Executive Function: The Engine that Could

Everyone is talking about executive function or “executive function disorder” these days to try to explain difficulties their child may be having at school or in life. It is not clear, however, that this term is being understood in the same way by parents or teachers. Moreover, there is no such diagnosis. Diagnosis notwithstanding, deficits in executive function can play a significant role in a young person’s development.

Executive function has been likened to an orchestra conductor who, with a wave of the baton, tells the musicians when to play, how loud or soft to play, and when to begin and end. Another way of thinking about executive function is as a group of neuropsychological processes that serve as the engine to drive or regulate an individual’s access to his or her cognitive abilities. Without adequate “torque,” the engine does not drive the car.

An example of this is the intertwined executive functions of activation, attention, and memory. Individuals with high levels of arousal-that is, they need a great deal of stimulation to get activated-will be unable to fully direct their attention to the task at hand. Since attention is the bedrock of learning, there will likely be important information missed. Furthermore, whatever has not been attended to can’t be encoded in memory. Consequently, teachers may complain that students learn something one day, but are unable to remember it the next day. There are other executive function deficits that can explain this common complaint. For instance, some students have very slow retrieval speed. Thus, some have difficulty encoding information while others have trouble retrieving it.

Here is the point: individuals with excellent ability can have problems functioning if their executive functions are not operating efficiently as they will limit access to those abilities.

What is a parent or a teacher to do? Deficits in executive function are frustrating and often feel resistant to remediation. Very often logical and reasonable strategies fail miserably. For instance, there are a myriad number of planning and organization problems students exhibit where they are either having trouble planning how to complete a task and underestimating the time needed or regularly lose important papers or books. Applying logical solutions like organizers and timers or color coded folders work at times, but just as often do not work because they are not utilized correctly or regularly.

Since executive functions are wiring, modifying them requires a good deal of effort to enlist the cooperation of the individual student to battle with wiring issues. First, awareness must be raised because executive functions operate automatically and while disruptive, they have a certain familiarity and are often not dystonic. That is, students may not be as troubled by these issues as adults are. An example of this is telling students who have problems with time that they will earn lower grades, not get into a good college, or try to extoll the virtues of being on time may not register as these students have not developed a good time perspective.

A second step, and one often missed, is to assess a student’s objections to “buying in” to using a strategy. This is essential in order to search out unspoken resistances. Without first understanding these obstacles to successful application of a strategy, students are likely to act out their objections by not being cooperative or compliant. It is only when you understand what prevents reasonable courses of action from working that you can achieve success. Exploring these objections requires patience and a healthy dose of tolerance as the rationales may not be logical. However, this does not make them less potent as forces that can destroy your efforts. Once you unearth these objections, you can find a way to join with students so you are not viewed as an adversary, but, instead, someone who understands them. It is this understanding/joining that builds relationships and leverage. Once this is accomplished, the probability of having strategies “stick” will increase.

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Response To the Right Intervention (RTRI): Marrying Neurocognitive Science to RTI

In an excellent chapter, “Linking School Neuropsychological with Response to Intervention Models,” in Best Practices in School Psychology, Della Toffalo (2010) asserts that “…educationally relevant cognitive neuropsychological assessment…can and should occur at any time (any tier) in the RTI process when an intervention team has good reason to believe that standard protocol interventions may not be adequate to address the needs of an at-risk student (p.176).”

What does this mean? When IDEA was revised to include RTI as a way to establish eligibility for special education to correct the flaws of the ability discrepancy approach, it did not go far enough. That is, students who simply fail to be successful after a RTI plan should not be automatically considered to be learning disabled. First, this view of a learning disorder fails to include the universally accepted definition of a learning disability as including a processing deficit. Moreover, it just becomes another wait-to-fail model as students may proceed through tiers of intervention without the process being informed by cognitive processing information that could help in targeting students’ deficits earlier in the intervention process.

To elaborate, it is essential that the intervention team have available all tools that can diagnose students’ learning, behavioral, or emotional difficulties at any time (any tier). Della Toffalo includes a list of disorders involving learning disabilities which RTI alone may not be successful. It just makes no sense not to use all the neuropsychological tools available to identify the source of students’ learning and performance difficulties and to have this information drive the intervention process. Otherwise, the team is in danger of shooting from the hip, a practice that may inevitably lead to the failure of the prescribed interventions.

For example, academic subjects are byproducts of cognitive processing skills. Identifying and isolating those processes that are causing students’ problems can lead to more effective interventions. Does a students’ reading problem stem from a phonological or orthographic processing deficit? Are math problems due to a problem with memorizing basic math operations or the sequential steps to solve a word problem or to conceptual difficulties? This kind of specific knowledge about students’ issues is needed to craft an individually tailored plan. This kind of information can be obtained from the administration of specific subtests from a neuropsychological battery that are targeted to the areas of concern. In addition, this can all be done prior to going through four tiers when a full battery is needed. Of course, if a comprehensive evaluation is needed, it should be considered. However, RTRI can spare students and the intervention team a lot of time, effort, and pain.

