Ask Amanda - Dealing with anxiety

Q:
I wanted to put a vote in for the "Ask Amanda" days - this occurred to me last night as I tossed and turned trying to work out how to help my daughter deal with anxiety. She has just started Year 1 and has had a number of wee accidents at school (none over the break) and she wakes up every night and insists on sleeping in our bed - both these behaviours have started with the new term hence I think they may be about her anxiety...would love any advice/tips or simply stories of similar experience...

A:

Imagine this...

You have just been invited to a new friend's home for dinner. It will be the first time you have been there.


Getting there

First, you double check that you have the address right and you are given a description of the place. You might even get someone to drive you past just so you are confident you can get there.

Then you consult Google maps and get a set of written directions, a map and a street view of the place. You are getting even more confident.

On the night you have butterflies in your tummy, but that is expected. Another friend who knows the way offers to come with you. So now you barely worry at all.

With a little anxiety, you get in the car. But because you have someone you trust with you, and you have a written road map, and pictures representing the place, you manage to get there and enjoy the evening - and get home!


A break

But then you don't get invited there for a while. Until one day, a few weeks down the track, you get invited again. Because you have been there before, you don't really worry. You just set off....


Getting there again

But last time you were driving at dusk, so now all the landmarks look different.

And while you thought you could remember all the turns, it turns out that you don't... and you forgot to bring the maps and instructions. And this time you are giving a lift to someone who "sort of" knows the way, but you don't know them well enough to trust them.

You do get there. But by the time you get there you are so anxious it is hard to relax and enjoy the company - all you can think of is having to drive home again.

But you don't really want to tell anyone because you feel like you should know what to do because you know you have done it before.


The analogy

No, this isn't just a random story :). It is an analogy of how a child may feel as they transition back to school after the school holidays...

"Landmarks" change, "supports" are different or fewer. And the expectations are different. For children with developmental disabilities, add to this a difficulty with problem-solving and analysing your environment, and it is no wonder that the transition back to school after the holidays is a very anxious time.


So what can we do?

I will take a little time this month to talk about what can be done. But if anyone reading this blog has a story or some advice to offer, please post a comment here.

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Helping children stay on track

How do we help children who are constantly going off task? How do we help children who don't think before they act?


Reducing distractions

One of the most important ways to help children with inhibitory control difficulties stay on task is to reduce the number of things going on in the child's environment.

- When learning: In the classroom there are many possible distractors. These can include things hung on walls, peers talking, movement around the room or outside a window. One key strategy is to have a seating arrangement that means the child is sitting away from windows, facing the front with no peers between them and the teacher and no distracting wall hangings within their direct line of site. Keep ambient noise low, paying attention to the noise coming from fans, heaters and other students.

Having clear, written rules that have been negotiated with your students will also be essential to maintain a distraction-free environment and help children with inhibitory control issues stay in their seat and on-task. You will need to have a display of these rules and frequently refer to them.

- When doing homework: It is important that a child with executive functioning difficulties not be expected to complete a task requiring concentration in a room that has many distractors. Many of these children benefit from a quiet, clear space away from TVs, toys, computers and other possible distractors.


Expect concentration on only one thing at a time

Use Pointers

Reading can be a very difficult task for children who have trouble with their "inhibitory control" because it can effect their concentration. They can lose track of where they are in the text, skipping words or even whole lines. They can be distracted by noises, and find it hard to pick up where they left off.

An effective tool is a pointer. This can be anything from a child's finger, to a laser pointer on the board, or a ruler under the line they are reading. Another tool is a little window cut out of a piece of card large enough for the child to only see one or two lines of the text at a time.

Using colour-coding can also be useful. You can highlight key words by writing or highlighting them in different colours. You can write/highlight the beginning of each paragraph, sentence or line in a different colour to help children keep track.


Break it down

Big chunks of information, or lots of steps in a task, will be hard for a child to remember if they are struggling to filter out distractions. To address this we should break tasks down so they can focus on one step at a time. The best way to do this is through checklists or graphic organisers (British Columbian Ministry of Education, 2010).

You can use visual checklists on Velcro strips where a child can remove a picture and put it in a "finished" box as each step is completed. Some places where you can get free visuals include www.visualaidsforlearning.com and www.do2learn.com

You can use a written checklists for children with good literacy skills, ensuring they can check each step once it has been completed.

