This book provides a basic foundation for understanding several key concepts regarding a child's development of executive functions. The developmental and behavioral theories and models discussed and many of the management techniques outlined seem to target clinicians from varying backgrounds as the main audience of this book. The authors have provided an easy way to understand definitions of the clinical terminology used and have thoroughly described any psychological theories or models making this book an easy read for nonclinicians as well. Several high-yield suggestions for school and home-based interventions are presented, making this book an invaluable tool and resource for clinicians and nonclinicians alike.
As a board-certified pediatrician who is now pursuing specialty training in developmental-behavioral pediatrics, I greatly appreciate the care taken by these authors to ensure that all core concepts are (1) presented as clinically relevant case examples and (2) placed within the context of normal child development. At the very heart of this book lies the understanding that a child's executive functions develop within the context of, and perhaps as a result of, language and social development. The authors write, “All children follow a natural developmental path from externally to internally directed behavior… both language and play, two central activities of childhood, begin in external form, and are gradually internalized, providing the child with increased ability to regulate his/her own thoughts, perceptions, and emotions” (page 103).
The cornerstone of the author's belief is that “the construct of executive function provides specific concepts and terminology that can help children learn that they themselves can do a great deal to improve their own performance” (page 21). Its fundamental goal is to “empower them to live a life in which they can act in accordance with their intentions, pursuing the goals and upholding the standards that are important to them” (page 17). Dr Barkley has proposed that response inhibition is the “most fundamental of the brain's executive functions and the gateway to accessing the other executive functions such as working memory, cognitive flexibility, planning, and problem solving (Barkley, 1997).
Using this developmental model as a backdrop, the authors caution against simply instituting a system of rewards and punishments as the primary means for intervention. They propose that although a reward system may work well for a child who is simply lacking structure and motivation, this system is unlikely to work in a child who lacks the underlying competencies that allow for self-regulation, which is typically a prerequisite for a child to demonstrate success with meeting these goals. The authors write “for those children, intervention needs to move to the next level, improving the underlying capacity for self-regulation” (page 76–77). The authors propose 2 ways to do this: (1) providing coregulation and (2) enlisting the child in planning and using self-regulation strategies.
The authors use several case examples as a means to demonstrate their proposed coregulatory and self-regulatory strategies and interventions. These examples further provide a framework within which the roles of each of the child's caretakers, childcare providers, various school personnel, physicians, and therapists are examined. The authors propose several potential pitfalls of standard assessment techniques and intervention modalities with particular emphasis on those that are typically used in daycare and school settings. They further discuss why these assessments and interventions can be particularly harmful when used to assess and treat children who have delays in executive functions.
This book is an easy to read high-yield manual that I would recommend for any clinician or nonclinician who is involved in the care of a child who has delays in their executive functions. This book will provide them with a foundation for understanding the child's difficulties and a roadmap to help determine the kinds of assessments and interventions that, if implemented, would best serve the child. The authors provide tempered advice on how to provide individualized assistance to each child implementing an appropriate balance of support and independence as a means to propel each child along within the constructs of their own executive function developmental continuum.