Assessment and
Intervention for Executive
Function Difficulties Part 3
Presented by
George McCloskey, Ph.D.
Philadelphia College of Osteopathic Medicine
gmccloskz@aol.com or georgemcc@pcom.edu
1
Workshop Objectives
Describe
general strategies for
mediating ef difficulties through
external control and improving ef
capacities through strategies for
self-regulation.
Describe specific intervention
methods that address executive
function difficulties.
2
Internal versus External Control
The neural circuits for executive
function activation are routed
differently depending on whether
the activation is based on an
internally driven desire or
command versus an external
demand.
3
Internal versus External Control
Because internally driven production
is much easier to accomplish than
externally demanded production for
children with “producing difficulties”
their lack of production on demand
often stands in stark contrast to their
seemingly effortless production
“when the spirit moves them.”
4
Internal versus External Control
The on-demand deficiencies
observed by others are often
attributed to negative personal
characteristics such as lack of
responsibility, apathy, passive
aggressive stance, or
oppositional defiance.
5
Producing versus
Learning Difficulties
As Martha Denckla has
pointed out, Executive
Function difficulties of a severe
nature (especially in the
Symbol System Arena) do not
result in Learning Disabilities;
they result in “Producing
Disabilities.”
6
A General Model for Conceptualizing
Learning and Producing Difficulties
Learning
Difficulties
Only
Learning
Difficulties
And
Producing
Difficulties
Producing
Difficulties
Only
Often NOT recognized as a
Learning Disability, even
when severe, unless an
evaluation involving process
assessment is done
Recognized fairly quickly
as a Learning Disability
When severe, typically
attributed to lack of
motivation, character flaws,
or behavior/personality
7
problems
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.
FBA: Is A-B-C Enough?
Because of their strong emphasis on
observable behaviors, functional
assessments typically do not provide a
conceptual basis for understanding the
root causes of why setting events and
antecedent conditions result in problem
behaviors even when the negative
consequences associated with the
problem behaviors are completely
undesirable from the student’s
perspective as well as everyone else’s.
FBA: Is A-B-C Enough?
While some strict behaviorists
might argue that it is unnecessary
to speculate on such causal
issues, parents, teachers, and
students themselves find such
explanations to be central to their
attempts to make sense of things.
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
Response
Antecedents
Perception
Emotion
Cognition
Action
Consequences
EF-Driven FBA
While it might appear that the child is consciously
choosing how to perceive, feel, think and act when
a lack of production is observed, proper
conceptualization of executive function difficulties
requires an acknowledgement that the source of
the executive function problem is most likely a
result of less than optimal nonconscious brain
function rather than a conscious choice to act in a
contrary manner.
Most importantly, clinicians must help parents and
teachers, as well as themselves, realize that the
executive difficulties that are so exasperating to
them are just as exasperating to the child, with the
only difference being in the nature of the reactions
that are expressed.
EF-Driven FBA
With a good understanding of executive
functions, problems can be clearly stated in
terms of perceptions, emotions, thoughts or
actions that can be changed through
intervention. The goal here is twofold: 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.
EF-Driven FBA
An Executive Function-driven FBA can identify the
executive function difficulties that are the source of
the behavior problems.
Subsequently, part of the intervention plan would
be to help parents and teachers understand the
nature of these executive function difficulties, their
impact on the student’s behavior, and the reasons
why external control strategies are required.
Additionally, understanding the executive function
difficulties producing the problem behaviors will
help those charged with delivering the intervention
adopt an appropriate perspective during
implementation.
Executive Function Difficulties
Are they the result of:
Disuse through
Conscious Choice
Innate Deficiency
Maturational Delay
Disuse through
Nonconscious 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.
EF Intervention Strategies
Orienting Strategies
External Control Strategies
Bridging Strategies
Internal Control Strategies
EF Intervention Continuum
Orienting Strategies
External Control Strategies
Bridging Strategies
Internal Control Strategies
EF Intervention Levels
Interventions will vary
depending on the EF level
or levels at which difficulties
are occurring and will be
constrained by the level of
development attained by the
person.