It could also be beneficial to have relevant rewards for each step that has been completed. For example, a child might get 1 point each time they finish a step, and once they have gathered 10 points they are able to dip into a lucky dip of small items relevant to their interest. Other children will be motivated by merit certificates, and others by time doing a favourite activity.

Here are some charts you might be able to use:

• Desk Chart
• Step-by-step Chart
• Flow Chart
• Homework checklist (for older children)
• Chain of events
  

Stop, think, do....

To help children who are struggling to think before they act the steps involved in the Stop, Think, Do program can be used. I have discussed this previously here and here.


In conclusion...

Here is a great checklist from the British Columbian Ministry of Education that can help teachers working with children who have ADHD: www.bced.gov.bc.ca/specialed/adhd/app4.htm The strategies in this document could be helpful for any child who has executive functioning difficulties.


References

British Columbian Ministry of Education (2010) Teaching Students with Attention-Deficit/Hyperactivity Disorder: Planning for Success at School. Retrieved 31st July, 2010 from www.bced.gov.bc.ca/specialed/adhd/plan.htm

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Executive functioning and self-control

The final element of executive functioning is "inhibition." This is the function that helps us control our responses to what we see, hear and feel.


The Tigger Syndrome

Anyone who is a lover of Winnie-the-Pooh by A.A.Milne will know what I am talking about. If you aren't a fan, visit the official Disney Winnie-the-Pooh and find out a little more about Tigger. For those who don't know, his hobbies include:

"Bouncing, causing mayhem, exaggerating the truth"

For those of us who are fans, we also know that Tigger isn't a "malignant" character. He never intends to cause harm. He just gets side-tracked, is over-enthusiastic (some would say out of control :)), and has a very fertile imagination.


Perhaps Tigger has executive functioning difficulties....

Perhaps he forgets to stop and think before he acts. Perhaps his "inhibitory control" is not functioning as it should.

As Oates and Grayson (2004) state,

"If you were unable to inhibit responses to stimuli that do not relate to the task that you have planned to do, then it would probably be impossible to complete it and achieve your goal. You would be drawn from one stimulus to another, in a haphazard fashion, and it would be impossible to undertake any coherently organised action."

Example: Having a conversation

A conversation with a child who has difficulty with inhibitory control may go something like this...

Hi, Billy. That's a great picture you are drawing. Can you tell me about it?

Yeah. I am drawing a truck. I saw a truck the other day. It was red. I spilt red jelly all over my mum. She told me I had to clean it up. My room has lots of cupboards. I have a nintendo......

The original goal of the conversation was lost as the child followed whatever train of thought occurred. This can happen with tasks, where a child gets distracted by sights, sounds, movement and any other irrelevant stimuli. This is quite natural for very young children, but as we grow older and develop our executive functioning skills this behaviour should disappear or at least dramatically decrease.



In the next post I will explore some ways to help children with inhibitory control issues stay on task


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

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Helping children self-correct and problem-solve

How do you avoid meltdowns when something changes? How do you help your child recognise that what they are doing is making others upset? How can you help a child recognise when they have said or done something that "crosses the line"? Or when someone else has done something to them that "crosses the line"?


Prepare

You are about to go to a new shopping centre. Or your child is about to go to a new school. These situations will bring up a whole range of new information that they will need to quickly process in order to behave as expected and cope.

For children with executive functioning difficulties, as mentioned previously, this will cause many difficulties (Oates & Grayson, 2004). The best thing to do is to prepare your child as much as possible for their new environment.

Talk about what is going to happen. Talk about the environment, and set relevant rules (Dodd, 2005). Further, whilst talking use video, photos, even a drive past or short preparatory visit to help them process as many things prior to the visit where possible. This will help limit the amount of new information they need to process when making choices about their behaviour.

Using repetitive patterns of language, such as if... then... statements, can also children develop an awareness of possible consequences. This means that this is one less thing that they have to think up in a difficult situation.


Rehearsal

The importance of repetition and rehearsal has been discussed previously, but it is important to recognise the significance of role play in helping children develop self-awareness and problem-solving abilities. For young children, this may be done through dress-ups and dramatic play.

