Executive functioning in the classroom: Primary school teachers’ experiences of neuropsychological issues and reports

Teaching and Teacher Education 86 (2019) 102912

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Teaching and Teacher Education journal homepage: www.elsevier.com/locate/tate

Executive functioning in the classroom: Primary school teachers’ experiences of neuropsychological issues and reports L. Keenan a, S. Conroy a, A. O'Sullivan b, M. Downes a, * a b

School of Psychology, University College Dublin (UCD), Belfield, Dublin, Ireland Kildare Town Educate Together, Kildare, Ireland

h i g h l i g h t s

g r a p h i c a l a b s t r a c t


Teachers frequently encounter young children with executive dysfunction in the classroom.
Teachers recognise the importance of supporting students' executive functioning development.
Teachers lack training on the topics of executive functioning and neuropsychology more generally.
Neuropsychological reports are often not fully translated into practical applications due to poor communication.
Systemic issues limit teachers' abilities to provide classroom-based early interventions.

a r t i c l e i n f o

a b s t r a c t

Article history: Received 7 December 2018 Received in revised form 25 June 2019 Accepted 19 August 2019 Available online 28 August 2019

Executive functions are crucial for young students to achieve academic success. Classroom environments can influence executive skill development. Teachers act as key players in the promotion of executive functions by providing students with targeted support and scaffolding. Therefore, it is important to establish teachers' understanding of executive functions and barriers to supporting executive dysfunction. Focus groups with primary school teachers (N ¼ 10) highlighted the importance of promoting students’ executive functions. Knowledge gaps related to neuropsychological terminology were identified. Barriers emerged for the successful implementation of evidence-based interventions, which are compounded by wider systemic issues. Implications for early intervention and for the translation of neuropsychological evidence into the classroom are discussed. © 2019 Elsevier Ltd. All rights reserved.

Keywords: Executive functions Neuropsychological assessment Teaching Educational policy Early childhood education Early intervention

1. Introduction Abbreviations: Executive functioning (EF), Primary school teacher (PST). * Corresponding author. Michelle Downes School of Psychology, University College Dublin, Dublin 4, Ireland. E-mail addresses: [email protected] (L. Keenan), sarah.conroy1@ucd. ie (S. Conroy), aisling.o'[email protected] (A. O'Sullivan), Michelle. [email protected] (M. Downes). https://doi.org/10.1016/j.tate.2019.102912 0742-051X/© 2019 Elsevier Ltd. All rights reserved.

Executive functioning (EF) is an umbrella term encompassing several goal-directed, higher-order cognitive skills that can be distinguished from one another yet remain inter-related (Lepach, Pauls, & Petermann, 2015). The preschool years represent a

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critical developmental period for EF, with its development being particularly open to the positive effects of early intervention (Garon, Bryson, & Smith, 2008). This critical period of brain and behaviour development occurs in parallel to the educational milestone of starting school. There is an established relation between EF proficiency and measures of school readiness and academic success (Mann, Hund, Hesson-McInnis, & Roman, 2017). Importantly, factors in the classroom environment can influence EF skill acquisition, with teachers playing a key role in providing neuropsychological supports and evidence-based interventions to promote these skills (Diamond, 2016). 1.1. EF development The development of EF skills is a complex and protracted process, beginning in infancy with the emergence of three core components: inhibitory control, working memory, and cognitive flexibility (Allom, Mullan, & Hagger, 2016; Alloway & Alloway, 2010; Carroll, Blakey, & FitzGibbon, 2016). The preschool and early school years represent a critical developmental stage for EF. In these years, EF skills, and their underlying neural systems, develop most rapidly and development is particularly malleable to early intervention (Garon et al., 2008; Nilsen, Huyder, McAuley, & Liebermann, 2017). Neuroimaging studies implicate the prefrontal cortex as a core brain region for EF (Nowrangi, Lyketsos, Rao, & Munro, 2014), however the underlying neural mechanisms involved in EF tasks incorporate a wide range of developing neural networks (Downes, Bathelt, & de Haan, 2017). It is therefore essential that young children develop a solid repertoire of foundational EF skills early in life as the development of later emerging, more complex EF skills, such as planning and organisation, builds upon these foundational skills throughout later childhood and into adulthood (Diamond, 2013). Neurodevelopmental disorders can lead to altered trajectories of EF development or executive dysfunction. For example, poor inhibitory control tends to be a facet of attention-deficit hyperactivity disorder (ADHD; Woltering, Liu, Rokeach, & Tannock, 2013) and cognitive inflexibility is often characteristic of autism spectrum disorder (ASD; Van Eylen et al., 2011). In these patient populations, consideration of EF difficulties is required at an early stage of development in order to ensure that they are promoted at an age where interventions have the most impact (Chaimaha, Sriphetcharawut, Lersilp, & Chinchai, 2017). However, delays and difficulties in EF development can also arise in otherwise typically developing children and environmental inputs play an important role at early developmental stages. A strong research base shows that EF development can be influenced by socioeconomic status (Müller, Baker, & Yeung, 2012), parenting techniques (Blair & Raver, 2012), and exposure to stimulating educational resources (Clark et al., 2013). 1.2. The influence of the school environment on EF development A range of factors influences EF development. For a young child at primary school stage this can include biologically-determined neurodevelopmental trajectories, home and family factors, classroom environments, and teacher behaviour. The bio-ecological systems model proposes that layers of proximal and distal influence interact with a child throughout his or her development in a cascading fashion (Bronfenbrenner, 1986; 2005). The microsystem, referring to one's immediate physical and social surroundings, includes family, friends, and school. The mesosystem refers to the ways in which each of these microsystem components interact, such as the home-school link. The exosystem describes the larger

