Improving Executive Functions:

Strategies to Change the Brain

and Change Behavior

Presented by

George McCloskey, Ph.D.

Philadelphia College of Osteopathic Medicine
[email protected] or
[email protected]

1
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Key Concept

Assessment of the
Use or Disuse of
Executive Functions
Hinges on Careful
Observation of
Behavior.
4
Behavior Observation and
Inferences about Brain Function

What’s the difference between a

Similarities Scaled Score of 12
(75th percentile) …

…and a Similarities Scaled Score

of 12 (75th percentile)?
 Key Concept
Task Performance is
directed by Executive
Functions or an
Executive Functions
substitute.
The neural networks used to
perform a task depend on
perceptions about how the
task should be done. 6
Key Concept
Most of what a
teacher, therapist, or
work supervisor says
to student, client, or
worker is intended to
activate specific
neural networks within
that person’s brain.
7
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.
8
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.

9
EF as the Conductor of the Brain’s Orchestra
or CEO of the brain (i.e., EF as “g”)

EF
What are executive functions? Thoughts

EF

EFs
EF EF EF
Perceptions
ef efef ef ef
e ef/es
ef/es ef/es ef/es
ef/es
ef/es ef/es
ef/es
ef/es
f
ef/esef/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
e
s

Emotions Actions
 Key Concept
Executive Functions:
 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
Executive Functions Are Not a Unitary Trait

Appropriate Metaphors for Executive

Functions:
 The conductor and section
leaders of the mind’s Orchestra
 The management structure of a
multinational mind corporation
 The coaching staff of team mind
The Management Structure within a Holarchical
Model of EF EF Trans-Self Integration

EF EF EF
Self-Generation

Self- Self-
ef ef ef ef ef
Realization Determination
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
Domains of Functioning Directed by Executive Functions
Action
Executive control of modes of output
Action including behavior in the external
E world and storage and retrieval of
internal representations
m
Cognition
o Executive control of thoughts
and thought processing
t Cognition
i Perception
o Executive control of modes of
perceptual input including external
n Perception sensory stimuli (visual, auditory,
kinesthetic) and internal
(representational) stimuli

Emotion
Executive control of moods, feelings,
and the processing of emotions
 The Management Structure within a Holarchical
Model of EF EF
Trans-Self Integration

EF EF EF
Self-Generation

Self- Self-
ef ef ef ef ef
Realization Determination
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
 Management Structure within a Holarchical Model
of EF
Executive EF
Capacities
EF

Executive EF
Functions
EF
Executive ES
Skills
Management Structure within a Holarchical Model
of EF EF
Trans-Self Integration

EF
Self-Generation
EF EF

Self-Realization Self-Determination
ef ef ef ef ef Self-Awareness Goal setting
Other-Awareness Long-range Planning &
e Self-Analysis Foresight
ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es f/ ef/es
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es ef/es
Self-Regulation
s
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive Monitor Plan
ef/es Focus Correct Evaluate/Compare
Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

Self-Activation
Activation
Key Concept
It is important to
distinguish between
Executive
Functions
and
Executive
Skills. 19
 Self Regulation Executive Functions

Executive Functions involve the part of

the executive network that that is used
to become aware of the need for the use
of executive skills and other mental
capacities and used to cue and direct
the use of the needed
executive skills.

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 Self Regulation Executive Skills

Executive Skills are responsible for

cueing the specific areas of the
brain needed to perform specific
tasks (e.g., attending, inhibiting,
modulating, planning,
organizing,
associating).

21
Key Concept
Executive
Functions
develop
Holarchically
across levels
rather than
Hierarchically
Holarchy vs Hierarchy

Hierarchy

Holarchy
Key Concept

Executive
Functions cue
and direct in
different ways at
different levels.
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EF Tiers within the Holarchical Model of Executive
Functions EF Trans-Self Integration

EF Self-Generation
EF EF

Self-Realization Self-Determination
ef ef ef ef ef Self-Awareness Goal setting
Other-Awareness Long-range Planning &
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es Self-Analysis Foresight
ef/es f 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
e
ef/essef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive Monitor Plan
ef/es Focus Correct Evaluate/Compare
Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

Self-Activation
Activation
Self Activation

Initiation and “ramping up” of

basic executive functions
related to an awakened state
of mind and to overcoming
sleep inertia.

Self-Activation
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Self Activation Interventions
 How do you take control of a brain
whose control center is not
awake?

Self-Activation 27
Executive Functions and Language

 It is important to recognize that

language does not necessarily
connote consciousness
 Language can be used by
executive functions as a form of
conscious expression and as a
tool to modify brain function

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29
System 1 – Fast, effortless,
automatic

System 2 – Slow, effortful,

non-automatic
Self Activation Interventions
 How do you take control of a brain
whose control center is not
awake?
 Use behavioral conditioning to
create an automatically activated
stimulus-response routine (alarm
rings, get out of bed, turn on
lights, get in the shower)
Self-Activation 31
 EF Tiers within the Holarchical Model of Executive
Functions Trans-Self Integration
EF

Self-Generation
EF EF EF
Self-Realization Self-Determination
Self-Awareness Goal setting
ef ef ef ef ef Other-Awareness Long-range Planning &
Self-Analysis Foresight
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es f/ ef/es Self-Regulation
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es ef/es Perceive Monitor Plan
s
Focus Correct Evaluate/Compare
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

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

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

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Self Regulation Executive Function “Clusters”
ENGAGEMENT
Energize
Initiate OPTIMIZATION EFFICIENCY
ATTENTION Inhibit
Monitor Sense Time
Perceive Stop Pace
Modulate
Focus Pause Sequence
Balance
Sustain Flexible Execute
Correct
Shift
SOLUTION
INQUIRY Generate
MEMORY
Anticipate Associate
Hold Gauge
Manipulate Prioritize
Analyze Plan
Store Estimate Time
Retrieve Organize
Compare Decide
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Key Concept
Tools of the Mind
(Bodrova & Leong) is
an effective preschool
/kindergarten
curriculum that helps
young children
improve self-regulation
executive functions.
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Tools of the
Mind
Elena Bodrova
& Deborah
Leong
38
Bronson &
Merryman
discuss their
observations of
the Tools of the
Mind
curriculum in
Chapter 8
Can Self-
Control Be
Taught?

39
EF Tiers within the Holarchical Model of Executive
Functions EF Trans-Self Integration

EF
Self-Generation
EF EF

Self-Realization Self-Determination
ef ef ef ef ef Self-Awareness Goal setting
Other-Awareness Long-range Planning &
e Self-Analysis Foresight
ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es f/ ef/es
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es ef/es
Self-Regulation
s
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive Monitor Plan
ef/es Focus Correct Evaluate/Compare
Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

Self-Activation
Activation
 Self Realization (of self & others)
 Directs cognitive processes that
engage in awareness of self and
others, reflection about self and
others and self-analysis.
 Cues cognitive processes to access
accumulated information about self
and apply it in specific situations.

EF
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 EF Tiers within the Holarchical Model of Executive
Functions EF Trans-Self Integration

Self-Generation
EF EF EF
Self-Realization Self-Determination
ef ef ef ef ef Self-Awareness Goal setting
Other-Awareness Long-range Planning &
Self-Analysis Foresight
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es f/ ef/es
e
Self-Regulation
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
s Perceive Monitor Plan
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Focus Correct
ef/es Evaluate/Compare
Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

Self-Activation
Activation
 Self Determination EF
 Foresight/Long-Term Planning and
Goal Generation
 Directs the use of cognitive processes
to construct visions of the future and
plans for action over longer
periods of time. Attempts to to
align daily self-regulation
with long-term goals.

