I feel like people say, "Did you know that the brain isn't fully formed until 25!?" often as a "shocker-did-you-know" fact. Yes, in fact, newest studies are showing that the pre-frontal cortex may not even be fully formed until our 30s. So, what gives? Aren't we fully functioning adults at the age of 18?
While we are responsible for our own decisions legally at the age of 18, the frontal lobe of our brain, or the portion right behind our foreheads, takes significantly longer to fully develop. This part of our brain is responsible for executive functions. Executive functions are the tasks of anticipation, inferencing, planning, selecting goals, self-monitoring, taking and using feedback, and completing purposeful activities. If you are like me and are a 30-something (or older), you can see that the use of these executive functions definitely did not develop fully until at least your mid-twenties. This does not mean that you cannot make good decisions, be mature, or lead your life in a purposeful way, but something about your way of thinking, impulse control, and decision-making definitely slows down the older you get.
So, you may be asking yourself why on earth I am mentioning all of this on a speech therapy blog. Well, unfortunately, where the frontal lobe sits in our brain, it is very susceptible to damage. You may be thinking back on all of those times you got hit in the head with a ball in gym class (Is that just me?) or that time you got a "mild-concussion." However, not only are we very susceptible to getting injured externally, but also internally our frontal lobes rest against bony areas of our skull and are easily bruised or damaged that way. Damage to our frontal lobes may cause emotional, behavioral, and cognitive problems. Particularly, executive functions are affected.
Executive functioning is a term that we use to portray a collective functioning of our brain to perform higher level tasks. Some argue that the frontal lobe is what makes humans human. Executive functioning helps us to see outside of ourselves, think about the future, learn from the past, and take information in to figure out what is going on. You can see why damage to this area may have a big impact on your life and why you may want to get additional help if damage does occur.
It should be said that problems with executive functioning do not just happen from external trauma. Brain anomalies (i.e.: tumors), other medical disorders (i.e.: stroke, poor circulation/oxygenation), some drugs (i.e.: illicit drug use, cancer drugs, some prescription drugs), or a developmental disorder or syndrome (i.e.: autism, speech and language disorder) may be the cause of executive functioning disorder.
Now, again to the main question you may have: why on earth do I care as an SLP? Well, I work on executive functioning and cognition in my scope of practice because it is a necessary function of typical language. So, what do I do if I get a client with executive functioning disorder.
First, I take the patient's history. If there a history of traumatic brain injury, concussion, stroke, or other brain injury? Are there any previous diagnoses, speech and language and otherwise? Did their mother have a normal pregnancy and delivery? Did they spend any time in the NICU when they were born? Is there a history of drug or alcohol use, whether from they themselves or their mother during pregnancy? Have there been any serious illnesses? The reason I ask all of this is not to get a personal history from you, to make any judgement about you, or determine how to charge you. It is simply to get a full picture of what the cause of the executive functioning may be and how to proceed with a diagnosis and treatment. It benefits everyone by telling the truth on patient history forms. Remember, we as practitioners cannot discuss your personal information with anyone without your expressive and written consent.
Next, I will administer as assessment to determine the areas of executive functioning you or your child is having difficulty with. This including: orientation (know the day, month, year; your name, age, birthday; etc.), attention span, memory (long-term, short-term, and working memory), word retrieval, reading comprehension, reasoning skills, inferencing skills, ability to understand figurative language (ex: idioms, puns, jokes), sequencing skills, problem solving, and mental flexibility. I may also assess math skills, reading speed, and other higher-level functioning tasks.
Once I have established the areas of need, I come up with a treatment plan. The key focus is on functional outcomes. This means, what are the long-term goals of therapy knowing that executive functioning may be difficult for the rest of the client's life. This is of course determinate on the severity of dysfunction. Mainly, we teach strategies to complete tasks (tools, plans, or methods to help aid an individual to complete daily tasks) and teach clients how they are thinking, helping them to fill in the gaps.
General treatment guidelines for a person with executive functioning disorder, from the book, The Source For Executive Function Disorders by Susanna Phillips Keeley (published by LinguaSystems) are also good tidbits of advice for loved ones. Those general guidelines include:
Without further ado!
While we are responsible for our own decisions legally at the age of 18, the frontal lobe of our brain, or the portion right behind our foreheads, takes significantly longer to fully develop. This part of our brain is responsible for executive functions. Executive functions are the tasks of anticipation, inferencing, planning, selecting goals, self-monitoring, taking and using feedback, and completing purposeful activities. If you are like me and are a 30-something (or older), you can see that the use of these executive functions definitely did not develop fully until at least your mid-twenties. This does not mean that you cannot make good decisions, be mature, or lead your life in a purposeful way, but something about your way of thinking, impulse control, and decision-making definitely slows down the older you get.
So, you may be asking yourself why on earth I am mentioning all of this on a speech therapy blog. Well, unfortunately, where the frontal lobe sits in our brain, it is very susceptible to damage. You may be thinking back on all of those times you got hit in the head with a ball in gym class (Is that just me?) or that time you got a "mild-concussion." However, not only are we very susceptible to getting injured externally, but also internally our frontal lobes rest against bony areas of our skull and are easily bruised or damaged that way. Damage to our frontal lobes may cause emotional, behavioral, and cognitive problems. Particularly, executive functions are affected.
