Executive Functioning Skills: CO-OP Model Part 3: Time Robbers

By: Laura Van Zandt, OTR/L

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I was recently asked by a parent to elaborate more on a concept I integrate within GoalPlanDoCheck called “time robbers”.  The concept of “time robbers” was first introduced to me at a continuing education class taught by speech therapist Sarah Ward. A “time robber” is something which keeps us from doing other things which have more value or importance to us.

The concept of “time robbers” can be a fun way to call to attention all the little (or maybeclock not so little) things we do that take away from our goal. Time robbers can occur to everyone. They can occur anywhere. They can also be anything. Time robbers can be things we do as well as things other people do. Sometimes time robbers are imposed upon us by others or circumstances and are less in our control. Other time robbers are self-inflicted. Some examples of time robbers are being hungry, tired, or worried. They can also be sounds in our environment, noises/shows on the television, or games on the iPad.

The following is a handout I developed to help introduce the concept to children.

What? Time robbers are a little like impulses. Impulses are the feelings we have to do or say something…sometimes without even realizing! Time robbers are just like impulses. They are the things that we do that take away time from our overall goal and plan.
When? Time robbers can happen all the time. They don’t have to be limited to just school or home.
Examples? Time robbers can come in all forms. They might as easy as a thought that should remain in my thought bubble or as complicated as getting your bike out, riding to the store, buying a snack, and returning home to finish your homework. Other examples can be having the television on when doing homework, wanting to play longer with a favorite toy, arguing, changing ideas, etc.
Consequences? Time robbers are not our friends. They take away time from us getting things done. If they take away from one thing it means there is less time to do something that might be more preferred or fun.
How to fix? Practice your thought bubbles and keeping any time robbers hidden away inside our brains until we are finished with our goal and initial plan. STOP and Think – monitor your space, time, objects, and people. Think if this is an expected time to bring up your time robber.

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When beginning any new strategy or tool with your child, I often find it helpful to first identify in yourself examples and then start calling attention to different tools you use to help defeat the different time robbers. When your child is starting to recognize time robbers, then it is a good time to introduce the concept to your child to help identify and address them.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

 

Tips For Fitness-Focused Activities: Run, Golf, Bike & More

Fitness-focused activities are a great complement to a child’s therapy sessions, and an opportunity to work on therapy goals while also participating in an athletic or recreational activity.  By encouraging involvement in new activities for children of all abilities, they are learning the importance of health and wellness at a young age.

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The benefits of fitness-focused activities are far-reaching and can impact a child in many ways.

“We all need to challenge ourselves in order to reach our potential. Our job as therapists is to to see that potential in others and encourage kids to try activities that are outside their comfort zones, so they will truly be all they can be.  Any fitness or recreational activity that interests a child is worth pursuing for the benefits it provides physically as well as emotionally, cognitively and socially.”  – Laura Znajda, PT, C/NDT

Physical Wellness
Children of all abilities should participate in athletic and/or recreational activities as physical fitness is important for ALL.  Physical fitness, as defined by the American Physical Therapy Association, is “a dynamic physical state – comprising of cardiovascular/pulmonary endurance; muscle strength, power, endurance and flexibility; relaxation; and body composition – that allows optimal and efficient performance of daily and leisure activities.”

Just because as individual has a disability, does not mean that physical fitness is any less important.

Building Confidence
Participating in activities outside of a child’s comfort zone help support their emotional development.  Trying something new can be intimidating and challenging. Keep the focus on what makes the activity fun and avoid getting caught up in the competition. Every child approaches new activities differently, but it’s ok to remind them that no one is good at everything.  No one!  You can help temper frustration by celebrating every improvement – no matter how small, and sharing your own example of a time that practice and persistence led to success.

Socialization
Physical activities take many forms and are a great opportunity to increase peer interactions, build friendships and promote health and wellness for the whole family. Embrace a child’s interests and find ways to involve friends and family.