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Chapter 21
Motivational
Interviewing with
Adolescents
and Young Adults

John S. Baer and

Peggy L. Peterson

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EF Tiers within the Holarchical Model of Executive
Functions EF Trans-Self Integration

EF
Self-Generation
EF EF

Self-Realization Self-Determination
ef ef ef ef ef Self-Awareness Goal setting
Other-Awareness Long-range Planning &
e Self-Analysis Foresight
ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es f/ ef/es
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es ef/es
Self-Regulation
s
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive Monitor Plan
ef/es Focus Correct Evaluate/Compare
Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

Self-Activation
Activation
Self Generation EF
 Directs the posing of speculative questions
related to the meaning and purpose of life
and/or the ultimate source(s) of reality and
physical existence, mind-body relationships,
spirit, and soul; contemplates existence
beyond the physical plane.
 Directs the generation of a philosophy of life
used to guide self-awareness, self-realization
and the other levels of executive function
processes; serves as a basis for an ultimate
source of intentional behavior direction.
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EF Tiers within the Holarchical Model of Executive
Functions EF Trans-Self Integration

EF
Self-Generation
EF EF

Self-Realization Self-Determination
ef ef ef ef ef Self-Awareness Goal setting
Other-Awareness Long-range Planning &
e Self-Analysis Foresight
ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es f/ ef/es
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
ef/es ef/es
Self-Regulation
s
ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive Monitor Plan
ef/es Focus Correct Evaluate/Compare
Sustain Balance Decide
Energize Gauge Sense Time
Initiate Anticipate Pace
Inhibit Estimate Time Sequence
Stop Analyze Execute
Interrupt Generate Hold
Flexible Associate Manipulate
Shift Organize Store
Modulate Prioritize Retrieve

Self-Activation
Activation
Trans-Self Integration EF
 Directs the engagement of mental
processes that enable realization and
experiencing of a trans-self state of
ultimate or unity consciousness.
 In most spiritual traditions, this state is
considered the highest achievement of
human consciousness and therefore very
different from the maladaptive states
characteristic of clinical diagnoses of
dissociative states.
49
Key Concept

Effective use of
Executive Functions
can vary by Arena of
Involvement as well
as by Domain of
Functioning.
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Arenas of Involvement

Intrapersonal Interpersonal
Control of Self in Control of Self in
Relation to Self Relation to Others

Environment Symbol System

Control of Self in Control of Self in
Relation to Relation to Academics
Surroundings (Reading, Writing, Math)
Key Concept

Executive Functions
are developing from
birth; maturational
delays can cause
difficulties.

52
Executive Function Development

Some EF-based clinical syndromes,

such as ADHD, demonstrate clear
patterns of delayed developmental
progression. Barkley (1998)
estimates developmental delays of
about 30% associated with various
EF processes such as Inhibit,
Manipulate, Shift, Sustain, Time,
Monitor, Correct.
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Developmental Progression with a 30% Delay

100
90
80
E 70
F
60

A 50
G 40
E
30

E 20
Q 10
0
6 8 10 15 21 30 39 60 90
Chronological Age 54
EF Development does not progress
by continuous equal intervals

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EF Development does not progress
by continuous equal intervals

56
DAILY PROGRESS BY CLASS
WEEK 1 WEEK 2 WEEK 3 WEEK 4
ENGAGEMENT 4-Feb 5-Feb 6-Feb 7-Feb 8-Feb 11-Feb 12-Feb 13-Feb 14-Feb 15-Feb 19-Feb 20-Feb 21-Feb 22-Feb 23-Feb 25-Feb 26-Feb 27-Feb 28-Feb 1-Mar
Math 3 3 3 3 2 0 2 0 0 1 1 0 3 0 3 2 2 3
Science 3 3 3 0 2 0 0 0 0 3 0 2 2 0 2
Social Studies 3 3 3 3 2 0 3 2 3 3 3 3 2 3 1
English 3 2 3 3 0 3 3 0 3 0 0 0 3 3 3 3 3
Reading 3 3 3 3 0 0 3 3 3 0 3 3 3 3 3 3 3
Math Facts 0 3 3 3 0 3 0 3 0 3 3 0 3 3 3

WEEK 5 WEEK 6 WEEEK 7 WEEK 8

ENGAGEMENT 4-Mar 5-Mar 6-Mar 7-Mar 8-Mar 11-Mar 12-Mar 13-Mar 14-Mar 15-Mar 18-Mar 19-Mar 20-Mar 21-Mar 22-Mar 25-Mar 26-Mar 27-Mar 28-Mar 29-M
Math 3 3 3 1 3 3 2 1 0 0 1 0 3 1 0
Science 0 2 1 3 3 0 0 0 0 0 3 1 3
Social Studies 3 3 2 1 3 3 3 3 3 3 3 3 3
English 2 2 3 1 3 3 3 3 3 0 3 3 3 3
Reading 3 3 2 3 3 3 3 3 3 3 3 3 3 3
Math Facts 0 3 0 3 3 3 3 3 3 3 3 0 3 3

WEEK 9 WEEK 10 WEEK 11 WEEK 12

ENGAGEMENT 1-Apr 2-Apr 3-Apr 4-Apr 5-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 22-Apr 23-Apr 24-Apr 25-Apr 26-Apr 29-Apr 30-Apr 1-May 2-May 3-May
Math 2 2 3 0 0 3 0 0 3 0 0 3
Science 3 3 3 0 0 0 3 3 3 3 2 2
Social Studies 3 3 1 3 3 3 3 3 1 2 2 0
English 3 3 2 0 1 3 3 0 3 3 0 3 3
Reading 3 3 3 2 3 3 3 1 3 3 3 3 3 3
Math Facts 3 3 0 3 3 3 1 3 2 3 3

WEEK 13 WEEK 14
ENGAGEMENT 6-May 7-May 8-May 9-May 10-May 13-May 14-May 15-May 16-May 17-May
Math 0 1 0 1 2 0 1 1
Science 2 3 2 3 2 2 1 1 0
Social Studies 3 3 3 0 0 0 0
English 3 3 3 3 0 3 2 0
Reading 3 3 3 3 2 3 2 3 57
Math Facts 3 3 3
END OF YEAR SUMMARY ALL CLASSES

ENGAGEMENT %
Rated 3, 2, or 1 78%
Rated 0 22%
ATTENTION %
Rated 3, 2, or 1 78%
Rated 0 22%
WORK
COMPLETION %
Rated 3, 2, or 1 70%
Rated 0 30% 58
Key Concept
Intervention efforts require a
therapeutic perspective that
emphasizes a Growth
Mindset over a Fixed Mindset
and a patient belief in the
idea that EF difficulties “won’t
last forever; but probably
longer than you would like.”

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60
61
Zeno’s Paradox

 An arrow is released at a target.

 At any point in the arrows flight
toward the target, the distance
between the arrow and the target can
be halved.
 Mathematically, the distance between
the arrow and the target therefore can
be halved infinitely such that the
arrow never really reaches the target.
62
Langer: Reverse Zeno’s Paradox

 Every intervention starts with an infinitely

small step toward positive growth.
 Each successive step doubles in impact.
 Response to intervention therefore may
not be noticeable until long after the
intervention has started.
 Once positive change is detectable, it
seems to increase dramatically in a short
period of time.
63
Key Concept

Virtually all
individuals who
struggle with
psychological
disorders exhibit
executive function
difficulties.
64
Executive Functions and
Clinical Diagnoses

“Deficits in PFC [prefrontal cortex, aka

frontal lobes] function are evident in
every neuropsychiatric disorder
(indeed, the term “psychiatric problem”
seems synonymous with PFC
dysfunction).”
Arnsten & Robbins 2002 in Principles of Frontal
Lobe Function
Executive Functions and
Clinical Diagnoses

 Most of the clinical conditions

described in the DSM-V reflect
some form of Executive Dysfunction
 The DSM-V can be thought of as “A
User’s Guide to All the Things That
Can Go Wrong With the Frontal
Lobes”
 Executive Functions and
Clinical Diagnoses
 A sampling of conditions involving EF deficits:
 Autism Asperger’s Syndrome
 ADHD and ADD
 Conduct Disorder
 Oppositional Defiant Disorder
 Depression and/or Anxiety
 Obsessive-Compulsive Disorder
 Fetal Alcohol Syndrome
 Key Concept
Executive Function Deficits

