98: The Benefits of Executive Function Training for Occupational Therapists
Executive Function Brain trainer podcast features guest Diane Randall from pediatric occupational therapy
Erica: Welcome to the Executive Function Brain trainer podcast. I'm Dr. Erica Warren.
Darius: And I'm Darius Namdaran. And we're your hosts, sponsored by ivvi. Imagine turning your meeting's audio into a live mind map instantly so you remember what matters. Well, try Ivy for free now at ivvi.app. That's, ivvi.app.
Erica: sponsored by the Executive Functions Coaching and Study Strategies certification course, a comprehensive training for educators, coaches, and parents. I am so excited today to have Diane Randall with us. And Diane is an executive functioning coach, but she also works in a pediatric occupational therapy clinic. And she's here today to talk to us about the benefits of executive functioning training for occupational therapists, or OTs. Sometimes people call them. So, Diane I was fortunate enough to meet. She took my executive functioning course and we're becoming fast friends. So I am going to pass it over to Diane, who really has a, really interesting expertise and vantage point that I really think people will find a lot of gems. Gems in this conversation.
Diane, finishing executive functioning training for occupational therapists was amazing experience
So, Diane, tell us a little bit about what your thoughts are on the benefits of executive, functioning training for occupational therapists.
Diane: Well, first I'd like to say how excited I am to be able to talk to you. Just finishing the course that you did with the strategies and the executive functioning coaching was an amazing experience for me and really taught me things that I hadn't really considered even working within the occupational therapy world for the last 17 years. There were things in there that I thought, wow, I could really use this. And I just can't say enough about it. It's really been a wonderful experience.
Erica: Fantastic. Fantastic. And, yeah, and you definitely have a really interesting spin on executive functioning because of your background. So that's what I'm really curious about diving into today. I'll let you start the discussion in whatever way you feel comfortable.
Diane: Sure. I mean, I, feel that we have to kind of define occupational therapy a little bit because it's not one of those professions that comes to mind and people know exactly what it is. I've had people try to guess what it is, and it's usually not correct.
Erica: Right. Everyone thinks like a. Like a job coach.
Diane: Yes, I'm.
Erica: Because you're helping people on finding their occupations. But that's a complete misnomer.
Diane: Right. And occupation really is participation in life, daily life, not necessarily isolated skills. You know, it's about participation in your environment, the home, school, work, community, and occupational therapists and therapy assistants. We all work in this world where we have to look at executive functioning, but we don't necessarily call it that. So. So I feel like there's a need to maybe bring more awareness to the fact of what we're doing because I think it justifies, you know, what we do as a profession, but also helps with documentation and justification for insurance, which is always the issue nowadays. And. Yeah, so I'm really excited to talk about it.
Erica: Well, and you bring up a really interesting point. I mean, occupational therapists can bill insurance, executive functioning coaches can't. Unless you have another expertise that allows you to bill insurance. And they're billing it as something else. But yeah, occupational therapy I've always had a real admiration for. I think that they're doing such valuable work and in a way that's very different than other professionals, because I think so many professionals in this realm of psychology education lens, they're just working on the brain and you guys really integrate the body and the brain. And that is something that I think is vitally important and it's something that is often missing in education. And that type of therapy for children who are, who have these motor issue is, is so important because the brain and the body are not two separate entities. They are very much interrelated. And so I find that your work is extremely important in the development and then even the rehabilitation too, of individuals.
Diane: Yes, I agree. And I feel like, what's so great about the profession is that we take such a holistic approach
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Diane: to patients and clients and there's really no limit to what we can actually do and work on. You know, our creativity is only limited by us. And I feel like it's just one of those professions that can just, you know, you never get bored, you know. Yeah, yeah, you just keep learning, and you keep doing and you keep trying different things and you see the way that it impacts the patients, and it makes it all worth it, you.
Erica: Know, and it's really interesting because what I've noticed in education is the areas that they keep cutting are the areas that are vitally important, like kinesthetic learning, like gym, like art, like some of the hands-on stuff. You know, it's just we've moved farther and farther away from integrating the body. And for those kids, the, that are in those environments and need it. Occupational therapy is vital.
Diane: It is. And you bring up being able to move your body. You know, that's very important with executive functioning. It's how it's built, really. You have to integrate that motor and, you know, many of the things that I even do in the clinic are motor based because I've found that that is the best way to work on executive functioning skills. It's not necessarily sitting down with a worksheet or even the knowledge of it. You have to practice it and that's always a good way to do it.
