Thursday, August 12, 2010

Executive Functions - EF and CPS

The collaborative problem solving approach addresses the many cognitive skills that a child may be lacking. When we solve problems in a collaborative way we promote executive functions, language processing skills, emotion regulation skills , social skills and cognitive flexibility.

Executive function Skills – from care givers handout

These are the thinking skills, associated with the frontal lobe of the brain. They enable one to do the clear, organized, reflective thinking in the midst of frustration that is crucial for solving problems in an adaptive (non-impulsive) manner. The executive skills include:

• shifting cognitive set (the ability to shift gears, to make transitions in activities and thinking smoothly)

• organization and planning, and working memory (allow you to use hindsight and forethought to solve problems in a systematic fashion)

• separation of affect (the ability to put feelings on the shelf to get on with the clear thinking needed to solve problems)

When lacking, these children will have difficulty shifting from one activity to another. They will have difficulty anticipating problems. In the face of frustration, they will have difficulty staying calm enough to think clearly and will have difficulty sorting through different solutions to organize a coherent plan of action.

Here are 2 check lists – the ALSUP Assessed Lacking Skills and unsolved problems from Dr Greene's site ' CPS – lives in the balance and a similar list from the TSI – thinking skills inventory from – Dr Ablon

Dr Greene feels that categorizing the skills into executive functions etc gets in the way of focusing on the real problem , the concerns of the child and the underlying skill. It becomes a label , a diagnoses that get's in the way of helping kids. Too often , clinicians will try to promote executive functions independently of problems and the child's concerns. It is much better to work with the check list of the lacking skills together with unsolved problems. Dr Ablon reintroduced the categories at the request of parents in order to help them remember the various cognitive lacking skills. Separation of affect – putting emotions on the shelf – is now categorized by Dr Ablon under emotion regulation skills.

The various lacking cognitive skills may be found in nearly all childhood disorders and that is especially true for executive functions. So it is a bit silly to say if a kid has executive functions deficits he must have ADHD. This proves the CPS approach claim that diagnoses don't tell much and actually get into the way of a clear understanding of the underlying challenges of the child and the compatibility and responsiveness of the child's care givers.

From : Treating Explosive children - Executive functions

Handling transitions, shifting from one mindset or task to another (shifting

cognitive set).

Sticking with tasks requiring sustained attention (perseverance)

Doing things in a logical sequence or prescribed order (organization)

Reflecting on multiple thoughts or ideas simultaneously (working memory)

Maintaining focus for goal-directed activities (sustained attention / concentration)

Ignoring non-relevant stimuli (distractibility)

Thinking before responding, considering the likely outcomes or consequences of

actions, forecasting (reflective not impulsive thinking)

Considering a range of solutions to a problem

We can  train kids to be  more organized, planful, intentional ( non-impulsive ) thinking when we use Plan B – taking perspectives and concerns, defining the problem , using hindsight to reflect on past solutions and their outcomes, foresight to predict likely outcomes of potential solutions , anticipating problems and proactively solving them .

Responding to changes in routines or demands to change cognitive sets from one set of rules and expectations and making transitions is a skill which relies also on the capacity to anticipate and predict the near future and thereby not being taken by surprise.

Pan B of CPS promotes executive functions as we work through unsolved problems. We can collaborate – not top down skills instruction – with the child to see how together we can formulate goals , make the day more predictable and organized –

see below resources – Sara Ward and Ann Epstein = intentional choice and planning.

We can help kids make lists and schedules. This is also great because it gives them a sense of time and a wider time horizon. In the moment , a kid may feel that their needs are not being met , for eg not going to the swimming pool or a play date. When they check the week's schedule they are able to perceive the bigger picture.

Supporting a kid's autonomy is very important for their development. Autonomy does not mean independence but rather interdependence. It means being in touch with your inner core values and making decisions which express your true self and not just a reaction against parents.

When a kid had made a list or schedule , we can ask ' what about brushing teeth , do you see any problems ' etc . We don't have to give orders or instructions to do things , because it is the list the kid made is creating his agenda.

In today's modern world with plenty of technology with which kids love to mediate the world we can make use of ' Assistive Technology - check my post on ' AT'

Here are some Resources

here are some links - Sara Ward's pdf

Sara Ward has some ' amazing presentions ' here  - Chandler Papers on childhood disorders   - Ann Epstein   - Edward de Bono













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