Executive Function Toolkit: Morning routines to get off to a great start

 

Getting out the door can be especially challenging for people with executive function (EF) challenges. There are, however, some steps that can be taken to establish routines that make this easier.

Getting out the door on time starts the night before with a couple activities:

·         Put the backpack and everything needed for the next day together and by the door ready to go. If a lunch needs to be made, make it the night ahead of time and leave it in the fridge. Put a sticky note on the door or backpack to remind someone it is ready to go.

·         Plan what will be worn the next day. There should be no searching for anything, no wavering on which outfit, no finding out that the special x needs to washed in the morning. Check the weather and pick the clothes out.

·         Turn off devices. Phones should be kept out of bedrooms. Parental controls can keep notifications and interactions from being a problem. (If you need help to do this just google the particular device and parental controls.) Use an alarm clock rather than a phone. Cheap alarms (less than $15) are available at Amazon.

·         Set a bedtime and stick to it. Yes, teenagers often have difficulty getting to bed early, but with consistent routines it can work. Preschoolers need 10-13 hours and teenagers need 8-10 hours of sleep per night. If children do not get enough sleep, they will struggle with waking up, maintaining control of their attention and behavior, maintaining a healthy weight and performing well in school.

In the morning

·         Leave off the TV, computer and phone. These distractions are time suckers. They grab attention and then either things don’t get done or time escapes you and you leave late.

·         Identify the tasks that need to be done (ex. feed the dog or wake another sibling). Make sure there is enough time in the routine to those tasks. You can dry run your routine on a weekend to see how long it really takes to complete all the activities. People with EF challenges are often terribly bad at judging how long it takes to do things. Make a schedule- pictures for young kids, bulleted list for older ones. It can be laminated or copied and things can be checked off every day for those with really impulsive and distracted natures.

·         Use timers. Visual timers, like those to the side can help people really understand time. There are phone apps and timers available from Amazon that can be used. Digital clocks blur an understanding of time. The visual timers help people understand what 30 minutes means.

·         Provide protein rich breakfasts. Proteins metabolize more slowly that carbs so energy is maintained throughout the morning. Also proteins in the morning help your brain create melatonin at night to assist with sleeping.

·         Provide rewards for making it work. A week of out the door on time with no yelling from a parent might mean extra screen time, selecting a favorite dinner/breakfast cereal, or a trip to the dollar store.

This does require that parents lead the way and if your EF skills are not excellent it can be a challenge for parents too, but these strategies work for everyone. Routines can make the morning easier for everyone.

Susan Brown, MSE

ptasusanb@gmail.com

 

Resources

ADDitude, Use This Sample Schedule With Kids with ADHD / ADD (additudemag.com)

ADDitude, Morning Routines for ADHD Families: Schedules to Wake Up and Go (additudemag.com)

Caring for kids, https://caringforkids.cps.ca/handouts/pregnancy-and-babies/healthy_sleep_for_your_baby_and_child

Time Timer, https://www.timetimer.com/blogs/news/4-tips-for-getting-out-the-door-on-time

Resistance stories from black history

 I picked up Rann Miller's Resistance Stories from Black History for Kids Expanded Edition: Inspiring People and Events that Every Kid Should Know based on a reference from another text. Although I learned things from the book, it did not meet my expectations. It is more of a textbook than a story book. It details many things that I did not know. At times it made me uncomfortable, a sure sign my white privilege was dealing with information that I was both unaware of and not proud about. Unfortunately, the story of our country's past is not a uniform one of greatness. It is full of stumbles, missteps and serious errors, not always followed by corrections. We have great ideals and do not consistently work to uphold them.

The book spans the timeline from ancient African civilizations to modern day America. It provides information primarily about the Americas, but tells of modern black history as it impacts and is impacted by the people in the lands it speaks of. I learned about Caribbean and South and Central American efforts at throwing off the mantle of persecution and drivee for both freedom and equality. Portions of it could be very inspirational for students struggling to define their personal identities. I wish there was more of a storytelling slant to the work. The pedantic style will not engage everyone. It is heavily referenced with 847 footnotes, a glossary, many context clues for vocabulary understanding and a comprehensive index.

The book is an easy read with short chapters followed by reflection questions. That said, it is inconsistently edited. Portions include grammatical errors, missing words and awkward sentences. I do not fault the author's use of vernacular, but that is not where these issues emerge. It would be interesting to take some of the sentences out of the text for an ELA task of Jeff Anderson's idea of building sentences. (Break a sentence into a series of simple sentences and get students to combine them to form a single sentence.) 

The book provided a thoughtful read, but not the stories I was looking for. I can see pulling out segments to enhance a social studies curriculum.

