Strategies to Develop Executive Control Skills in LanguageImpaired Children Kerry Howland, Ph.D., CCC-SLP Boston University Department of Speech, Language and Hearing Sciences Plan for the Session • What are Executive Control Processes (ECP) – and why are they important to an SLP? • Identification of children with ECP deficits • How can we help to improve ECP skills in our clients? Welsh and Pennington (1988) Definition of Executive Control The ability to maintain an appropriate problem solving set for attainment of a future goal. Executive Control Processes • Managing attentional focus • Engaging in goal directed behavior • Employing strategies • Inhibiting irrelevant/inappropriate responses • Planning • Prioritizing • Reflecting on the learning process • Taking another’s perspective • Coordinating information in working memory When are EC Processes Needed? • Diamond (2006): When “going on automatic” would lead one astray. • When a new skill is being learned; until that skill becomes automatized. • To complete tasks that demand integration and coordination of multiple skills. IMPACT OF EXECUTIVE CONTROL DEFICITS • EC skills predict academic success more effectively than tests of academic achievement or cognitive ability. • Children with poor EC skills are at high risk for dropping out of school. • Children with poor EC skills are also at high risk for social/behavioral problems. • EC skills are essential to the development of theory of mind abilities. Executive Control • Generally associated with frontal systems, specifically the pre-frontal cortex • Pietrus (2005): Networks almost always have an “office” in the pre-frontal cortex. • EC skills are employed until a skill becomes automatized. • Children with poor automatization abilities compensate with frontal systems Development of Executive Control Skills • The pre-frontal cortex is one of the last areas of the brain to fully develop. • There is a rapid increase in myelination of the PFC during adolescence • This development continues through the early 20’s and perhaps even beyond. Executive Control and Older Students • As educators, we have increasingly and appropriately focused on development of EC skills in middle school and high school • But... executive control skills don’t suddenly emerge in adolescence. The foundation is laid in early childhood and builds throughout the school years. • We can’t afford to wait until middle school to work on executive control. Environmental Influences • Development of executive control is driven not just by maturation, but also by EXPERIENCE • Given the right experiences, children can improve executive control skills • Children who live in urban areas are at high risk for problems in executive control. So... • We need a developmentally appropriate curriculum to directly teach executive control skills from the start of school. • Rather than problem behaviors that need to be managed, we need to think of executive control processes as skills to be developed What does this have to do with speech and language? • Executive control processes are intricately linked to language development. • In order to use language effectively in the classroom, we continually need to integrate and coordinate multiple linguistic abilities. • Language is a primary tool for self-regulation, so the child with language deficits may, as a result, experience problems with executive control. • We can’t escape the impact of EC processes in our therapy sessions! They help us or they hurt us! Core Executive Control Skills • Working Memory • Inhibition • Planning • Cognitive Flexibility • Self Regulation Baddeley’s Adapated Model (2000) Central Executive Visuospatial Sketchpad Phonological Loop Episodic Buffer Inhibition • The ability to stop a “pre-potent” response from occurring. • Often measured by Go/No Go Tasks • A fundamental ability that is key to – Regulating attention – Social adaptation – Effective learning • Inhibition is HARD WORK Planning • Planning skills become increasingly important throughout elementary, middle and high school (and beyond). • Planning relies heavily on the interaction between working memory and inhibition. Cognitive Flexibility • The ability to change or adapt plans as circumstances demand. • The ability to shift sets • Requires recognition of the need for change • Requires the ability to inhibit the original action in favor of a new response Self Regulation • Intentional use of metacognitive strategies to manage EC processes, including management of emotions • Verbal mediation (self-talk) is a primary strategy for self regulation. • For this reason, many of our language impaired children have trouble in this area. ECP in Infancy: • By 8-12 months of age, the foundation skills are being set: • Working Memory: – Establishment of Object Permanence • Inhibition: – Understands and responds to “no” – Detour Reaching – not yet established – Repeatedly searches for displaced object in the same location even when sees it move. • Planning: – Emergence of intentional action to gain a result or resolve a problem Still Face Experiment • Self-Regulation – Management of Arousal Level – Ability to Attain a State of Calm-Alert