Emotional Attunement in Teaching and Therapy: Some Things Do Not Change

As the fields of education and psychotherapy continue to evolve toward an increasing reliance on “evidence based practices,” it is of equal or even greater importance not to forget that the preponderance of the professional literature points to the importance of emotional attunement in teaching or in whatever form of therapy is being practiced. In our fast paced world, it may be easy to assign a lesser value to certain relationship variables that are prerequisites for making therapy work. Having a good enough relationship with students and patients provides the leverage that moves them to engage collaboratively on the road to accomplishing their goals.

Creating a relationship that will support teaching or therapy in good times and bad begins with a recognition of the immense power of induced emotion. That is, emotions are constantly being exchanged between therapists and teachers and their patients and students often nonverbally and without being noticed unless one is primed to recognize them. Just as we unknwoleingly catch colds, we also catch emotions. Strong emotions, positive or negative, need to be experienced, tolerated, and washed clean of any toxic elements that may derail the therapeutic or educational process. In a previous paper, I cited a quote from Sheldon Kopp who referenced a biblical saying: “If you want to raise a man from mud and filth, do not think it is enough to keep standing on top and reaching down to him a helping hand. You must go all the way down yourself, down into the mud and filth. You must not hesitate to get yourself dirty.” This is not an easy task. It means using the emotions being communicated in a personal way without personalizing them. When all feelings are tolerated and can be mirrored, then patients and students feel they are with someone who is like them. As a result, they are more likely to like you, and this makes the teaching or therapy “go.” Resisting the urge to take actions to deflect emotions that feel intolerable must be resisted because this amounts to rejecting the student or patient.

It is only through this process of embracing the emotional contagion that is part and parcel of every human relationship that we can return to those with whom we are engaged in an educational or therapeutic process an emotional communication that will move students or patients progressively forward.

 

Summer is Almost Here: A Perfect Time for a Neuropsychological Evaluation

If your student has had a difficult year, summer is the time to consider an evaluation to understand the roots of the difficulties and to develop a plan to address them in the fall in order to have a better next year.

Why a neuropsychological evaluation?

A neuropsychological evaluation is the most comprehensive assessment available. The scope of the evaluation is much broader than psycho-educational evaluations performed at school. Moreover, the choice of a test battery and the interpretation of the findings rely on a theoretical framework that represents the best science available.

What does a neuropsychological evaluation assess?

Academic subjects are comprised of neuropsychological processes including cognitive processing abilities and executive functions. The neuropsychological evaluation assesses these brain processes with a focus on understanding which of these is the cause of the academic or behavioral problem.

What kind of help can I expect to get from a neuropsychological evaluation?

The evaluation will examine each of the processing abilities and executive functions involved in performing successfully in each academic area. Once that information is obtained, an individualized instructional plan can be created that is tailored to each student’s neuropsychological profile. This will help teachers to differentiate instruction in a way that targets specific areas of deficit.

Why should I seek an evaluation from me?

First, I conduct all evaluations personally. I do not use a technician to perform the testing. This is important because the observations and interactions that occur during the test administration are very important parts of understanding your student. I believe the testing and the interpretation should be done by the same person. In addition, the reports I write are done personally after extensive analysis of the data and are not computer generated with reams of general and impractical recommendations.

Second, I have been conducting evaluations and working with children and adolescents for over 35 years. I know child and development and I know how to create a test battery that focuses on your student’s issues. My knowledge of the linkages between processing skills and academic performance and how to make realistic, practical, and reasonable recommendations has been obtained over three decades.

Third, I have intimate knowledge of how schools work and understand what kinds of recommendations they are able to implement and those they would ignore.

Fourth, I remain available after the evaluation to help you navigate the school system and child study team. I can accompany you to school meetings and help you in advocating for your student.

The Importance of Understanding before Doing: Fixing Response to Intervention (RTI)

Anyone who reads the RTI literature will see the word “fidelity” in the context of implementing interventions. This is, of course, common sense in that any interventions need to be applied properly. However, in order to attain fidelity, the teachers (and planners) need to have an understanding of why a strategy is being recommended otherwise it is in danger of being applied in a robotic, out of context fashion without any real conviction by the teacher. Having a belief in what is being done can only be accomplished by first comprehending the purpose of the strategy, having an opportunity to ask questions about it and even share objections or reservations about it, and discussing what to do in the event it fails to deliver the expected result.

It has been my experience that teachers often have not been given a framework from which to observe, analyze, and understand student’s difficulties. They are then in the position of doing what they know and if this does not work, they reach an impasse about what to do next. Adopting the principle of understanding before doing is the first step in changing this situation and providing teachers with the supports and tools they need to feel success with their struggling students.

What do they need to understand? Academic and behavioral challenges are best understood through the lens of the framework the Cattell-Horn-Carroll cognitive processing theory provides. First, teachers need to know that academic subjects are really byproducts of neuropsychological processes like cognitive processing abilities and executive functions. Second, by understanding the linkages between cognitive processing and academic subjects, teachers can better identify the specific processing domains that are causing a student’s struggles. At the very least, they can begin to generate informed hypotheses about the root causes which can then be translated in interventions tailored to the individual student’s cognitive profile.

