Friday, December 9, 2016

ASHA 2016: Executive Function Skills and Task Management

Anthony Bashir, Ph.D. and Bonnie Singer, Ph.D. presented on a simple way SLPs, teachers and other school staff can think about, document and support the five core executive function (EF) processes in the school setting.

Note: This blog post is not to replace the presentation of Drs. Bashir and Singer, but to simply share with you some of the information I found helpful and important for my own clinical practice.  If you would like hear Drs. Bashir and Singer speak on this subject at your school you can contact them here.

What is an executive function?  EF is a brain based process dedicated to: 1) inhibit an automatic response (or action), 2) plan (figuring out "the WHAT" to do), 3) organization ("the HOW" to do it), 4) hold those plans in one's working memory (WM), and 5) maintain self-regulation (of emotions, behavior, cognition, language and learning)

1. Inhibition
2. Planning
3. Organizing
4. Working Memory
5. Self-Regulation

Note: Although these skills all develop over time from birth through to mid-20s (as seen by myelin growth), they do NOT develop in sync (thus supporting that EFs are actually multiple separate functions rather than one large function as previously thought years ago).  Rather they develop differently over time.  Therefore it is imperative to determine which EFs will inhibit a student's success for individualized tasks in order to address them effectively.

Task Management:

In order to manage a task (either daily living or school/academic activity), we need to use BOTH our EFs AND Self-Regulation (SR) skills SIMULTANEOUSLY in order to achieve success.  Yet, what are the EFs and SR skills we need to manage and complete a task?  They are not as simple as one might think.

Task management with Core EFs + Self-Regulation skills= Academic Success!

But what do we do for children with poor self-regulation skills? We need to teach our students to do the following:
  1. establish attainable goals to complete the task
  2. choose and use effective strategies to reach the goal
  3. self-monitor, evaluate, mediate one's performance with self-talk (positive)
  4. maintain motivation (either with internal loci of control or external--outside help from SLP/staff)
  5. seek support from other resources

When teaching our students effective self-talk, first we much know what type of self-talk they use.  Ask them "what's going on in your head right now?" or "what are you thinking?".  This will give you a glimpse of where they fall on the self-talk continuum.  We will likely have to spend much time on teaching our student's how to use positive self-talk in order to problem solve and reason through situations.  In fact, some children need to learn positive self-talk so they can initiate a project/task/activity.  The goal being that positive self-talk can assist them in initiating, maintaining and completing the realistic goal.

                                                         Self-Talk Continuum
Negative                                                                                                                         Positive
Counter Productive                                                                                                      Facilitating

Bashir and Singer shared what I like to call three rules that should govern our thinking when working with children and adults with EF difficulties.

The Rule of Reciprocity:

The Rule of Rapid Deterioration:

The Rule of Demands vs. Capacities:

Stay tuned for the next post where I'll share with you a bit about Bashir and Singer's suggestions regarding treatment for children and adults with EF deficits.

Happy Talking!

Monday, December 5, 2016

ASHA 2016: Word Finding Difficulties: Assessment and Treatment

If you missed the first post explaining the 3 types of error patterns exhibited by adolescents and adults with word finding deficits based on Dr. Diane German's work, click here.  Today we will be addressing Dr. German's suggestions for assessment and treatment for these deficits.

Please keep in mind, this information is only a small portion of the information presented by Dr. German.  I highly recommend you look into her work on word finding deficits and if you have a chance to hear her speak, to do so as it will be worth your while.

Dr. German suggests you can use both formal and informal assessment measures to analyze error patterns.   If you are interested in a formal standardized test, you may want to look into the Test of Adolescent/Adult Word Finding-Second Edition (TAWF-2).

However, if you are also interested in informally assessing word finding skills Dr. German recommends analysis of the following:

1.  Target Word Comprehension:  does the child/adult understand the concept of the target word?  (comprehension can be demonstrated receptively or expressively by pointing or labeling pictures)

2.  Delayed Response Time:  any word retrieval that is >3 secs. is considered an error (regardless of whether the word retrieved was correct).

3.  Responsiveness to Phonological Cues:  determine if the child is responsive and can retrieve the word with a phonological cue (either initial sound or syllable).  If word is retrieved it is still considered in error but this information will provide diagnostic information regarding the type of error pattern that exists.

4.  Ability to Imitate Segmented Word:  if the child/adult could not retrieve the word but could imitate the word segmented into syllables, this suggests it is more likely a word finding deficit rather than a motor planning issue.

5.  Nature and Target of Substitutions:  nature of the substitutions used will lead you to determine the type of error pattern (EP) (e.g. semantic substitutions-EP 1,  withdrawal/refusal (IDK)-EP 2,  phonological substitution-EP 3).

6.  Manifestation of secondary characteristics:  determining if secondary characteristics exists and what types are used will help also determine the type of EP the child/adult exhibits.

Note:  Knowing the word finding EP exhibited will guide our treatment in the strategies we will use as well as the types of curriculum terms/words we will practice with out students.


Goal:  a)  help the child with automatic retrieval of curricular vocabulary, b) decrease word finding behaviors (to typical range ~19% of the time) using strategies.

Error Pattern 1:

Teach:  EF Strategies:  1) self-monitoring, 2) self-correcting, 3) strategic pauses (i.e. pauses before content words, before the noun in a noun phrase, before the object in a prepositional phrase, etc.)

Choose to target:  high frequency words, that are short and have more common phonological patterns or combinations, such as words with large word families (Dr. German labels them as words "in dense neighborhoods").  For example words like "fan, man, pan, Stan, can, tan" is considered a "dense neighborhood".

Error Pattern 2:

Teach:  1) word meaning and metalinguistic reinforcement (number of syllables in word, etc.), 2) phonological mnemonic cues, 3) rehearsal of targeted word in isolation, phrases, sentences and discourse

Phonological Mnemonic Cue:  you are going to allow the child to come up with a familiar phrase with the 1st syllable of the word being the phonological cue in order to recall the word.   Example provided during the presentation was a boy trying to recall the word "density" so he made a phonological mnemonic cue that meant something to him "Denver city".

Choose:  less frequent, less familiar words in "sparse neighborhoods" (less common phonological combinations or fewer number of members in a word family).

Error Pattern 3:

Teach:  1) metalinguistic reinforcement, 2) phonological mnemonic cue, 3) rehearse target word (isolation, phrase, sentence, discourse)

Example of phonological mnemonic cue:  for the word "paradox", the cue is "pair of socks".

Note: same techniques as EP 2 

Choose:  multisyllabic words, that have unfamiliar/atypical/infrequently used phonological patterns/sound combos, from "sparse neighborhoods".  

Remember: for any and all error types, the goal is always to teach the child which type or types (there can be a combination) of error patterns they use AS WELL AS their strategies.  The goal is not to eliminate word finding difficulties but to teach strategies so as to reduce these difficulties to those of typical peers (i.e. word finding deficits are exhibited ~19% of the time). For more information regarding this incidence, please refer to Dr. German's work.

Stay tuned for more posts from specific sessions I attended at ASHA 2016.  Remember, if you are looking for more posts regarding my ASHA16 experience, to look under the label "ASHA 2016" by scrolling down to the labels section on the right side of this page.

Happy Talking!

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