My Student Was Diagnosed with ADHD ASD LD ID ....Now What?

Classroom Executive Function Strategies with Neurodiversity Strengths in Mind

Rachelle Hansen, PhD, LPClinical Psychologist, Neurodevelopmental Specialist

April 15, 2021

“I used to think that the brain was the most wonderful organ in my body. Then I realized who was telling me this.”

-Emo Philips

SSC Team ApproachLicensed Psychologists & Social Workers Registered Dieticians & Nutritionists, Occupational Therapists Wellness & Executive Function Coaches School Psychologists & Educational Consultants

Neurodevelopmental Disorders● group of complex and heterogeneous

disorders associated with atypical brain development that may give rise to impaired cognition, communication, adaptive behavior, and psychomotor skills

● complex genetic and environmental factors come together to change brain development

● tend to run in families suggesting common causes

Born with it Work with it Grow with it!

ND’s includeAttention Deficit Hyperactivity Disorder, Developmental Coordination Disorder, Tic Disorder, Tourette’s Disorder, Intellectual Disability, Autism Spectrum Disorder, Specific Learning Disorder, Dyslexia, Dysgraphia, Dyscalculia, Child-onset Fluency Disorder, Stuttering, Speech Sound Disorder, Developmental Language Disorder, Social Communication Disorder, Fetal Alcohol Spectrum, Prenatal Toxin Exposure, Bipolar, Schizophrenia

KEEP IN MIND!➔ Not Lazy!

brains work differently, neurodiversity is needed!

➔ Will Not “Outgrow”Emerges in early development, changes across development

➔ Changes Over Time & Stageschange with development, some areas will improve while new challenges and/or new demands make other weak areas apparent

➔ Family System~20% risk family members (sibling, parent) with neurodevelopmental disorders too

Executive Functions Brain-based abilities that stick together across several diagnosis & learning differences

TipRemember. If something sounds like common sense, people will ignore it.

Highlight what is unexpected about your topic.

Neurodevelopmental

DisordersExecutive Function Skills➔ Behaviors

inhibiting, self-monitoring

➔ Emotionsshifting, emotional control

➔ Cognitive initiation, working memory, planning, organization, task monitoring

➔ Action Skillsseparate from crystallized intellectual skills

➔ Beyond ‘what’ to ‘how’ skills

Executive Function DeficitsExecutive Dysfunction

➔ Self-Regulatory Deficitsperception, modulation, sustained attention, flexibility, working memory, response inhibition, emotional regulation

➔ Deficits in goal-oriented cognitive processesplanning, organization, time management, self-monitoring

➔ Contributorsneurodevelopmental brain differences, prenatal conditions, mood, sleep, stress, pain, diet, injury, illness, and substances (including medications)

Executive Function AssessmentAs part of full

NEURODEVELOPMENTAL ASSESSMENT

Parent/teacher/carer report

Self-report or (classroom) survey

Examiner observation

Norm-referenced direct testing

Minnesota Executive Function Scale (MEFS) (ages 2 and up)

Source: Understood.org

Executive Function Developmental Ladder

6 to 12 months12 to 24 months

2 to 4 years 5 to 10 years 10 to 12 years

13 to 17 years

18 to 25 years

25 years+

Response Inhibition

Sustained Attention

Working Memory

Goal Directed PersistenceEmotional Control

Planning/Prioritization

Metacognition

Cognitive Flexibility

Heterogeneity in Strength & Challenges amongst ND’s

ICD-10 R41.844 Frontal Lobe and Executive Dysfunction

A. Deficits in managing cognitive and mental processes for self-regulatory skills:

a. Perception b. Modulation c. Sustained attention d. Flexibility e. Working memory f. Response inhibition

g. Emotional regulation

B. Deficits in managing cognitive and mental processes for goal-oriented skills:

a. Planning b. Organization c. Time management d. Self-monitoring

Give your students TOOLS for LIFE!

Source:Rethinking Challenging Kids-Where There's a Skill There's a Way | J. Stuart Ablon | TEDxBeaconStreet

Kids will do well if and when they can!Where there’s a SKILL there’s a WAY!

Source:J. Stuart Ablon

TipExecutive Function Skills and Strategies can be learned skills

Homework Help by SSC

EF Coach

LifeFx program everyday LifeHax

A Boss in My Brain - A Chef in My Head - An Orchestra Conductor - An Air Traffic Controller & Other Ways to Explain What is Going on!Partner with your student (and parent/professional team) in explaining and addressing executive functions.

Working with the brain using a STRENGTHS & NEURODIVERSITY approach

Working with student, parents, peers, teachers, professionals to be active participants in learning how to learn

Your Chef in Your Brain ...

