Cognitive, Executive, Emotional, and Behavioral Interventions for students. Designing interventions that work!

Presenter: Dr. Sarah Allen

View the webinar’s corresponding slides here       

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Designing interventions in a classroom can be tricky. A whole-child centered approach is needed to improve children’s functioning, build skills, and develop strategies to promote learning and independence. This lecture will review the essential systems for learning including cognitive, executive, emotional, and behavioral aspects of students’ functioning. Participants will also learn how to approach designing interventions as well as understand specific strategies that work in classrooms.

Sarah Levin Allen, PhD, CBIS is the Executive Director of Neuropsychology at Brain Behavior Bridge and an adjunct faculty member at Drexel University. Dr. Allen is also a consulting Neuropsychologist for Weisman Children’s Hospital. Dr. Allen consults for districts all over the state of New Jersey regarding brain based program designs for public and private schools.


2:09 This is Doctor Allen’s second webinar for us. 2:12 She previously presented on March 14th, 2018 on Learning Systems, which was a particularly interesting webinar on the brain and how it works. It’s available for free download on our website, and I would strongly recommend to you. 2:30 Doctor Ellen received her PHD in clinical psychology with a concentration in pediatric neuropsychology from Drexel University. 2:40 She is the Executive Director of Neuropsychology at Brain Behavior Bridge in Burlington County, New Jersey, an assistant process professor of psychology at the Philadelphia College of Osteopathic Medicine. 2:57 Doctor Allen specializes in the area of evidence based interventions for schools as well as school wide concussion management and recovery programming. 3:08 Her work focuses on translating medical and neuropsychological interventions for schools, specifically promoting and integrating brain based learning approaches into the classroom. 3:22 She has a primary interest and expertise in building executive functioning skills through interventions that combine neuropsychology with behavioral approaches. 3:33 As a member of the Child and Adolescent Committee of the Brain Injury Alliance of New Jersey as well as through her clinical work, she has worked closely with medical and school professionals to design and implement return to school programming for students with concussions as well as other brain injuries. 3:53 Doctor Allen, we’re so pleased to have you back again and now, without further introduction, I’m going to turn tonight’s presentation over to you. 4:02 Wow, Marty, thank you so much for that. You didn’t know you did all that, right? You know, That. That was very exciting, OK. So, thank you for mentioning also the previous webinar, for anyone joining us today that didn’t have a chance to see that. I’m going to briefly summarize some things that you’ll need to know for the remainder of this talk and the beginning. For those of you who have already seen that talk, I’m just going to refresh your memory a little bit, too. So, if there’s things that I’m going over in the beginning of the talk that you’d like to know more about, definitely, reference that earlier webinar. 4:37 But for today, I’m going to talk OK, my second. 4:42 We get this working. Here we go. I’m going to talk a little bit about cognitive, executive, emotional, and behavioral interventions for students. And my primary focus today is going to be on intervention, so designing interventions that work. 4:56 When we look at the goals for this talk, I really want to talk about a whole child centered approach. And when we use this, it’s used to improve children’s functioning, to build skills. Which is really an area that I’d like to highlight because we tend to forget about building skills in areas other than academics, and I’ll talk more about that. 5:16 We want to develop strategies to promote this learning of these skills, but also independence. So I’ll talk a lot about how do you shift from teaching a skill to then helping people generalize that skill. So we’re going to review essential systems for learning cognitive, executive, emotional, and behavioral aspects. I’ve broken them down into these four areas. 5:39 And then we’re going to learn how to approach designing interventions for these kids, specifically for strategies that will work in the classroom, and I will mention home strategies as well. 5:49 So before we do that, I want to give a little bit of background. So I’m going to talk a little bit about brain, structure, and function. For those who took a big gasped don’t worry, it’s one slide, Then we will start looking at brain systems, those ones that I talked about. And then I’m going to focus specifically on executive skills, because I’d really like to emphasize what that looks like in terms of teaching skills, and then improving skills in that area. 6:17 OK, so the first system, we’re going to talk about, is this executive system, actually missing a couple of slides. Here we go, OK, I think I have this data. So before we get to the executive, certain, excuse me, we’re gonna talk about the brain. And I want to mention a couple different parts of the brain. First, I want to talk about the hippocampus here. So generally speaking, when you talk about learning and memory, you’re talking about this area of the brain. The hippocampus, this area is really responsible for taking learning in. Once learning gets in, it helps to consolidate memory, but memory is actually stored in all different parts of your brain. So it helps to pull those into memories would be a nice way of explaining here. 6:58 Then you have the amygdala right here. The amygdala is the emotion center of your brain. This becomes very important when we talk about the emotion system, specifically, but it has a huge impact and learning. And if you look here, the amygdala is very highly tied with this hippocampus. And in the brain, it’s location, location, location. So when things are next to each other, they are going to talk to each other. And emotion, and you can see emotions, centers, and learning centers are very highly tide. I also want to mention a couple of other parts, the basal ganglia here. Basal ganglia is really responsible for root nice learning things like riding a bike or any kind of routines that you have, are generated, in that basal ganglia. 7:39 Then, you have the thalamus here, which is really a sensory processing relay station, gives and takes information from lots of parts of the brain as well. Then, you have some basics here, your cerebellum, which is co-ordination of balance, of movement, and also some cognitive functions. Your brain stem is basic, heart rate and breathing. 8:00 So within these I’ve mentioned a lot of parts of the brain that are sub cortical parts of the brain. You have some critical parts of the brain. And then you have this life’s pink layer here that’s critical parts of the brain. Those are the outer layers of the brain. The outer layers of the brain are really more putting things together. And what we call thinking happens in these areas. The sub critical parts are more of your basic skills needed for survival. So we need to learn and remember things like, this snake that bit me is bad, because that’s beneficial to my survival. So that’s deep inside the brain, but remembering how to be able to inhibit that feeling. So you can hold the snake, and take a picture, is more of a frontal lobe activity. I say that because we just got back from Mexico with my family, where we did that. So we have a lot of inhibition of emotional responding in order to do that. 8:53 So we’ll talk a lot about this pre-frontal area of the brain, which is an executive system, as well. So those are your basic brain parts, one slide. I promised we’re all done with that now. I want to talk about the learning domains. We have several systems, and I’ve broken it down into these. So, we have this Academic Learning domain, which is really this cognitive, I’m calling it a cognitive system. This is a system responsible for gaining new information attaching old information to that and then showing what you know. So that’s your basic academic learning in a classroom, for example. Then you have a Control Domain, that’s your Executive Domain, Executive Domain, manages all other systems, so that highly supports your ability to gain new information, attach information, and show what you learn. 9:39 Then you have two additional support domains, your emotion on, your behavioral. Your emotional domain is going to set yourself up for learning. I’ll talk more about that in a little bit. And then your behavioral domain is going to either encourage or discourage learning. And I will delineate that as well. 10:00 So first, let’s talk about the executive system. This, again, is the control system. The brain, everything we do needs to be controlled when a child is first learning. We’re looking at their ability to control things. So what’s the first thing we look for? We look for their ability to grasp things. That’s a fine motor control. We look for their ability to walk, that’s control over motor movements. We look for their ability to be able to pick an item up and put it in their mouth and swallow, also a motor movement, and then we learn. We look at things like babbling and speaking control over their language. And then, as they start to get older, we start looking for more cognitive skills, understanding and controlling their responses back to you, controlling their behaviors, that’s all executive. So that’s the front of the brain right here. This part of the brain develops all the way up through your early twenties. So it’s a very essential part of the brain, and it’s learning constantly. 10:56 So skills in this area include things like organizing and planning, being flexible, problem solving, working memory, or holding things in your mind. Eventually metacognition, which would be thinking about your thinking. So understanding how you think in order to be able to change that thinking. 11:17 But then it also has control over these other systems I talked about, your emotional system, so your frontal lobe, your executive systems responsible for controlling that emotion and controlling that behavior. 11:31 OK, so let’s look at the Emotional System here. Emotional System is heavily tied to learning. It’s got some really cool aspects. There are two main roles. The first is that any heightened emotion is going to increase your learning. If you’re really scared, you will remember that. if you’re really happy and really excited, you will also remember that time, as well. So that heightened emotion creates this, what I call, a salient factor for learning it. It’s the strength in your emotion tells you what to remember and what you can forget. 12:05 Then it has the second aspect of emotional stability. 12:08 That is, that basic emotional stability creates an openness for learning instability, things like depression, anxious states, anxiety, responses, those create issues for learning, things that aren’t related to that emotion. So if we have a child who is very socially anxious and anxious about people in the, in the classroom, it makes it very difficult for them to learn math while they are unstable, emotionally there. 