Erica: And it brings in the fun factor. And I know you and I totally get along when it comes to that. That we both really feel that play is vital. I mean how education has taken play out of learning it. Oh, just breaks my heart because that's what makes it engaging and fun and investing. Right. We want our kids to invest in learning, but somehow if we take play out of it, it's no longer fun and then that's when kids start to check out.
Diane: Yes. Well, we all, even as adults, we want to be motivated to do the things that we want to do and to learn. And we can't expect our kids not to have some type of motivation to want to do the things that are hard. And play actually addresses that. And it changes part of our brain in a way that it makes it more receptive to maybe things that are a little bit more difficult. So I find that's a really good strategy to use. And it's part of coaching; it's part of OT. It's really a part of a lot of different professions, but I think it's really important. Oh.
Erica: and I think it's not a part of enough professions.
Erica: You know, we have to let kids be kids. We can't take away their childhood, but we also don't want to take away play. Because even as adults it's just important. It's important to have some play and kinesthetics and all of those things. You know, if we're stagnant too long, it's interesting. We don't survive.
Diane: Yes. And play is not just for childhood; it is for adulthood as well. And although I don't work with adults right now, I do know that that is incredibly important. It looks a little different maybe than it would in early childhood, but it is equally important and it's actually preventing that loss of executive functioning skills that happens naturally over the course of time. Right.
Erica: Because even if you're dancing, you have to remember a sequence of steps that's executive functioning. You have to organize; you have to compose. What, particularly if you are dancing by yourself. I mean, so it's, it's. Yeah, it's really, really interesting that I think that was a great definition of occupational therapy too.
Executive functioning is one area where occupational therapy and school can overlap
Is there anything else about occupational therapy you'd like to share with the audience to make it a clearer of what it is.
Diane: Yeah, so I feel like occupational therapy gets pigeonholed a little bit into just, oh, you know, you help people put their pants on or just ADL's and things like that. But there's this whole other part IADLs where, you know, you could do, do cooking tasks and we're talking about adults here, but when it comes to kids, it, it really runs the gamut. We, you know, if you work in schools, it looks a little different than when you're in a. More of a medical clinic. Where I am in schools, the academics take precedent and the goals that are created for a child that's in a, in an academic setting. The occupational therapy goals are very succinct to that. It's like access to school, you know.
Erica: And then when m. You fine motor.
Diane: So they can write correct or handwriting, anything like that. But when you get into a clinic, more of a medical, you can do those things as well, but you can expand on those and really get creative, I think in a way that maybe you can't in school sometimes. So I, I feel like some parents will pursue going to a clinic like mine in addition to the occupational therapy that they get in
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Diane: school because they do know that it's not all one thing.
Erica: Share some activities that you do in your clinic that you wouldn't necessarily get in a school.
Diane: Well, and I hope I'm not misrepresenting anybody who does things in school because they possibly could be doing these things and I don't know, but from the people that I've talked to, maybe some more like dressing anything where there's access, you know, the child is having difficulty just putting on shirts and pants and you know, all of those ADL's and things. I don't know.
Erica: I'm sorry to interrupt you, when you say ADL, can you tell everybody what that means?
Diane: Yes. Activities of daily living.
Erica: Ah, okay.
Diane: So it's basically just, you know, being able to do your routine in the morning. So brushing your teeth, putting on, ah, a shirt, being able to button it, putting on your pants, your shoes, following a routine in the morning, things like that. Those are things that we can tackle maybe in a clinic setting a little easier than it would be in a school setting, because in schools they're dealing with what's happening during the day and unless it's impeding their academic progress in some way, it probably won't be a goal for them. So that's in some Ways how you have to think about that.
Erica: I think that's a great way of putting it. Yeah, yeah. And I think a lot of the kids that have the executive functioning problems in school are the ones that have those same executive functioning problems at home. And you're right, those daily living tasks that do require those executive functioning skills. Listening skills, attention, cognitive flexibility. Yeah, all those, all those things.
Diane: And I do think executive functioning is one area where those things completely overlap. Because what we're seeing in the clinic and what you're seeing in, in schools, in an occupational therapy context, they really do overlap. You know, you're going to see some of that maybe time management issues or organization or anything that runs the gamut for executive functioning, you're probably going to see across settings because that's the nature of executive functioning. Right.
