Post on 26-Mar-2015
EXECUTIVE FUNCTIONSEXECUTIVE FUNCTIONSUsing Language To Using Language To
ThinkThink
Shelly Wier, MS, CCC-SLPShelly Wier, MS, CCC-SLPEaster Seals Outreach ProgramEaster Seals Outreach Programhttp://arslpedconsultant.comhttp://arslpedconsultant.com
swier@ar.easterseals.comswier@ar.easterseals.com501-221-8415501-221-8415
Orchestra AnalogyOrchestra Analogy
Orchestra AnalogyOrchestra Analogy
Orchestra AnalogyOrchestra Analogy
Language & Language & CommunicationCommunication
PrerequisitePrerequisite
Subtle, UnspokenSubtle, Unspoken
FlexibleFlexible
Operational DefinitionOperational Definition
A cluster of brain functions/skills that allows us to . . .• Anticipate consequences• Generate novel solutions• Initiate appropriate actions/responses to
situations• Monitor the ongoing success/failure of
one’s behavior• Modify performance based on
unexpected changes.
Tertiary ProcessingTertiary Processing
Conscious
Independent
Purposeful
Goal-Oriented
Self-Serving
Monitored
Evaluated
Flexible
Adaptive
Underlying Cognitive Underlying Cognitive FunctionsFunctions
AttentionAttention
InhibitionInhibition
Working MemoryWorking Memory
Five Levels of AttentionFive Levels of Attention
FocusedFocused
SustainedSustained
SelectiveSelective
AlternatingAlternating
DividedDivided
InhibitionInhibition
AllowsAllows for sufficient planning and for sufficient planning and
organizationorganization
PreventsPrevents disruptive, unwanted, disruptive, unwanted,
unintentional and irrelevant impulsesunintentional and irrelevant impulses
DelaysDelays appropriate actions appropriate actions
until the appropriate timeuntil the appropriate time
BasisBasis for delayed gratification for delayed gratification
and optimal results at a later time and optimal results at a later time
Working MemoryWorking Memory
““Memory ChalkboardMemory Chalkboard””
Mental Storage SpaceMental Storage Space
Immediate ComparisonImmediate Comparison
Used RepeatedlyUsed Repeatedly
Reliant on Sustained AttentionReliant on Sustained Attention
Six Six Components Components of Executive of Executive FunctionFunction
Goal SelectionGoal Selection
Planning &Planning &OrganizationOrganization
Initiation &Initiation &PersistencePersistence
FlexibilityFlexibility
Execution &Execution &GoalGoal AttainmentAttainment
Self-RegulationSelf-Regulation
Goal SelectionGoal Selection
Behavioral determinationBehavioral determination
Predict and anticipatePredict and anticipate
Externally-controlled at firstExternally-controlled at first
Increasingly internally-controlledIncreasingly internally-controlled
Requires Requires sophisticatedsophisticated language!! language!!
Planning & OrganizationPlanning & Organization
RecognizRecognize the need to acte the need to act DetermineDetermine what is necessary what is necessary SeekSeek relevant materials & information relevant materials & information
OROR ““Make doMake do” with what is available” with what is available DevelopDevelop relevant strategies relevant strategies SequenceSequence plans, information, materials plans, information, materials AccountAccount for time, expectations, for time, expectations,
requirementsrequirements
Initiation & PersistenceInitiation & Persistence
Self-selected startSelf-selected start
OROR Time-sensitive initiationTime-sensitive initiation
Persist with efforts to completionPersist with efforts to completion
Continually “re-start” efforts as neededContinually “re-start” efforts as needed
Terminate efforts as appropriateTerminate efforts as appropriate
FlexibilityFlexibility
Adapt! Adapt! Adapt!Adapt! Adapt! Adapt!
