The building blocks to executive function are skills developed over time, starting as early as the first year of life. SST is an appropriate service to help parents learn how to support their child’s development of executive function skills. Three building blocks for executive function are: Working memory - includes the ability to following multiple-step instructions and taking turns in group activities; Inhibitory control - makes the following possible: selective, focused, and sustained attention. It also includes joint attention, and the ability to take turns; and Cognitive flexibility - includes the ability to switch gears and adjust to changed demands. Watch the 5 minute video for an explanation of the building blocks of executive function and how they work together: (2012) Let’s look at how the skills of executive function relate to the cognitive process of problem solving. Problem solving requires 4 steps: Assessing the problem Developing a plan to address the problem Executing the plan Evaluating the effectiveness of the plan Skills needed to assess the problem include working memory of the issues related to the problem and the ability to focus (inhibitory control) on the problem. Skills to develop a plan include working memory of the available options and inhibitory control to arrive at the best plan. Execution of the plan requires inhibitory control and cognitive flexibility, as seen in the ability to change priorities or fix mistakes. Evaluation of the plan requires the use of all 3 skills: working memory, inhibitory control, and cognitive flexibility. Executive function includes both cognitive processes and social interaction. As noted above, the building block, inhibitory control, includes joint attention and turn taking. Joint attention and turn taking are also foundational social skills. Behavior issues may impact a child’s ability to benefit from intervention for delays in other domains.
Medical/Physical Issues Physical pain or discomfort decrease ability to and learn Invasive or painful procedures may result in trauma Side effects of medication can include: Increased activity level Gastric problems Increased aggression Drowsiness Sleeplessness Inattention/lack of focus Frequent, inconsolable crying or screaming Withdrawal Hyperactivity Aggression Help parents find the best times of day for different activities Teach parents to use activities the child finds calming or stimulating depending on what the child needs Accompany parents to medical appointments to help them explain any problematic side effects Help parents establish calming bed time routines if is a problem Consult RN, dietitian, OT or licensed professional with expertise in social-emotional development (e.g. LCSW, LPC) if strategies are unsuccessful Parenting Issues Lack of consistency Expectations for the child to progress and learn like typically-developing children Ineffective or overly-harsh consequences Lack of development knowledge Tantrums Aggression Withdrawal follow rules Anxiety Help parents develop consequences for problem behaviors Provide anticipatory guidance and other information on both typical and delayed child development Help parents identify when they are not being consistent If concerns persist, consult a licensed professional with expertise in family relationships (e.g. LPC, LCSW)
Bathing/Toileting or Dressing Ask her if she needs her diaper changed, encouraging her to imitate “yes” or “no”. hand to walk her to changing area. Read picture books which discuss toileting. Snack Time Give a small amount of food or drink and ask if she wants more, asking her to sign or verbalize “more”. Point to high chair and ask her to walk to it. Provide support if needed. N/A Play Time Give her options between two toys or play objects. the words she needs to use to express her choice. Assist her to play ball (throw and catch) while she is standing. Make a book with photographs of family members and pets. Encourage her to point to each family member when named. Assist her in turning the pages. Now You Try: This exercise will help you develop a collection of activity strategies that can be used to work on a variety of IFSP outcomes. Pick outcomes from a recent IFSP you developed. Fill in the outcomes at the top of the table and add in activity ideas for each of the applicable routines. You may also add in different routines at the end of the “daily home routines” column. IFSP Outcomes Daily Home Routines
More examples: Activity Gross Motor Fine Motor Cognitive Social/ Emotional Self Help Speech/ Language/ Communication Points to and labels pictures; answers simple questions; listens to stories read aloud positioning kneel/ standing) Yes – follow with finger/finger isolation/ visual tracking/ localization Yes- attention, memory, processing Yes – bonding/ meaningful interaction N/A Yes – receptive and expressive naming (nouns, verbs, adjectives, etc.), auditory attention Activity Motor Fine Cognitive Social/ Emotional Self Help Speech/ Language/ Communication Kicking ball Yes balance, maintenance of balance on one foot while kicking No Yes working memory, inhibitory control, problem solving interaction with significant adult Yes - balance, following directions, bilateral coordination Yes – following directions, verbalizations during interaction, requesting
