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Building Blocks - Higher Order Processes

Colorado Kids with Brain Injury - A banner with young kids in primary colors and a colorful brain.

Building Blocks of Brain Development

The higher order thinking skills – executive function and social emotional competency are represented at the blue level.


Executive Function - Initiation

 

Behavioral Impacts

  • Difficulty starting tasks independently
  • Can state what they are supposed to do but does not get started
  • Slow to shift at same time as peers
  • Requires constant cueing
  • Does not make plans academically or socially
  • Appears aloof or disinterested in peers
  • Follower
  • Lagging in independent living skills
  • May appear lazy, unmotivated or spacey
  • Often gets overlooked because they are not trouble in the classroom
  • Seeks out adults for social interaction

Cognitive Academic Impacts

  • Appears passive/resistant
  • Difficulty knowing how to get started
  • Difficulty managing long-range projects
  • Does not complete homework or seatwork
  • Turns in poor quality work
  • Woefully incomplete work

Assessment Suggestions

  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2)
  • Comprehensive Executive Function Inventory (CEFI)
  • Delis Rating of Executive Function (D-REF)
  • Neurocognitive Evaluation Form 
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • Provide a written routine to assist/help student begin work
  • Provide assistance with getting started with school work
  • Provide more frequent check-ins to ensure student is completing work
  • Teach students how to observe others to identify what to do next
  • Use visual imagery to practice the activity steps prior to initiation
  • May need friendship groups or support initiating social interactions
  • See Planning and Organization Building Blocks

Resources and Interventions

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Executive Function - Planning

 

Behavioral Impacts

  • Difficulty with problem solving
  • Doesn’t make plans with friends
  • Rigidity of thinking
  • Often late for class
  • Often unprepared for class

Cognitive Academic Impacts

  • Difficulty organizing thoughts
  • Difficulty with long term assignments
  • Difficulty with sequential tasks
  • Difficulty with time management
  • Difficulty writing papers
  • Doesn’t brainstorm

Assessment Suggestions

  • Cognitive Assessment System, 2nd (CAS2): Planning Scale
  • Kaufman Assessment Battery for Children, 2nd: Planning Ability Scale
  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Attention and Executive Function Subtests
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Block Design
  • Differential Ability Scale, 2nd (DAS-2): Recall of Designs and Block Design
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2)
  • Comprehensive Executive Function Inventory (CEFI)

  • Delis Rating of Executive Function (D-REF)
  • Delis-Kaplan Executive Function System (D-KEFS): Tower Test
  • Trails Making (A&B)
  • Rey-Osterrieth Complex Figure
  • Neurocognitive Evaluation Form 
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

Resources and Interventions

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Executive Function - Organizational Skills

 

Behavioral Impacts

  • Seems confused
  • Copies behaviors of others
  • Difficulty with transitions
  • Easily frustrated
  • Resistant
  • Follower
  • Is disorganized
  • Loses things easily
  • Spacey
  • Conversations may be disjointed

Cognitive Academic Impacts

  • Difficulty with long range projects
  • Unable to do more than one step on a task
  • Doesn’t turn in homework
  • Homework is incomplete
  • Not independent learner
  • Often forgetful
  • Work is messy
  • Difficulties answering open-ended questions

Assessment Suggestions

  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2): Organization of Materials and Planning/Organization Scale (look at specific items)
  • Comprehensive Executive Function Inventory (CEFI)
  • Neurocognitive Evaluation Form 
  • Observations in the environment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • Establish daily routine
  • Check in/Check out system
  • Color code subjects
  • Provide student with step-by-step instructions
  • Report and Talk Aloud strategy
  • Smartphone apps: clock/timer, calendar with reminders, Evernote recordings/pictures/detailed instruction
  • Use of classroom websites with posted notes and assignments
  • Multiple small storage bins; label storage area contents – create routines for use
  • Support between home and school to implement an organization system
  • Teach/support organization skills/systems (folders, planners, etc.)
  • Use of graphic organizers
  • Use a “zipper” folder containing sections for each subject and sections for work “to do”, “completed” etc.
  • Teach goal-directed problem solving process 
  • See Initiation and Planning Building Blocks

Resources and Interventions

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Executive Function - Mental Flexibility

 

Behavioral Impacts

  • Argumentative
  • Concrete thinker
  • Rigid thinker
  • Perseveration
  • Difficulty making friends
  • Difficulty taking feedback
  • Difficulty with transitions
  • Doesn’t like to try new things
  • Lacks empathy
  • Stubborn
  • Issues with understanding the perspective of others

Cognitive Academic Impacts

  • Difficulty coming up with solutions
  • Difficulty deviating from schedule
  • Difficulty shifting between tasks or ideas
  • Difficulty with abstract thinking
  • Doesn’t do what asked
  • Doesn’t learn from mistakes
  • Doesn’t think well on his/her feet

