Executive Functions - Part 5

Uploaded by famsciEIU on 18.05.2011

>> Jill Fahy: Goal selection will refer to
this concept of that moment in time where the prefrontal
cortex is faced with the need to decide what am I going to do?
Now that can be for something as simple as the baby
wanting to reach out and grasp a toy or reach out towards
a sound or a face.
It can be as complex as the 22 year-old trying to decide should
I take this job or should I take that job or what
if there is no job offer?
Do I move back home with mom and dad?
It's the eight year-old who is faced with the social situation
on the playground and this child has Asperger's and social
interaction is difficult for this child anyway.
The decision and opportunity comes into play.
Do I use these social verbal communication skills or do I
follow impulsive, less well-thought out plans?
How do I decide what is the behavior that I think is
appropriate to this set of conditions?
So what am I going to do?
Do I call up something I've used before?
Do I use a standard routine from before?
Or do I have to, in this case, determine some completely new,
novel course of action.
Goal selection is also dependent on the ability
to predict and anticipate.
So predicting outcomes, anticipating consequences, those
are very abstract skills and in the younger child who doesn't
have well-developed goal selection yet and who doesn't
have very abstract language yet at all and isn't expected to, a
lot of goal selection, a lot of this piece of executive
functions is determined by external sources.
The adults in that child's environment or the rules.
With maturity, then you kind of move from the continuum of
external in control decisions about what you will behaviorally
do to the young adult who is assuming their own internal
control for goal selection and determining what
I am going to do?
And somewhere in between, you've got the teenager who has
evermore increasing opportunity to go off into unforeseen
circumstances, novel situations, and you just hope you've done
your best to lay out a good array of prior knowledge, past
experience, so that when they get into a position of having to
decided what am I going to do?
They poll all of this information into working memory.
Then you hope that that 16 year-old is going to make a
mature decision about what to do as opposed to one
that is less advantageous.
So goal selection.
The next is planning and organization.
So again, as I go through each of these, think of these as a
very discrete, specific, separate skills.
Different components of executive functions.
There are multiple executive functions and I've boiled them
down into these main six to best represent what the literature
talks about and what terms you'll see used in formal tests
that you might come across or decide to use.
So first there was goal selection, now we have
planning and organization.
So if I have determined what to do, the next phase of those
executive functions skills is to decide how am
I going to do next?
It encompasses the ability to recognize the need to act.
I have to determine what things are
necessary to complete this task.
That includes whatever relevant materials, what is the relevant
information that I have got to do, that I have got to find?
It includes taking into account what do I have available or am I
going to have to make due with what I have.
Planning an organization also has to do with strategy
development to meet an outcome.
Sequencing of those plans, that information and those materials.
It also is the part where we have to account for the time
constraints or the expectations or the requirements.
So you can't really just plan in your own little bubble.
We have to be able to plan how to carry out this decision, how
to carry out this goal that I have opted to execute.
How will I plan it and organize it and get a strategy and
develop steps and sequence those steps in some fashion to account
for how much time I have, what are the expectations that people
have of me and what are the requirements?
So how many of our kids do we work on
sequencing, planning, organization.
Think about the language skills of some of the kids in your case
load and how well those language skills do or do not support
effective planning, effective organization.
How many of those kids in your case load have poor planning and
poor organization, do they use language well to group
information, to sort content, can they sequence steps in a
task, can they determine which things are relevant or not
relevant to carrying out a task?
We do a lot of verbal planning.
We do a lot of verbal planning.
We do a lot of work to help verbal organization.
The reason is because those verbal organization skills,
assigning meaning, assigning degrees of difference, being
able to use language words to sequence
thoughts and steps and plans.
Those are all critical to that tertiary processing where now I
have decided what I am going to do.
I have been able to attend long enough to pay
attention and get the big picture.
I can attend to what's relevant.
I can inhibit my impulsive response long enough and think
and allow the executive functions to kick in.
I have the working memory capacity that is sufficient to
allow me to juggle all of these variables at once and make a
determination, make a prediction, compare to previous
experiences and decide how I am going to do this.
Now, I've got to plan and organize.
I still have to inhibit my impulses.
I still have to maybe withhold my initial response long enough
to let language come into the picture and mediate your
thoughts whether it's a manipulative task or initial
spacial tasks.
Some degree of deliberate thinking and reasoning and
planning and organization has to come into play.
And if we don't have the linguistic backing to help us do
that, the planning and organization element of
executive functions will be impaired.
When you work with the brain injury population, you might see
every aspect of these six executive function
components impaired.
On the other hand, depending again on which part of the
frontal lobe, if it is a very specific site of lesion, if it
is a very focal lesion, you might see somebody who could
determine relatively good plans and make fairly good decisions
and absolutely lack in planning and organization.
So all of this good comparison and decision making, prediction
of outcomes, and impulse control, it's all wonderful but
if I can't plan and organize, how effective will
the outcome be?
Third component of executive functions is
initiation and persistence.
So can I get going?
This is really more to do with the ability, the actual ability
to self-start.
It's more than just realizing I have to start doing something.
It's more than just knowing what the goal is.
It's more than knowing what the goal is and having
generated a viable plan.
Now I have to do something.
I have to start and in some kids, if you look at sort of a
continuum of extremes, you've got those kids I'm sure you can
all think of who don't have any problem getting started or
persisting because they can't stop.
Getting started is not the problem.
Probably for this group of kids, impulse control and inhibition
is the problem, that's the piece that is really missing.
On the other end of the continuum, you have an extreme
opposite for the kid who cannot get started.
Can't initiate.
This group of kids tends to be a lot more flat affect.
They have minimal output, they have limited verbal output, they
tend to initiate very little, they tend to have minimal
appearance of concern.
Time constraints don't really seem to have an affect.
It's this inability to initiate and again in head injury
population, you see somebody who has this specific piece of
executive functions knocked out.
It can really be astonishing.
You'll see a person who stands, sits, does nothing.
And you might linguistically, they
may completely comprehend the task.
I once had a woman with a frontal lobe injury and
language-wise, she completely understood her request, I'd like
you to write your name on this paper.
She could rhetorically repeat that sentence to me.
She could restate the request in her own words.
She could acknowledge.
We already ruled out language receptive
and expressive as a problem.
So she comprehended you want me to write my name
on this piece of paper.
She did not have upper extremity, fine motor weakness
control problems.
She did not have those motor deficits and she could write.
Now, when you pull all of this together into a functional
situation such as simple requests, would you please go
ahead and write your name on this piece of paper?
We sat for 15 minutes and so periodically I would say what
are you getting ready to do?
I'm going to write my name on this paper.
Okay, do you have everything you need?
Yes, I've got the paper and this pen.
Okay, whenever you're ready.
And we sit and we sit and we sit.
Minutes pass and you can again recue and reprompt.
What are you thinking about doing right now?
I need to write my name on the paper.