Assessment, Consultation, And Evaluation

Recharging the “Fuel Tank” of our Attention and Executive Function

Some students and adults must work much harder than others to sustain their attention and employ various executive skills in settings which they find non-stimulating. Today’s researchers believe there is a way to replenish the resources needed to stimulate these tasks on an ongoing basis. These replenishing methods may range from taking more breaks or doing other activities that the individual finds more replenishing for the attentional and executive tasks later. Our specialists can experiment with brief activities throughout the day to see which ones are the most helpful at “fueling the tank.” For example, something that can improve a student’s ability to sustain attention for longer periods of time may be an increase in sensory stimulation such as a fidget object, chewing gum, work while standing up, doing chair push-ups, passing out class materials, running errands, having a chair that allows for motion, or an exercise band around the legs of the chair. Some teachers strategize to allow students to have a sensory break by creating designated zones in their classrooms for refocusing purposes or having a set of physical activities one can do on their way to the bathroom. Other useful methods may include noise cancelling headphones or listening to music to screen out other distractions. Further, visual cues which monitor the individual’s attention, such as a watch which vibrates periodically or post it notes with a code word can help the individual to remain focused.

 

Written directions/checklists

The student may miss important information when screening out distractions (auditory attention), remembering information long enough to write it down (working memory), repeatedly switching attention between listening and writing (cognitive flexibility), and then writing the information down fast (rapid fine motor). A good strategy to combat distractions from tasks is to provide the student with a visual copy of the instructions, listed in order. If there is no time to provide written instructions, auditory directions should be given to the student while maintaining eye contact and minimizing external distractions. The student should be able to repeat back instructions so that the teacher can check that they were accurately comprehended. Directions, both written and auditory, should be short and clear, with one direction (as opposed to multiple) given at a time with supplemental visual aids. Questions should be encouraged, and the student should have access to an additional classroom helper who can further clarify missed directions.

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Impulse Control

Behavioral inhibition is a notorious weakness to individuals with this profile. For example, they may blurt out answers without being called on, start tasks without reading the before-hand instructions, and rush through tasks they find non-stimulating to something more interesting. In encourage impulse control, frequent check-ins, visual reminders, and time to pause and check work can be helpful.

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Coaching

These individuals may benefit from the help of a coach who can (ideally) meet for a few minutes before school begins and just after school ends a few days per week. This individual will help with planning, organization, and time management functions, by running through a list of daily requirements. This will help the student turn in homework, have a correct list of assignments and the correct books to complete their task. Furthermore, allowing the student to mentor a younger student in some way may give themselves a sense of accomplishment and additional encouragement. There is also a watch available through www.watchminder.com that allows a student to program a series of messages and vibrating alarms, which will provide additional sensory cues to promote their concentration. If a student struggled with remembering to write down their homework for the night, for example, the alarm could remind them every five minutes before the end of the school subject with a message reading “homework”!

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Homework modification/reduction

Long and repetitious tasks for students with this learning profile are a known difficulty, especially when it comes to homework assignments. These difficulties can be minimized by allowing the student to demonstrate a mastery on a small number of items, a focus on quality over quantity so to say. A helpful strategy for completing homework would be writing the assignment step by step, skipping a line underneath each task, and filling in a brief reward for themselves following the completion of each assignment. For example, math problems, watching videos for fifteen minutes, reading a chapter, texting a friend for ten minutes). Another helpful strategy is studying in various places, such as in the closet or outside on the trampoline in their early years, and in their later years in places such as a coffee shop, the park, or the beach. Increasing sensory stimulation (listening to music, reading on a treadmill, sitting on a therapy ball) or working with a peer who is focused on the task for short bursts rather than longer periods can also be beneficial. If problems continue to persist, an after-school homework club or a tutor can further decrease stress and insure homework completion. College mentors who can teach study skills and oversee homework are available at Club Xcite (www.exciteway.com).

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A home-school behavior plan

For a successful home-school behavior plan, close communication between the teacher and the family is essential. There is a variety of ways this can be structured; however, it is important to note that this plan may not last when the novelty wears off and it will need to be restricted anywhere from three days to a month.

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Nonverbal Prompts and Cues

Nonverbal prompts and cues are preferred to auditory ones in order to minimize stigmatizing the student in front of their peers. Simple methods such as moving closer to the student’s desk or putting a hand on his or her shoulder can help them re-focus on the task at hand once more.

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Prioritize and Monitor

Parents or other family members can help break down larger tasks into smaller ones, help decide which tasks are of larger priority than others, and monitor that the student is making progress.

