Beyond Medication Improving Executive Functioning in Students with ADHD Christopher Leonard, LCSW, M.Ed., Director of Operations

cleonard@sageday.com Sarah Collins, MA, Teacher of Mathematics scollins@sageday.com

Thought Leaders in Executive Functioning

▪  Sarah Ward, MS CCC-SLP, Cognitive Connections Therapy www.efpractice.com

▪  Nancy Sulla, Ed.D., author of Students Taking Charge and It’s Not What You Teach But How www.idecorp.com

▪  Russell Barkley, Ph.D., author of numerous books/studies on ADHD www.russellbarkley.org

Workshop Objectives

▪  Understand causes of Executive Function (EF) difficulties ▪  Learn strategies to help build EF skills ▪  Learn about classroom practices that support EF ▪  Practice using a variety of strategies to build EF ▪  Develop a plan for utilizing at least one strategy with your child

or student(s)

Executive Functioning….It’s not a matter of “not feeling like it…”

What is Executive Functioning?

“The executive functions are a set of processes that all have to do with managing oneself and one's resources in order to achieve a goal. It is an umbrella term for the neurologically-based skills involving mental control and self-regulation.” -Joyce Cooper-Kahn and Laurie Dietzel

What Does Successful Executive Functioning Include?

▪  Self Regulation/Impulse Control/Social Navigation ▪  Situational Awareness ▪  Organization/Task Focus/Working Toward a Goal ▪  Information Processing/Remembering Details/Analysis ▪  Knowing When and How to Ask for Help ▪  Planning & Problem Solving ▪  Anticipating Outcomes/Considering Future Consequences ▪  Cognitive Flexibility ▪  Time Management ▪  Memory & Study Skills

Who struggles with Executive Functioning?

Individuals with… ▪  ADHD ▪  Learning Disabilities (e.g. Dyslexia) ▪  Spectrum Disorders ▪  Anxiety ▪  Depression or Mood Disorders ▪  Fetal Alcohol Syndrome ▪  Traumatic Brain Injury ▪  Cancer Treatments

Executive Functioning Depends on Non-Verbal Working Memory

If I’m going to solve those Chem problems, I’ll need...

Future Glasses: Non-Verbal Working Memory

Self Talk: Verbal Working Memory

Without EFFECTIVE Non-Verbal Working Memory... I have no idea where to

start...

Non Verbal Working Memory

Verbal Working Memory

Mimetic Ideational Information Processing (“Future Thinking” Ward, 2016)

▪  Running through (miming) the idea in your head

▪  A mental “dress rehearsal” ▪  Try it out to see how it feels

beforehand ▪  Mental trial & error (no risk of

error)

Space Time Objects People

But all my students have great Executive Functioning! (?)

“The average capacity of working memory has declined from 7 bits of information to 4-5 bits of information for adolescents and adults.” -Sarah Ward

Miming in your head allows you to run Plan A and Plan B in your head...

I could finish those problems now and get them over with...

I could go watch Netflix. I’ll have time to do those problems later.

FOUR CHALLENGES: Challenge 1: Self Regulation

▪  Toddlers Learn to Wait (Impulse Control) ▪  Waiting = Prerequisite for Planning ▪  Limitations of the “Point Person.” ▪  Myth of Laziness ▪  All Behavior =Communication ▪  Attention, Escape, Sensory Satisfaction,

Tangible Object or Reward

Supporting Self Regulation

▪  K-8: Social Decision Making and Problem Solving, Maurice Elias

▪  K-12: Hanging In, Jeffrey Benson ▪  Mindfulness:

▫  Therapy! ▫  Coaching! ▫  Wherever You Go There You Are, Jon Kabat-Zinn ▫  Peace is Every Step (and many more!), Thich Nhat Hanh ▫  K-8 Mind-up Curriculum ▫  Teens: www.mindfulteachers.org

Challenge 2: Situational Awareness: (STOP and Read the Room)

SPACE: Navigate the room

TIME Know the Timeline

OBJECTS Organization

PEOPLE Reading Others

What is this place? Time of Day? Layout of space Facial Expressions

What’s going on? Kind of Time? Location of materials

Body Language

Expected or Not? What is going on NOW?

Purpose of Objects Appearance/Tone

How do I get around?

Sequence and Pace Priority of Objects Mood

What’s Next? What’s relevant? Pace

Reading the Room: Space, Time, Objects, People

Try this: Think of a student who struggles with EF. Which aspect(s) of STOPPING would they struggle with?

