© 2018 Peter Singer
TRAUMA, EXECUTIVE
FUNCTIONING,
AND LEARNING
PETE SINGER, MSW, LICSW
LEAD CONSULTANT
ADVANCED TRAUMA CONSULTING
© 2018 Peter Singer
*
OBJECTIVES
• Develop an understanding of executive functioning skills and how they may be impacted
by trauma
• Identify several ways that executive functioning deficits may impact development and
learning
• Learn several interventions that may help strengthen a child’s executive functioning and
better equip them to learn
© 2018 Peter Singer
WHAT IS TRAUMA?
© 2018 Peter Singer
WHAT IS TRAUMA?
• The THREE E’s
• Verbal, Physical, Sexual, Emotional Abuse
• Neglect
• Witnessing domestic violence
• Parental chemical or mental health concerns
• Parental separation or divorce
• Parental or close family death or serious illness/injury
• Parental incarceration
• Removal from family
© 2018 Peter Singer
WHAT IS TRAUMA?
• Extreme poverty, low SES, or lack of resources
• Witnessing or experiencing crime, especially violent crime
• Natural disasters
• War
• Displacement
• Painful or frightening medical procedures
• Threatened death, serious injury, sexual violence, loss of integrity of the self
© 2018 Peter Singer
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WHAT IS TRAUMA?
• Lifetime prevalence of 50-60% of people in the US
• As many as 70-100% of children in urban areas of the US
• As many as 1/3 of girls and 1/5 of boys sexually assaulted by the age of 18
• Nationally, 3.4 million children received an investigation or alternative response from
child protective services agencies in 2015 (how many cases are unreported?)
• Over 25,000 substantiated cases of child maltreatment in MN in 2013
• Cases have increased over 25% since 2015
© 2018 Peter Singer
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WHAT IS TRAUMA?
• Physical changes in the brain
• Genetic changes (www.nature.com/news/fearful-memories-haunt-mouse-descendants-1.14272)
• ACES
• Resilience mitigates some effects
• Relationship mitigates some effects
• Development of EF prior to the trauma mitigates some effects
• Language aids in processing trauma
© 2018 Peter Singer
WHAT IS EXECUTIVE FUNCTIONING (EF)?
© 2018 Peter Singer
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WHAT IS EXECUTIVE FUNCTIONING (EF)?
• Command and control
• Helps manage ALL of life’s tasks
• “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.”
• Related and overlapping, especially from late childhood forward
• Significant situational variability
• Based in the frontal parts of the brain
© 2018 Peter Singer
WHAT IS EXECUTIVE FUNCTIONING (EF)?
• Learned skills
• Development is often not linear
• Controls developmental tasks
• Many of the brain changes that allow development of EF are driven by experience
(myelination, neuron proliferation, cell death, synaptic pruning, etc.)
• Site of activity in the brain shifts with age
© 2018 Peter Singer
WHAT IS EXECUTIVE FUNCTIONING (EF)?
• Some disagreement on what they are, how they work, and how to assess
• Hard to measure because EF modulates and manages the practical abilities necessary for
performance on the assessments (language, visual/spatial relations, motor skills, memory,
etc.), so it is sometimes unclear if the assessments measure EF or the abilities needed for
performance
• Females MIGHT have generally better EF, but it is not clear
• Deficits may be related to a lower level of COMPETENCE with the skill or a lower level
of CONFIDENCE in using the skill
© 2018 Peter Singer
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WHAT IS EXECUTIVE FUNCTIONING (EF)?
• INHIBITION
• Stop behavior and thinking at appropriate times
• Allows delayed gratification
• Deficits appear as impulsivity
• SHIFT
• Move freely from one situation to another
• Reaction time and processing speed
• Flexible thinking
• Generalizing
• Dealing with new demands and changing plans
• Deficits appear as rigidity
© 2018 Peter Singer
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WHAT IS EXECUTIVE FUNCTIONING (EF)?
• EMOTION/FOCUS CONTROL
• Focus: withdrawal from some things to effectively deal with others
• Modulate emotional response
• May involve thinking or skills
• Also assists with delayed gratification, focus on the goal
• Deficits appear as emotional lability, avoidance/numbing, distractibility, poor follow through
• INITIATION
• Begin tasks and activities
• Independently generate ideas, options, problem solving
• Deficits appear as procrastination, laziness, getting “stuck,” lack of motivation
© 2018 Peter Singer
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WHAT IS EXECUTIVE FUNCTIONING (EF)?
