The importance of routine...

We can help children with executive functioning issues using routines.

For example, a child with ADHD may lose track of time, not remember where they are up to or what they are meant to be doing. They may hear a school bell, and not know what it means. as bells at different times mean different things.

Routines can be used at home as well as at school. But there are some key elements to making them work.


Be Clear

The best way to make sure the routines are clear to a child is to provide them with a written or visual schedule. First thing of the day, either in class or at home, go over the schedule so the child knows the goals for the day. This will help them follow a pattern or plan to achieve the desired goals.

Goals such as getting ready for school, listening to the teacher, playing with friends, catching the bus... all these have associated behaviour and social skills. If there is a familiar routine, the child is more likely to have success with these goals.

Image from Sparkle Box

Stick to the Plan

It is important that once you establish a routine that you stick to it. Variation can cause behaviour difficulties such as meltdowns that come out of the child's difficulty in adjusting to changes ... which is about the difficulty with flexible thinking, a topic I will discuss when I come to the self-correction element of executive functioning.


If you can't, give warning

There will be times when unforeseen circumstances may interrupt the routine. As far as you are able, make sure that you talk to the child about this. Use visuals to prepare them for the change. This could be about getting them involved in taking one thing off their timetable and replacing it with the new event. This will help them process the information.


Rehearsal

However, as discussed in the previous post, repetition is the key. The more you repeat a process, the more automatic it will become. This way it will be easier for a child to keep track of what is going on and what they should be doing in different settings at different times.

It will help them plan, or act with purpose as they work to achieve a goal either socially or academically (Oates & Grayson, 2004).

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Visual cues to help planning

Recently I wrote a post about the Stop, Think, Do! program on the Learn to be Buddies Series blog. This has been used with some success with children who have executive functioning issues because it helps with the planning process in social situations.

I will discuss the "Stop!" step when I address the inhibition element of executive functioning. In this post I want to focus on discussing the "Think!" phase.


Think!

The "think" phase is about helping children think ahead, identify choices and consequences for their actions before they act.

The catchy, simple phrase "Stop! Think! Do!" is acts like a script in a play. It provides structure to help a performance run smoothly. But the only way it can work is if it is rehearsed and if we have prompts in place to remind a child about what they should be doing if they get off track.


Prompts

At first introducing a child to this phrase, you will need to discuss each step. When you come the the "Think" phase you will need to find ways to help children make links between the way they act and how this affects others.

One way can be developing "if ... then ..." visual or verbal statements depending on the child's way of learning. If you are helping a child with Autism, it is usually best to use visuals. If you are helping a child with ADHD, visuals may be appropriate but you may find that older children/youth can also learn through verbalising "if...then" statements.I made up this little visual prompt using microsoft clipart, but there are many different options for visuals. More and more schools, preschools and other services for children with disabilities have access to Boardmaker, which is a valuable tool for helping children who learn visually.

If you are using visuals, make sure they are hung in and around the places where the behaviour is most likely to occur. The example above would be hung in any room or space dedicated to craft activities. This way the child's memory will be constantly triggered every time they look up. Further, you will be able to use the visual to remind children about the consequences for their actions.


Rehearsal

It is important that any script or prompt be used repeatedly. This repetitiveness helps children with executive functioning issues remember.

Executive functioning issues effect the working memory and so can make it harder for things to "stick". The more you use the phrase, "Stop! Think! Do!" and the same visual prompt, the more likely it is to "stick" with the child. The product of this is hopefully helping children plan and make more appropriate choices socially and in risk-management.


Just remember:

Children won't be able to plan if they don't first stop. Don't try to talk a child through a problem if they are in the middle of a melt-down. Help them relax and regain control first.... I will talk more on this when I come to discussing the "inhibition" element of executive functioning.

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Executive Function and Planning

"Planning... is about intending to do something that will achieve a goal."
(Oates & Grayson, 2004 p214)

The second key element of executive functioning is the ability to plan before you act. This function helps us identify what we want to do and predict what might be the consequences of our actions (Queensland Health, 2007).


When it works well...

Imagine you are at a social gathering and you have just been introduced to someone new. What you notice first is what they look like. But you choose not to say anything about their purple and orange striped hair, or lush purple pants worn with a startlingly red sequenced top that is perhaps several sizes too small for their curvaceous figure.

Instead, you say something like, "So how do you know Kim?" (which is the mutual friend who just introduced you).

This is because you have a plan: To get to know someone new and avoid offending them or your mutual friend.

And you have thought about what fits with that plan: This is based on what you predict will be the consequences of various things you could have said based on your knowledge of social rules and theory of mind.