ADHD All individuals with

ADHD exhibit EF
deficits but not all
individuals that
exhibit EF deficits
are ADHD.
68
Executive Functions and ADHD?
All individuals with ADHD have executive
functions deficits…

Executive Function Deficits

ADHD

…but not all individuals with executive

functions deficits have ADHD.
69
 Executive Functions and ADHD

 EF and ADHD are not synonymous terms;

rather ADHD is a condition involving EF
deficits in:
 Focus/Select, Sustain, Inhibit, Modulate
 Nearly all persons with ADHD also have
additional self-regulation difficulties; the
nature of these additional difficulties is what
makes ADHD so variable from one person
to the next and what causes confusion in
diagnosis.
 Different Constellations
Perceive Energize Shift Monitor Est Time Organize Sense Time Hold
Initiate Flexible Correct Anticipate Analyze Plan Sequence Manipulate
Stop Associate Evaluate Pace Store
Interrupt Balance Generate Decide
Gauge Execute Retrieve

Focus Sustain Modulate Inhibit Alan Age 10

Same
Core
Focus Sustain Modulate Inhibit Katie Age 11

Energize Organize Sense Time Hold

Perceive Shift Monitor Est Time
Initiate Correct Anticipate Sequence Manipulate
Flexible Analyze Plan
Stop Evaluate Pace Store
Associate
Interrupt Balance Gauge
Generate Decide Execute Retrieve

Different Constellations
Executive Functions and ADHD

 Pharmacological treatment of ADHD usually

only addresses the problems associated
with the EFs specific to ADHD (Inhibit,
Modulate, Focus/Select, Sustain)
 Most persons with ADHD will require
additional interventions to assist with the
additional self-regulation difficulties that
persist even when medication is being used
effectively to treat the primary ADHD
problems.
 Key Concept
Producing difficulties
are different from
learning difficulties;
vs
producing difficulties
reflect poor use of
executive functions.

73
Producing versus Learning

Executive Function difficulties of

a severe nature (especially in
the Symbol System Arena) do
not result in Learning Difficulties;
they result in Producing
Difficulties.

vs
74
A General Model for Conceptualizing
Learning and Producing Difficulties

Learning
Often NOT recognized as a
Difficulties
Learning Disability, even
Only
when severe, unless an
evaluation involving process
Learning
assessment is done
Difficulties
And Recognized fairly quickly
Producing as a Learning Disability
Difficulties
When severe, typically
Producing attributed to lack of
Difficulties motivation, character flaws,
Only or behavior/personality
problems 75
Executive Functions and Intelligence

 The concept of executive

functions is not synonymous with
the traditional concepts of
intelligence or “IQ”
 Executive functions are not
directly assessed with standard
intelligence tests
= EF?
Measuring Executive Functions
with a Reasoning Task

Directions for the Wisconsin

Card Sorting Test (WCST):
I can’t tell you much about how
to do this task. Which of these
do you think this one goes
with? I’ll tell you if your answer
is right or wrong.
= EF?
Executive Functions and School

The more classroom instruction

resembles tests of executive functions
like the Wisconsin Card Sorting Test
(figure out what we’re learning, I’ll tell
you whether you are right or wrong), the
more executive difficulties are going to
impact classroom learning and
performance.
= EF?
EF Rating Inventories

The McCloskey Executive Function

Scales (MEFS) assess 33 self-
regulation executive functions
across multiple domains of function
within multiple arenas of
involvement.
MEFS Rating Options
Always or almost always does this on his or her own.
5 AA Does not need to be prompted or reminded (cued) to
do it.
4 F Frequently does this on own without prompting

3 S Seldom does this on own without being prompted,

reminded, or cued to do so.
2 AP Does this only after being prompted, reminded, or
cued to do it.
Only does it with direct assistance. Requires much
1 DA more than a simple prompt or cue to be able to get it
done in situations that require it.
0 UA Unable to do this, even when direct assistance is
provided.
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).
Functional Behavior Assessment

A B C
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.
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 students
that differs in an important way.
 Functional behavior assessment ignores
internal considerations (i.e., perceptions,
emotions, thought) and focuses on
applying external control to effect
change in behavior.
The EF Driven FBA
Informed by knowledge of executive functions, the
functional behavior assessment model can be revised
as follows:

A B C
EF
Behavior
Antecedents Consequences
Response

Perception Emotion Cognition Action

A Key Concept
An EF-Driven FBA
enables problems to
be clearly stated in
terms of perceptions,
B emotions, thoughts or
actions that can be
C changed through
intervention. 85
EF- Driven FBA

The goals of an EF-driven FBA are:

1) to help the child, the parents, and
professionals to understand the
nature of the deficit and
2) through proper intervention, to
assist the child or adolescent in
changing the behavior from a
negative to positive.
Progress Monitoring

Progress monitoring
techniques for interventions
targeting the improvement of
the use of executive functions.

87
Self Regulation Capacity: Focusing and sustaining attention when working independently on tasks.

Duration Frequency
1 2 3 4 5 6 7
Never Occasionally Sometimes Often Very Often Almost Always Always
0% of the Approximately Approximately Approximately Approximately Approximately 100% of
time. 10% of the 20%-40% of the 50%-70% of the 80% of the time. 90% of the the time.
time. time. time. time.
1
Unable to focus and sustain
attention for more than a few
seconds when independently
working on tasks.
2
Able to focus and sustain attention
for about 1 minute when working
independently on tasks.
3
Able to focus and sustain attention
for about 2-3 minutes when working
independently on tasks.
4
Able to focus and sustain attention
for about 5 minutes when working
independently on tasks.
5
Able to focus and sustain attention
for about 10 minutes when working
independently on tasks.
6
Able to focus and sustain attention
for about 15 minutes when working
independently on tasks.
7
Able to focus and sustain attention
for 20 or more minutes when
working independently on tasks.
 Progress Monitoring Form for Zach Date: __________________

Goal 1: Managing Frustration and Engagement

3 Fully engaged Maintained positive engagement throughout
without class and no frustration was apparent.
frustration
2 Frustration Frustration was apparent but was effectively
managed with managed and positive engagement occurred
self cued likely due to self-cued use of strategies.
strategy
1 Frustration Frustration was apparent but was effectively
managed with managed and positive engagement occurred
teacher cue or after teacher provided a cue for strategy use
Reset Or Zach returned after using the Reset strategy.

0 Frustration not Frustration was apparent and strategy use was

managed cued by teacher but positive engagement did
not occur and student left class. 89
Executive Function Difficulties

 Are they the result of:

 Disuse through
Nonconscious Choice
 Maturational Delay
 Innate Deficiency
 Disuse through Conscious
Choice
Executive Function Intervention

For intervention purposes, it is best

to assume that EF deficiencies are
the result of disuse through
nonconscious choice. The general
intervention goal then becomes
education to make the child conscious
of the EFs needed and how to engage
them.
 Interventions for EF Difficulties
 EF Self-regulation skills eventually need to
be just that—Self-regulated.
 During classroom instruction, it is necessary
to find the balance between providing
enough EF SR cueing to help students
function, but not too much to prevent EF
skill-development.
 It is easy to underestimate the multiplicity of
EFs required and focus only on those
related to attention and organization.
Executive Function References
 Promoting Executive Functions in the Classroom–
Lynn Meltzer (2010)
 Executive Function Skills in Children and
Adolescents 2nd Edition – Dawson & Guare (2009)
 Smart but Scattered – Dawson & Guare (2009)
 Late, Lost, and Unprepared – Cooper Kahn &
Deitzel (2008)
 Assessment & Intervention for Executive Function
Difficulties – McCloskey, Perkins & VanDivner
(2009)
 Executive Functions in the Classroom – Chris
Kaufman (2010)
EF Intervention Continuum

