Thank you to Tara Roehl, MS,CCC-SLP for writing this guest post for the SpeechladyJen Blog community. You can find Tara's blog at http://www.speechykeenslp.com/.
Teenagers with executive functioning difficulties often struggle to know what is important to attend to in their environment. Between their academic demands, social expectations and familial roles, information is coming at them a million miles a minute. The breakdown can happen in a variety of aspects of their daily life, which is why it’s often difficult for therapists to know where to begin and how to best help the myriad of difficulties associated with these executive functioning delays. Sarah Ward, a speech therapist and executive functioning specialist, speaks about the need to increase our students’ awareness to improve their executive functioning skills throughout the day. She labels the four key area of awareness using the acronym STOP.
S is for Space: awareness of the area they are in, what is happening around them
T is for Time: awareness of what is happening in the moment, what will happen next
O is for Objects: the organization of things, why they are organized that way
P is for People: reading the people in your environment
I have used these four areas to informally assess student’s abilities and plan therapy sessions. This strategy has helped my students understand their environment and employ successful executive functioning skills into their daily life. Some of my students will be successful in at least one of these areas, but without all four they struggle to use higher order thinking. This manifests itself in impulsivity, disorganization and stress for them and those who support them. In this article I will discuss the first two: Space and Time.
Assessment: To begin, I will demonstrate drawing out a floor plan of a space, typically using the therapy room. I then ask them to sketch out a room that they have spent a lot of time in. This could be a classroom, their bedroom or even a waiting room. Some students are very aware of their environment and do a great job with this task. But for a lot of my students, it shows me how much awareness they lack. By lacking understanding of the spaces they occupy on a regular basis, they struggle to see organization around them and how to work inside of that space.
Therapy: If this is an area of struggle for a particular student, I will tailor my therapy session to begin in this domain. Without an awareness of the space they are in, the remaining domains fall apart. Some therapy activities include mapping out the organization of their room, the fridge, a local grocery store, etc. The goal is to help them see the organization in spaces around them, which in turn can lead to lessons in maneuvering through environments and “reading the room” in new situations. An important key feature is to keep lessons visual. By cutting down on the amount they have to read, you cut down on how much they need to interpret. In my sessions, we’ll work off of pictures to break down the organization of a classroom by circling and labeling. In one group I walked to a local mini-mart four times in a single session until a student was able to identify key elements of that environment (ex: cashier, drink dispensers, coolers, etc.)! Later on, you can repeat this activity, but by adding in the other three domains to the exercise (ex: where are the people, what goes in each aisle, are people taking their time or in a hurry).
Assessment: Ask your student to write out their daily schedule and/or how long it takes them to complete daily tasks (ex: walking from their locker to third period, walk from the front door to their first class, etc.). This quick exercise alone will allow you to assess their awareness of time as it impacts them throughout their day. All of my students struggle with time in some fashion. Some cannot change their own speed based on their environment (e.g. mom is moving fast, I need to hurry), while others have little realization of the amount of time tasks take.
Therapy: Technology has been a huge asset in helping students understand this realm of executive functioning. Setting up their schedule on their smart phone is a great way to help them monitor their day. To do lists with auditory alerts help students set up a reminder system while also reminding them of their reminders! We will do a variety of tasks and time ourselves, noting how long they actually take and problem solving how we need to adapt our day to accommodate the time each tasks takes. WE practice moving “quickly” to class verses “taking our time” and then I help the adults in their environments (teachers, parents, therapists) know how to communicate to them the change in expected speed throughout their day.
The benefit of executive functioning therapy is that, when it is tailored to the specific difficulties of our students, we can see steady improvement over time. The goal is to keep your focus on the concepts you want to teach, and not just the skill. By teaching the students a skill, you limit the usefulness of your lessons to specific situations. When you teach the concepts, and help them learn how to help themselves, you are preparing them to use executive functioning concepts throughout their life.
Tara Roehl is a nationally certified Speech-Language Pathologist. She works in a private practice clinic focusing on the social/pragmatic needs of students with ADHD, High Functioning Autism, Aspergers and related disorders.