12:39 That being said, the same thing goes for a kid who is experiencing depression, When experiencing depression, everything is a bit depressed, and the learning ability, thinking, and being able to organize thoughts is going to be much more difficult. This holds true also for kids with highly stressed environments, that stress around them creates actual reduction in their ability to learn. And remember, we actually see reduction in the cells in the hippocampus, that learning and memory center in kids growing up in highly stressful environments. And that can also go for stress in a classroom, as well. 13:22 I’m sorry, OK, so let’s talk about this behavior system. The behavior system, again, has the supportive role, but it has a very strongly supportive role. So it acts in two ways. one would be a reinforcement or reward, would make somebody continue a behavior. And then you also have a punishment aspect which would make somebody stop behavior. 13:49 So it can either encourage learning or discourage learning in certain ways. Rewards are going to again, increase a person’s desire to do that behavior again and so it will make something happen over and over again. If you add a punishment like somebody crosses a child process, the street and you spank there, but they’re going to remember that punishment is going to keep them from crossing the street. Again, the only problem with this is they still don’t know how to cross the street. And that’s going to be the focus of our talk today. We actually have to teach them how to cross the street, as well as teaching them not to do it in that particular way. 14:27 What I’m showing you here is there’s actually a reward pathway in the brain. And there is a chemical in the brain that we use to learn called dopamine. And we actually get increases in this reward pathway, increases in dopamine, In this reward pathway, when we, when we get rewarded, or when we feel really good about doing something. And so this provides not just, it doesn’t just feel good. You actually get extra brain chemicals here. And when we get extra dopamine in the frontal lobe of the brain, that gives us extra power to do other things. And I’m gonna talk more about that as we go along. 15:04 OK, so all of that being said, what makes learning happen? And what makes learning happen is the connections between all these systems when your cognitive, executive, emotional, and behavioral systems work together to be able to produce that learning response we asked for in a classroom. 15:23 So the executive system in the frontal lobes controls all those other systems. The emotional system enhances learning by creating this salient factor, this kind of measurement, of, yes, remember this, or don’t, you don’t need to remember this as much. Then your behavioral system contributes to learning through these reinforcement and punishment systems, but the key is that all systems have to be stable, efficient, and effective in order to learn. So they must see learning, stable effect, sable efficient, and effective. 15:55 So what does this system stability look like? Again, that caught going back to our systems, your cognitive system has to gain that academic information, attach old information. Show what you know. Your executive system has to control that looks like. Be able to organize, plan, problem, solve, manage emotions, and manage behavior as well. 16:18 The problem here is that that executive system only has so much power. So it has this huge responsibility of control across domains, but it only has so much power. 16:28 When you get into the emotional system, emotional systems responsible for that basic stability were also responsible for the salient factor. But when it produces emotion, it can also drain that executive power. 16:43 Anything drains executive power, bi strong, emotional responses, need to be controlled. And so when they get controlled, you run into an issue where your executive systems controlling your emotion, and it’s not then able to help your cognitive system. So we need to have a balance of those. And then your behavioral systems, supporting all of this by telling you what you want to do and what you don’t want to do via rewards and punishment. 17:08 And then also using that emotion to enhance learning in the ways I described with that reward system. 17:19 OK, so let’s talk a little bit about layering now, Tourettes, on top of system stability and environment. 17:27 So when it comes to Tourette’s, or other Disinhibition or just executive syndromes, it adds another layer of complication to what’s already a complicated system, as I talked about. And basically a taxes, the brain a little bit more. So in Tourette’s, you have these uncontrolled movements. Again, it’s all about control. So it’s requiring executive control to help to manage these behaviors or vocalizations or thoughts that you see in some of these behavior as some of these diagnosis like texts and OCD. Even with ADHD as well, trying to control behavior is a frontal lobe activity and executive low, that activity. So already, kids with issues in any of these areas are taxing their frontal lobes to begin with this, so they’re already working on unlimited power. 18:16 When you add in the complications of these diagnosis with the other systems, because you’re running on lower power, things can tip you over a lot easier. So we need to also look for environmental triggers that are going to aid instability, and not take away from that stability. So for a kid with Tourette’s, for example, in a classroom that is a stressful environment. Maybe the teacher is particularly stressed, and so the classroom feels a little overwhelming. That is going to make it much more difficult. If there’s increased anxiety, that increased anxiety made much more difficult to learn in the classroom. So we really need to look at all these other systems a little bit more deeply in order to help kids with any of these conditions. 19:10 So, that being said, Let’s move into how you can help. And I think that’s where I am. Yes. So, I want to talk about design. And all of that being said, I want to talk about designing interventions that work. So, the first thing we have to look at is the system stability, and then we have to start moving into designing interventions. So, let’s take a look at this. 19:30 Remember, this is our system stability. So, we need to make sure all of these things are intact. 19:38 And when it comes to designing interventions, we can ask ourselves a series of questions. 19:43 So the first thing is, what systems are impacted, and are they stable? So we go through our cognitive, or executive, or emotional and our behavioral system and make sure their stability across. Oftentimes, by the time I see kids, there’s instability in multiple systems, and we need to take We can’t ignore one. So, if we’re working on just the cognitive system, let’s say kids are having trouble with the academic portion of learning. There’s often an emotional component that we need to look at as well. Or, if we’re looking at executive skills, there tends to be an emotional or behavioral component as well. So we can’t ignore one of the systems. 20:25 We want to also look at that environment. I mentioned a couple of different environmental issues. And that’s what I’m talk a ton about. Talk about the Matan today. But we do want to look at the environment to make sure we can be as helpful. It is as conducive to stability as possible. 20:41 Then we want to know what system is deficient and what prerequisite skills does it take to make the system stable. And that’s what we’re really going to target today. 20:51 Then, I want to make sure there’s a balance of compensation and remediation, and let’s talk about what those two words mean to support these skills. 20:58 And then we’ll talk about identifying goals and how to track and monitor progress. 21:09 So, I mentioned our system stability. This is always where we start. So every time we go to designing interventions, we want to look at these basic system for this whole child centered approach. 21:23 Then we’re going to take a look at these prerequisite skills, so we want to target system deficits, as well as the prerequisite skills that that’s observe them. So most of these skills can be broken down into a series of prerequisite skills, and I’m going to start with something like reading, because it’s an academic skills. Something we’re very used to thinking about in this way. 21:44 So if we just look in our cognitive example of reading, one prerequisite in this area is phonological processing. You also have word reading fluency, accuracy. There’s lots of other prerequisite skills, but we can take a look at all of them, and target them individually. 22:04 Under the executive example, we can look at classroom learning overall and think of what goes into classroom learning, absorbing content in the classroom. one of the prerequisite skills here would be organization in order to access that learning. So if you don’t think about things in an organized fashion, you’re going to have more difficulty absorbing content. For example, some of you may be saying, OK, there are four systems, system, 1, 2, 3, and four. And every time I go through them, you think about that, them, in those that organized manner that’s going to allow you to absorb the content a lot more than someone who hasn’t yet realized that there are four systems that I’m talking about. So you can take a look at just that. Simple example shows you how organizing content as you are learning, it is very important. 22:54 When we look at an emotional example, Anxiety management is one that we could use here. And when it comes to anxiety management, there’s a number of prerequisite skills identifying emotion, looking at the connections between thoughts, feelings, and behaviors, identifying a strategy, a calm down strategy that works, and then becoming proficient in that calm down strategy. And I’m gonna go into that a lot more in a little bit. But these are all, again, little skills that go into that big skill of managing anxiety. 23:24 And if we just use attention under our behavioral example, there’s a number of things that we neglect to realize sometimes goes into paying attention. Knowing what attending is. Our young kids especially, will come home and say, oh, I got yelled at for for not paying attention. Well, were you, I guess not? 23:42 And they say I guess not not to be rude. But because they really have no idea, they just know they got yelled at, so they must have done a bad job, but they may not even understand what that means or know what it feels like to pay attention and when, what that feels like when they are, when they’re not. 23:59 And then we can also talk about being reinforced for paying attention, So actually learning to pay attention, then these things, kinda these systems blend together. And I’m going to show you under each one kind of how we can do that, but I can just give you an example from my own children here for reading, For example. As kids get older, you start to see that the emotional system plays a larger role. The executive system can play a larger role. The behavioral system can play a larger role. You often need to kind of start by reinforcing kids for reading until they become proficient enough to want to read on their own with, with my kids. For example, one of my children had some trouble learning to read. And in the beginning, it wasn’t just trouble learning to read, but it was also an emotional issue, as well. So she would get nervous about reading, and that would just limit her ability to, to read. So first, we had to target her prerequisite skills, which she was lacking her phonics and rules for reading. 