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OT IN PEDIA
COGNITIVE SKILLS AND EXECUTIVE FUNCTION SKILLS
| Term | Definition | Key Features | Schema | Limitations |
|---|---|---|---|---|
| COGNITION | - Mental functions that enable learning, reasoning, problem-solving, and adaptation. - Foundation for participation in play. school, self-care, and social life. | |||
| GLOBAL MENTAL FUNCTION | - Consciousness, orientation, energy/drive, personality/temperament | |||
| SPECIFIC MENTAL FUNCTIONS | - Attention, memory, perceptual functions, thought (sequencing, categorization), executive functions. - Higher level skills, but still needs lower skills. | |||
| TYPICAL DEVELOPMENT | - Cognitive skills progress from sensorimotor exploration → symbolic thought → logical reasoning → abstract thinking - Development occurs through interaction with environment and occupations | |||
| Match the activities with the cognitive level of the child | - follow the typical development when giving activities, instructions, and other critical elements of the activity. | |||
| THEORY OF COGNITIVE DEVELOPMENT BY JEAN PIAGET | The purpose of intelligence was to help humans adapt to the environment. In the process of adaptation, cognitive structures changed through the process of assimilation and accommodation. | |||
| ASSIMILATION | Integrating new information into existing mental structures (schemas). | |||
| ACCOMODATION | Adjusting or creating new mental schemas when existing ones don’t fit | |||
| ADAPTATION | Balance of assimilation and accommodation that drives learning and cognitive development. | |||
| PIAGET’S STAGES OF DEVELOPMENT 1. SENSORIMOTOR (0-2 YRS) | Learning through senses and motor actions; cause and effect understanding; development of object permanence (when you press a button, a light pops up). | - Type of thought - The more you provide opportunities, the more you acquire schema. | ||
| Sensory information | - you understand how your body responds | |||
| substage: Simple Reflexes | Age: Birth - 1 Month Description: Reflexive responses ore the are the basis of interaction in the world Example: Rooting, sucking, grasping | |||
| substage: First Habits & Primary Circular Reactions | Age: 1 - 4 Months Description: Repetitions of actions centered on the body Example: Repeatedly sucking thumb differently from nipple | |||
| substage: Secondary Circular Reactions | Age: 4 - 8 Months Description: Intentional actions directed toward environment Example: Infant coos to keep caregiver nearby | |||
| substage: Coordination of Secondary Circular Reactions | Age: 8 - 12 Months Description: Goal-directed behavior, object permanence emerging Example: Infant pushes a toy aside to grab one underneath | |||
| substage: Tertiary Circular Reactions, Novelty, & Curiosity | Age: 12 - 18 Months Description: Trial-and-error exploration; problem-solving Example: Infant drops a block in different ways to see results | |||
| substage: Internalization of Schemes | Age: 18 - 24 Months Description: Mental representation of events, beginning of symbolic thought Example: Infant imitates a tantrum they observed the other day | |||
| PIAGET’S STAGES OF DEVELOPMENT 2. PRE-OPERATIONAL (2-7 YRS) | Symbolic thought, pretend play, rapid language growth, egocentric thinking (difficulty seeing other’s perspectives) | Lack of logical operations; cannot conserve quantity or understand reversibility. | ||
| Symbolic pretend play - up to 4 | - Has language and scripts (ex: check if he is sick, etc) (animalistic thoughts) - Could be the misrepresentation of the function of an object. More of the reality that you are misrepresenting | |||
| Egocentric thinking | - Difficult for them to understand others (tumitigas ulo nila, saying “no”, being firm) | |||
| Age: 2-4 y/o | Stage: Symbolic Function (PC) Cognitive Milestones: • Mentally represent an object not present (draws, language, pretend play) Representing from mental imprint • Strong egocentrism and animism (3) | |||
