Executive Functions - Part 9

Uploaded by famsciEIU on 17.05.2011

>> Jill Fahy: Okay Asperger's Syndrome,
this is I think a really fascinating group of kids
and adults because their deficits are so
closely associated with right hemisphere processing deficits.
They include a lot of the social, non-verbal skills, the
abilitty to perceive social cues, facial expression,
prosody in voice, intonation, emotional tone.
The ability to take the perspective of another.
Those right hemisphere deficits really limit and collaborate
with some executive function deficits that are seen with kids
with Asperger's.
Those executive function deficits are significant
difficulty with impulse control, lack of flexibility, difficulty
organizing and sequencing and planning.
There's not such a difficulty in generating goals,
determining behaviors.
These kids tend to know exactly what they want to do, but
whether it really fits the environmental constraints or the
requirements of the situation, that's where
the problem comes into play.
Other pieces of the puzzle for kids with Asperger's that are
kind of a combination of right hemisphere type deficits and
executive function deficits, they're not very good at forming
concepts and getting an overall big picture.
They tend to be rigidly focused on, and so when we're thinking
back to attention and decision making and planning and
organization, are they applying their executive function skills
to all of the environmental criteria.
Are they focused on relevant pieces of information
in the environment?
Are they organizing their language and their responses and
directing their thinking to the most appropriate and relevant
pieces of the puzzle, so to speak.
Kids with Asperger's have difficulty predicting
and anticipating.
They tend to be focused on right here and in the moment, so
earlier when we spoke about how to predict and anticipate
outcomes to help you make better choices and better selections.
That tends to be a difficulty.
Those skills that novel decision making, novel problem solving,
creative solutions, that helps us deal with
unfamiliar circumstances.
The kid with Asperger's really needs that
rote, predictable routine.
It's not easy for them to come up with their own novel
understanding about something unexpected or unplanned.
They're not flexible.
They don't adapt well.
These are those executive function skills that we have
been talking about today that are specifically problematic for
this population of kids.
You know in treatment a lot of the language goals you can use
are ways to self talk, to prompt them, to look for all the cues
in the environment to prompt them to use
phrases like stop, think, plan, do.
In order to verbally kick in some impulse control just for a
second or two to give them long enough to generate a different
plan or even to make them aware that they might need to get
ready to shift, get ready to flex.
Stop, regroup, refocus, shift, you can use language to teach
them some compensatory strategies and to make their own
self control of executive functions a little better and
more functional for them.
ADHD, okay well, you know, distractability, poor
inhibition, impulse control issues, inattentive, working
memory deficits, disorganization, poor
flexibility and shifting of attention.
These are all classic, that's a classic list of deficits in some
of those three foundational cognitive processes that
underlie and support our executive functions.
A student of mine just did an oral report in class last week,
and I don't have the authors cited up
here in this presentation.
But there's some new theories that ADHD is not necessarily an
intentional disorder, but rather it's a disorder based on lack of
impulse control, poor inhibition, poor
These executive functions that kind of put the
breaks on our impulses.
If you think of the prefrontal cortex, the conductor is the one
who can slow things down.
And if I can't slow things down, how can I focus my attention and
land on any one given thought or moment or idea or task long
enough to [unclear dialogue] any of my other language
or visual processing skills.
Often their decisions are based on working with incomplete or
misinterpreted information or being focused on the completely
wrong outcome or irrelevant circumstances.
As kids get older, those impulse control deficits and attending
to irrelevant information, those things result in really poorly
organized narrative outputs and discourse.
Language that's not very cohesive, not coherent, of
course you've seen poorly regulated
social behavior in these kids.
But also limited prediction of outcomes, trouble sticking with
or completing a task, difficulty planning, organizing, shifting,
self-monitoring, difficulty profiting from any kind of
feedback from the environment.
Why because my intentional foundation, my intentional
control system is not engaged adequately.
If you think back to that circle where I poured all of the
components and processes into four skill sets.
Intentional control, clearly this is a difficulty with
intentional control.
If you wanted to think of Asperger's as being really you
know difficulty with flexibility, flexible,
purposeful behavior and also I would say information processing
with the nonverbal social cues.
This ADHD I look at as a huge difficulty with that skill set
of intentional control.
Non-verbal learning disabilities and executive function deficits,
this one too is another diagnosis that is very much a
right hemisphere based disorder.
In fact, kids who have nonverbal learning disabilities react,
present very much, if not exactly like adults who
haven't acquired right hemisphere pattern deficits.
What is the right hemisphere supposed to do for us?
Draw conclusions, demonstrate [unclear dialogue] thinking, see
the big picture, identify what's relevant, think conceptually,
analyze, synthesize, pull it all together, flex, be creative.
Kids with NVLD don't do that.
They fail to see the obvious.
They will draw the wrong conlusion.
They fail to make inferences that we
think are extremely obvious.
Their ability to predict outcomes, even when they are in
the midst of doing a hands on simple experiment in therapy.
Their ability to look at the manipulatives in front of them
and use language to say what will happen
if x is quite impaired.
[unclear dialogue] focus or direct
their thinking, what's relevant?
What's a priority?
What's a creative idea, what's an obvious solution?
A lot of the plans these kids generate just to carry out
simple homework actiivities or complete a worksheeet in school,
their plans are not relevant.
They are able to initiate, but it often has nothing to do with
the requirements they are given.
And they don't execute or achieve a lot of outcomes
because they are working inefficiently on the wrong
things without direction.
Overemphasis on detail to the exclusion of the main idea,
what's relevant.
This shifts their thinking and their commmunication to areas
that don't really serve the bigger picture
New learning is poor, adaptability and
generalization is not good.
What do I do with all of this information?
How do I take all these details and wrap them up into some tidy
little group of thinking?
Language, often if you give a [unclear dialogue] test, they'll
look fine, they'll perform normally, but if you dig
underneath that and look at the metaphorical, the implied, the
inferential, the subtle, those performance
scores will not be normal.
So their efforts lack relevance, and their
behaviors and attempts are perseverative.
I've seen many, many kids continue on with efforts that
are failing, have failed, that you've pointed out to them that
this strategy is not working.
And yet they cannot integrate that.
They have a poor perception of the perspective of others, and
finally they fail to use self-talk to
regulate all these skills.
You can work on teaching some of those language based, self-talk,
self-regulatory strategies.
And I think one of the most useful things you can do for
this group is to teach them organizational skills,
comparison, relevance, conclusion, prediction, [unclear
dialogue], abstraction.
Because as they move up through higher grade levels and the
expectation and the demands increase and the assumptions
about their language gives the wrong impression, these kids
will have more trouble academically and socially.