Erica: You're teaching kids to be the conductors of their cognitive skills. And that's what executive functioning is. And you're doing it in a very explicit way.
Diane: Correct.
Erica: Very concrete, very body oriented, very organized. So, you're offering that executive functioning structure initially and then pulling the structure away so they can handle it themselves. But yeah, bringing in the play factor. Now I can remember I had one student that I worked with, and she couldn't remember how to get things done. Or it was really more of her parents would say, do this and she'd go upstairs and she would forget what she needed to do and they would find her 10 minutes later doing something else. And so what we did is we assigned all the tasks that they wanted her to do to Beanie Babies. So if it was like a. She had to brush her teeth, we had, we had a. I'm, just basing on the name. A beaver. So we had a beaver. So it was a beaver with big teeth. And so when she had to brush her teeth, they would give her the beaver and say, okay, go upstairs and brush your teeth. Or if she had to put on her clothes, they would give her the bear that had clothes that you could put on or take off. And, and so they'd say like, okay, so I want you to brush your teeth and get dressed. And so they give her the beaver and the bear. And so I imagine that's the type of stuff that you guys do as well. Is that true?
Diane: Yeah, absolutely. You have to be creative. And I think that's actually the most fun part of doing that kind of work is that you often don't know what strategies you're going to use until you get into that situation. And then you have to make it up as you go along. And that's an example of that kind of creativity that you can infuse into something and something that might have not stuck before starts to stick because you're able to make it work for that particular patient or client.
Erica: Yeah. And I find that if you tap into the kids what they already love, like, if you know they love Pokémon, then that's, like, that's the sweet spot. If you can turn that into an activity, then all of a sudden, you've got them something that they refuse to do. I can remember a kid that refused to pick up a pencil, but he loved Pokémon. So we spent a lot of time on YouTube, drawing Pokémon’s, watching demonstrations, and we'd do it together. And then he would say to me, why does yours look better than mine? And I'd say, well, because I hold my pencil like this. Now all of a sudden, he's motivated to listen to me or he wasn't before. So it's fun.
One of the best ways to improve executive functioning skills is playing board games
I'd love to hear any stories that you might have of some of these creative ideas. I'm catching you in the moment. But as we talk, if you think of things, please share them.
Diane: Well, I was just thinking what you said about Pokémon I do
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Diane: have right now, a lot of the kids are into Minecraft and things like that. So we do use whatever is the most motivating for that child to have them work on a skill. It only makes sense. You know, I'm trying to think, well, it's sort of considered Lego therapy in a way, where each person in the group has their own job that they have to do. They have to be the builder, the supplier. And I'm trying to think of what that third one is, but if you catch my drift, it's kind of like each child has to stay within their job description in order to create this project. It was invented, and I don't recall the name, but there is something called Lego Therapy. But all of those kits and things that we bring out for Lego Therapy, they're hot, you know, they're Minecraft. They're highly motivating for whatever child is doing that. So the theme is actually carrying the day a little bit, you know, and everything else flows from that.
Erica: I love that idea of each student having, because, I mean, wow, that teaches so many skills that they have to stay within their job description, so to speak. And of course, they can always change job descriptions so that they can get that kind of cognitive flexibility as well. Yeah.
Diane: And you can see the cognitive flexibility issues coming out right away because everyone wants to be the builder. And there will be protests and there are. And some of the kids will be like, no, I'm the builder. And I'm like, well, you're going to be the supplier for now, but then we're going to change jobs. And it just really teaches all of the executive functioning skills you really see in those groups like that.
Erica: So in that particular case, it's teaching the inhibitory control.
Diane: Yes.
Erica: Right. So each role is teaching a different executive functioning skill.
Diane: Absolutely.
Erica: You know, if you're the architect, if that's something that they do, then that would be more of the working memory because you'd have the spatial skills and having to hold all that information. What was the other one? There was the builder.
Diane: And then so we have the builder flyer and the engineer, I believe.
Erica: Engineer. Okay. Engineer is like an architect. Okay.
Diane: Yeah, yeah, I think it was those three. And it was developed by someone there. There is, there are LEGO therapy groups that go along, you know, in the country somewhere, but we just incorporated it lightly in our clinic and it works really well.
Erica: Yeah, yeah.
Diane: Really enjoy it. Yeah.