Orienting Strategies

External Control Strategies

Bridging Strategies

Internal Control
Strategies
 Interventions for EF Difficulties
Requires keeping in mind:
 The need to increase awareness and
provide goals.
 The need to move from external control
to internal control through bridging
strategies.
 The environment in which intervention is
happening: Requires those close to child
to have reasonable EF capacities and be
able to model those capacities.
 Key Concept
Improving students’
executive functions
starts with increased
awareness and goal
setting and progresses
from external control to
internal self-regulation
96
 Key Concept
Orienting Strategies
increase awareness of
executive functions
and expectations for
their use and provide
self-regulation goals
for students.
97
Explanation of Executive Functions

98
Explanation of Internal Command/External Demand

99
 Engagement of Self-Determination and Self-Regulation

Self-Determination
Executive Functions

Self-
Regulation
Executive
Functions

Nucleus
Accumbens
Internal Command Pathway:
Intrinsically Rewarding
100
Chapter 21
Motivational
Interviewing with
Adolescents
and Young Adults

John S. Baer and

Peggy L. Peterson

101
102
 Key Concept
External Control
strategies enable an
individual to perform
more effectively but do
not necessarily help to
improve an individual’s
capacity for self-
regulated performance.
103
External Control Strategies

Rewards can be a tremendous

benefit to an individual who has
difficulty aligning internal desires
with external demands. Use
rewards, but heed the following
cautions:
 Using Rewards to Increase Production
 Rewards do not teach how to reflect on and
alter perceptions, emotions, thoughts or
actions, they simply reward the presence of
desired behaviors.
 Reward programs imply that one can do it if
he/she wants to or is motivated enough. This
often leads away from the realization that
many persons who are motivated and do
want to change their behavior don’t know
what to do to change it.
External Control Strategies

Punishment in mild form can

be an effective means of
obtaining compliance with
external demands. When
choosing to use punishment,
heed the following cautions:
Using Punishment to
Increase Production
 Punishment does not teach how to reflect on
and alter perceptions, emotions, thoughts or
actions, they simply punish the presence of
undesired behaviors.
 Punishment implies that a person can do it if
he/she wants to or is motivated enough. This
often leads away from the realization that
many persons who are motivated and do
want to change their behavior don’t know
what to do to change it.
External Control Strategies

Provide predictable, consistent

structure to classroom environments
and routines:
 Post and discuss class rules and
schedules
 Review and rehearse routines
 Maintain basic room
arrangement
External Control Strategies

Provide external prompts

and cues as a substitute
for self-regulation.
 Perceive
 Perceive cues the use of sensory and
perception processes to take information in
from the external environment or “inner
awareness” to tune into perceptions,
emotions, thoughts, or actions as they are
occurring.

 Prompt examples: “Listen to this.” “Look up

at the board.”
“How are you feeling right now?”
 Focus
 Focus cues the direction of attention and
effort to the most relevant specifics
(perceptions, emotions, thoughts, and/or
actions) of a given environment, situation, or
content while downgrading or ignoring the
less relevant elements.

 Prompt example: “Pay attention to

what happens to the baking soda after
the vinegar is added.”
 Sustain
 Sustain cues sustained attention to the most
relevant specifics (perceptions, emotions,
thoughts, and/or actions) of a given
environment, situation, or content.

 Prompt example: “You will need to watch

the computer screen carefully for the entire
10 minutes.”
 Energize
 Energize cues the investment of energy to
the level needed to achieve the desired
results

 Prompt example: “This will require a lot of

effort.” “You’ll need to focus all of your
energy on task if you want to finish.”
 Initiate
 Initiate cues the initial engagement of
perceiving, feeling, thinking, or acting.

 Prompt example: “Start walking now.”

“Begin work on the count of five.”
 Inhibit
 Inhibit cues resistance to, or suppression of,
urges to perceive, feel, think, or act on first
impulse.
 Inhibit prompts direct capacities to an
alternate source rather than drawing
attention to the perception, emotion,
thought, or action that should be inhibited.

 Prompt example: “Don’t start until I tell you

to go.”
 Stop
 Stop cues the sudden, immediate
discontinuation of perceiving, feeling,
thinking, or acting.
 The Stop cue always precedes the Shift cue
when altering problem-solving based on
changing conditions, and switching or
alternating attention.

 Prompt example: “Stop writing now.”

 Pause
 Pause cues the brief cessation of, and the
return to perceiving, feeling, thinking or
acting.
 Efficient use of the Pause cue enables a
quicker return to a previous mental state or
activity.

 Prompt example: “Pause for a moment and

listen, then I want you to go back to what
you were doing.”
 Flexible
 Flexible cues a willingness to alter the
frame of reference for the direction and
engagement of perceptions, emotions,
thoughts or actions in reaction to what is
occurring in the internal or external
environments.

 Prompt example: “It doesn’t need to be

done exactly the same way each time.”
 Shift
 Shift cues a relatively quick change in the
direction and engagement of perceptions,
emotions, thoughts or actions in reaction to
what is occurring in the internal or external
environments.

 Prompt example: “The museum is closed

for emergency repairs, so we won’t be able
to go on the field trip.”
 Monitor
 Monitor cues the activation of appropriate
routines for checking the accuracy of
perceptions, emotions, thoughts or
actions.

 Prompt example: “Periodically check the

task directions to see if you are following
all of them.”
Modulate/Adjust

 Modulate cues the regulation of the amount

and intensity of mental energy invested in
perceiving, feeling, thinking, and acting.

 Prompt example: “Let’s all use our indoor

voices now.”
“Please tone it down a bit.”
 Balance
 Balance cues the regulation of the trade-off
between opposing processes or states
(e.g., pattern vs detail; speed vs accuracy;
humor vs seriousness) to enhance or
improve experiencing, learning, or
performing.

 Prompt example: “Work as quickly as you

can, but be careful not to make any
mistakes.”
 Correct
 Correct cues the use of appropriate routines
for correcting errors of perception, emotion,
thought, or action based on feedback from
internal or external sources.

 Prompt example: “Correct any errors you

find.”
 Sense Time
 Sense Time cues the monitoring of the
passage of time (e.g., cueing the
engagement of the mental functions that
enable a person to have an internal sense of
how long they have been perceiving, feeling,
thinking or acting).

 Prompt example: “How long have you been

working on that?”
 Pace
 Pace cues the awareness of, and the
regulation of, the rate at which perceptions,
emotions, cognitions, and actions are
experienced or performed.

 Prompt example: “You will need to work

quickly as there is not much time left.”
 Sequence
 Sequence cues the orchestrating of the
proper syntax of a series of perceptions,
feelings, thoughts, and/or actions, especially
in cases where automated routines are being
accessed or are initially being developed.

 Prompt example: “Remember the order of the

steps needed for completion.”
 Execute
 Execute cues the engagement of a well-
known series of perceptions, feelings,
thoughts, and/or actions, especially in cases
where automated routines have been
practiced and used frequently.

 Prompt example: “Use the routine you

learned to do these.”
 Hold
 Hold cues activation of the necessary
cognitive processes required to maintain
information in working memory and
continues cueing these processes until
the information is manipulated, stored, or
acted on as desired.

 Prompt example: “Hold that thought while

we hear a reaction from the other group.”
 Manipulate
 Manipulate cues the use of working
memory and other cognitive processes for
the manipulation of perceptions, feelings,
thoughts or actions as they are being held
in mind or being accessed in the
environment.

 Prompt example: “Visualize what it would

look like if you turned it upside down.”
 Store
 Store cues the movement of information
about perceptions, feelings, thoughts and
actions from the mental processing
environment of the present moment into
“storage” for possible retrieval at a later
time.