social system, such as the local educational context. The macrosystem encompasses wider attitudes and ideologies, such as the country's educational policy. Finally, the chronosystem refers to the cumulative experiences across a lifespan. This theoretical framework is one way to understand how EF can be shaped by wider influences, with factors in more distal levels affecting an individual's more proximal systems (Li, Fox, & Grieshaber, 2016). Given the crucial influence of teachers within a child's microsystem and mesosystem, research is required to explore teachers' understanding of their role and their experiences in supporting students' EF development. Internationally, children typically enter formal schooling between the ages of three and seven (Barakat & Bengtsson, 2018). EF is particularly malleable in these years (Garon et al., 2008) and so the transition to formal schooling coincides with a period of rapid EF development (Zelazo & Carlson, 2012). Thus, school-related factors can influence developmental trajectories at this crucial stage of EF skill development. Structured classroom environments with consistent rules and scheduling, for example, can facilitate EF development, allowing children with developmental delays the opportunity to target the same milestones as their peers (Roberts et al., 2015). Students’ EF development can also be influenced by pedagogical practices and teacher behaviour (Neuenschwander, Friedman-Krauss, Raver, & Blair, 2017). Autonomy-supportive teaching styles that allow students to actively pursue intrinsic goals, for example, can encourage EF skill development. This can result in increased motivation and improved EF skills in children (Sosic-Vasic, Keis, Lau, Spitzer, & Streb, 2015). Teacher-student relations can also influence EF skill development. Longitudinal research has found that the development of working memory is best fostered through positive teacher-student interactions e free from conflict. However, students with poor baseline working memory often experience increased teacher conflict (De Wilde, Koot, & van Lier, 2016). This suggests the presence of a feedback loop, which can be either positive or negative (Diamond, 2016). It is therefore essential for the healthy development of EF that teachers respond effectively to children experiencing executive dysfunction (Vandenbroucke, Spilt, Verschueren, & Baeyens, 2017). 1.3. The role of EF in school readiness and success From an educational perspective, there is a need to prioritise EF due to the role of executive skills in school readiness and academic success, as well as social interaction. Upon entry to formal schooling, novel academic and social challenges rely on the EF system (Vandenbroucke, Verschueren, & Baeyens, 2017). Successful learning often requires students to complete tasks while retaining verbal instructions and selectively ignoring distractions (Blair & McKinnon, 2016). The core components of EF are required for various learning activities that take place in the classroom. Working memory, for example, allows a child to follow verbal instructions, retain information, and is also an essential building block in the acquisition of early literacy skills (De Abreu et al., 2014) and successful reading comprehension (García-Madruga et al., 2013). There has been a recent focus on the relation between EF proficiency and measures of school readiness and academic achievement, with a strong evidence base rapidly accumulating (Jacob & Parkinson, 2015). Research shows that EF measures, such as working memory and inhibitory control, can be a better predictor of later academic achievement in numeracy and literacy than measures of IQ (Alloway & Alloway, 2010). A solid repertoire of foundational EF skills in the preschool years may therefore allow for a smooth transition into formal schooling, with EF appearing to be the main predictor of both academic and socio-emotional school readiness (Mann et al., 2017).