EF Intervention Levels
Individuals with little selfactivation capacity need classical
conditioning interventions that do
not require any EF involvement
Individuals with little or no selfregulation or self-realization
capacities will require strict
behavior modification treatment
regimens
EF Intervention Levels
Individuals with some selfregulation capacity may respond
well to cognitive behavior therapy
Individuals with some selfregulation and self-realization
capacities may respond to
mindfulness-based cognitive
behavior therapy
Development of 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.
Development of 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.
General Literature Sources for
Intervention Information
Executive Function References
ADHD Interventions
TBI Interventions
Dynamic Assessment/ Instrumental
Enrichment Programs
I Can Problem Solve (ICPS) program
Metacognition applied to academics skill
areas; especially reading
Cognitive Behavior Therapy
OT/PT Motor Planning and Motor Praxis
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)
Orienting Strategy
Increase student awareness of:
self-regulation expectations
personal self-regulation
strengths and weaknesses
Orienting Strategy
Increase Awareness of EF
Difficulties; raise consciousness
of the specific difficulties that
result from EF deficiencies in
order to clearly define the
problems; when possible, use
videotaping for reality testing.
29
Orienting Strategy
STATING GOALS
To assure that executive function capacities
are used to their fullest potential, it is
important to state goals for both
achievement and self-regulation. Stating
goals enables executive function capacities,
either consciously or nonconsciously, to
engage the perceptions, emotions,
thoughts, and actions, needed to achieve
the goals.
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
Classroom Management
that Works (Marzano)
Marzano & Pickering (2003) identified
four components of effective classroom
management:
Classroom Rules and Procedures
Disciplinary Interventions
Teacher-Student Relationships
Mental Set
External Control Strategies
Design and Implementation of Classroom
Rules and Procedures involves clearly
stating general expectations and standards
(rules) for behavior and providing specific
behavior routines (procedures) that enable
the students to meet the general
expectations.
Classroom Rules should address SelfRegulation expectations, thereby increasing
awareness of the need for self-regulation.
External Control Strategies
Provide external prompts
and cues as a substitute
for self-regulation.
External Control Strategies
In preschool, kindergarten and early
elementary years, in many ways, teachers
ARE their student‘s frontal lobes.
Providing executive prompts and cues are
important to assure that children are engaged
appropriately in the instructional process.
Modeling good executive functions helps
children see how they can self-regulate their
own perceptions, emotions, thoughts and
actions.
External Control Strategies
In late elementary, junior-senior
high school, college, and even
graduate school and work places,
effective teachers/supervisors
provide executive function prompts
and model good executive function
use.
Assessing the Use of EF Prompts
in the Classroom
An Observation Form (McCloskey,
Perkins & VanDivner) has been
developed for use to help structure
observations and assist in providing
effective feedback to teachers.
Executive Function
Classroom Observation Form (EFCO)
The form has two components
A definition and sample sheet to
help you focus on the types of
prompts that you are observing.
The observation form, that lists all
33 SREFs, has a space for taking
notes and keeping track prompts
that are observed.
Example Prompts
The definitions & sample prompts
are used to prepare for the
observation
For each self-regulation EF,
examples of positive and specific
prompts and negative, vague
and/or poorly timed prompts are
provided.
EFCO Example Prompts
Each self-regulation EF has
sample prompts for each of the
four domains of function:
P =Perceiving;
F = Feeling;
T = Thinking
A = Acting
33 Self-Regulation EFs
Perceive
Focus
Sustain
Energize
Initiate
Inhibit
Stop
Interrupt
Flexible
Shift
Modulate
Monitor
Organize
Correct
Prioritize
Balance
Decide
Gauge
Sense Time
Anticipate
Pace
Estimate Time Sequence
Analyze
Execute
Compare/Eval Hold
Generate
Manipulate
Associate
Store
Plan
Retrieve
Strategies for Becoming Familiar
with SREFs and Prompts
To effectively use the observation form,
you will have to build familiarity with each
of the 33 self-regulation areas.