Success requires changeSuccess requires change
Allow for unexpected parametersAllow for unexpected parameters
React strategicallyReact strategically
Depends on divergent thinking and Depends on divergent thinking and verbal reasoningverbal reasoning
Execution & Goal Execution & Goal AttainmentAttainment
Relies on . . .Relies on . . .• Initiation & Persistence•Attention & Vigilance•Adaptability & Flexibility•Self-Evaluation
Manage time constraints and pacingManage time constraints and pacing
Poorly developed EF = more Poorly developed EF = more
supervisionsupervision
Self-RegulationSelf-Regulation
ObservationObservation JudgmentJudgment MonitoringMonitoring ReactionReaction RecognizingRecognizing
Relies on . . .Relies on . . .•Making comparisons•Drawing conclusions
SSUUMMMMAARRYY
CCOOMMMMEENNTTSS
Pop Quiz 1Pop Quiz 1
1.1. Define “executive function.”Define “executive function.”2.2. Give 3 behavioral adjectives to describe Give 3 behavioral adjectives to describe
“tertiary processing.”“tertiary processing.”3.3. Name 3 underlying cognitive functions Name 3 underlying cognitive functions
that are prerequisite to EF development.that are prerequisite to EF development.4.4. Name 5 levels of attention.Name 5 levels of attention.5.5. Name 3 of the 6 components of EF.Name 3 of the 6 components of EF.6.6. Which component requires Which component requires sophisticatedsophisticated
language?language?7.7. Which component is Which component is syntacticallysyntactically
complex?complex?
Remediate Deficit
Skills
Improve Awareness of Deficits
Teach Compensatory
Strategies
Teach Compensatory
Strategies
Remediate Deficit
Skills
Improve Awareness of Deficits
Remediate Deficit Skills
Teach Compensatory
Strategies
Improve Awareness of Deficits
Longest Developmental Longest Developmental PhasePhase
Frontal lobe development is prolongedFrontal lobe development is prolonged
Slowest maturational phase of all the Slowest maturational phase of all the developmental progressionsdevelopmental progressions
Not completed until mid-20’sNot completed until mid-20’s
Normal, age-related changes in mid-40’sNormal, age-related changes in mid-40’s
Slow decline in synaptic density with ageSlow decline in synaptic density with age
Emerging FoundationsEmerging Foundations
First Two YearsFirst Two Years
Reflexive at firstReflexive at first Inhibition and simple, Inhibition and simple,
focused attention focused attention emerges between 6-12 emerges between 6-12 monthsmonths
Simple shifting of Simple shifting of attention emerges attention emerges between 1-2 yearsbetween 1-2 years
Two Year OldsTwo Year Olds
Life is here-and-Life is here-and-nownow
Impulse-drivenImpulse-driven DistractibleDistractible PerseverativePerseverative No flexibilityNo flexibility No self-correctionNo self-correction Immature, but Immature, but
developing developing attentionattention
Three Year OldsThree Year Olds
Attention, environmental awareness, and Attention, environmental awareness, and language continue to developlanguage continue to develop
Verbal fluency and impulse control improvesVerbal fluency and impulse control improves
Able to process Able to process 1 simple rule1 simple rule
Shift between Shift between tasks 1 at a timetasks 1 at a time
Use inefficient Use inefficient strategiesstrategies
Four Year OldsFour Year Olds
Language is really starting to helpLanguage is really starting to help Follows simple rulesFollows simple rules
Generates new ideas Generates new ideas and makes simple plansand makes simple plans
Shifts btw simple tasksShifts btw simple tasks Better task completionBetter task completion Delays first choiceDelays first choice Complex demands still Complex demands still
troublesometroublesome
Five Year OldsFive Year Olds
Impulsivity is Impulsivity is decliningdeclining
Language, verbal Language, verbal fluency, and now fluency, and now processing, is processing, is increasingincreasing
Better balance btw Better balance btw internal needs & internal needs & external demandsexternal demands
Follow simple, multi-Follow simple, multi-step directionsstep directions
Six Year OldsSix Year Olds
More self-controlled; More self-controlled; less other-controlledless other-controlled
Attention much Attention much better; span is longerbetter; span is longer
Language processing Language processing is of great helpis of great help• Begin to use silent,
verbal mediation!!! Simple problem Simple problem
solving appears solving appears
7 - 9 Year Olds7 - 9 Year Olds Typically, language is Typically, language is
well-developedwell-developed Attention skills more Attention skills more
selective and deliberateselective and deliberate
Better at switching Better at switching between rules and between rules and sets of conditionssets of conditions
Ten Year OldsTen Year Olds
Nearing maturity in ability to selectively Nearing maturity in ability to selectively attend and identify relevant informationattend and identify relevant information
Significant Significant increase in increase in complex reasoning complex reasoning and strategic and strategic behaviorbehavior
Able to consider Able to consider task requirements task requirements over personal over personal impulsesimpulses
11 – 12 Year Olds11 – 12 Year Olds
• Ability to learn from mistakes
• Ability to generate alternate strategies
• Goal-setting for complex issues
• Problem solving, and planning & organization complexity
Language abstraction significantly Language abstraction significantly increases:increases:
AdolescentsAdolescents
Significant increases in all skills Significant increases in all skills and and relativerelative maturity of: maturity of:• Attention & inhibition• Working memory• Language processing• Cognitive flexibility• Decision-making• Deliberate behaviors• Multi-goal oriented efforts• Multi-strategy
development
Early 20’sEarly 20’s
Executive function skillsExecutive function skillscome into full maturity!come into full maturity!
