28/04/2021
Why, Why, Why!
The most popular question I get from parents of teens and young adults on the spectrum is “Why does my son struggle so much in simple, real life judgment and reasoning? Why can he know what he is supposed to do, but stumble so much while doing it?” Another one is “We can preview what to do before he leaves, but he forgets to do it once there!” Another popular question is “Why can’t he see the effects his behavior is having on others, and not see when he is out of sync with everyone else?”
The answers to these questions lie in the “executive functioning” center of the brain (frontal lobes). This area of the brain gives us the ability to appraise a situation, plan and organize a course of action, execute the plan, and monitor how we are doing while carrying out the action. To effectively carry out a course of action that matches the expectations of the demands, you have to engage in multi-tasking (which is a brain function difficult for people on the spectrum.)
To match your behavior to the situational demands you have to (1) continually appraise the situation, (2) assess what is needed, (3) plan how to respond, (4) monitor how you are doing as you are “doing” it, and (5) evaluate how effective your actions are. You have to perform all these five functions simultaneously to stay coordinated with the expectations. It requires the abilities to (1) process multiple information simultaneously and (2) multi-task the five functions above. This is where the person on the spectrum has difficulty with any social situations that demands them to perform. Plus, when you add the “anxiety” over performing under such conditions, what ability they have to multi-task crumbles. In essence, most daily responding that doesn’t involve responding by “habit” requires us to “think about” what we are doing while we are doing it. We step back and monitor what we are doing as we are doing it. We are constantly appraising, evaluating, and adjusting or actions based on this monitoring. This is very difficult for people on the spectrum.
At best, most kids on the spectrum can learn to appraise what is needed before acting, rather than during the response. They need to plan out a course of action based on that appraisal. However, once they decide to act, they have difficulty “monitoring” their actions while doing them. They have difficulty continually appraising, evaluating, and adjusting their actions in the mist of doing them. So, if their actions are not in sync with what is needed, they often have no clue that they are off balance. Or, if they feel that they are off course, they do not know why and what to do about it.
How can we help?
1. Prepare the child before entering a situation about (1) what he can expect, and (2) what is expected of him. Lay out a script for him. Very literally define any rules and expectations on what to do and what not to do. If possible role play and practice any known behavior expectations, and how to handle possible snags. Give them a mental map to follow.
2. Simply providing them a mental map a head of time is not enough. People on the spectrum have problems with “working memory.” They may understand what you tell them is expected, but forget it during the acting of “doing.” They often have a hard time maintaining this information in their “working (short term) memory”, and referencing back and forth between this memory and their behavior to keep their actions in sync with what is needed. We think that by telling them what is expected (previewing), they will naturally remember to do it. Then get mad at them for not following the expectations. We can enhance this previewing by providing them a more concrete path to follow. The following are possible strategies to use.
a. Use concrete visual roles and rules. For example, when taking a young child grocery shopping, you have to provide very concrete rules that set a path for correct behavior (otherwise they are all over the place and getting into everything). We need to give the child a role to play (push the cart) and concrete boundaries (path), such as “hands always on the cart, and walk alongside mom”. These two tools, concrete “roles and rules,” provide the visual “map” to keep the child on the correct “path.” If they start to steer off these boundaries (take hands off cart, or walk faster than mom) then we stop the action and redirect them back on track. When they don’t have a clear path, they are left to wonder haphazardly and get into trouble. We often yell at them to stop doing annoying things without providing them a concrete path to follow.
b. Another tool that can help is connecting the child’s actions to the sequential steps of the task by providing visual cues to each step. This is when picture sequence routines are helpful. Sequence of pictures of “what to do” at each step. When “A” happens, you do this, than when “B” happens, you do that, etc. The visual cue of each step of the task can cue them what to do next. Scrape the plate, then rinse the plate, then place it in the dishwasher, with a picture designating each step.
c. Another tool for bridging the weak “working memory” is to provide written instructions as a path to follow. At each step of the task, the child can reference the directions as needed, just like we navigate a map, street signs, etc. while driving. This often works well for school tasks; writing down the steps and directions. This gives a check list of what to do, step by step through the task.
3. Once the child starts into action, he must learn to monitor (appraise, evaluate, and adjust) what he is doing as he is doing it, to make sure he is doing it right. To help with this, teach the child to break the task/event down into sequential steps, than for each step “appraise, act, and evaluate”. Appraise what is needed for that step, do the step, then evaluate how he did before moving on to the next step. If the child has difficulty understanding what is “good enough” performance, provide him with a model, or picture of what the completed step looks like. This way he can check his performance to the model. We teach the “habit” of appraising what to do, doing it, then checking to see if it is right before moving on. So a multi-step task will be broken down into sequential steps of appraise-act-evaluate, appraise-act-evaluate, etc. The child is going to need some coaching to learn how to appraise and evaluate. This can be very taxing and mentally draining for the child. However, over time, the performance with become more automatic (habit).
4. Until the child becomes old enough to do the “self monitoring” in step 3, he will need someone coaching him during the action. This is where “guided participation” is a good technique. With guided participation, the coach and child do the action together, with the child learning by following the lead of the coach. The coach teaches by showing and using assistance to keep the child on the right “path.” Guided participation provides a very clear path, along with assistance to frame the child’s actions to stay on the right path. Once the child understands what is needed, the guide fades the assistance.
5. Another good strategy used in guided participation is teaching the child what to reference when monitoring how he is doing. Frequently through the action, the coach stops and evaluates how well their action is (if they are on the right track). This teaches the child to (1) stop and check, as well as “what to check.”
6. Once the action/task is completed, then help the child evaluate how his performance was in regards to the “path” that was laid out. If they got off the path, discuss what broke down and how you can tighten up on the path.
In conclusion, in order to support the child with poor executive functioning skills, you need preview what is expected ahead of time, provide him a concrete path to follow, coach him down the path, and then help his evaluate how he did.
