autism: the brain, thinking and behavior executive function

Autism: the Brain, Autism: the Brain, Thinking and Thinking and

BehaviorBehaviorExecutive Function Executive Function

Mary Jo Lang, Ph.D., Mary Jo Lang, Ph.D., A.B.P.N.A.B.P.N.

Beacon Day SchoolOrange, California

Mary Jo Lang, Ph.D., A.B.P.N.-Beacon Day School-Orange,

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Autism DefinedAutism Defined

AutismAutism is a is a brain development disorder that impairs social interaction and that impairs social interaction and communication, and causes restricted communication, and causes restricted and repetitive behavior, all starting and repetitive behavior, all starting before a child is three years old. This before a child is three years old. This set of signs distinguishes autism from set of signs distinguishes autism from milder milder autism spectrum disorders (ASD) such as (ASD) such as Asperger’s Syndrome. .


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Autism—According to the Autism—According to the NIHNIH

• Autism is characterized by three distinctive Autism is characterized by three distinctive behaviors. behaviors. – difficulties with social interactiondifficulties with social interaction– problems with verbal and nonverbal communicationproblems with verbal and nonverbal communication– repetitive behaviors or narrow, obsessive interests. repetitive behaviors or narrow, obsessive interests.

• These behaviors can range in impact from These behaviors can range in impact from

mild to disabling. Autism varies widely in its mild to disabling. Autism varies widely in its severity and symptoms and may go severity and symptoms and may go unrecognized, especially in mildly affected unrecognized, especially in mildly affected children or when more debilitating handicaps children or when more debilitating handicaps mask it. mask it.


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Systemic Approach to Systemic Approach to Understanding the BrainUnderstanding the Brain

In order to understand an individual In order to understand an individual with Autism,with Autism,

it is necessary to understand him or her it is necessary to understand him or her as anas an

individual from a individual from a systems approachsystems approach::

• How do mind and body function?How do mind and body function?• How does the individual fit into the community and How does the individual fit into the community and

society?society?


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Breaks in the SystemBreaks in the System• It is becoming clear that the normal trajectory of It is becoming clear that the normal trajectory of

neurodevelopment is altered in autism.neurodevelopment is altered in autism. Abnormalities in brain growth, neuronal patterning Abnormalities in brain growth, neuronal patterning and cortical connectivity are often seen. and cortical connectivity are often seen.

• Changes to the structure and function of synapses Changes to the structure and function of synapses and dendrites have also been strongly suggested in and dendrites have also been strongly suggested in the pathology of autism .the pathology of autism .

• Finally, environmental factors are likely to interact Finally, environmental factors are likely to interact with the underlying genetic profile, and foster the with the underlying genetic profile, and foster the clinical heterogeneity seen in autism spectrum clinical heterogeneity seen in autism spectrum disorders. disorders.

• *reference: *reference: Pardo CAPardo CA, , Eberhart CG, “The neurobiology of autism,” Brain Pathol. 2007 Oct;17 (4): Eberhart CG, “The neurobiology of autism,” Brain Pathol. 2007 Oct;17 (4): 434-47. 434-47. Department of Neurology, Johns Hopkins University School of Medicine Department of Neurology, Johns Hopkins University School of Medicine


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Course Objectives:Course Objectives:

Part IPart I• Understanding the Body, the Brain and the Environment Understanding the Body, the Brain and the Environment

as a Systemas a System• Understanding How the Brain WorksUnderstanding How the Brain Works• Identify Factors which Influence the Brain, Thinking and Identify Factors which Influence the Brain, Thinking and

Behavior (intro to framework)Behavior (intro to framework)

Part IIPart II• Explore Brain Behavior with Regard to Attention, Memory, Explore Brain Behavior with Regard to Attention, Memory,

Language, Visual-Spatial Functioning, Executive Function Language, Visual-Spatial Functioning, Executive Function and Emotional Functioning and Emotional Functioning

Part IIIPart III• Examine a Framework within which Individuals with Examine a Framework within which Individuals with

Autism can Maintain Maximum Independence and Quality Autism can Maintain Maximum Independence and Quality of Lifeof Life


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PART I—ObjectivesPART I—Objectives

• Understanding the Body, the Brain Understanding the Body, the Brain and the Environment as a and the Environment as a SystemSystem

• Understanding How the Brain WorksUnderstanding How the Brain Works

• Identifying Factors that Influence Identifying Factors that Influence the Brain, Thinking and Behavior the Brain, Thinking and Behavior (intro to framework)(intro to framework)


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Systems Systems TheoryTheory

A system is greater than the sum of A system is greater than the sum of its parts.its parts.