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1.4. Teachers’ understanding of EF Given the importance of EF from an educational perspective, it is necessary to investigate the extent to which teachers understand EF and their integral role in fostering EF skills in young students. Perceptions and beliefs surrounding various educational and psychological concepts can determine teachers' choice of instructional strategies (Wilson & Bai, 2010), impacting the range of learning opportunities available for EF skill development (Kaya, 2014). For example, teachers' use of modelling and scaffolding when interacting with students could be enhanced (Zinsser, Shewark, Denham, & Curby, 2014) e practices shown to have a positive impact on EF skill development (Bardack & Obradovi
c, 2019; Clark, Pritchard, & Woodward, 2010). Crucially, recent research suggests that teachers who mislabel young students' executive dysfunction as behavioural problems may unintentionally create negative learning experiences for these children (McKinnon et al., 2018). Despite these findings, research examining teachers’ levels of awareness regarding EF and evidence-based interventions is limited. Internationally, teachers appear to lack understanding of neurodevelopmental disorders commonly associated with EF impairments (Mulholland, Cumming, & Jung, 2015) and desire more training in this domain (Young, Mannix McNamara, & Coughlan, 2017). This suggests that teachers may also display misunderstandings of EF issues in a broader sense with levels of understanding potentially varying based on when and where teaching qualifications were received (Sciutto et al., 2016). Recent research has investigated teachers’ awareness of the role EF plays in academic success, with studies conducted in the United Kingdom (Gilmore & Cragg, 2014), Israel (Rapoport, Rubinsten, & €rnqvist, & Katzir, 2016), and Sweden (Nyroos, Wiklund-Ho € fgren, 2018). Using questionnaires, these studies found that Lo teachers typically recognise the importance of EF skills for learning in general (Nyroos et al., 2018) and for specific academic domains such as mathematics (Gilmore & Cragg, 2014) and reading (Rapoport et al., 2016), but display limited familiarity with neuropsychological terms. Teachers report that the association between EF skills and academic success is recognised through extensive classroom experience rather than through teacher training courses (Gilmore & Cragg, 2014). Special education teachers e many of whom receive more explicit information in training and have more contact with students experiencing executive dysfunction e identify a stronger link between EF and academic success. As such, they may utilise targeted supports for EF skills more frequently (Rapoport et al., 2016). Together, this research highlights the need for training courses to incorporate neuropsychological themes into teacher training curricula in order to enhance the brain-behaviour relation in the context of learning. However, the use of questionnaires alone limits these findings, as other factors e such as the teachers' personal insights and experience e are inaccessible through purely quantitative means (Baker-Henningham, 2011). Additionally, studies have not yet considered teachers' understanding of their own role in fostering EF skills in the classroom, nor has research investigated teachers’ experiences with executive dysfunction and implementing EF interventions in the classroom. Given the window of opportunity in the early school years that allows EF to be shaped and guided by teachers (Neuenschwander et al., 2017), early intervention in classroom settings is an essential consideration. 1.5. Classroom interventions for EF Increased interest in the malleability of EF in the past two decades has led to the development of classroom-based interventions targeting EF skills (Jacob & Parkinson, 2015). These interventions

