Chapter 2: What I’ve learned from representing AmplioSpeech across the states
By Dr. Nikosi Darnell
Thoughts of summer always instill a sense of nostalgia in me. Longer daylight hours, outdoor music festivals, picnics, ice cream, family reunions, travel experiences. . .
These are some of the things my family and I enjoyed during our summer breaks. As both parents worked in the school system, summer afforded us the opportunity to travel to some pretty amazing places. Whether traveling by car or plane, it was always such a fun and exciting experience for our family.
These early experiences definitely spurred on my love of traveling as it is now one of my favorite things to do. Personally, I don’t feel as if I have truly had a summer break unless I travel somewhere.
Well, this summer was definitely the time for travel! I enjoyed traveling to Florida where I was terrified while riding the Tower of Terror at Hollywood Studios. I’ll never forget the fun experience of going to Georgia and seeing all of the beautiful historic homes with their lush and enviable gardens. And even though I don’t really gamble, Las Vegas was very inspiring as I enjoyed all of the amazing performers at the Mat Franco Magic Reinvented show and Cirque Du Soleil. I mean, what talent!
Not only did I travel for personal pleasure, but I received the opportunity to represent AmplioSpeech at various educational conferences across the states. I had an amazing time interacting with my fellow colleagues, educators and administrators as we shared the unique features of AmplioSpeech’s approach to evaluating and treating speech-language disorders in students. Talk about an energizing opportunity to engage with decision-makers and begin to qualitatively shift their paradigm to one that is open to accepting a new and innovative approach for positively impacting the lives of students!
As you can imagine, traveling to these various conferences resulted in my spending a considerable amount of time in the airport. I’ve always enjoyed what we call “people watching”, so that’s what I did. I watched the hustle and bustle of travelers as they were trying to make their connections. I watched the airport staff as they went about their day. I watched the plane arrivals and departures and couldn’t help but think of the pressing responsibilities held by the air traffic controllers. I mean, their sole purpose is to ensure safe operations of airplanes. Did you know that each air traffic controller is in charge of a region? For each region they must:
- coordinate the movements of thousands of aircraft
- keep them at a safe distance from each other
- direct them during takeoff and landing from airports
- direct them around bad weather
- ensure that traffic flows smoothly with minimal delays
Did you know that our brain functions in a similar manner in regard to executive functioning skills? Well it does. Our executive function skills help us:
- maintain systems to keep track of information or materials
- make decisions about what’s important to focus on and what’s not important
- estimate how much time one has, how to allocate it, and how to stay within time limits and deadlines
- resist the urge to say or do something allows us the time to evaluate a situation and how our behavior might impact
- revise plans in the face of obstacles, setbacks, new information or mistakes
A formal definition of executive function skills (EFS) identifies them as mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses.
EFS begin to develop at an early age in the prefrontal cortex; however, they do not reach maturation until the mid to late 20s in a neurotypically developing individual. Why do we as speech-language pathologists (SLPs) need to know this? How does this skill impact our students? Heck, how does it impact us! Well, let’s not get ahead of ourselves. Let’s get a little more comfortable in identifying the specific executive function skills that we’re dealing with.
First, we know that executive function skills are essential life-long skills that we begin to develop as children through our intrapersonal and interpersonal interactions. Executive skills can be classified in a myriad of ways. For the purpose of this article, we will focus on 11 areas that I believe are critical:
- Working memory – holding information in memory while performing complex tasks. Incorporating past learning or experience to apply to a situation at hand or to project into the future.
- Planning and prioritization – creating a roadmap to reach a goal or to complete a task. making decisions about what’s important to focus on and what’s not important.
- Organization – creating and maintaining systems to keep track of information or materials.
- Time management – estimating how much time one has, how to allocate it, and how to stay within time limits and deadlines.
- Response inhibition – thinking before you act. Resisting the urge to say or do something allows us the time to evaluate a situation and how our behavior might impact it.
- Emotional control – managing emotions in order to achieve goals, complete tasks, or control and direct behavior.
- Sustained attention – maintaining attention to a situation or task in spite of distractibility, fatigue, or boredom.
- Task initiation – beginning projects without undue procrastination, in an efficient or timely fashion.
- Goal-directed persistence – having a goal, following through to the completion of the goal and not being put off or distracted by competing interests.
- Mental flexibility – revising plans in the face of obstacles, setbacks, new information or mistakes. Being adaptable to changing conditions.