At first, this can seem overwhelming, but if
you use your own EF’s effectively, it can
be accomplished!
Organize according to the 7 clusters,
perhaps study one a day. In less than 2
months, you can have them mastered.
SREF “Clusters”
The 33 self-regulation
executive functions can be
grouped based on “Clusters”
in which several srefs are
used in an integrative
manner.
There are seven primary
clusters to consider.
SREF “Clusters”
Attention
Engagement
Optimization
Inquiry
Solution
Efficiency
Memory
Attention Cluster
“What’s going on out there?”
Includes: Perceive,
Focus/Select, Sustain
Engagement Cluster
 “Get to it – or not”
Includes: [Attention Cluster],
Energize, Initiate, Inhibit,
Stop/Interrupt, Flexible, Shift,
[Optimization Cluster]
Optimization Cluster
 “How am I doing?”
Includes: [Attention
Cluster], Monitor, Modulate,
Balance, Correct
Efficiency Cluster
“The Smooth Operator.”
Includes: Sense Time,
Pace, Sequence, Execute,
[Optimization Cluster]
Memory Cluster
 “You CAN get there from
here.”
Includes: [Attention Cluster],
Hold, Manipulate, Store,
Retrieve, [Efficiency Cluster]
Inquiry Cluster
“Inquiring minds need to know.”
Includes: Anticipate, Gauge,
Estimate Time, Analyze, [Memory
Cluster], Evaluate/Compare,
[Solution Cluster]
Solution Cluster
“I’m the Decider.”
Includes: Generate, Associate,
Prioritize, Plan, Organize,
[Memory Cluster], Choose/
Decide, [Optimization Cluster]
Perceive
The Perceive function 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
The Focus function 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
The Sustain function 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
The Energize function 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
The Initiate function cues the
initial engagement of
perceiving, feeling, thinking, or
acting .
Prompt example: “Start
walking now.” “Begin work on
the count of five.”
Inhibit
The Inhibit function cues resistance to,
or suppression of, urges to perceive,
feel, think, or act on first impulse.
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
The Stop function cues the sudden,
immediate discontinuation of
perceiving, feeling, thinking, or acting.
The Stop cue always precedes the
Shift cue when altering problemsolving based on changing conditions,
and switching or alternating attention.
Prompt example: “Stop writing now.”
Interrupt
The Interrupt function cues the brief
cessation of, and the return to
perceiving, feeling, thinking or acting.
Efficient use of the interrupt cue
enables a quicker return to a previous
mental state or activity.
Prompt example: “Stop for a moment
and listen, then I want you to go back
to what you were doing.”
Flexible
The Flexible function 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
The Shift function 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
The Monitor function 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
The Modulate function 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
The Balance function 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
The Correct function 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
The Sense Time function 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
The Pace function 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
The Sequence function 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
The Execute function 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
The Hold function 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
The Manipulate function 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
The Store function 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
The Retrieve function 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
The Gauge function 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
The Foresee/Plan function 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
The Estimate Time function 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
The Analyze function 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
The Compare/Evaluate function cues the
realization of the need to make comparisons
among, or evaluate the adequacy of,
perceptions, feelings, thoughts or actions.
Prompt examples:
“Is that the best you can do?”
“Are you sure you are finished?”
“Does yours look like the model?”
“Are you sure that what you said was a good
explanation?”
Prioritize
The Prioritize function 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
The Generate function cues the realization
that novel, fluid problem-solving efforts are
required and cues the activation of the
resources needed to carry out problemsolving 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
The Associate function 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
The Organize function 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)
The Plan function 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
The Choose function 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.
External Control Strategies
Rewards can be a
tremendous benefit to a child
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 the child how to
reflect on and alter perceptions, emotions,
thoughts or actions, they simply reward the
presence of desired behaviors.