Theory of mind

Theory of mind is broadly defined as the ability to predict or think about what others may be feeling. Robson (2006) adds that it is about:

"understanding that other people's thoughts, beliefs, feelings and desires may differ from our own, and that our own can change over time." (p70)

This is what helps us empathise, behave with respect, as well as avoiding being tactless and behaving in ways that hurt or offend others. It has also been called social imagination - see this previous post for further discussion.


When you forget to plan...

Think back to the previously described scenario where you have been introduced to a colourful new person. If your executive function of planning is not working efficiently, instead of acting according to a goal you might simply say whatever comes into your head.

For example, "My goodness, your hair is bright!"

"Your top is a bit small, isn't it?"

"Why are you wearing purple pants?"

"So you're the entertainment for the party?"

All of which are likely to produce reactions such as embarrassment or anger or other responses not helpful to the development of new friendships.

Statements like this might be cute (though still embarrassing) coming from very young children - basically because they have not yet had enough experience to develop awareness of the consequences for such statements. But as adults it is expected that you would have a bit more tact and respect for individual differences.

Alternatively, you might get away with saying things like this to a close friend, someone you know well and who knows the intent behind your words is not nasty or destructive. But, if you had really thought about the consequences of your words, these should not be the first words you say to someone you have just met.


How it effects learning...

Without planning we will struggle with:

• Bringing all our equipment to class
• Getting assignments done on time
• Completing our work in a logical, step-by-step way in the time allotted in class

What can we do?

Next time I will write about what we can do to help children with executive functioning issues plan before they act.

References:

Oates, J. & Grayson, A. (2004). Cognitive and Language Development in Children. Blackwell Publishing: Oxford.

Queensland Health. (2007). Executive Function and Capacity. Retrieved 8th May, 2010 from http://www.health.qld.gov.au/abios/documents/behaviour_mgt/exec_functn_capacity.pdf

Robson, S. (2006). Developing Thinking and Understanding in Young children: An Introduction for Students. Routledge: London.

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Using Journals and Charts to help older children self-evaluate

I just wanted to write one more post about the self-evaluation element of executive functioning because it plays such an important role in our children's self-esteem, learning progress and social development. In this post I want to focus on how we can use a KWL chart and/or learning journal to help children identify their successes, what they have learnt and what they have yet to learn.


A KWL Chart

Blaxendall (2003) discusses how important advanced or graphic organisers can be in helping students with special needs organise their thoughts and recall important information when approaching an academic task. A KWL chart is one example.


As seen above, this chart has three columns. The first and second columns are completed before a student begins a task or is introduced to a new topic. The first column is a way to help them "brain-storm" or activate their "search engine" for anything they might know on the topic. The second column is to help them think about what they don't know (recognising their limitations), and it also helps engage them with the topic as they think about what might interest them.

The final column is an explicit way of noting down their successes. This chart can then be pulled out the next time they complete a task on the same topic, helping them to recall information and self-evaluate before they start the new task.


A Learning Journal

A learning journal is an informal way of doing the same thing. It can be a place to record words learnt, formulae that need to be remembered, work samples (like work sheets, photos of a project completed) of which the child is proud. All these can help students, no matter what their age, recall important information.

A learning journal should be something that records the most important information, like a study guide, rather than the child having to search through pages and pages of writing or activities that have been done in class.


A final word on self-evaluation

On a final note, it is important to acknowledge once again that children with executive functioning issues can find it hard to find the completion of a task or success in a social situation intrinsically rewarding. That is, they may not get the same feeling of pleasure or satisfaction from a task well done, or from successfully resolving a conflict with a friend. For this reason our rewards systems, or extrinsic rewards, are very important in helping to build their self-efficacy and desire to use the skills they have been taught.


References

Baxendell, B.W. (2003). Consistent, coherent, creative: The 3 C's of graphic organizers. Teaching Exceptional Children, 35(3), pg. 46.

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Helping children/youth put things in perspective

A broken search engine can lead to unbalanced thinking.

To help us "understand and measure [our] strengths, weaknesses, resources, and opportunities [and] understanding of the difficulty level of specific tasks" (Queensland Health, 2007) we need to think back on our past experiences. If our "search engine" isn't working, or if we can't relate anything we have done before to the activity or task, then we can find it very hard to be balanced in our thinking.


Panic!

An example is when I went with a young relative of mine to the Sydney Aquarium. The closer we got to the Aquarium, the more unsettled the child was - until we got nearly to the entrance and the tears and panic began.

It turned out that the presence of sharks was the trigger for the distress. But once we had talked about the fact that the sharks were behind thick glass, and that many people were coming and going without being harmed, the panic subsided.


Think Good, Feel Good

One of my favourite books is Think Good, Feel Good by Stallard (2002). There are two versions of the book, one for younger children and one for youth. The book is written in simple language and has a lot of teacher/parent resources that could be used to help children/youth with problem-solving and managing their thoughts and emotions. I have a copy of the booklet for youth.