Assessment Suggestions

  • A Developmental Neuropsychological Assessment, 2nd (NEPSY-II): Attention and Executive Function Subtests
  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Picture Concepts, Matrix Reasoning, Comprehension (questions requiring multiple responses)
  • Differential Ability Scale, 2nd (DAS-2): Matrices
  • Woodcock Johnson, 4th (WJ-IV) Test of Cognitive Abilities: Concept Formation
  • Delis-Kaplan Executive Function System (D-KEFS): Sorting, Trail Making, Verbal Fluency, Design Fluency, Color-Word Interference, Tower
  • Wisconsin Card Sort Test
  • Children’s Category Test

  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2): Shift Scale
  • Comprehensive Executive Function Inventory (CEFI): Flexibility Scale
  • Neurocognitive Evaluation Form 
  • Observations in the environment
  • Functional Behavioral Assessment
  • Behavior observations during testing
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • Develop, teach and reinforce routines
  • Block & Box (Sarah Ward)
  • Explicitly teach flexible thinking skills (i.e., warnings, counting down time, timers, practice changing schedule)
  • Guided Self-Reflection
  • Plan for situations that require mental flexibility
  • Teach Stop, Relax and Think
  • Teach coping strategies, belly breathing, mindfulness, meditation, relaxation techniques
  • Social skills groups. Teach perspective taking
  • Use of social narratives
  • See Reasoning and Social/Emotional Competency Building Blocks

Resources and Interventions

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • BrainSTARS Chapter 3 and Blue tabbed section: #10 Mental Flexibility
  • Collaborative Problem Solving (Greene/Ablon)
  • Executive Function in Children and Adolescents, 2nd (Dawson/Guare)
  • Explosive Child (Greene)
  • Lost at School (Greene)
  • Promoting Executive Function in the Classroom (Meltzer)
  • Smart but Scattered (Dawson/Guare)
  • Smart but Scattered Teens (Guare/ Dawson/Guare)

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Executive Function - Reasoning

 

Behavioral Impacts

  • Acts without thinking of the consequences
  • Does not follow through with request to complete tasks
  • Doesn’t think well on his/her feet
  • Followers
  • Lacks common sense
  • Makes poor behavioral and social choices
  • May appear depressed
  • Oppositional
  • Poor social judgment and risk taking behaviors e.g. promiscuity, school suspension
  • Argumentative
  • Stubborn
  • Does not learn from mistakes

Cognitive Academic Impacts

  • Can do rote learning but does not get broader concepts
  • Concrete thinker
  • Difficulty responding to open-ended or essay questions
  • Difficulty with comprehension, e.g. reading, math, written expression
  • Difficulty with math word problems
  • Does better on multiple choice tests
  • Does not generalize information appropriately (over or under generalizes)
  • Does not get the big picture
  • Lacks insight

Assessment Suggestions

  • Wechsler Intelligence Scale for Children, 5th (WISC-V): Fluid Reasoning Index, Picture Concepts, Arithmetic
  • Cognitive Assessment System, 2nd (CAS2): Simultaneous Processing Scale
  • Differential Ability Scales, 2nd (DAS-II): Nonverbal Reasoning Composite
  • Kauffman Assessment Battery for Children (KABC-II): Simultaneous Processing Ability Scale
  • Woodcock Johnson, 4th (WJ-IV), Test of Cognitive Abilities: Number Series, Concept Formation, Visualization, Analysis-Synthesis
  • Test of Problem Solving, 2nd Ed Adolescent (TOPS-2)
  • Test of Problem Solving, 3rd Ed Elementary (TOPS-3)
  • Delis-Kaplan Executive Function System (D-KEFS): Sorting, 20 Questions, Word Context, Proverb
  • Behavior Rating Inventory of Executive Function, 2nd (BRIEF2): Monitor Scale
  • Comprehensive Executive Function Inventory (CEFI): Monitoring Scale
  • Neurocognitive Evaluation Form 
  • Observations in the environment
  • Functional Behavioral Assessment 
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

 

Resources and Interventions

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3) 
  • BrainSTARS Chapter 3 and Blue tabbed sections: #8 Judgment, #12 New Learning, #13 Non-Verbal Learning, #20 Social Skills
  • Executive Function in Children and Adolescents, 2nd (Dawson/Guare)
  • Helping the Child who Doesn’t Fit In (Nowicki/Duke)
  • Lost at School (Greene)
  • Promoting Executive Function in the Classroom (Meltzer)
  • BrainWise (Barry)
  • Bully Proofing Your School (Garrity/Bonds/ Camilli)
  • Circle of Friends 
  • The Incredible 5 Point Scale (Buron/Curtis)
  • Skill Streaming (McGinnis)
  • Superflex: A Superhero Social Thinking Curriculum (Winner)
  • Why Try (Moore)
  • Zones of Regulation (Kuper)
  • BrainLine Kids
  • Center on Brain Injury Research & Training 
  • Project LEARNet 