| Egocentrism | They think that everyone is thinking the same as them. That is why they can throw tantrums and meltdowns because they do not understand that we all think differently. | |||
| Animism | Giving lifelike features. Talking to toys and dolls like they are alive. | |||
| Age: 5-7 y/o | Stage: Intuitive Thought Cognitive Milestones: • Children seem so sure of their knowledge and understanding yet are unaware of how they know that they know • Curiosity and primitive reasoning • Centration, conservation, irreversibility | |||
| Irreversibility | It wouldn't be clear yet that ice is water, and water is ice. Children do not understand this and so they only have irreversibility at this time. | |||
| PIAGET’S STAGES OF DEVELOPMENT 3. CONCRETE OPERATIONAL (7 - 11 YRS) | - Preschooler - Pretend play becomes more complex, more activity level | Logical thinking about concrete, tangible events; conservation of mass/number; classification and derivation (ordering by size/number) | ||
| PIAGET’S STAGES OF DEVELOPMENT 4. FORMAL OPERATIONAL (11 & ABOVE) | Abstract thought, hypothetical reasoning, deductive logic, metacognition (thinking about thinking) | |||
| FACTORS AFFECTING TYPICAL COGNITIVE DEVELOPMENT | - 0-7 y/o is a very crucial age for development because marami na namiss na milestones. Kaya pag ganto age, wag masyado panoorin ng youtube. - If we want to build schemas, we give stimulus and opportunities such as play and human interactions | |||
| FACTORS AFFECTING TYPICAL COGNITIVE DEVELOPMENT Biological: | genetic conditions, brain injury, sensory processing | |||
| FACTORS AFFECTING TYPICAL COGNITIVE DEVELOPMENT Environmental: | family routines, exposure to play/learning, socioeconomic context | |||
| FACTORS AFFECTING TYPICAL COGNITIVE DEVELOPMENT Social: | caregiver interaction, peer relationships, cultural values | |||
| FACTORS AFFECTING TYPICAL COGNITIVE DEVELOPMENT Occupational: | opportunities for play, school participation, technology use | |||
| RED FLAGS 1 | - Difficulty with sequencing routines - iI therapy centers, it is a common redflag sa parents na they are waiting for the kid to do certain things na it is past their age already. | |||
| RED FLAGS 2 | - Struggles in symbolic or pretend play beyond age expectations - Poor attention span or inability to follow age-appropriate instructions - Challenges in adapting strategies across contexts | |||
| IMPACT OF COGNITIVE SKILLS ON OCCUPATIONS ADLs: | forgetting steps, trouble sequencing dressing or hygiene | |||
| IMPACT OF COGNITIVE SKILLS ON OCCUPATIONS Education: | poor attention, weak memory, difficulty problem-solving | |||
| IMPACT OF COGNITIVE SKILLS ON OCCUPATIONS Play: | difficulty with rule-based or cooperative games | |||
| IMPACT OF COGNITIVE SKILLS ON OCCUPATIONS Social Participation: | trouble with perspective-taking, turn-taking | |||
| IMPACT OF COGNITIVE SKILLS ON OCCUPATIONS Leisure/Work (Older Child): | trouble planning, organizing, managing time | |||
| EVALUATION - STANDARDIZED ASSESSMENTS Bayley Scales of Infant Development | - Measures cognitive, motor, and language development | |||
| EVALUATION - STANDARDIZED ASSESSMENTS Mullen Scales of Early Learning | Early cognitive and motor milestones | |||
| EVALUATION - STANDARDIZED ASSESSMENTS Wechsler Scales (WPPSI,WISC) | - Intellectual functioning - Usually used by devpeds | |||
| EVALUATION - STANDARDIZED ASSESSMENTS Behavior Rating Inventory of Executive Function (BRIEF) | Everyday executive functioning | |||
| EVALUATION - STANDARDIZED ASSESSMENTS School Function Assessment (SFA) | Participation and task performance in school | |||
| EVALUATION - OBSERVATIONAL METHODS | - Play Routines (Problem solving, symbolic play) - Classroom Activities (attention, task completion) - ADLS (sequencing, organization, memory in routines) | |||
| EVALUATION - ECOLOGICAL ASSESSMENTS | - COPM (Canadian Occupational Performance Measure) - Caregiver and teacher interviews. - Contextual analysis of home, school, and play environments. | |||
