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The Source® for Development of Executive Functions
Ages: Birth-18   Grades: Birth-Adult

Learn the characteristics of executive function in children–how they present, how to assess them, and how to treat them in children with a wide array of developmental communication disorders.

Outcomes

  • Use goal-directed behavior to experience success in academics and in life
  • Generalize language skills learned in therapy to real-life situations
  • Monitor, manage, and integrate language in relation to behavior
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Educators and medical professionals are increasingly labeling children with clusters of adaptive and self-regulatory behavioral deficits as having impairments in executive functions.  When executive functions work well, the result is goal-directed behavior that is appropriate to the situation and circumstance.  Executive functions are dynamic, interactive, evolving skills, such as goal selection and attainment, planning and organizing, initiation and persistence, flexiblity, and self-regulation.

The chapters include:

Chapter 1—Defining Executive Functions
the components and anatomy and physiology of executive functions

Chapter 2—Development of Executive Functions 
frontal lobe development, cognitive development, development of self-control, and more

Chapter 3—Co-Morbidity of Executive Functions with Other Disorders 
how executive functions are affected in autism spectrum disorders, attention deficit/hyperactivy, fetal alcohol syndrome, Tourette's syndrome, Fragile X syndrome, TBI and more

Chapter 4—Assessment of Executive Functions 
deficits in fundamental language skills, specific executive function skills, developmental expectations, impact of intelligence, formal and informal assessment, and more

Chapter 5—Global Treatment Approach 
increasing self-awareness, using compensatory techniques, specific language/communication objectives, modifying expectations, and more

Chapter 6—Functional Strategies and Goals 
attention deficits, impulsitiviy, impaired self awareness, deficits in flexibility, impaired initiation, and more

"He can't seem to get started."  "She's always talking out of turn."  "He is so disorganized."  If these sound familiar, The Source for the Development of Executive Functions is the resource you need.  This very practical manual takes the mystery out of executive functions and helps explain your student's behavior.  Copy the activity pages or print them from the FREE CD.  

  

Copyright © 2005

Components
188-page book plus a CD of the reproducible pages, evaluation tools, goals
  • Executive functions are a group of cognitive skills localized in the frontal lobe structures.  Deficits in executive functioning involve both discrete skills and the processes that control the use of these skills (Cicerone et al., 2000).
  • Impairments in executive functions may co-occur with a variety of disorders or syndromes, including traumatic brain injury (TBI), fetal alcohol, very low birth weight, and attention deficit hyperactivity disorder (ADHD).  The speech-language pathologist (SLP) plays a critical role in treating these children as language skills are needed to adapt or compensate for these executive function deficits (Marlowe, 2000).
  • Early detection of executive function disorders allows educators and SLPs to implement needed intervention strategies in the preschool years (Isquith, Gioia, & Espy, 2004).
  • By the age of four, children with higher language abilities perform better on measures of executive function, such as working memory and inhibitory control, thus enabling them to make more advantageous decisions (Carlson, Davis, and Leach, 2005).
  • Children with ADHD present with impairments in executive functions which disrupt working memory, rapid naming, strategy development, and self-correction (Shallice, Marzocchi, Coser, Del Savio, Meuter, & Rumiati, 2002).
  • Difficulty with memory, problem solving, and self-monitoring are all deficits commonly seen in the TBI population. Intervention to address these problems can target the underlying cognitive process or may work on compensatory strategies.  The SLP must follow a developmental approach to treatment should a TBI occur in childhood or adolescence (Kennedy & Coelho, 2005).

The Source for Development of Executive Functions incorporates these principles and is also based on expert professional practice.

References

Carlson, S.M., Davis, A.C., & Leach, J.G. (2005). Less is more: Executive function and symbolic representation in preschool children. Psychological Science, 16(8), 609-616.

Cicerone, K., Dahlberg, C., Kalmar, K., Langenbahn, D., Malec, J., Bergquist, T., et al. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine & Rehabilitation, 81(2), 1596-1615.

Isquith, P.K., Gioia, G.A., & Espy, K.A. (2004). Executive function in preschool children: Examination through everyday behavior. Developmental Neuropsychology, 26(1), 403-422.

Kennedy, M.R.T., & Coelho, C. (2005). Self-regulation after traumatic brain injury: A framework for intervention of memory and problem solving. Seminars in Speech and Language, 26(4), 242-255.

Marlowe, W.B. (2000). An intervention for children with disorders of executive functions. Developmental Neuropsychology, 18(3), 445-454.