25:03 And we were able to, to do that while also teaching her some additional sight words, so that she could feel good about reading, and then reading some same things over and over again, So she could feel like she could read some books. So we’re boosting that emotional system as we’re boosting her academic system, as well. 25:24 And then, in addition, we did some compensation scale. So I’m going to talk about that as we go along here. 25:30 So, next is, OK, we how do we teach these prerequisite skills? We’re going to use these strategies of compensation and remediation. So, compensation is accommodating are going around the problem. This can be environmental, too. So we can move a child to the front of the classroom. That’s a compensation. That doesn’t change anything about their skill base. It just makes it easier for them to absorb materials. So that’s going around the problem. These can still be just as effective. They’re just a different method. Remediation would be actually teaching that skill and making that better in a child’s brain. 26:08 So when it comes to compensation verse remediation, I’m going to talk a lot about the balance of the two of these. So, how do you make that decision about whether to remediate or compensate for these system deficits. And we, we look at this kind of a chart to take a look at this. So when it comes to the level of deficit, this is a scale from mild to severe. And on this axis, it’s younger to older. So, as kids get older, and their level of deficit is still more severe, you’re going to use more of a compensation strategy. When kids are younger and or the deficit is more mild, you’re going to use remediation strategies. That being said, as kids are right here, we’re using combinations of remediation and compensation. And as we go through the talk today, I’m going to show you exactly how to do that. 27:04 I’m sorry, my Thank you for bearing with me on my slide presentation here. 27:09 So let’s start with the cognitive system of reading Reading, again, a great way of showing this. So the first thing we’re going to do is say OK, are all other system stable? We have a good executive system, emotional system and behavioral system in place, if we have all of those, then we’re going to start breaking down these prerequisite skills needed. 27:27 Understanding phonics, tracking, scanning, sustaining that mental effort. And then you get into a number of other executive skills for reading. 27:39 So how could how do we do this? Let’s start with remediation. We can do. We can make some of these things better, we can do a phonics program, like Wilson or Foundations for. for reading. We could have occupational therapy or vision therapy for tracking. We could use some other, if it’s attention and it’s starting to go in the behavioral domain. We can look at the motivator, self monitoring systems and I’m gonna talk a lot more about those when I get to the behavior. 28:03 Our domain, if it’s an abstract thinking issue, we can actually practice using prediction questions and work through strategies on that. And if it’s a fluency issue, we can just do drills and daily practice. 28:17 Now, we also want to look at some compensation strategies. So, when it comes to compensation for reading, for reading accuracy, for example, we might read the material to the student. 28:27 That way, we know that they understand it. You use a text to speech program. If there’s tracking scanning issues, we could use reading windows, make things larger, put less on a page, Another compensation strategy, shorter lessons, movement breaks, and so forth. We can give some extra time if it’s a fluency issues speed issue. So, all of these things would be going around the problem. But the question then becomes, which ones do we use? 28:57 And what we really want to do is use a combination of strategies. So I’m gonna give you that example of my daughter again. We did a number of strategies. So the first thing we did is there was a lack of phonics instruction with her early years. 29:10 So we added that phonics instruction, that’s a remediation strategy, then we also compensated for it in other subjects. So when she was reading to learn, and not learning to read, it’s subjects like science, social studies, math. 29:27 Her teachers would read that to her, or, at least, give her The ability to come up, and ask to be read to. And that way, we knew that she wouldn’t be able to understand the material. And in that sense, as she was learning to read, now, that she’s in the next grade. She doesn’t need that compensation strategy anymore, because the remediation strategies were so effective. But if we didn’t happen, say, for her, at the younger ages, we would have now had not just a reading problem, but a math problem, and a science problem. And a social studies problem unlikely, and emotional problem, and a behavioral problem, as well. So that’s why we want to target all these other systems. 30:01 So it’s just one example of the reasoning for why we’re looking at all these other systems. So first, check all these systems. Then consider these prerequisite skills. Then, as I just explained in terms of designing interventions to target those sales skills while looking at compensation and remediation, and then we can track each skills they develop and scaffold off those skills. And I’ll talk more about that towards the end. 30:31 OK, so, when it comes to, now, looking at learning in general, we want to say, let’s say that the issue isn’t purely academic. We want to target the skills, so that kids can actually access their learning. So we want to look at these support skills to access learning. 30:49 So just like academic skills and the cognitive system, we actually need to teach executive skills to improve the ability to learn, just like we need to teach. Also, emotion and behavior, but I’m going to target just executive here for a minute. These executive skills underlie all academics learning, behavior, and emotion management. Remember, it’s the control for all the system. In general, the general rule of thumb we’re going to use is that when a goal is to acquire specific knowledge or skill, we’re going to compensate for these executive skills. When the goal is to improve the ability to learn or focus, We’re going to remediate those executive skills, so I’ll talk a little bit more about that. 31:32 So, let’s look at learning as a domain overall. And try to break these down into a prerequisite skills. So first thing is, you have the cognitive ability to actually ability to do this. This would be like an IQ. Can the child is the child able to absorb the content once we know the child able to learn the material? Now, we have a number of other systems to take a look at. Is their behavioral stability? Is their emotional stability towards the end? Those are two things we want to look at, but when we break down learning, there’s a huge chunk of information that is all executive in nature. 32:07 So, inhibition or control. So a child in a classroom needs to be able to control their thoughts and behavior. They can’t blurt out everything they want, right that second. They need to be able to hold it back and raise their hand, For example, just simple readiness skills. They need to be able to keep that thought in their mind. While a teacher is talking, In order to be able to ask that question later, they need to be able to problem solve. They need to be able to get started on their work on their own. They need to be able to organize their thoughts and plan through, and they need to be able to be flexible when things change. So all of these are within that executive system. 32:51 So let’s look back at that executive system. Just as a reminder reminder, it’s a control system. So all of those things I just mentioned are within this executive system. 33:03 So before we can talk about, when executive systems go wrong, we have to talk about what does normal executive functioning look like. So in preschool, this looks like simple errands and chores. They’ll need reminders, anyone who has a preschooler now suddenly reminders, they can straighten the room, however, with some help. And they can inhibit some behaviors to things like don’t hit, It’s hot, keep your hands to yourself. They should be able to do all of those things. Interestingly, to, when it comes to holding things back, between the ages of about 3 to 5, they start to have this kind of self speech. By grades two, through three, they start to turn that self speech into an internalized speech, so closer to the ages. Closer to your third, fourth and fifth grade, they start to internalize that speech. 33:57 So that’s actually an inhibition behavior. 34:00 So grades 2 through 3 can run errands, simple chores, homeworks, all about, 20 minutes, worth of length in length. They can get their papers back and forth to school, tell you when they have homework. They should be able to follow through with their homework, decide how they want to spend their money, follow rules, et cetera. 34:17 By sixth grade chores. Increase in length. They should be able to clean the room. They should babysit. Actually, sixth graders are probably your best babysitters because they’re the most attentive and interested. Organization systems they should be able to follow, they can follow complex schedules, I can’t tell you how many times I go into middle school, and a child knows there are days 1 through 6, and it’s a Tuesday, and it’s a, it’s a day six, and tomorrow, it’s a, it’s a Wednesday, and it’s a day one, And they know their schedule, and how it changed in a way that I can exactly grasp. They should be able to do that at this age, and they need, they should be able to follow rules and inhibit, rule breaking without having any cues. And then by the older ages 8 and 9, they should be able to effectively manage their work day to day, established, long term goals, plan, and things like that. 35:07 So that being said about normal executive skills, how do you know if you need to have executive skill instruction? How do you know things are going wrong? So the first thing is, they look different than other kids their age. So if you’re a parent of an old, of a one child, or it’s your older child and you’re not sure, I would recommend going on playdates with kids of the same age as your child asking to sit in the classroom. So you can see other kids, those ages, look at. There’s look at them at their sporting events, take a look. how different do they look from other camps? 35:40 Because what we’re looking for is, if our, is their behavior age appropriate, or not? If they’re not the same as their peers, that’s a sign that something is developing a little bit differently. 35:51 If kids are capable of the content, but they really can’t learn without help, that’s a sign that it could be an executive skill issue. 35:59 If they have trouble starting their assignments. But they do well when they’re monitored, and they’re queued throughout, that can also be executive skills. 36:07 If they do a lot of forgetting tasks and homework, they just don’t have a great sense of those things. Time can also be an issue. If they have trouble estimating time, how long a project is going to take the trouble problem solving, when things change. All these are some subtle signs that there could be some executive skill issues. Another way to figure this out would be to get an assessment by a neuropsychologist, which would look at executive skills as a domain and let you know whether that area is significantly different than their peers. 