- Metacognition – standing back and taking a birds-eye-view of oneself in a situation. Self-monitoring, self-evaluation (e.g. asking yourself, “How am I doing? or How did I do?”).
(Adapted from Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention – Dawson & Guare, 2018).
Cumulatively, we use these skills to reach our short- and long-term goals. As previously stated, these skills do not reach maturation until the mid to late 20s in neurotypically developing individual. Now imagine how long it might take for those who are not following a typical neurodevelopment pattern. This could be your student, even if they appear to be normally developing with the exception of a speech-language impairment.
Numerous studies have indicated a correlation between the development of language and executive function skills. In 2017, Rodriguez, Santana, and Exposito conducted a study on children with different subtypes of specific language impairment (SLI). They wanted to focus on the differences in neuropsychological, linguistic, and narrative behaviors of children presenting in the varying SLI subtypes. Study findings indicated students presenting in the expressive SLI group as demonstrating significant difficulties with grammar, verbal fluency, and working memory, while those students with a receptive-expressive subtype presented with depressed scores with the neuropsychological components of testing. Simply stated, both SLI groups demonstrated impairments in executive functioning skills. These impairments were not limited to verbal tasks but included non-verbal tasks as well.
Often, speech-language pathologists are providing speech-language services to students who demonstrate difficulty with their executive function skills.
We might unknowingly be addressing impairments of EFS with students as we utilize behavior management techniques through visual aids, auditory cues, and verbal redirection.
Characteristically, what should we as clinicians look for in students experiencing executive weaknesses? Let’s take a brief look. Students may demonstrate:
- Poor attention to tasks
- Incompletion of tasks or activities in a timely manner
- Difficulty following single or multi-step directions
- Inappropriate social behavior(s)
- Anti-social behavior(s)
- Inability to foresee consequences of their actions
- Difficulty recalling information
- Difficulty getting started on a task
So how can we as SLPs best meet the needs of our students who may present with EF weaknesses? I am listing practical suggestions along with the EF area that is addressed with the activity. Please see all of the resource links and detailed explanations at the end of this article.
- Create a monthly goal(s) calendar with your student (planning and prioritization/organization/goal-directed persistence/metacognition)
- Practicing mindfulness techniques (emotional control/mental flexibility/response inhibition)
- Developing a visual timetable (organization/attention/working memory/task initiation/time management)
- Follow the Get Ready, Do, Done Model (organization/planning and prioritization/time management/working memory/metacognition)
- “Reading” a wordless storybook to work on sequencing skills (organization)
- Play “Simon Says” (sustained attention/working memory/impulse control)
- Find the hidden picture games (sustained attention/mental flexibility)
- Self-control bubbles (impulse control)
- The What’s Missing Game – you can do this online on a Whiteboard or with a facilitator assisting the student with the same props, i.e. Mr. Potato Head (working memory/sustained attention)
- Encourage self-talk that focuses on growth by recognizing that an experience, particularly a failure, can offer lessons for improvement and shouldn’t be considered the final judgment on their abilities (metacognition/emotional control)
Not only do we need to address our students executive functioning skills to make a positive impact on their lives, but we need to involve them in the process as well. Involving them in the process of identifying EF weaknesses and developing a plan to address them will give them confidence they need to take ownership of improving their skills. As Benjamin Franklin said, “Tell me and I’ll forget. Show me and I might remember. Involve me and I will understand.”
Ph.D., M.S., CCC-SLP
AmplioSpeech Lead SLP
Join AmplioSpeech community of empowered SLPs: http://bit.ly/2FJzre2
- Monthly Goals
- Mindfulness: Sesame Street Breathe, Think, Do website printouts or app
- Visual Timetable: Picture My Task app
- Get Ready, Do, Done Model: Template Form
- Wordless Picture Books: PayerSmith Books, Imagistory app
- Hidden Pictures
- Self-Control Bubbles: Download / Lesson plan
- The What’s Missing Game
- Dawson, P. & Guare, R. (2018). Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention. 2nd Edition. New York: The Guilford Press.
- Rodriguez, A., Santana, R., & Exposito, H. (2017). Executive functions and language in children with different subtypes of specific language impairment. Neurolagia, 32(6), pp352-362. Retrieved from ScienceDirect on September 2, 2019
- Sibley, M. H. (2016). Parents-Teen Therapy for Executive Function Deficits and ADHD. New York: The Guilford Press.