Shifting the Balance

 My instructional coach gave me Katie Egan Cunningham, Jan Burkins and Kari Yates' text Shifting the Balance: 6 Ways to Bring the Science of Reading into the Upper Elementary Classroom thinking I might enjoy reading it. She was right, I did enjoy reading it. It reaffirmed my beliefs about teaching reading> Even if that is not my primary job now, I do try to incorporate reading instruction into my work with high school students with special needs.

A couple of years ago the balanced reading approach was debunked and our pendulum is now swing to the science of reading. This swing is one that I have seen over the years I have taught and I expect that it will swing again in the future. What the science of reading proposes is that students pay attention to the print on the page in order to understand it rather than using a 3 cueing strategy. It puts a focus on phonics and phonemic awareness, especially in the early years. Other components are added in: language, fluency and comprehension, generally, it is assumed, later. I will advocate that all five components need to be woven together with a heavy emphasis in the primary years on phonemic awareness, phonics and language and adding a shift to greater focus in the later elementary years on fluency and comprehension. Shifting focus does not mean the other components are ignored, just given different amounts of attention.

This book is generally organized into six sections:

1. knowledges' impact on comprehension
2. strategy instruction
3. vocabulary
4. word reading
5. fluency
6. independent reading

With each section providing a vignette of a teacher with a concern, a list of misunderstandings and the science behind the explanations, and then recommendations for making the shift. The easy read format means you do not need to read the book cover to cover to find information you are looking for. The authors advise to make a small change rather than trying to change everything at once. 

Key things I took away include a focus on on prior and background knowledge. Some reading series have focused on this idea of Hirsch's Core Knowledge Curriculum. I have previously written about the importance of prior knowledge and am glad to see it focused on here. Eliminating science and social studies for a language arts block does not make sense, incorporate these subjects into the reading block so that kids read about what they are studying as well as develop knowledge about the world around them. This is especially important in places where children may not have rich outside experiences and language development.

Another important idea is that strategies, while useful and important, should not be the major focus of instruction throughout the upper elementary grades. Students still need instruction in phonics skills that they may not have yet acquired. Strategies are important tools, not the goal of instruction.

From vocabulary, we need to recognize that vocabulary develop is grown in three ways- oral language, wide reading and direct instruction. There is not enough time in the day to directly teach all the vocabulary students need. In Living Environment (aka biology) students need to learn three words a day, every day. Just for that course. Just level three words. We cannot teach all the words kids need to learn throughout the course of the day. They need multiple exposures to words in oral speech: According to the passage, what is a significant contributing factor to the fall of the Roman empire? Instead of just reading the question, add the definition of important after the word significant. We need to see vocabulary in text that we read, both in school for a class and independently. Unfortunately, while many kids are reading more, the texts and memes they read do not have a lot of language sophistication. I really liked the chart on page 80 that indicated rare words per thousand words:

• print ranged from newspapers 68.3 to children's books at 30.9
• TV ranged from adult TV of 22.7 to children's programing at 20.2
• speech indicators were expert witness at 28.4 and college graduate conversations at 17.3, 
• While not indicated, I suspect high school students and the tic tocks that appeal to them would be in the range of 10 words per 1000.

Students need lots of exposure to text with complex vocabulary and support to help them understand the complex vocabulary. Even children's books, a favorite instructional tool of mine, are better than mere conversation. I really like them because they are so accessible and can be followed up with more complex texts. Once the content and vocabulary framework have been built, they can then handle more challenging readings.

I have also written a great deal about fluency. If you look through those you will see that the most important thing here is that kids read quickly with meaning with understanding. Merely looking a speed eliminated the need to understand the text, a common criticism of fluency instruction. Fluency, however, is essential, because it is the bridge to comprehension.

Leveled reading is something, as a special education teacher, I have been concerned about. Giving work that is too far outside the zone of proximal development is counterproductive. That said interest and supportive knowledge and language work can make texts more accessible. Students should not be barred from reading hard, self-chosen books, they should be encouraged to reread interesting passages and books and they should be allowed to put a book down if it does not engage them.

This book is a great resource for people trying to reset their reading instruction to reflect the science of reading at the elementary level, but the book is also great for teachers at the secondary level who are concerned about their students success with reading.

Executive function toolkit: procrastination

 

Understood.org defines executive function (EF) as “a set of mental skills that include working memory, flexible thinking, and self-control. We use these skills every day to learn, work and manage daily life. My favorite definition however is the set of skills to get things done and not get punched in the face. EF skills are important to learn as poor ones can interfere with school, job and relationship success.

 “Experts define procrastination as a self-defeating behavior pattern marked by short-term benefits and long-term costs. Many of us know it as putting off things that we need to get done, no matter the level of difficulty behind the task.” (McLean) Procrastination is a common phenomenon in both children and adults. Approximately 20% of adults struggle with it. Often procrastination is linked to depression, anxiety, ADHD and poor physical health. As the graphic indicates, procrastination has many possible sources and often they overlap. So what can you do?