Setting Goals and Staying Motivated
Community based therapy programs and special recreation can target individualized therapy goals. For example, a child with hemiparesis might be working on running in order to use both sides of her body more fluidly, as needed for natural arm swing while walking. A child with sensory processing challenges might be building the strength needed for wall climbing so that he can include this activity in his weekly routine to assist with state regulation.

Motivation comes from finding ways to turn therapy activities into games with friendly competition, involving the whole family and plenty of cheering!

Therapy activities include dynamic warm-ups which may include animal walks, relay races, and jumping games; a progressive walk/run/bike program building up to increased time running/biking and increased overall distance; client-specific strengthening and agility tasks to target weak muscle groups and to promote the symmetry of movement required to efficiently run or ride a bike; and stretching to promote muscle flexibility and adequately cool our bodies down.”
– 
Laura Basi, Physical Therapist


How to Get Involved

Look for organized activities in your community that help bridge the gap between individual therapy and daily life.  Here are some examples of upcoming events at Easter Seals DuPage & Fox Valley that present ways for skills to carry over into home, school and the community.

May 6, 2017              
Run for the Kids: Superhero Hustle 5K Run/2 Mile Walk
Easter Seals DuPage & Fox Valley, Villa Park, IL
This superhero themed run/walk is a family-friendly event for all ages and abilities.
Register here

  • Set a goal to run the race, roll or drive the distance in a wheelchair or take a few unassisted steps across the finish line.

    Participants of the Hustle for Health community based therapy program are training to run all 3.1 miles of the race independently.  The Hustle for your Health program began because many children struggled with the 1-mile run in their school P.E. class. A 10-12 week training program is intended to target running pattern and cardiovascular endurance so that participation in community run/walk events becomes a reality.

June 9, 2017              
Golf Outing in Partnership with Freedom Golf Association
Cog Hill Golf & Country Club, Lemont, IL
Enjoy 18 holes of golf and help bring the joy of golf to children with disabilities.
Register here

  • Try something new by learning the game of golf in an adapted golf clinic.

    The golf clinic welcomes children of all abilities to participate in the fun with adapted clubs and equipment and 1:1 training from expert golf coaches from Freedom Golf Association.

    To register for this golf clinic email spike@eastersealsdfvr.org by May 1.

September 17, 2017               
2nd Annual Bike for the Kids
Easter Seals DuPage & Fox Valley, Elgin, IL
Choose a cycling distance ranging from 12 – 100 miles or participate in a 2.5 mile family ride.  Adapted bicycles and trailers welcome!
Register here

  • Go on regular bike rides and train as a family throughout the summer.

All proceeds from these events support infants, children and adults with developmental delays and disabilities at Easter Seals DuPage & Fox Valley. For a complete list of upcoming events visit here.

Executive Functioning Skills: CO-OP Model Expanded

By: Laura Van Zandt, OTR/L Recently I wrote a blog (https://eastersealsdfvr.wordpress.com/2017/03/) on how to develop and strengthen executive function skills using the CO-OP (Goal–Plan–Do–Check) model. I thought I’d take a moment and expand on a very important foundational skill. “Do with me and not for me” So often we have great intentions and we do […]

By: Laura Van Zandt, OTR/L

Recently I wrote a blog on how to develop and strengthen executive function skills using the CO-OP (GoalPlanDoCheck) model. I thought I’d take a moment and expand on a very important foundational skill.

“Do with me and not for me”

So often we have great intentions and we do for our children. This isn’t a bad thing; we want our children to succeed. It’s hard to see them struggling. When we do for our children we neglect one very important step in developing their executive function skills. We accidentally take away their ability to plan, prioritize, problem solve, manage their space/time/materials, and reflect.

If we do not expect our children to be an “active participant” in his or her life, then we take away the many opportunities to learn the daily life skills needed for adulthood and the ability for learning how to tackle and master challenges. Involving your child in daily activities and encouraging them to be an active participant builds a strong sense of competency and positive self-esteem. It helps provide the confidence that your child can do many things and learn to ask for assistance when things go wrong.