36:41 OK, so, now that we’ve seen, all of those are typical executive, and now we’ve kind of seen how executive system can go wrong. I wanna give you an example in this executive system of how we design an intervention. So, there’s a number of executive systems for the sake of time here, because this could be an entire day’s worth. I gave problem solving here. So first thing we’re going to do, again, look at the other systems. Is everything else stable? We have a good cognitive system, emotional system and behavioral system in place. 37:11 Once we have those things, we wanna look at prerequisite skills and start checking intervention. And then we’re going to balance our compensation and remediation strategies. So let’s look first that remediation here for problem solving. So this is we, if kids are having trouble with problem solving, we need to go through the steps of problem solving. This is just one example of those steps you make a pact to solve a problem. This was actually a dissertation at Drexel University years ago. It’s a lovely system, I still use, so the packed would be problem actions, consequences, and try it. The problem you state, what problem, what the problem is, and help frame the situation. Then the actions you list all possible ways to solve the problem, good and bad, Then you look at the consequences of those. Are they good or are they bad, and then try it, try one and if it doesn’t work, you try and others to make a pact to solve a problem. This is a remediation strategy. 38:10 When it comes to compensation, there’s a number of strategies that you could use here to providing rules for approaching problems. So, whenever I Teachers have little tricks that they use in the classroom, even ones like Class C class? Yes, yes. Those are all kinds of tricks to help kids learn some executive skills. Because I know that, and that means be quiet. That teaches me that when I say this, I’m quiet, so saying things in the same way Every time in that manner is very helpful. So providing rules for approaching problems, you say things in the same way, every time you make a pact to solve a problem. What do we do? We make a pact to solve a problem? I’m saying it the same way Every time. Is there a problem? What should we do? We make a pact to solve a problem that helps to provide those rules in the same way. 39:03 You can provide a list of class assignments or chores on the board. So you write the instructions for a task in the order of completion that helps kids go through problem solving steps. You can create a book for how to solve problems. So you can include steps for how to approach each thing. For example, fractions is a great one. You can break that down by making the denominators, the same, changing the enumerators, and just step by step. 39:27 And then another key one when you do a book like this would do, would be to do, to talk about what to do, when you don’t know what to do. 39:34 Because inevitably something will happen and you won’t know what to do. The best example I can give you is we’ve had kids where we have a problem solving strategy for coming home at a time management strategies. So the child supposed to get off the bus. Come in the house, get their snack, eat their snack for five minutes. Start their homework. Do their homework for 15 minutes. Put it away. Read a book. 39:58 The child gets off the bus. They go to the door, and the door is locked. 40:02 The whole system falls apart, because we don’t know what to do when we don’t know what to do. 40:07 So, that’s always a great strategy. What do you do when you don’t know what to do? Who do you ask, Who do you call were kids with problem solving issues? This is the big one. 40:15 You can give new information in smaller units to help with a problem solving skills. You can break longer tasks down into smaller units, as well, and then you can just help the child gets started, and then check periodically, and support them along the way. 40:29 But, so far, the way I’ve talked about these, they’re very separate. 40:33 So, how do you balance remediation and compensation? 40:37 And this goes across interventions. That was the first thing you want to do, is start with queuing, and then you feed back towards independence. So you’re queuing should be consistent across settings and caregivers. You start with heavy queuing. And then you transition to just a look or the starting a free, so for using the problem solving technique. I said, What do you do? you make a pact to solve a problem? What are the problems? What are the actions? What are the consequences? 41:03 Which one are we going to try? We work through those just using those cues. And eventually, I should say, What are we going to do? And the child to say, use a pack to solve a problem. Moving towards me, Just being able to look at them, and they’ll probably say, I know, use a path to solve a problem, and they’ll start doing it themselves. As soon as a kid rolls their eyes at me and repeats what I’ve said to them a million times, That shows me that they’re starting to build independence with that strategy. So, you want to teach children how to do these things, and how to how to become more independent with those. 41:36 In addition to that, you want to teach children how to start to generate these things on their own. So we mentioned all these compensation strategies, but you can flip them to be a little bit more of a remediation strategy by having the child generate rules for approaching problems, by having them list the class assignments or chores, or breaking down those assignments or checking in. The number one reason interventions fail grade to grade is because a teacher is highly accommodating or apparent even at home is a highly accommodating, and then they go to another setting or work with another person. And that person doesn’t accommodate in the same way and the child data loss. 42:14 But if you teach the child what you’re doing, that is helping them, and you teach them how to do that. 42:22 Now, you’ve given them some strong, independent skills that they can use to accommodate themselves. This, I’ve seen a lot in math. For example, if kids have problems with math, problem solving, and a teacher break, there was one teacher in particular who broke the entire page down into a grid, and did step 1, 2, 3, 4, 5, and six, and the child did beautifully in that class. But when the next math teacher didn’t use the grid, the child suddenly wasn’t, was half a year behind in math. And it was just because we didn’t talk to that student about what the teacher was doing. I’m going to read this paper. We’re going to start with step one, step two, step three, step four. 43:05 Here’s a blank piece of paper. What should you do? 43:08 What happens first? Oh, you read the paper, that’s great. After you read the paper, what do you do? And you have that child generate those strategies. Now, you’re, you’re balancing those compensation and remediation techniques and really helping your child be able to generalize these strategies. 43:25 So, let’s shift over to the emotion management system for a minute. So, again, first thing we’re going to do, look at the cognitive system. Executive system and behavioral system, make sure those are all stable. 43:37 Then we’re gonna look at prerequisite skills, and then we’re gonna balance. 43:42 So first, before we go into this too much, I want to talk about how emotion is generated. I don’t have a ton of time to spend on this, but it is a fight or flight reaction. Let’s just talk about anger, like anger Management for a second. In particular, so the brain is going to send messages to glands. And then you have all of these responses. Heartbeat, fast restoration, deepens. You get more oxygen, and pupils, dilate. 44:07 You get trembling, sometimes, body pressurizes, all of these kinds of fight or flight reaction. All of this is happening at one time. 44:16 When this system gets activated, whether it’s an anger reaction and anxiety reaction, if your reaction this is a lot of body systems happening. It’s actually a physiological response. So when kids bodies are hyped up this much, you really need to kind of ride out that system. 44:35 You can use some strategies for calming down, but it takes a really, it takes a good amount of time to be able to get down. This is why you can’t talk to kids when they’re angry because their bodies are so hyped. 44:46 You either need to teach them how to prevent the anger in the first place, or work on some strategies for getting them calm so that you can then talk to them. 44:56 That being said, there is a level of optimal stress. So, we do want to have kids, they’ll be a little stressed, because that creates this level of optimal performance right here. So, calmness, we kinda get calm stability, But when we want to see focus and learning and energy, we do want a little bit of stress. When kids are a little anxious about a test, they study, and they learn, and they want to perform, that’s a good thing. It’s when that becomes too much stress that you get fatigue, exhaustion, breakdown, burnout, and you have a problem. So we really want to maintain the, the, the middle level of stress. 45:38 OK, so how can we help our kids with this emotional system? So if we look at prerequisite skills and how to remediate them, we couldn’t do a social emotional skill development program, that would just be a general skill building program. We could teach strategies for identifying emotional triggers prior to an outburst isn’t a preventative approach. This is great because if we can prevent their bodies from getting hyped that much, then we stop the reaction and we can still be logical. 46:05 But as soon as the body goes up, we have to we have to comment down and that would be your other strategy. Would be teaching some calm down strategies. Free things like breathing, progressive, muscle, relaxation, changing the channel on thoughts is one of my favorite. So this strategy involves an incompatible emotional response. So with kids, if actually with anybody, if you find something very, very funny, you can’t find something funny and laugh and also have a strong anxiety reaction At the same time they’re incompatible emotional responses. So you can help kids by creating change the channel cards, where they put things on there that are really funny to them as cues of things to think about. And eventually, you can drop the cards and just use your thoughts to be able to shift and over there. And that helps to calm down, as well. 46:54 But, again, we have to calm down, before we can think, logically. 