Shallice, T., Marzocchi, G.M., Coser, S., Del Savio, M., Meuter, R.F., & Rumiati, R.I. (2002). Executive function profile of children with attention deficit hyperactivity disorder. Developmental Neuropsychology, 21(1), 43-71.

Author(s)

Gail J. Richard, Jill K. Fahy

Biography

Gail J. Richard, Ph.D., CCC-SLP, is a professor and Chair in the Department of Communication Disorders & Sciences at Eastern Illinois University in Charleston, Illinois.  Gail's teaching at the university and in workshops around the country focuses on childhood developmental language disorders, especially the autistic spectrum, processing disorders, learning disabilities, medical syndromes, and selective mutism.  Prior to 25 years in the university setting, Gail worked in the public schools, serving preschool through high school-aged students.  She especially enjoys the diagnostic challenge of differentiating among the various aspects of developmental disorders.

Professional awards include being named as a Fellow of the American Speech-Language-Hearing Association and Illinois Speech-Language-Hearing Association, Distinguished Alumnus of Southern Illinois University-Carbondale and Eastern Illinois University, and five Faculty Excellence Awards.  She has served on the ASHA Legislative Council since 1991; and as an NCAA Faculty Athletics Representative since 1994, currently appointed to the NCAA Division I Management Council.

This is Gail's seventh book in the LinguiSystems' Source series.  Previous publications with LinguiSystems include The Source for Autism, The Source for Treatment Methodologies in Autism, and The Source for Processing Disorders.  Co-authored publications include The Source for Syndromes and The Source for Syndromes 2 with Deb Reichert-Hoge, The Source for ADD/ADHD with Joy Russell, The Language Processing Test 3 and Language Processing Kit with Mary Anne Hanner, and Differential Assessment of Autism & Other Developmental Disorders (DAADD) with Lynn Calvert.

Jill Fahy, M.A., CCC-SLP, recently joined the faculty at Eastern Illinois University in Charleston, Illinois.  After an undergraduate degree in foreign languages, she discovered the field of speech-language pathology and completed her master's degree at the University of Illinois.  Jill's previous clinical experience includes work in medical settings in Illinois and Virginia, as well as affiliation with several academic programs as a clinical supervisor and adjunct faculty member.

Jill's clinical background focused primarily on the treatment of communicative, social, and vocational impairments associated with acquired brain injuries.  At Eastern, Jill teaches graduate courses in developmental executive functions, motor speech disorders, and clinical methods.  Her clinical caseload includes overseeing therapy services for a wide range of children and adolescents with deficits in executive functions, all of whom are working to develop adaptive life skills for the future.

This is Jill's first publication with LinguiSystems and her first collaboration with Gail.

Introduction

Executive functions are dynamic, interactive, evolving skills in an individual.  When they work well, the result is goal-directed behavior that is appropriate to a given situation and circumstance.  Performance is constantly appraised and altered to reflect varying degrees of success or failure, and to respond to unexpected changes in the situation.  Executive functions collectively result in the ability to inhibit poorly planned or impulsive behaviors and to sustain successful, goal-oriented behaviors in the context of the everyday environment.

The prefrontal section of the frontal lobe guides us through our day.  It can behave with purposeful intent or it can run wild.  Three different analogies to clarify the role of executive functions follow.

Driving Analogy

Imagine yourself on the freeway, perhaps on your daily commute or on a trip.  You have a destination; you have established a plan to get to your destination; and you are able to safely navigate among unexpected detours or errant drivers.  You are aware of the need to accelerate or slow down and can time these actions to avoid disastrous consequences.  The journey demands a constant balancing act between incoming sensory information about the environment around you, your own internal urges or frustrations, the success or failure of your driving skills, and the frequent changes in direction required by road signs along the way.  When all these variables are juggled appropriately, the result is a fluid, dynamic road trip that allows you to arrive safely at your destination.

Now consider an alternative to the above scenario.  This time you are driving without direction; you have no plan.  In fact, you may not even recall where it is you are supposed to be going or when you're expected to arrive.  You drive aimlessly, missing important road signs, taking wrong turns, and bolting through tollbooths.  You alarm other drivers as you drift in and out of lanes, erratically speeding up or slowing down.  Perhaps you come to a complete halt, stuck in the freeway of life as you sit in the middle lane, unable to proceed.  Maybe you are running on high-octane fuel, speeding so fast you cannot possibly process all the incoming information.  Your actual driving ability might be completely functional, but the ability to make appropriate plans to effectively execute the trip is impaired.  To make matters worse, you have limited awareness of your situation and proceed under the misguided impression that all is well, even when you succumb to impulsive road rage behavior.