Getting your child involved doesn’t have to be an elaborate process. Take whatever you are currently doing for your child and give him/her a simple job with the task. If the child is used to doing “nothing” start very small. Any job, regardless of how small (e.g. hold the pillow and place it on the bed while you make the bed, put one or two dishes into the dishwasher, drop a few articles of clothes in the washer, raise his arms to put his shirt on, etc.) is a start.

The best therapeutic opportunities are often right in front of you. There are endless activities (e.g. cooking, laundry, shopping, bathing, etc.) that make up your day.  You can use all your little interactions for many opportunities to develop executive function skills. By taking a little more time, you can  get your child involved around the house. Instead of just doing, slow down and ask for help. You might find your child enjoys helping and you may even start making some new memories together!

Basi Family

By doing with your child, you have the opportunity to break down the task so your child can be successful. In the process your child then starts to learn that a goal (e.g. making a bed) has many steps to the plan (e.g. put on the fitted sheet, do opposite corners, put on the sheet, put on the duvet/comforter, hold open the pillow case and put in the pillow, place the pillows on the bed). When we do the goal sometimes we work with a team (e.g. you and your child) and sometimes we need to adjust our plan (e.g. having them help this time) and sometimes we check throughout the process (e.g. did we get all the pillows?). You should celebrate with your child by “doing it together” with praise, giving high fives, and other gestures of companionship that you and your child share together. In turn, your child feels productive and competent; driving a desire to learn more. Over time your child learns to feel “good” about doing, and the typical daily challenges that are now a major struggle start to melt away. The child becomes more eager to learn, rather than driven to avoid.

I briefly used GoalPlanDoCheck but let’s use the concept in two better examples. Let’s use the first example for getting your children ready for school and let’s use the second example to model tools you use to help yourself get ready. Both ways involve your children.

1) Helping Your Child Get Ready in the Morning

Goal– While first getting your child up in the morning, tell them “It’s time to get ready so our goal is for you to be at school on time.” Use the word goal so your child knows that is GettingReadyforSchoolyour expectation.

Plan– Talk to your child about the steps. “First we need to go the bathroom so we can wash your face and brush your teeth. This usually helps wake you up so you can focus on getting dressed all by yourself. When you are getting dressed all by yourself, mom and dad will be downstairs making your breakfast. You need to eat your breakfast and then grab your lunch so we can get you to school. Don’t forget to double check your backpack and make sure you have everything you need for school or any after school activities.”

Depending on your child and the age of your child, you might simplify the plan. You might use visuals to help your child remember the plan. There are tons of different strategies that can worked within each child’s individual plan that are tailored to his or her specific needs and specific interests to ensure motivation. Depending on your child you might also need to use incentives to help with motivation and time management.

Do– Divide and conquer. Depending on your child’s age, he or she would not be expected to do all the pieces of the plan.

Check– Keep talking to your child. “Did we get everything? Are we on time? What helped us stay on time? What were time robbers?”

2) Modeling Tools You Use to Get Ready in the Morning

Children learn through modeling. This is a great way to begin introducing your child to this concept as well as teach through modeling different strategies.

Goal– While first getting up in the morning and working with your child, talk aloud to them. Talking aloud is not something that comes naturally and must be practiced; however, talking aloud is a great strategy for modeling the development of executive function skills. Tell them “It’s time to get ready so our goal is for you to be at school on time.” Use the word goal so your child knows that is your expectation.

Plan– Talk to your child about the steps; however, instead of listing the steps like we did in the first example, we are going to focus on you and tools that you use. This is important for kids who just seem disorganized, can’t get their arousal level just right, and just need help. Modeling is great to let them know we all use a variety of tools and that tools can be helpful. Here is an example of a conversation you might have while getting ready with your child:

“It’s time to get ready so our goal is for you to be at school on time. I don’t know about you, but mom is feeling really tired today. I have to get up earlier than you so that I can help you get ready. Do you know what helps me wake up so I can focus on getting ready? I start my morning with a shower. Sometimes the feel of the water on my skin wakes me up. Let’s try washing your face since we don’t have time for a shower.”

