Lynne Kenney, PsyDwww.lynnekenney.com

@drlynnekenney

Brain-Based Interventions 2013

Becoming A Brain-Based Clinician

What is a Brain-Based Intervention?

An intervention that engages cognitive or motor parts of the brain

One that increases neuronal communication

One that builds skill sets One that increases collaborative parenting

strategies

Neuroscience in Psychology

Books on Brain Development

Brain Facts – Society for Neuroscience The Brain That Changes Itself ~ Norman

Doidge, MD The Woman Who Changed Her Brain ~

Barbara Arrowsmith-Young Brain School ~ Howard Eaton The Whole Brain Child ~ Dan Siegel, MD How To Reach and Teach Children with

Challenging Behavior ~ Otten & Tuttle Smart But Scattered ~ Dawson & Guare

Neuroscience + Cognitive/Dev Psych + OT + PE

Today’s Landscape ADHD and EF Learning Disabilities and EF Social Skills and EF Teaching skills sets across diagnoses Play Math (STM, WM, VSM, M2T) Motor Intelligence Therapy

What does executive dysfunction “look like”

Child completes work but “forgets” to hand it in Child has difficulty transitioning from one

situation or task to another Child doesn’t seem to catch “careless” errors Child needs more external support and

reminders than peers Child can’t seem to keep track of directions,

possessions, and assignments Child is very inconsistent in her performance

What is Executive Functioning (EF)? An umbrella term covering related yet

distinct skills Refers to mental control/self-

regulatory processes Can be understood as Cognitive and

Limbic

McCloskey 23 Self-Regulation Executive Functions

Perceive

Initiate

Modulate

Gauge

Focus/Select

Sustain

Stop/Interrupt

Flexible/Shift

Inhibit

Hold

Manipulate

Organize

Foresee

Generate

Associate

Balance

Store

Retrieve

Pace

Time

Execute

Monitor

Correct

EF Domains (Kenney, 2012)

Attention, focus, distractibility Cognitive control, shift and flexibility Memory, input, manipulation, output Emotional regulation and modulation Problem solving, decision making Impulse control and management Organization, planning, and time management Motor management planning, pacing, initiation,

maintaining, stopping

I. Executive Functions include the ability to: Survey and preview Plan, organize, sequence, initiate and

execute tasks Hold, manipulate and retrieve

memory Shift focus, sustain attention, tolerate

and adapt to changes in expectations Stop, think, decide, respond

II. Executive Functions include the ability to: Conduct visual-spatial mental operations Track information and activities in working

memory Perceive, read, interpret and respond to social

situations Regulate and manage emotions Evaluate, plan and manage time Use language to facilitate communication

within relationships Reason, evaluate choices and make decisions

Don’t All Kids have Executive Dysfunction? EF follows a developmental course as

do all cognitive and social-emotional skills

We all have domains in which we could improve

EFD interferes with daily adaptive living skills

Good Books on EF

Twitter ~ The Research Playground BRAIN DEVELOPMENT

@davidnowell @drbethkids @all4mychild @braininsights @viviensabel @drmarty01 @DrEscotet @TheTeenDoc

Enhancing Executive Function with skill set development

Where we are heading:Improving Neuronal ConnectionsKnowing the different between a skill deficit and willful non-complianceStrategies to build brain connections

Your Brain is Like A Placemat Insulted?

Don’t be.A placemat is

a good thing.Connect the

dots.

How do Neurons Connect?The electrical signals (nerve impulses) carried by neurons are passed on to other neurons at junctions called synapses. The signal may be directly transferred at electrical synapses or, if there is no physical link between adjacent neurons, the signal is carried across the gap by chemicals called neurotransmitters. By using neurotransmitters, the nervous system can alter the way a message is passed on. Each neuron communicates with many others and this contributes to the amazing complexity of the brain. www.sciencemuseum.org.uk

What is The Synapse? When a nerve impulse reaches the synapse at

the end of a neuron, it cannot pass directly to the next one. Instead, it triggers the neuron to release a chemical neurotransmitter. The neurotransmitter drifts across the gap between the two neurons. On reaching the other side, it fits into a tailor-made receptor on the surface of the target neuron, like a key in a lock. This docking process converts the chemical signal back into an electrical nerve impulse. www.sciencemuseum.org.uk

