1 executive Function Fixes5 Michael Uram MA, LMFT, LPCC executive Function Fixes

2 Tonight is about solutionsThere are 5 Fixes. They are doable, realistic, and real world oriented. There are plenty more though… With dedicated effort, EVERYONE in this room is able to improve their organization, focus and task completion skills.

3 Am I too old to change? According to Peg Dawson, No. When we learn new executive skills, our neurons develop new pathways through myelination, which is more difficult as we age, although far from impossible.

4 The 5 Clinical ApproachesExternalize Information Externally Represent or Remove Gaps in Time Externalize Motivation Intervene at the Point of Performance in Natural Settings Intervene at the Most Disrupted Level

5 Talk about your feelingsThe 5 Fixes Schedule Everything Reward Yourself Often Use Positive Self Talk Share Your Plan Talk about your feelings

6 Externalize InformationThe provision of Physical representations of that information will be needed in the setting at the point of performance. Since covert or private information is weak as a source of stimulus control, making that information overt and public may help strengthen control of behavior by that information. Do not nag the person or allow them to fail and learn from their mistake… The solution is to fill the immediate context with physical cues comparable to the internal counterparts that are proving so ineffective. (Barkley, Pages )

7 Fix 1 Input every single activity that you do on your phone’s calendar and backup the calendar.

8 Plan out everything… From the time that you wake up until the time that you go to bed, put everything on your schedule, EVERYTHING!!!!! The more that is written down, the more that we can know exactly what are expectations are and structure it to the point that nothing falls through the cracks. This includes showering, breakfast, drive times, meetings, lunch, family events, appointments, calls, checking … Did I mention that it had to include EVERYTHING!!!!!

9 Backup your phone (Your life)So many people that struggle with Executive Functioning Skills Lose the most important things to them, whether it is their keys, their phone or their paperwork. Losing everything on your phone can greatly complicate your life… One quick fix is to backup your phone, so whatever is lost can easily be replaced. On an iPhone, Pay 99 cents per month for 50GB of backup space and have a automatic phone backup. If your phone is lost, you login to iCloud and everything is right there to be restored on your new phone. Android is just about as easy and free using Google Backup and Android Backup Service. For more details, please read this article: perfect-data-backup-for-the-1-5/

10 Externally Represent or Remove Gaps In TimeIf one has little regard for future events, then much of one’s behavior will be aimed at maximizing the immediate rewards and escaping from immediate hardships or aversive circumstances without concern for the delayed consequences of those actions. Those with deficient EF could be assisted by making time itself more externally represented and by reducing and or eliminating gaps in time among the components of a behavioral contingency (event, response, outcome) We can also reduce or eliminate these problematic time-related elements of a task when feasible. Rather than tell the person that a project must be done over the next month, assist him with doing a step a day toward that eventual goal so that when the deadline arrives, the work has been done but done in small daily work periods with immediate feedback and incentives for doing so. (Barkley Pages )

11 Fix 2 Track your daily progress by having simple goals and rewards written in for each day.

12 7:00 PM – Replace light in hallway FIX 2 Example 7:00 PM – Replace light in hallway 7:10 PM – Watch TV Show on Netflix after the light is replaced.

13 Externalize MotivationInternalized, Self-Generated Forms of motivation are weak at initiating and sustaining goal-directed behavior; Externalized sources of motivation, often artificial, must be arranged within the context at the point of performance These compensatory, prosthetic forms of motivation must be sustained for long periods. If the external motivation is removed, the behavior will not be further sustained, and the individual will regress to more erratic goal-directed behavior with less ability to sustain actions toward tasks and goals. Clinicians can intervene through these 5 vectors: situation selection, situation modification, attentional control/redirection, reappraisal, and response modification/ suppression. (Barkley Page 203)

14 Externalize motivationVarious cognitive behavioral therapies may prove useful at the reappraisal pathway. Bauer and Baumeister (2011) stated that research indicates that each implementation of Self regulation (working memory, inhibition, planning, reasoning, problem solving, etc.) depletes this limited resource pool temporarily such that protracted SR may greatly deplete the available pool of effort. To Replenish the Pool, Barkley outlined a few interventions on Page 205 I will give one example… (Barkley Pages )

15 FIX 3 While doing any task, notice and use self talk to point out any positive skills or traits that you are currently using.

16 Intervene at the Point of Performance in natural settingsOnce per week counseling is unlikely to succeed with the patient with deficient EF without efforts to insert accommodations at key points of performance in natural settings to address the impaired domains of major life activities. Russell Barkley recommends medication as the most effective intervention for this EF deficit. I recommend technological interventions and texting with your counselor at those specific times. Amazon sells Bluetooth watches that sync with your phone, with reminders for as little as $5 (U8 Watch) and to schedule texting your therapist after the task is accomplished, while your therapist texts you back if they did not hear back from you by a certain point. Accountability during the point of performance is a great motivator.(Barkley Pages )

17 Fix 4 Arrange with another person to text them after you have accomplished a task. They will share in the excitement when it is accomplished, and you would have a much greater chance of success.

18 5. EMOTIONAL REGULATION I have many clients that get emotionally drained by their day and overbook themselves. Take 3 minutes throughout the day to do an emotions check. When our emotions are intense, our calendar goes out the window… Breaks are important. Breaks can include: meditation time, playing games on your phone; browsing the internet, going for a walk, etc.

19 Emotional Regulation For adults with ADHD, it is reasonable to block out small chunks of time and breaks regularly. Talk about emotions with the other people in your life, don’t ignore them, they come back intensely. Identify emotions and come up with a plan to address them. If you don’t, you will likely be exhausted most of the day, sitting at your computer, on your couch or on your bed…

20 Pay attention to and Talk about your feelingsFix 5 Pay attention to and Talk about your feelings

21 Bonus fix - Impulse ControlYou are likely going to have strong urges to resist accomplishing your own goal. Here are some suggestions to deal with that drive to avoid the task: When you are avoiding it, remind yourself of how much of a priority the task represents. Prioritized behaviors that are in line with values that you care about will likely increase your motivation and you may have much more energy… If you do the avoidance behavior, do it for an extended period of time, even when you are ready to get back to work, it will help you to understand how absurd it is to avoid doing something that you care about. When the urge to do anything but the task happens, notice it and allow it to go away by postponing the distraction by one minute, and seeing if the urge subsides.

22 Resources “Executive Functions” What They are, How They Work, and Why They Evolved by Russell A. Barkley PhD, ABPP, ABCN website: russellbarkley.org “The Smart but Scattered Guide to Success, How to Use Your Brain’s Executive Skills to Keep Up, Stay Calm, and Get Organized at Work and at Home”” by Peg Dawson, EdD and Richard Guare, PhD website: smartbutscatteredkids.com Bauer, I.M., & Baumeister, R.F. (2011) Self-Regulatory Strength For More Information on Michael, please visit: Michaeluram.com