Assessment and Intervention of Children with Executive Function Difficulties

Question 1

Intervention approaches

Answer 1

• cognitive strategies (top-down approach) = executive function
• reading, hand-writing, math, following directions
• muscle tone, gross motor skills, fine motor skills, bilateral coordination, visual-spatial, attention
• sensory strategies = vestibular, proprioception, tactile, visual, auditory, olfactory, taste

Question 2

Executive function

Answer 2

• the underlying processes that allow children and adolescents to regulate their behaviors towards a goal
• develops in infants, increases at around age 5
• develops significantly in adolescence
• reaches maturity in early adulthood

Question 3

Diagnoses commonly associated with difficulties with executive function

Answer 3

• ASD
• Learning Disabilities
• Attention Disorders
• TBI
• Mental Health
• Developmental Coordination Disorder (DCD), also referred to as dyspraxia

Question 4

Components of executive function

Answer 4

• focus = sustained and shifting attention to tasks; internal or external distractions many interfere with focus,
• inhibition = controlling one’s impulses, ability to stop behaviors or responses
• memory = utilizing working memory and accessing recall
• emotion = feelings and responses to an event, identifying emotions
• goal-directed action = ability of memory to be manipulated into new behavior sequences

Question 5

Skills underlying executive function that an OT can address

Answer 5

• planning and organizing
• time management
• working memory
• metacognition (awareness of thought process)
• response inhibition
• emotional control
• sustained attention
• initiation and persistence
• flexibility

Question 6

Assessing executive function

Answer 6

• occupational profile = parent/teacher interview
• clinical observations
• formal assessments

Assessments:
- BRIEF 2 = Behavior Rating Inventory of Executive Function, Second Edition
- Weekly Calendar Planning Activity
- Kitchen Task Assessment

Question 7

BRIEF 2

Answer 7

• parent and teacher form for children ages 5 to 18
• adolescent self-assessment for children ages 11 to 18
• assesses everyday behaviors associated with executive function in the home and school environments

Categories include:
- inhibition
- self-monitor
- shift
- emotional control
- initiate
- working memory
- plan/organize
- task-monitor
- organization of materials

Question 8

Goals related to executive function

Answer 8

• attention (ex: Joey will maintain attention to complete his morning dressing routine; Joey will attend to independent classwork for 10 minutes to complete a worksheet.)
• inhibition (ex: Joey will raise his hand, Joey will refrain from physically pushing peers when upset.)
• persistence (ex: Joey will complete math worksheet; Joey will complete homework.)
• problem-solving (ex: Joey will identify the perspective of another child; Joey will state two solutions to a problem)

Question 9

Weekly Calendar Planning Activity (assessment)

Answer 9

• performance test of executive function
• adolescents and adults with subtle differences in executive function
• for individuals ages 12 to 94
• clients are required to enter a variety of tasks onto a weekly calendar

Question 10

Childrens’ Kitchen Task Assessment

Answer 10

• assesses executive function (specifically imitation, sequencing, safety judgement, organization, working memory) through the novel occupation of making playdough
• for children ages 8 to 12
• created by WashU (materials are available for free on the website)

Question 11

Interventions related to executive function (environmental modifications)

Answer 11

• divide tasks into small parts
• provide checklists to organize work
• visual organizers
• timers
• structure environment
• clear explicit expectations of behavior and consequences

Question 12

Superflex (an intervention related to executive function)

Answer 12

• a superhero social thinking curriculum designed by Michelle Garcia Winner
• based on cognitive behavioral theory

Lessons target:
- worrying
- inflexible thinking
- maintaining attention
- overreacting to situations
- impulse control
- perspective taking

*recently changed from unthinkable to unthinkabots

Question 13

SOCCSS (an intervention related to executive function)

Answer 13

• situation = who, what, when, and why
• options
• consequences
• choices
• strategies = plan
• simulations

Question 14

CO-OP (an intervention related to executive function)

Answer 14

Cognitive Orientation to daily Occupational Performance