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What Are the Touchstone Principles of Treating Those With Executive Dysfunction?

Tere Bowen-Irish, OTR/L

May 1, 2023

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Question

What are the touchstone principles of treating those with executive dysfunction?

Answer

Touchstone Principles

  • My favorites are:
    • “Touch More and Talk Less” 
    • “Act, Don’t Yak”
  • Holding information in their mind and using it isn’t always easy. Use lists and visual memory references as much as you can.
  • Self-awareness cueing, as they need to improve this trait. He suggests video reviewing both the expected and unexpected behaviors, a non-verbal cueing system between him and the adult.
  • Don’t call on, unless hand is raised (may have word retrieval challenges)

Barkley (2012) calls these the touchstone principles. One of my favorites is "touch more and talk less." When you are checking in with a student, decrease the verbiage, go over, look at them, give them a thumbs up, or put your hand on their forearm. When you do that, you are not becoming Charlie Brown's mother going "wah-wah, wah-wah."

Another favorite is, "act and don't yak." He talks about  point of performance coaching. You may have a kid with his deadphones (headphones with no sound) on, his desk turned around, and a worksheet in front of them. All you might need to do is point to number one on the page and say, "Do that one. Raise your hand when you finish."

When they have to hold information in their mind, we need to give them a lot of lists and visual memory references. It could be a point of performance for each subject or a room poster like what bus they are on or the steps they have to do when they turn in their homework.

The other part is self-awareness cueing. Barkley says that the child should be videotaped in the classroom. The idea is to have them look at what they are doing at certain points, and tell you where they went sideways or what they could have done differently.

Another cool thing is cueing. Many of these kids do not want their names being called seven times in 30 minutes. "Julie, Julie, Julie sit, Julie sit down." Julie is going to tune you out. Instead, go over to her and say, "Remember, if you need me, turn your paper over. I will be scanning the classroom and will come by if you need that help."

The other part Barkley talks a lot about is word retrieval. Do not call on kids with prefrontal cortex challenges if their hand is not raised. They are going to feel put on the spot, and some of that emotional dysregulation may show its ugly face. There is a YouTube video by a talented young woman called "Doing ADHD" that I highly recommend. In it, she talks about hand raising.

Barkley, R. A. (2012). Executive function: What they are, how they work, and why they evolved. The Guilford Press.

 

This Ask the Expert is an edited excerpt from the course, Executive function and its application to occupational therapy in school based treatment, by Tere Bowen-Irish.

 


tere bowen irish

Tere Bowen-Irish, OTR/L

Tere Bowen-Irish has been practicing occupational therapy for over 40 years in pediatrics and psychiatry. Tere provides assessment, treatment, and collaborative services in public and private school systems. Through her business, All the Possibilities Inc., she offers workshops for therapists, parents, and educators focusing on service delivery, classroom management, mindfulness, wellness, and prevention for all school-age children. Tere is also the creator of The Drive Thru Menu Suite of Exercises (published by Therapro), an initiative to bring movement into today’s classrooms. She is a certified YogaKids Inc. teacher and incorporates creative movement and yoga into her practice. She is a Certified Mindful Schools Instructor. She is also the author of Yoga and Me, Come be a Tree and co-authored My Mindful Music with Mary Ann Harman.


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