 Prompt example: “This is important; it will

be on Friday’s quiz.”
 Retrieve
 Retrieve cues the activation of cognitive
processes responsible for finding and retrieving
previously stored information about perceptions,
feelings, thoughts and actions.
 The more specific the demands or constraints
placed on the retrieval task, the greater the
requirements for precision of retrieval cues.

 Prompt example: “To answer the question

correctly, you will probably need to recall all that
we learned about photosynthesis.”
 Gauge
 Gauge cues one to identify the demands
(perceptual, emotional, mental, physical) of
a task or situation and cues the activation
of the resources needed to effectively
engage the task or situation.

 Prompt example: “Consider what it’s going

to take to get this job done right.”
 Anticipate
 Foresee/Plan cues the anticipation of
conditions or events in the very near future,
such as the consequences of one’s own
perceptions, feelings, thoughts and/or
actions.

 Prompt example: “If you keep erasing in

that same spot, what do you think will
happen to the paper?”
 Estimate Time
 Estimate Time cues the use of time
estimation routines (e.g., cueing the
engagement of mental functions that enable
a person to have an internal sense of how
long something will take to complete, or how
much time is still left in a specific period of
time).

 Prompt example: “Tell me how long you

think this will take you to do.”
 Analyze
 Analyze cues the realization of the need to
examine more closely perceptions, feelings,
thoughts or actions to obtain a greater
understanding of a problem or situation.

 Prompt examples: “Make a list of the positives

and negatives and then compare them.”
“Are there additional factors that need to be
considered?”
Compare/Evaluate
 Compare/Evaluate cues the realization of the need
to make comparisons among, or evaluate the
adequacy of, perceptions, feelings, thoughts or
actions.

 Prompt examples: “Did you complete all the

steps?”
“Does yours look like the model?”
“Why do you think what you said was a good
explanation?”
 Prioritize
 Prioritize cues the use of routines for
ordering perceptions, feelings, thoughts,
and/or actions, according to their relevance,
importance, or urgency.

 Prompt example: “Think about how

important each of these tasks is, and then
list them in order of importance so the most
important ones get done first.”
 Generate
 Generate cues the realization that novel, fluid
problem-solving efforts are required and cues
the activation of the resources needed to carry
out problem-solving routines.

 Prompt example: “We haven’t tried to solve a

problem like this one before.”
“This problem will require some novel thinking if
you are going to find a solution.”
 Associate
 Associate cues the realization that associations
need to be made, and cues the activation of the
resources needed to attempt to make the
necessary associations.

 Prompt examples: “Have you heard anything like

that before?”
“This problem is very similar to one you worked on
last week.”
 Organize
 Organize cues the use of routines for
sorting, sequencing, or otherwise arranging
perceptions, feelings, thoughts, and/or
actions, to enhance or improve the
efficiency of experience, learning, or
performance.

 Prompt example: “Let’s establish the order

in which you need to do things to get this
task done.”
 Plan (Short-term)
 Plan cues the engagement of the capacities
required to identify a series of perception,
feelings, thoughts, and/or actions that, if carried
out, would be most likely to produce a desired
outcome in the very near future (within minutes to
within several hours).

 Prompt example: “Write down what you will do

over the weekend and when you will do it so that
you will be ready for the test on Monday.”
 Choose/Decide

• Choose cues the need to achieve closure,

i.e., to make a choice among alternatives
now.
 Prompt example: “Make a choice now.”
“Pick one now.” “Choose now.”
• The Choose cue often must be preceded
by the Stop/Interrupt cue.
• Prompt example: “You need to stop
thinking about it and make a choice now.”
External Control Strategies

Provide time management

aids, such as calendars,
clocks, timers, schedules,
peer leaders and coaches,
work teams, etc.
Key Concept

Bridging strategies
effect the gradual
transition from
external control to
self-regulated
internal control.
144
Bridging Strategies

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

Model appropriate use of

self-regulation executive
function capacities
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).
Five Stages of Strategy Instruction

1. Explain the purpose of

self-regulation strategies
in general and describe
and discuss the specific
steps of the strategy that
will be taught.
Strategies
151
Five Stages of Strategy Instruction

2. Model the use of the

strategy using
language and
examples that connect
with the students.
Strategies
152
Five Stages of Strategy Instruction

3. Students memorize the

steps in the strategy as
well as any mnemonics
that are used as part of
the strategy.
Strategies
153
Five Stages of Strategy Instruction

4. Teacher supports the

implementation of the
strategy by the students,
scaffolding as necessary
to help the students to
master the use of the
strategy. Strategies
154
Five Stages of Strategy Instruction

5. Students independently apply

the self-regulated strategy
covertly (in their own minds).
Students and teacher
collaboratively evaluate the
effectiveness of student self-
directed strategy application.
Strategies
155
Source Acknowledgements

156
Writing as a Holarchically Organized Process

PLAN ORGANIZE
Reviewing/Revising

Text Generation
PLAN
Text Transcription

Language Representation

Idea Generation 157

Executive Functions and Writing

• What Evan wrote for me:

My favorite game is … “mabul
roling it is
fun. I like making
the box to role in
to. Iam prety gode as
well. It is rell inters
ing. It is so fun
Executive Functions and Writing

• What Evan told me:

“My favorite game is rolling marbles. I
think it is fun. I just learned it yesterday. It
can be pretty hard at times. It can be fun
and it’s interesting if you make it
challenging. I like making the boxes to roll
the marbles into. You probably need to be
pretty skilled with eye hand coordination to
do it. To get up the ramp you need to roll it
really fast.”
 Executive Functions and Writing

 What Evan wrote for me: • What Evan told me:

“My favorite game is rolling
My favorite game marbles. I think it is fun. I
is…“mabul just learned it yesterday. It
roling it is can be pretty hard at times. It
fun. I like making can be fun and it’s interesting
if you make it challenging. I
the box to role in
like making the boxes to roll
to. Iam prety gode as the marbles into. You
well. It is rell inters probably need to be pretty
ing. It is so fun skilled with eye hand
coordination to do it. To get
up the ramp you need to roll it
really fast.”
Steve Graham
Self-Regulated
Strategy Development
(SRSD)
161
The Report Writing Strategy

1. Select a topic.
2. Brainstorm what you know
and what you want to learn.
3. Organize your information
using a visual web.
4. Review your visual web and
identify any holes or
disconnects. 162
Web for what I know and what I want to learn

Habits Looks
Active at night Large eyes
___________ Long tails
___________ Lemurs Rings on tail
___________ ___________

Live Pets? Eat?

jungle What do they eat?
trees Can they be pets? ___________
Country??? ___________ ___________
zoos ___________ ___________
___________
The Report Writing Strategy

5. Gather new information and

revise your visual web.
6. Use the visual web to help
construct an outline for the
report or to begin writing.
7. Review, plan and revise as
you write. 164
The Report Writing Strategy

8. Check the visual web; did

you write what you wanted to
write?
9. Add information that is
missing; fix sentences that
don’t say what you want
to say.
165
Scaffolding Step 9

A. Read the sentence silently

and/or aloud.
B. Does the sentence make
sense to you? What does it
mean?
C. Is that what you meant to
say?
166
Scaffolding Step 9

D. What’s missing? What

doesn’t make sense?
E. Restate what you want to
write. Repeat it to yourself.
F. Write what you just said.
G. Read what you wrote; go
through steps A-F if needed.
167
Bridging Strategies
Practice and rehearsal of the use
of executive functions. This is
the single best way to increase
engagement and efficiency of the
use of executive functions.
Bridging Strategies
Whenever possible, use game
formats and game strategies to
practice the use of executive
functions.
Simon Says
Pay Attention:
Help for
Children with
ADHD

Daniel Yeager &

Marcie Yeager

170
171
Bridging Strategies
Align external demands with internal
desires to maximize motivation.
 Allow self-selection or choice of
assignments whenever possible
 Use high interest material to
illustrate application of new
knowledge and skills
173
Bridging Strategies
Develop a common vocabulary
and set of nonverbal symbols for
describing or signifying self-
regulation capacities and signaling
their use (e.g., cueing
flexibility with “The
Coconut Story”)
Cognitive Strategy Instruction