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Social/Emotional Competency

 

Behavioral Impacts

  • Difficulty keeping and making friends
  • Difficulty reading social cues
  • Difficulty with anger management
  • Emotionally labile
  • Meltdowns
  • Over/under reaction

Cognitive Academic Impacts

  • Cognitive distortions (exaggerated or irrational thought patterns)
  • Difficulty with group learning
  • Emotional pre-occupation that interferes with academics
  • Trouble focusing

Assessment Suggestions

  • A Developmental Neuropsychological Assessment (NEPSY-II): Social Perception Subtests
  • Behavior Assessment System for Children, 3rd (BASC-3)
  • Emotional Disturbance Decision Tree (EDDT)
  • Scales for Assessing Emotional Disturbance, 2nd (SAED-2)
  • Behavior Rating Inventory of Executive Function, 2nd Ed (BRIEF2): Emotional Control Scale
  • Comprehensive Executive Function Inventory (CEFI): Emotional Regulation Scale
  • Children’s Depression Inventory, 2nd (CDI2)
  • Reynold’s Adolescent Depression Scale, 2nd (RADS-2)
  • Revised Children Manifest Anxiety Scale, 2nd (RCMAS-2)
  • Multidimensional Anxiety Scale for Children, 2nd (MASC 2)
  • Conners, 3rd

  • Conversational Effectiveness Profile – Revised (CEP-R): An assessment tool measuring Social Interaction, Social Communication, and Social-Emotional Regulation; socialpragmatics.com
  • Social Skills Rating System (SSRS)
  • Test of Pragmatic Language, 2nd (TOPL-2)
  • School Functional Assessment (SFA)
  • Vineland Adaptive Behavior Scales, 2nd (Vineland-II)
  • Adaptive Behavior Assessment System, 2nd (ABAS-II)
  • Functional Behavioral Assessment (FBA) Behavior observations during testing
  • Neurocognitive Evaluation Form 
  • Observations in the environment
  • Parent, Teacher and Student Interviews

Environmental Supports and Accommodations

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3)
  • Give clear and simple directions
  • Provide, teach and reinforce routines and clear expectations
  • Provide calm down area
  • Discuss and practice age-appropriate behaviors in real life situations
  • Social skills groups
  • Social narratives
  • Teach coping strategies, belly breathing, mindfulness, meditation, relaxation techniques
  • Behavior Intervention Plans
  • See Inhibition, Mental Flexibility and Reasoning Building Blocks

Resources and Interventions

  • Brain Injury in Children and Youth: A Manual for Educators (Chapter 3 and 4) 
  • BrainSTARS Chapter 3 and Blue tabbed sections: #1 Adolescent Self-Regulation, #3 Emotion Regulation, #18 Self-Regulation, #20 Social Skills
  • Collaborative Problem Solving (Greene/Ablon)
  • Explosive Child (Greene)
  • Lost at School (Greene)
  • Tools for Teaching (Jones)
  • Alert Program: How Does Your Engine Run (Williams/Shellenberger)
  • Aggression Replacement Training (Goldstein/Guck/Gibbs)
  • BrainWise (Barry)
  • Bully Proofing (Garrity)
  • Circle of Friends 
  • In Focus (McSheehy)
  • Incredible 5 Point Scale (Buron/Curtis)
  • Incredible Years (Webster-Stratton)
  • Make Social Learning Stick! (Sautter)
  • MindUp Curriculum (Hawn Foundation)
  • Positive Behavior Intervention Supports 
  • Project Achieve – Stop & Think Program (Knoff)
  • Project Success (Kastner)
  • Second Step 
  • Social Thinking Worksheets for Tweens and Teens (Winner)
  • Skill Streaming (McGinnis)
  • Superflex: A Superhero Social Thinking Curriculum (Winner)
  • You are a Social Detective (Winner)
  • Why Try (Moore)
  • Zones of Regulation (Kuper)

View more information on Social Emotional Competency

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Additional Resources

 