Neurotransmitters Your brain uses over 50 different

neurotransmitter chemicals. Although electrical signaling between neurons is quicker and more energy efficient, chemical signaling is far more versatile. The signals carried by some neurotransmitters excite the target cell while others dampen down their activity, depending on the type of neurotransmitter released at the synapse and the receptors they reach. This is what sharpens the contrast between light and dark in the eye, for example. www.sciencemuseum.org.uk

Connections Neurons can connect with up

to a hundred thousand other cells. This number of connections is a truly enormous number: 10 thousand trillion.

One neuron can have as many as 100,000 dendrites.

In a human, there are more than 125 trillion synapses just in the cerebral cortex alone

How Do We Build Brain Connections? Exposure Experience Doing, thinking,

mirroring Practice ~ and a

lot of it

www.unc.edu

Pruning In a human fetus, almost a trillion

neurons are produced. During the last month, they are produced at the unbelievable rate of 250,000 per second.  Eighty-to-hundred billion of these neurons will be utilized by experience and become permanent, while the other 900 billion will be pruned – that is, carefully dismantled with the material recycled by the brain’s unique immune system. jonlieffmd.com

Brain Training Some programs include Luminosity,  Captain’s Log,

COGMED, MC2, Brain Gym and Brain Builder. If the child or adult has not had a neuropsychological or executive function evaluation that may be a first step.

Exercise is brain training. Activities that involve motor control and thinking at the same time build brain connections. Some activities to consider include: XBox Dance Dance Revolution, karate, double dutch jump rope, yoga, hacky sac, swimming and tennis. Getting up, out and moving in any way possible is good for everyone.

Preventing brain loss: Cognitive-motor exercises, working memory, nutrition, exercise

Executive Function and Education EF and intelligence Twice Gifted Disorganized students Homework interventions Task Analysis Skill-set development Multi-sensory interventions (MIT)

NOVELTY Only four to eight minutes of pure

factual lecture can be tolerated before the brain seeks other stimuli, either internal (e.g., daydreaming) or external (Who is that walking down the hall?). If the teacher is not providing that novelty, the brain will go elsewhere. Bruce Perry, PhD

Teaching with Visual Aides and Movement 50 % of children are kinesthetic learners so

why not begin with touch? Visual learners learn by watching. 40% of

learners are in this category. Only 10 percent of secondary students learn

best auditorily, but 80 percent of instructional delivery is auditory.

JP Das Prep & Cogent

EF and IntelligenceDeveloped by Frederic Perez-Alvarez & Carme Timoneda-Gallart, neuroscientists and authors of A Better Look at Intelligence from Girona Spain, FUNDI is designed to teach children, parents and their teachers about critical aspects of meta-cognition and executive function. Applying PASS theory developed by JP DAS, the producers of these valuable films seek to help children learn about their cognitive processes in a manner to which children understand and relate.

Television

Flashlight

Parrot

Conductor

Evidence That Enhances Learning 1. Frequency and recency of neuron synapses increase memory Increase

frequency through practice and maintain fluency through use 2. Emotions strengthen memory Appeal to and engage emotions while

learning 3. Learning causes changes to the physical structure of the brain Allowing

children to teach increases their ability to learn throughout their lives 4. Memories are stored in multiple parts of the brain Engage all senses

when learning 5. Our brains are programmed to focus on new and unusual inputs Learning

should tap into the brain’s natural curiosity and intrinsic motivation

Sources: Donald J. Ford, Ph.D., C.P.T., Carl Haywood, PhD

Hello Remembering… Most people forget newly learned concepts after

a day. Re-learning forgotten concepts is easier than

learning new ones. This is even true years after something is forgotten.

Over-learning typically occurs during motor learning this repetitive form of learning reinforces information and requires high levels of brain organization.