1.       Don’t think about one overwhelming thing or all the overwhelming things, pick one little thing that will help you get there. Don’t think about the whole paper, think about writing the first sentence. Then write one more…. Don’t think about going to the gym to work out for a while, just get your gym bag ready to go. Then get in the car to go. Don’t think, I have to clean my whole room, just start with the clothes on the floor. Then pick another thing. S. Perler

2.       Chunking- if your child has an IEP you might have seen this word. It just means breaking a task down and giving yourself credit for each little piece. Depending on how bad your procrastination is, you may need to use smaller chunks. For one person it is the first sentence, for another, the first paragraph, for another, it is getting out your computer. This is related to the above idea. S. Perler

3.       Sometimes therapy with or without medication can help with catastrophizing, anxiety, and depression.

4.       Learn to tolerate discomfort. Name the feeling, imagine yourself doing the task, face the discomfort and notice that the sky doesn’t fall down. L. Phillips

5.       Pomodoro technique: Pick a task, set a 25 minute timer, work on the task as hard as you can until the timer rings, take a 5 minute break, and repeat. Todoits For children, 25 minutes may be too long to work. You can start as short as 5 minutes and gradually increase your time on challenging tasks. You can even chart the number of successful cycles that you complete in a day and try to increase it.

6.       Set the conditions right- working in a warm environment with sunlight can by itself help with focus. K. Davis Then eliminate distractions- turn off the TV and music, set your phone to silent and maybe even put it in another room, go to the bathroom and get a drink.

7.       Get enough exercise. K. Davis If a child is not getting 60 minutes a day of exercise, push to increase exercise. Adults should target at least 30 minutes a day. This can help with mood and fitness, but grades, attentiveness and impulsivity are improved with exercise.

8.       Reward yourself when you finish a challenging task- spend some time on that favorite video game, watch your favorite show, whatever it is that you will work for. Caution: rewarding children with money can backfire. They can start to work ONLY for an offer of cash, and as adults, no one pays us to clean our toilets. Sometimes we just have to do the unpleasant job.

Driven to Distraction

 Edward M. Hallowell and John J. Ratey's book, Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder From Childhood to Adulthood, is a classic text on ADD. Although not an especially recent text, published in 2011, it offers good insights into the disorder, especially as it relates to adults. The beginning of the book is dedicated to diagnosis and vignettes about personal impact on the lives of people affected with ADD. Since this area has been quite formalized, it is not particularly important to discuss at this moment. He cautions that ADD is often comorbid with other conditions, such as anxiety, depression and OCD, and those conditions should be treated as well. Individuals often choose to try and self-medicate or are driven to high risk behaviors resulting in substance abuse as well.

Form my personal warehouse of knowledge. When people use mamajuana they damage the amygdala in the brain. This damage is permanent. One of the roles of the amygdala is to regulate what the brain should pay attention to. Since people with ADD struggle with focus to begin with, adding this chemical to the mix is particularly harmful.

 One comment that struck me as pertinent was, " the ADD therapist must offer concrete suggestions concerning ways of getting organized, staying focused, making plans, keeping schedules, prioritizing tasks to be done, and, in general, dealing with the chaos of everyday life" (p. 112-3). From there he goes on to talk about some of these concrete suggestions to manage the disorder. He notes that people with ADD are often poor self-reporters of their behavior and the impact it has on others. He strongly suggests finding an ally to provide reports and supports as the individual with ADD seeks treatment.

Of Hallowell and Ratey's top suggestions is medication. He comments that it should not be forced on people but they should be convinced by facts that it is the path to go on. Convincing people can be challenging, but worth the risk. He comments that not all medications work for all people and that standardized dosing may not be the most appropriate. As a result he suggests being prepared for a potentially long period of trials to establish a therapeutic dosage. Further, he does admit that not all people with ADD benefit from medication. Getting client buy in is critical in this time period. Since many recommended drugs are fast acting, success at a particular dosage can fairly quickly be assessed. 

The biggest suggestion he offers is the establishment of routines and structures. Patterns as he often refers to them. Structures must be reinforced for extensive periods of time, since the ADD person will have difficulty recalling the structures. Once, however, the item becomes a pattern of behavior, it helps to organize the person's life. Current phone capabilities provide many methods for developing reminders. Alarms can be set to remind an individual about events. Phone based agendas and planners and calendars can help establish reminder lists.

The next thing the authors strongly recommend is a coach. People with ADD have a high need for feedback and reinforcement. Video games provide this and so are often sought after by people with ADD. A coach, be it a friend, teacher, parent, or spouse, can provide outside evaluation of success and frequent reinforcement of appropriate behavior. Although medication can make it easier to implement interventions, even without them, behavioral interventions are essential. The coach can provide daily support for how the individual is progressing.