Reward programs imply that a child can do
it if he/she wants to or is motivated enough.
This often leads away from the realization
that many children 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 the child how to
reflect on and alter perceptions, emotions,
thoughts or actions, they simply punish the
presence of undesired behaviors.
Punishment implies that a child can do it if
he/she wants to or is motivated enough. This
often leads away from the realization that
many children who are motivated and do
want to change their behavior don’t know
what to do to change it.
Bridging Strategies
Encourage the
engagement of executive
functions through the use
of reflective questioning.
Reflective Questioning
Repeat the child’s question back to the
child instead of providing an answer. In
situations where the child seems
unaware of the need to be asking
questions for adequate engagement,
reflective questioning involves the
mediator asking the child a question that
is intended to make the child 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 students
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 child realizes that selfregulation 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 as
specific skill routines using
Cognitive Strategy Instruction
approaches (e.g. Graham & Harris
Self-Regulated Strategy
Development approach for Written
Expression).
Bridging Strategies
Strategy Example – CC3 Method:
Carefully CONSIDER (accurately
perceive) and COPY the word.
COVER and COMPOSE the word.
COMPARE your spelling with the
word and CORRECT any errors you
see.
Bridging Strategies
Develop a common vocabulary
and set of nonverbal symbols for
describing or signifying selfregulation capacities and signaling
their use (e.g., cueing flexibility
with “The Coconut Story”)
Bridging Strategies
Based on assessment of EF difficulties, school
psychologist and 9 year-old student established
cue vocabulary that staff and parents used:
“Read the room”—to increase perceive
and monitor capacity
“Start”—to increase initiation
“Wait”—to increase inhibition
“Check”—to monitor work or behavior
“Correct”—to edit/fix errors
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
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
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 selfadministered reward routines to
increase the use of selfregulation 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.
Executive Functions Interventions
Specific Programs
and Approaches to
Improving Clients’
Executive Functions
include the following:
104
Executive Functions Interventions
Teaching self-control in
Preschool and Kindergarten;
programs such as Tools of
the Mind (Bodrova and
Leong) are being used to
increase the self-regulation
capacities of young children.
105
Early Childhood Evidenced Based
Interventions: Tools of the Mind
Teachers can have a positive effect
on children’s self-regulatory
capacities (e.g., Burchinal, PeisnerFeinberg, Bryant, & Clifford, 2000).
Interventions that include selfregulatory components are more
likely to improve achievement (Blair
& Raza, 2007).
Early Childhood Evidenced Based
Interventions: Tools of the Mind
Children who participated in Tools of the
Mind classrooms had higher rates of selfregulation than matched controls and selfregulation levels correlated with achievement
in literacy and mathematics (Diamond,
Barnett, Thomas, & Munroe, 2007).
Early self-regulation has a stronger
association with school readiness than IQ or
entry-level pre-reading or pre-math skills
(Blair, 2002. 2003; Normandeau & Guay,
1998).
Techniques Used in Tools of the Mind
Self-Regulation Activities
Children practice self-regulated learning throughout
the day by engaging in a variety of specifically
designed developmentally appropriate self-regulation
activities.
Children learn to regulate their own behaviors as well
as the behaviors of their friends as they enact
increasingly more complex scenarios during
imaginary play activities.
Briefer activities are also used. For example, children
practice inhibitory control during an activity called
Graphics Practice. Children draw different kinds of
marks to music and must stop and start on cue.
Techniques Used in Tools of the Mind
Dramatic Play
The cornerstone of Vygotsky’s theory of
cognitive development on which the
curriculum is based. Structured dramatic
play involves role-playing scenarios that are
planned and agreed upon in advance.
Engaging in sustained role-playing requires
the inhibition of role-inappropriate behaviors,
as well as the use of working memory to
sustain attention and effort to the imaginative
enactment of the selected role.
