “support” to those who seek it

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Context: Role of Students

• Provide medical and/or psychological documentation to Disability Services

• Participate in the process of determining and implementing accommodations

• Inform Disability Services when accommodations are not working, need to be modified, or if symptoms change

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Independence & Advocacy

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Context: Role of Instructors

• Refer students to Disability Services

• Participate in the process to determine and implement accommodations

• Identify essential course components for accommodations to be determined

• Request assistance from Disability Services as needed

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What is Dynamic Coaching?

• A form of intervention that supports and instructs individuals in the use of their own executive functions to be able to assess situations accurately that and solve problems that arise and to accomplish both their proximal (immediate) and distal (long range) goals.

‘dynamic’ reflects these self-regulation processes are on-going and ever changing with students’ needs, situations and contexts.

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Traditional Therapy

Coaching Approach

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Partnership

Context

Clinician as expert

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Coaching

Self-expertise

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Partner with Students to

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develop goalsplans (strategies, timelines)establish routines identify barriers

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Partner through Coaching

Coach

Motivates, Inspires

Models

SupportsInstructs

Guides

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Evidence in support of Coaching College Students

• Ylvisaker & Feeney, 1998; Ylvisaker, 2006• Quinn, Ratey & Maitland, 2000• Parker & Boutelle, 2009• Dawson & Guare, 2012• Field, Parker, Sawilowsky & Rolands, 2010; 2011• Kennedy & Krause, 2011• Kennedy, Krause & O’Brien, 2014• O’Brien, Schellinger & Kennedy, (strategy outcomes) in

preparation• Kennedy, Schellinger & O’Brien, (qualitative outcomes) in

preparation

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Coaching is based on best-practices

Supports change (& recovery) naturally through experiences

Strive for Effortless behavior

Self-awareness & metacognitive strategies

Person-centered goals

Instruct Self-Regulation

Maintenance & Generalization

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• Systematic Reviews

– Tate et al. (2014) – JHTR

– Kennedy et al. ( 2008) – Neuropsychological Rehabilitation www.ancds.practiceguidelines

– Cicerone et al. (2000, 2005, 2010)

– Institute of Medicine (IOM, 2011) report on cog rehabilitation

Scientific Evidence for Using Self-regulation through Metacognitive Strategies

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Metacognitive strategy instruction/Direct Instruction had a larger tx effect on functional activities than ‘control’ tx for adults with sufficient attention & memory.

Practice Standard

Intervention for executive functions after traumatic brain injury: A systematic review, meta-analysis and clinical recommendations (Kennedy et al., 2008)

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• Combining the DI with SI to achieve the best outcome!! Kennedy et al., 2008

Promoting Metacognitive Strategy Instruction

Impairment outcomes Activity/Participation

Non-MSIinstructions

MSI instructionsEffect sizes

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“Treating” Self-awareness

• Educational material

• Experiential, activity based intervention

• Learning (about self) while doing

– Using tools, strategies

– Feedback (self, others)

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Tate et al., 2014

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Table2.1.Similaritiesanddifferencesbetweendynamiccoachinganddidacticinstruction.Coachescanberehabilitationprofessionals,instructors,orpsychologists.

DynamicCoaching DidacticInstruction

Coachprovidesindividualizededucation Coachprovidesindividualizededucation

Bothcoach&studentareexperts Coachistheexpert

Emphasizesprocess&result Emphasizesprocess&result

Coachasksquestions,studentsselectstrategies

Coachidentifies&selectsstrategies

Coachreliesinterviews,questionnaires&behaviortogatherinformationaboutstudent

Coachreliesontestscores&behaviortogatherinformationaboutstudent

Coachmodelsself-regulationandprovidesstructure,studentprovidescontent

Coachmodels,providesstructure,andprovidescontent

Goalsareidentifiedbystudentwithcoachingguidance

Goalsareoftenindependentoftheinstruction

Coachingoccursinthecontext,inrealtime,e.g.,collegecampus

Instructionoccursoutofcontext,e.g.,therapyroom

Isteambasedinwhichstudentselectsteammembers

One-on-onetherapyorinstructionaretypical

Lessintensive,e.g.,onesessionperweek Moreintense,e.g.,2-3timesperweek

Process-basedgoalsareasimportantastheproduct-basedgoals

Productbasedgoalsareimportant

Distributedpracticeoccursnaturally Practiceisartificial,outofthecontextfromwhichstrategieswillbeused

Feedbackcomesnaturally,frommultiplesources

Feedbackcomesfromthecoach

Self-regulationisemphasized,i.e.,-monitoring,implementing,adjusting

Learningthestrategyisemphasized

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Coaching involves…

Guiding students using active listening, questioning = motivational interviewing (Miller & Rollnick, 2013)

"a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion."