| HOW DO WE GRADE COGNITIVE SKILLS? | - Age appropriate or age inappropriate; emerging, developing, mastered - especially if using Piaget - Does not matter if advanced for the age, it is still age appropriate because we look at the typical development | |||
| Why do we use GFP in adults? | - Because they are already mature (not in the stage of skill attainment) - We look at how they use the skill efficiently, if there is blablabla (Di ko narecord) | |||
| INTERVENTION APPROACHES - REMEDIATION (SKILL-BUILDING) | - Sequencing games - Categorization and sorting activities - Memory tasks (matching, recall games) | |||
| INTERVENTION APPROACHES - COMPENSATION (SUPPORTIVE STRATEGIES) | - Visual schedules and checklists - Timers and reminders - Simplified instructions with step-by-step prompts | |||
| INTERVENTION STRATEGIES - COGNITIVE STRATEGIES | - CO-OP (Goal-Plan-Do-Check) - Problem-solving scripts, self-talk - “Stop-Think-Do-Check” Routines | |||
| INTERVENTION STRATEGIES - OCCUPATION-BASED INTERVENTIONS | - Real routines (packing backpack, cooking, morning dressing). - Schoolwork planning (breaking assignments into steps). - Play with peers (games requiring turn-taking, flexibility). | |||
| INTERVENTION STRATEGIES - ENVIRONMENTAL SUPPORTS | - Teacher/Caregiver scaffolding - Peer-assisted learning - Structured, predictable routines. | |||
| EXECUTIVE FUNCTIONS | - Higher-order cognitive processes that enable self-regulation, goal-directed behavior, and problem-solving | |||
| Behavioral Regulation | - Emotional control - Shift - Inhibit | |||
| Meta-cognition | - Monitor - Organization of materials - Plan/Organize - Working memory - Initiate | |||
| WHY REGULATION COMES FIRST? | - EF skills rely on prefrontal cortex activity. - In a dysregulated state (fight/flight/freeze), the limbic system “hijacks” → EF goes offline. - Trying to teach EF skills during a meltdown or high stress moment will not “stick” | |||
| CO-REGULATION IS THE BRIDGE | - Before EF teaching, the child usually needs support from a regulated adult. - Once calm, the brain is more ready to engage in EF learning. | |||
| Co-regulation strategies: | calm voice, sensory tools, movement breaks, predictable routine | |||
| REGULATION AS A PRE-REQUISITE SKILLS | Teach regulation → then practice EF | |||
| regulation in action | For younger children or those with development challenges, EF is _________________. | |||
| regulated state | EF strategies (e.g. “Stop-Thing-Do-Check”) only makes sense when the child is back in a ______________. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - THINKING (COGNITIVE) Planning and Prioritization | - set goals, set steps to reach goal - decide the first and last of importance - The ability to create a roadmap to reach a goal, deciding on steps and priorities along the way. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - THINKING (COGNITIVE) Organization | - task and information - The skill of keeping track of materials and ideas in structured, logical ways to avoid confusion. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - THINKING (COGNITIVE) Time Management | - Ability to use your time effectively - plan and schedule accordingly to allocate the time reasonably to finish it - The capacity to estimate how long tasks will take, set deadlines, and use time effectively | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - THINKING (COGNITIVE) Working Memory | - Holding information in mind for use - The ability to hold and manipulate information in mind to complete tasks or solve problems. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - THINKING (COGNITIVE) Metacognition | - Thinking about thinking - Capacity to monitor and reflect on what you are thinking - The skill of self-monitoring and reflecting on one's own performance to make adjustments. | |||