Erica: Ah, there are all sorts of games that are now getting morphed into therapy, which is, which, is really cool. And it's so interesting how so many games are executive functioning tools. I know that when I used to have a private practice, that I had this enormous closet of games, just tons of games, and a lot of the parents would be like, I feel like you're just playing games with my kids. And I would say right now I am. Yeah.
Erica: Uh-huh. And do you notice a difference? And then they would pause and be like, yeah, I do. I kind of do. And I think as families, that's one of the best ways for you to improve executive functioning skills is just play a lot of board games.
Erica: Board games, card games. You know, as long as it's not something that is. A lot of these online games are just a matter of how quickly you can press the button. That's not an executive. That doesn't help executive functioning skills. You want something that has a little bit more intellect, whereas maybe you only press the button at certain times. That's executive functioning. But it's just, if it's just how quickly you can press a button, that's just, that's fine motor processing speed and nothing more.
Diane: Right. And we never, we don't really like, work on skills in isolation. It's always in context of occupation. Like, what is that final Result. What are we trying to get to? And you mentioned about board games. What I always tell my parents is to go old school. So when I was growing up, the games that I played with, with my sister and my friends in the neighborhood, those are the games that we actually have in our clinic. And I remember really funny, my husband asked me one day, he said, he goes, oh, well, look, It's. It's Connect 4. When was the last time you played that? And I'm like, well, I think yesterday, because this is what we do. We play. We play those games. And those games are the games that really develop those executive functioning skills in a way that newer games with all the bells and whistles and the music and sometimes just touching buttons, they're not really building those skills. So there is some education about that for parents.
Erica: I. Yeah, I know what you're saying, because they've taken things like Scattergories and put it on. On a device that makes all these sounds and noises. But the traditional Scattergories is an absolutely fantastic executive functioning game. But there are some new ones that have come out that are absolutely fabulous.
Diane: Oh, yeah. Oh, yeah. You
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Diane: know, I think people are getting wind.
Erica: Oh, my God. Spotted is amazing. Or I don't know if. I don't know if it's a Blokus or Blockus.
Diane: I don't know.
Erica: You know what?
Diane: We have that in our clinic.
Erica: That's a good one.
Diane: They play that. Play it all the time. And I still don't know how to pronounce that name. But I'm so glad you.
Card games require a lot of executive functioning and processing
Erica: I'm so glad you feel that way.
Diane: It's either Blokus or Blokus, but I'm not sure which one it is.
Erica: That's really funny.
Diane: But yes, yes. And I feel like our therapists. So I work with a lot of speech therapists, I work a lot of pts, and, and they all come. They all have their, their favorite games that they pull out. And. And they are really great at just figuring that out. You know, what is it? What does that kid need at that moment?
Erica: Yeah, yeah. My partner Nancy, she has probably 10 times more games than I have, and she still works with kids one on one. And, yeah, there. There's some really, really fabulous ones out there.
Diane: Yeah. Especially the card games. You said card games too. And we play Taco Cat, Goat Cheese.
Erica: Oh, I've heard about that one.
Diane: Those line of cards, those are really inhibitory control. We really love working on with our groups with that. And it's amazing when you start learning about executive functioning and going through this course that you created, you start to see everything through the lens of executive functioning. And you're like, oh, this is what I've been doing. But I've been labeling it a little bit different.
Erica: So I think I mentioned it in the course. So you might have seen it. Have you ever seen the Mini Luke?
Diane: The Mini Luke, this is something that.
Erica: Was designed in Europe somewhere and there's no language, but they're all puzzles and you have to figure out what the rule is by looking at the puzzle. So it doesn't require language, but it requires a lot of executive functioning and processing. And the coolest thing about them is they're little tiles and you have these books of puzzles to do and they're self-scoring. It's really interesting. So you set it up how you think the answers are and then you flip it over and if the design matches, that's on the back design matches what's in the book, then you got it right. It's fascinating. If you've never seen the Mini Luke, you can get them on Amazon and they're absolutely. When I saw this, I was like, I so amazed. I was like, oh, I wish I invented this because it's that amazing. They're really, really cool. And some of them work on visual spatial skills, some of them work on kind of rudimentary mathematical skills, some are more visual processing. I think most of them are made for pretty young kids, but I see the benefit of using them at any age if you need to develop those skills. And it's just the fact that they're self-scoring is really, really cool. But yeah, I mean I could literally just ping back and forth with you like product after product after product. That, that's true because it's. Which is a whole other episode of getting into the, the gamification.