Although not a new tome, the text, has many useful suggestions for helping people with ADD to manage their disorder so that they can be more productive members of our community.

Young, Gifted and... selectively mute

 Parenting for High Potential yet again has published a volume of remarkable insight and helpfulness for parenting different types of children who are gifted. The latest edition focuses on 2e children- children who are both gifted and struggle with a learning difference of some sort. The article that struck me as remarkable harkens back to a student I worked with years ago who was selectively mute and the challenge I had finding resources to help.  Fortunately my student wasn't gifted because literature on how to best support students who are both gifted and selectively mute is virtually nonexistent. Laura Giuliana Neher wrote "Young, Gifted and ... Selectively Mute?!" Unsurprisingly many teachers feel that a gifted child cannot be selectively mute. Similarly giftedness might mask mutism. Careful observation, however, reveals the giftedness of a child who cannot talk. Of critical importance, treatment should begin as early as possible. One noted study by Bergman, Gonzales, Piacentini and Keller showed improvement over 5 months only in children receiving treatment. 

The author advocates for 8 intervention tips which are useful for any student with selective mutism, not just those who are gifted.

1. Instead of open ended questions, ask forced choice questions. ex. Do you want the yellow or green paint?

2. Instead of rescuing the child, acknowledge non-verbal behavior and provide wait time. ex. I see you looking at the cookies. Wait 7 sec for a response, then if needed, rephrase a s a yes/no response.

3. Model and practice exchanges before needing to do them. Provide a script for the exchange.

4. Instead of insulating the child from social interactions, gradually desensitize them. Praise brave talking. ex. We will go and you need to greet two people and then I will talk. Then  you need to greet and ask a question. Then you need to greet and ask two questions or complete a conversation circle.

5. Create forced choice questions and enlist friendly conspirators to help by giving them questions to ask. Involve other people.

6.Use low pressure and lots of encouragement and reinforcement.

7. Gradually develop trust and comfort. Use PRIDE during play time: Praise, Reflect, Imitate, Describe and Enjoy.

8. Prepare to educate others and yourself. Use the Selective Mutism Educator ToolKit or Toolkit for Caregivers to prepare teachers and others for your child.

Disability Visibility

 In my advocacy research I ran across this title and had to explore it. Alice Wong's Disability Visibility: First-Person Stories from the Twenty-First Century is a series of essays she collected. All the authors have some disability, many have intersections with other minority categories (race, gender, orientation,...). The essays vary. Some I found to be easy reads and others not. Some were more complaint oriented and others more advocacy focused. Together they create a collage of the challenges and attempts to solve the challenges that people with disabilities face on a daily basis.

Two essays strongly resonated with me. One, "The Fearless Benjamin Lay," by Eugene Grant highlights the lack of disability portrayals in history. Many authors and researchers have expounded on this. His essay pointed out a character who was an early abolitionist with whom I was not familiar but more than that, he had dwarfism. This essay could be a great introduction to someone with dwarfism to historical characters of impact by people like them. Further, it showcases a strong person with a disability who strongly advocated for a worthy cause, even though it had negative repercussions.

"Six Ways of Looking at Crip Time" by Ellen Samuels, irritated me. I have heard so many excuses for not being timely and it irritates me. Parents of small children who "can't" get out the door. People who are just "bad with time." People who are just "too busy." Public transport doesn't arrive in a timely manner. People with disabilities who can't make it because it took too long to charge their device or assemble their go pack. Full disclosure. My mother was habitually late. Yes, there were 8 kids, one of whom has a significant disability. Yes, her husband had a TBI and was erratic and unable to see other perspectives. I, however, was the last child to be picked up with the pitying adults there asking if they should call my home to make sure someone was coming. I was the scared child left waiting. As an adult, I am neurotic about being on time. I hate when people start meetings late waiting for stragglers because it lacks respect for the people who made it on time. I sit in parking lots waiting for an appropriate time to go in. I lived in Hawaii where "island time" was an excuse to not be punctual. My students were habitually late. I get that your life is hard and has challenges. I get that you may have executive function issues that make it hard to be punctual. I get that public transport in this country is often not timely and reliable. "Manic Monday" by the Bengals highlights the issue. Everyone can make excuses for why they are not on time. We can do better. It takes work, training and thoughtfulness, but it can be done. I do not expect perfection, but being late should be the exception, not the rule.

Some authors quote statistics and research which they do not provide links to. I wish they did. Overall, however the picture painted highlights concerns, many of which I had not considered. It highlights some of the work done to try and get additional help for people that need it. I am not for full socialism, but we need to be a compassionate capitalist state that takes care of our neediest citizens. 

A thought provoking read that I highly recommend.