• WORKING MEMORY
• Hold and access information for the purpose of completing tasks or solving problems
• Includes spatial awareness, manipulation of information
• Deficits appear as poor memory, not trying, forgetting
• PLANNING/ORGANIZATION OF IDEAS
• Ability to manage current and future-oriented tasks and demands
• Holding multiple ideas at once
• Planning ahead, sequencing, prioritizing
• Deficits appear as procrastination, poor follow through, opposition, difficulty following
directions
© 2018 Peter Singer
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WHAT IS EXECUTIVE FUNCTIONING (EF)?
• ORGANIZATION OF MATERIALS
• Ability to impose order on work, play, and storage
• Distinct from organization of ideas
• Deficits appear as disorganization, messiness, losing things, chaos
• SELF MONITORING
• Ability to manage one’s own performance and measure it accurately against a standard
• Recognition of environmental context and expectations
• Deficits appear as denial, poor insight, blame, not understanding why people are upset, etc.
© 2018 Peter Singer
WHAT IS LEARNING?
© 2018 Peter Singer
WHAT IS LEARNING?
• DICTIONARY.COM:
• The acquisition of knowledge or skill through experience, study, or being taught
• Active
• Cumulative
• Occurs in complex social environments
• Authentic context (need to know or want to know)
• Requires learner’s motivation and cognitive engagement
© 2018 Peter Singer
WHAT IS LEARNING?
• Multiple theories of how it occurs
• Connecting information in meaningful ways
• Aided by language, though language is not required
• Imitation plays a role
• Multiple styles
• Visual
• Auditory
• Reading/writing
• Kinesthetic
© 2018 Peter Singer
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HOW DOES TRAUMA IMPACT EF?
© 2018 Peter Singer
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HOW DOES TRAUMA IMPACT EF?
• Testing shows a clear connection between trauma/PTSD and impaired EF
• Impacts functioning of the frontal lobes, where EF primarily resides
• High stress causes hormone release that leaves neurons susceptible to later insults
• Flood of hormones from high stress decreases receptors
• Physical abuse may involve blows to the head that damage parts of the brain where EF dwells
• Several diagnostic criteria of PTSD relate directly to EF
• EF develops from meaningful social engagement, yet this may be lacking with trauma
© 2018 Peter Singer
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HOW DOES TRAUMA IMPACT EF?
• EF is learned, but trauma may take the child out of the learning environment or
frequently change the learning environment
• Engage in distraction or dissociation to reduce focus on constant threat
• Family-related trauma more damaging to EF than other trauma
• Trauma places focus priority on threat and negative emotional stimuli, which impacts
planning and several other EF skills
• Appears to enhance shift toward threat stimuli, while inhibiting shift away from it
• Reciprocal impact creates a cycle
© 2018 Peter Singer
HOW DOES EF IMPACT LEARNING?
© 2018 Peter Singer
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HOW DOES EF IMPACT LEARNING?
• Multiple studies show a strong link between EF and learning
• If deficits inhibiting other stimuli, hard to pay attention
• If deficits paying attention to information, information is not properly stored
• If deficits in storing and organizing information, harder to access it
• If deficits accessing information, hard to problem solve or know what is needed
• If deficits knowing what is needed, hard to self monitor or ask for help
© 2018 Peter Singer
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HOW DOES EF IMPACT LEARNING?
• Planning/organization needed for long-term projects
• Working memory needed to build on concepts or reflect knowledge on tests
• Planning, inhibition, regulation, and self monitoring needed for group projects
• Self monitoring needed to ask for help or self advocate
• Inhibition, organization, and working memory needed to distinguish sets of information
• Shift needed to switch between words, sounds, and different parts of a story in reading
© 2018 Peter Singer
HOW DOES EF IMPACT LEARNING?
• Learning requires motivation and engagement
• Learning requires connecting information in meaningful ways
• Dissociation
• Studies show CAUSALITY between increased EF and improved academic functioning
• Strong EF can buffer many of the effects of poor Home Learning Environment
© 2018 Peter Singer
WHAT CAN WE DO?
© 2018 Peter Singer
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WHAT CAN WE DO?
• Meaningful social interactions
• Enjoyable activities
• Increasing demands
• Progressive skill building – academic success, then personal goals, then self monitoring
• Active learning
• Breaks with a chance to restart “attention clock”
• Support reflection and planning
© 2018 Peter Singer
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WHAT CAN WE DO?
• Recognize and reward success
• Recognize and reward resilience, even if the full outcome is not achieved – Mrs.
Anderson
• Help students identify their support system
• Model
• Trauma treatment
• School-based mental health support
• Family support
• Address primary and secondary traumatic stress in staff
© 2018 Peter Singer
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WHAT CAN WE DO?