Woo: OT informed clinician can help improve executive functioning skills
Diane: Yes, yes.
Erica: But I want to hear a little bit more about your OT perspective. Where would you like to take the conversation from here?
Diane: Well, I wanted to talk about just what it looks like when you're an OT informed clinician for executive functioning skills versus maybe traditional and maybe put a plug in for getting maybe a little bit of extra training in what to look for and in executive functioning skills either through a training course or through a CEUs, just to be able to see the same activities with a different perspective and maybe come up with something different as a result of it. Because I think that's that that's what's happened to me. So I'm Hoping that's what would happen to other people. But you take something like task initiation. Right. We often would work on something like that with a craft or a worksheet or some type of a game setup and from a skilled OT. But maybe a non-EF lens you might use some prompts and encouragement and maybe a countdown or something to start. But then when you kind of look at things through more of an EF informed lens, you start to think, oh, maybe I could like reduce the startup load or I can highlight the first step, or I could teach some initiation strategies. So it basically opens up your toolbox to be able to really look at things in a different way and it builds in, you know, independence and dependence on like that prompting. You want to decrease that prompting over time.
Erica: Interesting. It almost makes it from an external prompt to an internal prompt.
Diane: Is that true or like an implicit to an explicit kind of prompt, you know. Oh, interesting that that's another way of maybe putting it. But yes, yes you want to eventually it's just a basic awareness of, of maybe why something is happening, not just that
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Diane: it's happening and it just allows you to dig a little deeper. If you're thinking about something like inhibitory control, you would think about like a turn taking game or just waiting for something. From a non-EF lens you might just do reminders to slow down and wait and maybe keep it very verbal. But somebody who has decided to look through an EF lens might use pause strategies, modify response speed or cues, something like that. They might use like a specific strategy and, and it teaches the child to inhibit, not just that they should inhibit and it's just a little deeper.
Erica: Yeah, it really gives them the tools to conduct their own cognitive skills. Yeah. I just m a firm believer that we should be training this in preschool and elementary school. That it's really should be a precursor to reading and math because what if kids learned how to pay attention? What if they learned what metacognition was when they were really little and they learned how to think out loud and then they were kind of guided on what's appropriate thinking or we had discussions with them about their inner voice and how they could use that to help them memorize things or remember things or visualization. It's so funny. Our inner voice and visualization. It's like we've been trained to keep it to ourselves.
Diane: Yes.
Erica: It's so odd. And I think it all comes back to keep your thoughts to yourself. But what are your thoughts? Your thoughts are either words or images because I think, well, and of course you hear of those people that have Asperger's, they can't hold in their inner thoughts. And then people are horrified by what they hear. But we all have those. And I guess because we do have thoughts that are inappropriate, we're told to keep them to ourselves. But we have a lot of thoughts that are not inappropriate, that we're keeping to ourselves.
Diane: Yes, yes.
Erica: And even if they are inappropriate, maybe we just need to get it out there. Because why are we hiding our cognition? And really what we're doing is we're preventing ourselves from understanding our own brains and understanding how to manage them. That we don't have to be puppets from the outside, we can be puppets from the inside.
Diane: Well, and you had mentioned before, and it's the truth that, between three and four, executive functioning skills. Woo. They just go up on that chart. This is where they're starting to really blossom as far as development. So. So if you're any age group with those types of things, preschool's it a huge learning time.
Erica: Yeah, yeah. And then what you really are doing is preparing them to be a student, which is not easy to tell a little kid to sit still at a desk and to listen. That's, it's hard for anybody but for a little kid. But those are the types of skills that are taught. But through play and from an internal sense of, I can manage my own attention, I can manage my own thoughts, I can manage my own memory that you do have choices. Life doesn't have to happen to you. It can happen for you, or you can be a part of the creation of it. And I think in the work that I have done with little kids, they love it. And you know, people are like, oh, this is too complicated. You can't teach them about metacognition or working memory. And it's not that hard. Working memory, is your memory working? Metacognition is a big word, but so is syllabication. Right, right. Diphthongs and digraphs. We teach them that. We teach them, you know, what a vowel and a consonant is at a very young age. That doesn't sound any more intimidating. Has a syllabication, five syllables. Metacognition, five syllables. There you go. They're both five syllables.
Diane: And interesting that you mentioned metacognition too, because I know those skills really start to develop early, but they really solidify. Probably around what age do you think that they solidify? And do you think by introducing it earlier, do you think it would change how they can, like, actually use it in real life.