For children who struggle with imaginative play, using scripts will be important. That is, teach the child to use a set phrase or set of actions in response to a situation. Older children might want to help you design a screen play and video their new skill.


Visualise


Children with executive functioning issues will need help storing the information and skills, so they need a concrete reminder to carry around with them in case of "emergencies." Ways to do this include:

• A task card
• A social story
• A comic strip
  
• A picture sequence

The bottom line is to ensure that any visuals are small enough to carry in the child's pocket or on a lanyard or key ring. They need to be immediately accessible, but hard to lose.


Teach emotions

Help children get feedback from others around them by teaching them about body language and facial expressions. You can do this through books, videos, photos and picture strips (Dodd, 2005).

Recently I borrowed a great book called Sometimes I feel....: How to Help Your Child Manage Difficult Feelings by Dr. Samantha Seymour. Apart from the great hints and tips for parents/teachers at the beginning of the book, it is full of great photos of different facial expressions and body language. It also helps build awareness of what can cause someone to feel a certain way.

For example, pages 14-19 read:

Sometimes I feel angry... like when my mummy tells me I have to eat my breakfast before I can go outside and play. Or when it's my turn and my sister won't share."

These are accompanied by relevant photos of young children. This is a great book to help children recognise what can cause others to feel angry, sad, worried and so on. Knowing this can help them self-correct more effectively.

Dodd (2005) also discusses the usefulness of video modelling. This is effective as it can be played over and over again, and can demonstrate step-by-step a process of dealing with or responding to certain emotions.

Another great strategy highlighted by Dodd (2005) on page 187 are little picture cards that include an illustration of an emotion with relevant questions (see image adapted from her examples below).


Have a crisis management plan

It is important to also anticipate difficult emotions and situations when a child may not be able to cope. Have a plan for those times.

One of the strategies that has been discussed previously is the use of a feelings thermometer. This is a visual way of helping children recognise and manage difficult emotions.



Be proactive and positive

But most importantly, we should remember to always be proactive - prepare and anticipate in order to prevent negative events as much as possible - and positive, giving praise and positive reinforcement rather than focusing on "don'ts".



References:

Dodd, S. (2005). Understanding Autism. Sydney: Elsevier.

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

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Helping children adapt to change

Self-Correction:

"The ability to monitor and accurately evaluate performance and to make changes. Ability to learn from experience and feedback." (Queensland Health, 2007)

Problem-solving:

"The ability to recognise when the actions you are taking are ineffective, to stop, re-evaluate, and to formulate a plan." (Queensland Health, 2007)

Struggling with change

It would be simplifying things far too much to draw a direct link between executive functioning issues and children's difficulties adapting to change in their environment. However, it can play a significant part in this. But before I discuss the problem-solving and self-correction element of executive functioning, I want to look quickly at changes that children may find difficult to deal with, what behaviour they may display, and some other key factors that can contribute to difficulties adjusting to change.


What changes can cause difficulties?

There are many changes that can cause children with Autism Spectrum Disorders, anxiety disorders, depression, ADHD and even children who are chronically tired to feel threatened or anxious. These can include:

• New people
• Familiar people behaving differently
• Interrupted routines
• A favourite toy missing
  
• New sounds
• Moved furniture
• Complex, unpredictable interactions
  (Dodd, 2005; Oates and Grayson, 2004)
  

In fact, almost any change that a child with these difficulties is not prepared for will cause them distress.


What might you see?

Every child will have their own individual way of demonstrating that they aren't coping, or don't know what to do, when dealing with a change. Some examples:

• Meltdowns: I have talked about these in a previous post.
• Withdrawal
• "Stubborn" behaviour, or refusals. This often comes up in the context of children with Down Syndrome.
  

Executive functioning, self-correction and problem-solving

These elements of executive functioning, alongside the ability to plan and self-evaluate, help us adapt to the changes and complexities of life. As Oates and Grayson (2004) discuss, "the ability to switch flexibly between planned actions and different approaches to a task, without losing sight of the goals that are being aimed for, is a high-level cognitive function that is critically important in everyday life." (p214) That is, in order to cope with the many complexities of life - social, academic and physical - we need to be able to constantly evaluate, identify what is/is not working and adjust our behaviour accordingly.

When the executive functions aren't developed appropriately, then children will have difficulties adapting to change unexpected behaviour.

