Transforming Behaviour Webinar Series - Supporting Executive functioning
Transcript:
Good morning everyone. It is so lovely to
have you here. Thank you for joining us.
At today’s webinar, we’re talking about
supporting executive functioning. Now
that is something that has such a broad
reach. Executive functioning impacts all
areas of our lives and it impacts all
areas of the lives of folks with
disability. So today’s going to be a
broad overview into the topic so
that you can start your own explorations.
Into the way that executive functioning
might be impacting or executive
dysfunction rather might be impacting
somebody’s day-to-day capabilities and
the way that you might get started and
investigating and also
intervening with supporting somebody’s
executive functioning so.
Before we start, I’d like to acknowledge
the Gadigal people of the ER nation on
whose land I live and work and from where
this webinar is being broadcast today and
acknowledge any Aboriginal or Torres
Strait Islander people present today.
This is what we’re going to be chatting
about today. So we’re going to be talking
about what is executive functioning. I
think it’s a term that gets thrown around
a lot without a lot, without a lot of
clear definitions so that we know what
we’re talking about and we know that what
what we’re addressing.
So we’re going to
be talking about what is executive
functioning and breaking it down into its
constituent parts. We’re going to be
talking about how disability and
executive dysfunction interacts and the
way that disabilities might interact
with executive functioning, How they
might look different, how they might
struggle, how they might be really
amazing. And just looking at the
different ways that different types of
disabilities can interact with executive
function.
We’re going to be looking at
what are some signs and symptoms that
either yourself or somebody you care for
might be struggling with their executive
functioning. And we’re also going to be
looking at how can you assess executive
functioning, what are the options that
are out there in terms of getting started
on the road to supporting somebody’s
executive functioning.
We’re then going to be talking about, OK, we’ve
established what executive functioning
is. We’ve established that we’ve got to
struggle with it. What can we do? Where
do we start with supporting somebody’s
executive functioning with
putting in place day-to-day
accommodations and stuff like that.
Next we will be answering some
questions and at the end, we always
follow up with our references.
As always, if you’d like to get in touch,
if you’d like us to address a specific
topic, please do send us an email to
[email protected]
All right, so. A very valid
question that you might be asking is who
is this person? Why is she talking about
this? What’s her background? So. My
name is Ella. I’m the chief clinical
officer here at Transform Life. I’ve been
working in the Allied health and
Disability space.
Oh, probably, Let’s
say let’s say nine years at this point.
So my background and qualifications are
in psychology, my degrees in
psychology, and now I’m working in
positive behaviour support and in
clinical executive leadership,
so. That’s me. I’ve been
so lucky in my career.
I really have to be able to
work in the homes, in the lives
alongside folks with disabilities and
their families. And I really think that
all of the important things that I’ve
learned about what
matters when you’re supporting somebody
with a disability haven’t been from all
you know, the degrees, the uni study, the
internships you know they’ve been from.
Families with disabilities, honestly
sharing with me what makes a difference
to them. So I always say families have
taught me everything. So
I don’t come here
to speak for disabled people. I myself
don’t identify as disabled. What I come
here is to share the knowledge that that
I have learned from people
with disabilities and their families as
well as obviously my study and expertise.
So. With no further ado,
let’s get started on what is executive
functioning so. I
like to think of executive functioning as
anything that you do or any thought that
you have that is about what you are
doing. So we’ll just go through this
definition here. Executive function and
self regulation skills are the mental
processes that enable us to plan.
They enable us to focus, they enable us
to remember specifically short-term
and also to juggle multiple tasks
successfully. So the Harvard
Centre for Developing the Child. A
really good metaphor that I find really
helpful at illustrating the role that
executive functioning plays in our lives.
If we think of our lives as a busy
airport, we’ve got things coming and
going. We’ve got multiple pieces that
need to coordinate with each other.
That’s our brain. We have
multiple different systems that need to
coordinate. We have different
stimuli coming and going.