In Chapter 7 Stallard talks about challenging our negative thoughts. He provides a table that could be used when youth have got into a cycle of thinking that is preventing them from recognising their strengths, resources or opportunities. The table guides youth to answer the following questions:

• What were your thoughts and how strongly to you believe them? (Use the scale or a "thought thermometer" to rate it - see below)
  
• What evidence supports your thoughts? What evidence challenges these thoughts? (This encourages youth to look for facts - activating their "search engine")
• What would your best friend say about these thoughts? What would you say to them if they had these thoughts?
  

All this aims to help them work in a step-by-step way through the process of self-evaluation, and to self-evaluate in a balanced way by using the questions to prompt memories or bring up relevant information.


References:

Queensland Health. (2007). Executive Function and Capacity. Retrieved 8th May, 2010 from http://www.health.qld.gov.au/abios/documents/behaviour_mgt/exec_functn_capacity.pdf

Stallard, P. (2002). Think Good- Feel Good. John Wiley & Sons: Australia

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Helping children self-evaluate

To help with self-evaluation, we need to help children keep records of their successes - and review their limitations.

In the last post I addressed self-evaluation, one task driven by our executive functioning as identified in the document by Queensland Health. As mentioned, when our executive functioning isn't working as it should, we find it hard to "search" our previous experiences and learning to work out what strengths and difficulties we bring to a situation.

So for children with executive functioning difficulties - including many who have ADHD, Autism, anxiety disorders, cerebral palsy and a range of other conditions - we need to find more visual ways to help them recognise and remember their strengths and limitations.


Rewards and Behaviour Charts

Starting from a very young age we can use reward charts to help children identify and remember their successes. We can use these for social and behaviour skills, as well as learning achievements.

There is a difference between using rewards as a "bribe" and using them as a prompt for their memory. For example, if you say "If you do ...., then you will get..." then the reward becomes a bribe. If you say, "Let's look at our stars. What do we need to do?" then the reward becomes a reminder.

A very subtle difference, but one that is important.

For a reward system to work as a reminder rather than a bribe, it needs to be focused on specific things. See the example below from www.freeprintablebehaviorcharts.com/

If used well, rewards charts can be a visible record of achievements, reminding children of what they are able to do, as well as a reminder of what you want them to do.

For some great, free behaviour charts and records visit www.freeprintablebehaviorcharts.com/ If you know of any others, please share them with us.


Social Stories

I have discussed social stories at length in a previous post, so I won't discuss them in depth here. However, it is important to recognise that social stories can help children recognise their limitations as well as their strengths.

For example, a social story can be used to explain when they should ask for adult help when faced with bullying or other safety issues.

"I will try to find an adult when someone bigger than me says things that make me sad."

Communication Book

I wrote a little about communication books in a previous post. These are not only great ways to keep the communication lines open between home and school when a child has communication and/or memory difficulties. They are also great records to help remind a child of what they have achieved and learnt.

Read the communication book together like a storybook. Read it before your child goes back to school if possible. This can stir their memory and help activate their "search engine" for relevant things to apply to their day.


Hang reminders everywhere...

Hanging reminders (with visuals such as those you can find here) everywhere can also help children self-evaluate.

"I can tie my own shoe laces!"

"I can get dressed by myself!"

"I can carry my own bag."

"I can say, Thank you! when somebody helps me."

In the next post I will explore some strategies for older children, like using diaries and learning journals....

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Executive function, self-esteem and risk taking

Executive function is like your own personal search engine.

When you face a task or situation, this brain function immediately goes into search mode. It asks the questions:

• Have I done this before?
• How did I do it?
• What did I do that was successful? What didn't work?
  

This helps you to face the task or situation with a real sense of your abilities and limitations.


Why some toddlers have no fear

Many toddlers do things that give their parents heart-attacks (not literally, of course). Things like climbing in unlikely places. Or running off to explore... despite busy roads and the risk of getting lost.

Why do they do these things?

Because they haven't yet built up a bank of information that tells them what is safe and what is dangerous. Or, to put it in other language, they haven't had a wide range of experiences that their "search engine" can draw on to build a picture of their abilities and limitations.


Why some children with executive functioning issues have no fear

As we heard in several of the parent stories told last month, one of the greatest fears for parents of children with Autism was the fact that they may run away when in public. This is not because of a lack of experience. This is because their "search engine" isn't working in the same way as other children their age.

This means that if you are walking them through a shopping centre, and they see something they want, their executive function does not flash warnings based on prior experiences and what they have been taught... eg.