ECP and the Toddler: Foundation Skill: Regulation of Emotions • Working Memory – Able to hold relationships in mind– phrases emerges – More sophisticated levels of object permanence • Inhibition: – Not distracted as easily from goal. – Remembers rules for NO. – Inhibition is reliant on adult mediation. • Planning – Creates multi-step sequences to attain goal: (collects stool, climbs on it to attain out-of-reach cookie jar) • Emotional Self-Regulation – Tantrums emerge – a good sign! – Frustration with handling requirements of inhibition – The time to really begin to teach self-regulation!! ECP and the Pre-Schooler: Foundation Skill: Inhibition • Working Memory – Children are thinking in the past and future now. – Can maintain focus and interest for plot-driven stories – Recount own experiences in small sequences • Inhibition – Key transition from 3 years old to 4 years old. – Three year olds understand go/ no-go but cannot abide by the rules. • Marshmallow Experiment Inhibition and Theory of Mind • 3 year old have trouble with TOM tasks but 4 year olds are successful. • Classic Tasks – False Belief: – False Location: – Strategic Deception Theory of Mind Tasks • Certainly TOM requires an understanding of perspective – BUT what else is involved: • Requires a high degree of working memory • Requires inhibition of the pre-potent response (the child’s own knowledge) Planning in the Pre-School Years • Symbolic Play is the Best Vehicle for Assessing and Observing Planning in the Pre-Schooler • Changes in Level of Sequence Carried Out – 2-3 years: short self-limiting single schema sequences – 3-4 years: Multi-scheme sequences encompassing broader time frames - links sequences together. – 4-6 years: PLANS the sequences out, coordinates roles, uses language to set the scene • Remember planning requires inhibition + working memory Self-Regulation in Pre-School Child • Tantrums subside between 3-4 years (for most children). • Increasing ability to abide by the rules – Regulation of others emerges before regulation of self. • Increasing ability to play rule governed games– interest in these games develops and increases – Predominantly non-strategic play– guesses same spot over and over in memory until about 5 years old. – Inflexible about rules– fantasy must abide by real-world • Most children still have trouble tolerating losing– very poor sports! Assessment of the Pre-School Child • Our tests require cognitive flexibility – is it language or shifting set that is the issue –PLS for example. • Play assessment is essential. Look at play sequence, organization, and persistence. • Discourse assessment is essential – Is child stuck in the here and now? – Can child recount experiences? – Does the child follow stories with plots? • Many kids ace the PLS and the CELF-PS, but show problems in their organization of play and discourse, even when adults are scaffolding them. • Don’t brush this off as “immaturity” – a little work now might mean a lot less work later!!! ECP in Elementary School Foundation Skill: Sustained Attention • Working Memory – Children become increasingly strategic– they try to remember – Working memory is essential to developing automaticity with early academic skills– reading and math • Inhibition – Increased resistance to distractions – Children are expected to abide by rules of the classroom – Poor inhibition becomes increasingly socially and academically penalizing – Social skills and inhibition ability are intricately intertwined ECP in Elementary School • Planning: – Children regularly carry out multi-step directions Children independently work in learning centers Children carry out daily routines for school and home – Children become increasingly strategic in playing sports and board games. – Children can conceptualize long-term planning (saving money to buy a toy) • Self-Regulation – Children are learning to be good sports – still working on this. – Children can focus on lessons for extended period of time. – Teacher and parents still carry much responsibility for children getting work done-staying on task ECP in Middle School and High School Foundation Skills: Planning, Organization and Self-Regulated Learning • Working Memory: – Demands within lessons expand exponentially – Significant increase in the amount of new information in each lesson – Demands for memorization increase. – Demands for multi-tasking (note-taking) increase. • Inhibition – Children need to self-manage distractions (ipod, IM) – Planning and inhibition become increasingly intertwined (choosing how to manage time, inhibiting desired activity in favor of long term goal). – Social pressure is very high– children must balance social and academic priorities Middle School and High School • Planning/Organization – Long range planning continues to develop and become refined. – Children are expected to become self-managed in handling homework and school projects– Study skills become essential – Organizational Skills become critical in all aspects of learning – Initiation becomes a big factor– kids get stuck in procrastination ECP in Middle and High School • Cognitive Flexibility – Multiple teachers, classes, learning strategies