Our executive functioning that takes
place in the very front part of our
brain, well primarily that’s the
simplified version is like the traffic
control, air traffic control system. So
it’s thinking about OK, how am
I, how am I organising these
multiplecoming and going stimulus,
how am I synchronising these systems
together? How am I able to think
about the thoughts that I have
now Executive functioning has a number of
different. Yeah, different.
Component functions that we’re going to
go into and they all need to
be really integrated with each other
seamlessly to enable the highest level of
functioning. And so when we have
executive dysfunction, often it’s because
one or more of these areas of executive
functioning are not performing to the
highest level. And that could be for a
number of reasons that we’ll go into. But
overall, think of executive functioning
as anything that enables the rest of
our. Trying to do what it needs to do.
The air traffic control system, they’re
managing the airport of our brain.
All right. So let’s talk a little bit
about the way that executive functioning
can be split into four
components. Some people like to think of
it as a constellation of different
cognitive processes that are involved
in managing our day-to-day cognitive
functioning. So those are working memory.
Inhibition. Set shifting
and fluency. Now some of those might
have meaning to you and some of them
might not, so. I’m
gonna explain them all to you now. So
working memory This might be something
that you already have a little bit of
familiarity with. Working memory is.
The memory process within our brains that
enables us to keep a piece of information
at the forefront of our brains while
we’re doing something else. A really good
example of this is when you need to
remember a phone number that’s on one
piece of paper and put it into your phone
by remembering it. So you’re looking at
one piece of paper, you’re thinking
048264 and then you’re repeating it to
yourself O48264048264. That’s your
working memory supporting. You
to transfer a piece of information while
you’re doing a task. So that’s that’s the
first part you’re working memory.
So it enables us to
temporarily and in a very short term
process, store and manipulate
bits of information in conscious
awareness. So the other parts of our
memory longer term and even short
term to a certain capacity are actually
subconscious. They’re sub awareness
levels, but the the
part of work of memory that is involved
in executive functioning is conscious
you’re consciously aware of. Trying to
remember something.
The next component is inhibition. Now
this is something that’s really related
to a lot of the disabilities that that I
work with a lot and that we see a lot
here at transform life. Now
inhibition is your ability
to. I guess it’s your ability to
hold back a
automatic or predominant
reaction that’s previously been learnt.
Thought that might be inappropriate in
a relevant in a specific
context, so for example.
You might have had a
really scary experience with a dog
in your childhood, so your pre learned
reaction is to flinch and
have fear anytime you hear a dog barking.
But. You go into a situation where
you hear a dog barking on the TV and
consciously, you know, oh, I don’t
actually have a reason to be afraid in
this moment because it’s actually just a
dog on the TV.
You being aware in that moment
of halting your pre
learned or automatic response to that
stimuli is your inhibition, executive
functioning, kicking in. It’s
it’s the kind of thing that when you have
an impulse to engage in a behaviour,
it’s the voice in your head that says
don’t do that. We decided not to do this
remember? So Anna, lots of people think
of this colloquially as.
Oh, what’s the word that I’m thinking of?
They think of it as self control.
Self control, discipline, that kind of
thing. And we
we see that that can be really tricky for
folks who have things like ADHD
or emotional dysregulation of some kind,
so. The next component
is called set shifting. Now this is
something that you may be haven’t heard
of as much in the kind of colloquial
literature.
Now set shifting is
it’s an ability that helps us to
modify the attention, the
behaviour that we’re exhibiting in
response to changing circumstances and
demands. So it’s the ability that allows
us to modulate our behaviour based on the
context in which it’s appropriate. So.
Somebody who might be struggling with
executive functioning could do something
like having overly
or unhelpfully rigid ideas of what
appropriate behaviour is, irrespective
of the context in which it’s being
required. So that’s that could
be a dysfunction of somebody’s set
shifting capacity within their executive
functioning. The next one is fluency.
Now fluency is something that
it’s, it’s quite specific and it
actually represents the ability to
produce, produce
information on demand at the pace at
which you want to. Get access
to it so. It’s the ability
to kind of maximise the
productionof verbal
or visual information over a specific
time period at the same
time as not repeating unhelpful.
