Unstuck and On Target: Improving Executive Function, On-Task and Flexible Behavior
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- The study evaluated the effectiveness of the Unstuck program versus a social skills program at improving executive function skills in students. - Students who received the Unstuck intervention showed significantly greater improvements in visual-spatial skills as measured by the Block Design subtest of the WASI compared to students who received the social skills intervention. - The Unstuck program, which is focused on teaching executive function skills, resulted in better performance on a task requiring visual-spatial abilities when compared to a social skills program.
Unstuck and On Target: Improving Executive Function, On-Task and Flexible Behavior
- 1. Improving Executive Function, On-Task and Flexible Behavior Lauren Kenworthy, Ph.D. Professor, Pediatrics, GW Medical School Director, Center for Autism Spectrum Disorders Children’s National Medical Center Lynn Cannon, M.Ed. Social Learning Coordinator The Ivymount School, The Maddux School
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- 6. GIVEAWAY! We’re giving away one free copy of Unstuck & On Target!, Second Edition! One attendee will be selected at random & announced after the Q&A. Stay active in the chat to increase your chances!
- 7. Lynn Cannon, M.Ed., is a social learning specialist at The Ivymount School and The Maddux School. She received her M.Ed. in special education from the University of Virginia. For over 15 years, she has worked as an educator, administrator and program director, serving students with neurodevelopmental disabilities. Lynn is also a co-author of Solving Executive Challenges, a resource guide for teachers and parents; The Conversation Club, an instructional manual for teaching conversation skills to students with neurodevelopmental disabilities; and the Ivymount Social Cognition Instructional Package (IvySCIP). The IvySCIP offers a comprehensive, online system for assessing and supporting social and emotional learning in K–8 students with high-functioning autism spectrum disorders. Her research and teaching interests are in developing interventions and support materials for students with neurodevelopmental disabilities, therapists, educators and their families. She has co-authored more than five peer-reviewed publications and has received federal funding for two research grants. Lauren Kenworthy, Ph.D., is Professor of Neurology, Pediatrics, and Psychiatry at the George Washington University School of Medicine, and Director of the Center for Autism Spectrum Disorders at Children’s National Health System. Dr. Kenworthy received her B.A. from Yale University and Ph.D. from the University of Maryland. Her research interests are in describing and treating the neuropsychological phenotype of autism. She is an author of more than 60 peer-reviewed publications; a co-author of the Behavior Rating Inventory of Executive Function (BRIEF); and a co-author of Solving Executive Challenges, a resource guide for teachers and parents. She is currently completing a trial of Unstuck and On-Target in low-income schools for children with ADHD or ASD.
- 8. Unstuck Team Ivymount Model Asperger Program/Take2 Summer Camp • Katie Alexander • Lynn Cannon • Monica Werner Children’s National Center for Autism Spectrum Disorders • Laura Anthony • Lauren Kenworthy Copyright 2011, 2014, 2018 Brookes
- 9. GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Function (EF)? oEFs are fractioned and plastic 2. Why do they matter? oEFs are necessary for effective everyday functioning 3. Specific components of EF & accommodations oFlexibility, Organization, Planning/Working Memory problems 4. How can we treat EF problems in autism? oIn everyday settings, with self regulatory scripts
- 10. “The Unity & Diversity of Executive Function” Teuber, 1972; Gioia, et al 2002; 2016; Friedman & Miyake, 2017 Initiate Working Memory Plan/Organize Task Monitor Inhibit Self- Monitor Flexibility Emotional Control Initiate Working Memory Planning Organization/Integration Task Monitor Inhibit Self-Monitor Flexibility Emotional Control
- 11. GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Function (EF)? oEFs are fractioned and plastic 2. Why do they matter? oEFs are necessary for effective everyday functioning
- 12. Executive Dysfunction (Teuber, 1964): “The curious dissociation between knowing & doing” EF problems relate to: • Adaptive daily living skills • Academic learning • Locus of Control • Family stress • Adult outcomes • Understanding our social world
- 13. Looks Like Won’t… Could be Can’t Oppositional, Stubborn Difficulty shifting Avoiding overload Can do it if he wants to Difficulty shifting Lack of salience Self Centered Impaired social cognition Poor self monitoring Won’t put good ideas on paper Poor fine motor Disorganization Sloppy, erratic Poor self monitoring Overloaded Won’t control outbursts Overloaded Disinhibition Doesn’t care what others think Impaired social cognition Poor self monitoring Greene, 1998; Bernstein, 2000
