EF Final Project

Executive function: Case study

By: Abigail Chong & Sim Scott

time for class

Start

2. Child Description

3. Day in the Life

4. Pre-Assessment

5. Diagnosis

1. Disclaimer

table of Contents

8. Goals & Strategies

6. Public School Assessment

10. References

7. Photos

9. Progress

Disclaimer

Here's a heads-up

Disclaimer

The individual described in this presentation is fictional but heavily based on Sim's friend K, who gave us permission to share all of the information he collected from interviewing her. This presentation would not be what it is without K's generous contributions. After completing the requirements listed in the rubric, we added some extra info to make a more comprehensive presentation.

Child Description

Who is this?

Child Description

• Phelony Bubonic Jones, aka Lonny Bonnie
• 16 years old
• 11th grade
• Health Sciences Academy at Plano East Senior High School, also in the DC program

• Previous therapy: public school speech therapy for gliding in kindergarten
• Current therapy: generalized anxiety disorder therapy since 9th grade
• Healthcare professionals: PCP and LPC
• Languages: English, ASL, Spanish (beginner)

Child Description

Strengths include:

• Planning & organizing
• Reading
• A "people person" (good interpersonal skills)

Weaknesses include:

• Social pragmatics (e.g., turn taking, staying on topic)
• Difficulty conversing when overstimulated
• Public speaking
• Low self-esteem

Day in the Life

What does a typical day look like?

Day in the Life

• Min 10 hours community service per semester
• DC Health, Composition, Pre-Cal, U.S. History
• Must maintain a minimum grade of 75 in DC classes
• First time without consistent school schedule, high autonomy

• Balance b/w socializing and homework during free time
• Disconnect b/w PESH admin and HSA complicates expected plans
• Hobbies: coooking, crafts, reading

Pre-Assessment

What has led up to *public school* assessment?

Pre-Assessment

• MD Assessment consisted of the following components:
• Patient/parent interview
• Questionnaires (intake and ADHD-specific)
• Standardized assessment

• LPC noticed potential signs of executive dysfunction
• She suspected these may result from ADHD
• The therapist did not formally refer to psychiatry, but recommended Lonny and her parents to seek evaluation

• MD assessed in early June

diagnosis

ADHD Presentation, EF Deficits, and Existing Tools & Strategies

Diagnosis - ADHD & Anxiety

• Every child with ADHD presents it differently. In general, we expect: -
• Having trouble paying attention

• Controlling impulsive behaviors (may act without thinking about what the result will be)

• Overly active
• Have trouble taking turns
• Squirm or fidget
• Daydream a lot
• Forget or lose things easily

ADHD & How it Affects EF Development

• Inhibit: Notices lack of inhibition compared to peers, impulsivity (e.g., blurts out comment, doing things you know you shouldn’t do, spending money on things they shouldn’t be spending), usually there are no safety concerns.

• Shift: Transitions are difficult when highly engaged in an activity, having trouble moving on to the next/coming back to it. Struggles with flexible thinking. Stuck in a loop of doing the same thing before being able to move on.

ADHD & How it Affects EF Development

• Emotional Control: Anxiety possibly contributes, constant “fight or flight”, difficulty with coming down from fight or flight mode. Could potentially get stuck in frustration, not mean to people, but unable to view the person in a different light (villainizing/holding a grudge).

• Initiate: Procrastinates, sometimes on major projects. Lacks initiation because of the volume of a task, feels overwhelmed and does not know where to start/what to tackle first. Might only be able to do the bare minimum because initiation is lacking.

ADHD & How it Affects EF Development

• Working Memory: Working memory can feel inconsistent, might feel trapped holding onto a thought & unable to let go because once the information is let go, it becomes immediately absent & hard to recall. It might occur for a task, conversation, and decision-making. May hold onto information too tightly or immediately lose it, hard to remember options listed out loud or follow step-by-step directions.

• Planning & Organizing: Planning to achieve goals could be less successful as having difficulty with breaking it down to smaller parts or feeling things are ‘all over the place’, sometimes excessive planning may occur which contributes to anxiety.

ADHD & How it Affects EF Development

• Task Monitoring: Might get distracted very easily. For example, going off-topic when finding a more interesting topic to talk about when doing a group research project. Sometimes locks in on small components of a greater task.

• Self Monitoring: Might not acknowledge hunger/thirst cues or recognize exhaustion during highly-engaging tasks. Might not be able to recognize own emotions until they reach a high point/emotional outburst.

Brain break! Any questions?

Public school Assessment

Assessment

• Psych Dx: ADHD
• The psychiatrist prescribed medication
• Phelony reports that meds have been beneficial so far
• The psychiatrist also administered the BASC-3 standardized assessment
• She was referred for public school services

• The PESH SLPs Abigail and Sim met with Phelony in late August

• Our assessment consisted of an interview asking Phelony what her educational struggles were and what she wanted to focus on in therapy.