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Help Develop Routines

Parents and other family members can help the student develop routines which can ensure that tasks are completed on time. For example, having a designated place (preferably visible to the parent) and time for daily homework assignments, where the student can leave all their learning supplies and then successfully pack them up for the next school day. Memory strategies may also aid in memory and organization, such as an acronym and a saying. For example, “Don’t leave the house without your PANTS” where P stands for parent note, A is for assignments, N is for notebook, T is for textbook, and S is for the student themselves.

 

Health and Lifestyle

It is recommended that parents assist in maintaining a child’s healthy lifestyle which includes a balanced diet, regular exercise, and enough sleep, as each of these factors can have a significant impact on the child’s behavior. For example, parents may encourage their child to receive sensory stimulus before the start of the school day, such as through activities like running or surfing, or afterschool to replenish themselves. Regular exercise can help not only the student’s health but also their executive functions and emotional regulations. Furthermore, children with attention and executive function challenges may have a hard time falling asleep, so a consistent bedtime routine is immensely helpful. As sleep deprivation can mimic or worsen the student’s challenges, it is important to consult with a sleep expert if challenges in this area persist. Examples of helpful things to incorporate your child’s nightly routine may include limiting or excluding screen-time after dinner, taking a bath or shower, brushing their teeth, reading quietly, meditating, or listening to soothing music).

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Compliances

Individuals in this demographic can struggle with compliance both at home and at school, presenting as what can be called a “difficult child.” Working with a therapist can help both parents and the child work at methods of managing behavior. An additional useful tool is a book by Ross W. Greene which provides a problem-solving approach to challenging children: The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. Ross W. Greene has further resources on his website (www.livesinthebalance.org).

 

Greene’s work is built around the belief that 1) kids will do well if they can and 2) that behavior is always preferable to misbehaving. This shifts the view that misbehavior is a result of attention-seeking, manipulation, testing, and/or being poorly motivated. In contrast from the standard view, Ross Greene works to show that misbehavior is a result from the demands placed on the child, exceeding the skill that they must respond positively. A few examples of skills a child might be lacking include frustration tolerance, flexibility to shift mindsets, adaptability, acknowledge other’s perspectives, self-soothe, and problem solve. An important goal of the collaborative problem-solving process is to identify which skills a child is lacking and the specific conditions or situations in which a challenging behavior is occurring. These unresolved problems, however, happen to be highly predictable. When struggling to meet the demands and expectations placed upon them, kids can react in a number of fairly common ways: whining, pouting, sulking, withdrawing, crying, screaming, swearing, hitting, spitting, kicking, throwing, breaking, lying, stealing, and so forth. It is vital for you to know why and when your child is reacting in these ways, in order to correct the listed behavior.

 

Luckily, because these challenging behaviors are in response to highly predictable unresolved problems, a collaboration between you and your child can solve them. If adults attempt to tackle these issues without a collaborative spirit, simply by asserting their will, Greene’s Plan A outlines how this will likely increase the number of challenging episodes or prolog them into the future. However, through collaboration, or Plan B, the child will be more inclined to incorporate lasting solutions. Furthermore, the child will learn the skills they were lacking all along over time. Plan B is described in the following way, with three basic ingredients. The first ingredient is called the Empathy Step, which involved gathering information and understanding the child’s concern or perspective, which will allow the child to feel fully heard and understood. The second ingredient, called Defining the Problem, involves bringing the adult’s concern or perspective to the table. The third ingredient, called the Invitation Step, involves a collaboration between the parent and the child as they brainstorm solutions and arrive at a plan that is realistic and mutually satisfactory to both parties.

 

In addition to the Ross Greene’s model for helping behavior management, general strategies such as those listed below can be of further help in reducing noncompliance behaviors.

1.       Daily Positive Attention

It is important for the parent and teacher to connect with the child on an individual level, where he or she is the focus of positive attention. At home it can range from playing games together, reading, chatting, sharing a hobby together, or going on walks. At school it can be the teacher asking the student to help with a special task (such as setting up for a class project), giving them a special job (such as feeding the class pet), or setting up special activities like having hot chocolate or a snack together once a week. A positive experience at the start of the day can create a further positive behavioral momentum.

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2.       Notice and Compliment.

Even if it is for the smallest behaviors, reward even the smallest amount of compliance. This will solidify that good behavior is noticed and appreciated.

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3.       Offering Two Choices

By allowing the child to choose between two choices, it allows the child to feel a sense of control over the situation. For example, instead of asking “Do you want to get dressed now” you instead phrase the question into “Do you want to wear your blue or your red shirt?” In the end you get the desired result, a dressed child.

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4.       Using Grandma’s Rule of Discipline

This strategy uses the When/Then or the If/Then method, framing things as incentives rather than negative consequences. For example, instead of saying “You can’t play video games because your room is messy” you instead say, “You can play video games as soon as your room is clean.” To put it simply, when X is done, then y will occur.

