Executive Functioning Archives - Page 2 of 6 - North Shore Pediatric Therapy

Executive Functioning Skills for School Success

in Executive Functioning, Occupational Therapy, Parenting, School

Multi-tasking seems to be the norm of the everyday lifestyle. When you think about it, in order to multi-task, your brain needs to be able to focus on two different types of stimuli, organize two sets of information, plan for two different motor movements and remember two sets of “to-do” lists. Sounds like a lot of work! The ability for your brain to do this is possible with executive functioning skills. Executive functioning skills are the higher-level brain skills that allow a person to complete tasks throughout the day. These skills include memory, initiation, inhibition/impulse control, shift, and organization. Executive functioning is best understood by listing specific skills, however, it is not a unitary skill. Often times, these skills build upon one another and are used in conjunction to complete complex tasks.

School places executive functioning demands on children on a daily basis; from reviewing the daily schedule to written work. Some children find the school day to be more cumbersome due to difficulty in utilizing one or more executive functioning skills. When these executive functions are not working effectively, the individual, despite strong abilities, can experience significant problems in many aspects of learning, getting work done, social functioning, and self-esteem. These children, with or without an executive functioning or attentional difficulty diagnosis, can appear confused, become frustrated or angry easily, or refuse to complete work.

As the demands of school increase with each passing year, having well-developed executive functioning skills is critical to academic success. Below is an overview of each of the before mentioned executive functioning skills, along with, activities to help promote these skills at home.

Executive Functioning Skills Overview:

Executive Functioning Skill	Definition	Activities to Try
Memory	Ability to retain and manipulate distinct pieces of information over short or long periods of time	Sequential tasks of 3-5 steps with or without use of visual aides.Memory card games Recall the events of the day in order from waking up to dinner time.
Initiation	Ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies.	Utilize a “to-do” list of 3-5 items. This will encourage the completion of each task.Minimize distractions: encourage work to be completed in a specific location in the house with minimal visual and auditory distractions. Create a weekly schedule for house-specific initiation of tasks (i.e., chores). Each day should have its own specific task to decrease the amount of demands presented.
Inhibition/Impulse Control	Ability to stop one’s own behavior at the appropriate time, including stopping actions and thoughts.	Teach social rules for a variety of settings: “When we walk into the store, first we will look at mommy’s list, and then we can look at bikes”.Redirect your child when they are interrupting you: “I am talking on the phone, I can talk to you as soon as I am done”. Make sure to praise your child immediately after you direct your attention back to him. Incorporate a fidget into daily activities, especially sedentary tasks, to provide a means to “get the wiggles out” without needing to flee from the task.
Shift	Ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation.	Create a cognitive obstacle course: create 3 stations in which the child is to complete 3 different tasks (ex. gross motor, writing, puzzle) with 3 minutes dedicated to each station. Rotate between the stations until all 3 tasks are completed.Encourage multi-tasking in a structured manner. Sedentary tasks for multi-tasking can include a game-play scenario mixed with writing. Use of a picture schedule to promote ease and regulation during transitions between activities.
Organization	Ability to manage current and future-oriented task demands. OR Ability to impose order on work, play, and storage spaces.	Create a “school ready” system to promote organization of school materials. This can be done in multiple ways: folders, binder system, use of a weekly planner.Use of graphic organizers for academic success: outline templates, Venn diagrams, idea webs, 3-5 step sequence graphs, main idea organizers. Create a map of the school: utilize this map to establish a routine for navigating the hallways in an efficient and timely manner, including stops at either the bathroom or locker.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Understanding the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V)

in ADHD, Diagnostics, Executive Functioning, Neuropsychology, Parenting

In the world of psychological assessment, the Wechsler Intelligence Scales are considered to be the gold standard measures of intellectual functioning. The assessments represent over 70 years of research and subsequent revisions that reflect advancements in neurodevelopmental and neurocognitive research, psychology, technology, and changes in population. (Wechsler, 2014).

The Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V):

One of the most commonly used assessments for school-aged children is the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V). The assessment generates five composite score indices:

Verbal Comprehension (VCI)
Visual Spatial Index (VSI)
Fluid Reasoning Index (FRI)
Working Memory Index (WMI)
Processing Speed Index (PSI)

Together, a Full Scale Intelligent Quotient (FSIQ) is developed. When large discrepancies are identified between the indices which comprise a child’s FSIQ, alternative scores can be calculated to best capture a child’s cognitive profile. Alternative scores may be considered when deficits in language, attention, or motivation appear to have negatively impacted a child’s overall performance. Through the analysis of the general and specific domains of cognitive functioning, clinicians are better able to make informed decisions regarding diagnostic conceptualization and treatment recommendations.