Executive functioning is a term that we use to portray a collective functioning of our brain to perform higher level tasks. Some argue that the frontal lobe is what makes humans human. Executive functioning helps us to see outside of ourselves, think about the future, learn from the past, and take information in to figure out what is going on. You can see why damage to this area may have a big impact on your life and why you may want to get additional help if damage does occur.
It should be said that problems with executive functioning do not just happen from external trauma. Brain anomalies (i.e.: tumors), other medical disorders (i.e.: stroke, poor circulation/oxygenation), some drugs (i.e.: illicit drug use, cancer drugs, some prescription drugs), or a developmental disorder or syndrome (i.e.: autism, speech and language disorder) may be the cause of executive functioning disorder.
Now, again to the main question you may have: why on earth do I care as an SLP? Well, I work on executive functioning and cognition in my scope of practice because it is a necessary function of typical language. So, what do I do if I get a client with executive functioning disorder.
First, I take the patient's history. If there a history of traumatic brain injury, concussion, stroke, or other brain injury? Are there any previous diagnoses, speech and language and otherwise? Did their mother have a normal pregnancy and delivery? Did they spend any time in the NICU when they were born? Is there a history of drug or alcohol use, whether from they themselves or their mother during pregnancy? Have there been any serious illnesses? The reason I ask all of this is not to get a personal history from you, to make any judgement about you, or determine how to charge you. It is simply to get a full picture of what the cause of the executive functioning may be and how to proceed with a diagnosis and treatment. It benefits everyone by telling the truth on patient history forms. Remember, we as practitioners cannot discuss your personal information with anyone without your expressive and written consent.
Next, I will administer as assessment to determine the areas of executive functioning you or your child is having difficulty with. This including: orientation (know the day, month, year; your name, age, birthday; etc.), attention span, memory (long-term, short-term, and working memory), word retrieval, reading comprehension, reasoning skills, inferencing skills, ability to understand figurative language (ex: idioms, puns, jokes), sequencing skills, problem solving, and mental flexibility. I may also assess math skills, reading speed, and other higher-level functioning tasks.
Once I have established the areas of need, I come up with a treatment plan. The key focus is on functional outcomes. This means, what are the long-term goals of therapy knowing that executive functioning may be difficult for the rest of the client's life. This is of course determinate on the severity of dysfunction. Mainly, we teach strategies to complete tasks (tools, plans, or methods to help aid an individual to complete daily tasks) and teach clients how they are thinking, helping them to fill in the gaps.
General treatment guidelines for a person with executive functioning disorder, from the book, The Source For Executive Function Disorders by Susanna Phillips Keeley (published by LinguaSystems) are also good tidbits of advice for loved ones. Those general guidelines include:
- Understand how the impairment affects a person's understanding, integrating, and retaining information
- Simplify information for the person, including written information
- Give many practice trials for tasks and slow down rate of presentation
- Listen actively to the person with executive functioning disorder; tailor their treatment and environment based on the information they are giving you.
Without further ado!
- Write it down. Write all important information down! This includes using a calendar, making grocery lists, writing memos so you don't forget your lunch in the morning (just me?) Think of it this way: can you remember phone numbers, what you are doing after work 3 Thursdays from now, or how to spell your doctor's last name with 13 letters without writing it down? Well, people with executive functioning disorder need to write even more information down so they do not forgot!
- Break information into smaller chunks. I always use the example of a phone number. Remembering 10 numbers in a row is hard. But when we break it into 3-3-4, it is a lot easier. This goes for other information as well. If you need a person with executive functioning to follow a 3-step direction, try breaking it into easier directions to be able to get the task done. For example, if you tell your husband who has executive functioning disorder, "I need you to clean the bathroom. Clean the toilet with the Mr. Clean under the sink, get the grime off of the shower head with the de-lyming agent, and don't forget to clean the mirror." You may want to simplify (ex: Can you clean the bathroom?) or break it into 1-step directions as he completes them. Additionally, going back to our last suggestion, you can write steps down, making sure he is doing them one-at-a-time.
- Make Associations. For this, I suggest trying to remember harder information by thinking of something you already know. For example, I tell people, "My name is Kathleen. Have you ever known someone named Kathleen or Kathy? If so, think of that person when you see me and it will help you remember my name!" I usually talk about mnemonic devices at this point too (like My Very Eager Mother Just Served Us Nachos is a way to remember the planets in the solar system). A good way to think about this would be if you needed paper towels, paper plates, and napkins at the store. It may be easier for someone to remember PPN or to remember that you need three things made out of paper.
- Make a picture in your head. Typically, this has to do with comprehension and retention of information. To go back to the cleaning the bathroom example, were you picturing everything I wrote? The more vivid and detailed you make that picture in your head, the more likely you are to remember. I work on this with children in terms of following multiple-step directions. I tell them, "Make a movie in your head of you doing these things."
- Repeat. I saved the best for last. Repeat information. A lot. Try not to get too frustrated by how many times you may need to repeat directions, readings, lists, and other information. Teach the person to advocate for themselves and ask for repetition of information in they need it.
Until next time!
Kathleen
Comments
Post a Comment