5 Michael Uram MA LMFT LPCC This PowerPoint is now available at michaeluramcom What is executive functioning It is a Problem Solving Skill Set It is having a toolbox to address situations both novel and familiar with increased success ID: 540602
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Slide1
executive Function Fixes
5
Michael Uram
MA, LMFT, LPCC
This PowerPoint is now available at
michaeluram.comSlide2
What is executive functioning?
It is a Problem Solving Skill Set.
It is having a
toolbox
to address situations, both novel and familiar, with increased success.
It is being
open
to feedback about our performance.
It is about setting clear goals and priorities
It is developing interventions and plans to solve the problem.
It is having the time, energy and social support to carry out that plan.
Roughly adapted from the Washington State Department of Early Learning Webinar on Executive Function’s Essential Core Skills, Page 7 of 12: http://deltraining.com/courses/Executive_Function/content-frame.htmSlide3
Individuals of Any Age can change…
According to Peg Dawson, when we learn new executive skills, our neurons develop new pathways through myelination, which is more difficult as we age, although far from impossible. Slide4
The 5 Clinical interventions
to improve executive functioning
Externalize Information
Externally Represent or Remove Gaps in Time
Externalize Motivation
Intervene at the Point of Performance in Natural Settings
Intervene at the Most Disrupted LevelSlide5
The 5 Fixes – adapted From the Clinical Interventions
Be a Detective
Schedule Everything
Share Your Plan and Give Rewards
Create Reminders to try the fixes
Know your feelingsSlide6
Fix 1 -
Be a Detective
Understand your patterns first by entering every single activity that you do on your phone’s calendar and backup the calendar.Slide7
Fix 1 – be a detective by Externalizing Information and studying it
Know everything that you can about the situation at hand.
When you are helping another person externalize information, do not excessively remind the person or decide to allow them to fail and learn from their mistake…
The solution is to fill the immediate context with physical cues (Barkley, Pages 201-202)
“We never know enough about how to solve our problems, we can usually improve each time that we do the task.”
Write down how you solved problems.
Mindmeister is a great app to draw a mindmap and to practice thinking through projects. Slide8
Fix 1 - And Backup your life (Data)
So many people that struggle with Executive Functioning Skills lose the most important things to them, whether it is their keys, their phone or their paperwork.
Losing everything on your phone can greatly complicate your life…
One quick fix is to backup your phone, so whatever is lost can easily be replaced.
On an iPhone, Pay 99 cents per month for 50GB of backup space and have an automatic phone backup. If your phone is lost, you login to iCloud and everything is right there to be restored on your new phone.
Android is just about as easy and free using Google Backup and Android Backup Service. For more details, please read this article: http://arstechnica.com/gadgets/2015/10/android-6-0s-auto-backup-for-apps-perfect-data-backup-for-the-1-5/Slide9
Fix 2 - Schedule everything…
When we plan out every little thing, we decrease the chance that things come up and delay our next actions.
From the time that you wake up until the time that you go to bed, put everything on your schedule, EVERYTHING!!!!!
The more that is written down, the more that we can know exactly what are expectations are and structure it to the point that nothing falls through the cracks.
This includes showering, breakfast, drive times, meetings, lunch, family events, appointments, calls, checking email… Did I mention that it had to include EVERYTHING!!!!!Slide10
Fix 2 - Externally Represent or Remove Gaps In Time
If we only focus on the present, we may do well, but unfortunately, we may never achieve our long term personal goals.
Think of everything as a complete process to evaluate
(E+R=O) (event + response= outcome)
Reduce or eliminate these problematic time-related elements
When managing others, rather than tell the person that a project must be done over the next month, assist him with doing a step a day toward that eventual goal
When the deadline arrives, the work has been completed in small daily work periods with immediate feedback and incentives for doing so.
(Barkley Pages 202-203)Slide11
Fix 3 –
Share your plan and give rewards
Track your daily progress by having simple goals and rewards written in for each day.Slide12
FIX 3 Example
7:00 PM – Replace light in hallway
7:10 PM – Watch TV Show on Netflix after the light is replaced.Slide13
Fix 4 –
Create reminders to try the fixes
Externalize Motivation to increase your accountability and pride when you achieve your goal
Internalized, Self-Generated Forms of motivation are weak at initiating and sustaining goal-directed behavior;
Externalized sources of motivation, often artificial, must be arranged within the context
at the point of performance
.
