Supporting Z’s Development with Executive Functioning Skills
Introduction:
In February 2024, we were introduced to Z, an 8-year-old student, through a referral. Z’s parents provided consent for us to review his neuropsychological evaluation from Small Brooklyn, which outlined some challenges he was facing, particularly in executive functioning (EF) skills. Z is a bright and engaged boy who thinks deeply about topics he’s interested in and makes new and insightful connections. However, he has difficulty regulating his focus and energy, which gets in the way of his learning at his accelerated school. He also has a history of anxious rumination and can get easily “stuck” and then derailed. Small Brooklyn recommended several treatment options, including executive function coaching, to help him get back on track and shine academically. Based on this information, we devised a tailored support plan to help Z improve in these areas.
Initial Planning and Implementation:
In early February, Julia, one of our experienced special educators, had a detailed discussion with Z’s teacher. Together, they formulated a plan for Julia to begin in-school sessions with Z starting Monday, March 4th. The plan initially included one session per week, with discussions ongoing about potentially adding a second session on Thursdays. Julia received clearance from the school for security purposes and eagerly anticipated starting her work with Z.
First Impressions and Adjustments:
Julia’s first session with Z in early March went exceptionally well. Following this, they scheduled another session for the same week. Julia and Z’s mother agreed to continue with twice-weekly sessions for the initial period. After about a month, they planned to reassess Z’s needs and decide whether to maintain or reduce the frequency to once a week.
Positive Feedback and Observations:
Mid-March brought positive feedback from Z’s mother, who reported that Z enjoyed his time with Julia. Julia had meticulously observed Z, engaged with his teacher, and built rapport with him. Based on her observations and interactions, she started implementing strategies.
Julia provided regular, detailed updates to Z’s mother, who found them helpful. These updates included insights into Z’s behavior, progress, and any adjustments made to the support plan.
Progress and Continued Efforts:
By May 10th, Julia observed significant improvements in Z’s organizational skills, working memory, and tendency towards negative self-talk. Z’s teacher, who had been with him for two years, noted that although the progress was slow, it was consistent with Z’s pace. She also highlighted Z’s enthusiasm for his sessions with Julia, recognizing the value they brought.
Julia and Z’s teacher discussed additional tools to support Z, such as therapy, to address underlying issues contributing to his EF challenges. Despite occasionally needing to send multiple reminders to Z’s parents, the overall experience was positive, and they were ending the school year on a high note.
Conclusion:
This case study of Z highlights the importance of personalized support and continuous collaboration among tutors, teachers, and parents. Julia’s consistent engagement and tailored strategies significantly contributed to Z’s progress. The ongoing communication ensured that Z received the necessary support to improve his executive functioning skills, setting a strong foundation for continued development.
Case Study: Expanding V’s Language and Writing Skills
Introduction:
In September 2023, we were introduced to V, a 9-year-old 4th-grade student, through a referral from her neuropsychologist, Dr. Nicole Katz. The neuropsychological evaluation report outlined language-based learning challenges, attentional difficulties, and language development deficits related to written expression. Based on this information, we devised a tailored support plan to help V improve in these areas.
Initial Planning and Implementation:
Michelle, one of our experienced Speech-Language Pathologists, reviewed the neuropsychological report and had a detailed discussion with V’s father. Together, they formulated a plan for Michelle to administer a SALT assessment (an assessment of language acquisition and disorders using language samples) to identify V’s language skill deficits. The assessment results indicated that V’s speech rate was below that of her peers across all tasks, and her story-retelling showed weaknesses in several areas. Research supports using scaffolding techniques, like those Michelle planned to use, as effective for children with language-based learning disabilities (Dynamic Assessment for Children With Communication Disorders: A Systematic Scoping Review and Framework). Michelle began in-person sessions with V on October 5, 2023.
First Impressions and Adjustments:
Michelle’s first session with V in early October went exceptionally well. After discussions with the parents, it was decided that V would have two 60-minute weekly sessions to practice story retelling, sequencing events in narratives and read-aloud stories, and working through visual aids, structural frameworks, and graphic organizers to help V organize her ideas in writing tasks. The use of these visual aids and structural frameworks aligns with research indicating their effectiveness in improving language and writing skills (Effectiveness of Intervention for Grammar in School-Aged Children with Primary Language Impairments: A Review of the Evidence).