Collaboration

Evocation

Autonomy

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MacFarland, L. (2012). Canadian Journal of Speech-Language Pathology and Audiology, 36/1.

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What do Coaches do?

• Instruct in strategies, with emphasis on strategy use in context

• Work to extinguish ineffective strategies

– Clients track performance

– Clients report back to coach

– Together, reevaluate based on outcomes

– Coach client to make change or stick with plan

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Re-evaluation and Follow-up

Planning and SupportSelf-Learning

Self-Management

Self-Advocacy

Intake and Evaluation

Coaching Phases

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• Interview using the College Survey for Students with Brain Injury (CSS-BI, Kennedy & Krause, 2009)

– Academic experiences, goals

– Vocational goals

– Medical history

– Academic history

• [Review of documentation/medical history of brain injury

• Gather other neuropsychological reports

• Supplement testing to determine strengths and weaknesses]

Example of an Intake and Evaluation of Student with Brain Injury

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Evaluating functional executive functions

• Obtained NP report• Controlled Oral Word

Association Test• Wechsler Adult Test of

Reading• Functional Assessment of

Verbal Reasoning & Executive System - Student

• CSS-BI &/or LASSI interview– Academic experiences– Strategies – learning,

organizational, advocacy– Goals

• Compare recall with and without taking notes

– Made predictions

• Predit how long it would take to complete tasks vs. how long it took, with goal of improving predictions

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5-point Likert rating scalestrongly disagree disagree neither agree strongly agree

1. Others do not understand my problems.***

2. I have to review material more than I used to. ***

3. I forget what has been said in class.*

4. I don’t always understand instructions for assignments.*

5. I get overwhelmed in class. *

6. I have trouble prioritizing assignments & meeting deadlines.*

CSS-BI Academic challenges: To what extent do you agree with the following statements about your

experience as a college student since your injury?

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7. I have fewer friends than before.*

8. I have trouble managing my time.*

9. I get overwhelmed when studying.

10. I procrastinate on things I need to do.

11. I get nervous before tests.

12. I have trouble paying attention in class or while studying.

13. I am late to class.

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Kennedy, Krause, & O’Brien, 2014

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College Survey for Students with Brain Injury

(CSS-BI)

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Organizing, managing

Studying, learning

Psychosocial

Nervousness

Kennedy et al., 2008, 2014

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I have to review material more than I used to.

Agree:

Give example?

How do you review? Or What do you do to review?

• May need to give example, e.g., highlight?

I don’t always understand instructions

Agree:

Give example?

What do you do when you don’t understand?

* May need to give example, e.g., check syllabus, ask peer

I have fewer friends than before

Uncertain:

So you are uncertain about this?

• Yeah well, I don’t really have fewer friends, but I have different friends, better friends

Interviewing procedures

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Interpreting strengths & weakness

I am able to: Examples of this are:

1. Pay attention 1. I stay focused in class

2. I can study for long periods of time

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I have trouble with: Examples of this are:

1. Dysinhibition, inability to ‘wait’ 1. I ask too many answers to questions in class

2. I don’t always weigh consequences before making decisions

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Domain overlap

Self-learning

Self-management

Self-advocacy

Nervousness

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1

2

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Teach them self-regulation

Goal –

Self-monitor

Strategy decision – Self-control

Implement strategy

Compare (& adjust)

Metacognitive beliefs &

Sense of self

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Revised from Flavell, 1979; Kennedy & Coelho, 2005

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Identify potential

goals

Select doable goal

Identify potential

strategies, solutions

Select optimal

strategy; back-up

Learn the strategy

Create steps,

materials

Initiate strategy

steps

Track strategy use

Track perfor-mance

Compare to goal, review

Adjust goal, adjust

strategy

Apply to other situations

Goals

Implement Strategies

Adjust

Self-regulation process for complex activities

Kennedy & O’Brien, 2016

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Value is in the process, not just the product

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• Internal process - problem or activity based (Goal, Strategy, Adjust – GSA)

• External process – weekly sessions of persisting in problem solving, support, adjusting that models and builds resiliency

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Performance & Self-Regulation Goals

Performance goals are appealing because they are written to be measurable and specific to identified situations

• “…will recall 4 out of 5 details from orally presented story after 5 minute delay across 3 sessions”

However, these target only the level of theskill and not changes in self-regulation