Self-control Self-control Adaptive to changeAdaptive to change
Goal-directed behaviorsGoal-directed behaviorsAvoid sabotaging effortsAvoid sabotaging efforts
Ethical, moral, legal decisionsEthical, moral, legal decisionsBehave within parameters of societyBehave within parameters of society
12
121
2Broca’s
Wernicke’s
3
Prefrontal Cortex (PFC)Prefrontal Cortex (PFC)
1.1. Integrates relevant prior Integrates relevant prior learning and internal stateslearning and internal states
2.2. Makes premotor cognitive Makes premotor cognitive decisionsdecisions
3.3. Mediates the temporal Mediates the temporal sequence of behaviorssequence of behaviors
4.4. Produces context-Produces context-dependent, relevant dependent, relevant behavior behavior
PFC ComponentsPFC Components
Orbitofrontal = Orbitofrontal = STOPSSTOPS
Ventromedial = Ventromedial = DECIDESDECIDES
Dorsolateral = Dorsolateral = ACTSACTS
Let’s take a Let’s take a break!break!
Please return in 10-15 Please return in 10-15 minutes.minutes.
Dx: Executive Function Dx: Executive Function Disorder?Disorder?
So what happens to self-guidedSo what happens to self-guided
behaviors and mature behaviors and mature
independence when independence when development development
of EF is atypical orof EF is atypical or
something else goes wrong?something else goes wrong?
Poor AttentionPoor Attention Poor Working Poor Working MemoryMemory
Poor InhibitionPoor Inhibition
Poor Goal SelectionPoor Goal Selection
Poor PlanningPoor Planning
Poor Poor InitiationInitiation
Poor Poor FlexibilityFlexibility
Poor ExecutionPoor Execution
Poor Self-Poor Self-RegulationRegulation
EF Deficits and SLIEF Deficits and SLI
Syntax-BasedSyntax-Based Impaired attention Impaired attention Impaired inhibitionImpaired inhibition Poor organization for sentences, Poor organization for sentences,
narrativesnarratives Poor strategy development and planningPoor strategy development and planning Decreased flexibilityDecreased flexibility
Difficulties intensify asDifficulties intensify asacademicacademic demands increase! demands increase!
EF Deficits and SLIEF Deficits and SLI
Semantics/Pragmatics-BasedSemantics/Pragmatics-Based Failure to readily develop social Failure to readily develop social
relationshipsrelationships Impaired emotional perceptionsImpaired emotional perceptions Impaired social playImpaired social play Poor or no interpretation of Poor or no interpretation of
facial expressionsfacial expressions
Difficulties intensify asDifficulties intensify as
socialsocial demands increase! demands increase!