What Needs To Change? 1. We move to learn, we play to behave

(provide opportunity for creativity and critical thinking)

2. Multi-modal sensory learning strategies

3. Rhythmic daily movement 4. Make children the teachers/mentors 5. Instruct less, interact more

Disorganized Students

Thinking Skill Domains Organization Planning Systems and methods (Parrot) Initiation Attention to detail Finding the data Problem solving Explaining one’s answer

What every student needs to know ~ How to…

Plan InitiateExecuteReviewReviseTurn In

SOAR ~ Susan Kruger Reading comprehension Critical thinking Active learning Written expression Time management Organization Active listening Attention to detail Learning strategies Independence

Handwriting Without Tears

EF Management Calendars, planners and schedules Routines and daily activities Task Lists Project Management

SYSTEMS: Digital, paper, post-it notes, planners, mobiles tools Cozi.com, myjobchart.com, famzoo.com

IN CLASS Listening alone is not enough (Columbia,

Stanford, Cornell) Note Taking Skills Matter

Modified Cornell Method Remaining alert Remaining active

Transferring information Summarizing

Modified Cornell Method

AT HOME Actively use a planner Thrive in your homework setting

(snacks, distractions, tools) Initiate, execute and complete one

task at a time Establish time-frames for discrete

tasks (chunking) Review, revise, summarize

Tips For Parents Check the website Check the backpack Support the homework system Talk about the homework process for

today Help child manage time and tasks Be available to help

Test Preparation Be visual (Cornell, notecards,

teaching content to others) Sleep, eat and have a + mindset Arrive early Bring all needed materials Stress relievers Read questions carefully, show your

work

Calendars and Planners

Weekly and daily calendars Reviewing next weeks assignments

on Sunday Transferring working onto a marker

board or EF action plan

Planning/Time Management Use timers (auditory, visual) Use alarms Estimate amount of time needed for a

task and then write down actual time Sarah Ward ~

cognitiveconnectionstherapy.com

Manage The Work Space What does your space look like?

How functional is it? How organized is your study space? Does your student have all the items he needs? Does your student have the ability to use multi-sensory transfer

skills? Describe the study space setting, could you work there? Is there an adult near-by? Do you have a time set aside? Are you working in 15 min increments or those suitable to your

child? Do you have prompts or cues? Is your workspace portable or stationary?

Go Multi-Sensory Encourage transfer skills Use video, audio and tactile strategies Use marker boards Use quad bulletin board Draw and doodle Vary the types of paper available Plain, graph, wide ruled, narrow ruled

Building Routines and Habits Overlearning and automaticity Motor movement Systems and routines Habit replacement Visual cues Secret signals

Talking with Students about their Study Styles Emphasize strengths Keep it short and simple! Use visuals Discuss weaknesses as hypotheses (it

seems that you lose track of your ideas when you are writing...is that true?)

Instill hope as you describe interventions

Collaborate, collaborate more…

There are no BUT’s here Help the student feel valued Let the student have some control in

the discussion and plan Ask questions without making

assumptions The relationship is the agent of

change

Organizing The Disorganized Student Determine “Help Me” domain

listening, attending, focus, note taking, impulse control, transferring data, input, output, audition, vision, organization, previewing, planning, execution, time-management

Identify needed skill-set Make a plan Execute, monitor, review plan

Skill Set Tracking

PrioritizationThe modified Sullivan technique

for prioritizing, planning and execution

A B C

48 hrs

Cognitive Flexibility Social stories

Social skills training (individual, dyad, group)

Positive reinforcement for managing a change or generating a new way of responding (reinforce new habits)

Gifted Talented ~ 2 E

EF and Reading Efficient EF is essential to reading

comprehension- need to adjust reading rate to level of difficulty of material and monitor as one reads

EF and Math Word problems require the ability to

ignore extraneous information, sequence steps, and monitor one’s work

Many kids with executive dysfunction make “careless” computation errors and use inefficient procedures

EF and Writing Writing is the most complex task we

ask students to master. It involves: keeping track of directions physical act of writing using correct mechanics (spelling,

punctuation, and capitalization) creating complex sentences transferring ideas into written form deciding on main ideas, details, flow of

ideas

Proper diagnosis Behavioral skill building Academic support Medication Brain Training An organized home environment Access to competent parental figures Nourishment

Interventions

Data Based Treatment Planning Do you have a brief neuropsych eval to assess

IQ and executive function? Do you see an OT for sensory issues? Do you improve food and nutrition? Do you look into amino acids to impact

neurotransmitters? Do you do brain training? What behavioral interventions do you consider? Is it time for a medication trial?

