Wednesday, June 21, 2017

FLIPP the Switch and SOARR

In my quest to further develop my understanding of Executive Function (EF) disorders, I picked up FLIPP the Switch: Strengthen Executive Function Skills by Sheri Wilkins and Carol Burmeister. My pervious posting was about an EF workbook for teens. Its target audience is higher functioning teen agers who can use it with little support. This book targets people with more significant challenges. Strategies include strong visual components that would be especially useful for people with ASD. They acknowledge that many people with disorders classified under the DSM and some physical medical concerns often show weaknesses in some EF skills, such as ADHD, ASD, TBI, Intellectual Disorders, SLD, and OCD. Critically, it is important that there is a range of EF skills and although there may be patterns of strength and weakness profiles, no two people have exactly the same skill set. Furthermore it is important to recognize that just because someone is weak in a skill area, it does not mean they cannot improve it or learn to effectively deal with it.

Wilkins and Burmeister group EF disorders in five categories: flexibility, leveled emotionality, impulse control, planning and problem solving. As Sarah Ward said years ago- it is not important how many categories you use, but how you address the problems.

One strategy from the Flexibility chapter that I found particularly interesting is called SOARR. Since I cannot find reference to it on Google, I believe they created it. Although they do not reference the work of Michelle Garcia Winner in this section, it pairs nicely with her social thinking framework. It also plays well with Sarah Ward's  STOP strategy:
  • Space – Where am I?
  • Time – What is happening now? Later?
  • Objects – How is the room organized?
  • People – What are the facial expressions/body language of the people?
There is a large recognition in all these approaches that expected social behaviors shift according to context. Without clearly understanding context, we cannot help people develop approaches to social success.

The text provides four concrete examples of the strategy for young people to use the strategy with vignettes describing the situation that led to the need for the strategy and a simple outcome of implementation of the strategy use. Below I have included a very slightly modified example of their template and a version of how I might have used it for my son's recent flight to visit relatives on the other coast. The book has the template in a landscape orientation that would probably work better because of the possible increase in writing space.

Specify
Observe
Analyze
Respond
Reflect
What is the situation/ specific context?
Example:
Ordering food and eating in a restaurant- what kind of restaurant
Participating in PE class
Attending a worship service
Joining a group in a general education class
What are other people doing in this situation?
How are they behaving?
What do I need to do to fit into this context?
What questions do I need to ask and answer in my head?
Example:
What is the noise level/volume?
Does the discussion/tone/mood seem fun or serious?
Is there a leader?
What is my role in this group and where do I fit in?
If I am unsure about something is there somebody I can approach with questions?
Based on my analysis, respond appropriately,
As I am responding, pay attention to how others are responding to me.
What happened?
What did I learn?
What can I do differently next time?

Blank SOARR template from Wilkins, S. and Burmeister, C. (2015) FLIPP the Switch: Strengthen Executive Function Skills, p. 49

Specify
Observe
Analyze
Respond
Reflect
What is the situation/ specific context?

What are other people doing in this situation?
How are they behaving?
What do I need to do to fit into this context?
What questions do I need to ask and answer in my head?

Based on my analysis, respond appropriately,
As I am responding, pay attention to how others are responding to me.
What happened?
What did I learn?
What can I do differently next time?
In line at the airport to go through security
People are standing in line, keeping their hands to themselves. Some are in groups that are a little closer together, but most groups are not talking to each other. People are using a quiet voice. When asked a question or given a direction by a uniformed person, people do what is asked of them.
People are waiting. I need to wait to move with the line. I should not talk to people I do not know unless they ask me a question. I need to use a quiet voice. If I need help there are people in uniforms I can ask questions.
Some people do not move along in their line as quickly as they can, but I keep my comments about that to myself. I wait patiently for my turn at the various spots before moving on through the terminal.
It was hard to wait patiently because not everyone moved as fast as I wanted them to. I need to have my paperwork and ID in an easy to access location so I do not hold up the line.




I think working within this framework, young people could learn to address social issues, but training in reflection, problem solving and forecasting human behavior would be an important part of an intervention. This book has me eager to read to learn more concrete strategies for helping young people learn to deal with their weaknesses in EF.