Challenge 3: Time Blindness:

For students with ADHD there is

NOW...

...and NOT NOW.

Challenge 4: Development of the Time Horizon by Age Range

▪  Age 2: Now ▪  Ages 3-5: 5 - 20 minutes ▪  1st grade: Several hours ▪  3rd grade: 8-12 hours ▪  Ages 12-16: 2-3 days ▪  Ages 17-23: 2-3 weeks ▪  Ages 23-35: 3-5 weeks

Executive Functioning not fully developed until age 23-26! -Sarah Ward www.efpractice.com

Remedy: Future Thinking (mental dress rehearsal) The Mind M.I.M.E -Sarah Ward

Make an Image: What will it look like? (Schematic Future Thinking)

I look like…What will I look like? (Episodic Future Thinking)

Moving...How am I moving to do this? (Prospective Visual Motor Memory).

Emotion...How will I feel.

Problems with Task Visualization & Completion

▪  We tend to plan tasks in one space, carry them out in another. ▪  Students more likely to use phones* or teacher websites than agendas

(no opportunity to MIME self completing work). ▪  Today’s students do not experience time the way we did. Their time is

either managed for them or “on demand.” ▪  When a student has emotional issues it makes MIME difficult.

Goal: Help students picture themselves in the future and extend the time and space horizon in which they can see themselves.

What Helps Students Become Independent Planners?

▪  Daydreaming & Imaginative Play ▪  The Arts (Visual, Music, etc.) ▪  Scaffolding: Provide Supports and Teach tools

to stop, visualize the future, organize, plan, manage time

▪  Shift from External Regulation to Internal Regulation

Steps to Independent Planning

To decrease impulsivity, facilitate distance from action. This begins to create a mental anchor. ▪  Step 1 Concrete: Teach transitions through space ▪  Step 2 Visual : Provide Actual Pictures (photos) ▪  Step 3 Visual-Abstract : Create Maps & Diagrams ▪  Step 4 Visual-Physical : Practice pointing out your

plan

Step 1: Concrete Support for Situational Awareness: Anchor Transitions Through Space

Discuss: Where could your students benefit from STOPPING?

STOP DO YOU HAVE

WHAT YOU NEED?

Visual (Step 2) Photos: Managing Materials: Skitch

Managing Materials: Block and Box

1.  Lay out items. 2.  Group what goes

together. 3.  Take photo 4.  Student can create album

in phone called “Get Ready”

Visual-Abstract (Step 3): Mapping/Future Sketching

1.  Sketch 2. Tap it out

Visual-Physical (Step 4) Miming/Talking Through

▪  Teaches visualizing space (we plan in one space, carry out task in another).

▪  A pointer or other physical mediator can help reduce impulsivity.

Learning Resources Hand Pointers available on Amazon Try This: Practice miming/talking through a

task.

Self Regulation: Gradual Release of Responsibility Method -Sarah Ward

1.  I do it...You Watch Me...We Talk 2.  I do it...You Help Me...We Talk 3.  We do it together...I Help You...We Talk 4.  You do it...I Watch you...We Talk

Try this...

Identify a skill to teach using the Gradual Release of Responsibility Method and plan out how you would teach it.

Getting Started and Following Through: Start with the End in Mind -Ward & Jacobsen (2014) Every Task has 3 Phases….

Example

Every Task has 3 phases….. ...or maybe 3 ½...

Practicing Get Ready, Do, Done, Get Done

Try This: Think of a typical household or other routine task that you do… 1.  What does DONE look like? 2.  What steps will you DO? 3.  What will you need to GET READY? Pair & Share...

Organized Thinking: Teach “Same but Different” -Ward 2016

Ready for English

Ready for Statistics

Developing Time Awareness: Use the Analog Clock

Cognitive Connections: 360 Thinking App

Identify Time Robbers & Management

The Story So Far… (Break?)

▪  Executive Functioning requires us to picture ourselves in the future. ▪  Lack of nonverbal working memory makes it difficult to envision

ourselves in the future. This makes it hard to navigate Space, Time, Objects & People.

▪  Giving students tools to become better planners, organizers and doers helps them picture themselves in the future and increases the time and space horizon in which they can see themselves.