47:00 When it comes to compensation, we can do things with the environment. We can create a supportive school and classroom environment. When a child is already very upset, maybe they’re getting a little bit aggressive. We can either have that child leave the room so that we don’t provoke them any more with the other students or leave the child in the room. If you have the ability to do so and take the other students out, which is actually one of my favorite strategies, if you can use it. Because, once that, again, that physiological responses up, they’re likely to get themselves into more trouble because they can’t think logically. So, removing other potential provoke versus a good thing, and it gives them a way of calming down in a private environment as well. 47:41 You can provide short breaks when the emotion level rises too much. Or you can shift your approach. So, if a child doesn’t like an individualized approach and you’re talking working directly with them, you can shift your strategy to having more of a classroom wide approach. Or if the classroom wide approach is provoking for them, you can talk to the class about, you know, we’re going to break up into small groups. Now, I want you to talk with your partners about how we’re going to do this task. And that way, you shift the instruction strategies as a way for limiting that emotional trigger, reaction, and giving more time to be able to put strategies in place there. You can just reduce environmental triggers in general. If you know certain things are going to trigger kids, you can take them away, and that will be helpful. Provide time and space to reduce that physiological response. That’s like letting them leave the room or creating a quiet space in your room. 48:37 And also, you can reduce expectation when it’s appropriate. When a kid comes in and they’re already agitated and you know that they’re going to be triggered easily, you can shift into not doing that extra high level of work, but doing a level of work that you know that they’re capable of doing. 48:58 OK, so when it comes to balancing remediation and compensation strategies, I wanna go through what it would look like to help a child with their emotional reactions. The first would be to teach a child to identify their emotion and their emotional triggers. So they can kind of be a detective and start to collect data on what trends to trigger them. What happens before they get angry? This is the beginnings of a remediation. 49:22 At the same time, you can remove as many environmental triggers as possible. While a child is starting to learn to identify their emotions, you want them to be as successful as possible. So after they identify these triggers, and you’re starting to remove these things, now, kids can actually practice some skills. At first, you might say to them, Leave the room when they’re, when you feel this way so you don’t get too angry. And kids are very capable of starting to do that. And you should make them feel good about avoiding this outburst because that’s going to provide that extra brainpower and give them extra motivation to continue. Once the student can identify and reduce the outbursts, you’re going to teach them strategies for actually then reducing their emotional reactivity. That’s a remediation strategy. And then you want to make them feel good when they use those strategies. So over time, you want to slowly encourage them to stay in the room and have them exposed to these triggers, to allow them to practice these new skills. 50:19 And remember, this is a great time that when it comes to the skills using these change, the channel cards is a great time to great thing to use for these incompatible emotional responses. So that’s a great example of how you can balance these remediation and compensation strategies and overtime. You might reduce similar comp compensation strategies as your remediation strategies become more effective. 50:44 Um, I just wanted to add some tips for emotion management, especially. You really want to provide time and space to reduce that physiological response. 50:55 During these, leave the runtime, So when they’re leaving the room, either create, create a quiet space in the room. They can stay or quiet space outside of the classroom, in some way, or out even in the home, you can do this as well. So, you want to encourage a child to leave the space that they’re angry and go to a private location. In my home, it was the guestroom. My daughter will still stomp into the guestroom and shut the door and say, I just need a minute and calm herself down in that way. Because we provided that quiet space. You don’t want to go add a kid when they are physiologically arouse, like that Too. Many times, I’ve gone into a school where a kid is having trouble managing their emotion, and sitting, actually sitting in a chair, which would be amazing in the first place. And teachers will go towards them to talk to them. That’s just going to result in you getting kicked or hit, or something this child doesn’t want to do, because their body isn’t capable of answering you yet. You have to provide that’s quiet, calm space to reduce that physiological response. 51:52 You can test this by asking them logical questions. Like, you know, hey, what period do you have this or any question, you know, is it do you think it’s going to rain today anything that distracts them enough but that you can get a response from them. If they answer you calmly, that’s a sign that they’re ready. If they start yelling at you, it’s a sign that they’re not ready. 52:16 You want to reduce those expectations when appropriate, it’s OK for a child who’s working on emotion management. If you don’t give them the highest level of math that day, If you decide that the skill they need to work on is emotion management, and you focused on that, and less on the academics, that’s going to take them further, that’s OK. 52:36 Use the same skills, or same cues. That’s always very important. 52:40 And practice when the emotions reduced, so that they can apply it when their emotions increased. You might also want to use cue cards to avoid the extra stimulation. So if you want to queue them or remind them to use a strategy, sometimes the extra verbal stimulation will trigger. So you want to find a way to kindly and supportive lead cue them. 53:02 OK, and then I’m going to talk a little bit about this attention system again. First, we’re going to make sure all the other systems are stable work. And then we’re going to look at prerequisite skills, and the balance of compensation and remediation strategies. So, first remediation strategy is one of my favorite, is self monitoring strategy called the motivator. We want to use self monitoring strategies for executive or surfer behavior, and executive and emotional systems in general, because we want kids to be aware of what they’re doing, if they’re aware of what they’re doing. And they can then make that change. The motivators are buzzing watch. That you can set to buzz every at Howard Length of time, two, minutes, five minutes, whatever you pick, and then a child’s can mark, whether they’re paying attention or not. I’m going to talk in a second about how to use that. 53:49 Here, you can also practice short time, sustained attention tasks, so kids really get a sense of what it’s like to pay attention for five minutes. You can teach learning check, so teach kids how to stop at portions of their assignments and check in to make sure they understand what they’re learning. 54:08 And then we can provide specific contingent positive reinforcement, which I’ll talk about in a second, as well. 54:16 We’re compensating. We just going around the problem We’re building and breaks, Were reminding students that external reminder where were, you could use a 15 minute rule for an assignment. So this child has to hold the assignment for 15 minutes. They can’t turn it in until then to encourage them to recheck their work. Engaging instruction is just automatically a good strategy for compensation retention. If they’re engaged in what you’re doing, they’re going to be less likely to not pay attention. 54:46 Make sure things are removed from the desk. All if that’s compensation or asking the child to get up And run an errand in or out of the classroom is also a compensation strategy. 54:56 So how do we balance these? 54:58 First, we could use a behavioral reinforcement system and that’s going to jumpstart our programs, Behavior, systems, Jumpstart programs. They don’t maintain systems very well. So you want to give them the the excitement, enthusiasm, motivation to do this program. But then the fact that they’re paying attention should internalize. It should feel good that they’re able to understand the content and get A’s on their test and send their homework in. So at that point, you want to fade back your behavioral intervention, and replace it with that internal system. 55:32 And then you want to reinforce each of the prerequisite steps. So if we’re using the motivator, for example, we might have that motivator go off every five minutes and have the teacher and the student mark whether the child was paying attention. 55:47 So if we’re doing that first and you can do this with a motivator, you could do this just on a chart or a paper chart. But, first, you’re going to reinforce the child for correctly identifying when he is or isn’t paying attention. So, he doesn’t always have to be paying attention, but if he knows if he is or isn’t any matches their teacher, then that gets reinforced. So once that’s at about 90 to 95%, then you move to saying, OK, now you need to match the teacher. And you also have to have 80% in the attention side. 56:18 Once you have that, and you’re, so you’re matching and improving the skill, about 995%, now, we’re going to just reinforce for paying attention, while self monitoring, So the teachers removed from that, and you’re improving that independent skill building. So again, that helps you with that balance of remediating and compensating. 56:39 OK, so when we bring all of this together, there’s gotta be a balance of cognitive and academic learning with these how to’s, skills necessary to learn. These include that executive control as well as your emotional and behavioral systems support. Remember that executive system controls all the other learning system, but it’s taxed by your emotional and behavioral systems, which also support learning, and they have to be stable in order for a child to learn. And we wanna focus on the balance of these compensation and remediation strategies when teaching these skills, because we want to promote independence. So I promised to talk about identifying goals and tracking progress. 57:18 You can identify all of these skills that I mentioned, our goals, whether they’re in the executive, emotional, or behavioral domain. So I’d encourage you to think about them as bowls, treat them just like you would a reading goal. Identify them as a goal and then start to track that and start to collect data and track your progress. So, we can actually use the data here to ensure that we’re building these skills and work towards independent functioning. Here’s an example of one. strategy you could use. So here, you have attention as a focus. 57:51 You have organization. So you have a little behavioral, executive, little meta cognitive aspects. So we just listed the areas this child needed to work on. And then this is a self monitoring system with a staff. So these student will say, Yes, I did pay attention. Or Yes, I did maintain focus on my, my task, or no, I didn’t. 58:11 There’s other tricks you can use, these little dots, give this child three different tris. so if they get 3, 3 not paying attention, then they have to so-called, no. 58:23 Otherwise, even if only two or Mark, they can circle, yes, this would be early on with a kid who really has significant difficulty. 