Assessment

• Behavioral Assessment System for Children, 3rd edition (BASC-3)
• This is a comprehensive set of 4-point rating scales that uses a triangulation method for gathering information.
• Teacher Rating Scales (TRS)
• Parent Rating Scales (PRS)
• Self-report of Personality (SRP)
• The newest digital version includes additional indexes for evaluating EF

• Flex Monitor can be used to evaluate progress during intervention
• BASC-3 has high reliability and validity
• Phelony's results would most likely demonstrate anxiety, hyperactivity, deficits in adaptability and study skills.

Photos

Let's take a fun photo break

I made this while procrastinating

- Phelony Bubonic Jones, 2023

Goals & Activities

What do we want to target?

Goals & Strategies

• After the interview with Phelony, we noticed Phelony had greater defictis in : -
• Working memory
• Inititiaon
• Task monitoring
• Shift

• We determined that the above functions would provide Phelony with the greatest educational benefits if we targeted them.

Goals & Strategies

GOAL 1: -

• Phelony will actively listen and wait for her turn to speak without interrupting in 80% of observed opportunities for 4 consecutive sessions.
• Strategy: Visualizing, writing down keywords on a graph with two sections (left- what is the other person saying and right- what I want to say) and talk about it when it's her turn
• Activity: SLP will give a brief lecture (2-3 minutes), and Phelony will use note-taking strategies to track keywords and misunderstandings so she can ask any and all appropriate questions at the end of the lecture

Goals & Strategies

GOAL 2: -

• Phelony will create a structured school work routine and independently eliminate distractions to facilitate initiation of school work 5 times per week for 30 days.
• Strategy: Plan backward, execute forward & Time Robbers
• Activity: SLPs will educate how to use Get Ready, Do, Done charts and Phelony will use them for daily and weekly class assignments

Goals & Strategies

GOAL 3: -

• Phelony will improve her task-monitoring skills by requesting constructive feedback at least twice a day from peers, teachers, therapist, and family members to facilitate effective task monitoring for 8 consecutive sessions.
• Strategy: Request for feedback with a rating scale
• Activity: Long-term personal narrative essay for dual credit English Composition class, clinicians work together with Phelony to provide scale for her classmates/family to determine progress, how much has been written, how much writing is left, what needs to be edited and when, have requirements on the rubric have been met.

Goals & Strategies

GOAL 4: -

• Phelony will sustain her attention on a given task or activity for 10 minutes while limiting distractions and independently reorient herself to the task at hand for 2 times per session for 4 consecutive sessions.
• Strategy: A modified version of the Unthinkables (modifying it to better cater to a teenager), Modifying the environment
• Activity: Clinicians will act as the Brain Eater, Rock Brain and other Unthinkables while the student is working on a task. Clinician will also prepare a sticky note to remind her to focus.

NOTE: We are not trying to overstimulate her, our goal is to replicate natural distractions in her daily life.

Goals & Strategies

GOAL 5: -

• Phelony will demonstrate improved transitioning skills by creating transition routines to facilitate smooth transitions between activities 3 times per session for 4 consecutive sessions.
• Strategy: Make a digital to do list, using a color-coded schedule to highlight changes and timer, incorporating first, then.
• Activity: Phelony will create a flow chart before beginning activities, including end times for each activity, so she is not caught off guard when it’s time to transition. She will put away supplies out of sight for each activity when it is time to move on. *trivia quiz online, read an article, update schedule.

Progress

How is she improving

Ideal Progress (end of Fall semester)

As of December, Phelony has already achieved 4 out of 5 of the public school goals set in September. Woohoo! She is applying strategies in her daily life and has acclimated to her dual credit schedule. Abigail and Sim will re-assess Phelony a few weeks after the Spring semester begins to determine if therapy should be continued with new goals or if she should be discharged. She hopes to enroll in EMT certification program. Phelony also plans to apply to universities soon, and Texas A&M is her top choice.

References

10

Where we got the info

References

American Psychological Association. (2015). BASC 3 Behavior Assessment System for Children, Third Edition. American Psychological Association (APA). https://www.apa.org/depression-guideline/behavior-assessment-system-children.pdf Centers for Disease Control and Prevention. (2023, March 30). Attention-Deficit/Hyperactivity Disorder (ADHD). https://www.cdc.gov/ncbddd/adhd/index.html#:~:text=People%20with%20ADHD%20may%20have,improve%20as%20the%20child%20ages Dawson, P., & Guare, R. (2009). Smart but scattered: The revolutionary "executive skills" Approach to helping kids reach their potential. Guilford Press.

References

Gollis, C (2023). Lectures from COMD 7v86 Executive Functions in Children and Adolescents. University of Texas at Dallas. Pearson. (2019). BASC 3 assessment services publication summary form. Pearson Assessments. https://www.pearsonassessments.com/content/dam/school/global/clinical/us/assets/basc-3/basc3-publication-summary.pdf Suchy. (2016). Executive functioning : a comprehensive guide for clinical practice. Oxford University Press.

ANY QUESTIONS FOR US?

Thank you so much for being a great audience, and have a great summer!