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may be integrated into classroom curricula or take the form of targeted behaviour management and computer training programmes (Diamond & Lee, 2011). More novel approaches, such as mindfulness-based interventions, have also been found to improve EF in preschool children, leading to better outcomes in the first year of formal schooling (Thierry, Bryant, Nobles, & Norris, 2016). Despite the increased adoption of curricula such as Tools of the Mind in early years programmes (Bodrova & Leong, 2007), how widely EF interventions are implemented in everyday primary school settings across different countries is currently unclear. There is likely also considerable variability in the promotion of EF across individual schools and classrooms (Little, 2016). Different classroom realities may limit the amount of time teachers can devote towards ensuring appropriate interventions are accessed and implemented effectively (Ertmer, Ottenbreit-Leftwich, Sadik, Sendurur, & Sendurur, 2012). For effective implementation, training is required to ensure schools can identify at-risk students, choose the most effective interventions, and allow teachers the resources to best apply guidelines into the classroom (Serpell & Esposito, 2016). Interventions for EF are often recommended to teachers directly by psychologists through individual neuropsychological reports (Pelco, Ward, Coleman, & Young, 2009). Neuropsychological reports are often provided for children undergoing the diagnostic process for a neurodevelopmental disorder and typically incorporate a battery of neuropsychological assessments, many of which target EF skills (Racanello, Tomb, Algermissen, & Margolis, 2016). The results of these assessments, which may contain information on a child's performance on EF tasks, are presented in a report for the child's teacher (Donders, 2016). While the presentation of neuropsychological reports may vary between clinicians (Zimmerman, 2011), they typically contain information on reasons for referral, observations from the clinician, neuropsychological test results, and conclude with recommendations (Eriksson & Maurex, 2018; Tzotzoli, 2012). However, these reports have been cited as being unnecessarily complex, with vague recommendations for interventions (Baum et al., 2018). This can result in poorly or incorrectly implemented interventions (Zhang, Terry, & McHorney, 2014). In relation to EF, vague or inaccessible reports may result in missed opportunities for early interventions. For this reason, teachers' experiences with neuropsychological reports in practice require in-depth investigation. While inadequate reporting may be one barrier to effective implementation of EF interventions, the extent to which teachers are equipped to appropriately administer targeted supports in classroom settings can also vary with levels of knowledge and understanding of EF (Little, 2016). As such, the insufficient data regarding teachers' understanding and experience of EF-related issues must also be addressed. 1.6. Present study While the neuropsychological literature emphasises early assessment and intervention for EF, the practicalities of translation and implementation of EF supports into the everyday classroom environment remain unclear. Teachers’ knowledge of EF and their experiences with neuropsychological reports and interventions for EF needs to be established. This is important and necessary for two reasons; it is often teachers who identify children with poor EF in the first instance and teachers are frequently expected to apply neuropsychological report recommendations in the classroom. However, teachers' ability to recognise EF difficulties and to interpret and translate reports into practical classroom supports has not previously been explored. The current study aims to investigate teachers' understanding of EF and their perceived role in supporting EF development, explore their experiences of students with executive dysfunction, and investigate if their training

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incorporated EF and neuropsychological issues. As a secondary objective, we investigated teachers’ experiences with neuropsychological reports and interventions, exploring potential issues with the translation of applied supports into the classroom. Focus group discussions comprised of a small sample of teachers were deemed most suitable for the aims of this study. Importantly, this mode of investigation allows for an interchange of experiences and the uncovering of richer data that would be inaccessible through alternative research methods (Aelterman et al., 2013; BakerHenningham, 2011). 2. Methods This study implemented a qualitative design with primary school teachers (PSTs) in Ireland. PSTs in Ireland work with children ranging in ages from four to thirteen. For an explanation of the structure of primary school education in Ireland and to ensure familiarity with the terminologies used throughout this paper, see Appendix. A population of PSTs were divided into two focus group discussions, allowing for in-depth information on PSTs’ understanding of EF and experiences with neuropsychological reports and interventions. 2.1. Participants Participant eligibility criteria were to be a fully qualified PST and to be currently working in the profession. Participants were recruited through informational posters shared on primary teaching websites, forums, and social media. Ten qualified PSTs were recruited from nine different schools across four counties in Ireland (Dublin, Kildare, Meath, and Wicklow). Two focus groups were formed, with five participants from separate schools per group. See Table 1 for a breakdown of participant characteristics. 2.2. Procedure Ethical approval was obtained from the University College Dublin (UCD) Research Ethics Committee. Informed consent was obtained. Focus groups were conducted in parallel in two separate rooms at the UCD School of Psychology e outside of teachers’ working hours. LK facilitated FG1 and SC facilitated FG2. Following a semi-structured format, thirteen open-ended questions were developed to explore shared understanding on topics related to the research questions (see Table 2 for question categories and sample questions). These questions were displayed on a projector and provided in hard copy to participants to focus and guide the discussions. Additionally, participants were provided with a definition of “executive functioning” after their initial understanding of the concept was explored, allowing further discussions to be informed by an accurate understanding of the topic. The following definition was used: “Executive functioning is an umbrella term for several goal-directed, higher-order skills e including attention, inhibitory control, and cognitive flexibility. These are skills that allow children