Case
Example:
Zach
Chapter 21
Motivational
Interviewing with
Adolescents
and Young Adults

John S. Baer and

Peggy L. Peterson

Page 320 - 332

176
Motivational Interviews with Zach

“I’m here to help you get what

you want, but in order to do
that I need to know what it is
that you want.”
Goal Setting with Zach

Zach’s self-selected long-

term goals:
 Pass all classes in 8 th

grade
 Get promoted to 9th grade
th
and attend 9 grade at the
district Senior High School
Ross Greene’s
Collaborative
Problem-Solving

179
Collaborative Problem-Solving with Zach

“When I was observing you in

Science class, I saw that you
just put your head down on
the desk and stayed that way
for most of the class. What
happened?”
Collaborative Problem-Solving with Zach

When asked specifically about his

refusal to do classwork that day in
Science class (as observed by the
psychologist), Zach offered that he
was not purposefully refusing to do
the work, but that he was unable to
get himself to do it, stating: “It feels
like I am hitting a wall and the harder
I try, the more it hurts.”
Collaborative Problem-Solving with Zach

Using Zeke’s own descriptive metaphor,

the psychologist explained to Zach that
he was going to teach Zach strategies
that would enable him to stop hitting the
wall, step back and find the door in the
wall, open the door and go through it;
“Once inside the door, you are now in the
control room of the brain and you can
take control and make your brain do the
things you want to achieve your goals.”
Goal Setting with Zach

Goals developed through discussion

with Zach about how to achieve his
long-term goals:
 Improve my mood; get engaged
with class
 Pay attention in class
 Complete class work and home
work
Cognitive Behavior Therapy
It was also explained to Zach that
it is possible to improve the
capacity to respond on demand,
especially if he were to have a
strategy worked out that he could
use in situations where demands
were being made of him, such as
the demands for participating in
class and doing homework.
Cognitive Strategy Instruction

The Psychologist met with

Zach and his mother to come
up with strategies that he
could use to achieve his
immediate goals. After the
strategies were developed,
the psychologist summarized
them in a powerpoint file.
Cognitive Strategy Instruction

The Powerpoint file was used

to teach Zach how to use the
strategies and used with
school staff to help them
understand how Zach was
going to work on improving
his behavior.
Cognitive Strategy Instruction

Zach’s
Cognitive Strategy
Powerpoint
 Long-term Goals

Get passing grades in all subjects

Get promoted to 9th grade

Immediate Goals

Improve my mood; get engaged with class

Pay attention in class

Complete class work and home work

 Ask: How am I doing right now?
Do I feel good?
Am I doing what I need to do for class?
 Say: I need to use the
Purple Elephants Strategy
 Take a deep breath and relax.
Say: I need to adjust my attitude
so I can have a good day.
Say: Looking at my Purple Elephants file
will help me feel better.
Say: I am in control now!
Say: I feel better.
I’m ready to do what
I need to do for class.
Ask: What should I be doing for class?

Say: OK, I’m on it.

or
Say: I’m not sure.
I will ask for help.
 How am I doing right now?
Do I feel good?
Am I doing what I need to do for class?

I need to use the

Purple Elephants Strategy

I need to adjust my attitude

so I can have a good day.

Looking at my Purple Elephants file

will help me feel better.

I am in control now!
OK, I feel better.
I’m ready to do what
I need to do for class.
What should I be doing for class?

I’m not sure.

OK, I’m on it.
I will ask for help.
Ask: Am I paying attention right now?
Say: I need to use
the Focus Strategy
Yawn and Stretch.
 Say: I am in control now!

Say: I am energized and ready

to pay attention!
Say: What should I be doing for class?

Say: OK, I’m on it.

or
Say: I’m not sure.
I will ask for help.
Am I paying attention right now?

I need to use the Focus Strategy

Yawn and Stretch.

I am in control now!
I am energized and ready
To pay attention!

What should I be doing for class?

I’m not sure.

OK, I’m on it.
I will ask for help.
Ask: Am I doing my class work?
Say: I need to use the
Just Do It Strategy
Say: I need to do my class work
so I can earn a passing grade
and go on to 9th grade next year.
Say: I am in control now!

Say: I am energized and

ready to work!
 Say: I can complete my class work if I
know what I need to do and how to do it.
Ask: Do I know how to do this work?”
Say: OK, I’m on it.
or
Say: I’m not sure.
I will ask for help.
 Am I doing my class work?

I need to use the

Just Do It Strategy

I need to do my class work

so I can earn a passing grade
and go on to 9th grade next year.

I am in control now!

I am energized and
ready to work!

I can complete my class work if I know what I

need to do and how to do it.
Do I know how to do this work?”

I’m not sure.

OK, I’m on it.
I will ask for help.
Cognitive Behavior Therapy

The psychologist created a list of

cognitive distortions and related
cognitive corrections that was
used with Zach to discuss how
he could change his thinking
about school and academic
tasks. The list was shared with
Zach’s counselor who also
worked with Zach on cognitive
 Cognitive Distortion Cognitive Correction
Dichotomous Thinking: Contextual Thinking:
“I’m either a good student or a “Sometimes I perform poorly but
failure.” many times I perform well.”

Overgeneralizing: Specifying:
“I hit the wall in class today and “I hit the wall today and couldn’t
couldn’t find the door. I have no find the door. The next time I hit
control over my emotions.” the wall, I will use my Purple
Elephant strategy and find the
door.
Mindreading: Mindsharing:
“I didn’t do all of the assigned “I didn’t do all my work. I’ll let the
work. I know the teacher is teacher know that I plan to finish
disappointed with me.” all of it if that is ok with him/her.”

208
 YOU ARE IN CONTROL!
Cognitive Distortions and
Counteracting Cognitive Corrections Worksheet
Developed by George McCloskey, Ph.D. Philadelphia College of Osteopathic Medicine

Cognitive Distortion Cognitive Correction

209
Teacher Training

Zach’s teacher’s met with the

psychologist for 90 minutes to
receive training on how to use a
series of prompts to cue Zach to
use the strategies he was
learning to improve his
engagement, attention and work
completion during classes.
Teacher Training

 Deliver 1-3 prompts during

class
 Provide daily ratings of
engagement, attention and work
completion based on need for
and response to prompts
Teacher Training

 Prompt 1: Self-awareness
cueing (Zach, you seem to be
having some trouble with…)
 Prompt 2: Zach, you need to
use your _ strategy.
 Prompt 3: Zach you need to
use your reset strategy.
Cognitive Strategy Implementation
 Zach self-cues engagement,
attention and work completion
 If prompt 1 is used: Zach realizes
the need to use his strategies
 If prompt 2 is used: Zach, uses his
strategy as suggested by teacher
 If prompt 3 is used: Zach leaves
the room and uses his reset
strategy.
Progress Monitoring Form for Zach T Date: __________________

Goal 1: Managing Frustration and Engagement

3 Fully engaged Maintained positive engagement throughout

without frustration class and no frustration was apparent.

2 Frustration managed Frustration was apparent but was effectively

with self cued strategy managed and positive engagement occurred
likely due to self-cued use of strategies.

1 Frustration managed Frustration was apparent but was effectively

with teacher cue managed and positive engagement occurred
after teacher provided a cue for strategy use.

