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