to complete tasks and reach various goals”. Each discussion lasted approximately 60 min and was dual recorded using dictaphones and Garage Band (Mac OS). 2.3. Analyses Analysis of the focus group data was guided by the two overarching research questions: (1) do PSTs in Ireland understand EF and their potential role in shaping its development in students, and (2) what are PSTs' experiences with neuropsychological reports and interventions. Analysis was approached from a constructivist perspective (Willig, 2013), examining PSTs' acquired knowledge through personal experiences of working in the profession. It aimed to access PSTs' own understanding of the area, rather than to gain objective insight. Additionally, as the bio-ecological systems perspective underpinned the present study, analyses considered layers of influence in the phenomenon of interest. An inductive thematic analysis was conducted on the focus group data, given the flexibility and robustness of this approach (Vaismoradi, Turunen, & Bondas, 2013). The six stages outlined by Braun and Clarke (2006) were followed: (1) the audio recordings were transcribed verbatim by the focus group facilitators immediately after the discussions, before being swapped over and independently reviewed for accuracy; (2) each transcript was coded line-by-line by both facilitators until re-reading no longer yielded further codes. These codes were then discussed to ensure inter-coder reliability; (3) coded passages were extracted to divide the transcripts into codes and relevant quotes. A cut-and-paste technique sorted the codes into groups representing possible themes, generating an initial thematic map; (4) potential themes were reviewed for relevance to the research questions and representativeness of the dataset as a whole (see Fig. 1 for a refined thematic map); (5) themes were analysed in relation to one another and defined; and (6) definitions and descriptions of themes were expanded, and relevant quotes were chosen to represent both the themes and the dataset as a whole. To ensure quality and transparency, the 21-item checklist for the standards for reporting qualitative research (SRQR) was consulted (O’Brien, Harris, Beckman, Reed, & Cook, 2014). 3. Results An inductive thematic analysis of the focus group data identified five major, interlinking themes with sub-themes. In relation to the research questions, the five main themes were “knowledge of EF”, “lack of training”, “poor communication”, “systemic issues”, and “EF as a priority”. These are described below e supported by summaries and representative quotes. 3.1. Knowledge of EF PSTs’ knowledge of EF emerged as a key theme in the focus group data, and is represented by two sub-themes: lack of EF knowledge and recognising the importance of EF. Participants

Table 1 Characteristics of focus group participants (N ¼ 10). Group (n) Gender

Mean age (range) Teaching experience in years Highest level of education

FG1 (5)

All female 41.4 (30e55)

>10 (n ¼ 4); 1e5 (n ¼ 1)

FG2 (5)

All female 41.8 (28e56)

>10 (n ¼ 2); 6e10 (n ¼ 2); 1e5 (n ¼ 1)

Higher diploma (n ¼ 4); Master's degree (n ¼ 1)

Classes currently teaching

Special education (n ¼ 3); 1st/2nd class (n ¼ 1); Senior infants (n ¼ 1) Bachelor's degree (n ¼ 1); Higher diploma (n ¼ 3); Master's degree (n ¼ 1) Special education (n ¼ 3); Junior infants (n ¼ 1); Special class (n ¼ 1)

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Table 2 Focus group question categories and sample questions. Question category

Description

Understanding of EF

- What do you understand by the term “executive function”? - Is it something that you were taught about during your training? - What issues have you had with translating neuropsychological assessment reports to applied support in the classroom? - What do you think can be done to improve reporting to assist you in the classroom? Questions aimed to illicit further thoughts from participants that - Do you think it would be beneficial to receive more training on may have arisen throughout the discussion executive function? - Do you have any further thoughts or ideas?

Experiences with neuropsychological assessment Personal insights

Sample questions

Questions explored knowledge of relevant theory and how participants gained knowledge relating to EF Questions explored issues with translating report recommendations into the classroom

Fig. 1. Refined thematic map.

reported some unfamiliarity regarding the term itself. However, there was an awareness of the importance of EF, with participants noting potential long-term negative outcomes of executive dysfunction, and recognising their role in providing individual supports in classroom settings. 3.1.1. Lack of EF knowledge Most participants felt that they “know very little about [executive functioning]” (FG1) and when presented with the term in the past, they “had to look [it] up” (FG2). While no participant claimed to fully understand the term, there was general agreement amongst participants that EF had “something to do with the brain” (FG1) and referred to “mental skills” (FG2). After the FG facilitator provided a definition of EF, there was a recognition that EF difficulties are more prevalent in children with neurodevelopmental disorders, including ADHD, ASD, and dyspraxia. One participant felt that EF is “best defined when it's impaired” (FG1), and another noted that teachers “know what it means when [they] look at the children [with] an emotional or behavioural difficulty” (FG2). 3.1.2. Recognising the importance of EF Participants appeared to understand the impact of executive dysfunction within the classroom, with one describing students with EF difficulties as “the children who bring the classroom to a standstill” (FG2). While the relationship between EF and academic achievement did not explicitly emerge in the focus groups, participants acknowledged the importance of EF skills for students, and one participant noted the link between executive dysfunction and