Feels tired / Needs rest.

Went too fast / Went slow &

careful.

Forgot to check the recipe /

Looked over the recipe

before they started.

Seemed overwhelmed / Took

a break.

Chef - Ingredients - Recipe - Equipment - Helper - Timer

Neurodevelopmental

DisordersExecutive Function Skills➔ Behaviors

inhibiting, self-monitoring

➔ Emotionsshifting, emotional control

➔ Cognitive initiation, working memory, planning, organization, task monitoring

➔ Everyday Life TOOLSTeaching ‘how’

Executive Function DeficitsExecutive Dysfunction

➔ Self-Regulatory Deficitsperception, modulation, sustained attention, flexibility, working memory, response inhibition, emotional regulation

➔ Deficits in goal-oriented cognitive processesplanning, organization, time management, self-monitoring

➔ Contributorsneurodevelopmental brain differences, mood, sleep, stress, pain, diet, injury, illness, and substances (including medications)

Inhibition. Self-Monitoring. Delayed Gratification.

FYIMischel’s 1972 Stanford Marshmallow Test was found NOT to be culturally or SES sensitive. Learning and developmental factors played into success, test scores & IQ outcomes originally measured .

Source: The Globe and Mail - Youtube

Inhibition. Self-Monitoring. Delayed Gratification.

MODELINGPEER SUPPORTEXTERNAL SELF TALKSET-UPs/ GAMESINTERNAL REGULATION

https://www.facebook.com/ollieandcameron/videos/169066791171629/?t=27

Shifting. Flexibility. Emotional Control.

Luria found Executive Control is mediated by “self-directed speech” Self Talk , poor verbal do not have well developed self talk

Unexpected limits

Generalize and Adapt to novel situations - generate new responses - seems new each time

New Day New Rules

Stephanie M. Carlson, Ph.D., and Philip D. Zelazo, Ph.D., Developmental Social Cognitive Neuroscience Lab

University of Minnesota.

Shifting. Flexibility. Emotional Control.

SELF TALK TAPE

SOCIAL STORIES

SCRIPTS/RECIPES

BODY DOUBLE

PURPOSEFUL PAUSE

MINDFULNESS

JUST BREATHE.

Source: Youtube

Task Initiation. Task Completion.

Overousal vs Underousal

Skill Deficit/Self Doubt

Working Memory Deficit

Inattention/Distraction

Anxiety/Depression

Fatigue

Task Initiation. Task Completion.

Calm Nervous System

Bilateral Activation & Arousal

Centering/Regulation

Increase blood flow

Bilateral Coordination/Midline

Focus

TALK

Source: Brain Gym P.A.C.E.

P.A.C.E.Brain Gym

Occupational Therapy Protocol

Multitasking. Planning/Sequencing Organizing.

TIPPoint to visual then read aloud to maximize learning and reduce dual tasking

Neurodevelopmental Considerations

ASD have higher rates of Cognitive Inflexibility - getting stuck from repetitive behaviors which leads to intense feelings, difficulty with different, break in patterns

ADHD have higher rates of Working Memory deficits which leave to high levels.

Comorbidity Considerations

Anxiety Disorders are most frequently occurring heterotypic comorbidity in NDs. Comorbid depressive disorder was associated with older age, and comorbid anxiety disorder with female gender. Consider addressing factors beyond NDs that are impacting PFC - mood, stress, illness, pain, injury, hunger, medication, diet, blood flow.

Processing Speed Considerations

Timers for initiating not finishing! Processing speed is not an EF but can influence and take away cognitive resources from EF.

Verbal/Nonverbal Processing Considerations

ASD without verbal differences scored similar in EF planning, self-monitoring as children with language impairments but no ASD or ADHD. Be careful about dual tasking verbal/nonverbal attention tasks.

Gender Considerations

When controlled for developmental age, little support for significant gender or sex differences in executive function. Eventhough many ND’s are more common in boys than girls, environmental stressors seem to play larger role in gender differences when it comes to EF.

Set up’s for SUCCESS

Backwards Chaining, inclusive with peers as well as small group/pull out time to allow to be expert in the group

Questions ...Do you have any suggestions for parents to help their children at home when they are completing homework?

“How do we engage students with executive function concerns who are demotivated while learning from home?”

What are some modalities for teaching executive function skills?

