I’ve written an introduction to self-regulation, what it is, and why we should be interested in it. Please have a look and let me know what you think.
A: We actually do work on attention while we focus on the different executive functions.
First let’s look at a few different kinds of attention:
- Selective attention – this is where attention is paid only to the most important information available. We choose what to focus on – sights, sounds, smells, taste or feel – whatever is most important. This means paying less attention to or ignoring other things.
- Sustained attention – this is where we sustain or continue paying attention.
- Shifting attention – this is where we move our attention from one thing to another. It’s really important when we have to keep a few things in mind at the same time. We have to move our focus from one thing to another.
When we work on executive functions, we’re working on all types of attention.
Take inhibitory control for example, children have to focus on just the most important things. At the same time, they have to ignore things that aren’t important. This takes selective attention, sustained attention, and sometimes, shifting attention.
When planning and organizing, children have to pay attention to just the most important things, keep their focus while making their plan, and shift their attention from one item to the next.
As you can see, attention is an important focus to our approach. But it’s integrated into the total program rather than being worked on separately.
Photo by ian dooley on Unsplash
A: Emily Jupiter wrote an excellent article in the ASHA Leader magazine (1) on this topic. Here are some of her suggestions along with a few of my own:
Play games like Red Light/Green Light, Freeze Dance, and Simon Says. These help inhibitory control, working memory, self-monitoring, and cognitive flexibility.
Practice yoga and Turtle Breathing. These help children learn how it feels to be calm.
Planning adventures and excursions. Planning helps children learn about planning and setting priorities. It also helps them with inhibitory control, working memory, self-monitoring and cognitive flexibility.
For school-aged children:
Plan a party or get-together. Brainstorming helps with cognitive flexibility. Then the planning help with organization, working memory, and inhibitory control. Self-monitoring will be important as you review the plan as the even gets closer – how are we doing?
Play games like Rush Hour, Uno, Rat-a-tat-Cat. Mazes and “Rush Hour”. These help with planning, inhibitory control, working memory, cognitive flexibility, and self-monitoring.
Make sure whatever you do it’s fun.
Jupiter, E. (2017). Put the Fun Into Executive-Function Skills Practice This Summer. ASHA Leader.
Self-regulation starts with the brain, with executive functions. Brains work 24 hours a day and move into high gear when you’re working on self-regulation. This is especially true when you’re first learning.
So what’s your tummy got to do with it?
Well, your brain needs fuel to function and that fuel comes from food. Not just any food but good quality foods that have lots of vitamins, minerals and antioxidants (1). A balanced diet includes a variety of foods that contain nutrients necessary for good health …. and for brain function.
We know that up to 90 per cent of children with autism have selective diets (2). That means they have strong preferences for just a few favorite foods. Those favorite foods are usually carbohydrates (sugars and starches) and highly processed snack foods (3, 4, 5, 6). Favorites I’ve seen are goldfish crackers, chips/crisps, dried fruit snacks, and noodles. Those foods don’t fuel brains or bodies very well or for very long.
Food and mood are also linked. That is, the better the food you eat, the better your mood. Children with autism who have selective diets (limiting the amount of protein and fiber they eat) are more likely to have temper tantrums (7). And it’s not just children with autism! Non-autistic boys whose diets are low in vitamins and minerals are more likely to have behavior problems (8). I worked with a lot of children who were selective eaters. You can almost predict their ‘mood crashes’. It seemed that they soared on the sugars they ate and then just fell apart when their ‘fuel’ ran out. Two hours after they ate, they’d become irritable and angry and couldn’t do much of anything.
Watch them carefully and know what they eat. If we expect them to regulate their bodies, thinking and emotions, their brains need lots of good quality ‘fuel’ from food. If we want them to interact positively and consistently, their mood needs food too.
In spark*, I emphasize the importance of fueling the children’s brains when working on self-regulation. Young children trying to regulate their bodies, thinking and emotions should eat nutritious foods every 2 to 2 1/2 hours to keep their fuel levels up. But how do you get them to eat something other than ‘the usual’?
Selective eating in children with autism is related to sensory issues and to their preference for sameness. Food texture, appearance, taste, smell, and even temperature can figure into food choices (9). I’ve heard of children who’d only eat yellow food or crunchy textures. The way food is presented (such as food packaging, how food is placed on a plate) and eaten (fingers, spoon, fork) can affect whether they’ll eat them (10) – they prefer the same old things. Our children aren’t keen to try anything new.