Monday, June 19, 2017

executive functioning workbook for teens

Sharon A. Hansen penned a wonderful book for teenagers with executive function weaknesses, The Executive Functioning Workbook for Teens. Although this book will not provide all the tools, especially the motivation, to work on improving weak skills, it is a beginning.

The book opens with a letter to teens, inviting them improve their lives by learning skills they are not strong in. It is a welcoming, non-confrontational start. Then it moves to a brief checklist. As opposed to many other checklists I have seen and used it is brief. This one has four statements in each of 10 areas and youth are asked to circle the ones that describe them, such as I need to have directions repeated and I blurt out answers in class without being called on by the teacher. Then they can target the areas in which they circled 2 or more descriptors. If you were doing this with kids, I can see where it would take some degree of trust  to get accurate responses from them. Following the self-assessment are three activities per area to focus on. Each area of focus begins with a short vignette. These would be useful for getting buy in, a critical component for change. The exercises always begin with examining something not personal to the student- think about the story at the beginning, what might be some people's responses to these things. Then they move to the personal- what about in your life.

One thing that I think the book does not do well is demonstrate how long it can take to learn new skills and make a change. Although the beginning has a line about it takes 28 days to make a habit with a new skill, and for kids with a challenge in an area, it can take three times as long (p. x), it does not revisit that idea. One thing many people with executive function issues have is a lack of persistence. Developing ways to sustain the effort for three months or more is a daunting task and will require reinforcement and reminders. It showcases why even teachers who do a good job with initially teaching and reinforcing executive function skills have students that don't learn the skills- they are not reinforced long enough.

This book is going to be a useful tool to use with students, but the time component is one that I will need to keep in mind.

Sunday, June 18, 2017

70 Play activities

Both in parenting and teaching we do many roles. We do what is right for our kids regardless of what the official job title of the "responsible" party may be. I have worked with parents who clean out trachea tubes before making dinner and teachers who stretch their students to stand. These jobs belong to a nurse or PT respectively, but we do them because we care.  Lynne Kenney and Rebecca Comizio wrote 70 Play Activities for Better Thinking, Self-Regulation, Learning & Behavior integrating the role of the OT who is focusing on sensory processing with those of the psychologist. While I picked this book up after an EdWeb after watching a webinar to see what I might be able to use to reinforce and teach executive function skills, I see that her integrative approach can be used to do that and more. Although it seems that many of her strategies really focus on elementary students, adaptations, which she encourages, could lend them a broader appeal.

A key component of her approach seems to be that movement and play can both teach and prime the brain. For example, she looks at using ball bouncing to reach self-regulation and control. While the activities can be used to alert or calm a student, with the proper preface, they can showcase how self control feels and demonstrate how it helps with completion of a task. The last section of the book talks about how movement can be used to reinforce math. We now have studies that say gesticulating during math learning and explanation increases math performance. It stores information in more places in the brain helping students develop both better encoding and recall. If we start bouncing from me to you and back again, we then add the cognitive piece of reciting math facts. For example skip count or multiplication facts can be mirror counted, alternate counted, chorally counted or only student counted.

One activity I liked from the webinar that is discussed in the section on musically rhythm goes like this. Practice a rhythmic skill that the student can do to automaticity- like marching, or clap-tapping- then add counting. One, two, three, four, one, two, three, four, ... Then ever fourth cycle add a piece of cognitive recall such as identify the type of quadrilateral, continent, chemical element, phonetic sound of a letter, math fact or color I show on a piece of paper.

One, two, three, four, one, two, three, four, one, two, three, four, one, two, three, trapezoid.
One, two, three, four, one, two, three, four, one, two, three, four, one, two, three, Africa.
One, two, three, four, one, two, three, four, one, two, three, four, one, two, three, carbon.
One, two, three, four, one, two, three, four, one, two, three, four, one, two, three, A- apple- /a/.
One, two, three, four, one, two, three, four, one, two, three, four, one, two, three, 12/4=3.
One, two, three, four, one, two, three, four, one, two, three, four, one, two, three, green.


This could also work with chanting to a beat, whether it be marched, clapped, jumped, or some other combination thereof. You could even have the definition projected on a whiteboard. This sort of practice is highly associated with recall. If you involve more of the brain, more dendrites fire and students are more likely to encode it and then recall it.