Associated ImpairmentsAssociated Impairments
CommunicationCommunication
Disorganized discourse Disorganized discourse Tangential, wandering narrativesTangential, wandering narratives Failure to comprehend main theme or Failure to comprehend main theme or
ideaidea Reduced ability to use self-talk to Reduced ability to use self-talk to
mediatemediate Inattentive, impulsive listening Inattentive, impulsive listening Lack of initiationLack of initiation
Associated ImpairmentsAssociated Impairments
Pragmatics & Social InteractionPragmatics & Social Interaction
Poor ability to take others’ perspectivePoor ability to take others’ perspective Inability to transitionInability to transition Impaired recognition of nonverbal cuesImpaired recognition of nonverbal cues Poor inhibition of impulsivityPoor inhibition of impulsivity Inaccurate judgment Inaccurate judgment Inappropriate behaviorInappropriate behavior
Associated ImpairmentsAssociated Impairments
Processing & ReasoningProcessing & Reasoning
Limited abstract reasoningLimited abstract reasoning Difficulty recognizing relevant versus Difficulty recognizing relevant versus
irrelevant inputirrelevant input Difficulty drawing conclusionsDifficulty drawing conclusions Difficulty making inferencesDifficulty making inferences Limited divergent thinkingLimited divergent thinking Limited ability to predictLimited ability to predict
Associated ImpairmentsAssociated Impairments
Problem-Solving & LearningProblem-Solving & Learning Impaired strategic thinkingImpaired strategic thinking Limited ability to generate multiple Limited ability to generate multiple
solutionssolutions Difficulty generalizing Difficulty generalizing Trouble learning from consequencesTrouble learning from consequences Impaired ability to complete tasksImpaired ability to complete tasks Impulsive attemptsImpulsive attempts Unable to recognize failureUnable to recognize failure
Associated ImpairmentsAssociated Impairments
MemoryMemory
Difficulty retaining information Difficulty retaining information
Forget to execute tasks or be where Forget to execute tasks or be where
necessary at a given timenecessary at a given time
Recall information out of sequenceRecall information out of sequence
Failure to integrate long-term Failure to integrate long-term
memoriesmemories
Conceptual DifferencesConceptual Differences
Traditional Tests:Traditional Tests: Control for every variableControl for every variable Provide scripted instructionsProvide scripted instructions Eliminate distractionsEliminate distractions Allow for Allow for very littlevery little novel thinking novel thinking Eliminate opportunities for errors in Eliminate opportunities for errors in
planning or sequencingplanning or sequencing Examiner controls order of things Examiner controls order of things
and establishes goals and objectivesand establishes goals and objectives
Crystallized vs. FluidCrystallized vs. FluidVerbalVerbal
•Vocabulary•Verbal reasoning•Syntax,
semantics•Knowledge base•Static demo of
knowledge•Detail analysis
PerformancePerformance•Use of
knowledge•Use of language
to develop strats•Flexible, applied•Nonverbal•Perceptions• Intuitions•Gestalt analysis
Assessment OptionsAssessment Options
Formal Assessment ToolsFormal Assessment Tools
Informal Assessment ToolsInformal Assessment Tools
•Observations
•Interviews
•Rating Scales
A Quick ExperimentA Quick Experiment
TREETREE
STROOP TaskSTROOP Task
greengreen red red brownbrown whitewhite
whitewhite brown brown greengreen redred
red red whitewhite greengreen brownbrown
brownbrown greengreen whitewhite red red
whitewhite brown brown redred greengreen
greengreen whitewhite brown brown redred
red red brownbrown greengreen whitewhite
Best Buy:Best Buy: “BRIEF” “BRIEF”
Behavior Rating Inventory of EFBehavior Rating Inventory of EF InhibitionInhibition ShiftingShifting Emotional controlEmotional control InitiationInitiation
Working memoryWorking memory PlanningPlanning OrganizationOrganization Self-monitoringSelf-monitoring
Informal Tools: Informal Tools: Observations, Interviews, Observations, Interviews,
and Rating Scalesand Rating ScalesObservation OpportunitiesObservation Opportunities
There are opportunitiesThere are opportunities
for informal observation of EF for informal observation of EF skillsskills
within problem solving taskswithin problem solving tasks
and social interactions.and social interactions.
When Problem Solving . . .When Problem Solving . . .
Watch forWatch for•Overall independence
and success•Novelty of problem•Planning,
organization, and reasoning used
•Adaptation•Correction•Self-monitoring
Possible ActivitiesPossible Activities
Tasks from PBSKids.org and Tasks from PBSKids.org and
ZOOM ZOOM
•Experiments
•Cooking
•Building
•Designing
When Interacting Socially . . .When Interacting Socially . . .
Watch forWatch for•Types of behaviors•“Normalness” of
interaction•Use of social
conventions•Awareness of . . .•Rule-following•Overall self-
awareness
Possible ActivitiesPossible Activities
GamesGames
Group craftsGroup crafts
Running errandsRunning errands
Making purchasesMaking purchases
Informal AssessmentInformal Assessment
PROVIDEPROVIDE ultimate outcome (end ultimate outcome (end product) requirementsproduct) requirements
DO NOTDO NOT provide plans or provide plans or point out errorspoint out errors
RESISTRESIST the urge to help the urge to help ALLOWALLOW natural consequences natural consequences WATCHWATCH for spontaneous use for spontaneous use PROMPT PROMPT only if . . .only if . . .
Bottom Line for Bottom Line for AssessmentAssessment
Language ToolsLanguage Tools
Problem Problem SolvingSolving
Social Social SkillsSkills
EFsEFs
Self-talkSelf-talk
ReasoningReasoning
IntentIntent
Making meaningMaking meaning
Playground successPlayground success
Friends, ConnectionsFriends, Connections
Emotional developmentEmotional development
Academic successAcademic success
Pre-vocational skillsPre-vocational skills
Self-help skillsSelf-help skills
Where will Where will student be in 10 student be in 10
years?years?