These compensatory, prosthetic forms of motivation must be sustained for long periods.
If the external motivation is removed, the behavior will not be further sustained, and the individual will regress to more erratic goal-directed behavior with less ability to sustain actions toward tasks and goals.
Clinicians can intervene through these 5 vectors: situation selection, situation modification, attentional control/redirection, reappraisal, and response modification/ suppression. (Barkley Page 203)Slide14
Fix 4 - Externalize motivation
reappraisal pathway.
Bauer and Baumeister (2011) stated that research indicates that each implementation of Self regulation (working memory, inhibition, planning, reasoning, problem solving, etc.) depletes this limited resource pool temporarily such that protracted SR may greatly deplete the available pool of effort.
To Replenish the Pool, Barkley outlined a few interventions on Page 205
I will give one example… (Barkley Pages 204-205)Slide15
Fix 4 - Intervene at the Point of Performance in natural settings
Once per week counseling is unlikely to succeed with the patient with deficient EF without efforts to insert accommodations at key points of performance in natural settings to address the impaired domains of major life activities.
Russell Barkley recommends medication as the most effective intervention for this EF deficit.
I recommend technological interventions and texting with your counselor at those specific times. Amazon sells Bluetooth watches that sync with your phone, with reminders for as little as $5 (U8 Watch) and to schedule texting your therapist after the task is accomplished, while your therapist texts you back if they did not hear back from you by a certain point.
Accountability during the point of performance is a great motivator.(Barkley Pages 205-206)Slide16
Fix 4 example
Arrange with another person to text them after you have accomplished a task. They will share in the excitement when it is accomplished, and you would have a much greater chance of success.Slide17
Fix 5 – Know your feelings
Pay attention to and discuss your thoughts and feelingsSlide18
Fix 5 - EMOTIONAL REGULATION
When you get emotionally drained or overwhelmed by your day, the last thing that you should do is to overbook yourself again tomorrow.
Take 3 minutes throughout the day to do an emotions check. When our emotions are intense, our calendar goes out the window…
Breaks are important. Breaks can include: meditation time, playing games on your phone; browsing the internet, going for a walk, etc.
“I learned a lesson I’d never forget. The lesson was that, when you have setbacks and failures, you can’t overreact to them.”
―
Angela Duckworth
,
GritSlide19
Fix 5 - Emotional Regulation
For adults with ADHD, it is reasonable to block out small chunks of time and breaks regularly.
Talk about emotions with the other people in your life, don’t ignore them, they come back intensely.
Identify emotions and come up with a plan to address them.
If you don’t, you will likely be exhausted most of the day, sitting at your computer, on your couch or on your bed…Slide20
Bonus fixes - Impulse Control and Overwhelming anxiety
You are likely going to have strong urges to resist accomplishing your own goal. Here are some suggestions to deal with that drive to avoid the task:
When you are avoiding it, remind yourself of how much of a priority the task represents.
Prioritized behaviors that are in line with values that you care about will likely increase your motivation and you may have much more energy…
If you do the avoidance behavior, do it for an extended period of time, even when you are ready to get back to work, it will help you to understand how absurd it is to avoid doing something that you care about.
When the urge to do anything but the task happens, notice it and allow it to go away by postponing the distraction by one minute, and seeing if the urge subsides.
Acknowledge that the impulse to stop the task will go away in a few minutes, persevere and refocus.Slide21
Resources
“Executive Functions” What They are, How They Work, and Why They
Evolved by Russell A. Barkley PhD, ABPP, ABCN
website:
russellbarkley.org
“The Smart but Scattered Guide to Success, How to Use Your Brain’s
Executive Skills to Keep Up, Stay Calm, and Get Organized at Work
and at Home”” by Peg Dawson, EdD and Richard Guare, PhD
website:
smartbutscatteredkids.com
Bauer, I.M., & Baumeister, R.F. (2011) Self-Regulatory Strength
“Grit: The Power of Passion and Perseverance” by Angela Duckworth,
For More Information on Michael, please visit:
Michaeluram.com