Now consider some of the children on your caseload.  How many of them are driving through each day without a plan?  They are spinning their wheels in vain attempts to execute simple tasks in the classroom, at home, or in other social situations without awareness of how futile their efforts are.  The result is poor performance and frustration despite going through the appropriate motions.  The isolated discrete skills are intact (i.e., driving ability) but the functional outcome is a complete failure and waste of time and energy.

Orchestra Analogy

Consider another analogy for executive functions—an orchestra.  With an optimal blend of talented, well-trained musicians and a dynamic, attentive, multi-tasking conductor, the result can be sublime.  Each instrumental section is composed of musicians who have mastered the art of playing their instruments and reading complex musical notation.  The discrete skill of producing harmonious notes from the musical instrument has been acquired as a prerequisite to being a member of the orchestra.  Reading a musical score is another discrete skill that each musician must have acquired to a certain level of competence to qualify for inclusion in the orchestra.  As a member of an orchestra, a musician must integrate a series of discrete isolated skills into a functional whole.  Competent musicians in an orchestra are skilled at listening to others around them, taking direction from the conductor, and merging technical requirements with artistic expression.

The conductor must simultaneously divide his attention among the many instruments and parts to perform the near-magic of organizing possible chaos into aesthetic beauty.  The task is demanding, necessitating a sustained focus with attention to detail.  Each performance requires the conductor to constantly monitor and revise the timing and blending of each individual musician's and section's contribution.  A conductor is skilled at processing multiple channels of incoming information.  He must integrate previous experience with each new piece the orchestra attempts so that he can identify and rectify any gaps or problems.  The conductor needs to recognize strengths and weaknesses within the orchestra as a whole and compensate to achieve a satisfactory result.

Well-trained musicians, led by a highly skilled conductor, can build a repertoire of musical styles and complexities.  An orchestra can become very adept at performing certain types or genres of music.  Additionally, they can improvise, creating new variations on a theme when necessary.  Performances can be impromptu or planned, but the result is fluid and coordinated.  For the audience, the cumulative experience is satisfying and harmonious.

In the event that some musicians in the orchestra are unprepared for the demands required to achieve a well-integrated performance, the result is likely to be less successful. Imagine the sound of poorly-played violas, cellos, flutes, violins, tympanis, French horns, trombones, and trumpets sounding off simultaneously in different keys and rhythms.  No matter how gifted the conductor might be, the end result will not meet the anticipated expectations.  Despite some skilled performances, the functional outcome will be in deficit.

A similar scenario could result if the conductor, rather than the musicians, is lacking in skill.  Without the leadership of a competent orchestra conductor, the coordination and awareness of timing, balance, and integration of parts to achieve a satisfying whole are absent.  If the orchestra is lacking order and organized direction, each section can freely play whatever they choose.  The woodwinds might be engaged in the mellow smoothness of a laid-back jazz piece, while the strings are competing for the audience with a fiercely fast rendition of a classical overture.  The percussion section doesn't know who to follow.  The horn section is also confused and not sure whether to play, be silent, wait, or simply leave.  To further add to the chaos, the conductor continues waving his baton, oblivious to the surrounding confusion.  If the conductor persists with the same ineffective attempts to coordinate and integrate the various instrumental sections, frustration and behavior problems are likely to erupt.

It is important for the conductor to pay attention to feedback from the audience and musicians in the orchestra and learn from his mistakes.  Preparing the orchestra for its next performance requires a careful analysis of exactly where and why the breakdown occurred.  Do the musicians need work on their discrete primary skills?  Are the prerequisites to a successful performance in place?  Does the conductor require help in discriminating the productive versus nonproductive aspects of the orchestra's performance?  Perhaps someone should provide an objective opinion or critique to point out to the conductor what is obvious to the audience.  Some assistance is required to effectively organize the primary ability of the musicians with the integration capacity of the conductor.  The deficit lies in the ability to organize the multiple talents available into a single, eloquent, focused entity that moves smoothly from one musical action to the next.

Language Analogy

A child may acquire normal language skills and, like the orchestra member, be able to demonstrate skill on specific discrete isolated tasks.  Establishing a language foundation is prerequisite to engaging in successful, appropriate communicative experiences.  Yet, the specific isolated skills might not translate into language competence in a connected environmental situation.  Being able to generate antonyms in an isolated language subtest is very different from being able to discern the subtle aspects of connected discourse.  Communication demands a grasp of the subtle, unspoken message.  That message can change, depending on circumstance and context.  Competent language skills also demand flexibility, on-the-spot restructuring, and formatting-to-go.  Children who have mastered phonetics, syntax, and semantics in context-free environments may not be able to competently blend into the orchestra of communication demands in real life.