Techniques Used in Tools of the Mind
Scaffolding
The strategy of providing, and gradually
removing, external support during learning and
producing activities. During scaffolding the task
itself is not changed but what the learner initially
does is made easier with support. As the learner
takes more responsibility for performance of the
task, less assistance is provided.
Scaffolding attempts to move the child further
along the continuum of self-regulation from being
externally regulated by others to engaging in
"shared" regulation to eventually becoming selfregulated.
Techniques Used in Tools of the Mind
Example of the Use of Scaffolding:
If a child needs support to approach writing as a
task that is performed from left to right, the
teacher may begin shaping the behavior by
explaining to the child that writing begins on the
left and progresses across the page. Verbal
prompts may be used several times, then a
mediator (a visual prompt such as an asterisk) is
placed on the left side of the page to remind the
child of where to start writing. Once the child
follows the visual prompt without difficulty or
hesitation, the asterisk is no longer placed on the
page.
Techniques Used in Tools of the Mind
Reflective Thinking
Refers to thinking about how you arrived at
an answer or how you are thinking about
something. Reflective thinking involves the
use of metacognition (the ability to think
about thinking).
During activities, children are asked to think
about how they arrived at an answer or
how/what/why they are thinking about
something. Teachers model their use of
reflective thinking by explaining to children
what/how they are thinking about something.
Techniques Used in Tools of the Mind
Using Props to Enhance Attention and
Working Memory
Physical props are used as reminders of
what the child should be doing during an
activity.
For example, during an activity where
children read to each other. The reader
holds a picture of lips and the listener holds a
picture of an ear. The pictures are
exchanged when the roles are switched.
Techniques Used in Tools of the Mind
Using Props to Enhance Attention and Working
Memory: Continuum of Outcomes
The children learn to transition from both
wanting to read and neither wanting to listen, to
one listening while holding the ear and one
reading while holding the lips, to not needing the
physical props to engage in the reciprocal roles,
to changing the passive role of listening into an
active role of listening and asking questions of
the reader to a final state where active listening
becomes an internalized process for enhancing
the listener’s comprehension.
Techniques Used in Tools of the Mind
Self-Regulatory Speech
Activities involve teaching children how to
internally regulate speech and use internal
speech to monitor external events.
For example, children pair off and collaborate in
counting objects; one child counts aloud, and the
other monitors the oral counting of the first child.
The child doing the monitoring learns to inhibit
the desire to count for themselves and instead to
listen to the counting of the other child and to
think metacognitively about the accuracy of the
other child’s counting.
Evidence Based Intervention:
Cognitive Strategy Instruction
Cognitive Strategy Instruction (CSI)
emphasizes the development of thinking
skills to increase learning and production.
CSIs help students to become more
strategic, self-reliant, flexible, and
productive in their learning endeavors
(Scheid, 1993). Use of these strategies
have been associated with increased
academic production (Borkowski, Carr, &
Pressley, 1987; Garner, 1990).
Evidence Based Intervention:
Cognitive Strategy Instruction
CSI techniques employ
metacognition and focus on
modeling and teaching students
strategies for completing tasks
and routines and then modeling
and teaching methods for selfcueing the use of the strategies.
Evidence Based Intervention:
Cognitive Strategy Instruction
CSI techniques have been
used effectively to improve
written expression, reading
comprehension, math
calculation and problemsolving, study skills, test-taking,
and project completion.
Evidence Based Intervention:
Cognitive Strategy Instruction
Lynn Meltzer (2010)
employs CSI techniques in
the Drive to Thrive
classroom program and the
BrainCogs and Essay
Express software programs.
Evidence Based Intervention:
Cognitive Strategy Instruction
Drive to Thrive and BrainCogs both address five
general areas of self-regulation:
Goal Setting, Planning and Prioritizing
Organizing
Remembering
Shifting and Flexible Problem-Solving
Self-Monitoring and Self-Checking
Executive Functions Interventions
Cognitive Behavior Therapy (CBT).