| self-monitoring: | Having the responsibility checking or correcting his or her own work | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - DOING (BEHAVIORAL) Response Inhibition | - The ability to think before acting and resist impulses that could interfere with goals. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - DOING (BEHAVIORAL) Emotional Control | - Regulating to meet the task demands - The capacity to manage feelings so they do not disrupt thinking or behavior. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - DOING (BEHAVIORAL) Sustained Attention | - For a significant period of time - The skill of maintaining focus despite boredom, fatigue, or distractions. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - DOING (BEHAVIORAL) Task initiation | - The ability to begin tasks without undue procrastination or delay | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - DOING (BEHAVIORAL) Flexibility | - Shift between tasks without difficulties (frustrated, inefficient) - The ability to revise plans in the face of obstacles, setbacks, new information, or mistakes. | |||
| TWO DIMENSIONS OF EXECUTIVE FUNCTION SKILLS - DOING (BEHAVIORAL) Goal-directed Persistence | - Sustaining effort towards goal-directed activities - The ability to stay motivated and follow through with a goal despite difficulties. | |||
| TYPICAL DEVELOPMENT Preschool (3-5 yrs): | Simple inhibitory control, emerging working memory | |||
| TYPICAL DEVELOPMENT School age (6-11 yrs): | Improved attention, rule-following, planning simple routines | |||
| TYPICAL DEVELOPMENT Adolescence (12-18 yrs): | Abstract planning, long-term organization, metacognition | |||
| TYPICAL DEVELOPMENT Adulthood: | Mature executive control, but still context-dependent | |||
| FACTORS INFLUENCING EXECUTIVE FUNCTION SKILLS DEVELOPMENT Biologic: | Brain maturation (prefrontal cortex), neurodevelopmental conditions (ADHD, ASD, TBI) | |||
| FACTORS INFLUENCING EXECUTIVE FUNCTION SKILLS DEVELOPMENT Environmental: | Parenting style, routines, school structure, stress | |||
| FACTORS INFLUENCING EXECUTIVE FUNCTION SKILLS DEVELOPMENT Occupational: | Opportunities for play, games with rules, real-world problem solving | |||
| IMPACTS ON OCCUPATIONAL PERFORMANCE IMPACTS ON OCCUPATIONAL PERFORMANCE ADLs/IADLs: | Forgetting steps, poor time management, safety risks | |||
| IMPACTS ON OCCUPATIONAL PERFORMANCE Education: | Trouble initiating homework, organizing materials, sustaining attention | |||
| IMPACTS ON OCCUPATIONAL PERFORMANCE play: | Difficulty following multi-step games or flexible play scenarios | |||
| IMPACTS ON OCCUPATIONAL PERFORMANCE Social Participation: | Impulsivity, difficulty taking turns, poor emotional control | |||
| EVALUATION - STANDARDIZED ASSESSMENTS * BRIEF / BRIEF-2 (Behavior Rating Inventory of Executive Function) | - Everyday EF behaviors in natural settings - Most commonly used | |||
| EVALUATION - STANDARDIZED ASSESSMENTS D-KEFS (Delis-Kaplan Executive Function System) | - Measure higher-level cognitive skills in structured tasks | |||
| EVALUATION - STANDARDIZED ASSESSMENTS NEPSY-II (Neuropsychological battery) | - Broad cognitive functions including attention, memory, social perception, and EF | |||
| EVALUATION - STANDARDIZED ASSESSMENTS SFA (School Function Assessment) | - Participation, task supports, and performance in school routines. | |||
| EVALUATION - OBSERVATIONAL METHODS | - Classroom routines (initiation, self-monitoring) - Play tasks with rules - ADL sequencing | |||
| EVALUATION - ECOLOGICAL ASSESSMENTS | - COPM with c/g - Daily routines analysis (home and school) | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION | - Standardized rating scale completed by parents, teacher, or self-report (older children/adolescents) - Captures real-world executive function behaviors across home, school, and community | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Purpose: | - Evaluates how children regulate emotions, behavior, and cognition in everyday life. - Identifies EF strengths and weaknesses that affect ADLs, school play, and social participation | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Ages: | 5-18 yrs | |||
| BRIEF Preschool: | 2-5.11 yrs | |||