"I might get lost if I run away"

Instead, their "search engine" doesn't kick in, and they may act without applying any thought about previous experiences at all.

So, for children whose executive function is affected by different conditions, you might find that they take big risks - physically (like getting stuck up a tree), emotionally (like trusting someone who ends up bullying them), or academically (like picking books to read that are beyond their reading ability).


Why some children with executive functioning issues live anxiously

The other side of this difficulty using their "search engine" is that children will also not be able to recognise and apply their strengths. If you approach a task or event without applying memories about previous experiences of success, you are less likely to feel confident.

This contributes to children being timid or anxious in new environments. It also may mean that they struggle with a task that they had successfully completed in class the day before. And it may also contribute to timidity or shyness when interacting with other people.

So executive functioning can effect your self-efficacy, or your belief in your own ability built up by learning from watching others and your own experiences (Cherry, nd). This, in turn, plays a role in your self-esteem.


Who might have these difficulties?

Children who might have these difficulties include those affected by Autism, ADHD, Bi-polar Disorder, Depression or other developmental disabilities.

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What is Executive Functioning?

"Executive functions allow us to set goals and maintain focus, screen out distractions, check our progress and regulate feelings." (KidsMatter, 2009 p2)

Executive functioning is a brain function. It helps us to understand, remember and follow all the unspoken rules and processes involved in everyday life. If our executive functioning is effected by health issues or conditions such as Autism and ADHD it can have a significant effect on how we interact with others and learn in our environment.


The Elements of Executive Function

Queensland Health (2007) discusses six key areas which are effected by executive function. These include:

1. Self-evaluation
2. Planning
3. Initiation
4. Self-correction
5. Problem-solving
6. Inhibition

This month I want to focus on discussing each of these in more depth, and make suggestions about what strategies can be used to help address the issues that arise from each area.


What might it look like?

Let's first explore what difficulties with executive functioning may "look like" in children.


Getting ready for school

Imagine a child getting ready for school. They have to remember to follow a series of steps that look something like this:

• Get out of bed
• Eat breakfast
• Clean your teeth
• Get dressed
• Pack your bag with everything you need for the day
• Get to the bus stop by 8.00am

For most children they may require one or two prompts during the process... but generally they will get on the bus at the right time with all the equipment they need for the day.

For children with executive functioning issues, they will struggle to monitor time. They may focus on thoroughly doing each task, but miss the bus because they couldn't get organised in time. Or they may get distracted by cartoons, seeing a football that is just begging them to kick it, looking for something.... then forgetting what they were looking for.

They many need constant reminders of what to do next, which will probably make the morning a "little" ;) more stressful. And then mum or dad will probably need to check what they have packed to ensure they have not left any important things like pencil-cases and homework at home. And because they lost track of time, mum or dad may have to run them to school because they missed the bus.


At school

Despite having their bag checked by mum or dad, they may turn up to their first class without essential equipment (eg pencils and books). They will also find it hard to settle into class, finding it hard to start concentrating on the things that are important, like the teacher's instructions, as opposed to greeting friends or trying to find their favourite pen.

And when the teacher starts to teach, the child may call out regularly- not intending to disrupt, but because they have a thought they want to express, either on the topic the teacher is talking about or about something seemingly irrelevant but triggered by what the teacher said. They either don't recognise that is not an appropriate time to speak, or only think about this once they have started speaking.

And when they get out on the playground, they are more likely to get into tiffs or find it hard to maintain friendships because they tend to not think before they act. Which means they may hit or kick when they are angry, be excruciatingly truthful about what they think of their friends, be a bit bossy or struggle to wait their turn or share.


Back home

Then when they get home they discover they have left their bag at school, containing the homework that must be done by tomorrow. When they get to school the next day, they find the bag and discover that it contains rotting food since they forgot to eat it due to being distracted by all the fun on the playground.

When they get home they also find it very hard to be controlled in any way because they have spent so much of the day trying to follow rules and not to get in too much trouble at school. Which makes the first few hours after returning from school very hectic, and homework next to impossible, with the child usually being sent outside to kick a ball, jump on the trampoline or punch their punching bag until they feel better.


These are just some of the patterns of behaviour and interaction that you might see in a child who has difficulties with executive functioning. If this rings a bell with you as a parent or teacher, then I hope the next series of posts will be useful for you.

References:

Kidsmatter (2009). How Attention Deficit Hyperactivity Disorder (ADHD) affects children. Retrieved 8th May 2010 from http://www.kidsmatter.edu.au/wp/wp-content/uploads/2009/09/adhd-overview.pdf

Queensland Health. (2007). Executive Function and Capacity. Retrieved 8th May, 2010 from http://www.health.qld.gov.au/abios/documents/behaviour_mgt/exec_functn_capacity.pdf

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