• Also do not explicitly activate the self-regulation loop to allow for an updated understanding and awareness of the skill

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Self-Regulation Goals

Often attainable, even when performance goals

may not be

Target the client’s ability to monitor their own progress toward the

performance goal

With improved monitoring, the client can

become involved in the problem-solving process

of the therapy plan

Clients can suggest strategies and evaluate their effectiveness at

improving performance

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• Individualized scaling system

• Allows clinicians and clients to: – develop goals together

– quantify progress toward reaching the goals

– Rating scale with 5 levels of achievement

• Demonstrated to be useful for people with TBI with complex executive function tasks such as financial management (Grant, Ponsford, & Bennett, 2012)

Goal Attainment Scaling (Malec and colleagues)

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clinicians and clients not only to develop goals together, but also to quantify progress toward

reaching the goals, using a rating scale with 5 levels of achievement. It has been demonstrated

to be useful for people with TBI with complex executive function tasks such as financial

management (Grant, Ponsford, & Bennett, 2012).

Table 2. A goal attainment scaling example that a college student with TBI and the SLP coach

created together

Goal Area: Reading Journal

5 Writing summaries of all chapters read. Effectiveness of notes in triggering

recall is consistent, resulting in rich, specific recall of events and characters. Scanning of the book is limited to only specific scenarios (such as using quotes for an essay). Notes are well elaborated and allow for integration of ideas across the narrative.

4 Writing summaries of all chapters read. Effectiveness of notes in triggering recall is fairly consistent, so that only minimal scanning of the book is needed to recall details. Notes are well elaborated.

Target 3 Writing summaries of most, but not all chapters read. Alternatively, all chapters have notes, but effectiveness of notes in triggering recall is inconsistent. Some time is spent scanning the book rather than relying on summaries.

Starting Point

2 Writing summaries of only a few chapters. Effectiveness of notes in triggering recall is inconsistent. More time is spent scanning the book than relying on summaries.

1 Writing summaries of chapters read only rarely or not at all.

As an example of GAS, a college student with TBI scaled goals with the guidance of his

clinician. This student had severe declarative memory impairments but strong executive

function abilities. As a result of his memory deficits, he was having difficulty recalling a novel

he read for a literature class. Each time he began the week’s reading assignment, he was

unclear about what had already occurred and found himself rereading previous chapters. In a previous semester, he had to complete a weekly journal of his reading, so he thought a journal

might help with this as well. The goal to complete journal entries for each chapter that would

trigger accurate and effective recall was set and scaled from 1 to 5 (see Table 2). Using GAS,

baseline is set at a level 2, describing his current performance but allowing for some backward

movement. The goal is initially set at level 3, with levels 4 and 5 showing further improvement.

Each week, he ranked his own performance and compared it to the coach’s rating. This student progressed to a 5 over a period of 3 weeks and maintained this when he began a second novel.

Thus, this highly adaptable scale allows both the client and clinician to track and monitor

progress over time.

This focus on process also allows clinicians and clients to consider the cost-benefit

trade-off of multiple PCOs that a focus on outcomes alone would not. For one college student, her goal to earn a 4.0 GPA was problematic because it required her to eliminate nearly all other

aspects of college life. She studied constantly, rarely interacted with roommates, was involved

in no extracurricular activities, and repeatedly checked her work to excess; all of this had a

side effect of bouts of anxiety and self-doubt. More appropriate goals for her instead focused on

engaging in activities that she enjoyed and establishing social networks at college. Although it

took two semesters of her constant study habits to convince her that these other goals were in her best interest, she eventually lowered her academic expectations to allow these other goals

to be addressed. As a result of her new goals, grades did indeed decline in some classes, but

the trade-off was that she had time and energy to participate in social activities (e.g., being in a

school musical, moving to an apartment with friends) while maintaining a positive outlook, all

Sample Scaled Goal

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Management as a Core Skill

Studying/learning

Self-advocacy

Manage-ment

Stress/anxiety

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Kennedy et al., 2014

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Self-Learning (SL)

Grade based: want to get a B

Process based: Write better papers; use keywords

Develop strategies for taking multiple

choice tests

Self-Management

(SM)

Turn in all my papers on time

Keep up with a long term project instead of waiting

until the end

Prioritize assignments to work efficiently

Self-Advocacy

(SA)

Discuss my brain injury with my

professors

Find more activities that I can

still do with my friends

Become a part of a class study group

Coaching measurable goals

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Self-management: Goal generation

Problem Performancegoal

Self-regulation goal

Coaching

It should only take me 2 hours a week to read assigned readings, but am not sure… I don’t know how to plan.