The book intersperses brief theory and explanation with pages of activities. As I mentioned, most of the activities would need some modification for older kids. Her thought is to encourage older kids to play the coach or person who will help others learn. Although she talks about the neuroscience of learning, it is on a very light scale. This book is highly readable, but if you want to teach kids the neuroscience behind the idea, you will need to do more research. She does talk about specifically labeling the executive function you are trying to develop and showing how the activity helps do it. This piece of metacognition is important in helping kids understand the science behind it working. Altogether an interesting book working on using sensory processing, physical movement and cognition to improve skills in children.

Thursday, June 15, 2017

The Smartest kids in the world

Amanda Ripley went on a year search to try and identify what makes international students perform so well in school and describes her search in her book, The Smartest Kids in the World and How they Got That Way. She identified three American foreign exchange students and one American who spent years in Korea going to countries with high math PISA (Program for International Student Assessment) scores: Poland, Finland and Korea. Math was selected because a) American students perform relatively poorly on international math tests and b) math is a better predictor of future economic success than other subject areas. The importance of this is emphasized by the fact that Americans are second only to Luxemburg in education spending (p. 24). We are not getting the bang for our buck. 

She performed extensive interviews, visited schools and conducted a survey to gather data for the book. Throughout the text she traces key moments of the experience for each student and then wraps up in an appendix with her summation.

What were the differences? First there was a high expectation that education was the key to adult success. In the foreign countries, technical jobs were highly valued. Families expected a high degree of rigor. In the countries studied there was far less testing than in the US, but students were expected to take a rigorous test at the end of their school. Unlike American exit exams which are gatekeepers to graduation, the international tests were a gatekeeper to the entrance to higher education. Good performance virtually guaranteed a good university placement and job, whereas poor performance was limiting. Students in Poland and Korea dominate their high school years with preparation for success. The 50 hour Finnish test includes one extended essay for which the students had six hours. In Korea, planes are rerouted on test day. There is no retest for a year. Students cannot plead extenuating circumstances. These tests are taken seriously.

Another difference was in the concept of self esteem. Personally I define self-esteem is a measure of someone's resiliency- how well they bounce back from challenges and persist with hard things. It is not built from doing well or Atta boys; it is constructed from striving against challenges. If your NBA player only practices against primary school basketball travel teams, he will do very well, but will not improve his skills. She points out that "during the 1980s and 1990s, American parents and teachers had been bombarded by claims that children's self-esteem needed to be protected from competition (and reality) in order for them to succeed ." (p. 109) By way of contrast, in the other countries, student test grades were read off with rankings- everyone knew who was the top performer and the worst performer on every exam. The world is a giant competition and students should try and fail when young so they can avoid it as adults, when it is more expensive. This caused stress and motivation for the students to move up in the ranks or maintain their status.

Sports constitute another major contrast between the US and the other high performing countries. In the US high school sports are nearly revered. My sister's school district built an $80 million football stadium. Parents have been known to hold students back from kindergarten access in order for them to be relatively older than their peers and consequently bigger when sports teams were constituted. If a New York school budget does not pass, the first thing put out is that the sports program will be canceled and the budget usually passes. Sports teams get lots of attention in local news but academic teams get virtually none. Teachers are hired and pressured to be coaches, or worse, hired because they would be a good coach. The list goes on. In these other countries, high school sports are virtually non-existent.  Korean students might spend an extra 8 hours a day at school, but it is studying not playing sports. Finnish teachers do not coach. Polish students play recreational sports that are unaffiliated with high schools.

Technology is another division. In American teacher colleges, technology plays an important role. Teachers in training learn how to use interactive whiteboards and prepare lessons using them. "Good" schools have an interactive whiteboard in every classroom. One to one initiatives are all the rage. Flipped instruction means teachers prepare online lessons for students to view as homework and then the guided and independent practice takes at school. Rare is the international school with this level of technology. The money is not spent on gadgets. Students go home to technology not available at school.

Perhaps most telling however is the caliber of the staff. In America just 5% of Schools of education were located at highly selective institutions (p. 85). When I took my exams to be a teacher, NY required a passing rate of 79% whereas Mississippi only required a 39%. NY just eliminated the ELA part of the new praxis test because too many minority students failed the exam. Instead of working to increase their skill set, they were content to dumb down the profession. In all of the other three countries all of the schools of education were highly selective. Only the best were admitted to the programs. When I was in Denmark they talked about their special education teachers. First they had to teach for at least five years in a general education classroom. Then they had to get a recommendation from their administrator. Then they had to earn a high enough score on an entrance exam. Only a few made it through the process. While not all of the nations reserved high salaries for teachers, they were all in the upper middle class range, rather than the lower middle class range in America.