later outcomes: “a lot of them can end up in delinquency and in prisons […] because of that impulsivity” (FG1). Participants appeared to recognise that teachers play a role in shaping EF skill development, as participants in both focus groups listed potential individual supports they have provided to children displaying EF difficulties in the classroom. These supports included modelling, visual timetables, movement breaks, fidget toys, meditation, and mindfulness. However, no participant mentioned any formal classroom-based EF interventions. 3.2. Lack of training In terms of PSTs’ understanding of EF and their role in shaping development, lack of relevant training emerged as a key theme. This was represented by three sub-themes: poor understanding of EF due to limited training, the use of trial-and-error, and the need for comprehensive training. 3.2.1. Lack of EF coverage There was a general consensus amongst participants that EF is poorly understood by PSTs due to little to no coverage of EF in undergraduate or postgraduate teaching courses: “it does depend on the course you do, but I would doubt that it'd be taught enough in the teacher training courses” (FG2). Some participants reported that the term was “thrown in to scare us […] but not specifically taught” (FG1). While the specific terminologies associated with EF were not fully understood by participants, behaviours related to executive dysfunction were reported as being easy to recognise:

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“teachers can't but be aware of them […] they are the children who bring the classroom to a standstill” (FG2). However, the complexity of various difficulties in students makes it unclear where the issues lie: “it's a mishmash and it's a spectrum and it's very hard to filter out […] because there's so much cross-over” (FG1). This confusion appears to be exacerbated by a lack of relevant training, resulting in PSTs being unaware of how to effectively support EF development: “we just did not get that training […] you don't feel fully qualified, you don't know if you're meeting their needs properly” (FG1). 3.2.2. Trial-and-error With limited training, it emerged that PSTs may rely on trialand-error when designing classroom supports: “it's trial-anderror […] it's like ‘try this’, ‘try that’” (FG1). Participants reported “desperately Googling” (FG1) while being unaware of whether or not various strategies are “fad things” (FG1), finding it difficult to assess the quality of evidence behind supports: “you just don't know […] what the research is, is it worth doing, or is it wasting your time and distracting the children even more” (FG1). For one participant, “we're not sure what we're doing; sounds terrible, but we're not” (FG2). 3.2.3. Comprehensive training needed All participants agreed that further training in EF and established interventions is required: “there should be specialised training” (FG1). In particular, it was emphasised that this training should be comprehensive, involving experiential elements: “you have to learn it through your interactions with those students, your interactions with the lecturers and your understanding of yourself” (FG2). 3.3. Poor communication In relation to PSTs’ experiences with neuropsychological reports, several issues arose throughout the focus group discussions, each relating to a common theme of poor communication. In particular, the presenting issues participants experienced with these reports were a lack of symbiosis, inaccessible language, and limited information. 3.3.1. Lack of symbiosis When discussing neuropsychological reports, a lack of symbiosis was reported between PSTs, psychologists, and parents: “both the physical separation and an academic one […] they don't cross over” (FG1), with “no follow-up” (FG1). This lack of follow-up results in PSTs having limited access to relevant information regarding a student's current needs and a subsequent inability to “[work] on something in a symbiotic way” (FG1). Conversely, one participant experienced working with a psychologist that met with both the parents and teaching staff to explain report findings. For this participant, “it just meant that we all understood what [the psychologist] meant […] and it's really the most satisfactory outcome for reports” (FG2). 3.3.2. Inaccessible language Participants in both groups believed that psychologists often fail to communicate effectively with PSTs, using highly academic, inaccessible language in reports: “unless you actually look up the language […] understanding the terminology that is used can be a number one issue” (FG2). New PSTs in particular appear to find the language and terminology difficult to decipher: “reports were like double-dutch to me when I first came across them” (FG1). Participants highlighted difficulties in interpreting the results section of reports, describing “tables of results in the middle [with] poor understanding amongst teachers about what the information