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Systems Theory—Systems Theory—Common Elements: Common Elements:

inputinput outputoutput throughput throughput (or process)(or process)

feedbackfeedback controlcontrol environmentenvironment goalgoal


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Systems Theory Systems Theory

• OpenOpen--capable of growth, --capable of growth, development & adaptation. development & adaptation. Interaction occurs within the Interaction occurs within the environment.environment.

• ClosedClosed--relationships among system --relationships among system components are set and inflexible; components are set and inflexible; no interaction with the environment no interaction with the environment


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Human Body Systems System LocationNervous System Brain and NervesSkeletal System Bones and SkullMuscular System Skeletal, Cardiac and Smooth MusclesEndocrine System Glands and HormonesCardiovascular System Heart and BloodLymphatic and Immune Systems Lymphocytes and MacrophagesRespiratory System Lungs and AirwaysDigestive System Mouth and Gastrointestinal TractUrinary System Kidneys and BladderReproductive System Male and Female OrgansIntegumenary System Hair, Skin and Nails


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The Nervous SystemThe Nervous System• The nervous The nervous

system is the most system is the most complex of all the complex of all the body’s systems. body’s systems.

• Together with the Together with the endocrine system endocrine system it controls it controls everything the everything the body does.body does.


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The Nervous SystemThe Nervous System

• The nervous system reaches almost every part of The nervous system reaches almost every part of the body, from muscles and sense organs to the the body, from muscles and sense organs to the insides of teeth and bones. insides of teeth and bones.

• The body has more than 80 major nerves, and The body has more than 80 major nerves, and each one can obtain more than a million neurons.each one can obtain more than a million neurons.


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The Nervous SystemThe Nervous SystemPeripheral Nervous System Divisions:Peripheral Nervous System Divisions:

• The Sensory DivisionThe Sensory Division gathers information from gathers information from sensors to update the CNS about events sensors to update the CNS about events occurring inside and outside the body. (Autistic occurring inside and outside the body. (Autistic children may have sensory integration issues, children may have sensory integration issues, such as hearing, vision, etc.)such as hearing, vision, etc.)

• The Somatic DivisionThe Somatic Division carries instructions to carries instructions to skeletal muscles, enabling the body to respond skeletal muscles, enabling the body to respond under conscious control to outside events. under conscious control to outside events. (Skeletal-motor issues, muscule/skeletal, (Skeletal-motor issues, muscule/skeletal, sensory-seeking, etc.)sensory-seeking, etc.)

• The Automatomic DivisionThe Automatomic Division delivers messages delivers messages to the body’s internal organs to control their to the body’s internal organs to control their activities. (Intestinal issue, incapricous, bed activities. (Intestinal issue, incapricous, bed wetting, etc.)wetting, etc.)


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The Nervous SystemThe Nervous System

The Spinal CordThe Spinal Cord

• How does information How does information

travel to and from the periphery travel to and from the periphery

and respond to cues from the and respond to cues from the

brain?brain?


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The Nervous System—The Nervous System—The BrainThe Brain

• Evidence firmly links Evidence firmly links autism with autism with abnormalities in the abnormalities in the brain stembrain stem, the , the cerebellumcerebellum,, the the medial temporal medial temporal lobelobe, and the , and the frontal frontal lobelobe. .