- 14. This video is from online “e-Unstuck” course made in partnership with 3C Institute Video 1
- 15. GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Function (EF)? oEFs are fractioned and plastic 2. Why do they matter? oEFs are necessary for effective everyday functioning 3. Specific components of EF & accommodations oFlexibility, Organization, Planning/Working Memory problems
- 16. Unstuck Philosophy: Accommodate, then Remediate Neurodiversity is a civil right • Can’t vs Won’t • Predictability and Structure • Make Big Picture Explicit • Talk Less, Write More • Avoid Overload • Keep it Positive Overwhelmed people can’t learn
- 17. Initiate Working Memory Plan/Organize Task Monitor Inhibit Self-Monitor Flexibility Emotional Control Initiate Working Memory Planning Organization/Integration Task Monitor Inhibit Self-Monitor Flexibility Emotional Control *
- 18. “Asperger’s is like a vise on your brain. And each unexpected event is like another turn on the vise…it just keeps building until you feel like you’re going to explode. Sometimes when you explode, it comes out the wrong way.” - A young student with ASD (Rumsey, 1985; Hill, 2004, Kenworthy et al, 2008)
- 19. What does cognitive inflexibility look like? Can’t or Won’t? • Accept feedback, different opinions, ideas • Transition • Handle frustration • Start something they don’t want to do • Stop meltdowns • Stop doing something even if they have been told to stop • Avoid shutting down when something is challenging • Stop correcting people • Let other kids take the lead when playing
- 20. Inflexibility Risks and Accomodations Difficulty with violations of expectations • Schedules, Routines, Predict Change, Flexible Adult Rigid interpretations of rules • Respect need for clear, explicit expectations, Flexible Adult Overwhelming intense feelings • Breaks, Downtime, Flexible Adult Problems Negotiating • Compromise, Explicit Etiquette Rules, Flexible Adult Repetitive Behaviors/Intense Interests • Decide where they can/can’t happen, agree on a sign Schopler, Mesibov & Hearsey, 1995
- 21. Inflexibility Strengths • Deep datasets • Expertise in areas of interest • Persistence • Reliability • Loyalty • Routines that don’t interfere • Inflexibility is adaptive. It limits unexpected, overloading events. September 20, 2018
- 22. Unstuck Philosophy: Accommodate, then Remediate Neurodiversity is a civil right • Predictability and Structure Overwhelmed people can’t learn
- 23. Initiate Working Memory Plan/Organize Task Monitor Inhibit Self-Monitor Flexibility Emotional Control Initiate Working Memory Planning Organization/Integration Task Monitor Inhibit Self-Monitor Flexibility Emotional Control *
- 24. What do organization/integration deficits look like? Can’t or Won’t? • Disorganized language • Literal language • Asks for lots of structure in new situations • Gets stuck on details- doesn’t let go of small mistake/inconsistency • Dominates discussions without knowing it • Behaves worse in unstructured groups • Doesn’t set goals • Trouble learning from mistakes • Poor written expression, Doesn’t get good ideas onto paper • Draw meaning from a reading assignment • Know what to study for on a test
- 25. Disorganization Risks and Accommodations Lack of generalization • Put new information in familiar context • Explicitly review inferences, nuances • Teach in the setting where the behavior is expected • Structure Difficulty knowing what is important/Getting Stuck on details • Emphasis on goals • Break things down • Explicit short rules, recipes, checklists and routines • Structure Schopler, Mesibov & Hearsey, 1995
- 26. Disorganization Risks and Accommodations Con’t Don’t show what they know • Study guides, closed format tests • Writing rubrics • Structure Lack of awareness and overwhelm • Safe Person • Structure Schopler, Mesibov & Hearsey, 1995
- 27. Detail Processor Strengths • Patience for details • Respect, follow, use rules • Good with recipes, checklists, and routines • Powerful computer related thinking • Classification strengths • Attention to detail—Sherlock Holmes • Mastery of detailed datasets • Large vocabulary
- 28. Unstuck Philosophy: Accommodate, then Remediate Neurodiversity is a civil right • Make Big Picture Explicit Overwhelmed people can’t learn
- 29. Initiate Working Memory Plan/Organize Task Monitor Inhibit Self-Monitor Flexibility Emotional Control Initiate Working Memory Planning Organization/Integration Task Monitor Inhibit Self-Monitor Flexibility Emotional Control *
- 30. Poor Planning/Inner Speech/Working Memory Looks Like: Won’t Follow Directions, Work Independently • Talk Less, Write More • White Boards • Socratic method • Hand-held technology • Computer-based curricula Schopler, Mesibov & Hearsey, 1995
- 31. Break it Down & Make it Visual John has a book I want Hit John, take book Ask John for a turn Time out- Miss TV time Was this what I wanted? Look at book, give it back, get TV time Was this what I wanted?