58:31 The other trick I’d like to tell you, is, this number of cues needed, because we’re not going to let a kid not focus on a task. 58:39 So what happens is your data tends to look like, the kid is doing really well. when really, it’s a lot of queuing by an adult. So, generally speaking, if this is a yes, but there’s 20 cues needed here, then that shows us the rate of independence or lack thereof. In that case. Over time, if the Q is goes down to two, or maybe to zero, then we know this child is actually learning something. So it’s a great way to keep data on the support that’s needed, and the independence in that in the skills that we tend to need to support in order for a child to do well. 59:13 Other tips for interventions would be to individualize your interventions. Ask students, their interests. Ask them what works best. They tend to be, if you listen with the right years, like if you’re looking for these systems, you’ll be able to hear from what they say, where the issue is. Ask them what their perception is of hard. You can look at their profiles for strengths and weakness, if they’ve had a good assessment. And then you want to follow these natural, normal routines and tendencies. For example, I use my phone for everything. If you were to give me a paper and pencil planner, it would not be an effective strategy for me because I would forget where the planner was. I wouldn’t know what, where, where to look for, what to put in it. 59:58 If you started having me keep my calendar and my phone, which is the way that I happen, to stay, keep organized, and share that calendar with people so that they can understand my organizational system. Now this intervention is effective. So that’s my natural, normal tendency. If I need to do another intervention like making the list for grocery shopping because for some reason I’m incapable of making a list that I will remember. I can do it on my phone, and then I’ll have it with me. If I used another strategy of writing it on a piece of paper, wouldn’t be as effective. So if you follow the natural, normal routines of your household, of the kid, end of the classroom, also, strategies that work within that classroom, you will be much more effective. 1:00:39 I’d also encourage you, in terms of effectiveness, to think strategies that generalize use natural queuing as much as possible. You don’t want to create any interventions that are directly applicable to the real-world environment. You want to think of a strategy that can be used in Target, and at home, as much as it can be used in school, and vice versa. 1:01:00 And then I really like pushing models to help the strategies. So, for speech therapists, to be able to help with working memory strategies, not just within their individualized sessions, but pushing into the classroom and making sure that these generalized into the, into the classroom a little bit more. 1:01:16 Then, that last tip I can really give, you would be promote independence by reducing these cues and track the reduction of cues, because that will show your effectiveness. Even if the child isn’t able to independently do these things, You can show that the child is starting to do these things, and maybe starting to promote starting to build these prerequisite skills, and maybe starting to become independent. And when you break things down into prerequisite skills, you really are then able to show progress a little bit better. If you just have emotion management as your goal, and you don’t put those smaller goals in there, it’ll take you a really long time to reach the emotion management goal. And you won’t be able to to demonstrate all of the wonderful for requisite skills you’ve built. 1:01:59 OK, um, I don’t know, do I have time to go into a note about how to apply this in schools Marti We’ve gone a little long, as long as people are still hanging on. I’m happy to give you another couple of minutes and then we can, maybe, we’ll cut back a little on the Q and A and put this stuff in, the in, the questions in the blog. 1:02:20 OK, so, I’ll go through this really quickly. Basically, some of you may be saying, how do we do this in schools, and I just want to apply this to our models that we have in schools. So, we have a response to intervention and response to intervention model we use for academics, we have a positive behavioral support system model, we use for behaviors, all of them are based on these triangles. 1:02:43 You would use primary, secondary, and tertiary responses. I’ve provided here, and you can look in your handouts, different ways to apply what I’ve talked about at the primary, secondary, and tertiary levels. So you can see how you can use all these different strategies, and a number of ways to help support your kids. So if you’re looking at a primary level overall, study skills curriculum into your classrooms in general, or at home, work on study skills, that will help with overall executive skill building. You can apply these across domains. You can actually capitalize on the fact that we have these jellies and SEOs, and teach PowerPoint as a method for organizing thoughts. So you can help kids start to organize and create goals that way. 1:03:31 Secondary level, you can have things like a bookend class. So kids meet the beginning and the end of the day in order to stay organized thought with tasks. That’s one of my favorite systems level to study classes, study, skills, classes a good one, A check in electives. And then there’s things like peer mediation that, Help with emotional lunch, bunch groups, clubs. All that kind of connect people to their environment, then, at a tertiary level, we’re talking about those individualized interventions that I just spoke about. 1:04:02 OK, I think I’m ready for those questions. I’m sorry for going, Oh, that was, wasn’t very much, not to worry. OK, I am going to thank you. That was chock full of information, and I have to say right upfront, I’m glad I’m not don’t have kids in school right now. 1:04:20 So, I can, you know, watch my kids struggle with their kids. So, I have a question about the slide where you were talking about psychological response. and the question is, how do you handle it when the psychological response is more self injurious such as scratching themselves or hitting? 1:04:44 OK, so when we’re talking about self injurious response, I’m gonna guess you’re talking about this in more of an autism population. I think, is what you’re referring to, term doesn’t say, but, Right. So, self injurious behavior? So, the strategies we chat we generally use would be more behavioral, but I love that you asked about this in an emotional context as well, because increased emotional reactivity, especially in kids who either may have trouble expressing themselves or who have trouble controlling their responses. So, if you’re talking about ticks, for example, that are are, are self injurious and need to, I’m just going to interject one thing I just the person who posted the question said, Yes, high functioning, Autism doesn’t act out, just hurts cells. 1:05:35 OK, thank you, that gives me some context so if you’re talking about Autism, you’re going to any emotional reactivity, especially in a, either a non-verbal child or, in this case, you said high functioning, so probably very verbal, but emotionally reactive, likely, trouble controlling the emotional aspects or the executive aspects of emotion. It’s going to increase those behaviors. So generally speaking, the approach for those things would be more behavioral shaping in nature and working on trying to shift those behaviors into being less self injurious and being something that can be done to show that emotion, another way to get that that out. But you can use a number of other strategies to reduce the emotional reactivity in the first place, which will reduce the likelihood of seeing some of those behavioral responses as well. So that’s kinda how we get into the balance of those systems. So how would you do that then reduce those emotional? 1:06:34 And so what I’ve seen with kids with high functioning autism, especially when they have these kinds of self injurious behaviors, is that it takes a significant amount of energy to control and regulate emotional responding. So first I would target positive methods for coping with emotional responses that don’t involve the self injury is aspects. So if we can work on understanding what an emotion is, how it feels in the body and what to do about it to get rid of it in a way that’s a little bit more positive. This would go back to your progressive muscle, relaxation breathing, Changing the channels, those kinds of strategies, identifying triggers, and removing yourself when those triggers happens so that you prevent that strong feeling. 1:07:22 Those things can help to in addition to the behavioral strategies you would use to reduce the presence of those self injurious behaviors, mm, OK, All right. Thank you. 1:07:35 Another question about preschooler, with a possible diagnosis of behavior dysregulation and the question is asking you if you could recommend research or resources to assist with this child. 1:07:53 Now, suppose this thing you want to know, think about and answer on the blog, we could do that as well, just to have some time to maybe pull something together. 1:08:03 Yeah, you know, for a, for a specific recommendations about places to go, I would say, tell me your location and offline. I can give you that information. But one of the things I want to mention with behavioral dysregulation in preschoolers is, one of the biggest things to take a look at and preschools, is that, there’s huge variability developmentally, when it comes to developing the ability to control behavior, and to inhibit. So, there’s always, I’d love to talk much more about that, and whoever this is you have. my e-mail on here, our phone number on here, to, feel free to contact me, because there really is a lot to discuss in terms of how dis regulated, what could potentially be at the root of those issues. And then what it once we know that. What methods there could be for assisting with those? 1:08:52 There’s a number of reasons kids become, yeah, OK, Well, I’m, I’m assuming that the person who posted the question is still online, and here’s your answer. If not, I will make sure they get that tomorrow in an e-mail, So, So I’ll take care of that, OK, so, you didn’t talk much about behaviors. And so where do behavioral outbursts fit into this whole picture? 1:09:20 The great question and in children, one of the things and a lot number of you mentioned different behaviors as you ask questions. But generally speaking, behaviors are often a sign that something isn’t right. 1:09:30 And this would be a little less so with autism population, although I can tell you with a high functioning autism population, you do see this a lot. So sometimes you see these behaviors because the child’s feeling anxious or depressed, or because they’re having trouble in their learning environment. So I’d really encourage everyone to follow the intervention system I proposed, asking yourself those questions about the other systems before just putting a reinforcement system in place. So, we tend to say, Oh, this child needs to pay attention. Let’s just give him five points every time he pays attention. But if a child doesn’t know how to pay attention or in the example we just talked about, the child is feeling a strong emotion And the only way they know to get rid of that emotion is to do a self injurious behavior. That doesn’t That doesn’t work very well. So, you want to see what the child needs to learn, and make sure you’re teaching that skill. Not just trying to reward them, for showing you a skill. 