Student will keep up with reading & turn in assignments on time.

1. Student will accurately assess how long it takes to read.

2. Student will accurately assess how long it takes to complete assignment.

Strategy: 1. Instruct in ‘Plan-do-review’2. Provide form3. Student tracks4. Discuss impact on planning

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Plan Do Review

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Plan-Do-Review

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Self-Learning & Studying: Strategy & goal development

Problem Performancegoal

Self-regulationGoals

Coaching

Student: Reading a novel, I can’t recall what I read yesterday so I don’t understand next chapter

Recall a sufficient amount that he already read, so he could continue to read/understand.

1. To create a scale to assess how well I do.

2. To implement the journaling strategy.

3. To self-assess my recall, reading using the scale

Coach: Show me what you mean. What do you think you should do?

Student: I could ‘journal’ my reading as I go like I learned last semester.

Coach: Lets have you create a way for you to assess.

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Self-learning & Studying: Strategy

Performance goal

• To be able to review (& recall) what's been said in class.

Self-regulation goal: Strategy/Execution goal

1. Student will record lectures while taking notes using LiveScribe(SmartPen) & track use

2. Student will review lectures prior to quizzes

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Self-learning & Studying: Strategy, Implement, Adjust

1. Strategy – Live Scribe

Learn Pen

Use in class

Review notes

Hard to take notes

Draw images in class

2. Performance - Recall

Draw images

Use in class

Review images/listen

Easier to use

Recalls lecture material

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Self-Advocacy: Creating a Team

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Self-Advocacy: Implementation

Problem Performancegoal

Self-regulation goal

Coaching

“I get really nervous before exams. I am easily distracted”

Reduce experience of nervousness

1. Implement her accommodation to take exams in Disability services office

Coach: And this nervousness is since your injury? Student: Yeah. Coach: You could try to taking the exam in the DS office, right? Student: its seems like a hassle, and I don’t know, I just don’t like going thereCoach: But fewer distractions likely?

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• Problematic goal for student to earn a 4.0

– Capable … but at cost of studying constantly, no extracurricular activities, would not socialize with roommates, repeatedly checked her work to excess

– Side effect - anxiety, self-doubt

• Set goals to engage in activities that she enjoyed and establish social networks at college

– Got a lead in local production of ‘Fiddler on the Roof’

• Lowered her academic expectations to allow these other goals to be addressed

Self-Advocacy Goal: Benefits, Costs

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• Slight decline in grades, but had time and energy to participate in social activities (e.g., being in a school musical, moving to an apartment with friends)

• Maintained a positive outlook

• Grades alone do not tell the whole story – outcomes must measures the student beyond the classroom

– The back story

Self-Advocacy Goal: Benefits, Costs

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• Students will track their own performance on daily (weekly) basis

• Discuss with coach the factors that may be affecting performance

• Also discuss/rate:

– Effort

– Effectiveness of strategies

– Development of routines

Implementation goals: Self-tracking Implementation

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Tracking Strategy Use

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Form 4.X

Strategy Review and Application

Consider the strategies you are now adding to your toolbox. List these and identify other situations or activities in which you could use these strategies.

Strategy

Domain: SM, SL, SA

Current Use Other Uses

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FORM 4.X

Strategy Usefulness and Next Steps This form can help you figure out what happened when you implemented the plan or strategy. You can also consider your options. Write out the strategy, describe what happened, consider your options and identify what you want to do next.

Goal:

Strategy or Plan:

Did you use it enough so you can tell if it worked?

Yes No

Describe how well it worked: Describe barriers that interfered:

What is your plan? What is your plan?

___________________________

___________________________

___________________________

___________________________

__________________________

__________________________

__________________________

__________________________

Continue to use it as is & assess its usefulness

Continue to use it, but consider ways to make it easier, effortless

Discontinue its use (& why) & select a

different strategy

Discontinue its use, change your goal, figure out impact

Do nothing different & try again

Deal with barriers & try again

Use a different strategy, if so, what?

Have a backup strategy if barriers return

Change your goal, figure out impact 79

Portfolio – Table of Contents

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Supporting Executive Functions in Students with TBI by Coaching Self-regulation

• Work with transition teams

• Educate & translate impairments

• Educate in role of DS, college culture

• Explicitly instruct students in self-regulation– Monitoring/setting goals– Instruct in strategies– Implement– Adjust

• Students choose goals, strategies, ways to implement

• Domains of: – Time management,

organization– Studying and learning– Self-advocacy – identify

‘go-to’ supporters

• Have students create portfolio or toolboxes

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Resources

On-line

• www.ancds.org - Practice guideline publications on cognitive rehabilitation therapy for persons with TBI

• www.LearnNet.org – NY educational website

• www.thinkcollege.net - Think College!• www.brainline.org – resources about

TBI • www.cbirt.org – Center for Brain Injury

Research & Training– http://media.cbirt.org/uploads/2012/1

0/Transition_Toolkit_October_2012.pdf.