WISC-V Composite Score Indices:

VCI: The VCI measures verbal reasoning, understanding, concept formation, in addition to a child’s fund of knowledge and crystallized intelligence. Crystallized intelligence is the knowledge a child has acquired over his or her lifespan through experiences and learning. The core subtests which comprise the VCI require youth to define pictures or vocabulary words, and describe how words are conceptually related. Children with expressive and/or receptive language deficits often exhibit poorer performance on the VCI. Studies have also indicated that a child’s vocabulary knowledge is related to the development of reading abilities, and as such, weaker performance on tasks involving vocabulary may signal an academic area of difficulty.
VSI: The VSI measures a child’s nonverbal reasoning and concept formation, visual perception and organization, visual-motor coordination, ability to analyze and synthesize abstract information, and distinguish figure-ground in visual stimuli. Specifically, the core subtests of the VSI require that a child use mental rotation and visualization in order to build a geometric design to match a model with and without the presence of blocks. Children with visual-spatial deficits may exhibit difficulty on tasks involving mathematics, building a model from an instruction sheet, or differentiating visual stimuli and figure ground on a computer screen.
FRI: The FRI assesses a child’s quantitative reasoning, classification and spatial ability, knowledge of part to whole relationships. It also evaluates a child’s fluid reasoning abilities, which is the ability to solve novel problems independent of previous knowledge. The core tasks which make up the FRI require that a child choose an option to complete an incomplete matrix or series, and view a scale with missing weight(s) in order to select an option that would keep the scale balanced. A child with fluid reasoning deficits may have difficulty understanding relationships between concepts, and as such, may generalize concepts learned. They may also struggle when asked to solve a problem after the content has changed, or when question is expressed differently from how a child was taught (e.g., setting up a math problem by using information in a word problem). Difficulties with inductive reasoning can also manifest as challenges identifying an underlying rule or procedure.
WMI: The WMI evaluates a child’s ability to sustain auditory attention, concentrate, and exert mental control. Children are asked to repeat numbers read aloud by the evaluator in a particular order, and have memory for pictures previously presented. Deficits in working memory often suggest that children will require repetition when learning new information, as they exhibit difficulties taking information in short-term memory, manipulating it, and producing a response at a level comparable to their same age peers. It is also not uncommon for youth with self-regulatory challenges, as observed in Attention-Deficit/Hyperactivity Disorder (ADHD) to present with difficulties in working memory and processing speed (noted below).
PSI: The PSI estimates how quickly and accurately a child is able to process information. Youth are asked to engage in tasks involving motor coordination, visual processing, and search skills under time constraints. Assuming processing speed difficulties are not related to delays in visual-motor functioning, weaker performance on the tasks which comprise the core subtests of the PSI indicate that a child will require additional time to process information and complete their work. In the academic context, school-based accommodations may include allowing a child to take unfinished assignments home, focusing on the quality of work over quantity, shortening tasks, and allowing extended time.

In summary, IQ is more than one aspect of functioning and encapsulates several factors described above. As a result, it is often more helpful to assess the indices which comprise a child’s FSIQ separately in order to best inform treatment and intervention.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Strategies to Keep Your Child Organized This Summer

in ADHD, Executive Functioning, Parenting, Summer

Spring is in the air and with the warm temperature creeping in, this is a sure sign of one thing to come…school’s out for summer! For many, this is a time of year we look forward to, but it can also be a difficult time for our kiddos with ADHD that benefit from the structure and routine that school provides Monday through Friday. Check out these useful tips to help ward off the “I’m bored” summer bug.