We know that straight behavioral approaches (like rewarding acceptance of new foods) have limited success (11). They resulted in children eating more food but not a larger variety of foods. Other approaches, like desensitization and reducing sensory issues, haven’t been well-studied so the jury is still out.
There is one approach that is really appealing to children with autism. That’s The Eating Game (stands for Get Awesome Meals Everyday). It’s visual and structured. It makes meals predictable and, best of all, children learn to self-regulate their eating – they know when they’ve had enough and when they need more of certain types of foods. The Eating Game presents a visual plan for each day that shows the number of servings for each major food group. The food groups are color-coded as are pictures of foods within each group – of course, you can add personal favorites. Children match the color of each food option and see when they have the right ‘balance’ of foods. I’ve tried it. Children love it and it helps ensure they get the brain fuel they need.
(1) antioxidants protect your brain from oxidative stress or the “waste” (free radicals) produced when your body uses oxygen. Free radicals can damage brain cells.
(2) Ledford J. & Gast D. (2006). Feeding problems in children with autism spectrum disorders: a review. Focus Autism Other Dev Disabilities. 21, 153-166.
(3) Schmitt, L., Heiss, C. J., & Campdell, E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Topics in Clinical Nutrition, 23(1), 23–31.
(4) Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism or pervasive developmental disorder—Not otherwise specified. Journal of Autism and Developmental Disorders, 31, 505–511
(5) Schreck, K.A., Williams, K., Smith, A.F. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 13(4), 433-438.
(6) Williams, K. E., Gibbons, B. G., & Schreck, K. A. (2005). Comparing selective eaters with and without developmental disabilities. Journal of Developmental and Physical Disabilities, 17, 299–309.
(7) Dominick, K., Davis, N., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Res. in Dev. Disabilities, 28, p. 145-162.
(8) Robinson, SL, Marín, C, Oliveros, H., Mora-Plazas, M., Richards, BJ, Lozoff, B., Villamor, E. (2018) Iron Deficiency, Anemia, and Low Vitamin B-12 Serostatus in Middle Childhood Are Associated with Behavior Problems in Adolescent Boys: Results from the Bogotá School Children Cohort, The Journal of Nutrition, 148, 760–770,
(9) Schmitt L, Heiss C, Campbell E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Top Clinical Nutrition. 23, 23–31.
(10) Williams P.G., Dalrymple N., & Neal, J. (2000). Eating habits of children with autism. Pediatric Nursing. 26, 259–264.
(11) Marshall, H., Ware, R., Ziviani, J., Hill, R., & Dodrill, P. (2015). Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: a systematic review and meta-analysis. Child Care, Health & Development, 41, 278-302.
Executive functions and self-regulation typically develop and mature over a fairly long period of time.
Developing and refining self-regulation takes place over at least the first two decades of life. Each of the five key executive functions develops at different paces; some maturing earlier, some later.
Check out the diagram below. It shows that self-regulation starts developing from birth and doesn’t reach a mature level until at least the mid-twenties. That’s a long time but there are a lot of things going on.
We see the infant sucking his fingers and thumb to regulate and soothe himself and that’s just the beginning.
Preschoolers show an enormous surge in their abilities to control their bodies. Regulating their emotions also matures quite a bit. Attention skills become less scattered and children can pay attention to things for longer periods of time.
In the later preschool years, cognitive self-regulation improves. Children are better able to plan and organize themselves and things they want to do. Their working memory improves and they’re checking how they do. Their improved cognitive flexibility means that they can change plans and approaches to things more easier.
One really important change in the later preschool years is the emergence of meta-cognitive awareness. That is, children become aware of their thinking, things that help them remember, and things that make it harder to learn.
All three areas of self-regulation (behavioral, cognitive and emotional) continuing improving during the school years. There’s a small dip during the teen years – ask any parent of a teenager what that’s about – but it’s followed by continuing refinement.
After the mid-30s, self-regulation starts a decline. Those readers who are seniors will appreciate the changes in working memory and attention – “I’m in the kitchen, what was it I was going to do?”