For example, imagine you are a child who loves playing in the sandpit with your two close friends. Ever since you have been at school the three of you have gone directly to the sandpit as soon as the recess bell has rung. Then one day you are heading out to the sandpit and one of your friends decides they want to join the hand-ball games instead.

You want your friend keep to your routine, so you say, "Come on! Aren't you coming to the sandpit?"

Your friend replies, "Nah. Today I feel like playing in the sandpit."

You say, "Aww. Come on! Let's play in the sand pit. We always do!"

Now, if you have a well-developed ability to self-analyse, self-correct and problem-solve, once you start noticing that your friend is becoming annoyed, you think about previous experiences, what you have been taught, how your behaviour is effecting them. You then correct your behaviour and problem-solve based on your goal of maintaining friendships ... which could mean you join the hand-ball game or go to the sandpit with your other friend.

If you have executive functioning difficulties, you would probably keep insisting that your friend maintain the routine. You may become aggressive in your attempts to maintain the routine (eg. pulling the child towards the sandpit) or have a meltdown as you are unable to work out what to do next since your routine has been broken.


Other reasons why children may struggle with change

• Theory of mind or social imagination (as discussed in a previous post) ... Not being able to interpret and respond appropriately to your social context will lead to difficulties with problem-solving and self-correction, or the ability to be flexible and adapt to your environment.
• Intellectual Disability ... a person's IQ is only one element of diagnosing an intellectual or developmental disability. The other element is an assessment of adaptive behaviour. As the American Association of Intellectual and Developmental Disabilities states, adaptive behaviour is about the ability to use language, social, conceptual and practical skills to live independently and according to the social expectations of our culture. It is therefore recognised that a person's cognitive development influences their ability to problem-solve and self-correct.
  

Next time....

Next time I will talk about ways to help children self-correct and problem-solve.



References:

Dodd, S. (2005). Understanding Autism. Sydney: Elsevier.

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.

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Routines to help children get started

Q: What do you do with the child who can't seem to get organised in the morning?

A1: Have a set routine - repetition and rehearsal replaces the difficulties caused by executive functioning issues. It means that the routine becomes automatic - you don't have to think, analyse, prioritise or plan. So do the same things, in the same order to start the day.

A2: Use visuals - especially for young children or children with language and/or literacy difficulties.
A3: Use checklists - especially for older children or children who have good literacy skills. You can do this on little whiteboards, or you can use a table like the one at www.do2learn.com.

A4: Have a time frame - leaving time open can increase the chances that the child will daydream, or spend too much time focusing on details rather than the sequence of things they need to get done.

I recently went to a workshop by Dr Lee Sturgeon where he talked about the use of a Time Timer. This is a great tool that will help children keep track of how time is passing. You can find information on the different formats on the following links:

• Spectronics - find the watches, clocks and software application here.
• The iphone application can be found here.
  
• Find the complete package here - iphone application, software version and traditional clock version.
  

Q: What do you do with the child who takes ages to get settled in class?

A1: The same as might be done at home: have a set routine. This might involve a simple routine that determines the sequence in which the necessary equipment for the day is unpacked. Or it may simply be a routine such as:

• Line up
• Walk in quietly
• Sit down
• Get out your pens and books
• Look at the teacher
  

A2: Again, as with home, use visuals to represent your routine.

A3: Use checklists and advanced organisers. For example, this chain of events graphic organiser from educationoasis.com. You can find more here and here.

A4: Have a time frame - this is very important in classrooms as children with executive functioning issues often get "left-behind" at the beginning of lessons as they struggle to get organised and started. This can then have a significant impact on the rest of the lesson - or the rest of the day.

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Getting Started takes initiative

Children with executive functioning issues can find it very hard to get started and persist with a task (Kidsmatter, 2009; Queensland Health, 2007). This is due to the "initiation" element of executive functioning.

One of the reasons why children with executive functioning issues have this difficulty is because they find it hard to filter, or prioritise, activities and information (Dodd, 2005).


An Example

Have you ever woken up on a day when there are a hundred different things you need to do? How do you decide on what to start with?

One way we make decisions on where to get started is by identifying what is most urgent or important. But this requires the ability to identify what our goals are (planning) and what we are able to do in the time we have with the skills we have (self-evaluation). So if you have trouble with all these things, you could:

• Spend all day lying in bed stressing about where/when/how to start
• Start a range of tasks and never get them finished as you get distracted by the possibility that you are not focusing on the most important task.
  