0 Frustration not Frustration was apparent and strategy use was

managed cued by teacher but positive engagement did not
occur and student left class.
214
 Class: _____________________

Frustration 3 2 1 0 Work Comments:

Management Modified:
Yes No

Attention 3 2 1 0 Work
completed
Work 3 2 1 0 with
Completion extended
time?
Yes No

215
216
Staff Collaboration/Consultation

 Staff requested to have the

psychologist meet with Zach on
a regular basis to reinforce the
strategies and consult with
teachers and staff.
Progress Monitoring

 Weekly ratings were

summarized to help school staff
monitor progress and provide
Zach with feedback about his
performance.
DAILY PROGRESS BY CLASS
WEEK 1 WEEK 2 WEEK 3 WEEK 4
ENGAGEMENT 4-Feb 5-Feb 6-Feb 7-Feb 8-Feb 11-Feb 12-Feb 13-Feb 14-Feb 15-Feb 19-Feb 20-Feb 21-Feb 22-Feb 23-Feb 25-Feb 26-Feb 27-Feb 28-Feb 1-Mar
Math 3 3 3 3 2 0 2 0 0 1 1 0 3 0 3 2 2 3
Science 3 3 3 0 2 0 0 0 0 3 0 2 2 0 2
Social Studies 3 3 3 3 2 0 3 2 3 3 3 3 2 3 1
English 3 2 3 3 0 3 3 0 3 0 0 0 3 3 3 3 3
Reading 3 3 3 3 0 0 3 3 3 0 3 3 3 3 3 3 3
Math Facts 0 3 3 3 0 3 0 3 0 3 3 0 3 3 3

WEEK 5 WEEK 6 WEEEK 7 WEEK 8

ENGAGEMENT 4-Mar 5-Mar 6-Mar 7-Mar 8-Mar 11-Mar 12-Mar 13-Mar 14-Mar 15-Mar 18-Mar 19-Mar 20-Mar 21-Mar 22-Mar 25-Mar 26-Mar 27-Mar 28-Mar 29-M
Math 3 3 3 1 3 3 2 1 0 0 1 0 3 1 0
Science 0 2 1 3 3 0 0 0 0 0 3 1 3
Social Studies 3 3 2 1 3 3 3 3 3 3 3 3 3
English 2 2 3 1 3 3 3 3 3 0 3 3 3 3
Reading 3 3 2 3 3 3 3 3 3 3 3 3 3 3
Math Facts 0 3 0 3 3 3 3 3 3 3 3 0 3 3

WEEK 9 WEEK 10 WEEK 11 WEEK 12

ENGAGEMENT 1-Apr 2-Apr 3-Apr 4-Apr 5-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 22-Apr 23-Apr 24-Apr 25-Apr 26-Apr 29-Apr 30-Apr 1-May 2-May 3-May
Math 2 2 3 0 0 3 0 0 3 0 0 3
Science 3 3 3 0 0 0 3 3 3 3 2 2
Social Studies 3 3 1 3 3 3 3 3 1 2 2 0
English 3 3 2 0 1 3 3 0 3 3 0 3 3
Reading 3 3 3 2 3 3 3 1 3 3 3 3 3 3
Math Facts 3 3 0 3 3 3 1 3 2 3 3

WEEK 13 WEEK 14
ENGAGEMENT 6-May 7-May 8-May 9-May 10-May 13-May 14-May 15-May 16-May 17-May
Math 0 1 0 1 2 0 1 1
Science 2 3 2 3 2 2 1 1 0
Social Studies 3 3 3 0 0 0 0
English 3 3 3 3 0 3 2 0
Reading 3 3 3 3 2 3 2 3 219
Math Facts 3 3 3
 WEEK 1 WEEK 2 WEEK 3 WEEK 4
ATTENTION 4-Feb 5-Feb 6-Feb 7-Feb 8-Feb 11-Feb 12-Feb 13-Feb 14-Feb 15-Feb 19-Feb 20-Feb 21-Feb 22-Feb 23-Feb 25-Feb 26-Feb 27-Feb 28-Feb 1-Mar
Math 2 2 3 3 2 0 2 0 0 0 1 0 2 0 3 2 2 3
Science 3 3 3 1 3 0 0 0 0 2 1 2 2 0 2
Social Studies 3 3 3 3 3 0 3 3 3 3 3 3 3 3 1
English 3 3 2 2 0 3 3 0 3 0 0 0 3 2 3 3 3
Reading 3 3 3 1 0 0 3 3 3 0 3 3 3 3 3 3 3
Math Facts 0 3 3 3 0 3 0 3 0 2 2 0 3 3 2

WEEK 5 WEEK 6 WEEEK 7 WEEK 8

ATTENTION 4-Mar 5-Mar 6-Mar 7-Mar 8-Mar 11-Mar 12-Mar 13-Mar 14-Mar 15-Mar 18-Mar 19-Mar 20-Mar 21-Mar 22-Mar 25-Mar 26-Mar 27-Mar 28-M
Math 3 2 2 1 3 3 1 1 0 0 1 0 0 1 0
Science 0 3 1 3 3 0 0 0 1 0 3 1 3
Social Studies 3 2 2 1 3 3 3 3 3 3 2 3 3
English 3 2 2 1 3 3 2 1 3 1 2 2 2 3
Reading 2 3 1 3 3 2 2 3 3 2 1 0 2 3
Math Facts 0 3 0 3 3 3 3 3 3 3 3 0 3 3

WEEK 9 WEEK 10 WEEK 11 WEEK 12

ATTENTION 1-Apr 2-Apr 3-Apr 4-Apr 5-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 22-Apr 23-Apr 24-Apr 25-Apr 26-Apr 29-Apr 30-Apr 1-May 2-May 3-Ma
Math 2 2 3 0 0 3 0 0 0 0 0 3
Science 3 2 3 0 0 1 3 3 3 2 2 0
Social Studies 3 3 0 3 3 3 3 3 2 2 2 0
English 2 3 2 0 2 3 3 1 3 2 3 3 1
Reading 2 3 2 1 2 3 3 1 3 3 3 3 3 2
Math Facts 3 3 0 1 3 3 1 2 2 3 3

WEEK 13 WEEK 14
ATTENTION 6-May 7-May 8-May 9-May 10-May 13-May 14-May 15-May 16-May 17-May
Math 0 1 1 1 2 0 1 1
Science 2 3 2 3 1 2 1 1 0
Social Studies 2 3 2 0 0 0 0
English 3 0 1 2 0 2 2 1
Reading 1 3 3 3 1 3 2 3
Math Facts 3 3 3
220
 WEEK 1 WEEK 2 WEEK 3 WEEK 4
WORK CONPLETION4-Feb 5-Feb 6-Feb 7-Feb 8-Feb 11-Feb 12-Feb 13-Feb 14-Feb 15-Feb 19-Feb 20-Feb 21-Feb 22-Feb 23-Feb 25-Feb 26-Feb 27-Feb 28-Feb 1-Mar
Math 3 3 3 3 2 0 2 0 0 0 1 0 2 0 3 2 0 3
Science 3 3 3 0 2 0 0 0 0 3 0 2 0 0 1
Social Studies 3 3 3 3 0 0 3 3 2 0 2 0 0 1 1
English 3 3 0 3 0 3 3 0 3 0 0 0 3 2 3 3 3
Reading 3 3 3 3 0 0 3 3 3 0 3 3 3 3 3 3 3
Math Facts 0 3 3 3 0 3 0 3 0 2 3 0 3 3 3

WEEK 5 WEEK 6 WEEEK 7 WEEK 8

WORK COMPLETIO 4-Mar 5-Mar 6-Mar 7-Mar 8-Mar 11-Mar 12-Mar 13-Mar 14-Mar 15-Mar 18-Mar 19-Mar 20-Mar 21-Mar 22-Mar 25-Mar 26-Mar 27-Mar 28-M
Math 3 1 2 1 3 3 0 0 0 0 0 0 0 1 0
Science 0 2 1 3 0 0 0 0 0 0 3 0 3
Social Studies 2 1 0 0 2 2 3 3 3 3 2 1 3
English 3 2 2 1 3 3 2 1 3 0 2 1 2 3
Reading 2 3 1 3 3 1 2 3 1 2 1 0 2 3
Math Facts 0 3 0 2 2 3 3 3 3 3 3 0 3 3