Tips to Keep Your Child Organized This Summer:

Keep them happy campers: There are many summer camps out there that range from 1 week to several months long. Figure out what would work best for your family. This allows your child time to burn off some energy and engage in social interactions in a structured, monitored environment. Contact your local YMCA or park district for local camps or classes offered near you.
Keep morning routines the same: When kids know what to expect in the morning, it can help to limit meltdowns.
Post a weekly schedule of activities: These can range from very simple tasks like chores and reading to more involved activities like an outing to the park or museum. Make your child part of this so they feel empowered too! This can also be helpful for your child’s sitter if both parents are working.
Plan for at least one success a day: Let your child pick activities they enjoy doing (or do well J) and give praise for their work. Give them an opportunity to tell you about what they did, too!
Join a sport: Many times a child with ADHD may do better in an individual sport. If you child has a low frustration tolerance, difficulty following directions, or acts before thinking, think about enrolling your kiddo in martial arts, golf or bowling!
Dust off the old board games: Games like checkers, chess and UNO help with executive functioning skills. Uno helps kids practice switching between matching colors versus numbers helps to practice cognitive flexibility. Chess also can provide a platform for teaching impulsive children to slow down and think carefully before making their next move
Cook together:Waiting for instructions (inhibition), trying to remember the directions (working memory) and measuring and counting steps (sustained-attention) all help to develop executive functioning skills.

Have a fun and organized summer!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Occupational Therapy: The Benefits in a School Setting

in Development, Executive Functioning, Occupational Therapy, Parenting

Occupational Therapy, as a profession, focuses on promoting participation and completion of daily activities, whether they be work, leisure or self-care activities. Occupational therapy in a pediatric sense focuses on promoting developmental milestones, social and emotional well-being and independence in everyday tasks, whether it be at home or in the school.

Occupational therapists are also part of the educational system in the school setting, working in collaboration with educators and other therapy services. Their work allows children to develop the skills needed to perform to their best potential in their academic settings. Occupational therapists, and occupational therapy assistants, help a child in establishing academic and non-academic skills, including critical thinking skills, flexibility, self-regulation, social-emotional well-being, social skills, participation in sports and at recess, self-help skills and more. These skills are crucial as children spend a majority of their life in the roles of student, peer and friend.

Throughout the school year, children are screened and assessed in their natural environments to promote overall academic wellness. When educationally necessary, therapy services are set forth through an Individualized Education Plan (IEP) or through a 504, both of which are funded and administered by the state. OTs in this setting have specific knowledge and expertise to appropriately address a child’s needs within the realm of his/her IEP or 504 plan.

Occupational Therapists are trained to:

Observe a student in his/her setting and facilitate the student’s full participation.
Provide assistive technology as needed to promote academic and social performance.
Reduce barriers within the classroom to facilitate full access to the classroom and supplies.
Identify short-term and long-term goals for academic outcomes.
Provide suggestions for alternative and supported assessment methods, including homework completion and testing.
Promoting overall motor, social and emotional development.
Developing age-appropriate executive functioning skills, including increasing attention, problem-solving skills, and memory.

The idea of therapy services in the school setting may be daunting but rest assured, these services are individualized to allow children to thrive and perform to the best of their potential.

NSPT offers Occupational Therapy services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

New Year Resolutions: 5 Steps to Promote Executive Functioning Skills

in Executive Functioning, Executive Functioning, Health Topics and Conditions Database, Knowledge Nuggets, Parenting

New Year Resolutions and goal setting is an excellent way to foster executive functioning skills because it requires planning, organizing, managing time, and self reflection. What better time to set meaningful goals than the start of a new year?

5 steps to creating New Year Resolutions that also promote executive functioning skills:

Set the foundation of the activity by reflecting on favorite moments or proud accomplishments of the previous year. Help your child think about and identify at least 3 milestones they achieved.
Identify key areas that the child would like to improve upon in the upcoming year. Include both personal goals of the child as well as family goals. Goals should be specific, measurable, and attainable. For example, “I will complete a month-to-month 2014 family scrapbook by June 1, 2015.”
Break down each of these goals into smaller, more achievable parts. (i.e., if a goal is to keep a scrapbook of the year, you’ll want to identify steps to achieve that goal such as creating an outline for the organization of the scrapbook, buying the supplies, keeping a memory box for pictures or other memorabilia, a schedule or timeline to create sections of the scrapbook, etc.)
Make a plan to achieve each step! What do we need to do? When does it need to be done? Who will help and what is everyone’s responsibility?
Celebrate accomplishments! Provide reinforcement with a progress chart, journal, or checklist. Discuss what will happen when a goal is achieved (small gift, family night out, trip to a favorite store, etc.)

Don’t stop setting goals! This is a great habit to keep year round. As goals are met, continue to create new ones!

help your child with adhd get their homework done

6 Tips to Help Your Child with ADHD Get His Homework Done!

in ADHD, Executive Functioning, Parenting

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions found in children. The hallmark features associated with ADHD in children and adolescents are as follows:

Difficulty initiating and sustaining attentional regulation
Trouble with task completion
Difficulties organizing materials and work
Difficulty with initiation on tasks

Given the above concerns, homework completion is often found to be a difficult chore. Several of the below tips prove beneficial for improving the completion of daily work and assignments.