Information during that time period, so.
An example of this might be when you’re
trying to brainstorm, for
example, every word that you can think of
that starts with the letter G in 20
seconds. So your fluency
skills are the skills that would
either give you a lot of information
during that time. You can think of all
these words that start with G without
repeating, or have far fewer.
So not so if you were to have
fluency, dysregulation. Sorry,
dysfunction in your executive
functioning. Would be unable to think of
as many words in that time that
somebody else who had a really high
fluency skills and their executive
functioning would be able to use
or would be able to come up with.
So I think this.
It’s interesting that the different
components can really
be. Could be impacted in
different ways and any.
Interact sorry in.
Any treatment, any intervention that
we’re trying to put in place for these
people really needs to be
individualised so.
I guess there’s, you know, there’s lots
of specific different tests that we can
try and those kinds of things, but
I think it’s important to to recognise
that.
The. Issues
that we have with these, um.
That we have with these often come
about, um, when there’s an issue
in the neural networks
that connect the different parts of the
brain that are providing these functions.
So it might be an issue with their
with their white matter or with the
myelination of their the axons, which
are what connect the different
neurons in the brain, so all the
different brain areas that are. Involved
in these sorts of functions need to be
connected in the right ways to enable us
to help function at the highest level,
And when there is a disruption to these
things, that’s when we get
a. Difference in the
functioning of any one of these four
areas.
So there’s the neural network that
provides this functioning. It works
primarily in the prefrontal cortex, as I
as I mentioned before, this front part of
the brain directly behind the eyes, but
it also. Connects to the basal
ganglia, the fact the thalamus which is
further back in the brain, and the
cerebellum which is right at the back of
the brain. So the disabilities that
can impact executive functioning
are big. One is ADHD. We see a lot of
research and.
Community feedback around the executive
functioning impact that ADHD can
have on someone’s autism, Down
syndrome, depression and anxiety, and
acquired brain injury. Can all
have different kinds of impacts on
somebody’s executive functioning.
So how do we know if somebody might
be struggling with some area of their
executive functioning? So there’s a few
signs and symptoms of executive
functioning that might that might
raise some red flags for yourself if it’s
somebody you’re caring for or for the
allied health professionals who might be
working with that person. And a really
big one is trouble managing emotions. Now
I know that emotional regulation,
emotional dysregulation is something
that’s really. Are prominent at the
moment in the community talking about
what level of expectation should we have
for people to be able to manage their
emotions independently and from what age.
But one of the things that we really see
when somebody is struggling with their
emotional dysregulation is what we just
mentioned before is that inhibition
struggle. So that inhibition component of
their executive functioning means that
they’re unable to manage their emotions
or their emotional impulses.
So you might see some problems
with starting tasks, so initiating
tasks, organising your planning
tasks or completing tasks, any
of those. Areas could be a sign that
somebody is a specific component of
somebody’s executive functioning might be
being impacted. Trouble
listing or paying attention can be
something that can be involved in.
Executive dysfunction specifically
something to do with the working memory.
Is that person not able to process the
auditory information and hold back in
their functioning working memory? If so,
then that might be a sign of the
executive just function. Not paying
attention. That’s a really big one that
we see when somebody is really struggling
to inhibit their distracting.
Their internal or external stimuli,
that’s not allowing them to stay on task
and that’s very separate from being
motivated to stay on task. So somebody
can be very motivated to stay on task and
wanting to complete something, but if
they’ve got an impairment in here in the
inhibition, the inhibition
component of their executive functioning.
And then that’s going to be a flag that
we see, the inability to
stay on task. So inability to multitask
can be another sign that
there’s something going on, possibly with
somebody’s working memory or with their
fluency. Ability to
balance tasks as well. To be able to
change between tasks can be something
that we see. That’s an issue
that could be a sign of somebody with
executive dysfunction and socially
inappropriate behaviour. Or ability to
learn from the past.