| BRIEF Self-report: | 11-18 yrs | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Domains/Indices: Behavioral Regulation Index (BRI): | - Inhibit - Shift - Emotional control | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Domains/Indices: Metacognition Index (MI): | - Initiate - Working memory - Plan/Organize - Organization of Materials - Task Monitor | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Domains/Indices: Global Executive Composite (GEC): | - Overall summary score of EF - Total of 9 | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Scoring and Interpretation: (1) | - Raw scores → converted to T-scores (mean = 50, SD = 10) - T > 65 → clinically significant EF difficulty | |||
| BRIEF/BRIEF-2: BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION Scoring and Interpretation: (2] | - Profiles highlight whether issues are more behavioral regulation or metacognitive regulation - Comparison across raters (parent vs teacher) gives insight into contextual differences | |||
| HOW DO WE GRADE EF SKILLS? | - We do not use GFP in grading - Different milestones kaya bawal din age appropriate and inappropriate - Can use “emerging, developing, mastered” | |||
| INTERVENTION APPROACHES - REMEDIATION | - Games for working memory (card recall, simon says) - Inhibition tasks (red light/green light) - Cognitive flexibility challenges (sorting tasks with shifting rules) | |||
| INTERVENTION APPROACHES - COMPENSATION | - Visual schedules checklists, planners - Use of timers, alarms, or reminder apps - Breaking tasks into smaller steps | |||
| INTERVENTION STRATEGIES - COGNITIVE STRATEGIES | - CO-OP (Goal-Plan-Do-Check) - Problem-solving scripts, self-talk - “Stop-Think-Do-Check” routines | |||
| INTERVENTION STRATEGIES - OCCUPATION-BASED | - Real routines (packing backpack, cooking, morning dressing) - Schoolwork planning (breaking assignments into steps) - Play with peers (games requiring turn-taking, flexibility) | |||
| INTERVENTION STRATEGIES - ENVIRONMENTAL SUPPORTS | - Teacher/caregiver scaffolding - Peer-assisted learning - Structured, predictable routines | |||
| HOW TO IMPROVE AND TEACH EF SKILLS 1 | 1. Assess and collaborate 2. Prioritize 1-2 target skills 3. Create SMART goals 4. Select evidence-based strategies and external supports 5. Teach the strategy explicitly (instruction) 6. Guided practice with scaffolding | |||
| HOW TO IMPROVE AND TEACH EF SKILLS 2 | 7. Apply to real-life scenarios (contextualization) 8. Teach self-monitoring and reflection 9. Systematically fade supports and promote generalization 10. Reinforce, problem-solve and troubleshoot 11. Monitor progress and adjust accordingly | |||
| SCAFFOLDING TIPS | - Build EF skills through strengths-based approach - Start with the child's strongest EF area → scaffolding weak areas. - Embed strategies into meaningful occupations - Use rewards, visual cues, and consistent routines. | |||
| Executive functions | are the brain’s air traffic control system—when we strengthen them, children gain the power to direct their own actions, emotions, and future participation in life. | |||
| SESSION PLAN IMPLEMENTATION: UNDERSTANDING AND APPLYING EXECUTIVE FUNCTIONS 1 | - Higher skills needed to execute certain task - A set of higher-order cognitive processes that are responsible for the control and regulation of lower-level processes, enabling individuals to achieve goal-directed behavior. | |||
| SESSION PLAN IMPLEMENTATION: UNDERSTANDING AND APPLYING EXECUTIVE FUNCTIONS 2 | - Effortful mental processes are needed when a person has to concentrate and pay attention. | |||
| FRAMEWORKS - MIYAKE ET AL (2000) | Identified three EFs that work together for higher-level cognitive thinking - Shifting - Updating and Monitoring - Inhibition | |||
| Shifting | - Moving from one task or mental set to another | |||
| Updating and monitoring* | - Monitoring and revising the contents of working memory. | |||
| Inhibition | - Stopping oneself from doing the first or automatic thing that comes to mindIdentified three EFs that work together for higher-level cognitive thinking | |||
| FRAMEWORKS - DIAMOND (2013) | - Also follows 3 core EFs: Inhibition, Working Memory, and Flexibility | |||