CBT teaches strategies for improving
the use of executive functions to cue
and direct effective perceiving, feeling,
thinking and acting. Techniques have
shown good results at the adult and
adolescent levels and some early
indications that the techniques can be
applied effectively with children in the
elementary grades.
121
Evidence Based Intervention:
Cognitive Behavior Therapy
Cognitive Behavior Therapy
(CBT) emphasizes collaborative
reality-testing and the
monitoring and modification of
automatic perceptions, feelings,
thoughts, and actions that
cause difficulties for the child.
Evidence Based Intervention:
Cognitive Behavior Therapy
CBT with children and adolescents:
Reduces the use of thought logs
Focuses on internal experiences such as
monitoring perceptions, feelings, thoughts and
actions
Works toward affective shifts to illustrate the
cognitive model
Summarizes session content frequently
Keeps abstractions to a minimum, focusing
instead on concrete examples based on personal
experience
Evidence Based Intervention:
Cognitive Behavior Therapy
Outcomes of CBT with children and
adolescents:
Increased ability to monitor perceptions,
feelings, thoughts and actions
Increased engagement in positive
problem-solving strategies
Increased capacity for self-regulating
perceptions, feelings, thoughts and
actions
Evidence Based Intervention:
Cognitive Behavior Therapy
CBT has been used with children
and adolescents to deal with:
Depression
Anxiety
Bipolar Disorder
Eating Disorders
Evidence Based Intervention:
Cognitive Behavior Therapy
CBT has been used with children
and adolescents to deal with:
ADHD
Disruptive Behavior Problems
Obsessive-Compulsive
Disorder
Social Skills Deficits
Evidence Based Intervention:
CBT for Depression
“Since depression is most often an episodic
disorder, it usually improves over time. With
young children, CBT has been shown to be
more effective than 'watchful waiting' and
more effective than traditional school
counseling as a treatment for depression.
With adolescents, CBT has also been shown
to be more effective than 'watchful waiting'
and more effective than nondirective
supportive therapy.” www.abct.org
Evidence Based Intervention:
CBT for Depression
“For moderately to severely depressed
adolescents, the most effective treatment at
this time is the combination of CBT and an
SSRI medication. In the NIMH-sponsored
Treatment for Adolescents with Depression
Study (TADS), this combination led to the
best outcomes in terms of both reduced
depression and reduced risk of suicidal
events.” www.abct.org
Evidence Based Intervention:
CBT for Substance Abuse
“Support for CBT was found in a recent
review of the quality of evidence in support
of outpatient interventions for adolescent
substance abuse (Becker & Curry, 2008).
Across 31 randomized controlled trials,
CBT was the outpatient intervention
supported by the highest proportion of
methodologically stronger studies.”
www.abct.org
Cognitive Behavior Therapy
Resources for Practice
Friedburg, R. D., & McClure, J. M. (2002).
Clinical practice of cognitive therapy with
children and adolescents: the nuts and
bolts. New York: Guilford Press.
Mennutti, R. B., Freeman, A., & Christner,
R W. (Eds.) (2006). Cognitive-behavioral
interventions in educational settings. New
York: Routledge.
Cognitive Behavior Therapy
Resources for Practice
Reinecke, M.A., Dattillo, F.M., &
Freeman, A. (Eds) (2003). Cognitive
Therapy with Children and
Adolescents: A Casebook for Clinical
Practice.
Kendall, Philip C. (Ed) (2005). Child
and Adolescent Therapy: CognitiveBehavioral Procedures (3rd ed.).
Guilford Press.
Executive Functions Interventions
CBT variants such as Jeffrey
Schwartz’s “Brain-Lock: Free Yourself
from Obsessive-Compulsive Behavior;
subtitled as “a four-step self-treatment
method to change your brain
chemistry.” This method uses CBT
oriented techniques to strengthen selfregulation capacities and decrease
unproductive perceptions, feelings,
thoughts and actions.
132
Executive Functions Interventions
Ross Greene’s Collaborative
Problem-solving approach
featured in his books on Treating
Explosive Kids. Although Greene
does not specifically use the
concept of executive functions, his
intervention approach teaches
parents techniques for improving
both external control and building
internal self-regulation capacities.