Teachers in other lands also had great input in their curriculum when compared to American teachers. In our nation, textbooks could be used for weightlifting. The average 8th grade math text is 800 pages. In other nations that number is only around 200 pages. (Interestingly I have a slim volume, a math text from 1898. It has fewer than 250 pages and covers grades 1 through 12, with examples of entrance exams from several selective universities, such as Harvard, in the back.) New York State sponsored the creation of a series of math and ELA Modules to correspond to the Common Core, available online to all schools for free. If you were to print them out there would be hundreds of pages per unit. One of my friends commented that her principal was so happy because every teacher in her building was doing the same thing on the same day. I was horrified- how does that showcase teacher skills and differentiation for students? A robot could do that. While the Common Core was touted as having slashed the standards at each grade level so that they could go a mile deep rather than a mile wide, the 5th grade math strand, which was the most reduced, only took out 10% of the standards when compared with the NY standards. In the other nations, students were expected to learn it or score poorly. Teachers were expected to reach each student, afterschool tutoring abounded, students spent an increased amount of time working on higher order problems. In Finland half of the students received specialized instructional support at some time during their academic career- no label required. Teachers were also tasked with creating programs that aligned with the standards.

In the wrap up section, Ripley highlights a couple of ways we can increase our country's educational performance. All of them require a significant cultural shift, something Americans are reluctant to propose. First increase the rigor of the program both for the students and the teachers. Increase teacher autonomy so that teachers make decisions not politicians.  Then eliminate most of the testing but maintain testing that enables access to post secondary education. Increase the requirements for teacher colleges- both in order to access the program and exit the program with certification. Understand that math is a critical skill- at least as much as reading- and students need mental math fluency and problem solving expertise. No one should say I can't do math, my parents are not good at math and so neither am I, or math is not that important. True, you might not need trigonometry to survive as an adult, but a deep understanding of probability and statistics, fractions and decimals and using algorithms to solve problems is essential. We can do better, but it requires a cultural and cognitive shift to get there.


Tuesday, June 13, 2017

The smartest kids in the world- technology

When New York passed a technology funding resolution a few years back, people were delighted. Hardware for everyone! More than half a dozen years later our state still has schools that do not have adequate bandwidth to use online assessments. Those computers that were purchased are not just obsolete but in use and in disrepair. The challenge of technology is that it requires a constant on going expense to re-license, repair and secure it.

My daughter was a firm proponent of the smart boards we installed. They were fun to play on during activity period and they showed movies- mostly without permission from the studios. I have worked at private schools that cannot afford to pay their teachers much beyond minimum wage install smart boards in each room. I have always considered our love affair with technology an ill thought out crush. It is not that technology is not ever useful or desirable, but for the expense, we need to ensure we get bang for our buck.

We have research that says kids do not learn as much from reading electronically as they do from print see here or here or here. Smart board use has mixed results on achievement. One study I read years ago said it improved scores for 1/3 of students, had no impact on 1/3 of students and reduced scores for 1/3. A study of college students says that they improve student satisfaction and perception of learning, but had no impact on actual achievement. A report of school age use suggests nominal change in performance in spite of increased engagement. A study reported that notes on a laptop were by far inferior for student support of recall than handwritten notes. Students do less well in online classes than in face to face classes (or here).

Amanda Ripley, an author who has worked for Time magazine wrote The Smartest Kids in the World. She looked at differences between education in the United States and that in the high performing countries in the world, especially in the area of math, which tends to predict adult income, divorce rates and employment. One compelling difference she identified is that international schools do not spend on technology the way we Americans do. We look at  gadgets and get all excited. It is the wave of the future... Or is it the way to distraction?