6 Tips to Help Your Child with ADHD Complete His Homework:

Have the child start the work when he or she gets home. These children oftentimes have difficulty with transitioning between tasks and initiating action with their work. Children were in school all day and already have the mindset of doing academic work. It may prove difficult for the child to take a break and then attempt to initiate the work.
Have a set location established for homework routines. Keep the desk or table as clear of clutter as possible. Keep the location in a quiet room away from extraneous distracters such as the television, other children and family members, and other items such as toys that may be distracting for the child.
Have the child create a list of daily homework tasks as well as an expectation of how much time each task would take.
Have the child stick with one subject and complete the work to fruition before moving to another task.
Encourage the child to take short, non-stimulating breaks between tasks. Breaks should be going to get a light snack, walking around the house, etc. and not be anything that might be overly engaging such as playing videogames or watching television.
Have consistency with expectations of homework. Make studying and homework completion daily habits.

Click here to download your ADHD Symptom and Treatment Checklist!

teens and transitions how to help your child

Teens And The Transition To Adulthood: How To Support Your Child

in Development, Executive Functioning, High School, Mental Health, Parenting, Social Work, Teens

If you have a teenager at home, then you know how exciting of a time adolescence can be. With the excitement, however, brings a variety of challenges. As boys and girls begin their journey of becoming young men and women, parents are faced with having to constantly respond to the changing needs of their sons and daughters. Parents of teenagers will often notice that their relationship seems to change with their child during these years. While young teenagers are eager to separate from their parents and make their own choices, parents feel the pull to ensure that their teens are making choices that will be beneficial for their future. How do you support your teen as he/she transitions to adulthood?

We know that adolescence is a time of change. Physical, psychological, and social changes can create some real discomfort for a young teenager. Although it is no simple task, parents can do a great deal to support their young ones through these changes. The following are some tips for parenting your adolescent child.

How to Support Your Teen as He/She Transitions to Adulthood:

Encourage your son or daughter to speak to you about the changes he/she notices including the desire to be more independent.
Allow your child to make mistakes so long as safety and long-term future are not at risk. Talk to your teenager about the consequences of his or her choices in an empathic and understanding way.
Set clear and firm limits but allow for your teenager to have choices when possible; children of all ages need to have some say. Parents should collaborate with their children to set parameters and still allow for some “supervised” autonomy.
Help your child develop routines and structure to stay organized, especially when it comes to school. Teenagers are continuing to develop executive functioning skills and need your support to create and maintain solid systems for balancing home, school, and social life.
Be comfortable asking for help. If your teenager’s transition into and through adolescence seems especially difficult, be assured there is help available. Working with a social worker or other mental health professionals can provide you with support that is specific to you and your child’s situation.

smart strategies to build your childs executive functioning skills

10 Smart Strategies to Foster Your Child’s Executive Functioning Skills

in ADHD, Executive Functioning, Neuropsychology, Parenting

Executive Functions (EF) refers to our self-regulatory behaviors needed to guide our behaviors to follow rules and reach our goals.

Typically in children, there are 3 basic components of Executive Functioning:

Working Memory – being able to hold information in their mind and use it (organizing, planning)
Inhibitory Control – being able to control (stop, pause) thoughts and impulses while being able to resist distractions, temptations, and habits, while also thinking before acting
Cognitive Flexibility – being able to switch gears and adjust to new rules, demands, and perspectives

The simple of act of ‘turn-taking’ addresses all of these components of EF. Help your child stop what he is doing and let another child take control (inhibitory control) – when it is his turn again, he needs to remember what he was supposed to do (working memory) – initiate play again and in the instance of a new child joining the group and the rules changing, help him adjust again (cognitive flexibility).

Research has shown that early childhood experiences build the foundation for fostering productive members of society!

Here are 10 activities to help your child blossom his Executive Functioning (EF) skills!