Self-regulation develops over at least the first two decades of life. This long period of development means two main things:
- we have a wide window of time to help our children develop and improve their self-regulation, and
- we shouldn’t expect self-regulation to appear overnight.
Our brains are plastic in the sense that they can change and mold to new experiences. New nerve pathways are developed when we learn and practice new things. Keep in mind that learning to self-regulate takes time and daily practice. This is especially true for children who need to un-learn old ways of doing things and develop new approaches.
What are executive functions?
Executive functions are brain processes that are mainly contained in your frontal lobes (just behind your forehead). They make it possible to turn your ideas and goals into actions. Those can be things you do or things you say.
Have a listen to Dr. Adele Diamond, Canada Research Chair Professor in Developmental Cognitive Neuroscience at the University of British Columbia. Dr. Diamond has studied executive functions for over 30 years and is the leading expert in developmental cognitive neurosciences.
So how do executive functions work?
Have a look at the maze below. If I want to complete it, what do I need to do?
I have to get myself organized – what do I need? – a pencil and, thinking ahead, an eraser would likely be a good idea.
I need to control my impulses that make me want to add a sun to the sky and some bigger flowers.
I make a plan to start by drawing with my finger first, moving to the right to see where it leads me.
I have to keep my plan and my goal in my working memory as I move along.
Oops, I keep running into dead ends. Self-monitoring made me realize I need to stop and adjust my plan. I need to be flexible enough to stop what I’m doing and try a new approach.
Those acts used five key executive functions:
- Flexibility (cognitive flexibility) – being able to change what I’m doing if things aren’t working out
- Inhibitory control – keeping myself from doing the same old thing over and over again or from leaping at the first thing I notice or give up if I run into problems
- Memory (working memory) – keeping my plans and ideas in my memory while I work away
- Monitoring (self-monitoring) – checking to make sure I’m following my plan and that it’s working out okay
- Planning (planning and organization) – being able to change what I’m doing if things aren’t working out
That’s F.I.M.M.P. for acronym lovers.
Connecting self-regulation & executive functions
Self-regulation is the ability to consciously (deliberately) control your executive functions. That is, I remind myself to develop a plan and organize what I’m doing before starting. I tell myself to stay on task, keeping important things in my memory bank, and not get distracted. I also keep checking to see how I’m doing and change my plan if things aren’t working out.
Self-regulation is taking control of your executive functions and making them work for you – not just leaving things to chance.
By developing self-regulation skills:
- your behavior, thoughts and emotions don’t rule you
- you become more self-directed, planful, adaptable – not having to have another person hanging over you all the time
- you understand the relationship between effort & achievement; that is, what it takes for you to gain what you want or reach important goals
Cooking and following recipes is a great way to work on self-regulation. There’s need to use all executive functions – planning and organization involved, inhibitory control, working memory, self-monitoring and cognitive flexibility. It’s also fun to eat what you make.
Here are some FREE internet resources that can help making cooking successful:
Your Special Chef – beautifully organized showing the foods and tools you’ll need to make the food. This is followed by photos with short step-by-step instructions. Some reading is required but the photos are fairly self-explanatory.
Visual recipes – this site presents recipes in a fairly traditional recipe format but with photos to support the written text. Reading is required. There are a lot of interesting and delicious-looking recipes.
Here is a book that looks interesting:
I Can Cook: A Visual Cookbook – this book looks well-organized with good photos. Some reading may be required.
There were a few other books that had good ratings but they didn’t show sample recipes. That made it really difficult to determine how useful the books might be.
Keep your eyes open for kids’ recipe books on sale tables. There are often some good bargains there. Look for books that are well-organized, show photos of ingredients and of step-by-step instructions, and use not too many printed words.
There’s lots of talk about self-regulation and executive functions. But how do you use them in everyday life?
It’s always best to start with body/behavioral self-regulation as a foundation. But there are lots of ways you can work on individual executive functions.
Remember to use the six ways to activate thinking as you work on Planning & Organization.
Let’s look first at Planning & Organization. This is an area that can benefit all children.
Here are some things you can practice with your child on a daily basis:
– Make grocery lists. Get your child to help you look into cupboards and the fridge to see what you need. Help your child to write down the things you need to buy – use pictures if needed. As you go through the store, have your child check each thing you get off the list.
– Plan morning routines. Talk to your child about the things a person needs to do each morning. Have them write these things down on a list, using pictures if that helps. Work through the list in the same order your child specified.