((Reference: Penn, HE; Clinical-Reference: Penn, HE; Clinical-Developmental Psychology Program, Developmental Psychology Program, York University, Toronto, Ontario; York University, Toronto, Ontario; “Neurobiological correlates of autism: “Neurobiological correlates of autism: a review of recent research,” Child a review of recent research,” Child Neuropsychol. 2006 Feb;12(1):57-79. )Neuropsychol. 2006 Feb;12(1):57-79. )


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Systems Theory—The Systems Theory—The SensesSenses

Sensory Systems—Sensory Systems—all are affected all are affected

by Autismby Autism

Taste Taste SmellSmellHearingHearingSightSightTouchTouch


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The Digestive SystemThe Digestive System

• The job of the The job of the digestive systemdigestive system is to is to turn food into fuel that the body can turn food into fuel that the body can use for energy, growth and repair.use for energy, growth and repair.

• The body processes carbohydrates, The body processes carbohydrates, fats and proteins into fuels, and fats and proteins into fuels, and expels any expels any

undigested waste undigested waste

materials. materials.


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Functions:Functions:IngestionIngestion

PropulsionPropulsion

Mechanical DigestionMechanical Digestion

Chemical DigestionChemical Digestion

AbsorptionAbsorption

EgestionEgestion


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• The The gastrointestinal tractgastrointestinal tract is a long is a long tube-like system called the tube-like system called the alimentary canal. alimentary canal.

• It is divided into It is divided into – The esophagus and stomachThe esophagus and stomach– The small and large intestinesThe small and large intestines


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• Accessory organs are attached to the Accessory organs are attached to the digestive tract:digestive tract:– Teeth, tongue and salivary glandsTeeth, tongue and salivary glands– LiverLiver– Gallbladder Gallbladder – PancreasPancreas

– Cells lining the canal last only three to Cells lining the canal last only three to four days—due to excessive use, and four days—due to excessive use, and constantly rebuild.constantly rebuild.


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• Food on the MoveFood on the Move– Muscles power the Digestive System, which Muscles power the Digestive System, which

pushes food through the system at varying pushes food through the system at varying speeds.speeds.

– Food is made up of Food is made up of nutrientsnutrients, most of with , most of with are complex molecules that the body does are complex molecules that the body does not absorb. These molecules must be broken not absorb. These molecules must be broken down into simpler chemicals by down into simpler chemicals by enzymesenzymes——which cut up molecules at specific points.which cut up molecules at specific points.


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The Digestive SystemThe Digestive System• Surveys published in the gastroenterology Surveys published in the gastroenterology

literature have stated that gastrointestinal literature have stated that gastrointestinal problems, such as chronic constipation or problems, such as chronic constipation or diarrhea, occur in 46% to 85% of children diarrhea, occur in 46% to 85% of children with ASD.with ASD.

• In a recent cross-sectional study that used structured interviews In a recent cross-sectional study that used structured interviews and matched control groups, a lifetime history of and matched control groups, a lifetime history of gastrointestinal symptoms (including abnormal stool pattern, gastrointestinal symptoms (including abnormal stool pattern, frequent constipation, frequent vomiting, and frequent frequent constipation, frequent vomiting, and frequent abdominal pain) was elicited in 70% of the children with ASDs, abdominal pain) was elicited in 70% of the children with ASDs, compared with 42% of the children with other developmental compared with 42% of the children with other developmental disabilities (disabilities (PP = .03) and 28% of the children without = .03) and 28% of the children without developmental disabilities (developmental disabilities (PP < .001). < .001).

• Reference: Reference: Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd the Council on Children With Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd the Council on Children With Disabilities, “Management of Children With Autism Spectrum Disorders,” PEDIATRICS Vol. 120 Disabilities, “Management of Children With Autism Spectrum Disorders,” PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1162-1182No. 5 November 2007, pp. 1162-1182


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The Digestive SystemThe Digestive SystemGluten-Free, Casein-Free Diets are advocated by Gluten-Free, Casein-Free Diets are advocated by

some practitioners. Their Theories are some practitioners. Their Theories are unproven, but are based on:unproven, but are based on:

• The human digestive system did not evolve on a The human digestive system did not evolve on a diet containing large quantities of wheat and dairy diet containing large quantities of wheat and dairy products. Guten (in wheat, rye, barley and possible products. Guten (in wheat, rye, barley and possible oats) and casein (dairy) can cause problems:oats) and casein (dairy) can cause problems:

– They are common food allergens.They are common food allergens.– Certain peptides can bind to opioid-receptors in the brain.Certain peptides can bind to opioid-receptors in the brain.