How Do I Capture How Do I Capture Behavior?Behavior?
Build or borrow an observational Build or borrow an observational worksheet that uses . . .worksheet that uses . . .•Yes/No format•Continuity format•Context format•Degree of independence
format
Got Lunch?Got Lunch?Please return in no Please return in no more than one hour.more than one hour.
Concepts for InterventionConcepts for Intervention
EFDeficit
Educate
Expecta-tions
TeachEF Skill
Lang.Therapy
Environ-ment
Compen-sate
Self
DD
TT
TT
DD DD
DDDD
Did you note?Did you note?
Presence or absence of . . .Presence or absence of . . . Competing background noise Competing background noise Overwhelming visual stimuliOverwhelming visual stimuli Physical constraintsPhysical constraints Other studentsOther students Posted lists, reminders, Posted lists, reminders,
organizational bins, or organizational bins, or storage unitsstorage units
Modify the EnvironmentModify the Environment
In the ClassroomIn the Classroom BalanceBalance white space with visual stimuli white space with visual stimuli CreateCreate “quiet” areas and “loud” areas “quiet” areas and “loud” areas
ProvideProvide all necessary materials all necessary materials GroupGroup similar items together similar items together ExplainExplain organizational system organizational system UseUse labels, lists, and labels, lists, and
simple signssimple signs
Modify the EnvironmentModify the Environment
At HomeAt Home EliminateEliminate clutter, trash, unused clutter, trash, unused
itemsitems MaintainMaintain routine and consistency routine and consistency MonitorMonitor visual stimulation visual stimulation ProvideProvide visual schedules visual schedules
and chore lists and chore lists ImposeImpose external barriers external barriers
Improving Self . . .Improving Self . . .
-Awareness-Awareness
-Monitoring-Monitoring
-Evaluation-Evaluation
-Regulation-Regulation
Three Phases of “Self . . .”Three Phases of “Self . . .”
Intellectual AwarenessIntellectual Awareness
Emergent AwarenessEmergent Awareness
Anticipatory AwarenessAnticipatory Awareness
Compensatory StrategiesCompensatory Strategies
Self-TalkSelf-Talk
Externalized thought or thinking out loudExternalized thought or thinking out loud
Model! Model! Model!Model! Model! Model!
Provide:Provide:•Verbal strategies•Visual strategies•Communication
strategies•Physical cues
Language for ThinkingLanguage for Thinking
InfuseInfuse EF into language Tx and EF into language Tx and language into EF Txlanguage into EF Tx
MakeMake language use meaningful language use meaningful BuildBuild metacognitive vocabulary metacognitive vocabulary GenerateGenerate the idea that thinking the idea that thinking
is deliberate and useful is deliberate and useful ReinforceReinforce thru consequences thru consequences ModelModel “thought bubbles” and self- “thought bubbles” and self-
talktalk
Syntax for PredictionSyntax for Prediction
Cannot predict without logicCannot predict without logic Cannot comprehend logic Cannot comprehend logic
without an “if-then” without an “if-then” constructionconstruction
Cannot refer to past or think Cannot refer to past or think about future without tenseabout future without tense
Cannot reverse thinking Cannot reverse thinking without active and passive without active and passive verbsverbs
Cannot separate self from Cannot separate self from others without morphologyothers without morphology
Semantics for ReasoningSemantics for Reasoning
Need vocabulary to support conceptsNeed vocabulary to support concepts Need concept analysis to Need concept analysis to
reason reason (compare, contrive, (compare, contrive, and deliberate)and deliberate)
Need reasoning to strategizeNeed reasoning to strategize Need strategies to succeedNeed strategies to succeed
Words, language, thoughtWords, language, thought
Language and Language and Discovery LearningDiscovery Learning
Treatment PlanningTreatment Planning
Goals and InterventionGoals and Intervention Determine WHAT, WHY, and HOWDetermine WHAT, WHY, and HOW Blend easily measurable, functional outcomesBlend easily measurable, functional outcomes
with the underlying with the underlying process being targeted process being targeted
Include type/amount of Include type/amount of cueingcueing
Condition! Skill! Criteria!Condition! Skill! Criteria! Manipulate “structured vs Manipulate “structured vs
unstructured” and unstructured” and “distracting vs “distracting vs nondistracting” nondistracting” environmental variablesenvironmental variables
Example?Example?The student will demonstrateThe student will demonstrate
attentive listening in structuredattentive listening in structured
environments by demonstrating adequateenvironments by demonstrating adequate
processing and comprehension of simpleprocessing and comprehension of simple
directions needed to complete academicdirections needed to complete academic
tasks, given moderate amounts oftasks, given moderate amounts of
verbal cues and prompts,verbal cues and prompts,
with 80% accuracy. with 80% accuracy.
