Executive Function

I tested a student last week who is 15-8 diagnosed two years ago with Noonan Syndrome. His early milestones were within normal limits but he did have to have a feeding tube about the time he was learning to crawl and has always been a picky eater. He is home-schooled and doing seventh grade work although his age level would suggest ninth grade placement.

If something is being read to him or if he is involved in a family discussion, his mother said he has a different perspective than the other people involved. He will remember obscure facts and not get the obvious. What he gets out of a conversation may be quite different than the other people involved. He can learn something one day and it will be gone the next. He can be given three directions at a time – no more – or he forgets.

His mother says he needs time to process things: for example, he toured a radio station recently. When asked about it he said it was OK and gave no further feedback. A few days later he gave details on the tour. This is typical.

He took the Stanford Achievement Test and had an average verbal score at this level. His nonverbal score was below average as was his math and spelling. Socially his friends tend to be younger than he which is consistent with his small physical stature. He appears to have normal social interactions.

FYI: CAB scores for Vis Constr 79%, Aud Constr 71%, Syllable Dictation 60%, Word recognition 6th Grade level: 20%, Comprehension 5th/6th grade level 40%. Sentence Dictation at 5th-grade level 30%, Visual and Auditory Sequencing 58%.

First, for those who are unfamiliar with Noonan Syndrome. It is a syndrome which is thought to originate from a genetic mutation. It is often identified shortly after birth by specific facial characteristics. There is often abnormal development -structurally – of different parts of the body such as ribs, spine, indented chest and or webbed neck. There is usually a congenital heart defect and short stature. Sometimes there are learning problems identified with the syndrome.

This student has been quite fortunate to have few of the symptoms of this syndrome. He is also fortunate to have a parent who has the capability of home-schooling and providing supportive activities.

I think you already have identified that he has a delay in his processing/ response time. I would like to see a TOVA – Response Speed score on him if it is possible. Without that information, it is apparent that he requires mulling-time! This is why his responses in a conversation are based on a few, specific details and he appears to be missing the gestalt. The ah-hah! does not occur to him until much later. I have known students, including Luci, in Learning Victories, who would have an experience and then tell me that they got it in the middle of the night, or the next day.

One of the things that is happening at this point in his schooling is he is being asked to do more frontal brain activities which require the organization, conclusion generating, mental set shifts, processing, storing, and retrieving of information. In our earlier school years, most learning is- here is a fact – this ball is red – what color is the ball? – Red – Task completed. It is one level of learn, storage, retrieve.

Now he is at a level in which he is expected to learn information, apply it to past learned information and come up with new information. I think you will recognize this as Executive Function skills and you know that this is a primarily frontal lobe activity. So the activities we want to develop here are executive function skills. Planning, organizing, self-monitoring with feedback, anticipating outcomes/consequences, being able to shift concepts and thinks abstractly, goal setting, verbally regulating tasks/behaviors, time perception, internal ordering, and developing a perspective of how others are impacted by our behaviors. And in this instance, we need to work with the speed of processing, also. (Many of these are described in the DVD Executive Function Skills)
Big job – but doable!

The most difficult part of this job is learning to lead the student toward learning skills without directing him to do it. You will find that to this point your student is tempted to be a passive learner. In other words, he is expecting that it is your job to teach him. Now we want to shift to it being his job to learn. At first this will slow down his progress on gaining new skills, but eventually, it will allow him to be an independent, self-actualized learner.

Begin if you wish, with time concepts. Ask him to set his schedule for the day. First, have him identify all the things that he has to do in the day – from getting up to brushing his teeth, to eating, math, reading, history, TV, game time, etc. Have him create a full days schedule …you can ask prompting questions like… what are the things you do every day?… How would a schedule look to you? Let him experience his responses. For instance, if he takes a small piece of paper and writes the hours on it, let him experience attempting to get all the activities on the paper, let him learn that he needs more space. The one suggestion you can make is… if you find today that you do something that is not on your schedule, you will want to add it on the schedule as you do it. Allow him to live his schedule.

It will be a lot easier for him to do the next day when he creates his schedule. He may even decide to copy some from the previous day!… but let him figure that out. (That would be a generalization of the experience – excellent EF skill!) (He may decide to develop a form and fill in the things he does all the time! – excellent EF skill!) (He may decide to abbreviate some of the items! – excellent EF skill!)

You are giving him control and he is seeing graphically, organizationally, and verbally thinking about what he has to do. This may take several days or a month of days to become automatic but it will teach him to be anticipating what is happening next, what the expectation will be, and he will be in control (the most important piece of all.)

The next step will be learning to plan what he is going to do the next day. Before he ends his day, ask him, What are the important things you will have on your schedule tomorrow? Let him verbalize these (without adding any yourself) and no prompts. When you are beginning to plan or anticipate, then you are working in real time and you are using your active inner voice to direct your thinking. (These are the skills he will need for developing concepts in science, history, literature, etc.)

Another task in his daily work that would be useful to do would be doing trail-making or other activities which are done to a metronome. For instance, scatter (mix-up) the letters of the alphabet on a paper – some big, some small, some upper case, some lower case and have him move from a > B > c > D with his pencil at each beat of the metronome (starting with a very slow beat). You can make many trail patterns using numerals, counting by 10s, combined symbols 1 > A> 2> B> 3> C, etc. Look to him increasing his speed as he becomes adept at the task. Make a chart with animal names (cat > dog> bird) and tool names (hammer> saw>) and sports (baseball > wrestling>) then give him a topic such as tools and have him make a path to the tool names ignoring all the animals and sports moving to the beat of the metronome. This is beginning to increase his processing speed and working on concepts at the same time.

Let us know how these work and then we will have MORE! Fortunate young man to have you and his parent support team! Win > Win situation!

Dr. Joan M. Smith, Ed.D.
Dr. Smith’s work is accredited for Continuing Education Credit in the state of California. She is the author of You Don’t have to be Dyslexic, Learning Victories, 7 Brain Rules for Learning, The Calming Kitchen, and Mega Ways to Develop Executive Function Skills.

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