1:10:30 If you do it without teaching, you’re not going to be as successful behavioral systems. Are really an excellent jumpstart to learning programs, but they really, as I mentioned, before, we begin to lose their effectiveness in the long run. So, it’s important to start with a good behavior system. Then shift into more of an internal reinforcement, like I said before, If you’re if you’re reinforced for putting homework, and you should start to feel good about getting your homework, and then feed that back. The other thing I’d say about behaviors, is that a sudden change in behavior. You’re always looking for sudden changes. That’s generally a sign that, that something is going wrong and kids tend to speak with their behaviors, not as much with their words. No matter what is going on, and anxious kid can look aggressive, can ask, and get angry just as much as the depressed kid can. As much as a kid who’s having trouble struggling to learn. So, they often use that as a sign that something’s going wrong. 1:11:28 You know, it’s interesting, because you talked a lot in this presentation about things that kids have to learn and learn in, And so learning is I’m having trouble myself getting the words out here, but it’s they never, they never stop learning, I guess, and in some things, they seem to happen so naturally. 1:11:50 We think they just learn automatically, but they don’t, right? I love that you said learning because it’s all about building skills. 1:11:58 I mentioned the very first slide every time I look at my kids either as a mom, or if I look at kids in a classroom. I’m thinking about What could I teach them? What do they need to learn here? When a kid is throwing a tantrum on the floor, Do they need to learn about controlling their behavior, or expressing what they need in the appropriate way? If you all? If you start to look at kids and their needs in terms of what skills they need, or what do they need to learn, you’re always starting out in the right spot when it comes to developing intervention. 1:12:29 Hmm, hmm, well, thank you. Again, I’m glad I’m not raising kids right now. You spoke about stability when you were in the emotional system, Mary, you referenced stability, so could you explain a little bit more about how to recognize what is lacking, and how would a parent stabilize it? 1:12:54 What a great question. Um, yeah, I mean, I think a basis for this would be going back to a very good assessment. And, again, I would always, of course, recommended neuro psych assessment take a look across domains. 1:13:07 But in the absence of that, I would say, you really need to step back and take a look again, and say, OK, What was there a sudden change in behavior? When did that be? When did that behavior suddenly occur? Was it a different instructor? Was it a different format of instruction? Was there something, a stressor that happened in my child’s life that’s creating some additional emotional issues? Was there appear related issue that could create some of these emotional issue? Or, was the content and the academic, the little bit, academics, a little bit too high? Did my child have go from, maybe fourth or fifth grade, sixth grade, where the executive demands increased dramatically, and now, suddenly, we’re having some. 1:13:52 So I think you’re really looking for, sudden change in behavior, as well as, sure. Break. just breaking it down by those different systems, and going through each one, to take a look at where the strengths and weaknesses are there. 1:14:09 You know, it’s interesting that, when you’re a parent, and let’s say you’ve got three kids, and they’re all different ages, and you’ve got a kid with Tourette or some other issue. And it’s, it’s, how do you keep track of all that, and all of that learning that needs to happen, and all of that focus, that needs to happen? And, you know, it’s, it’s complicated. 1:14:33 And it gets very complicated. I think it starts with a really good team. I think getting a really good school team that’s well educated, that has all the information from your organization, as well as from the professionals, working with that student to really make sure the team understands the child is very important. 1:14:52 And then I think, you know, as parents, even of typically developing kids, we work all the time at just trying to keep our heads above water and track of all of these different things that we need to do. So, I think making sure, as a parent, you have really good support from other peers around you, to keep checking yourself, even as a professional. 1:15:16 I often, when it comes to my own children, I ask my colleagues because you have a heightened level of emotion, and you have all these systems going out of whack yourself when it relates to children. So I think you need to have really good support around you, Make sure your child has really good support around you, and just keep trying. Because if you’re, if you keep trying, you’re doing something right? 1:15:40 OK, I have another question about how to convince schools to agree to a neuro psychological testing evaluation because they would need to be on board so that they couldn’t agree to implement interventions that are recommended. 1:15:58 Yeah, that’s on … 1:16:02 Yes, and I actually, you know, I think one of the things I’ve been really excited about, the State of New Jersey is, I’ve had over 30 districts, probably more now, funded my services for neuropsychological. And my bowels tend to be a little bit more related to the school program than it does to the profile specifically. So, I’ll look at the profile, the child, but I always do observations, and I go into the school system, because it’s really important that your assessment apply directly to your school system itself. 1:16:31 But, generally speaking, the process for this is we, you have the right to request an independent evaluation in the state of New Jersey, though there’s a number of ways that you can request that. The first is, if it’s an initial evaluation, your school district will likely do three or so different avows. I’ve often have had districts fund my services at that point to say, OK, this is a more complex diagnoses. And there’s more complex issues happening with your child. We need an additional input from an outside professional on that. That’d be with a fabulous school district to, was really interested, and there’s a number of them in the state of New Jersey who are interested in really supporting their children. 1:17:11 If you get to the point where your evaluations are complete, but you feel you’re lacking information, so maybe they don’t qualify the student or they do qualify them, but you don’t think they have enough information to create a program, that’s when you can request that independent evaluation. You’re basically saying, I don’t agree with the evaluation results and I want another person and the schools are required to fund that independent evaluation at that point as well. So, using that right to an independent about is generally the way that you can have a neuro psych eval. That’ll go into your school system in the way that I described. You can also go through your medical insurance, your medical insurance neuropsychology. … can be excellent as well. They tend to not go into the school system is the only difference because once you step, once you do an observation school system, that’s generally not funded by your insurance, which falls under the medical domain. 1:18:01 So you kinda, while the system’s a little bit but using your right to an independent evaluation would be your number one method for getting for F or having schools help you with this problem, OK. Thank you. I’m going to, I know we’ve gone way over, so I figured one more question. So, this is the last question, and any that we haven’t haven’t hit on, we’ll be sure to post them to the blog. 1:18:27 So, this is a question about a child with behavioral and emotional difficulties, Also with selective mutism, OK, so I know you didn’t talk about that specifically, but but the question is, what’s the best way to connect and elicit co-operation from a child with selective mutism and behavioral and emotional difficulties? 1:18:51 This is a wonderful question. Again, goes back to the system stability issues. Generally speaking, selective mutism is a diagnosis based on significant anxiety. So, you really want to create an emotionally stable environment as much as possible, and connect with that student. I’m not sure if this question is related to classroom, or home. It sounded more classroom related to me. 1:19:14 So I would say really finding ways to relate to that child, make sure the they feel understood and they feel connected with because that’s going to create that stability, more stability in that emotional system where they’re already having some issues. Excuse me. The person with the question said this is a school related issue, OK? Great. Yeah. So I would create that warmth and the environment because we tend to ignore that component sometimes, but that’s a huge aspect of being able to reach a child. And I’m sure, if this, if you’re coming from a school, you understand, as a teacher, or as somebody involved in that school system, how important it is to really relate to today’s kids, You tend to not see this in evaluations, but you know this, I’m sure, as a, as somebody who relates to children, that you really need to have that really good rapport. And then once you, once you could do that, I would say make sure you have a really good sense of the child’s ability, and that can be very hard to kind of gage. But once you get to know a child, you can tend to kind of see when is this too much for them. 1:20:22 Cognitively, or when is it too much for them Emotionally, or behaviorally. You can also start to kind of identify their triggers, identify when their emotional levels are up, and in that case I would say once you know, their emotional levels are up. If you can naturally start to reduce the expectation while keeping them in that structure of school, you’re going to see less behavioral issues there too, because you’re not going to be as provoking. So, push when the child has a good, stable, emotional state, at that point. And reduce your expectation when the child, you can see their emotional system, or maybe there’s a little bit more out of whack and don’t be shy about doing that. You know, we think we have to push kids all the time, but that’s not necessarily true. 1:21:09 So try to get at your balance there of those two things and then you can start, once you have that system down, you can then start to target things to remediate for them. 1:21:20 Hmm, hmm, OK, thank you. 1:21:22 I’m going to wrap it up there on I’ll turn this back over to Kelly to close out and thank you. That was a really wonderful presentation, much appreciated. and Kelly, you can take it from here. 1:21:40 Thank you for joining us on our webinar for Cognitive, Executive, Emotional, and Behavioral Interventions for Students Designing Interventions, That Work. There is an exit survey, which we would like everyone attending to fill out. The webinar blog is open now and and available for the next seven days on the NJ CTAS website. And any additional questions that were not covered in tonight’s presentation will be posted there, and answered. That website is, WWW dot N J C T S dot org. Also, an archived recording of tonight’s webinar will be posted to the website. Our next presentation is Not Until January Turn, 23rd, 2019, Can’t Believe We’re Changing Into a New Year Soon. And it is on early identification and will be presented by doctor Brian to this ends tonight’s webinar. Thank you, doctor Allen, for your presentation. 1:22:40 And, thank you, everyone, for attending. Goodnight.