Reinforcers Motivators Rewards

Deliver intermittently, use system consistently

➔ ASD motivated to complete routine/patternComplete chart vs earn prize

➔ ADHD most salient closest to desired behaviorRespond well to token/points compared to neurotypical

➔ Be mindful of Rejection Sensitive Dysphoria

➔ Be mindful of Praise and Depression

Strategies for EF Skill Development

Can be applied to entire classroom, added to curriculum, and offered as individualized support

➔ Informal DevelopmentScaffolding, gamification/activities, peer mentoring

➔ Direct Teaching/Classroom SystemCollaborative goal setting, supervision, classroom organization systems, coaching

➔ Reinforcement/IncentivesGamification, timers, group work

➔ Model Behavior Script aloud behaviors before, while, and after using EF strategies

Adapted from Smart but Scattered by P. Dawson, EdD & R. Guare, PhD (2009, Guilford Press),*Parent-As-Therapist Sessions

eLearning ToolsConsider time of day, family resources, and adapting accommodations/modifications

➔ Fixed or Flexible Tasks

➔ One- Click Work List

➔ Flora, Free2Be, Eisenhower Matrix, Google Productivity

➔ Movement

➔ Reconsidering Homework

➔ ZOOm fatigue is real!

Lifelong LearnersBook reading/listening contest

Household “chore” experiments

Nature Exploration

Games

Multigenerational Experiences

Play

THANK YOU teachers who STICK with their students

Give them TOOLS to work with their brain, capitalize on their STRENGTHS, and build CONFIDENCE in their differences

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

2. Lisman J. (2015). The challenge of understanding the brain: where we stand in 2015. Neuron, 86(4), 864–882. https://doi.org/10.1016/j.neuron.2015.03.032

3. Xie S, Karlsson H, Dalman C, et al. Family History of Mental and Neurological Disorders and Risk of Autism. JAMA Netw Open. 2019;2(3):e190154. doi:10.1001/jamanetworkopen.2019.0154

4. Berit Hjelde Hansen, Beate Oerbeck, Benedicte Skirbekk, Beáta Éva Petrovski & Hanne Kristensen (2018) Neurodevelopmental disorders: prevalence and comorbidity in children referred to mental health services, Nordic Journal of Psychiatry, 72:4, 285-291, DOI: 10.1080/08039488.2018.1444087

5. Guare, R., Dawson, P., & Guare, C. (2013). Smart but scattered teens: The "executive skills" program for helping teens reach their potential. New York: Guilford Press.

6. Postal, K., & Armstrong, K. (2013). Feedback that sticks: The art of communicating neuropsychological assessment results. Oxford: Oxford University Press.

7. Branstetter, R. (2014). The everything parent's guide to children with executive functioning disorder: Strategies to help your child achieve the time management skills, focus, and organization needed to succeed in school and life. Avon, MA: Adams Media.

8. Crisci, G., Caviola, S., Cardillo, R., & Mammarella, I. C. (2021). Executive functions IN Neurodevelopmental DISORDERS: Comorbidity overlaps between attention deficit and hyperactivity disorder and specific learning disorders. Frontiers in Human Neuroscience, 15. doi:10.3389/fnhum.2021.594234

9. Mischel, Walter; Ebbesen, Ebbe B. (1970). "Attention In Delay Of Gratification". Journal of Personality and Social Psychology. 16 (2): 329–337. doi:10.1037/h0029815. ISSN 0022-3514. S2CID 53464175.

10. Solving Executive Function Challenges: Simple Ways to Get Kids with Autism Unstuck and on Target Kenworthy et al (2014)

11. Un Unstuck and On Target: Teaching Flexibility and Goal Directed Behavior to Children with ASD Cannon et al (2011)

12. Late Lost and Unprepared Cooper-Kahn & Dietzel (2008)13. School Success for Kids With Asperger’s Syndrome Silverman et al (2014)14. Barrett, K. (2018). ADHD and the Case for Support through Collegiate Age: Understanding the Lifecycle of

Developmental Delays in Executive Function for ADHD and its Impact on Goal Setting. Journal of Childhood & Developmental Disorders. 4, 3:11

15. Centers for Disease Control, National Center on Birth Defects and Developmental Disabilities (2020). Developmental Milestones Checklists. Retrieved from: https://www.cdc.gov/ncbddd/actearly/milestones/index.html.

16. Dawson, P., and Guare, R. (2009). Smart But Scattered. New York: Guildford Press17. Dawson, P. and Guare, R. (2010). Executive Skills in Children and Adolescents: A Practical Guide to

Assessment and Intervention, 2nd Edition. New York: Guildford Press.18. EdRev Expo 2018 Workshop: Family Dynamics by Jude Wolf, Ed.D., Lori Krauss, and Nathan Fernandez19. Executive Functioning Skills 101: The Basics of Task Initiation20. Executive Functioning Skills 101: The Basics of Time Management21. Life Skills Advocate – Virtual Executive Functioning Coaching22. Peters, K. (2017). Hierarchy of Social/Pragmatic Skills as Related to the Development of Executive

Function.