to manage – Study skills include plans for different types of academic tasks – Social thinking carries a new level of importance – Increase in demands for comprehending abstract reading material College/Adult Executive Skills • Long Range Planning • Time Management • Strategic Learning • Integration of information from multiple sources and perspectives KEY POINTS • It is very difficult to divide EC Skills – They are all intertwined. • Successful Learners integrate a variety of EC skills and language skills, and use them efficiently and effectively to accomplish a task. • MANY kids have the component skills, but cannot INTEGRATE them. Why We Fail To Identify Children with ECP Issues • Many kids with EC problems do well on tests of discrete language skills– Even discrete EC tests don’t always identify students with integration problems • These are the kids parents refer for testing, teachers complain about, and we test them and say they are fine. • They almost NEVER score below average on the CELF-4. Our Oral Language Tests • Emphasize word and sentence levels • CELF-4 – 1 subtest targets discourse level, and that one only has paragraphs of 4-6 sentences – Does not assess higher level language skills such as inferences (except a few items on the Understanding Spoken Paragraphs). • CASL-TLC-TOPS – Requires higher level skills, but… – Tests them mostly at level of sentence or short paragraph Our Written Language Tests • Very few written language tests evaluate discourse level. • Those that do, test mostly fictional narrative, occasionally a procedural sequence. • Often discourse items are only one of many items in the test, and many pieces are analyzed. • Example: TEWL story, narrative only, length over-rides organization in many cases. • OWLS only a few items are even discourse length, gives one big score. The Solution? • Qualitative Analyses are Essential – – – – Informal Reading Inventories Pragmatic Inventories Oral Language Samples Written Language Samples • You need not do them all– choose the ones best suited to your client’s problems • Without these analyses we cannot rule out language problems based in executive control. Discourse Comprehension and Executive Control • Open-ended assessment is essential. • Qualitative Reading Inventory: – Provides grade level text – Analysis of re-tell gives lots of information about organization skills, ability to select relevant points – Comprehension Questions (Factual and Inferential) Patterns of Performance on QRI Re-Tells • Ideal Performance: – Makes a summary statement regarding all essential parts of text – Narrative: Setting, goals, all events, and resolution represented by a statement. – Expository: Main ideas represented by a statement. – Events told sequentially • The Goldilocks Effect – Recalls too many details – Recalls information from only one section of the text • Misses the Organizational Frame – Narratives: missing the goals and resolutions – Expository text: missing the main ideas Patterns of Performance on QRI Questions • Scores at Frustration Level despite average reading skills on other measures. • Often misses the inferential questions even with look-backs • Over relies on previous knowledge rather than info presented in the text. • Perform differently depending on text type – LI kids tend to do better on narrative tasks – ASD kids tend to do better on expository tasks Language Sampling • Oral Narratives – Fictional Narrative – Conversational Narrative: Personal Experience – Conversational Narrative: Movie or Book Re-Tell • One technique is to show a video clip and re-tell that clip – Expository Narrative: Game Explanation • Written Narrative – We collect one timed sample: • Middle School and High School: Persuasive Essay • Elementary School: Descriptive Sample – We also request samples of work from classroom Oral Language Characteristics of Children with ECP Deficits • Disorganization is the biggest problem • May have many verbal disruptions, as a result of word-finding problems • Goes off on irrelevant tangents • Explains minor points with excessive detail. • Overproduction is the biggest problem, but underproduction is also a concern Kids with LLD and EFD both “use a knowledge telling strategy (i.e., pouring out any information that comes to mind without concern for its relevance). Nippold & Scott, (2010), pp 178, Written Language Characteristics of Children with ECP Deficits • Starts writing immediately, and ignores offer of graphic organizer • Writes until done, hands in paper without re-reading. • Again, organization is the biggest concern • Much more likely to under-produce for written language than oral language. • Often express extreme dislike and reluctance for completing the task. Analysis: Macro-Structure • This is relatively quick and can be done online by an experienced tester, although transcription is better. • A flip camera allows for a quick review and is easier to deal with than an audiotape– also allows for pragmatic analysis more easily. • Check off the major components as you hear them. • Note tangents. • Tally verbal disruptions/mazes: If they occur on more than 20-25% of utterances, that is excessive Microstructure