• Choose something randomly, with a high chance that the task turns out to be one that you could have done another time, while a more urgent task goes untouched.

As you can imagine, this can have a significant impact socially, academically and in every day tasks for children with executive functioning issues.


At home

Due to this struggle with initiation, children will find it difficult to:

• get ready for school on time
• follow every-day routines without verbal, written or visual reminders
• clean their room without being distracted by a favourite book, toy or TV show

At school

Due to the struggle with initiation, children will find it difficult to:

• Concentrate on the task at hand without being distracted by what is going on around them
• Get organised and ready to start at the beginning of a lesson
• Finishing what they have started

In the next few posts we will explore how we can help children prioritise, organise and stay on track even if they do have executive functioning issues.

References

Dodd, S. (2005). Understanding Autism. Sydney: Elsevier.

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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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.

Read more...

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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No such thing as evil

“There is no such thing as evil. Youth behaviour that challenges the common expectations and values of society is not the result of inherent wickedness, but is a multifaceted problem emerging from a complex network of factors.” (Leaman 2005 p1)

I don’t think there is anything I want to add to that… I just thought it was a great, thought-provoking statement. It draws attention to what is not always in the forefront of our minds when we are dealing with the most difficult behaviour: that behaviour is very complex and there are many factors both seen and unseen that influence that behaviour.

But, like Leaman, I also want to make that point that this is not excusing behaviour. Rather, it is an attempt to understand it so we can effectively change it.

Leaman also talks about three hidden contributors to aggressive or other disruptive or difficult behaviours.

Low self-esteem

There are many reasons for low self-esteem, but one that children with differing abilities may face more frequently than others is failure. Failure in the classroom. Failure in social relationships. Failure in achieving their potential in other areas.

A child who experiences what they see as failure can be at risk of spiralling into disempowerment and/or depression. For some children this can be seen in bullying behaviour as the child tries to empower themselves. For others it can be seen in both passive and active defiance, or refusals to complete tasks.

For example, it is recognised that children diagnosed with Oppositional Defiance Disorder often have low self-esteem (Better health Channel, 2007). Their refusals to obey rules, swearing, blaming or needling others can be linked to (though they are not exclusively a product of) low self-esteem and the need for power and control. Refusals to obey rules and swearing or bullying others swing the balance of power back in their favour. Blaming others for their mistakes or errors, or simply refusing to attempt tasks, can be a protection mechanism to avoid being seen as weak or having failed in a task. By doing these things they are controlling their environment through intimidation or defiance.

Egocentricity

Acting impulsively or acting without first considering the effect of their actions on others can also be a contributor to aggressive behaviour. For more on this see the previous posts on executive function and the development of empathy.

Internalised anger

Children with Down Syndrome can also be seen as stubborn or defiant. However, the issue is more that, due to their intellectual disability/developmental delay, it is more likely that they do not understand what is required of them (Feeley & Jones, 2006). The difficulty is that they may find it very hard to put into words as their developmental delay and physical difficulties can influence their ability to communicate complex, abstract concepts like emotions. This may be exacerbated by low self-esteem from experiences of “failure”, and thus increase the risk of the child acting aggressively or defiantly in order to express their feelings or protect themselves from embarrassment.

It is important, in this case, to recognise that children with Down Syndrome have been shown to be at increased risk of depression and other anxiety disorders (Pollack, 2009). So responding to the needs of the child rather than focusing on the behaviour is important.


Leaman has some great suggestions of strategies to deal with difficult and aggressive behaviour. If you can get your hands on this book, whether you are a teacher or a parent dealing with challenging behaviour, I am sure you will find it very helpful.


References:

Better Health Channel/Victorian Government. (2007). Oppositional Defiance Disorder. Retrieved 26th August 2009 from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Oppositional_defiant_disorder

Feeley, K. and Jones, E. (2006). Strategies to Address Challenging Behaviour in Young Children with Down Syndrome. Retrieved 26th August 2009 from http://www.down-syndrome.org/case-studies/2008/

Leaman, L. (2005) Managing Very Challenging Behaviour. London: Continuum

Pollack, S.D. (2009) Waisman Center. Retrieved 26th August 2009 from http://www.waisman.wisc.edu/faculty/pollak.html

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Ask Amanda

I am so sorry I have been neglecting my blog lately. It has been a very busy time getting Dave is Brave ready for print. But it is at the publishers now so I should have a little more time to write this week.