  1. Neil D says:

    Please explain how the emotional system compensation would work in a typical classroom. If the student were to leave the room, I assume it would be to go to the nurses office? What would the child expect to do there – I would not want it to feel like a punishment.

    • Dr. Allen says:

      Yes. The student can go to a nurse, counselor, or other location (depending on the school) in which the child can be supervised and safe. As students improve in their ability to monitor their emotional responses, this could even be as simple as going to the bathroom. Often, this intervention requires heavier supervision in the beginning, and then it can be faded to be a more independent activity. This would be ideal so that the child can generalize this skill and use it in a number of situations.

  2. Sara H says:

    Can you explain how test anxiety fits into the learning systems model you described?

    • Dr. Allen says:

      This goes back to our discussion about system stability. If the emotional system is unstable, like when a child is anxious about a test, a lot of executive brain power is used to work through that emotion. The front of the brain spends time working on reducing the feeling of anxiety. While it’s doing that, the executive system is unable to control other thoughts necessary for completing the test like systematically approaching a word problem, adding the right numbers, holding the concepts in mind, etc. Similarly, if a child is anxious in general, they aren’t as ready for learning for the same reasons, they don’t have as much power to think clearly. This is generally why we give students with anxiety extra time, it’s not because they need more time to think about the test, it’s because they need time to first reduce their emotional reaction, then they can start the test. The time is actually on the emotion management side.

  3. Linda S says:

    I’m confused about how reading and executive skills fit together. How can I tell if my child has trouble with reading comprehension or if it’s something else?

    • Dr. Allen says:

      Reading requires a number of executive skills in addition to basic reading skills like phonics. One must take an organized approach to understanding what they’re reading. For example, there are two characters, they live on a farm, they do some things for work and some things for fun. Thinking about what these characters might do next requires problem solving and the ability to remember what they just did. Holding things in mind as you are reading is a working memory skill. These are just some of the executive requirements to reading. There are a few ways to tell if your child has executive weaknesses as opposed to reading comprehension issues:
      (A) Does your child have trouble with longer texts, but does ok with shorter ones?
      (B) Is your child able to think abstractly and understand when you break down the material into smaller chunks?
      (C) Do they have lots of thoughts about the text, but they come out disorganized and out of order?
      Remember that working memory issues specifically, can also be a problem when learning to read. There are a number of reading rules that one must keep in mind when reading. What do you do if there’s an “e” at the end of a word, how do you tap out a word, what little marks go at the top of each part of a word. If a child has working memory issues, it may be harder for them to hold all of this in his or her head. You can make sure that the intervention is as simple as possible (i.e. not a lot of marks and rules), and add heavy sight word training. This will increase a child’s knowledge base of words while you’re teaching them to read. You can even use those words to write stories and read those stories (working on reading and writing). It will boost their emotional system to be able to read and provide some extra power and motivation for remediating their reading issues.

  4. Joan D says:

    Regarding calm down strategies – at what age would you expect a child to initiate their own calming if it has been modeled by the parents?

    • Dr. Allen says:

      You typically see children use calm down strategies appropriate to their developmental level. For example, even a two year old can be taught to “use their words” to get what they want instead of throwing a temper tantrum. Overtime, kids grow in their ability to control their emotions. By the age of 5 or 6, even those kids who have difficulty with this skill can learn to “take a breath” before getting upset. Some children will start putting themselves in “time-out” or using breathing strategies to calm down. The key really is modeling. You often hear yourself in your children. They will mimic the strategy you model for them. If you watch closely, they’ll begin using a small piece and then finally be able to use the entire strategy without cuing.

  5. Gerri T says:

    What does natural cueing mean and how do you do it?

    • Dr. Allen says:

      Natural cuing is using your words in real time to indicate what you’d like a child to do. For example, those children with limited language skills can be “naturally cued” to produce language in their environment. When they ask for something by pointing (e.g. a child points to a banana and says banana?), the teacher or parent can provide a natural cue by saying something like. ”Do you want the banana? Say I want the banana.” This can be done with problem solving as well. Teachers and parents can “talk out” their strategies first to model the thought process. Then they can cue a child to follow. For example, if I need to get my son Carter to wrestling, my daughter Juliana to swimming, and make dinner all at the same time, I might talk the problem aloud. “My problem is that I need to be in three places at once. I’m thinking about what I could do. Maybe I could ask another parent to drop off one of you. I could also make dinner before we leave. I thought about trying to drop both of you off, but I won’t have time. The first solution seems like it will work. I’ll try that!” When my child has a problem. I might then cue, “Can you tell me what the problem is…what actions could you take to solve the problem…which one do you think would work?” I can also practice problem solving in natural situations with my child. For example, you could play a game on the way home at night by asking your child what should be done and in what order (e.g. should we get in bed, take a bath, and then brush our teeth)? This game naturally works on children’s ability to sequence and solve problems because they get used to talking out how to do a task.

  6. Roger R says:

    I’m on this webinar on behalf of my 11 year old grandson with TS. You used a term I was not familiar with “Motivator”. Is that some technology we should buy or method of doing something? Please clarify.

    • Dr. Allen says:

      This is the watch to which I referred, however there are some other phone applications that you could use as well. The system is a self-monitoring program to help children become aware of what it feels like to pay attention. Self-monitoring programs are the key to success for behavioral interventions in children.