– Plan bathroom routine. Increase your child’s independence by helping organize daily routines, like hand-washing. Post the list to help your child be organized and on the right track.
Try the routine using the new list. Some things (such as putting on socks before shoes) need to be done in a specific order. If your child’s list isn’t in a workable order, let them try it out so the two of you can fix it up.
– Organize school work. Work with your child to decide what tasks need to be done with their school work. Help them prioritize and decide on the best order. Having a sequence that makes sense to your child can help set them up for success.
You can make visual plans that show just the necessary details. The example here shows a sequence of activities at the beginning of a school day. There are no times, just a simple sequence.
You can always increase the complexity of these plans. Add in times, descriptions of what needs to be done at both home and school. But, only add in one detail at a time. Help your child complete their plan in the beginning. See how much they can do by themselves. Our goal is to help children with planning and organization – we don’t want them to be overwhelmed with too much detail.
You can increase the complexity of these plans. Times can be added, descriptions of what needs to be done at school and at home. – add one detail at a time. Help your child with this in the beginning. See how much they can do on their own. Our goal is to help children plan and organize – not become overwhelmed in detail.
– Cook. Yes, cook or bake with your child. Cooking is an excellent way to work on planning and organization. Get out all the ingredients needed. Follow the recipe to find out what’s mixed with what and in what order. I’ll post some websites where you can find well-organized visual recipes your child will enjoy.
Yes, working on planning and organization takes time. Look at this as a great investment in your child’s future.
It’s not just children with autism or other conditions who need help with self-regulation. Every child could use a little help but some need more. Most children will need help at different stages in life. Self-regulation doesn’t just happen for many children.
As we talked about in February 2018, learning self-regulation takes a long time. Developing and refining self-regulation takes at least the first two decades of life. And, each of the five key executive functions develops at different paces; some maturing earlier, some later.
So who needs help?
Do you find that you have to remind your child over and over and over to:
- Put his things away (like his jacket or toys)
- Calm down
- Slow down
- Use a quiet voice or speak a little louder
- Listen carefully
- Not hit or push other children
- Do something on his own from beginning to end (like homework or chores)
If you answered ‘yes’ to any of these questions, your child could benefit from working on self-regulation.
Often we get used to patterns of behavior and don’t really notice if a child is different from others his age.
The Executive Function Survey will help you summarize your day-to-day experience and let you look at some of these patterns. Go ahead and complete the survey. Once you’ve finished answering all the items, add up each column from pages one and two. There are a total of 25 items but, even if your child does three or more things ‘very frequently’ or ‘always’, you should start working on your child’s self-regulation.
I’ve had parents say, “Oh, he’s just a busy boy.” and pass off the behaviors as just being a kid. That’s not really helping him. We all know what can happen if we just wait and see.
Start now and don’t wait for failure or bad experiences.
There are a number of ways to evaluate a child’s self-regulation skills. There are a few standardized (see notes below on standardized tests and scales) rating scales, direct standardized assessments, and quite a few non-standardized measures – in the September spark* News we included an informal survey I developed.
The list below isn’t exhaustive but it’ll give you a good start.
Standardized Rating Scales. These questionnaires are used to rate children’s performance and skills. Typically, the teacher or parent rates the accuracy or frequency of each statement about the child. For example, an item may ask how often the child “Acts too wild or out of control” – never, sometimes, frequently.
- Behavior Rating Inventory of Executive Function (BRIEF). The BRIEF in its various forms is designed for children from two to 18 years of age. It has both parent and teacher questionnaires. There’s a self-report version for children from 11 to 18 years of age as well. The results reflect such things as the child’s inhibitory/impulse control, attention, emotional control, initiation of activities, working memory, planning and organizing, organization of materials, and self-monitoring. Find out more here
- Comprehensive Executive Function Inventory (CEFI). The CEFI is designed for children from five to 18 years of age. It too has parent and teacher questionnaires as well as one for children 12 to 18 years of age. The CEFI identifies strengths and weaknesses in attention, inhibitory/impulse control, planning, emotion regulation, self-monitoring, initiation, flexibility, working memory, and organization. Read a review here
- Burks Behavior Rating Scales (BBRS). This measure is for children from four to 18 years of age and has rating scales for both parents and teachers. It looks at a number of behavioral, emotional, and social issues but it also examines impulse control. Find out more here
- Conners Comprehensive Behavior Rating Scales (CBRS). The CBRS is for children from eight to 18 years of age and has both parent and teacher forms. It looks at a number of different emotional, academic, and behavioral issues as well as executive functioning. Find out more here
Standardized Direct Assessments. These instruments require children to complete activities that tap their executive functions. I’m aware of two standardized direct measures.