• Causing sleepiness, giddiness, inattention and aggression.Causing sleepiness, giddiness, inattention and aggression.

• Reference: Adams, James B., PhD, “summary of Biomedical Treatments for Autism,” ARI Publication 40; Reference: Adams, James B., PhD, “summary of Biomedical Treatments for Autism,” ARI Publication 40; April, 2007.April, 2007.


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The Immune SystemThe Immune System

The human body The human body defends itself from defends itself from disease and disease and infection with its infection with its Immune System.Immune System.

People with autism People with autism often suffer from often suffer from compromised compromised immune systems.immune systems.


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The Immune SystemThe Immune System

Antibodies (immunoglobulins) are found Antibodies (immunoglobulins) are found in blood, lymph and other tissue fluids.in blood, lymph and other tissue fluids.

• These Y-shaped molecules have unique These Y-shaped molecules have unique “arms” that are programmed to a specific “arms” that are programmed to a specific antigen carried by specific pathogens. antigen carried by specific pathogens.

• The molecules can target The molecules can target

harmful pathogens for destruction.harmful pathogens for destruction.


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Part II—ObjectivesPart II—Objectives

To Explore Brain Behavior with To Explore Brain Behavior with Respect to:Respect to:

•MemoryMemory•LanguageLanguage•Visual-Spatial Functioning Visual-Spatial Functioning •AttentionAttention•Executive Function, and Executive Function, and •Emotional Functioning Emotional Functioning


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Brain-Behavior Brain-Behavior RelationshipsRelationships

1.1. CognitionCognition2.2. Educational Educational

AchievementAchievement3.3. Adaptive Adaptive

BehaviorBehavior4.4. Participation, Participation,

Social RolesSocial Roles5.5. HealthHealth6.6. ContextContext

Executive Function Executive Function


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Executive SkillsExecutive Skills

• Skills that select and achieve goals or Skills that select and achieve goals or develop problem solutions. develop problem solutions. – PlanningPlanning– OrganizationOrganization– Time Management Time Management – Working MemoryWorking Memory

• The ability to hold information in mind while The ability to hold information in mind while performing complex tasks. performing complex tasks.

– MetacognitionMetacognition• Observing how you problem solve (bird’s-eye Observing how you problem solve (bird’s-eye

view)view)Mary Jo Lang, Ph.D., A.B.P.N.-

Beacon Day School-Orange, California

Executive SkillsExecutive Skills

• Skills that guide or modify behavior as Skills that guide or modify behavior as one moves along the path. one moves along the path. – Response InhibitionResponse Inhibition

• Think before you actThink before you act– Self-regulation of AffectSelf-regulation of Affect

• Managing emotionsManaging emotions– Task Initiation Task Initiation

• Begin a task without undue procrastinationBegin a task without undue procrastination– FlexibilityFlexibility

• Revise plans when obstacles ariseRevise plans when obstacles arise– Goal-directed Persistence Goal-directed Persistence

• Capacity or drive to follow through to the Capacity or drive to follow through to the completion of a goalcompletion of a goal


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Executive Function Executive Function

• Parallel between brain development Parallel between brain development and the child’s ability to think, act, and the child’s ability to think, act, and feel. and feel. – Important in understanding how Important in understanding how

executive skills develop. executive skills develop.

• Frontal brain systems make up the Frontal brain systems make up the neurological base for executive skills. neurological base for executive skills. – Prefrontal cortex contains the executive Prefrontal cortex contains the executive

skills. skills. Mary Jo Lang, Ph.D., A.B.P.N.-


Prefrontal Brain SystemsPrefrontal Brain Systems

• Play a preeminent role in the Play a preeminent role in the relationship between brain structure relationship between brain structure and executive function. and executive function.

• Among the last to fully develop in Among the last to fully develop in late adolescencelate adolescence

• Final, common pathway for Final, common pathway for managing information and behavior managing information and behavior from other brain regions. from other brain regions.