If we really want to focus on emulating what successful schools in other nations are doing, perhaps we should junk the high tech and focus closer to home- teacher quality, motivation of students to work hard, and supporting a cultural change to truly value education over sports, entertainment or free time. It is not that tech has no value and well done tech can improve performance- if it is used to increase response rate and feedback. There is no discernable value in playing Jeopardy on the interactive white board over playing in with the clues written on pieces of paper taped to the wall. There is no advantage to taking notes from powerpoint over from an overhead projector or chalk board. There is no virtue in taking attendance by having student pop "balloons" on the whiteboard as they enter the classroom versus the teacher doing it on a sheet of paper.

Instead of focusing on pretty, as we Americans are so fond of doing, we need to focus on what actually makes the trinkets valuable- teachers and how they use them. Articles here, here and here discuss this idea. Ripley would certainly concur about the technology being a tool, not an end in and of itself. We spend more money than anyone on education, in part because we are not wise spenders. I remember a principal who would not allow any teacher to use the copier without prior approval. The idea was to not print drills but things that would support higher level thinking. Yes, he was a micromanager I would not like to work under. We can, however, apply this test to our technology choices. Is my intended use of the technology going to improve learning in such a way as to justify the cost? After all, we were incensed when the $10,000 hammer the government bought, but what about the $4500 tv  or overhead projector? We need to become more selective in our spending. It starts with us, the teachers who will use it.

Monday, June 5, 2017

Smart but Scattered

Peg Dawson and Richard Guare are leading researchers in the field of executive function (EF). Their website is smart but scattered kids.  They wrote Smart but Scattered for parents of children in grades K-8. This is different from their other book that I have read, Executive Skills for Children and Adolescents whose focus is more for teachers and other professional practitioners. This book is a very easy read, but at the same time chock full of information and practical ideas.

The term executive skills refers to "brain-based skills that are required for humans to execute, or perform, tasks" (p. 13). I like to think of them as the things your executive assistant might to help a CEO be successful. The authors include the following skills in their list, but other authors categorize the skills differently: response inhibition, working memory, emotional control, sustained attention, task initiation, planning/prioritization, organization, time management, goal driven persistence, flexibility, and metacognition.  They are required for independence of adults. Most people have a range of strengths in executive skills. Before designing interventions, you need to identify the areas of greatest needs.

The book contains a number of checklists for children at different ages- different aged children are expected to demonstrate different skill patterns. This helps people pin point skills to focus on. One are that they repeatedly return to is that when there is a weakness in both the adult and the child both should try to learn to improve the skill.

The authors begin with a quick overview of the ABCs of behavior.
  • Antecedents- things that occur before the behavior, the environment, people and expectations that confront the individual before a problem occurs. Cleaning the room always results in an argument. Getting ready for school is never completed on time with little drama. Long term projects never get turned in. In the beginning we modify the environment for children so that they can be safe and successful. We use outlet covers to keep toddlers safe. We hold hands in parking lots. We work with children to get homework complete. As they age we try and reduce that support. Children with EF concerns cannot handle this independence the same way their peers can.
  • Behavior- problem behaviors or skills. Children need to be taught how to not stick assorted things in outlets, look both ways before crossing the street/parking lot and determine when it is safe to go and how to go about completing long term assignments.
  • Consequences- things that reinforce the behavior. We might think that time out is a punishment, but if you get out of something you don't want to do it is not. We might think that getting a good grade is a powerful motivator in getting homework in on time, but for someone who lacks the skills required, it is not.
The authors suggest beginning with modifying the environment and then slowly making changes by teaching skills and inserting rewards to reinforce the appropriate behavior.  They have a range of strategies for teaching skills such as getting ready in the morning, studying for a test and learning to handle changes in plans.

They have a process for summarizing the program:
step 1- establish behavioral goal- use a specific objective ex. complete morning routine tasks within 20 minutes.
step 2 -design an intervention:
identify environmental supports to help reach the target goal: ex. timer, written schedule, cues from parents
specific skills to teach- ex. parents will create a schedule arranging activities in a preferred order, parents set timer, parents check and cue 2x during time, check items off list as completed, choose from prize box if goal met, if he is late to school he will be required to complete missed work during free time.

A great reference book for parents.

Sunday, June 4, 2017

Smart but scattered- flexibility

I have written about the challenge of change before, and flexibility is little more than adapting to change. Yes, that is a huge understatement. Children who learn to be flexible and adaptable quickly tend to be easier to parent and teach. Children on the autism spectrum tend to be adverse to change to the point of rigidity. Social Thinking guru Michelle Garcia Winner, speaks about flexibility as an essential social skill. Sarah Ward of Cognitive Connections, which focuses on executive function skills, includes flexibility training in her programing. The authors of Smart but Scattered, Peg Dawson and Richard Guare, include this skill in their program as well.