Erica: Absolutely. So, you know, they say that executive functioning isn't fully developed until you're around 25, but I think it's very individualized because I'll give you a great example. I had a grandparent who brought her son in, and she visualized, but she didn't know how to visualize when she read. And just me talking to her grandson and explaining that you can create a movie in your head when you read. And then she let me know weeks later that I can visualize
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Erica: and I can read, but I never thought of pairing the two. And just you are saying that enabled me to do it for the first time in my life, and it was marvelous.
If we don't know what tools are, then we're not developing
So she just walked into a whole executive functioning skill that she had the capacity for, but she wasn't utilizing. And to me, that's what it's all about. We all have the capacity for. But if we don't know what the tools are and how to use them, or if we've been kind of shamed into suppressing tools like our inner voice, our inner visuals, our inner spatial skills, then, yeah, then you're not developing them. You know, like, one of the most interesting things that I found is that in elementary school, there's a certain time where the teachers say, stop using your finger. when you read.
Diane: Right.
Erica: And actually, from everything that I've read, that's the wrong thing to say. It just means that they're going to slow down and they're going to struggle more with their tracking. And in fact, as adults, if you go back and learn how to speed read, they tell you to use your finger. So it's kind of funny.
Diane: Yeah. I mean, from an OT standpoint, we don't explicitly teach reading too much, but when we do writing and letter formation and things like that, we do encourage kids to maybe think about spacing and using their finger to space the words. You know, those are all techniques, and they're all fine. Sometimes they use tongue depressors or, you know, whatever fun thing, but it's really about building that awareness. It's not like they might use that tool forever, but using it now is important. You know, it's important for their learning.
Erica: But if they want to use it forever, go for it.
Diane: Yeah. Yeah. But they don't have to. Right? Yeah. So it's whatever. Right. And I think that's what makes OT and executive functioning so interesting to work together, because you understand that. That you have to meet the child where they are.
Erica: Yeah. And you have to be flexible and, and you're not accommodating yourself; you're accommodating them.
Diane: Right.
Erica: And they're not going to process the same way as you and they're not going to have the same needs as you.
Diane: Right, absolutely.
Erica: You know, but it's very hard for people to step out of their own way of processing.
Diane: Yes, yes.
Erica: Really, because it's, that's what they know. If it helps you to write things out, it must help out everybody because that's your reality. But that's what's so fascinating about this work is you start to learn how different people are, how people process things completely differently. And then makes you wonder like, wow, it's amazing that we can even communicate with each other. And then you have to think, well, maybe we're not, maybe we're not always communicating what we think we're communicating. We're communicating what they think we're communicating.
Diane: Yes. And going through the executive functioning coaching course that you created, you introduced the spy and all of the different ways, the 12 different ways of processing. That's incredibly important not just for coaching, but for occupational therapy, I think, because when you're presenting something, a skill, you might know a little bit more about how to present that. Because we do have. Everyone takes an information in a different way. And I think something like that really just highlights that. Yeah.
Erica: And although it's important, we want to get people to process with a wider lens, you know, a wider net, so we can teach them skills if they're weak at. But in order to connect with somebody, if you process in their most comfortable ways of processing, then you connect with them. But if you insist that they process in a way that's uncomfortable, there's a sense of disconnection. So for me, really honoring someone's way of processing is almost a way to befriend them. You just, I mean, who are your friends? Your friends are people that you have things in common with.
Diane: Right.
Erica: You know, you think similarly. And so there, there really is something to understanding how someone processes very quickly so that you know how to reach them. And, and then once you reach them and you have a connection, then you can get them to be more flexible because they trust you. You can be like, oh, can I show you another really cool way to look at this? And then they're like, hm, okay.
Diane: So you're building their cognitive flexibility too, as the process just starts to naturally unfold. So that makes a lot of sense. Yeah. And when we're working in the clinic with those kids, we often have to start with their learning style. And the hope is that over time we can expand.
Erica: Yeah, yeah, yeah, absolutely.
Diane: Yeah.
Erica: You're speaking my language for sure.
Executive functioning training can help strengthen OT practice, says Dr. David Zuckerman
What else would you like to share?