Let’s take a Let’s take a break!break!
Please return in 10-15 Please return in 10-15 minutes.minutes.
Treatment for Attention Treatment for Attention DeficitsDeficits
Visual scanning tasksVisual scanning tasks
Selective listening tasksSelective listening tasks
Listening and repeating wordsListening and repeating words
Listening and repeating sentencesListening and repeating sentences
Following directionsFollowing directions
Ignoring distractionsIgnoring distractions
Treatment for ImpulsivityTreatment for Impulsivity
Use negative consequencesUse negative consequences
Withhold necessary materials or Withhold necessary materials or
information information
Impose delaysImpose delays
Use barriers or other gamesUse barriers or other games
Use gestural cues and questions to Use gestural cues and questions to
delay delay
Treatment for Goal Treatment for Goal SelectionSelection
Compare and contrast exercisesCompare and contrast exercises Interpretation of “if-then” statementsInterpretation of “if-then” statements Deductive and conclusive reasoning Deductive and conclusive reasoning
taskstasks Using hypothetical situations Using hypothetical situations Inference-making exercisesInference-making exercises Using written lists of prediction Using written lists of prediction
outcomes to support memory and outcomes to support memory and comparisoncomparison
Discriminating advantageous versus Discriminating advantageous versus destructive plansdestructive plans
Treatment for Poor Treatment for Poor InitiationInitiation
Turn chores into “contests” Turn chores into “contests” Hang simple step-by-step listsHang simple step-by-step lists Use music and rhythm Use music and rhythm Use simple verb phrases Use simple verb phrases Give forced choicesGive forced choices Use timers or time constraints Use timers or time constraints Give first steps and subtask directions Give first steps and subtask directions Divide tasks into smaller, more Divide tasks into smaller, more
obvious stepsobvious steps
Treatment for PlanningTreatment for Planning& Organization& Organization
Plan itself is outcome, not executionPlan itself is outcome, not execution
Capitalize on the need for languageCapitalize on the need for language
Sorting and sequencing activities Sorting and sequencing activities
Teach and use key phrasesTeach and use key phrases
Feature analysisFeature analysis
Divide organization tasks Divide organization tasks
into parts into parts
Treatment for Poor Treatment for Poor FlexibilityFlexibility
Verbal fluency tasks Verbal fluency tasks Design fluency tasks Design fluency tasks Simple real life activitiesSimple real life activities Incorporate the unexpectedIncorporate the unexpected Require plan shiftingRequire plan shifting Structured, closed to uncontrolled, Structured, closed to uncontrolled,
unpredictable environmentsunpredictable environments Force sharing, joint effort, and Force sharing, joint effort, and
common goalscommon goals
Treatment for Self-SkillsTreatment for Self-Skills
Use video- and audio-tapingUse video- and audio-taping Chart problems and successChart problems and success Use a diaryUse a diary Role play Role play Planned failure tasksPlanned failure tasks Identify ineffective problem solvingIdentify ineffective problem solving Compare predicted w/ actual accuracy Compare predicted w/ actual accuracy Start in structured, nondistracting Start in structured, nondistracting
environmentsenvironments Transition less structured environments with Transition less structured environments with
planned distractionsplanned distractions Generalize to unpredictable and distracting Generalize to unpredictable and distracting
environmentsenvironments
Questions? Comments?Questions? Comments?
Please complete evaluation formsPlease complete evaluation formsprior to exiting.prior to exiting.
Thanks for coming.Thanks for coming.
Presentation and accompanying handouts Presentation and accompanying handouts will posted to Shelly’s Communication will posted to Shelly’s Communication
Board.Board.
Shelly Wier, MS, CCC-SLP, 501-221-8415 Shelly Wier, MS, CCC-SLP, 501-221-8415
http://arslpedconsultant.com, http://arslpedconsultant.com, swier@ar.easterseals.comswier@ar.easterseals.com