Data Based Treatment Planning

HOW TO HELPAccommodations

Strategies

Skill Building

At Home ~ The Family Coach Method Stay out of The Discipline Trap Establish routines and rhythm Clarify the family culture Collaborate on behavioral expectations Build a pond for better behavior Focus on what works

Three Tiers For In-Home Interventions

Intervention Pyramid Medication Neurotransmitters Food/NutritionDevelopmental,

Behavioral, Learning Interventions

Damage Control Using Previewing Planning Problem Solving Collaborating And BLOOM LANGUAGE

Skill Deficits vs Willful Non-compliance The 80/20 rule A skill deficit is when the task

demands exceed the skill level Are the expectations clearly

understood? Chunk Be detailed Model role play, practice

Is this a skill deficit?

Can he do it?If yes, expect itIf no, teach it

Case Example

Sammy and his “falling off” chair.

Freedomland

EF and Behavioral Change Visualizing and verbalizing Role Play Social Stories The Beginning, Middle & End Going Full Circle See, say, play, touch, build Mentoring others Motor movement

Cognitive Skills

Let’s Start Building J.P Das Suzy Koontz suzykoontz.com Jean Blaydes Madigan abllab.com SparkPE Eric Jensen www.jensenlearning.com Gil Connell @movingsmartnow

Breaking Down Skill Sets IListening

I chose not to speak I established eye contact I listened to someone speaking I nodded my head to show I was listening I repeated back what I heard, when asked I asked a question when I did not understand I remembered instructions I followed the instructions

Breaking Down Skill Sets IIListening

I chose not to speak I established eye contact I listened to someone speaking I nodded my head to show I was listening I repeated back what I heard, when asked I asked a question when I did not understand I remembered instructions I followed the instructions

Breaking Down Skill Sets IIIFor The Parent I defined an expected behavior I named the expected behavior I chose my behavior, thinking it through I practiced ready, steady, act I practiced “I have a choice” I thought about the next step I spoke the sequence of my actions I wrote the sequence of my actions

Impulsivity Waiting one’s turn Refraining from touching others Keeping one’s hands to self Not grabbing without permission Keeping one’s body still Thinking before you act Managing oral-motor movements Verbalization, waiting one’s turn Speaking in turn

Helping children “do as expected” takes previewing and planning 1. Tell the children what is about to

happen. “We are going outside to play. We will quietly get in line, stand helicopter distance from one another and keep our voices quiet.”

2. Tell them what they can do with their hands and their bodies. “While you are on the playground, keep your hands to yourself as you run, jump and play.”

3. Tell them how they will know the activity is over. “When you hear our ‘secret signal’, you will line up at the red door and we will slowly walk back inside.”

Self-Regulation

Calming Resources SEL www.kimochis.com Physical Movement www.sparkpe.org Repetitive Movement balavisx.com Rhythmic Breathing Take Five Music/Stories Listening www.stressfreekids.com Art Drawing Mandalas Listen to a Raisin – Meditate Vision Therapy

Me Moves

Anger Mountain

Polyspot Stories

The Caveman and The Thinker

Your Child’s Two-Part BrainThe Defensive BrainCollaboration WorksCalm the caveman to engage the thinker

We Calm Down To Think Teach relaxation breathing and self-talk Allow for a break (including a physical

place to calm down) when child encounters a change

Provide warnings (signals) prior to transitions – they can be visual, touch, or verbal

@stressfreekids Lori Lite

Subcortical Structures Sensory Integration, Sensory

Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings Leonard F. Koziol & Deborah Ely Budding & Dana Chidekel Cerebellum. 2011 Dec;10(4):770-92.