- Minnesota Executive Function Scale. The MEFS is a standardized assessment of executive function skills (specifically focusing on working memory, inhibitory control, and cognitive flexibility) designed for children ages two to seven years of age. It’s a child-friendly assessment that’s administered individually on a touch-screen tablet. The assessment takes an average of four minutes to administer. I (Heather) observed a demonstration of the MEFS and found it very engaging and wonderfully child-friendly. Find out more here
- NEPSY. This measure, for children from three to 17 years of age, is designed to assess neuropsychological development. The name, NEPSY, is an acronym that was formed from the word neuropsychology, taking NE from neuro and PSY from psychology. It looks at Attention and Executive Functions (planning, cognitive flexibility, inhibitory control, working memory), as well as language, sensorimotor functions, visuospatial processing, memory and learning, and social perception. Find out more here
Non-Standardized Rating Scales. These are rating scales that haven’t been tested on larger numbers of children. They’re at least superficially valid (that is, they focus on executive functions) and can be helpful in looking at areas of need and in checking progress.
Here’s one I developed for young children:
Here’s one I (Heather) developed for young children.
There are a lot of other informal surveys online. Just Google “executive function survey”
Non-Standardized Direct Measures. There is a growing number of direct non-standardized measures, chiefly used in research but they can be used to check progress.
- Corsi Blocks Task. This is primarily a visual working memory task for children from seven years of age. It involves imitating a sequence of taps on up to nine identical separate blocks. The sequence starts out simple, usually with two blocks. The task has forward patterns done in the same order as demonstrated and backward patterns where the child must touch the blocks in a reversed order. Try it out here
- Dimensional Change Card Sort – This task is similar to the Minnesota Executive Function Scale described above. It assesses working memory, inhibitory control and cognitive flexibility in two to five year old children. After learning to sort the cards according to one dimension (shape or color), children are asked to sort the cards according to the other dimension. For example, the first sort might focus on color, the second sort on shape, and the final sort might be a mix of color and shape depending on whether a card has a border or not. Find out more here
- Heads Toes Knees Shoulders Test. HTKS looks mainly at inhibitory control but attention, working memory, and cognitive flexibility are also needed to be successful. Children, three to seven years of age, are asked to play a game in which they must do the opposite of what the adult says. Children are instructed to touch their head (or their toes), but the children are supposed to do the opposite and touch their toes. Find out more here and watch the video below
- Numerous tests of inhibitory control/impulse control: Tongue Task (children are asked to hold a cracker or M&M/Smartie on his/her tongue and to keep from chewing it for increasing intervals of time); Crayon Delay Task (looks at children’s ability to keep themselves from coloring when left alone with coloring supplies); Gift Delay Task (the child is asked not to peek while the adult wraps a “surprise”, then the wrapped gift is put in front of the child and he’s told not to touch it while the adult leaves “to get a bow”); Whisper Task (children are asked to whisper the name of 12 familiar cartoon characters (e.g., Elmo, Dora the Explorer, Mickey Mouse), inhibiting the urge to shout out the names); Pig-Bull Task (children are told to do what the pig says and ignore what the bull tells them to do); Simon Says (children are told to follow a command only if it’s preceded by the words “Simon says”); See more here
Keep in mind that a standardized survey or test is carefully developed, then tested on a number of people. Developers of these surveys and tests make sure they test what they say it does (that is, it’s valid). The survey/test needs to be consistent – no matter who’s giving the test or how many different children are being tests (that means it’s reliable).
Non-standardized measures aren’t necessarily always valid and reliable. If given at different times by different people, the results may be different. In fact, they may not even be measuring just self-regulation or executive functions. This is not to say you shouldn’t use these test/surveys. They can be used to check a child’s progress, by comparing before and after you began using spark* or spark*EL. Just remember to compare only the results for that child and be aware that different testers may get different results.