This thread is getting a lot of new attention lately. (Hello #ADHDtwitter!) I've learned a lot over the year since I originally posted this. Here are a few insights and clarifications: /1 https://twitter.com/sayitslp/status/1187509381736226816

1) ATTRIBUTION: The info in my thread is based on the work of two Speech-Language Pathologists: @swardtherapy and @KJSLP. So credit where credit is due! These aren't my ideas but I learned of them doing some excellent continuing education last fall.
/2

2) #ADHD vs. EXECUTIVE DYSFUNCTION: These are different but very related things! Hard to pry them apart in a tweet so read more on the difference here: https://www.additudemag.com/what-is-executive-function-disorder/
#executivedysfunction
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3) THE THREAD DESCRIBES LOTS OF FOLKS: I had a huge number of "omg it's meeee!" type responses and it was really neat to be able to put language to people's experiences and to reach so many folks who felt seen!
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4) THE THREAD DOESN'T DESCRIBE LOTS OF FOLKS: I heard from a bunch of other people who had #ADHD or #executivedysfunction who were like "hey wait, this isn't how my brain works at all!" which was an excellent reminder that all brains are different (of course they are).
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In fact, we know there are different flavours of #ADHD and so it makes sense that there will be individual differences in how people experience challenges around task planning and execution. What's it's helped me see is there are multiple stages where breakdown can happen. So:
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5) CHALLENGES HAPPEN AT MANY STAGES: you can have a hard time with seeing what done looks like, you can struggle with identifying steps, you can find it challenging to prioritize steps, you can get distracted or sidetracked as you attempt to get ready to start... etc.
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You can struggle with all of these or one of these or anything in between. In reflecting on it, I've identified one key villain that disrupts pretty much every stage of the task planning/execution thing: distractibility.
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6) DISTRACTIBILITY IS THE WORST: You can see done? Great, but look, an email just came in. You have a list of steps you need to do? Wait, where did you put that list? You are trying to find scissors because- oh wait, better check the mail. And that's just the *planning* steps.
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Distractions also impact every stage of *executing* your plan, and they interfere heavily with staying on top of the crucial time management piece of how long each step should take. And that final step of handing in an assignment or cleaning up when you're finished? Oops.
/10

Basically, distractibility means getting the thing done is STILL HARD even with an excellent strategy in your toolbox because it's hard to sustain attention on using that tool. You have to remember to look at the plan in front of you, after all.
/11

7) EVIDENCE: a few folks have asked what the evidence base is for this theory about nonverbal working memory. Like, how do we know it really works this way? Well, admittedly this has been harder to pin down than I expected.
/12

I have reached out to @swardtherapy and @KJSLP a few times to ask for the studies that support this theory and, regrettably, haven't gotten any response. Sarah's workshop last fall didn't have any studies cited for the theory itself. So is it evidence-based?
/13

Well, that answer is complex but here's what I know: evidence based practice ( #EBP) is comprised of 3 things: client perspectives, clinical expertise, and the empirical evidence itself. More here:
https://www.asha.org/research/ebp/evidence-based-practice/
/14

The evidence arm of that trio can be further broken down into these levels (with the strongest/best evidence at the top):
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Further, this theory of nonverbal working memory and #executivedysfunction is theoretically based, meaning Sarah Ward began developing it based on extensive research and reading on this topic. And she is a qualified #SLP who knows about #EBP.
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That's not a free pass but she works with many clients in her practice for whom these strategies are helpful, even life changing. This raises it above the level of mere anecdotal evidence. Arguably, this could place it between case studies and cohort studies in that pyramid.
/17

Then we add in clinical expertise and what works for clients, right? Because the empirical evidence is only one of three arms of EBP. And while , #SLPs are always beating the #EBP drum, we do rely heavily on clinical expertise and meeting client needs, often creatively.
/18

Clearly, clinical experience and what works for clients are both strengths for this theory. In practice, it seems to explain a lot of people's experiences AND address their challenges. So the fact we are lacking RCTs here is not a huge red flag for me.
/19

Absent any confirmation or info from the creators of this theory, I am left to theorize that what we have here is a great theoretical framework for which research studies haven't been conducted YET. I'm hopeful that's coming down the pike.
/20

My assessment? I think this theory holds water. And my personal experience of seeing it help my son and resonate with so many others tells me there's something to it. And I would love to see some clinical research test it out.
/end