So those two things
are something that can be a sign of your
of somebody struggling with their set
shifting and component of their executive
dysfunction. So set shifting, as we spoke
about, is the ability to modulate your
behaviours based on the context in
which you find yourself to get the best
outcomes. And if somebody is having
socially inappropriate behaviours or
they’re unable to reflect on social
feedback from previous contexts and
apply. That too.
Altering their behaviour for current
social contexts, then that may be
something that is a sign of a
person having issues with
their that may be a sign of a
person having issues with the set
shifting. Component of
their executive functioning. So
there’s a whole bunch of different
assessments that we can engage to
understand a little bit more about
somebody’s executive functioning now.
You don’t have to go and spend lots of
money to have access
to information about somebody’s
executive functioning. There are some
very high quality, no cost to
consumer tools online that you can access
that will give you some more insights
into what areas of executive functioning
somebody might be struggling with so.
I think it’s important to remember that
we don’t have to go and spend a whole
bunch of money on, you know, expensive
psychological or occupational therapy
testing to understand that somebody is
struggling with their executive
functioning. If you have questions
about somebody’s executive functioning,
ask your allied health professional for
any resources that they might be able to
share with you. That can give you some
more insight into the specific domain or
component of executive functioning that
is impacting that person’s behaviour.
Like we said, if somebody might be
struggling with inappropriate social
behaviour, could that be a set shifting
issue and you know, we can find some
free resources on that. That being said,
there are of course lots of. Um.
There are lots of different types of
assessments and testing and those
kinds of things that your allied health
professionals can do for you. So
OT’s can do a wonderful different
array of functional testing
for somebody who we suspect may have
executive dysfunction. And they can do
great testing to understand OK, how
is how are the different domains of
executive functioning impacting different
functional capacities in somebody’s
life. And then
psychologists can do really good, really
detailed testing on specific cognitive
processing functionality within.
Within executive functioning, that can
really get into the nitty gritty of, OK,
which cognitive process is this person
having trouble with? That means they’re
not able to connect to particular
dots. That is causing them to
struggle in these ways. So because
there’s so many elements of executive
functioning, there are many, many
different types of testing that we could
do so. Any type of, you know, I’m not
going to suggest any one particular type
of testing because it would need to be
tailored to that person’s specific
area of functioning that they’re looking
to build on or the specific area of
deficit that we might be noticed. But
I’ve put a few on screen here for you.
You can see that there’s the So these
ones I think might be specific to
children. So the verbal fluency test,
the waste and the wire and those sorts of
things can all test different parts.
Yeah. Of executive functioning.
So let’s get on to the exciting stuff,
which is what can we do? You know, what
can we do if somebody we either
ourselves or somebody we care for is
struggling with some element of their
executive functioning, Or we suspect they
might be?As I said before,
the first thing that we’ve got to do is
to ascertain the area of functioning
that needs assistance. And then so that
starts with assessment. But often,
depending on that person’s level of
insight, they might be able to give you
some clues and feedback around
either experiences they’re having or not
having. You know, can do they have the
experience of being able to hold
something in their conscious short-term
memory while they’re working?
Do they have the experience of of? Not being
able to remember something even though
they want to do they have the experience
of not being able to. They
keep their cool when they would really
like to be able to or something like
that. So make sure that before you do
anything, you check in with that person
to the level that they’re able to
communicate with them in the way that
they best understand to get their
insights about. What their executive
functioning looks like after we’ve done
that, maybe we’ve been through some
some test batteries, we’ve talked to our
allied Health professional.
We then begin a skill building programme to
address the specific area of dysfunction
that we’ve noticed so. I always like
as as a clinician, I always find that if
we can get whoever we’re working with
that that person to get the
level of insight that’s possible for them
cognitively, developmentally, into their
own dysfunction. The more
that we can get them to understand the
better outcomes we’re going to have.
So and and that’s going to look different
for everybody depending on what
developmental stage they’re at. So if we
can have a discussion with somebody or
help them to understand, look, we’re
going to be doing some work to help you
with your executive functioning.