Diane: Yeah, I mean, maybe we can talk a little bit about why, explicit, like, executive functioning
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Diane: training might strengthen OT practice or the way that OTs practice. I love that. So I've been thinking a little bit more about this, and it really does, you know, sharpen your clinical reasoning, obviously, so you're not just pulling out tools like the kitchen sink approach. You know, we're like, well, let's try this, let's try this. Now you're. You sort of start to have that reasoning of why you're doing what you're doing a little bit more.
Erica: Yeah. It takes you out of that cookie cutter approach where, you know, there's so many people that are like, I just want to define my approach and then replicate, replicate, replicate, replicate. And that, unfortunately, is not great for the practitioner or the student because the practitioner starts to shut down because they've lost that sense of creativity. And the student tends to shut down because they have to fit into your mold.
Diane: Correct? Yeah. So, I mean, it, gives you kind of like a clearer identification of which executive functioning skill might be breaking down too, so that you can hone in on, on that particular skill. Whether it's transitions. We have a lot of transition issues. A lot of them are coming from, from being pulled away from electronics at the last minute to come into our sessions, which is a whole other episode I could talk about. But there are many other things as well. So I mean, it kind of gives you more intentional strategy selection. It kind of gives you stronger goal writing and stronger documentation because you're trying to justify your services and just better communication with the families and the teams, you know, just being able to give a reason why. Or maybe those home exercise programs that we give our parents will be a little bit more targeted to, like, well, let's try this strategy. And generalization is often, really an issue too. Sometimes the kids will do something in the clinic, but then not replicate that anywhere else in any other environment. And so I think maybe focusing a little bit more on that. Why maybe could help with that generalization too.
Erica: Yeah, well, and I think also that also is great for the practitioner in the sense that it builds their cognitive flexibility. and that's what's so fun about doing executive functioning work, is you're actually improving your own executive functioning skills.
Diane: Oh, yes.
Erica: So, I mean, learning about executive functioning is incredible remediation for yourself. And I use it all the time. And I analyze as I'm getting older, I'm now 60, and I'm thinking, oh, my working memory's a little weak. What could I do? What are the tools that I have that I could use to strengthen my skills? Oh, maybe I should use my inner voice more. Maybe I should use visualization or spatialization more. And I actually do that and it actually gets better. So I mean, there's just something so important about knowing not only about the components of executive functioning, but the tools behind them so that we can again manage our own cognition, which is exactly what executive functioning is. It's such a gift. It's such a gift to give an individual. It's almost like giving. Maybe this is a little far-fetched, but from my perspective it's not. It's like giving a blind child glasses that enables them to see, or a child that can't hear, you know, a hearing aid which enables them to hear. It's like opening another sense. That's an interesting thought, isn't it? That executive functioning is a sense that's not fully developed?
Diane: Absolutely. I mean, I could totally see how that would be the case because it's one of those areas that's surrounding us all the time. But you're talking about the senses. You know, we have those all of our senses and then we have other things like interoception and things like that that they're coming out with that we have like these extra senses and executive functioning. It might not be a sense in that respect, like that body sensation or whatever, but. But it is surrounding everything and it gives meaning to everything. So it's one of those things that's always kind of there.
Erica: The master sense.
Diane: Yes, like a master sense. Exactly, exactly.
Erica: That's cool. I never thought about it that way. Executive functioning, the master sense. Yeah, the sense of all senses. The sensible sense.
Diane: Yeah. It gives you a lens to interpret everything, you know. So I think that's really important. I mean, it also helps kind of move the terminology that you might use to describe behaviors away from vague like explanations like oh, they're just having attention issues or it's just a behavior or its lack of motivation. And it gives it, it gives it.
Erica: A name, raise it a name when people come in. I
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Erica: was like, my child's just not motivated. They're careless, they're lazy. And I am just like, no, no, they're. To me, those are curse words. They're so damaging. They're so shaming those words, and they're so incorrect. Everybody's motivated, you know. So you say that he's not motivated. All right. He's not motivated by what you want him to be motivated about, but he's motivated.
Diane: Right.
Erica: I mean, you're motivated not to do something. That's motivation. Right, right.
Diane: And I mean, I think it helps, you know, understanding that, helps you become more of a compassionate clinician. Because you're looking at it. You're not looking at it as they're displaying this behavior. Because they're doing something against me. That's right.
Erica: So whose issue is it? There are times where it's not an issue of the kid's motivation. It's an issue of the adult being too controlling right now. That's not always the case. That's not always the case. But, you know, sometimes we're trying to fit a square peg into a round hole.