Analysis • Use of complex sentences is more common in the expository text, so only analyze this text for syntactic complexity. • Count number of subordinating conjunctions used/tally ratio of simple to complex sentences • This is more essential for the LLD kid, and chances are good that formal tests of syntax will highlight the issue • If child seems to under-produce – transcribe the sample and get a productivity count. Intervention Skills: What to Target • Pre-School-1st grade – Inhibition – Planning through Play/Center Times • 2nd-5th grade – Develop Strategy Use – Graphic Organizers – Self Regulation of Attention • Middle School and High School – – – – – Independent and Flexible Strategy Use Planning/prioritizing/Organizing Being systematic Self regulation/self monitoring Self advocacy Inhibition Skills in At-Risk Children • Boston Public School Early Learning Center: Grades K0-1st grade • Children are teacher-referred for support in developing phonological awareness skills • We noted that a high percentage of the children who were referred had trouble with inhibition. Can you teach executive control to Pre-Schoolers • Tools of the Mind Program – http://www.mscd.edu/extendedcampus/toolsofthemin d/ • Based on Vygotskian principles • Diamond et al (2007) found that children enrolled in this program improved significantly in performance on a battery of Executive Control Tests Facilitating Inhibition • Distance helps • Hala and Russel (2001) found that three year olds could perform strategic deception if they pointed with a pointer, not with their own hand. • Children perform more successfully on false location tasks if the change in location is described but not observed by the child. • Dowsett and Livesy (2000) found that inhibition can be directly taught – Performance on a go/no-go task improved after children practiced a cognitive flexibility task (similar to Wisconsin Card Sort). – Just training inhibition alone is not as effective as embedding inhibition into a more complex task. Incorporating Inhibition Goals Into Therapy • Games • Visual and/or Tactile Reminders • “Prophylactic” Cueing • Peer regulation helps self regulation Games to Develop Inhibition • Duck Duck Goose • Freeze Tag • Simon Says (simplify for the younger child, do what the “good puppet” says, not what the “naughty puppet” says). • Slap (Tap) Jack (we do this with letters) • Musical Chairs • Mother May I? Visual Reminders • Rule board with simple visual symbols. (we use boardmaker symbols) • Stop/Go Signs • Thought bubbles and whispered responses to help inhibit talking out of turn. • Self-cues – Fingers to lips to inhibit talking – Hands behind back to help resist touching materials. Prophylactic Cueing • Treat inhibition as a skill that is being taught. • Cue and remind before mistakes are made. • If needed cue continuously through the “no-go” time. • Set small goals and make them attainable. • Make it motivating, fun and desirable to inhibit. Regulation of Peers • Children can recognize violations of rules in peers before they can self-regulate • By regulating peers, they can improve their own self regulation • Suggestions from Tools of the Mind program: – Child who uses a loud voice can monitor volume in the class – Child who never cleans up can monitor if each area is clean – Incorporate target goals into pretend play scenarios with the child Combining Inhibition and Phonological Awareness • Tap the card that starts with a given sound suppress responses to other cards. • Feed cards with target sounds to puppet, throw the others in the trash. • Variations on UNO (letter and color rather than number and color). • Board Games that require go/no-go responses. • Earning an “inhibition game” as a reward for successful participation in the session. Perspective Taking • Inhibition co-develops with theory of mind skills. • Build theory of mind games into circle time activities. • Play barrier games in the classroom. • Discuss character perspectives, feelings and during story telling activities. Planning and Pretend Play • Play is the best vehicle there is for building EC skills and language skills • Encourage your teachers to coach the children in the dramatic play areas – teacher suggests/expands on themes • Build pretend play into circle times by acting out stories. Planning Skills in Pretend Play • Have a pretend play theme each week. • Develop scripts for each theme. • Discuss what roles and props are needed. • Guide the play sequence, helping children to enact each next step. – Boardmaker symbols might be used to help children move through steps. • Repeat the play theme several times during the week. Planning and Center Time • Before children enter a center, they have to verbally state (or draw) a brief plan. • For pre-schoolers, this can simply be a single statement of intent – I’m gonna make a block tower – I’m gonna put the puzzle together with Jimmy • Note that it is not critical that the full plan is carried out • Evaluate afterwards: did you make a tower or did you change your plan? Planning in Kindergarten/1st Grade • True planning begins at this age • Emphasize planning elements in story telling activities (what is the problem, how can they solve the problem? What should they do first?) • Readers Theater is a great way to combine planning, perspective taking, inhibition and reading fluency. • Involve children in every step of the planning process, from assigning roles, to developing props, to making scripts, to inviting guests. Planning Throughout Early Grades • Use visual cue cards in centers to help children to carry out a sequence of steps independently. – Have children make their own visual plan card before entering the center. • Verbally plan what to write about in morning journal. • Involve the children in planning projects, trips, classroom events. • Verbalize your own planning process to give a model. Use the word plan, frequently. Discuss instances when plans go wrong, and how they can be changed. Language and Working Memory • Virtually all complex language tasks place a heavy demand on working memory – Following Directions – Understanding a Story – Comprehending the steps in a science procedure • This includes formulation demands as well as processing demands. – Formulating complex sentences – Telling a story – Explaining a procedure Can you directly improve working memory? • Not much evidence yet to answer the question • There is some evidence that intensive computerized intervention programs show some generalized language effects. • Perhaps these programs are serving to strengthen verbal working memory capacity Minimize Working Memory Demands • Use Visual Cues, Pictures or Organizers – Story grammar outline to keep the story on track – Manipulatives to help with math – Practice writing down key words to decrease juggling demands • Over-learn the core skills– skills that are automatic take minimal working memory • Memorization and Working Memory – If you cannot hold information in STM, transfer to LTM for retention may progress more slowly Memory Strategies: Direct Practice • Rehearsal may not take a student far if they have short term verbal memory deficits. • Visualization strategies may prove more effective for some of our LI students. – Adaptations of the Lindamood Visualization and Verbalization program can be helpful for some students. • Pair a motion/gesture with each step • Help children discover whether they remember best with auditory/verbal, visual, or kinesthetic cues (or a combination) • Use Clip Art: Let students select images they will remember Help Students to Chunk Information Storm Vocabulary: Hurricane Cloud Vocabulary Tornado Nimbus Cirrus Blizzard Nor-easter Cumulus Stratus Teaching an Organized Approach To Reading and Writing • Teach text types and their signal structures • Place a high focus on identification of main ideas • Teach self-questioning and self monitoring strategies. Text Types and Their Signal Words • Easier Types – Description: • For example, Characteristics of, Refers to, Someone who, Something that – Procedural • First, next, last, finally, before, during, if-then • Harder Types – Causation • As a result, As a consequence, Therefore, Due to, For this reason, Since – Compare contrast • Although, However, On the other hand, In contrast Effective Use of Graphic Organizers • Linear organizers work best for language assignments. • Keep organizers simple. Use only a few types. • Organizers should be school wide and system wide would be even better! • Have students identify the type of assignment and match it to the right type of organizer Using Organizers for Comprehension • Tailor the organizer specifically to the reading assignment. – The organizer should have the same number of main ideas and details as the text it is used on. • Identify main ideas first • Teach students how to use KEY words to summarize content on an organizer Multi-Paragraph Organizer MAIN IDEA MAIN IDEA MAIN IDEA detail detail detail detail detail detail detail detail detail RAP (Ellis & Graves 1990) • Read a paragraph, • Ask yourself “what were the main ideas and details in the paragraph” • Put the main ideas and details into your own words. – Teach concept of key words • This works great if the student actually knows how to find the main idea. Control Text Complexity and Type • Select Easier Text Types First – Descriptive – Chronological Sequence • Control Readability • Use Same General Format Repeatedly • Move Systematically from Concrete, Imageable Concepts to Abstract Ideas. Multi-Paragraph Organizer: Descriptive What it looks like detail Where it lives What it eats detail detail detail detail detail detail detail detail Self Monitoring Comprehension (AKA: DON’T just skip the parts you don’t get) • Identify/Highlight Unfamiliar Words • Identify Confusing or Contradictory Statements • Resolve: – Look up in your textbook or online – Ask your teacher or a peer • Give students texts that contain errors in logic, ask to identify the error Written Formulation • Teach writing as a process: – Don’t start writing the moment you get the piece of paper! – Planning does not need to take a long time • Give focus to the paragraph as the central part of writing • Practice Many Short Answer Paragraphs – – – – Brainstorm Ideas Organize into a main point– discard details that don’t fit Make a topic