Lend Me Your Brain: Supporting TBI Survivors around

Executive Function Deficits

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DavidNowell

DavidNowellSeminars

Overview

• Brain overview in 18 slides• Executive functioning•Understanding your brain’s

reward-and-planning system•Q&A&D

BRAIN OVERVIEW IN 18 SLIDES

Appendix A

Peak experiences

What does dopamine feeeel like?

Ways of thinking about the brain

• Left to right• Top to bottom• Front to back

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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what IS…

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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…what COULD BE

EXECUTIVE FUNCTIONING

The Executive Functions

• Making movies in your head

• Talking to yourself

• Being your own boss

• Thinking and creating “what could be”

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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1. 1-step errands

2. Chores with cues

3. Basic inhibition

Age-appropriate ExpectationsPreschool

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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1. 2-3 step directions

2. 20-30 minute assignments

3. Follow rules/inhibit/no grabbing

Age-appropriate ExpectationsKindergarten -2nd Grade

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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1. Simple shopping list

2. Keep track of variable daily schedule

3. Inhibit and regulate even without teacher present

4. Simple delayed gratification (phone)

Age-appropriate Expectations3rd-5th Grade

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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1. Complex chores

2. Organizing system

3. Time management

4. Self soothe

5. Manage conflict

Age-appropriate Expectations6th – 8th Grade

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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1. Independent with assignments

2. Make adjustments based on feedback

3. Inhibit reckless behavior

4. Say “no” to fun activity if other plans already made

5. Take others’ perspective

Age-appropriate ExpectationsTeenage-mid 20’s

Impact of Executive Dysfunction on School and Work

• Problems initiating and completing work.• Slowed work pace.• Increased impulsivity.• Decreased productivity.• Confusion and increased stress.• Trouble with generalization of new learning.• Distractible.

Impact of Executive Dysfunction on Social Skills

• Loss of friends and social circles.• Decreased affective regulation.• Increased impulsivity.• Increased agitation.• Decreased perspective-taking.• Premature return to school/work.

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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Lending Your Brain

Capacity

• Guardianship• Conservatorship• Representative payee

Meet with your ADHD employee for regular ongoing feedback

UNDERSTANDING YOUR BRAIN’S REWARD-AND-PLANNING SYSTEM

Image: wikimedia commons

Cortico-striatal loop

Cortico-striatal loop

The reward-and-planning system

The reward-and-planning system

Goal / State

Identify Tasks

Sequence/ Problem solve

Block Distractions

Ways the reward-and-planning system can go wrong

• Dante: “My biggest problem is that I want to do everything all at once!”

Ways the reward-and-planning system can go wrong

• Inna: “I just get blank. I usually start sitting more slouched, hold my head with my left hand, ….you freeze and instead of being able to think of alternatives, you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to you.”

Ways the reward-and-planning system can go wrong

• Hank: “I have things I need to do to improve my marriage, my health and my financial situation, but I honestly believe that I have zero chance of actually making any of those three things actually get better. ”

The reward-and-planning system

Goal / State

Identify Tasks

Sequence/ Problem solve

Block Distractions

The reward-and-planning system

Goal / State

The reward-and-planning system

Goal / State

STRATEGIES• Identify the goal-behind-

the-goal (what do you want to feel?)

The reward-and-planning system

Goal / State

Identify Tasks

The reward-and-planning system

Identify Tasks

STRATEGIES• Coaching• Interview someone who’s 

already done it• Vocational counseling

The reward-and-planning system

Goal / State

Identify Tasks

Sequence/ Problem solve

The reward-and-planning system

Sequence/ Problem solve

Strategies• Weekly planning session• Morning 10-minute review• Review your successes and strengths:  

What evidence do you have that you CAN do this?

10 minute morning check-in

The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it.

- E. Goldberg

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easy hard

Let your non-TBI family member tackle the detailed long-term projects while you manage the time-limited projects

60-Second Bathroom Cleaning Routine

Shower coach

Walk me up

Clocky

Launching pad

Clear (see-through) storage

The reward-and-planning system

Sequence/ Problem solve

Strategies• Weekly planning session• Morning 10-minute review• Review your successes and strengths:  

What evidence do you have that you CAN do this?

The reward-and-planning system

Goal / State

Identify Tasks

Sequence/ Problem solve

Block Distractions

The reward-and-planning system

Block Distractions

The reward-and-planning system

Block Distractions

Strategies• The Body Double• StayOnTask app• Increase salience (what’s in it 

for me?)

Increase salience

EZ-C Reader

StayOnTask app

The reward-and-planning system

Block Distractions

Strategies• The Body Double• StayOnTask app• Increase salience (what’s in it 

for me?)

The reward-and-planning system

Goal / State

Identify Tasks

Sequence/ Problem solve

Block Distractions

The reward-and-planning system

Goal / State

The reward-and-planning system

Goal / State

Strategies• Get clear about your unique 

motivations.• Maintain boundaries• Ask “what about this do I want?”

The reward-and-planning system

Goal / State

Identify Tasks

Sequence/ Problem solve

Block Distractions

What’s wrong with this brain model?

The “Big 5” Brain Supports

• Sleep• Exercise• Nutrition• Daily calendar review• Connection

Q & A & D

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davidnowell David Nowell Seminars