- 32. Unstuck Philosophy: Accommodate, then Remediate Neurodiversity is a civil right • Talk Less, Write More Overwhelmed people can’t learn
- 33. Unstuck Philosophy: Accommodate, then Remediate Neurodiversity is a civil right • Keep it Positive Overwhelmed people can’t learn
- 34. Overload: Looks like anxiety, impulsivity, meltdowns Brenda Smith Myles: AS and Difficult Moments
- 35. GOAL: Increase your understanding of executive functions and how to enhance them PLAN 1. What are Executive Function (EF)? oEFs are fractioned and plastic 2. Why do they matter? oEFs are necessary for effective everyday functioning 3. Specific components of EF & accommodations oFlexibility, Organization, Planning/Working Memory problems 4. How can we treat EF problems in autism? oIn everyday settings, with self regulatory scripts
- 38. Feelings Target
- 39. Feelings Chain
- 40. Teaching: Why Be Flexible • Advantages of physical flexibility • The “facts” of life • What to do when what I want is impossible • Pie charts: getting part of I want is better than getting nothing at all
- 41. The Story of Silly Putty (Why, Plan A/Plan B) Photo credits to Maurice Tome http://schoolwithinschool.org/look-forward-to-succeeding/
- 42. The Story of Silly Putty (Why, Plan A/Plan B) Photo credits to Maurice Tome http://schoolwithinschool.org/look-forward-to-succeeding/
- 43. The Story of Silly Putty (Why, Plan A/Plan B) Photo credits to Maurice Tome http://schoolwithinschool.org/look-forward-to-succeeding/
- 44. The Story of Silly Putty (Why, Plan A/Plan B) Photo credits to Maurice Tome http://schoolwithinschool.org/look-forward-to-succeeding/
- 45. The Story of Silly Putty (Why, Plan A/Plan B) Photo credits to Maurice Tome http://schoolwithinschool.org/look-forward-to-succeeding/
- 46. Teach How to Be Flexible: Self-Regulatory Scripts •Avoid too much talking •Refer to the big picture •Build an alliance—you’re collaborating! •Need to be practiced
- 47. How to be Flexible: Words and Scripts ©2011, Brookes Publishing, Inc
- 48. Flexibility Scripts ©2011, Brookes Publishing, Inc
- 49. Video: Modeling Plan A/ Plan B & Little Deal Video 2
- 50. GWPDC Script (Goal, Why, Plan, Do, Check) Goal To have fun at recess Why Recess is my free time Plan A Plan B Plan C Ask Johnny if he wants to play soccer (If J says, “no”) Ask Melissa to play soccer Swing on the swings Do Follow my plans Check Did I meet my goal? Which plan worked? Would I do it the same or different next time?