WEEK 9 WEEK 10 WEEK 11 WEEK 12

WORK COMPLETIO 1-Apr 2-Apr 3-Apr 4-Apr 5-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 22-Apr 23-Apr 24-Apr 25-Apr 26-Apr 29-Apr 30-Apr 1-May 2-May 3-May
Math 2 1 3 0 0 3 0 0 0 0 0 3
Science 3 2 3 0 0 1 3 3 3 2 2 0
Social Studies 2 2 0 3 2 1 3 2 2 2 1 0
English 2 3 1 0 2 3 3 0 3 2 3 3 1
Reading 3 3 2 1 2 3 3 2 3 3 3 3 3 3
Math Facts 3 2 0 0 3 3 3 2 2 3 3

Zach T. WEEK 13 WEEK 14

WORK COMPLETION 6-May 7-May 8-May 9-May 10-May 13-May 14-May 15-May 16-May 17-May
Math 0 0 0 0 1 0 0 1
Science 1 2 2 3 1 0 1 1 0
Social Studies 0 0 0 0 0 0 0
English 3 0 0 2 0 2 3 1
Reading 2 3 3 3 1 3 2 3
Math Facts 3 3 3
221
END OF YEAR SUMMARY ALL CLASSES

ENGAGEMENT %
Rated 3, 2, or 1 78%
Rated 0 22%
ATTENTION %
Rated 3, 2, or 1 78%
Rated 0 22%
WORK
COMPLETION %
Rated 3, 2, or 1 70%
Rated 0 30% 222
8th Grade Outcomes

 Zach passed all of his classes.

 Zach’s progress toward
behavior goals were judged as
reflecting adequate
improvement
 Zach was promoted to 9th grade
at the high school instead of
being transferred to an
alternative program
Internal Control Strategies
Key Concept
Once learned and
practiced, Internal
Control Strategies
enable students to
effectively “run their
own shows.”

225
Internal Control Strategy

Once learned, the child can use

internalized “self-talk” as a means of
increasing awareness of executive
functions and of when and how to use
them (e.g., modified Berninger mantra
for writing: “What I can think I can say.
What I can say I can write.
What I can write I can revise.”)
Internal Control Strategy

Model and teach the use of self-

administered reward routines to
increase the use of self-regulation
executive functions (e.g., teach the
child how to “bargain with yourself”
to get homework accomplished).
Internal Control Strategy

Teach the use self-monitoring

routines. These routines can be
used to monitor and correct
perceptions, feelings, thoughts
and actions.
 Key Concept
Some specific
educational programs
are designed, either
explicitly or implicitly, to
improve students’
executive functions.

229
Cognitive Strategy Instruction

Case
Example:
Billy
Lack of Inhibition?
Billy: Case Conceptualization
It is critical that the actual problem behavior and
associated EF difficulties be specified clearly and
accurately :
 Teacher used the terms Lack of Inhibition and
Impulsivity to describe Billy’s behavior, but her
behavioral descriptions of problem situations
were really examples of lack of effective
monitoring and modulating.
 Classroom observation confirmed that Billy’s
difficulties resulted from a lack of monitoring of
voice and activity levels and a lack of adjusting
of the intensity of voice and activity levels.

231
Billy: Case Conceptualization

 Teacher only used a Stop prompt

when voice or activity levels were in
the unacceptable range.
 Billy was not aware of why he was
being told to stop.
 Without awareness of the problem
and help in finding a strategy to
change voice and activity levels on
command, Billy was unable to
change his behavior.
232
Billy’s Intervention: Orienting Phase
 The psychologist described what he saw in the
classroom and listened to Billy’s explanation of what was
happening in the classroom.
 The psychologist helped Billy to think through why his
behavior was viewed as disruptive by the teacher.
 The psychologist asked Billy to help find a solution to the
classroom problems that resulted when he was unable to
monitor and adjust his voice and activity levels.
 Billy and the psychologist concluded that Billy needed
help learning how to monitor and modulate his voice and
activity levels.
 The psychologist and Billy met with the guidance
counselor to identify strategies that could be used to help
Billy learn how to improve his ability to monitor and adjust
233
his voice and activity levels.
Billy’s Intervention: Orienting Phase

 The team (Billy, the psychologist

and the guidance counselor)
decided to use an activity similar
to those used in the Tools of the
Mind curriculum to help Billy learn
how to monitor and adjust his
voice level.
234
Billy’s Intervention: External Control Phase

 The guidance counselor and Billy played a

game that Billy named “the Sounding Good
Game.”
 Billy and the counselor talked about the
different voice levels (library, indoor and
outdoor) and the best times to use each
one.
 In the first part of the sounding good game,
the counselor would describe a setting an
activity and Billy would tell the counselor the
type of voice that would be good to use in
that situation.
235
Billy’s Intervention: External Control Phase

 In the second part of the sounding good game, Billy

got to choose a song to dance to while playing the
game.
 As Billy danced to the music, the counselor held up a
card with a short sentence and a symbol for a specific
voice level printed on it.
 Billy would continue to dance while reading the
sentence to himself and while thinking about saying
the sentence out loud in the voice level that was shown
on the card.
 When the counselor stopped the music, Billy had to
say the sentence in the voice level indicated on the
card.
 The counselor would give Billy feedback about the
accuracy of his use of voice level.
236
Billy’s Intervention: Bridging Phase

 Billy and the counselor also played a

modified version of the sounding
good game; the counselor would
show Billy a card with the description
of an activity and Billy would read the
description in the voice level
appropriate for the activity.
 The counselor would give Billy
feedback about the accuracy of his
voice level when reading orally.
237
Billy’s Intervention: Bridging Phase
 Billy and the counselor discussed how he
could use what he was learning about voice
level control in the classroom.
 They decided that Billy’s teacher could cue
him about the right voice level to use in a
classroom activity by saying to Billy: “Billy,
what voice level do you think we should be
using now?”
 Billy’s teacher would also give him feedback
about the accuracy of his response.
 The counselor explained to Billy that the 238
Billy’s Intervention: Progress Monitoring

 The counselor kept track of Billy’s

progress informally by checking in
with the teacher at least weekly.
 Over the course of three months,
Billy’s teacher usually reported that
Billy was able to adjust his voice
level in class, but most often only
after being given the reflective
question prompt.
239
Billy’s Intervention: Progress Monitoring

 Because Billy was still being

provided with reflective questions at
the end of the school year to get him
to adjust his voice level, he played
the sounding good games with the
counselor a few times at the
beginning of the next school year
and his new teacher was asked to
provide the reflective question
prompt when Billy’s voice level was
inappropriate for the situation.
240
Billy’s Intervention: Self-Regulation Phase

 Reflective questioning was used with

Billy through September and
October. During November, the
teacher needed to use reflective
questioning only twice.
 Billy was able to self-regulate the
monitoring and adjusting of his voice
level for the rest of the school year
without requiring reflective
questioning.
241
Billy’s Intervention: Carry-Over to
Activity Level
 Although no specific teaching was provided to help Billy adjust
his activity level, the psychologist and the counselor discussed
with Billy how he could use what he was learning about voice
control to monitor and adjust his activity level.
 The counselor provided Billy with examples of how he could
think about a classroom activity and then think about how
active he should be during that activity (using the same level
names as voice – library, indoor, outdoor).
 Billy’s teacher was asked to use the reflective question
technique with Billy when his activity level was not appropriate
for an activity and give him feedback about the accuracy of his
response.
 Billy was coached by the counselor to recognize the teacher’s
reflective question as a prompt to monitor his activity level and
adjust it.

242
Billy’s Intervention: Progress Monitoring
 The counselor kept track of Billy’s progress
informally by checking in with the teacher at
least weekly.
 Over the course of four months, Billy’s
teacher reported that Billy was able to adjust
his activity level in class, but usually only
after being given the reflective question
prompt.
 By the end of the school year, Billy was still
requiring the use of the reflective question
prompt, but usually not more than 1-2 times
per week.
243