Cognitive/Social-Emotional Activity Table The following table explains how activities address the various components of cognitive and social-emotional domains. Age in months Activity WM IC CF ASA DS RSI 0-6 Sing lullabies and tell the baby nursery rhymes. Use a soft and gentle voice when talking to baby. Baby remembers familiar voices Soothing voices help baby resist crying Understands different voices may sing same song Becomes attached to soothing voices Identifies preferred voices or songs Response to songs or rhymes promotes social development 6-12 Hide toy cloth within child’s reach, remove cloth, instruct child not to touch, hide toy slightly out of reach, remove cloth Object permanence Not to touch Seek other methods of retrieval Autonomy Not to touch Learns rules 12-18 Take turns rolling a ball back and forth. Child has to remember what he/she is supposed to be doing when it’s his/her turn again Joint attention; child has to be able to release the ball and give the adult a turn Understand adjustments may be made in the way the partner the ball (e.g. different direction/to a different partner) Autonomy Identifies the partner(s) expectation of returning the ball once it is skills
24-30 Teach the child simple finger play songs, like “Eensy Weensy Spider” where Child has to remember the words to the songs and remember the finger plays has to use the appropriate hand movements at certain times Ability to recall which finger play goes with which song Autonomy Has to attend to and model the caregiver who is Response and interaction to songs and finger plays promotes social interaction and play
30-36 Make a “Me Book” with the (Create a book with construction paper and place Child has to remember names of special people and things, and events Conversational turn-taking understanding of different relationships with the different people in the book. Autonomy Identifies and discusses family members Learns social interaction and conversational rules
Activity Suggestions 6-12 months Share books with older infants. Show them books with interesting colors, patterns, pictures, and textures. Notice when infants drop items and pick them up, and allow them to repeat the dropping action. Allow older infants to touch your face, skin, or hair and name body parts (“That’s my nose. Here’s your nose.”). Provide toys and objects that make noise, and create opportunities to make and listen to different sounds together (crunch leaves or bang on pots and pans). Notice and respond positively to infants’ desire to play games over and over again. Create an environment that encourages discovery, and give uninterrupted playtime. Give older infants safe toys to repeat motions, such as rocking, sliding, or balancing. Engage and play alongside older infants. Celebrate when older infants learn how to use a toy or object. Recognize toddlers' interest in the natural world and help describe what they see, hear, and experience. Explore surroundings and talk about how things are similar and different. Keep toys around that respond to older infants’ actions, such as pop-up boxes, squeaky toys, and musical instrument toys. Create a variety of safe spaces and objects for older infants to crawl over, around, and through. Give infants similar toys of different sizes they can nest (bowls, measuring cups, nesting cups). Show excitement when older infants discover new uses for things (putting blocks in a box or pot). Keep containers filled with objects around and encourage filling and emptying the containers. for and encourage older infants’ use of words, signs, and gestures, such as pointing and reaching to signal what they want. Play hide-and-find games by placing a toy under a cloth or other cover for older infants to find. Activity Suggestions 6-12 months Talk familiar caregivers when they are not present.
Notes: Developmental Activities – Extension Do you need more resources incorporating learning activities into daily routines? These extension activities provide more ideas for activities and strategies, offer information about providing routines based intervention and suggest tips for involving caregivers in the early intervention visit. Resource Name Link Activity Routines Based Intervention Involving Caregiver Early Learning Guidelines X X Children’s Medical Services Training – Module 4, Lessons 2 (social emotional support) (Note that this is training for Florida’s Part C program. However, this information can be applied to the ECI program in Texas. You do not need to complete any of the activities that require you to fill out the Florida Part C forms.) X X X
Children’s Medical Services Training – Module 4, Lesson 3 (motor focused activities) (Note that this is training for Florida’s Part C program. However, this information can be applied to the ECI program in Texas. You do not need to complete any of the activities that require you to fill out the Florida Part C forms.) X X X Children’s Medical Services Training – Module 4, Lesson 4 (language focused activities) (Note that this is training for Florida’s Part C program. However, this information can be applied to the ECI program in Texas. You do not need to complete any of the activities that require you to fill out the Florida Part C forms.) X X X Children’s Medical Services Training - Module 4, Lesson 5 (cognitive focused activities) (Note that this is training for Florida’s Part C program. However, this information can be applied to the ECI program in Texas. You do not need to complete any of the activities that require you to fill out the Florida Part C forms.) X X X Delaware Learning Foundations X X Thinking Differently Therapy Materials X X TaCTICS – Using Routines as Context for Intervention X X X TaCTICS – Involving Careprovider in Teaching and Learning X X FACETS – Identifying Family Activities and Routines – Conversation Starters X X X