Dawson and Guare define flexibility as "the ability to revise plans in the face of obstacles, setbacks, new information, or mistakes" ( p. 256). The Simpsons have a segment where Bart never learns to stop grabbing the electrified cupcake, showcasing his lack of flexibility around food. Although comical in the cartoon, parents and teachers who deal with children with a lack of flexibility have a definite challenge.

For years when we had a school break I would plan out a schedule and write it down for my rigid child. Once it was recorded, it was "set in stone." God forbid a change need to be made. My son's preschool class traded places with the class across the hall on Wednesdays to try and build in some flexibility. Unfortunately, once that had been done a few times, it was part of the schedule and my son was fine with it. A weekly schedule was just as good as a schedule for the hour. A Sarah Ward workshop I attended years ago spoke about introducing a surprise card to a picture schedule. These big schedule attempts are a good place to start.

Dawson and Guare discuss two types of interventions for flexibility: environmental and skill development. With skill development they include consequences that will encourage use of the skill.
Environmental modifications:
  • reduce amount of change at one instance- Instead of changing every expectation, change just one at a time. From summer to school, do not change bedtimes and daily routines together. Even though you do not need to get up for school- get up at the same time and go to bed at the same time and change where you go for the day. Do not schedule a dentist appointment on the same day there is going to be a babysitter at night because you are going out.
  • keep schedules and routines- create picture or word schedules for the day. Develop routines around daily events- getting up, going to bed, eating meals,... This enables them to predict what is going on. It showcases that non-preferred activities do not go on forever and can highlight preferred activities.
  • provide advance warnings of change- My son's bus driver attended a training where they suggested not telling kids if she was going to be absent because they would dwell on it all day. Yes, kids might dwell on it, but they will do better if you train them what to do when there is a change. You can tell kids about vacations. The classic 25 day advent calendar or chain to count down to Christmas provides warning of the change.
  • scripts for handling the situation- this has been a great activity for my son. Bibliotherapy and social stories about what do at the dentist solved problems in handling going to the dentist. We have talked through what a phone conversation might sound like before picking up the phone. This reduces the anxiety around the event.
  • reduce complexity of task- Instead of the long term project being presented at once, present only one piece at a time. Instead of pick up your room, pick up the clothes on the floor. Instead of make a phone call, dial the number.
  • give choices- we need to drop off this material after school. Do you want to have a granola bar in the car or wait until we get to the office and have a yogurt for snack? Do you want to practice your spelling with mom or dad? Do you want to go to the zoo or the park on the vacation? You need two fruits or vegetables out of these four choices: carrots, beans, applesauce or salad. Really important here- do not offer choices you cannot live with.
Skills and strategies to encourage flexibility:
  • walk a child through the task- ordering at a restaurant: we role played it at home, now we will do it together, eventually you will be able to do it on your own.
  • Use social stories- Carol Gray designed this evidence based practice. For a month before my son's first dentist visit, every day we read stories about going to the dentist and watched a Mr. Rodgers episode about it.  When we got there we took pictures of him doing the various steps so that we could look at them before the next visit. For getting ready to fly to his uncle's wedding, we again hit the library up, but then scripted each step of the event. For a student who did not like leaving preschool, we wrote one about waiting patiently to be picked up.
  • Come up with a default strategy. Think of the most problematic situations and brainstorm with your child (when they are calm!) about how to handle the situation. When we might need to wait, we bring a book to read/look at. Teaching counting to 10 to relax. Teach ask an adult for help.
  • Use coping strategies- like above. You need to teach when calm. You need to practice. You need to reinforce when they handle the change well. The authors recommend a number of Dawn Huebner's books to introduce these ideas.

Overall the authors say you need to teach it. Flexibility does come easily for some. If you are a very flexible person and your child is not, this may be especially challenging to deal with. Routines and schedules will not be your thing, but you need to work on doing what your child needs. If you are a fly-by-your-seat teacher, these kids need more structure or you will have behavior problems. Routines can save much angst, but kids also need tools to handle when routines are set aside. Increasing flexibility is critical to adult success.