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Tips for: Executive Functioning for Girls with Fragile X

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Tips for Executive Function in Girls with Fragile X
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Executive function. There is so much to it, and it’s so hard for girls with Fragile X! As aforementioned, executive functioning is an umbrella term for a set of skills that include problem solving, impulse control, organisation and the ability to anticipate behavioural outcomes. I would like to just give you a few examples of templates that have worked well for our girls.


Problem Solving

This is a really important skill. Both of my girls initially found this skill very difficult. When they came up against a problem, they would shut down, repeat the same ineffective action over and over or have a tantrum. I think half the battle as a parent is having a cohesive way or technique to address issues like these. This is the template we use to solve problems in our house. We use the same template (usually verbally) every time with the aim that the girls with eventually internalise it.


  1. Decide whether you want to solve the problem. Step one in solving a problem is to work out whether you want to solve it or not! If you just want to whinge, there’s no point in going through this process. So I first ask the girls: Do you want to solve this problem? Recently, both girls were complaining about various issues. I asked them whether they wanted to solve the complaining problem, and thankfully they said yes!

  2. How will we know if we have solved the problem? Encourage a discussion about what that behaviour will look like. In our example, it was cheerful talking.

  3. What are five ideas you have that could solve the problem? Don’t feel you need to make a judgement on how good the solution is- just brainstorm. In this situation, my kids came up with:

a. do some craft together when we get home

b. have a snack in case we are complaining because we are hungry

c. do popping dropping with daddy

d. do reading eggs

e. ride our bikes

4. Which solution do you think would work best? They chose craft. If they choose a crazy solution, encourage discussion on what might happen if you try this solution.

5. How to be flexible and persist until the problem is solved. What will you do if doing some craft doesn’t work? Encourage a discussion about trying each solution in turn until the problem is fixed.


This strategy is adapted from: The Cool Kids Program by Macquarie University’s Anxiety Research unit.


Other Executive Function Skills: A Template

One way to address executive skills deficits is to have a general template you can apply to all sorts of different skills as needed. I find this helpful as I don’t need to hold as much information in my head about different ways to address these deficits. I’ve listed the steps I use with my girls and an example below.

1. Decide the target behaviour. If we say ‘impulse control’ or ‘organisation’ this is probably too broad, we need to break it down into something observable. Think Skinner and his carrier pigeons if you are familiar with the early behaviourist movement in psychology. For example, at the moment with Amelie we are working on not losing her temper when she is with her sister.

2. Identify the appropriate and inappropriate behaviours. We wrote a list with Amelie’s help. Our list was:

a. Appropriate behaviour when with Adelaide:

Speaking in a normal voice

Asking her to ‘stop it please’ if she does something annoying

Walking away if she does not listen

Telling mum or dad if you need help

b. Inappropriate behaviour with Adelaide:

Speaking in a raised voice that is louder than normal

Yelling

Grabbing or touching Adelaide in an unkind way

Saying unkind things

3. Tell a social story and role play the behaviour. In this example we talked with Amelie about expected and unexpected behaviour. I find this language less shaming than ‘naughty’ and ‘good’ behaviour. We explained that expected behaviour makes others feel safe and happy, unexpected behaviour makes others feel confused and unsure. The way she was interacting with Adelaide was unexpected and unkind. When we act in expected ways we make others feel good, we feel good about ourselves, and we keep our friends. Then we role played various scenarios where I pretend to be Adelaide and Amelie practiced how to respond appropriately.


This type of scaffolding is very useful and something we as parents typically skip. At this stage you can iron out all the difficulties that you may have had at the intervention stage without creating conflict with your child. For example, if your child role plays inappropriate behaviour thinking it’s appropriate, you can gentle correct them at this stage rather than letting that misunderstanding fester and cause frustration later when your child thinks they are doing the right thing and you see an inappropriate behaviour.


4. Collaboratively design a reward system. In this example we asked Amelie what she would like to work towards (a new bike). The reward should be proportional to the amount of effort the child has to put in to succeed. Then we grabbed 35 glass pebbles as tokens and set a jar up in the kitchen. We put the list of appropriate and inappropriate behaviours next to the jar so she could review them whenever she needed. Then we explained that every time she did a behaviour from the ‘appropriate’ list she could put a jewel in the jar. Whenever she did a behaviour from the ‘inappropriate’ list she had to take a jewel out of the jar. Amelie is very honest and will monitor herself so she was able to take more charge than my younger daughter would have been able to with the same intervention.


5. Follow through with the system. Sometimes I think that this is the hardest part! Our lives are so busy that we often start interventions like these and then forget them. Some ideas that I’ve found helpful are to stick with one behavioural intervention at a time to make it easier to focus on, sporadically role play with your child as the intervention progresses to reinforce the appropriate behaviour, and keep front of mind that once this new behaviour becomes a habit life will be better for you and your child!

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