We’re going to be doing some work to help you
to remember things. You know, we’re going
to be helping you do some work so that
you can pay attention through a whole
episode of Bluey. How great is that going
to be? Do you want to do that? Helping
them to understand what the goal is
because. Executive functioning work is
really quite cognitive based and anything
that’s cognitive based is the skill
building is going to be based on the
interior of neuroplasticity. So
neuroplasticity is something that’s been
thrown around in the in
media and that kind of thing, but it’s
it’s fundamentally based on the idea of
the use it or lose it principle and that
is that our brains are really malleable.
Our brains respond to the way that we
use them and they both build up
and also do what’s called shearing
of neuronal. Almost
hardware. Based on how we use
them and there’s some amazing research
out there by doctor what’s his name
Doctor Norman Deutsch and he talks about
OK, the brain has this incredible ability
to build up capacity, to
build up new skills, to build physically,
build new areas of the brain to support
specific functions.
So any type of Intervention that we’re going to be
putting in place that builds executive
functioning skills is going to be based
on the underlying principle of
neuroplasticity. That is, the brain
is going to come to the party as
we are attempting to rebuild a
specific skill. So
that means that it can be, there can be a
lot of repetition, there can be a lot of
doing things that specifically that are
difficult for someone and it can be a lot
of hard concentration and work.
And for somebody with executive
functioning that can be really tricky. So
if we’ve got somebody. To
a point of understanding and motivation
so that it’s meaningful to them.
We’re more likely to be able to do the
kind of work that can actually get
changes in the executive functioning
outcome. Now, I know that all sounds a
little bit nebulous, but I’ve got some
examples of things that you might be able
to use as part of this process
here, so. Executive functioning is
one of the areas of disability that
actually can be really well supported
using assistive technologies
and there’s lots of mainstream assistive
technologies that can be so incredibly
helpful for specific areas of the
executive dysfunction, so.
Up here on the screen, I’ve got your Apple
Watch, your smartwatch. Um,
I am. I work with
somebody who has an acquired brain
injury, and I know that
working memory can be something that
impacts their day-to-day functioning. And
so I’ve This wasn’t even something
that I put in. It was something that they
figured out on their own, but they
figured out that working memory was
something that impacted them when they
were driving, So they used their.
Their smartwatch to give them a
little buzz so that they
know when an upcoming skill is
being required of them when they’re
driving. So that might be OK,
I know that.
I’m gonna lose. The
my working memory of where I’m going and
what I need to do. But my I all but
to counteract that, this person uses
their watch to buzz them, to remind them.
OK, right. I’ve got something that’s
coming up that I need to do. I need to
turn. I need to indicate I need to
whatever it might be. What an incredible
accommodation they figured out for
themselves. I just got a little
reminder icon up here on the screen.
As I say, it doesn’t have to be fancy,
but there’s lots of different reminder,
obviously apps and those kinds of things
that can be really helpful for somebody
who’s struggling with an area of
executive dysfunction. I’ve got
the on here. I’ve got the Livescribe
Smart Pen. Now this is something that I
prescribed for somebody that I’m working
with at the moment. Now this person has
some.
Working memory struggles that that mean
that during class, even in the middle of
being of receiving an instruction, they
can, they can forget what’s happening and
they can become quite disoriented and
that’s really distressing, obviously. So
the Livescribe smart pen.
It records the audio records and
also visually records what you’re
writing, so that if you do have the
experience of forgetting what’s going on
in the middle of receiving an
instruction, or in this person’s case, in
the middle of a class, they can just link
it to their headphones and the
pen will play back to them the audio
instruction that they’ve received. Which
as you can imagine, could be so helpful
in a classroom where you know you can’t
necessarily be.
Asking the teacher every
two seconds to repeat the instruction
that person has a. Have the
tool, has an accommodation, has an
assistive technology that allows their
executive functioning to be better
supported. OK, so those are just
some examples. There’s lots of them, but.
I think it it’s. It’s
something that really can be well
supported by assistive technologies in
combination with skill building
programmes that can enable that person
to increase their independence of their
executive functioning.
So I think I’ll stop it there. If there
are any questions, we can chat about
them. Otherwise we
can meet again next week.