133
Executive Functions Interventions
Myrna B. Shure’s I Can
Problem-Solve (ICPS)
techniques for teaching
young children increased
self-control and improved
cueing of appropriate
problem-solving routines.
134
Executive Functions Interventions
Rueven Feuerstein’s approach to
improving cognitive functioning
through instrumental enrichment,
mediated learning and dynamic
assessment, all focused on
increasing self-regulation through
increased self-awareness and
strategy use.
135
Executive Functions Interventions
Michelle Garcia Winner’s Social
Thinking Curriculum Superflex.
Uses cartoon characters to teach
about self-regulation concepts
(e.g., Rock Brain represents
inflexible thinking). Intended for
upper elementary age children
diagnosed with Asperger’s, but the
techniques and ideas appear to
have wider application.
136
Executive Functions Interventions
Computer-based cognitive
training programs such as
CogMed and neurofeedback
programs are being closely
studied to determine the extent
to which they can be used to
improve self-regulation in
settings other than the
“computer lab.”
137
Executive Functions Interventions
Mindfulness-based CBT improves
Self-Awareness and Self-Analysis
capacities through the incorporation
of meditative techniques along with
teaching strategies for regulating
perceptions, feelings, thoughts and
actions, making it more likely that
learned CBT strategies will be cued
when needed.
138
Executive Functions Interventions
Use of Meditation, especially
witnessing meditation
techniques. Improving all
forms of self-control,
especially Self-Awareness,
through “quieting of the
mind.”
139
Executive Functions Interventions
Fostering development of
internal and external control
mechanisms through
“strengthening of the will”;
Improving or Developing
“Magnetic Center” therapeutic
techniques such as Roberto
Assagioli’s Psychosynthesis.
140
Executive Functions Interventions
Mindfulness-based Physical
Exercise Programs such as
Yoga and Thai Chi are likely
to have generalized effects
on a number of selfregulation executive
functions.
141
Executive Functions Interventions
Time - Natural maturational
processes affect executive
functions at all levels; timerelated expectations for EF
development often need to be
adjusted (e.g., recall the 30%
developmental delay often found
with individuals with ADHD)
142
Executive Functions Interventions
Pharmacological - Medications
help increase executive functions
use in conditions such as ADHD,
mood disorders, and OCD. In most
cases, the medication does not
directly enhance EFs but rather
reduces the disrupting effect of less
than optimal function of other
neural circuitry.
143
Executive Functions Interventions
Engage the Services of a
Cognitive Coach (i.e., Renta-Lobe) Make extensive
use of an external executive
function substitutes where
appropriate, e.g., ADHD and
Life Coaches.
144
Executive Functions Interventions
Encourage Symbiotic
Relationships (e.g. “Marry-aLobe” and Support Networks.
Enter into relationships where
there is a mutual interdependence that enables reduction of
the effects of EF deficiencies.
145
Executive Functions Interventions
Progress monitoring of
interventions targeting
the improvement of the
use of executive functions.
146
EF Assessment Using the MEFS-SRAV
Effectiveness Ratings
Rate the students use (or disuse) of the 23 Self-Regulation Executive Functions using the following criteria:
Internally SelfRegulated
Externally Guided
Typically self-regulates this
executive function.
7
Extremely
effective;
does not
require
any
external
guidance;
highly
independe
nt with
selfregulation.
6
Effective;
usually does
not require
any external
guidance;
often
independent
with selfregulation;
may
occasionally
require some
external
guidance.
Externally Controlled
Typically does not self-regulate this executive
function but demonstrates the capacity to use
this executive function when external guidance
is provided.
Does not self-regulate; use of this
executive function is minimal or nonexistent even when external guidance is
provided; External control is required
as a substitute to maintain adequate
functioning.
5
4
3
2
1
Requires
only
minimal
external
guidance to
maintain
the effective
use of this
executive
function.