Providing the “toolbox” or evidenced based strategies is the easy part. Training teachers to understand students’ difficulties and to create an instructional approach that emanates from this understanding is the key to fixing RTI. That is, we need to stop shooting from the hip or applying general strategies top individual students. This is one of the reasons RTI may not work. Moreover, having a framework to understand academic and behavioral challenges allows teachers to have an idea of what to do next if a strategy fails. It is important not lose faith if this occurs because each failure yields important information about what to do next.

However, it is essential to understand before doing. Students are complex and teaching is equally complex. Being able to break down academic tasks into the prerequisite processing skills needed will provide teachers with a concrete way to identify, understand, and “fix” their students’ challenges. Without it, RTI can be an exercise of whistling in the wind.

Peeling Back the Onion: The Value of a Neuropsychological Approach to Assessment

Neuropsychological assessment has historically been the province of evaluating individuals with some kind of brain trauma. However, in recent decades, the value of understanding cognitive processing skills and executive functions and their links to instructional practices for students has been acknowledged. In fact, academic subjects are considered to be byproducts of groups of cognitive processes that are necessary to learn and perform successfully in each subject area such that there is an arbitrary dividing line between the subjects and the brain processes themselves. In essence, the cognitive processes are the subjects.

A comprehensive evaluation of these processes implicated in learning and learning disorders includes assessing seven broad abilities and many more narrow abilities that are part and parcel of each skill area. It is essential to understand the part the different narrow abilities play in each ability domain in order to avoid making incorrect assumptions about students’ strengths and weaknesses. For example, an important broad ability, crystallized intelligence, measured by the WISC-V and required in reading, solving math problems, and generating narrative writing, is comprised of tasks that involve both the retrieval from long term memory of already acquired word definitions and identifying commonalities between dissimilar objects or ideas (i.e. concept formation). While each is part of this broad ability, each is also a very different skill. Consequently, if students score well when retrieving word definitions, but perform much less well in forming abstract concepts, then the overall broad ability score must be interpreted in this context. That is, if the overall ability score is Average because the scores on each task are combined, this does not necessarily mean that the student has Average crystallized intelligence. It may mean that a student has good rote recall, but weak abstract reasoning. Combining the scores masks the deficit. Peeling back the onion by differentiating between concept formation, an abstract reasoning skill, and long term recall, gives teachers and parents a roadmap about how to address students’ weaknesses by tailoring the approach to each student’s learning profile of cognitive processing strengths and weaknesses.

It is of equal importance not to omit assessment of any one of the broad ability areas. For example, many students who have difficulty reading suffer from dysphonetic dyslexia, a disorder of phonemic awareness where they are unable to decode or make connections between letters and sounds. Yet, there are some students whose decoding is not the issue. They may experience orthographic or surface dyslexia where they are unable to visually recognize the shapes and contours of letters and sounds or retrieve them from long term memory. Remember, reading begins visually although encoding happens phonetically. Students with undiagnosed surface dyslexia may unknowingly be prescribed a reading approach to correct a decoding problem rather than the difficulty with orthographic processing, resulting in rising frustration.

A competent neuropsychological evaluation will ferret out the subtleties that lie in the various narrow abilities that comprise each broad ability area. Most importantly, once the pattern of strengths and weaknesses is known, interventions can be targeted at the areas of deficit and utilize the areas of strengths to compensate. For professional evaluators, teachers, and parents, it is essential to understand before you do. Peeling back the onion may mean conducting either additional or targeted assessments to the areas suspected of being at the root of a learning problem. This kind of assessment approach, called cross battery assessment, is also individualized as it follows the principle of one size does not fit all. Peeling back the onion involves testing in the suspected area until you understand where the obstacles exist. Stopping the assessment prematurely may result in missing important information or clouding the interpretation of testing results.

Let’s Make NJMTSS a Success

86713_5_80x100Coming in January, 2018, the state DOE will be pushing out its’ Multi-Tiered Support System (NJMTSS) initiative to bolster efforts to support ALL students.

It will be essential to infuse MTSS with a theoretical framework that will provide teachers, child study teams, and administrators with a way to understand how students learn and what obstacles block their learning and performance. The Cattell-Horn-Carroll (CHC) principles are our best science about the kinds of cognitive processing skills that are necessary to read, write, and do math. CHC posits that academic subjects are byproducts of these cognitive processing skills. When paired with the Pattern of Srengths and Weaknesses (PSW) method of assessing students’ cognitive processing and executive functioning profiles, a roadmap can be created to tailor a specific plan to address weaknesses and highlight strengths. Teachers, in particular, need a way to understand why students are having trouble reading, solving math problems, and generating narrative writing. CHC and PSW provides a way to create individualized educational plans tailored to each student’s needs.

I, along with members of for professional groups in NJ-the NJ Psychological Association, the NJ Association of School Psychologists, the NJ Association of Learning Consultants, and the Learning Disabikuty Association of NJ-have been working hard to spread the word by sharing what we know. We are training child study team members, teachers, and interested administrators. If you have an interest in learning more about CHC and PSW and how it can help your school team or increase your knowledge base, feel free to contact me.

let’s get a jump start on making NJMTSS a success to support all of our students.