Positive Feedback and Observations:
V’s father immediately reported that the first session with Michelle was productive, and he was hopeful. On January 7, 2024, V’s father was praised for Michelle’s work with V. He stated, “Michelle has provided an incredible amount of structure and scaffolding to V, adapting to her style and growth areas. Based on last year’s feedback, we started the year with V objectively behind and the potential of her having clear deficits in some areas. We just caught up with her teacher, who told us that she was well within the norm now, that she may not even be eligible for a ‘practicum’ class next year designed for the students who need reinforcement in English, and that instead, they may decide that the best thing for her would be to start a new language.” He was also happy to report that V’s social issues at school had dissipated. The teacher’s theory was that since V now saw herself “on par” with her peers, she developed a renewed confidence to engage with her friends more constructively.
Progress and Continued Efforts:
In terms of story retelling, V initially needed help organizing her thoughts. She often could not “set up” her story with an appropriate sentence for background information, which usually left her confused about where to begin her retelling. Research by McCabe and Bliss (2003) supports the importance of narrative skills in academic success and social communication, indicating that targeted interventions can significantly improve these skills (Patterns of Narrative Discourse: A Multicultural, Life Span Approach). Reviewing story elements with V and encouraging her to begin her retells with an opening sentence that included the characters, setting, and a brief description of the main event happening in a given paragraph was incredibly helpful. Michelle worked with V on identifying problems/solutions in given stories and the characters’ associated feelings. They were able to phase the visual aids out completely for one-paragraph retells after approximately two months, and V continued to internalize the structure required to retell a story coherently.
On April 10, Michelle reported that they had been targeting V’s expressive language and retelling skills for longer passages and that she was progressing nicely. V enjoyed her sessions with Michelle and felt confident about her successes. V’s parents remained highly satisfied.
Once V demonstrated considerable progress with one-paragraph stories, Michelle and V began targeting longer passages (2-3 paragraphs). Generally, V had difficulty recalling pertinent details when a longer passage was simply read and she was asked to retell the story. In order to help V better store and process the information, they began to target note-taking. At first, V needed help identifying important information versus extraneous details to include in her notes. Michelle would often model note-taking for a given paragraph, which was helpful. It would also be beneficial if Michelle took notes on a paragraph and included some extraneous details, then had V try to identify which details were unnecessary. Research by Gillam & Gillam (2016) indicates that these methods help improve memory retention and expressive language abilities in children with language disorders (Narrative Discourse Intervention for School-Aged Children With Language Impairment Supporting Knowledge in Language and Literacy). Before breaking for summer, V had made great progress taking notes and easily identifying the pertinent information in a story, leaving out unimportant details. Her confidence in this skill grew tremendously. As Michelle did not want to spend their sessions reading a particularly long passage, V would often be assigned a longer passage for homework, which she would independently read, take notes on, and then record herself retelling the story. V would send Michelle her notes and her recording before their scheduled session, and they could then sift through her notes and ensure she included all the important information. At the same time, Michelle provided feedback on her recording.
At the end of the school year, Michelle began targeting V’s writing skills, following feedback from her teachers that this would be a good area to strengthen. To continue targeting retelling aspects, they worked on summarizing texts of various lengths and complexities. V made extraordinary progress in her writing skills. Initially, V’s writing contained little organization, and most of her sentences were run-ons. Research by Graham and Harris (2005) emphasizes the importance of explicit instruction and structured approaches in teaching writing to students with learning disabilities (Improving the Writing Performance of Young Struggling Writers: Theoretical and Programmatic Research From the Center on Accelerating Student Learning). V seemed to need a template/framework to help her organize her paragraph and set her up to explain events in a story sequentially and clearly. V continued to progress in identifying important details to include in her summaries, and she improved her ability to explain story events in her own words rather than lifting sentences or dialogue straight from the story.
Another area V’s teachers mentioned would be beneficial to work on was her ability to use text evidence to support her answers during short answer questions and essays. Often, V can find relevant text evidence, but she struggles to explain in writing why that particular piece of evidence supports the answer she provided to a question. V benefits from provided sentence starters to help cue her to explain. For example, once V inserts her text evidence into the answer to a question, Michelle types out “this shows that…” to remind her to explain her chosen quote or evidence from the text.
Michelle and V’s family decided to give V a much-needed summer break, but to continue her progress, they will resume services for the 2024-2025 school year.
Conclusion:
This case study of V highlights the importance of personalized support and continuous collaboration among speech-language practitioners, teachers, and parents. Michelle’s consistent engagement and tailored strategies significantly contributed to V’s progress. The ongoing communication ensured V received the necessary support to improve her language and writing skills, setting a strong foundation for her continued development. The interventions used in V’s case are supported by research, emphasizing the effectiveness of scaffolding, narrative-based interventions, visual aids, structured writing instruction, and explicit language therapy techniques in improving the language and writing skills of children with language-based learning challenges.