| Inhibition | - Selectively attend and focus on what we choose, and suppress attention to other stimuli - Resist extraneous or unwanted thoughts or memories - Works to aid working memory - Self-control - CTA: Simon task, Go/no-go task, Stop-signal task | |||
| Working Memory 1 | - Hold information in mind while mentally working with it. - Remembering instructions, rules, or sequences over short periods - Allows us to relate past information to present/future tasks | |||
| Working Memory 2 | - Essential for reasoning, problem-solving, and goal-directed behavior - Works closely with inhibitory control to sustain focus - CTA: Digit span, N-back task, Self-ordered pointing task | |||
| CognitiveFlexibility 1 | - Ability to shift perspectives, adapt to changing demand, or see things in multiple ways - Switching between tasks or mental sets - Helps adjust strategies when rules or environments change | |||
| Cognitive Flexibility 2 | - Supports creativity, problem-solving, and considering multiple situations - Builds on both inhibitory control and working memory - CTA: WCST, DCCS, Task-switching paradigms | |||
| FRAMEWORKS - DAWSON & GUARE (2009) | - Consists of 11 skills - Divided into two dimensions: Thinking, Doing | |||
| Thinking | - The executive functions that help a person plan, organize, and guide their actions before carrying them out. They Involve mental processes like reflecting, setting goals, and monitoring progress to support problem-solving and decision-making | |||
| Doing | - The executive functions that allow a person to put plans into action and manage behavior in the moment. They involve self-control, persistence, and flexibility to stay on track and adapt as tasks or situations change. | |||
| COOP (COGNITIVE ORIENTATION TO DAILY OCCUPATIONAL PERFORMANCE) | - Studies stated that this helped in improving children's occupational participation - Client-centered, performance-based, problem-solving approach that enables skill acquisition through a process of guided discovery - Follows the GPDC format | |||
| GPDC format | Goal - Plan - Do - Check | |||
| COOP Goal: | Client identifies and chooses a specific skill/occupation they want to learn and improve | |||
| COOP Plan: | OT uses guided discovery to help the client develop a plan to achieve their goal | |||
| COOP Do | Client carries out the plan and performs the chosen activity. | |||
| COOP Check: | The client and therapist reflect on the outcome | |||
| GAMES 1 | - Simon says, go-no go task, other playground games - Through repeated practice, the child strengthens their ability to pause, process the command, and decide whether to act. | |||
| GAMES 2 | - Game-based, behavior modification approach that uses a structured, playful activity to directly train response inhibition and sustained attention. - Game trains the child's brain to stop an automatic response and only act on a specific cue. | |||
| COGNITIVE REHABILITATION | - Comprehensive program that uses targeted activities to retrain cognitive processes. The goal is to improve the brain's ability to adapt to new situations and reduce rigid, repetitive behaviors (Ramezani, 2024). | |||
| INTERVENTION PLANNING- FLEXIBILITY LTG: | Claudine will improve cognitive flexibility by prioritizing accuracy and task completion over speed, as evidenced by reading instructions before answering and completing tasks with no physical outbursts independently within 6 months of OT sessions. | |||
| INTERVENTION PLANNING- FLEXIBILITY STG1: | Claudine will demonstrate cognitive flexibility by completing classroom tasks according to instructions, even if she is not the first to finish, with moderate verbal prompting and visual cues, in 3 out of 5 opportunities within 3 months of OT sessions. | |||
| INTERVENTION PLANNING- FLEXIBILITY STG2: | Claudine will demonstrate improved flexibility by refraining from physical outbursts (maintaining a calm behavior) when unable to finish first, given moderate verbal and physical prompting, in 3 out of 5 opportunities within 3 months of OT sessions. |
Created by:
avemaria