- 51. Modeling Goal Use • “I need to set a goal.” • “Let’s set a goal!” • “My goal is to.....” • “You did a great job making a goal!” • “That’s a terrific goal!” • “Are we on target?” • “What is your goal?” • “A goal is something you want or need to do.” • “I can see you really want to keep X as your friend, I think your target goal is to be a good friend” • “I know you really want to be a video game programmer- if this is your target goal, what are the things you need to do to accomplish this goal?” • "Oh man, I got so off target just then.” • “Way to stay on target!”
- 52. MISSION POSSIBLE GOAL What is my mission for today? To have a fun play date with Adam PLAN(S) Plan A What is my plan for my mission? 1. Pick up Adam from his house. 2. Go to the park 3. Ask Adam if he wants to play on the swings or the climbing wall. 4. If I feel tired or need a break I can tell Adam I need few minutes to myself. 5. Have a snack. 6. Drive Adam back to his house. Plan B What is an alternative plan? 1. If the park is too crowded or Adam does not want to go to the park we can go back to my house. 2. Ask Adam if he want to play Legos or soccer. DO What plan did I use to complete my mission? Plan A Plan B Other (explain) CHECK Did I accomplish my goal? YES NO How did it go? 1 2 3 4 5 Not so good OK Grea t NEXTSTEP Tomorrow, I will… MOVEON TRY AGAIN Why?
- 53. Video: GWPDC This video is from online “e-Unstuck” course made in partnership with 3C Institute Video 3
- 54. Trial #1 (NIMHR34): • Unstuck (n=47) • Social Skills (n=20; Baker, 2009) • Interventions delivered at school by school staff with fidelity • Parent training, teacher training, pull out groups, fidelity monitoring, interventionist supervision
- 55. WASI Block Design Higher Score = Better Performance 50 51 52 53 54 55 56 57 58 59 Pre Post T-Score Unstuck Social Skills
- 56. Blinded Classroom Observations 0 10 20 30 40 50 60 70 80 Reciprocity Rule Abidance Transitions Gets Stuck Negativity/ Overwhelm Participates PercentImproved Classroom Observations Social Skills Unstuck Kenworthy & Anthony et al, 2014
- 57. Project Overview (PCORI AD-1304-7379) • 3rd – 5th graders (with ASD or ADHD) from 22 Title 1 schools • Participants ided by school staff based on flexibility problems • Random assignment to Unstuck or Contingency Behavior Management: Both target executive function/flexibility
- 60. Unstuck Authors: (photo, L to R): Laura Anthony (lanthony@UCDenver.edu), Monica Adler Werner (mwerner@ivymount.org), Lauren Kenworthy (lkenwort@unmc.org), Katie Alexander (kt.calexander@gmail.com), Lynn Cannon (lcannon@ivymount.org) New for Parents & Teachers Summer 2018 e-Unstuck online training modules Developed with The 3C Institute Deb Childress childress@3cisd.com New for Interventionists
- 61. Q&A Session Questions? brookeswebmeeting@brookespublishing.com *Not to be combined with any other discounts or offers. Consumer orders only, please. Excludes BOL training, pre- discounted bundles, and online products such as ASQ Online and AEPSinteractive™. Save 20% at brookespublishing.com* Use code: EDWEBLC Expires 10/31/18
- 62. GIVEAWAY! We’re giving away one free copy of Unstuck & On Target!, Second Edition! One attendee will be selected at random & announced after the Q&A. Stay active in the chat to increase your chances!
- 63. Thank you to our presenters! Learn more about Brookes Publishing at www.brookespublishing.com Give us your feedback on this edWebinar! Click on this link in the chat: tinyurl.com/edWebinarEval Lynn Cannon, M.Ed. The Ivymount School and The Maddux School Email: lcannon@ivymount.org Lauren Kenworthy, Ph.D. George Washington University School of Medicine & Center for Autism Spectrum Disorders at Children’s National Health System Email: lkenwort@unmc.org
- 64. Get your CE Certificate for this edWebinar • If you’re an edWeb member your personalized certificate will be posted to your homepage by the end of the next business day. • If you logged in with your email address we’ll email you links to a CE certificate form, the recording, and how to get added resources. • You ONLY need to take the CE quiz if you dialed in by phone, are watching as a group, or are viewing this as a recording. Join edWeb to download and track your personalized CE certificates.