means” (FG1). Given the inaccessible language in reports, PSTs often go directly to the recommendations section before attempting to decipher the student's assessment results: “it's the recommendations you always look at” (FG2). 3.3.3. Limited information In addition to not providing reports with accessible language, participants felt that psychologists were omitting important information. Recommendations can be “very, very vague” (FG1) and “hard to apply” (FG2), preventing effective implementation. Some participants desired more transparency surrounding the tests and sub-tests used to reach diagnoses: “the understanding isn't there in terms of what the assessments are […] test materials are kind of kept under lock and key” (FG1). In relation to EF in particular, participants described reports that “deal with working memory and processing speed” (FG2), but participants in FG1 agreed that the term “executive dysfunction” has never appeared in reports they have received: “I've never seen it written down in a report” (FG1). 3.4. Systemic issues Systemic issues impacting PSTs’ understanding of EF and experiences with neuropsychological reports emerged as a key theme. For one participant, there is “a huge amount of issues that are not to do with diagnosis and understanding” (FG1). Specifically, these issues relate to funding, lack of experts to consult, and departmental pressure. 3.4.1. Funding Participants noted that funding issues can prevent access to necessary training: “there are issues at a very systemic level in teaching […] a big part of that […] is the lack of funding for teachers to do further study” (FG1). Lack of funding also acts as a barrier to implementing report recommendations. One participant described her frustration at being held accountable for “using this very expensive piece of [equipment] that the psychologists recommend […] and the funding is not there” (FG1). 3.4.2. Lack of experts to consult With limited specialised training and a reported trial-and-error approach, participants stressed the need for an expert to be readily available. While there is a clear demand, with PSTs “crying out for help” (FG2), there were difficulties reported in accessing support when encountering issues with reports and recommendations: “there was nobody in the school that you could go to […] I went to two education centres […] they didn't know what to advise” (FG1). Some participants expressed a need to have more time with the psychologists providing the reports, as once the assessment is complete, they can no longer contact psychologists with questions or for clarification: “that's you done for the year and there'll be no more emailing” (FG2). One participant described her struggles to access expert support as feeling as though she is “annoying everyone all the time, like asking” (FG1). 3.4.3. Departmental pressure Participants in both groups reported feeling pressure from the Department of Education: “it's all more, more, more […] we're getting hammered from the department” (FG1). Participants felt that much of the paperwork they are required to do is “a waste of everybody's time. We could be doing things” (FG1), causing them to feel “weighted down” (FG1) and “jaded […] from a departmental level” (FG2). When discussing whether or not EF should be promoted more in the classroom, both groups stressed the importance of intertwining supports into the typical school day, rather than

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placing additional paperwork and demands on PSTs: “teachers are overworked […] it needs to be very natural and normal […] little tools or techniques that are so quick […] so it seems easy and attractive” (FG2). The resulting time constraints emerged as a concern for participants in both groups. They feel “stretched to the max” (FG2) and from a practical perspective, “it's very hard to see […] how you would incorporate [EF supports] into a chock-a-block day already” (FG1). Participants recognised that the psychologists writing reports are likely under pressure themselves: “I know they're under huge pressure” (FG2). Because of this, participants found reports to often be “pure copy-and-paste” (FG1), with “the wrong children's names being on reports” (FG2). 3.5. Prioritising EF While participants reported a limited understanding of EF, the need for PSTs to prioritise EF emerged as an important theme. However, participants also felt that there are barriers preventing them from effectively promoting EF in the classroom. 3.5.1. EF as a priority There was recognition amongst participants that EF “is the key thing” (FG1), being predictive of success at school and of problems in later life. For some, the academic curriculum may need to be put on hold if EF-related issues require attention, because if students are “not available to learn, they're not going to learn” (FG2). Given some concern over whether or not this is feasible in a typical school day e which is “chock-a-block” (FG2) to begin with e participants agreed that whole-class activities like mindfulness are good options when addressing executive dysfunction. This allows all students to get involved: “everyone can do it, everybody enjoys it […] that's a good one for the whole class” (FG1). Some participants suggested incorporating supports and EF interventions into the curriculum, possibly including it in Social Personal and Health Education (SPHE) lessons: “it can be integrated through SPHE” (FG2). 3.5.2. Barriers to prioritising EF Despite participants' understanding of the importance of EF and their role in prioritising its development over curricular demands, one participant felt that the systemic issues outlined above result in it being “too early to talk about promoting executive function in the classroom […] even though this could actually make our lives easier, I think it's too hard for teachers to see it at the moment” (FG1). There appears to be a lack of accountability, with some participants feeling as though “there's no real accountability […] it's up to you whether you do it or not” (FG2) and “it's not a priority because it's not going to be tested” (FG2). The ability for PSTs to prioritise EF is further limited by a lack of formal acknowledgment of executive dysfunction as an issue, resulting in difficulties when allocating relevant supports for students. One participant described backlash when attempting to formulate a programme for students presenting with EF-related behavioural issues: “there was so much of ‘oh, how can you prioritise children that are kicking off or refusing to learn’ […] they lack awareness that those children actually need more nurturing” (FG2). Until executive dysfunction is formally recognised and prioritised, the current situation can be likened to “paddling your own canoe […] to the detriment of your school” (FG2). 4. Discussion This study aimed to investigate PSTs’ understanding of and experiences with EF and neuropsychological reports in Irish classrooms using a qualitative methodology. In-depth and unanticipated