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Frontal Lobe FunctionsFrontal Lobe Functions

• As summarized by Hart and Jacobs (1993): As summarized by Hart and Jacobs (1993): – The frontal lobes decide what is worth The frontal lobes decide what is worth

attending to and what is worth doing.attending to and what is worth doing.– The frontal lobe provides continuity and The frontal lobe provides continuity and

coherence to behavior across time. coherence to behavior across time. – The frontal lobes modulate affective and The frontal lobes modulate affective and

interpersonal behaviors so that drives are interpersonal behaviors so that drives are satisfied within the constraints of the internal satisfied within the constraints of the internal and external environments. and external environments.

– The frontal lobes monitor, evaluate, and The frontal lobes monitor, evaluate, and adjust. (pp. 2, 3)adjust. (pp. 2, 3)


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Developmental Tasks Developmental Tasks Requiring Executive Requiring Executive

SkillsSkills• Preschool Age Preschool Age

– Run simple errands (e.g., “Get your shoes Run simple errands (e.g., “Get your shoes from the bedroom”). from the bedroom”).

– Tidy bedroom or playroom with assistance. Tidy bedroom or playroom with assistance. – Perform simple chores and self-help tasks Perform simple chores and self-help tasks

with reminders (e.g., clear dishes from with reminders (e.g., clear dishes from table, brush teeth, get dressed). table, brush teeth, get dressed).

– Inhibit behaviors: don’t touch a hot stove; Inhibit behaviors: don’t touch a hot stove; don’t run into the street; don’t grab a toy don’t run into the street; don’t grab a toy from another child; don’t hit, bite, push, from another child; don’t hit, bite, push, etc. etc.


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Developmental Tasks Developmental Tasks ContinuedContinued• Kindergarten-Grade 2Kindergarten-Grade 2

– Run errands (two to three step directions). Run errands (two to three step directions). – Tidy bedroom or playroomTidy bedroom or playroom– Perform simple chores, self-help tasks; may Perform simple chores, self-help tasks; may

need reminders (e.g., make bed). need reminders (e.g., make bed). – Bring papers to and from school. Bring papers to and from school. – Complete homework assignments (20-minute Complete homework assignments (20-minute

max. )max. )– Decide how to spend money (allowance). Decide how to spend money (allowance). – Inhibit behaviors: follow safety rules, don’t Inhibit behaviors: follow safety rules, don’t

swear, raise hand before speaking in class, swear, raise hand before speaking in class, keep hands to self. keep hands to self.


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Developmental Tasks Developmental Tasks ContinuedContinued

• Grades 3-5Grades 3-5– Run errands (may involve time delay or greater Run errands (may involve time delay or greater

distance, such as going to a nearby store).distance, such as going to a nearby store).– Tidy bedroom or playroom (may include vacuuming, Tidy bedroom or playroom (may include vacuuming,

dusting, etc.).dusting, etc.).– Perform chores that take 15-30 min. (e.g., clean up Perform chores that take 15-30 min. (e.g., clean up

after dinner, rake leaves). after dinner, rake leaves). – Bring books, papers, assignments to and from schoolBring books, papers, assignments to and from school– Keep track of belongings when away from home. Keep track of belongings when away from home. – Complete homework assignments (1 hour max. ). Complete homework assignments (1 hour max. ). – Plan simple school projects such as book reports. Plan simple school projects such as book reports. – Keep track of changing daily schedule. Keep track of changing daily schedule. – Save money for desired objects, plan how to earn Save money for desired objects, plan how to earn

money. money. – Inhibit/self-regulate: behave when teacher is out of Inhibit/self-regulate: behave when teacher is out of

the classroom; refrain from rude comments, temper the classroom; refrain from rude comments, temper tantrums, bad manners. tantrums, bad manners.


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• Grades 6-8Grades 6-8– Help out with chores around the home, including both Help out with chores around the home, including both

daily responsibilities and occasional tasks (e.g., emptying daily responsibilities and occasional tasks (e.g., emptying dishwasher, raking leaves, shoveling snow); tasks may dishwasher, raking leaves, shoveling snow); tasks may take 60-90 min. to complete. take 60-90 min. to complete.

