Executive Function Fixes - PowerPoint Presentation

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