ri o ts presentation slideshare
TRANSCRIPT
Games and Apps to Improve
Executive Functioning
RI OT Pediatric Special Interest Group
RandyKulman. Ph. D.
@lw4k
learningworksforkids.com
pinterest.com/lw4k
What are executive functions?
The cognitive command and control systems of the brain.
The CEO of the brain
The manager, organizer, and coordinator of internal and
external information.
A collection of brain processes that guide thought and
behavior.
Capacities that enable independent, purposeful, goal-
directed behaviors.
Critical thinking and self-regulatory skills
Dawson and Guare 2004 (Model of executive functions)
Identifies 11 component executive skills that are consistent
with major theories of executive functioning by Brown and
Barkley.
The specific skills are also easily assessed by the best measures
of executive functioning {the Brown ADD Scales and Behavior
Rating Inventory of Executive Functioning (BRIEF)}.
The division of skills into 11 specific executive functions also
helps in developing clear interventions strategies.
LearningWorksforKids has modified the Dawson and Guare
model and has added a twelfth skill, social thinking.
Current Neuroscience
Executive functions are not located simply in the prefrontal cortex.
Executive functions involve neural networks involved with coordinating and processing internal and external information.
The prefrontal cortex sends reciprocal connections to many other areas of the brain involving executive functions.
It is best to view executive functions as an interconnected coordination process across wide ranges of areas of the central nervous system (including, but not restricted to, the parietal, temporal, and occipital cortex, basal ganglia, cerebellum, amygdala, and hippocampus).
http://learningworksforkids.com/executive-functions/
Development of Executive Functions
The growth of executive function skills in children and adolescents parallels the
maturity and development of the frontal lobes and the prefrontal cortex in particular.
Executive functions are observed as early as 8 months old, where infants are seen as
keeping an object in mind (while playing hide-and-seek).
Preschoolers learn to inhibit behaviors (eg. not touch a hot stove) and develop basic
social skills in peer play.
Growth patterns ages 5-7, 9-12, and adolescence.
Adolescents, in particular, are known to engage in risky behavior, often failing to
consider the consequences, plan effectively, or regulate emotional displays.
Slowly-developing executive skills are also seen across a wide range of psychiatric
disorders, and in particular Attention Deficit Disorders. Recent brain imaging studies
indicates slower development of the cortex in ADHD kids.
Executive Functions and Academic
Performance
Goal-directed persistence
Ability to set a reachable goal and display ongoing effort.
Sustain effort when a task becomes boring or interrupted.
Necessary for activities that require sustained practice for
improvement.
Willingness to delay gratification and be able to visualize or
imagine the future.
Executive Dysfunctions and Psychiatric Diagnosis
Disorders of executive function cut across a range of psychiatric diagnoses in children and adults.
Many individuals with significant executive dysfunctions do not readily fit into a diagnostic category. (For example, individuals may be very disorganized and have difficulty planning, but may not meet the criteria for an attention or learning diagnosis.)
Most often associated with Attention Deficit Hyperactivity Disorder and Learning Disabilities.
Also observed in Autism Spectrum Disorders, Nonverbal Learning Disabilities, Tourette’s Disorder, and Anxiety and Mood Disorders.
Sustained Attention
Maintain one’s focus in the presence of distractions and other activities.
Return to an activity when interrupted.
Persist in tedious and boring tasks.
Select the most important sources of information when confronted with multiple stimuli.
Developmental in nature; all children tend to focus longer as they mature.
http://learningworksforkids.com/playbooks/the-legend-of-zelda-skyward-sword/
Task initiation (getting started)
Get started directly on a task.
Understand what is expected.
Redirect one’s attention from a previous involvement.
Get activated even with non-preferred tasks.
Goal-directed persistence
Ability to set a reachable goal and display
ongoing effort.
Sustain effort when a task becomes boring or
interrupted.
Necessary for activities that require sustained
practice for improvement.
Willingness to delay gratification and be able to
visualize or imagine the future.
http://learningworksforkids.com/apps/story-builder/
Planning
Display sequencing and foresight.
Develop short- and long-term goals.
Respond to environmental and social cues.
Estimate and anticipate possible outcomes.
http://learningworksforkids.com/playbooks/minecraft/
Working Memory
Keep information in mind and perform an activity on this information.
Involve verbal and visual processes for memory.
Display cognitive function that holds information “on line” for a short
period.
Used for following instructions, paying attention, and problem solving.
http://learningworksforkids.com/apps/cogmed-working-memory-
training/
Organization
Arrange elements in a functional manner.
Utilize a systematic approach that facilitates goal-
directed behavior.
May involve sequencing and anticipation of the future
Ordering thoughts and communication with others
http://learningworksforkids.com/apps/first-then-visual-
schedule/
Flexibility
Improvise and shift approaches.
Adapt to the demands of a new situation.
Develop novel strategies.
Shift attention from one task to another.
Recognize the need to utilize different problem-solving strategies.
http://learningworksforkids.com/playbooks/portal-2/
Regulation of Affect
Manage one’s feelings effectively to make decisions.