Notice how in this example, you discussed with your child a tool you use (shower) and provided them with an option to try. This is a great way to model. There are lots of other dialogues you can have with your child to model tools. This was just one example.

Do– Looks the same as in the first example; however, depending on the tool you may or may not be modeling. Do in the example above was telling your child and then providing your child with an example to do together.

Check– Remains the same. In this stage, we are actively involving our child to think and problem solve.

Have fun with it and know that you are working on developing and strengthening your child’s executive function skills. Executive function skills are developmental and must be taught. When working with your child, you are setting a path toward greater independence. Start simple and build gradually.

If your child is not used to doing much, start with a couple of activities a day. Pick a time of the day when you are not feeling rushed and your child is not feeling stressed. This will give you practice in how to guide, assist, and engage your child. Once it starts to feel natural, expand the “we-dos” into many daily activities. Do them together, giving him/her a little part to play, and gradually expanding his/her role to build more competence.

You are an important part in the development of your child. The more you can help your child think about what they do and why, the more they will be able to use that thinking in any problem solving situation. As my other blog concluded, the overall goal is to teach your child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Executive Function Skills: CO-OP Model

By: Laura Van Zandt, OTR/L

GOALPLANDOCHECK.

Executive functioning skills seems like the new ‘buzz’ word for therapists and parents working with children of all ages. Executive functioning skills include the ability to pay attention, recall a series of information, manage your time, be flexible, self-monitor for your emotions and impulses, initiate tasks, problem solve, persist as well as plan, organize, and sequence. One of our former speech therapists, Jennifer Tripoli, wrote a nice blog in August 2014 which you can refer to for more information regarding the definition of executive function skills.

One strategy that I like to teach children is a concept from the Cognitive Orientation to Occupational Performance or CO-OP model by Helene Polatajko and Angela Mandich called GOALPLANDOCHECK.

The CO-OP model is a “client-centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.” Occupational performance is what we do and how we do things throughout our day. Cognitive orientation implies that what we do and how we do things involve a cognitive process. The approach is designed to guide individuals to independently discover and develop cognitive strategies to meet their goals. That sounds like a lot of executive functioning skill development to me!

The use of self-talk is key with GOALPLANDOCHECK. When we require children to walk us through their plan and teach us their steps by talking aloud, they engablogge in more effective approaches to learning.

When teaching children, we start with the GOAL. We teach the child to understand the word GOAL as being something we are working towards completing. One strategy that has been helpful for visualizing the end GOAL is the concept of “future glasses.” Have the child wear funny glasses or simply make your hands in the shape of glasses. Then close your eyes and visualize the completed GOAL and what it might look like when completed.

The word PLAN implies there are a series of steps we need to do in order to meet our GOAL. To me the PLAN is critical for developing our problem solving skills.

Next we DO our goal.

Finally, we CHECK. The CHECK is really important for developing and strengthening our meta-cognitive skills. It is very important to understand how we can do better next time based on what we did today. CHECK gives the opportunity for feedback control by finding and correcting a mistake before the plan is final. It allows for incorporating flexibility and the ability to shift strategies when the current plan is not working.

KevinThis process helps children strengthen their executive function skills in the areas of working memory to pull from previous experiences, planning and prioritizing steps involved, persisting to achieve goals, and reflecting back by checking in with the plan to see if it was successful. If not, make alterations in order to be successful, eliminate time robbers to help with impulse control, and manage their time. Remember, initially it is about the practice and not the end result. It is okay to make mistakes. We all learn from mistakes.

Parents and family are an important part of the CO-OP approach. The effectiveness of the intervention is greatly increased when everyone is involved. Parents and family help the
individual child to acquire and practice these skills. It also helps them to transfer and generalize the learned strategies into everyday life. By providing explanations as well as guidance and asking questions at an appropriate developmental level, we provide just enough support necessary for the child to be successful. The more you can help children think about what they do and why, the more they will be able to use that thinking in any problem solving situation. The overall goal is to teach a child how to work through a problem using a planned approach instead of acting impulsively.

To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

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