Sensory Integration Dysfunction There is considerable overlap

between executive and sensory processing

Both are related to self-regulation Many kids with sensory integration

difficulties also have trouble with cognitive flexibility

Oversensitivity Olfactory – “ewe it smells” Gustation – “It’s gritty mama” Tactile – “Ouch! That hurts” Visual – “There is still light” Sound – “I need to get out of this car!” Motor - “Inside I am just shaking”

A learning story ~ 9 year old Jason There is still light!

Twitter ~ The Research Playground INTERVENTION

@Inclusive_Class @marianne_russo @special-ism @movingsmartnow @micheleborba @talkingteenage @Kiboomu @kidlutions

5 Things About The Teen Brain You were afraid to ask, but need to know

Teen brain growth (neuronal connections) is in spurts and starts The Teen Years Explained: A Guide to Healthy Adolescent Development (Johns Hopkins University, 2009) by Clea McNeely and Jayne Blanchard

Go away! Wait, where are you going? (Separation and Independence)

Why so moody? The limbic interference relates to neuronal growth, hormonal changes and brain re-organization

Why so cliquey? Teens are herd animals… What? Your brakes aren’t working? (Impulsivity and risk

taking and the teenage brain)

Teens and Tweenies Teenage as a second language ~

Barbara R. Greenberg, & Jennifer A. Powell-Lunder

Get out of my life! But first will you take me and Cheryl to the mall ~ Anthony Wolf

Why do they act that way? ~ David Walsh

Food Rules

You are what you assimilate Get back to real whole food Consider amino acids

neurogistics.com

5 Food Rules1. 1 oz water per pound per day2. If it does not rot or sprout do without3. Consider 1-2 oz protein/fats every four hours for children 4. Consider 8-10 servings of color per day (1/2 cup per serving)5. Eat when you are hungry, mostly plants

SLEEPS = Similar bed-time schedule and

routine nightlyL = Light-off, dark, cool sleep

environmentE = Everything off, phone, TV, musicE = Exercise, regularly at least 45

mins dailyP = Preparation and planning

Twitter ~ The Research Playground NUTRITION

@NutritionBlogs @MelissaMcCreey @childobesity (nourish interactive) @ RMNutrition @eatingarainbow www.KidKritics.com www.pathways4health.org

Field Trip!

Play Math is a cortico-cerebellar math program that alternates fine and gross motor movement to teach children ages 6-12 fact families, factors and fractions (Kenney 2012)

Mirror or Skip Count (Balls) Slide and Glide (Blocks) Over and Up (Blocks) How do numbers fit together? What makes a family? Advanced techniques

The Method

Three things children taught me about how they learn math.We build brain connections

with: a. Rhythm b. Fine and Gross Motor

Movement c. Mentoring

Audition and Rhythm For younger kids who have trouble getting

started with the morning or evening routine at home, use a song they like to guide them through

Before starting a seated task, engage in some gross motor activity (quick walk, throw a koosh ball, etc.)

Alex Doman ~ Healing At The Speed of Sound @Kiboomu

The Importance of Play

We Teach EF Through Play Decision making Inhibition Cognitive Flexibility Attention Focus Shift Creativity/Imagination

Gill Connell ~ Play

PLAY: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul by Stuart Brown, M.D.

THE POWER OF PLAY: Learning What Comes Naturally by David Elkind, Ph.D.

PLAYFUL PARENTING by Lawrence J. Cohen, Ph.D. A CHILD'S WORK – The Importance of Fantasy Play by

Vivien Gussen Paley THE ART OF ROUGHHOUSING by Anthony T. DeBenedet,

M.D. and Lawrence J. Cohen, Ph.D.

The Power of Hopscotch HOPPING = MIDLINE DEVELOPMENT For children,

hopping signals sophisticated advances in both physical coordination, balance, AND cognitive development. You see, as your child refines her physical coordination, she is also building essential neural pathways in the brain. It's those exact same pathways which will one day become the conduits for left/right brain thinking tasks such as creativity, reasoning, and self-regulation.

DON'T STEP ON THE LINE = BODY CONTROL STOP & START = BODY RHYTHM LEAPING = MUSCLE STRENGTH SPACES = SPATIAL AWARENESS

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Neurodevelopmental Disorders and Special Population