NEXT: Building Executive Functioning Into the Classroom

A Look Into my Classroom: Sarah Collins

▪ Reflection on learning style ▪ First glimpse of active

learning ▪ Plan for my students

Attention/Focus

Inhibition

Problem Solving

Cognitive Flexibility

Planning Memory

Organizing & Prioritizing

Initiating Tasks

Completing a Task

Physical Organization

Self-Monitoring

Self-Regulation

Reasoning

Daily Goal Sheet

▪  Identify needs for the class period ▪ Realistic and simple goal ▪ Dedication and breakdown of time

Planning

Project Timeline

▪ A visual map of the project ▪ Schedule time and stay on track ▪ Duration and complexity

Planning & Problem Solving

Project Timeline Visuals

Classroom Space

▪ Types of work spaces ▪ Organized resource area ▪ Classroom dynamics changing

Inhibitory Control

Classroom Space Visuals

Weekly Consultations

▪ Time to relay findings or access help ▪ Check-in on process and progress ▪ Gradual release of responsibility

Planning, Cognitive Flexibility & Reasoning

Peer Collaboration

▪  Element of socialization ▪  Insight and perspective of another individual ▪  Teacher mediation to self-led ▪  Development of collaboration guidelines

Cognitive Flexibility & Self-awareness

Teacher as Facilitator

▪  Teacher’s role transforming over time ▪  Encouraging experts in learning ▪  Acknowledging progress ▪  Facilitation Road Map

Working Memory

Rubrics and Reflections

▪ Participation vs. project rubric ▪ Ability to grade themselves ▪ Daily notes and reflections

Self-awareness

Takeaway Thought

Learning should be an active process. Too often, students come to school to watch their teacher work.

-Will Daggett

Using the Tools: Case Studies

TOOLBOX ▪  Reading the Room ▪  Transitions Through Space ▪  Photos & Visuals ▪  Mapping/Future Sketching ▪  Gradual Release of Responsibility ▪  Block & Box ▪  Get Ready, Do, DONE! ▪  Managing Time & Time Robbers ▪  Goal Sheets ▪  Rubrics ▪  Facilitation Roadmap

1.  Discuss at least one of the three case studies.

2.  Select tools from left to make an intervention plan.

3.  Prepare to share. 4.  If you finish early: Begin to

consider how you might apply tools to one or more of your students.

Using the Tools: Your Plan Try This: Make a Plan to implement a strategy in your work this year...

QUESTIONS & ANSWERS

Works Cited

Barkley, Russell A. (2012). Executive functions: What they are, how they work, and why they evolved. New York: Guilford Cooper-Kahn, Joyce & Dietzel, Laurie (2008). Late, lost and unprepared: A parent’s guide to helping children with executive function. Woodbine House, Bethesda, MD. Elias, Maurice & Clabby, John F. (2001 Revision) Social decision making and problem solving. Livingston NJ: Rutgers University. Hanh, Thich Nhat (1992). Peace is every step: The path of mindfulness in everyday life. New York: Bantam. Hawn Foundation (2011). Mind up curriculum. http://thehawnfoundation.org/mindup/mindup-curriculum/

Works Cited (continued)

Kabat-Zinn, Jon (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York: Hyperion.

Littman, Ellen (2012). “The secret lives of girls with ADHD.” Attention Magazine. http://www.chadd.org/Membership/Attention-Magazine/Attention-Magazine-Article.aspx?id=73 Mindful Teachers (2016) http://www.mindfulteachers.org/p/free-resources-and-lesson-plans.html Minehan, Jessica (2012). The behavior code: A practical guide to understanding and teaching the most challenging students.Cambridge, MA: Harvard Education Press

Shade, Tara. (2013). What is executive function? https://www.youtube.com/watch?v=IfKLmqpjfWs Sulla, Nancy. The facilitation roadmap. Handout. IDE Corp. Ramsey, NJ, 2015. Print.

Works Cited and Additional Resources

Ward, Sarah (2016). “360 thinking: Developing executive functioning in students.” Presentation given at Newgrange School, Hamilton NJ, May 6, 2016, www.efpractice.com

Ward, Sarah & Jacobsen, Kristen (2014). “A clinical model for developing executive function skills. “SIG 1 Perspectives and Language Learning and Education, March 2014, Vol. 21, 72-84

ADDITIONAL RESOURCES Ask An Autistic: What is Executive Functioning? https://www.youtube.com/watch?v=229Xb50_o8M&nohtml5=False Executive Functions for Kids (video): https://www.youtube.com/watch?v=REo3fzja5xs

Tough, Paul (2013). How children succeed: Grit, curiousity, and the hidden power of character. New York: Mariner Books