sentence Write the supporting details Topic Sentence/Main Idea: Detail 1 Detail 2 Detail 3 Conclusion/Transition EmPOWER PROGRAM A Strategy for Teaching Expository Writing Singer and Bashir (2002) Innovative Learning Partners, LLC EmPOWER = • • • • • • Evaluate Make a Plan Organize the Information Work (Write) Evaluate Re-Work Generating content is particularly problematic for many of our students: – Assess/Teach Researching Skills • Internet Searches • Evaluating a source • Choosing relevant information – Assess/Teach Brainstorming skills • Activate knowledge base using sources • Conduct brainstorming in group settings • Practice divergent naming – Build Confidence and Motivation with Familiar/Preferred Topics Study Strategies • Make a Nightly Homework Plan – The Learning Center should not be “just a place to do homework” – It should teach you HOW to do homework/How to Study– Strategy oriented!! – Make a homework plan and evaluate how it works! • Develop Time Estimation Skills – Kids with EC deficits have a poor sense of time – Ask them how long it will take to complete a piece of homework – Have them time themselves on the task – Report back their accuracy • On-Task Log – Repeat timer goes off every two minutes, student checks whether they were working or not (reality check for how much time spent texting, etc). Find Best Study Environment • Do I need to be alone? • Can I have distracters present – Phone? – Internet – Music/TV • Does it help to study with a friend, sibling, or with parents around? • Do I want formal homework group? We ALL need Motivators! • Help Student Choose Incentives – Rewards to get through the homework – May be at end of task, after each math problem, etc. – Off-task moments work well – finish math then text a friend for five minutes. Set a timer. • Initiator Reward: Snacks can work very well. Start the task, eat a chip! Working With Helicopter Parents • Parents of Kids with EC deficits know their kids don’t self-manage– so they do it for them. • This can lead to learned helplessness– kids do ok in high school, and flunk out of college • Help parents to set up, and follow a plan to gradually decrease the structure (and nagging). • Help students to strategically use their parents support. Ask for what they need. Test Prep and Test-Taking Strategies • Time Planner: How far out to start studying for what type of tests. • Strategic Memorization: – What to memorize – How to chunk it into categories – Finding your best retrieval strategy • Preparing for In-Class Essays – Brainstorm questions – Brainstorm main idea and supporting detail answers – Practice writing paragraphs in time frame allotted. • Taking Multiple Choice Tests – Strategic Guessing – Look for clues from other questions Test/Homework Review • After an assignment is given back- don’t throw it away! • Self-Analysis: Did I get the grade I wanted? If not: – Did I study the same material that was tested? – What/How can I study differently next time – Will I need this skill again? For the next Lab? For the final? For MCAS? If so: • Do I understand what I did wrong? • Can I now do it correctly? • Who can help me learn what I don’t understand? Principles of Strategy Development • Simply telling student how to use a strategy doesn’t work. Strategy Development Involves: • Instruction and Rationale for Strategy • What to do • Why to do it • When to do it • Intensive teacher modeling of strategies, many times across many contexts Strategy Development Continued • Guided practice, many times across many contexts– • Student learns and explains steps in using the strategy • Student evaluates how the strategy worked • Grades incorporate strategy use as a factor (build motivation) • Peer-mediated, or or teacher-monitored practice many times across many contexts. • Independent practice with teacher spot checks Strategy Development • Training in how to modify the strategy to meet task demands • As multiple strategies are taught, students especially need guided practice in when and how to use each strategy. • If the student does not independently, consistently and flexibly use the strategy, you have wasted your time. Consultation in the Classroom • Many classroom teachers do not know what EC skills are, let alone how to accommodate for them. • Help teachers set up systems that promote selfregulation – Homework always handed in at the same time, and in the same place. – Homework written on the board, and ideally in an online website. – Procedures for how to complete a task written in sequential steps, visible in the classroom during the lesson/practice/test. – Study strategies discussed explicitly • Help teachers build strategies into the classroom, model their use, and guide students toward independent use. References • • • • • • • • • • • • • Brown, A.L. & Day, J.D. (1983) The development of plans for summarizing texts. Child Development, 54, 968989. Carlson, S.M., Moses, L.J. & Claxton, L.J. (2004). Individual differences in executive functioning and theory of mind: An investigation of inhibitory control and planning ability. Journal of Experimental Child Psychology, 87, 299-319. 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