  • Helping the Child who Doesn’t Fit In. 1992. Nowicki, S. and Duke, MP. Peachtree Publishers
  • How does your engine run? Alert Program for Self-Regulation. 1996. Williams, MS. & Shellenberger, S. TherapyWorks, Inc.
  • In Focus: Improving Social and Emotional Intelligence One Day at a Time. 2013. McSheehy, T. Burlington, WI: Thoughtful Learning.
  • Incredible 5 Point Scale. 2012  Burone, K. D. & Curis, M. Lenexa, KS: AAPC
  • Incredible Years, Incredible Years Program, Seattle, Washington http://www.incredibleyears.com/
  • *Interventioncentral.org – Interventions, suggestions, tools for social/emotional strategies. www.interventioncentral.org
  • Kidspiration (Grades K-5) & Inspiration (Grades 6-Adult) Software programs – http://www.inspiration.com/
  • Late, Lost, and Unprepared: A Parent’s Guide to Helping Children with Executive Funtioning. 2008. Cooper-Kahn, J. & Dietzel, L. Bethesda, MD: Woodbine House, Inc.
  • *LEARNet, Ylvisaker, M, HibbardM & Feeney, T. www.projectlearnet.org
  • Lifeskills Training http://www.lifeskillstraining.com
  • Lost at School: Why Our Kids with Behavioral Challenges are Falling Through the Cracks and How We Can Help Them. 2014. Greene, R.W. New York, NY: Scribner.
  • Make social learning stick!: How to guide and nurture social competence through everyday routines and activities. 2012. Sautter, E. Shawnee Mission, KS: AAPC Publishing.
  • The MindUp Curriculum: Brain Focused Strategies for Learning and Living. 2010. Hawn Foundation. New York, NY: Scholastic Teaching Resources.
  • *Positive Behavior Intervention Support. https://www.pbis.org
  • Project Achieve: Stop & think social skills program. 2001.  Knoff, H. Longmont, CO: Sopris West.
  • Promoting Executive Function in the Classroom. 2010. Meltzer. L. New York, NY: Guilford Press.

  • Providing Alternative Thinking Strategies (PATHS), Kusche, C. and Greenberg, M., Channing Bete Company.
  • Sarah Ward: Cognitive Connections: 360 Thinking.  http://efpractice.com/
  • SecondStep: Skills for Social and Academic Success. 2011. Goldstein, A & McGinnis, E. Research Press Publishers http://www.cfchildren.org/second-step SkillStreaming.
  • Smart but Scattered. 2009.  Dawson P & Guare R. NY: Guilford Press.
  • Smart but Scattered Teens. 2013. Guare, R., Dawson, P. & Guare. New York, NY: Guilford Press.
  • Social Thinking Worksheets for Tweens and Teens. 2014. Garcia Winner, M. San Jose, CA: Think Social Publishing, Inc.
  • Superflex: A Superhero Social Thinking Curriculum. 2008. Madrigal, S. & Garcia Winner, M.  Think Social Publishing.
  • Teachers Encyclopedia of Behavior Management 100 Problems/500 Plans. 2012. Sprick, R and Howard, L. Pacific Northwest Publishing
  • *Think:Kids – Rethinking Challenging Kids. Massachusetts General Hospital.  http://www.thinkkids.org/
  • Tools for Teaching, 3rd Edition. 2013. Jones F. CA: Frederic H Jones & Associates, Inc.
  • Treating Explosive Kids: The Collaborative Problem Solving Approach. 2005. Greene, R.W. & Ablon, J.S. New York, NY: Guilford Press.
  • Visual Spatial Portals to Thinking, Feeling and Movement 2012. Wieder, S., & Wachs, H. Mendham, New Jersey: Profectum Foundation
  • *What Works Clearinghouse. 2002. U.S. Department of Education, Institute for Education Sciences.   www.whatworks.ed.gov
  • Why Try – Building Resilience in the Workplace, at School and at Home.  Moore, C. https://www.whytry.org/
  • You are a Social Detective. 2008.  Garcia Winner, M. & Crooke, P. San Jose, CA: Think Social Publishing, Inc.
  • The Zones of Regulation: A Framework to Foster Self-Regulation & Emotional Control. 2011. Kuypers, L. San Jose, CA: Think Social Publishing.

Building Blocks of Brain Development & Glossary Developers/Authors (2018): Nicole Crawford, Patricia Colella, Judy Dettmer, Heather Hotchkiss, Karen McAvoy, Peter Thompson, Janet Tyler. Special Thanks to Tami Cassel, Donna Detmar-Hannah, Laura Dosch, Jayne Dougherty, Mary Linz, and Jennifer Mathis.

Revise only with permission.

Revised Brain Injury Matrix & Glossary Developers/Authors (2015): Nicole Crawford, Patricia Colella, Donna Detmar-Hannah, Judy Dettmer, Heather Hotchkiss, Corey Klein, Karen McAvoy, Peter Thompson, Kristy Werther.

Traumatic Brain Injury Networking Team Steering Committee (TNT)-Original Developers/Authors of the Brain Injury Matrix (2012): Nicole Crawford, Judy Dettmer, Jeanne Dise-Lewis, Priscilla Hurley, Megan Koepsell, Karen McAvoy, Kathy Patrick, Peter Thompson, Liz Wilburn.