Capable of sustaining one’s effort in the face of frustration.
Accept criticism without defensiveness
Able to regulate emotional displays
http://learningworksforkids.com/playbooks/if/
Response Inhibition
Use reflective rather than impulsive behaviors.
Demonstrate Self- Control in social situations
Stop or delay an action
Demonstrate appropriate caution in dangerous activities
http://learningworksforkids.com/playbooks/fruit-ninja/
Time Management
Respond to things in a timely fashion.
Follow a schedule.
Display skills at estimating the time necessary to
complete tasks.
http://learningworksforkids.com/playbooks/the-
blockheads/
Metacognition
Display self-monitoring and self-observation.
Check on one’s efforts and assess success and failure.
Provide perspective on decision making and understand the impact of one’s actions on others.
http://learningworksforkids.com/playbooks/the-legend-of-zelda-ocarina-of-time-3d/
Social Thinking
Label and describe one’s feelings.
Understand the needs of others.
Display perspective-taking skills.
Understand social conventions.
http://learningworksforkids.com/playbooks/draw-
something-2/
Assessment of Executive Functioning
Performance of complex everyday tasks are the best data.
Parent interviews :
Problems with homework and chores,
Frequent displays of frustration,
Anger, problems getting started and finishing tasks,
Difficulties following directions.
Assessment of Executive Functioning (Cont.)
Teacher interviews:
Difficulties in understanding social and classroom expectations
problems in sustaining attention and effort on independent classroom
assignments
difficulties in following complex directions
requires frequent prompting to get started or maintain effort.
Difficulties with organizing essays and written materials.
Performance of complex everyday tasks are the best data.
Assessment of Executive Functioning
(Rating Scales)
Behavior Rating Inventory of Executive Functioning (BRIEF) –
Scales include Initiate, Plan/Organize, Working Memory, Shift, Inhibition,
Monitor, Emotional Control
Brown ADD Scales – More of a measure of executive functioning than
specifically of Attention Deficit Disorder
Scales include Activation, Focus, Memory, Emotion, Effort, action
Executive Functioning Questionnaire (LearningWorksforKids)
Processing Speed Questionnaire (LearningWorksforKids) - face valid
methods for collecting observations of executive functioning and
processing speed concerns with children
Executive Dysfunctions in ADHD
DSM-V (2011) proposed criteria for ADHD describe six of the nine major symptoms as executive dysfunctions (Barkley 2007).
Problems in following directions, keeping things in mind, and getting started on tasks.
Difficulties sustaining attention and effort.
Problems in regulating feelings and becoming easily frustrated.
http://learningworksforkids.com/alternative-learners/adhd/
Autism Spectrum Disorders
Difficulties with social thinking and picking up on nonverbal cues.
Inflexibility and rigidity.
Metacognitive problems and difficulties in self-observation and perspective taking.
Difficulties in emotional regulation and controlling frustration and anger.
http://learningworksforkids.com/alternative-learners/autistic-spectrum-disorders/
Anxiety and Mood Disorders
Difficulties in regulating emotions.
Become overwhelmed by minor inconveniences and stress.
Lack of self-confidence and problems in getting started on tasks and sustaining effort.
Unable to complete homework.
Perfectionism or rigidity that may lead to inflexible problem solving.
http://learningworksforkids.com/alternative-learners/anxiety/
Executive Functions and Academic Performance
Goal-directed persistence
Ability to set a reachable goal and display ongoing effort.
Sustain effort when a task becomes boring or interrupted.
Necessary for activities that require sustained practice for improvement.
Willingness to delay gratification and be able to visualize or imagine the future.
http://learningworksforkids.com/wp-content/uploads/AcademicChartExecutiveFunctionsThinkingSkillsConnections.pdf
Reading
Phonological Awareness
Working Memory - keeping different sounds in mind while decoding
Fluency
Focus - ability to sustain attention to the task, keep going without getting distracted, not give up.
Comprehension
Planning - ability to form/plan comprehension goals before reading, use organizers, think about prompts
Organization - Have to be able to organize information that was read in order to make sense of it. Sequencing events, most important info.
Working memory - keep track of pieces of info to complete understanding
Writing
Vocabulary
Working memory - Recalling previous vocab learned and being able to use it when appropriate
Fluency
Focus - sustain attention to the task without being distracted or giving up, goal directed. Writing as a problem and step by step process, writing in stages.
Task initiation - Being able to define the first step and begin organizing thoughts with minimal hesitation and self - doubt, getting something on the page
Working memory - keeping multiple ideas in mind at once, recalling grammar/spelling rules
Organization
Working memory - Ability to pull spelling rules from long term memory and use when writing
Mathematics
Computation
Working memory - Keeping different steps to solving a problem in mind, recalling which formulas to use to solve which problems, keeping parts to a multi-step problem in mind
Focus - Sustaining attention to the task, not getting distracted in the middle of completing a problem, setting goals and working to meet them
Fluency
Working memory - Keeping all of the different components to a problem in mind while solving it, thinking about previous steps while doing the current one, retrieving previously learned information to apply it to the current problems/task, applying math rules.