– Baby-sit younger siblings or for pay. Baby-sit younger siblings or for pay. – Use system for organizing schoolwork, including Use system for organizing schoolwork, including

assignment book, notebooks, etc. assignment book, notebooks, etc. – Follow complex social schedule involving changing Follow complex social schedule involving changing

teachers and changing schedules. teachers and changing schedules. – Plan and carry out long-term projects, including tasks to Plan and carry out long-term projects, including tasks to

be accomplished and reasonable timeline to follow; may be accomplished and reasonable timeline to follow; may require planning multiple large projects simultaneously. require planning multiple large projects simultaneously.

– Plan time, including after school activities, homework, Plan time, including after school activities, homework, family responsibilities; estimate how long it takes to family responsibilities; estimate how long it takes to complete individual tasks and adjust schedule to fit. complete individual tasks and adjust schedule to fit.

– Inhibit rule breaking in the absence of visual authority. Inhibit rule breaking in the absence of visual authority. Mary Jo Lang, Ph.D., A.B.P.N.-



• High School High School – Manage schoolwork effectively on a day-to-day Manage schoolwork effectively on a day-to-day

basis, including completing and handling basis, including completing and handling assignments on time, studying for tests, creating assignments on time, studying for tests, creating and following timelines for long-term projects, and and following timelines for long-term projects, and making adjustments in response to feedback from making adjustments in response to feedback from teachers and others (e.g., grades on tests, papers). teachers and others (e.g., grades on tests, papers).

– Establish and refine a long-term goal and make Establish and refine a long-term goal and make plans for meeting that goal. plans for meeting that goal.

– Make good use of leisure time, including obtaining Make good use of leisure time, including obtaining employment or pursuing recreational activities employment or pursuing recreational activities during the summer. during the summer.

– Inhibit reckless and dangerous behaviors (e.g., use Inhibit reckless and dangerous behaviors (e.g., use of illegal substances, sexual acting out, shoplifting, of illegal substances, sexual acting out, shoplifting, or vandalism). or vandalism).


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Assessing Executive Assessing Executive SkillsSkills

• Assessing executive skills in the context of Assessing executive skills in the context of a formal evaluation is difficult. Some a formal evaluation is difficult. Some examples: examples: – Two critical executive skills are initiation and Two critical executive skills are initiation and

sustained attention. In standardized testing sustained attention. In standardized testing situations, the examiner cues the student to situations, the examiner cues the student to start and presents tasks that are necessarily start and presents tasks that are necessarily brief in nature, thereby reducing the demand brief in nature, thereby reducing the demand for sustained attention. for sustained attention.

– Standardized testing situations require the Standardized testing situations require the presence of an adult performing a monitoring presence of an adult performing a monitoring function. With the tester performing this role, function. With the tester performing this role, the student does not have to monitor his or her the student does not have to monitor his or her own performance to the same extent, a critical own performance to the same extent, a critical executive skill. executive skill.


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Assessing Executive Assessing Executive SkillsSkills

• Continued…Continued…– In the context of a highly structured, if not In the context of a highly structured, if not

ritualized, set of tasks, the need for planning ritualized, set of tasks, the need for planning and organization on the part of the student is and organization on the part of the student is reduced, if not in many cases eliminated. reduced, if not in many cases eliminated.

– Executive skills are most in demand in the face Executive skills are most in demand in the face of complex, open-ended tasks requiring of complex, open-ended tasks requiring problem solving and creative or unique problem solving and creative or unique solutions. Standardized tests are designed to solutions. Standardized tests are designed to be easily scored with a catalog of right and be easily scored with a catalog of right and wrong answers that are straightforward and wrong answers that are straightforward and invariant, again minimizing demands on invariant, again minimizing demands on executive skills. executive skills.


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Assessing Executive Assessing Executive Skills ContinuedSkills Continued

• Absence of evidence is not evidence Absence of evidence is not evidence of absence. of absence. A child’s strong A child’s strong performance on a clinic measure of performance on a clinic measure of executive function does not executive function does not necessarily mean that the same child necessarily mean that the same child applies good planning ability in the applies good planning ability in the context of daily performance at context of daily performance at home or at school. home or at school.