Requires
frequent
external
guidance to
maintain the
effective use
of this
executive
function.
Requires very
frequent
external
guidance to
demonstrate the
use of this
executive
function; use is
not maintained
even when
guidance is
provided.
External control
can be used to
effectively
substitute for the
absence of this
executive
function; the lack
of this executive
function is
apparent when
external control
is not present.
External control is
only marginally
effective or not
effective at all as a
substitute for the
absence of this
executive function;
a lack of this
executive function
is apparent even
when external
control is present.
EF Assessment Using the MEFS
MODULATE
Cues the
regulation of
the amount
and intensity
of mental
energy
invested in
perceiving,
feeling,
thinking, and
acting.
Internally
Regulated
Externally
Guided
Externally
Controlled
MODULATE
Self
Perceiving
3
Environs
Academics
3 2-3
5
3
Thinking
2
3
3
2
Acting
6
2
5
2
Feeling
7
6
5 4 3
2
Others
1
Notes: very negative about self and others; has a hard
time returning to a calm state once agitated; finds
academic work extremely frustrating; cannot modulate
attitude toward schoolwork.
Self Regulation Capacity: Focusing and sustaining attention when working independently on tasks.
Duration
Frequency
1
Never
0% of the
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.
2
Occasionally
Approximately
10% of the
time.
3
Sometimes
Approximately
20%-40% of the
time.
4
Often
Approximately
50%-70% of the
time.
5
Very Often
Approximately
80% of the time.
6
Almost Always
Approximately
90% of the
time.
7
Always
100% of
the time.
Self Regulation Goals for Lauren A College-Age Student Diagnosed with Asperger’s Disorder
Self Regulation Goal:
Use appropriate problem-solving routines to reduce excessive negative
emotional reactions and resistance to engagement when routines are altered or
unappealing tasks must be completed.
Effectiveness Rating
Internally
Regulated
7
Self Regulation Goal:
Work through and resolve difficult situations by use appropriate problemsolving routines to generate and compare alternate scenarios and selecting the
most appropriate course of action.
Internally
Regulated
7
2
1
6
Externally
Guided
5 4 3
Externally
Controlled
2
1
Effectiveness Rating
Internally
Regulated
7
Self Regulation Goal:
Recognize the need to engage in good personal hygiene routines, learn the
necessary routines, and perform the routines on a daily basis.
5 4 3
Externally
Controlled
Effectiveness Rating
Self Regulation Goal:
Recognize the need to engage in self-advocacy and use an appropriate
problem-solving routine to determine what to do and how to do it and then
carry out the actions needed to effectively address the self-advocacy need.
6
Externally
Guided
6
Externally
Guided
5 4 3
Externally
Controlled
2
1
Effectiveness Rating
Internally
Regulated
7
6
Externally
Guided
5 4 3
Externally
Controlled
2
1
Strategies for Improving
Assessment Methods
1) Offer bonus points for handing in
homework and assignments on
time instead of taking points away
2) Point out minor errors and offer
students a chance to correct them
before assigning a grade
Strategies for Improving
Assessment Methods
3) Offer feedback and
opportunities to revise writing
assignments before grading
them
4) Offer students choices for
ways to demonstrate content
knowledge
Strategies for Improving
Assessment Methods
5) Offer credit for all efforts to
correct work; offer opportunities
to retake failed tests
6) Deduct no more than 5-10% of
total points for minor detail
errors
Strategies for Improving
Assessment Methods
7) Offer multiple ways to
participate in classroom
activities, not just oral expression
8) Use pop quizzes only as a
diagnostic tool rather than a
graded performance measure
Strategies for Improving
Assessment Methods
9) Offer response choices (word
banks) for open-ended
question formats
10) Provide guidelines and
progress checks for long-term
projects
Strategies for Improving
Assessment Methods
11) Avoid placing constraints on
response modes as much as
possible
12) Teach note-taking, memory
strategies, and study skills
when necessary