Flexibility - Shifting between different representations-written in sentences, computation, etc. Being able to switch your approach/strategy when it is not working.
Concepts
Self-awareness - being able to explain and communicate your own reasoning in writing or to others, being able to think about and explain the steps you use to solve different kinds of problems, being able to explain the reasoning behind completing a math problem a certain way.
Improving Executive Functioning
Support and Scaffolding
Providing a child with external assistance that leads to the use of an executive skill
Training wheels on a bicycle
Often referred to as a parent or teacher taking on the role of the temporal lobe
The opportunity repeatedly to rehearse an executive skill
May require teaching or modeling of the skills
Sustained practice often requires salient rewards, reminders, recognition, and accomplishment
Improving Executive Functioning (Cont.)
Development
Teaches a child to use executive skills and apply them in new situations
Requires a teacher, mentor, parent
Understanding and ownership of the goal of developing a new skill on the
part of the child
Understanding of how this new skill will help the child
Generalization strategies to help apply it to new situations
Reasons to use video games and digital
media to improve EFs
Engaged kids
Catch them with what they are already doing
Willing practice
Sustained attention and effort
Uses skills (Efs) that are crucial to 21st century success
Research support for games and learning
Research -video games have positive
effects on children.
Improve processing speed (Green and Bavelier, 2009)
Improve working memory (Klingberg, et al, 2007)
Increase pro-social behaviors (Gentile et al, 2009) in children.
Improve social involvement (Ferguson, 2010)
Build brain regions Kühn and her colleagues study of Tetris
Improve Brain Flexibility with StarCraft
Rayman Raving Rabbids and Reading Fluency
Research-Negative impact of video games
on children
Increasing levels of obesity with screen-based time- primarily television
Poor psychological adjustment in kids who play more than 3 hours per day-
Pediatrics report
Violence and video games- Bushman data
7 hours 38 minutes per day of digital media time- Ignoring other activities-
Kaiser Foundation data
Video game addiction 3- 8% cited-DSM-V category Internet gaming
disorder
Generalization, Motivation and
Metacognition
The key Ingredient- Making game-based learning into
real world skills
Games are play, Play=Learning
Games (Traditional, think chess) require problem solving
Games are motivational
Games sustain attention and effort
Games require a variety of executive skills
Games promote extended practice
Generalization, Motivation, Metacognition- 2
Games are social and learning occurs with others
Games foster communication amongst kids
Games get special needs kids to participate
Games get kids to think about what they are doing
Flow and engamement
Games promote academic knowledge (eg history, geology)
Games promote digital literacy skills
How to Use Digital Technologies to Teach Executive Functions
Educational and Psychological Principles That Enhance
Effective Learning with Digital Technologies
Develop a partnership with the child for learning executive skills
Have the child identify areas that she wishes to improve
Practice skills in an interesting and reinforcing manner
Preview and review strategies -child "detect” use of executive skills with digital tech
Teaching strategies that help a child "reflect" on use of executive skills and her game play
Point of performance strategies-"connect" executive functions from games to real world
How Do Digital Technologies Teach
Executive Skills? (THEY DON’T)
Many do, however, require the use of executive skills throughout the game.
There is some evidence to suggest that the simple act of game play that
requires executive skills produces new neural connections in the brain.
Brain-training websites for adults such as Cognifit, Happy Neuron, and Fit
Brains report improved memory and attention skills.
Cogmed Working Memory Training has strong data including FMRI's of brain
change.
Wealth of anectodal evidence that children learn from electronic media
(television research, simulation-game research, and electronic toy-makers)
How Do Digital Technologies Teach Executive Skills? (Cont.)
The LearningWorks for Kids model:
Tailored interventions .Assess a child’s executive skills and weaknesses
Games as a vehicle for "engaging the gears" of a child's brain, as a teaching tool
Opportunities for children to practice an executive skill in a fun and engaging fashion
A teaching opportunity for parents, teachers, and clinicians
An opportunity to detect, reflect, and connect on the use of executive skills, Provide practice opportunities for real-world use of executive skills
Why Would OTs, SLPs, Clinicians Become Digital Play Therapists?
To become the most popular clinician on the block
To relate to kids where they are
To use "clinical play time" to do more than build relationships
To engage in an activity in which children often feel a sense of accomplishment
To provide a child with an opportunity to teach you, rather than you teach her
To engage in an activity in which homework assignments and ongoing practice are likely to be completed
What Does an OT, SLP, Clinician Need to
Learn?
"But I don't know how to play video games." (for parents, teachers, and
clinicians)
It's important to have some knowledge
Start learning
An opportunity to communicate with kids on their turf
It's good to know what the kids are up to.
Kids can learn from digital technologies, but they still need parents and
teachers to help them reflect, apply, and connect their knowledge.
Thank you
Contact info:
Learningworksforkids.com
www.facebook.com/LearningWorksForKids
Twitter- @lw4k
Pinterest.com/lw4k
@rkulman
401-515-2006