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Informal Assessment Informal Assessment MeasuresMeasures

• Case History/InterviewCase History/Interview– How does the child manage homework and other How does the child manage homework and other

chores and responsibilities at home? How organized chores and responsibilities at home? How organized is the child? is the child?

• Classroom ObservationsClassroom Observations– Sets the stage for a clear definition of the executive Sets the stage for a clear definition of the executive

skill as a specific behavior, points to the direction skill as a specific behavior, points to the direction for intervention, and provides the gold standard for for intervention, and provides the gold standard for evaluating effectiveness. evaluating effectiveness.

• Work SamplesWork Samples– Tests, writing assignments, and agenda pagesTests, writing assignments, and agenda pages

• Assess skills such as error monitoring, planning, and Assess skills such as error monitoring, planning, and organization and yields ideas for interventions such as cue organization and yields ideas for interventions such as cue questions and templates. questions and templates.


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Behavior Checklists Behavior Checklists

• Behavior Rating Inventory of Behavior Rating Inventory of Executive FunctionsExecutive Functions

• Brown ADD Scales- Adolescent Brown ADD Scales- Adolescent VersionVersion

• Comprehensive Behavior Rating Comprehensive Behavior Rating Scale for Children Scale for Children

• Child Behavior Checklist- Teacher Child Behavior Checklist- Teacher Report FormReport Form


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Formal Assessment Formal Assessment MeasuresMeasures

• NEPSYNEPSY• Porteus MazesPorteus Mazes• Matching Familiar Figures TestMatching Familiar Figures Test• Trailmaking TestsTrailmaking Tests• Wisconsin Card Sorting Test Wisconsin Card Sorting Test • Connors Continuous Performance Test-Connors Continuous Performance Test-

IIII• Delis-Kaplan Executive Function ScaleDelis-Kaplan Executive Function Scale• Cognitive Assessment System Cognitive Assessment System


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Behavioral Observations Behavioral Observations With Formal Assessment With Formal Assessment

MeasuresMeasures• Self-Regulation of Self-Regulation of AffectAffect

• Metacognition Metacognition • Goal-Directed Goal-Directed

PersistencePersistence• Flexibility Flexibility • Sustained Sustained

Attention Attention • Working MemoryWorking Memory

• Response Response InhibitionInhibition

• Planning/ Planning/ Prioritization Prioritization

• Time Time Management Management

• OrganizationOrganization• Task Initiation Task Initiation


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Steps in Executive Skill Steps in Executive Skill Intervention Planning Intervention Planning

• Step 1: Collect assessment Step 1: Collect assessment information from a variety of sources.information from a variety of sources.

• Step 2: Review data; list specific Step 2: Review data; list specific problem behaviors and connect them problem behaviors and connect them to the most appropriate executive to the most appropriate executive skill domain. skill domain.

• Step 3: Select one executive skill Step 3: Select one executive skill domain for initial intervention and domain for initial intervention and identify a specific behavioral goal. identify a specific behavioral goal.


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Steps Continued…Steps Continued…• Step 4: Design the intervention, incorporating one or Step 4: Design the intervention, incorporating one or

more of the following elements: more of the following elements: – Environmental supports or modifications that will be Environmental supports or modifications that will be

put in place to help support the development of the put in place to help support the development of the skill. skill.

– The specific skills the child will be taught and the The specific skills the child will be taught and the procedure used to teach them. procedure used to teach them.

– What incentives will be used to help motivate the child What incentives will be used to help motivate the child to use or practice the skills. to use or practice the skills.

• Step 5: evaluate intervention effectiveness by looking Step 5: evaluate intervention effectiveness by looking at each intervention component and answer the at each intervention component and answer the following questions:following questions:– Was the component put in place?Was the component put in place?– Was it effective?Was it effective?– Does it need to be continued?Does it need to be continued?– What is the plan for fading this component. What is the plan for fading this component.


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autism: the brain, thinking and behavior executive function

Documents

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californiamary jo lang

beacon day schoolorange

quality of lifemary

brain growth

brain pathol

neurobiology of autism

pathology of autism