Diane: Yeah. And sometimes we're trying to fix the child when we really should be trying to fix the environment around the child a little bit more. So starting with that big view is probably the best place to start as far as when you're honing in on those skills. Because it is like the carpet for the horse, right?
Erica: Yeah.
It would be really nice if our education could be more cognitively flexible
Yeah.
Diane: Well.
Erica: And sometimes we're shutting down capacities to try to force them to accommodate our paradigm or our lens or ours. What we want. I see that all the time with adults that I work with, adhd, where I feel that they've been forced to close their aperture, you know, that they have an open aperture. Everything comes flooding in, and they've been taught to close their aperture, but that's not who they are.
Diane: Yeah.
Erica: And then they struggle later on in life because, you know, they're walking around with a closed aperture, but it's not honoring who they truly are. It's really, really interesting. It would be really nice if our education could be more cognitively flexible, you know, and have a variety of different ways of teaching, and students could pick or they could even. Well, I guess that goes back to when you're in a classroom and they kind of have those. What do they call them? They might have, like, learning stations and then.
Diane: Yeah, I think. I think of Montessori, like Montessori schools and things like that. They're set up that way, you know. Yeah, yeah, yeah.
Erica: That's really interesting.
Diane: But,
Erica: But that's the problem. Our class sizes are so big that it's hard to accommodate the individual. And so what we have to do is we have to figure out what are the ways of teaching that reaches the most students. And of course, what is that? Mostly visual and auditory. and so, yeah, anyway.
Diane: Yeah, yeah. I mean, I think for the client or the patient, having the therapist look through this lens kind of gives them more independence, I think. And I can't prove it because obviously I haven't studied it, but I feel like their follow through, and their generalization might improve because of it. They could, I definitely see like reduced frustration with patients, and I think it could reduce that overwhelm a little bit too, where they're just overwhelmed and they don't know why. And your kind of giving them a little bit of compassion and, and grace and letting them kind of figure it out.
Erica: Well, you're giving them so much. You're giving them compassion; you're giving them grace. You're also giving them those tools of flexibility, and they learn how to think, and they learn that there are ways to externalize your working memory to make it bigger. You're giving them strategies, you're giving them games, you're giving them joy.
Diane: Right.
Erica: You know, if we can, maybe that's what it comes right down to is, you know, if we can give them what they need in a joyful way, then it's never work and then it's not work for us either.
Diane: Right, right. That's ah, true.
Erica: So whether it's OT or educational therapy or executive functioning, bring the joy in. And that means that we have to drop into the present when we work with kids too, I think dropping into the present and dropping into our own joy and letting go of whatever might be dysregulating us in the moment so that we can be fully present and enjoy the process. And when we do that, the kids do too. Yeah, they recognize.
Diane: Well, yeah, we go into sessions sometimes and we have all these grand plans and we're going to, we're going to hit this goal and we're going to do this thing and then it all falls apart because obviously, there was transition issues or maybe somebody's having a bad day and then you're like, okay, we're going to, we're just going to do what we need to do today and we're going to figure this out and we're going to make it fun and we're going to make it good and we're going to try to make it a learning experience. And that's how you
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Diane: have to be extremely flexible in order to do that kind of work.
Erica: And that's, that's when you do the best work. The Unexpected work is the best work, and it's the practitioner that has to be the flexible one. Yeah, yeah, yeah. Oh, what an interesting conversation. How fun. Diane, I'm looking forward to having you on the podcast again so we can have some more discussions because, yeah, I really enjoy speaking with you, and I think we have some rich things to share, and I like how we play off of each other. It's fun.
Diane: I really enjoy talking about this. It's definitely a passion of mine, and I welcome any future discussions to talk about it because I think it's important to get that word out.
Erica: I do, too.
Executive Function Brain Trainer podcast features guest speakers from across the country
Diane: Great.
Erica: Well, thank you so much for joining us today, and I look forward to the next time.
Diane: Well, thank you. I appreciate it.
Erica: Bye for now.
Diane: Bye.
Erica: Sponsored by learningspecialistscourses.com Courses and resources that support educators and coaches.
Darius: Sponsored by Ivy. Imagine turning your meeting's audio into a live mind map instantly so you remember what matters. It's ideal for students and managers. And with dyslexia or adhd. Try Ivy for free now at Ivy App. That's IVVI App. thank you for joining us at, ah, the Executive Function Brain Trainer podcast.
Erica: Check out our show notes for links and resources and follow us on social media.
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