• Enhancing and Practicing Executive Functioning Skills with Children from Infancy to
Adolescence – Harvard Center for the Developing Child
• INHIBITION
• Fruit Ninja
• Counting only one of several items
• Simon Says, Slow races, B-I-N-G-O
• SHIFT
• First, then
• Forbidden Island, Stay Tuned, and other collaborative games
• Labyrinth
• Arguing the opposite position
© 2018 Peter Singer
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WHAT CAN WE DO?
• EMOTION/FOCUS CONTROL
• Combat breathing, PMR, temperature/mood rings
• 5/4/3/2/1, sensory grounding (all senses), and other Mindfulness exercises
• Headphone lectures
• Consider Dissociation
• INITIATION
• Help with the first step
• Minecraft projects, puzzle games
• Storytelling
© 2018 Peter Singer
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WHAT CAN WE DO?
• WORKING MEMORY
• Deep breathing memory, including on tests
• Memory games, Stay Tuned
• Scavenger hunts by memory or in a specific order
• PLANNING/ORGANIZATION OF IDEAS
• Minecraft projects
• Risk, Jenga, Codename, and other strategy games
• Sorting games and puzzles
© 2018 Peter Singer
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WHAT CAN WE DO?
• ORGANIZATION OF MATERIALS
• Real or virtual building projects
• Sorting/storage activities
• Take home and return high value items
• SELF-MONITORING
• Opportunities for describing and rating self
• Timed activities (walking, breathing, etc.) requiring a person to do things more slowly than
usual
• Bubbles
© 2018 Peter Singer
RESOURCES
Aupperle, R.L., Melrose, A.J., Stein, M.B., & Paulus, M.P. (2011). Executive Function and PTSD:
Disengaging from Trauma. Neuropharmacology, pp. 1-9. Doi:
10.1016/j.neuropharm.2011.02.0008
Berkeley Center for Teaching and Learning/What Is Learning? (2017). Retrieved from:
https://teaching.berkeley.edu/resources/learn/what-learning
Best, J.R. & Miller, P.H. (2010). A Developmental Perspective on Executive Function. Child
Development, 81(6), pp. 1641-1660. Doi: 10.1111/j1467-8624.2010.01499.x
Browne, J. (2014). Enhancing and Practicing Executive Functioning Skills with Children from
Infancy to Adolescence. Cambridge, MA: Harvard Center for the Developing Child
Browne, T.E. (2009). ADD/ADHD and Impaired Executive Function in Clinical Practice.
Neuroscience and Neuropsychology of ADHD, 1, pp. 37-41.
© 2018 Peter Singer
RESOURCES
Cooper-Kahn, J. & Dietzel, L.C. (2008). Late, lost, and unprepared: a parent’s guide to helping
children with executive function. Bethesda:Woodbine House.
DePrince, A.P., Weinzerl, K.M., & Combs, M.D. (2009). Executive Function Performance and
Trauma Exposure in a Community of Sample Children. Child Abuse and Neglect 33,
353-361. Doi: 10.1016/j.chiabu.2008.08.002
Devine, R.T., Bignardi, G., & Hughes, C. (2016). Executive Function Mediates the Relations
Between Parental Behaviors and Children’s Early Academic Ability. Frontiers in
Psychology, 7, pp. 1-15. Doi: 10.3389/fpsyg.2016.01902
Kamradt, J.M., Ullsperger, J.M., & Nikolas, M.A. (2014). Executive Functioning Assessment and
Adult Attention Deficit/Hyperactivity Disorder: Tasks Versus Ratings on the Barkley
Deficits in Executive Functioning Scale. Psychological Assessment, 26(4), pp. 10951105. Doi: 10.1037/pas0000006
pp.
© 2018 Peter Singer
RESOURCES
Karasinski, C. (2015). Language Ability, Executive Functioning, and Behavior in School-Age
Children. International Journal of Language and Communication Disorders, 50 (2), pp.
144-150. Doi: 10.1111/1460-6984.12104
Weibe, S.A., Sheffield, T., Nelson, J.M., Clark, C.A. Chevalier, N., & Espy, K.A. (2011). The
Structure of Executive Function in Three-Year-Old Children. Journal of Experiential
Psychology, 108 (3), pp. 436-452. Doi: 10.1016/j.jecp.2010.08.008
Welsh, A. (2013). Effects of Trauma-Induced Stress on Attention, Executive Functioning,
Processing Speed, and Resilience in Urban Children. Setan Hall University
Dissertations and Theses (ETD).Paper 1907.
© 2018 Peter Singer
Pete Singer
info@advancedtraumaconsulting.com
651-747-6370