• www.neurocognitivelab.com –Kennedy’s website– http://neurocognitivelab.com/wp-

content/uploads/2015/09/Disability-specialist-document_final.pdf

Manuals & Books

• Collaborative brain injury intervention: Positive everyday routines. Ylvisaker & Feeney, 1998, Singular Publishing.

• Optimizing Cognitive Rehabilitation: Effective Instructional Practices, Sohlberg & Turkstra, 2011, Guilford Press.

• “Transitions” series, Brook’s Publishers

• Coaching Students with Executive Skills Deficits, Dawson & Guare, 2011, Guilford Press.

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Thank you!

May 13, 2016

markenne@chapman.edu

www.neurocognitivelab.com

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References• Carver & Scheier (1991). Self-regulation and the self. In J. Strauss & G.R. Goethals (Eds.), The

Self: Interdisciplinary Approaches (pp168-207). New York: Springer-Verlag.

• Cicerone, K., Dahlberg, C, Kalmar, K., Langenbahn, D., Malec, J., Bergquist, T., et al. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81, 1596–1615.

• Flavell, J.H. (1979). Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. American Psychologist, 34, 906-911.

• Kennedy, M. R. T. & Coelho, C. (2005). Self-regulation after traumatic brain injury: A framework for intervention of memory and problem solving. Seminars in Speech and Language, 26, 242-255.

• Kennedy MRT & Krause MO (2010). Academic experiences of adults with and without traumatic brain injury using the College Survey for Students with Brain Injury (CSS-BI). Brain Injury, 24, 325.

• Kennedy, M.R.T., Krause, M.O., & O’Brien, K. (2014). Psychometric Properties of the College Survey for Students with Brain Injury: Individuals with and without Traumatic Brain Injury, Brain Injury. DOI: 10.3109/02699052.2014.920520

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References• Kennedy, M. R. T., Krause, M. O., & Turkstra, L. S. (2008). An electronic survey about college

experiences after traumatic brain injury. NeuroRehabilitation, 23(6), 511-520.

• Kennedy, M.R.T. & O’Brien, K.O. (in preparation, 2016). Coaching college students with executive dysfunction: A dynamic approach. NY: Guilford Publishing.

• Kohler, P. D. (1996). Taxonomy for Transition Programming: Linking research and practice. Champaign, IL: Transition Research Institute at University of Illinois at Urbana-Champaign.

• Mealings M, Douglas J, Olver J. Considering the student perspec- tive in returning to school after TBI: A literature review. Brain Injury 2012;26:1165–1176.

• National Secondary Transition Technical Assistance Center NSTTAC. (2010). Evidence-based Secondary Transition Practices. Retrieved from http://www.nsttac.org/ebp/evidence_based_practices.aspx

• O’Neil-Pirozzi, T., Kennedy, M.R.T., & Sohlberg, M.M. (in press). Evidence-based practice for the use of internal strategies as a memory compensation technique after brain injury: A systematic review. Journal of Head Trauma Rehabilitation.

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References• Raue, K., & Lewis, L. (2011). Students with disabilities at degree-granting postsecondary

institutions. (NCES 2011–018). U.S. Department of Education, National Center for Education Statistics. Washington, DC: U.S. Government Printing Office.

• Sitzman & Ely, 2011, Psychological Bulletin, 137, 3, 421–442.

• Stuss, D., & Benson, D. F. (1986). The frontal lobes. New York, NY: Raven Press

• Tate, R., Kennedy, M.R.T., Bayley, M., Bragge, P., Douglas, J., Kita, M., Ponsford, J., et al. (2014). INCOG Recommendations for Management of Cognition following Traumatic Brain Injury Part VI: Executive Function and Self-awareness, Journal of Head Trauma Rehabilitation, 29(4), 338-352.

• Todis B, Glang A. Redefining success: Results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury. Journal of Head Trauma Rehabilitation 2008;23:252–263.

• Willmott C, Ponsford J, Downing M, Carty M. 2014. Frequency and quality of return to study following traumatic brain injury. The Journal of Head Trauma Rehabilitation 2014;29:248–256.

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