As I usually do at the end of every month I try to answer some of the questions asked by parents and teachers reading my blog. In this post I want to address the question directed at me from a parent. The question was….

Do you have suggestions how to improve working memory and executive function?

Here are a few things to think about…

Helping address working memory

… by linking new information to what the child already knows or using routine

If you are trying to teach a child a new skill in a way that will help it stick, make sure you tie it into something that the child is interested in or knows about. Keep referring back to this. Repetition may also help it stick.

Of if you want them to remember things like the equipment they need to pack in their bag for school, establishing a routine could be helpful.

For example, every day before school have your child do the same sequence of things – get up, have breakfast, get dressed, check the day’s timetable (if in secondary school), pack required equipment, watch cartoons if there is any time left.

The same principles can be applied to learning. Establish a classroom routine. When teaching new concepts, give examples that the child can relate to. Use their interests, like their favourite sport, art or music, to help establish the new concept in their minds.

…. By using songs, rhythm and rhyme

In addition to routines and repetition, use rhymes and mnemonics.

We (especially of the older generation) are likely to remember key spelling rules through rhymes like “i before e except after c”. Or the mnemonic “every, good, boy, deserves, fruit” to help us remember musical notation.

These can be useful and fun tools both at home and in the classroom to help children remember concepts and tasks.

… by using visual or written reminders

Most children with working memory issues will also benefit from visual or written reminders as well.

To help children learn maths, spelling and reading, hang words, numbers, formulae and poems or short stories around your house or classroom. Read these regularly. Label everything, and get children to read the label every time they want to use that object. Keep the same words hanging in one spot until the child can un-erringly read it for three or four days in a row. But make sure it remains fun, even if you have to use incentives.

For example, you might have a lucky dip box. Have a word or phrase or number on that box. Every time the child reads the word, they get to open it and take a reward. But make sure you reward their attempts at reading the word as well as their successes.

Using repetition, and the child’s learning style – whether it be visual (pictures), hands-on (learning by doing) or auditory (singing, speaking) – will increase the chances that they will remember what they have been taught or told.


Other aspects of helping address executive function

Impulsivity

Acting impulsively can be a great difficulty for children with executive function impairments. One of the tools that can be adapted for children, and adults, is the “stop, think, do” process.

This is a program originally introduced by Lindy Petersen, a child, clinical and family psychologist.

Basically it is about using visual and physical cues to help children stop and think about the consequences of their actions before they “do”. For children who act impulsively, this is the function that they fail to go through.

An example of how it may work:
You have a picture of traffic lights hung on the wall. You talk about what each colour means.

Red = stop = stop what you are doing, take a breath and relax.



Orange = think = ask, “What am I going to do? What will happen if I do it? Is there a better choice?”


Green = go = only go when you have thought about what will happen and made a good choice.

You then establish a signal. For example, you may hand out a red card like a penalty card in football (soccer). Or you may use a “stop” hand signal. The child then understands that they need to work through the process.

For a while you may need to get them to talk through their options with you, but the aim is to eventually get them to work through the process quickly and without your help.

You can read more about the process at:
http://www.stopthinkdo.com/display_article.phtml?article_id=3

There are also articles on the site about how the process can be used to help children with ADHD, Autism and anxiety disorders.

Disorganisation

Some simple things to help with the problem of disorganisation and forgetfulness:
1..Checklists of equipment hung on the wall, or on your child’s timetable. These can be visual (such as a photo) or written, depending on the child’s learning style.
2..Timetables, visual or written, hung on the wall preferably so they cannot be misplaced. These will help you establish your routines and help your child get into good habits – both at home and at school.
3..Set storage spaces. Have routine and even labelled spaces for important equipment that may be continually going missing.
4..Diaries may be useful, but only if the child doesn’t lose them. Try using email, watch alarms, or programs like Outlook to ensure your child is less likely to lose the tools meant to help them remember things like homework etc.

I hope that is helpful.

Picture from Dave is Brave, http://www.learn2bebuddies.com.au

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