Peek-a-boo: This challenges baby to remember who is hiding (working memory) and teaches self-control in waiting for the adult to pop back up!
Pat-a-cake: Predictable rhyming develops working memory as he gains familiarity with the rhyme and inhibiting (pausing) his anticipatory reactions
Freeze dance: This requires active inhibition.
Narrate your childs’ play: This helps your child understand how language is connected to actions and how asking questions about what is next can help him to plan his next move (planning and organizing)!
UNO: Switching between matching colors versus numbers helps to practice cognitive flexibility.
Cooking: Waiting for instructions (inhibition), trying to remember the directions (working memory) and measuring and counting steps (sustained-attention) all help to develop EF skills.
Sports: Rule following, and quick decision making (cognitive flexibility) make this a great EF skill building activity.
Music, singing & dance: Holding music/choreography in mind (working memory) develops EF skills.
Puzzles: This develops EF skills for all ages by encouraging thinking about shapes and colors needed (planning & organizing) to complete the puzzle.
Storytelling & imaginative play: Older children may naturally use ordinary objects as something creative (i.e. using a block as a car)- (Cognitive flexibility).

Resources: developingchild.harvard.edu

Mastering Morning Routines

in ADHD, Executive Functioning, Family, How To, Living Skills, Parenting

Many parents report the most anxiety prone time of the day is the weekday mornings. There is much going on in a very limited time. Parents often need to ensure that they are ready for work and have their children ready for school. This time of day is difficult for most children; however, children with attention problems or executive functioning weaknesses are much more prone to exhibit significant weakness with regard to their ability to follow routines and get out the door on time. Although it is difficult, it is not impossible for these children to be ready to go on time! Mastering the morning routine is the best way to get the family out the door, happily, each day.

Steps to Master the Morning Routine:

The main recommendation is to keep the mornings as structured and consistent as possible. Have the schedule planned and written out. Think about all daily routines from waking up, brushing teeth, getting dressed, to leaving the house. Think about not only the tasks that are expected of the child but also a reasonable amount of time to complete each task. It may come down to it that the list of expectations placed on the child’s morning is not realistic (today) and there might have to be some modifications.

Once it has been established that the tasks in the morning are reasonable, create a chart with picture cues for each task. Also, have the time expected for each task written down next to that item.

The first few days or weeks will require a significant amount of adult assistance to help ensure the child is finishing the tasks in the appropriate order within the required time allotments. Use strategies such as reinforcing completed tasks, timers, and praise.

Morning routines can be hectic but do not have to be impossible. With structure, organization support, and use of reinforcement, many children with attention concerns and executive functioning weaknesses are able to stay to the routine and get out the door in time.

Set-Up a Routine for Homework Happiness

in ADHD, Executive Functioning, Parenting, School

Children with attentional problems or issues with executive functioning often have difficulties with homework completion. Several issues associated with executive functioning lead to concerns with the ability to complete daily work including the following:

Initiation on work
Organization concerns
Time management
Difficulty transitioning

When is the best time for my child to do homework?

Oftentimes children will want to have a break from school work when they come home. They want to play for a while before doing work. I would actually recommend that the child immediately start homework when he gets home. Research has indicated that children with attentional problems and poor executive functioning have difficulty transitioning between tasks. The child is still in the school mindset when he arrives home. Having the child take a break and then later transition back to homework likely will prove difficult. Instead, I would recommend that the child have a light snack and then immediately start the work.

How should I structure the homework space?

Organization, or lack thereof, is a hallmark feature of poor executive functioning. With that in mind, I would highly recommend that the homework environment in which the child is working be as organized and structured as possible. Have a specific desk or table where work is to be done. Keep the table as clean as possible with a minimal amount of distractions in the room. Oftentimes, having the child complete homework in his room proves to be a disaster. There are too many distractions that keep the child’s interest away from the homework assignment. It may prove best to select a quiet room away from family members with the fewest distractions possible. Click here to watch a Pediatric TV Episode on setting up a homework station.

How do I work on time management with my child?

Parents often state that the child has no idea about time management or how long tasks should last. I often recommend that parents have the child provide an estimate of how long he perceives a task should last. Time the child and then provide the difference as to how long he thought the work would last and how long it actually lasted. Then the next day, have the child again provide an estimate as to how long the task will last. If the child is way off with the estimate, pull out the data from the night before and ask if he wants to revise his estimate. Keep this going until the child starts to develop an actual idea of how long tasks should last.

These are just a few tips to keep homework as structured as possible. Help the child start homework right away as it will help with initiation on tasks as well as ensuring a smooth transition between demands. Keep the room and desk as organized as possible to limit distractions and off-task behaviors. Provide some guidance with time management by helping identify how long tasks and assignments should last.

Read here for 8 more tips to ease homework time stress!