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5.       Use Logical Consequences

Whenever possible this outlines a logical consequence to a child’s actions which will make sense to them. For example, if a child is 15 minutes late to school, they must go to bed 15 minutes earlier at night, because they must need more sleep.

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Sadness, Friendships, and Bullying

A detailed report on these issues requires the full cooperation of student, parent, and teacher, as the child may not feel fully inclined the occurrence or the extent of these struggles. The parent rating scales allows the parent to express information about this subject, while feedback from the teacher will help the therapist better understand the academic and social setting of the school environment. Recommendations for these challenges will be discussed in later feedback sessions.

 

Malleability, Context, Resilience, and Advocacy

It is well reported that our abilities are malleable rather than fixed, our perception of whether or not we can alter our abilities through a combination of hard work, persistence, and the use of other resources can have a significant impact on our goals. An observation noted by Carol Dweck, a researcher at Stanford, noted that a student’s performance on a given task improves when he or she comes to view their abilities as malleable rather than fixed. Dweck has written a book and created a program that helps improve cognitive abilities and their performance. For more information please visit, www.mindsetonline.com (book) and www.mindsetworks.com (educational program).

 

In addition to the view of abilities as malleable, context for many learning profiles can help a student who was previously struggling in an environment to succeed in it. For example, a greater emphasis on project-based learning rather than through repetition can be of greater benefit. While both methods result in the same information being taught, the method in which the information is being taught and demonstrated can allow one student to thrive and another student to struggle, depending on the particular learning profile of the student. A comfortable fit between a student’s learning style and the context in which they perform their abilities determines their feeling of successfulness as a student which will motivate them to work harder.

Resilience is also an important concept for students with an uneven learning profile. It takes a lot of courage and resilience to overcome constant, frustrating situations in which your strengths and talents may not lead to frequent academic success and instead the few areas of weakness grow large. It is very important that the affected child understands the nature of their learning differences and prevent it from taking a toll on their sense of self, leading them to mistrust their own abilities. It should be emphasized that there are many impressive strengths the child possesses within many intellectual and cognitive areas. Many students with attentional differences suffer from demoralization and discouragement over time, and it is important for parents and teachers to highlight the student’s strength, talents, and good behaviors in order to insure continuous positive momentum for success. A few ways a teacher can foster a sense of mastery in the classroom for the student include giving him or her a special job that he or she already excels at, sending good news cards to the student’s parents of specific weekly accomplishments, and create a mistake jar which can teach a child that mistakes are ok and part of the learning process.

 

Our goal is to ensure that the child learns to be a self-advocate with time, without feeling ashamed or embarrassed of their difference. Individuals with these difficulties have the strengths and talents to be very successful in life, advocacy for their needs can help them realize their own potentials. We must be transparent with the child about all aspects of his or her condition, including insight on the many strengths, the few specific areas of weakness, and the many available strategies and accommodations that can be implemented to mitigate the weaknesses. An excellent resource for parents and teachers is a website known as understood.org which can allow them to better understand how it feels to have ADHD and other learning disabilities. When visiting the website, click on the Parent Toolkit tab and then the “Through Your Child’s Eyes” tab. There you will see opportunities to “try on” ADHD and understand things from your child’s point of view.

 

Other useful resources that have helped in better understanding the condition include:

• Children and Adults with Attention Deficit Disorder (CH.A.D.D.)

  • www.chadd.org

• Learning Disability Association (LDA)

  •  www.ldaamerica.org

• The University of Arizona, SALT Center provides information on what is available at a college level for students with uneven learning profiles. Access the program at

  • www.salt.arizona.edu

 

Intervention Strategies for Emotion Regulation

Helping Children/Adolescents Tolerate and Regulate Negative Emotions

• Outline the difficulties they have with negative emotions and build strategies to help them deal with and overcome these vulnerabilities.

• Discuss the barriers they have toward changing their emotions and develop a plan for overcoming these obstacles.

• Give them instructions on how to recognize and label emotions; help them identify emotional reactions that are specific to particular contexts.

• Provide training that enables them to identify the physical effect of emotions. Skills training in deep-breathing exercises and muscle relaxation techniques may help alleviate some of the physical symptoms of negative emotions, especially anxiety.

• Help them develop strategies to tolerate rather than avoid distress. If they are able to fully experience and develop an awareness of their emotions, they can learn to experience without judgment and then to let go. Avoidance behaviors may make the situation worse and become harmful over time.

• Teach them the technique for regulating negative emotions of expressing the opposite emotions. For example, if they are feeling sad, they would try to feel a counterintuitive or opposite emotion, such as gratitude or happiness.

• Provide strategies that will help them to be more aware of and increase the number of positive events in their life. These strategies may include providing techniques on how to avoid giving up, being more mindful of positive events, and building positive relationships with others.