The communication profile associated with Asperger's syndrome provides an illustrative example of a deficit in executive function.  Individuals with Asperger's syndrome demonstrate normal skills in fundamental language aspects, with the exception of pragmatics.  Measurements suggest competency in basic syntax, semantics, phonology, and morphology.  Standard scores tend to be age commensurate or advanced of chronological age expectations.  However, the practical management of using those language skills in a functional context is problematic.  Language fundamentals are applied in a rigid, inflexible manner.

In the "Asperger" orchestra, the musicians are capable of playing a given repertoire of notes, but the conductor is unable to reorganize the musical talents into other pieces or integrate them into a pleasing variation on the usual presentation style for that musical selection.  The piece must always be presented in the exact, same manner.  An audience listening to this concert finds itself on the receiving end of a repetitive soliloquy, just as the communication partners of children with Asperger's syndrome do.  The higher order integration of language skills with contextual demands and self-awareness is missing.

Now consider a child who presents with deficits in both language and executive functions.  In other words, the child has impairments in the structural components of language in addition to disorganization in the ability to integrate and apply language skills.  The dual deficits compound the challenges for this student.

Children with Williams syndrome typically exhibit expressive language that is superior to receptive language.  Following a delayed onset of language development, their course of language acquisition reflects a splintered pattern of impressive vocabulary and syntax, combined with deficits in semantics and overall comprehension.  They evidence a command of expressive language that is fluent, highly embellished, and produced with flair but lacks the comprehension and subtlety necessary for effective communication.

To further confuse matters, the overall cognitive profile for children with Williams syndrome is similarly splintered.  Their outgoing, gregarious social skills often mask underlying difficulty with basic concepts and big-picture reasoning.  Their impulsive problem-solving skills reflect limited planning and organization.  In this orchestra, performances are theatric, exciting, and fast-paced.  Musicians are likely to perform eloquent and inspiring renditions that are completely independent of their fellow orchestra members.  These performers lack the capacity to listen to one another and fail to recognize cues or direction from the conductor, who is experiencing his own difficulties in maintaining order.  This audience is in for an impressive but ultimately disorganized and incomplete performance that fails to satisfy.  In this case, a lack of full-scale comprehension of meaning in language, coupled with disorganized management and integration, results in ineffective functional communication, despite good expressive production skills.

Identifying the point at which effective communication breaks down is vital to planning effective treatment.  The development of language is fostered and shaped every day in every interaction.  Real life introduces language in a natural context, where meaning can be derived and conveyed from the unique circumstances of the situation.  The natural outcome of effective communication determines a child's ability to function successfully in the world.

To optimize the effects of treatment, differential evaluation of the primary communication deficit is essential.  Is the child lacking the isolated discrete language foundation skills of semantics, syntax, phonology, morphology, and/or pragmatics?  Is it the nonverbal, inferred processing skills that are lacking?  Is the deficit in the application of integration, executive function, and self-regulation of these language fundamentals?  Or is it a combination of these variables that are causing the problems?

Optimal treatment cannot be designed until differential analysis of language skills is completed.  Effective functional communication must blend mastery of language fundamentals with executive functions to facilitate academic and social success.  Children must have the tools to adequately generate, refine, and comprehend basic language fundamentals (semantics, syntax, phonology, morphology, and pragmatics).  This is analogous to providing individual music lessons to master production of notes on a musical instrument.  Then the child has to proceed to a higher level of performance expectations.

Now the child must function as a conductor with an ability to read the audience and elicit the best from each individual musician.  In language, a child must be able to read a communicative situation, modify input based on reactions, and effectively manage and coordinate each individual aspect of language.  If the child is able to integrate and coordinate all her language skills, the result can be a satisfying and fulfilling interaction.  If the child fails to effectively integrate all the language variables, embarrassment and frustration are likely to result.

Children with language deficits often need to be taught how to successfully integrate language skills in unique environments and contexts.  This is the role of executive function for the speech-language pathologist—to develop the ability to successfully monitor, manage, and integrate language in relation to behavior.  This important step is often overlooked in treatment plans.  Discrete specific skills are taught, children demonstrate competence on isolated subtests during evaluation procedures, and they are dismissed from services.  However, a teacher continues to experience difficulty, and the therapy progress demonstrated on discrete language skills doesn't generalize to result in positive changes in an academic environment.  Parents continue to observe difficulty in social situations for the same reason.

Language therapy must extend beyond remediation of specific isolated skills and must insure the integration and coordinated management offered by executive functions to blend discrete abilities into functional life situations.  Only then will the language orchestra achieve its full potential and produce a satisfying, cathartic performance.

Gail and Jill