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findings are discussed in relation to the overarching research questions. 4.1. PSTs’ understanding of EF and their role in shaping development Consistent with previous studies, PSTs report difficulties in understanding the complex nature of EF. Despite this, participants recognised the role of the teacher in fostering EF skill development in young students. This may be explained by the extensive experience PSTs have teaching students with EF difficulties. Indeed, the discussions reflect the highly prevalent nature of executive dysfunction and neurodevelopmental disorders associated with EF difficulties in Irish classrooms. Although the teaching profession in Ireland is reported to have one of the highest academic standards in the world (Corcoran & O'Flaherty, 2017), the present findings are in line with international research that suggests a gap in teacher training in relation to EF and neuropsychological issues more generally. In particular, PSTs recognise the importance of EF through classroom experience, rather than training (Rapoport et al., 2016), and appear to feel unqualified to deal with executive dysfunction. This has resulted in many PSTs selecting individual interventions in a trial-and-error fashion and expressing a desire for comprehensive training to support their promotion of EF in young students. This desire for further training is a common trend amongst PSTs in Ireland, with this population tending to be highly motivated to access professional development courses (McMillan, McConnell, & O'Sullivan, 2016). While the participants in the current study did not mention any formal EF classroom interventions, evidence for a positive impact of early years classroom interventions in the form of formal curriculums (e.g. Montessori, Tools of the Mind) and other add-on curriculums (e.g. Head Start REDI) on EF is emerging, with more recent studies even showing positive influence of classroom intervention at a later stage of primary school (Benzing et al., 2018; Diamond & Lee, 2011). However, issues related to EF definitions and EF measurement problems within the field of neuropsychology hamper the translation of targeted individual and classroom EF interventions into everyday school settings (Jacob & Parkinson, 2015). It has been found that several factors can influence the effectiveness of interventions, including teacher training, years of teaching experience, and availability of support for teachers (Sutherland, McLeod, Conroy, & Cox, 2013). Previous research has highlighted the need to involve teachers in the development of training programmes for classroom-based EF interventions (Domitrovich, Gest, Gill, Jones, & DeRousie, 2009). The present findings not only underscore the need to consider previous implementation evaluations for effective EF interventions, but also suggest that teachers must receive more comprehensive training to ensure adequate understanding of EF development and related issues. 4.2. PSTs’ experiences with neuropsychological reports and interventions It was necessary to explore PSTs' experiences with neuropsychological reports as it is through these reports that individual interventions for EF difficulties are typically proposed (Pelco et al., 2009). Barriers to understanding reports and implementing recommendations were centred on poor communication between the psychologists writing student reports and the PSTs receiving them. A clear language barrier was identified, with reports failing to explain assessments in an accessible manner, while also containing technical terminologies that are unfamiliar to PSTs. These findings

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are consistent with international research (Baum et al., 2018; Zhang et al., 2014), and results in limited comprehension of students’ assessment results and problems with implementing interventions. PSTs reported that they often go directly to the recommendations section of reports, citing a need for relevant practical information. However, the translation of these recommendations into the classroom also proves problematic. Resource limitations e including time, funding, and support e emerged as key barriers to implementing classroom interventions. PSTs appear to be constrained both by a limited comprehension of the reports themselves, and by a lack of resources while managing a large class of students with differing needs. 4.3. Systemic issues impacting PSTs’ understanding of EF and experiences with reports Unanticipated insights from the data allow these findings to be considered from a broader perspective. Complex issues that impact PSTs’ understanding of EF and experiences with neuropsychological reports emerged while exploring the research questions. The presenting issues can be understood through a systems approach. Drawing upon the bio-ecological systems model proposed by Bronfenbrenner (1986), factors appear to influence PSTs at every level e from educational policy to resource allocation and training (see Fig. 2 for a representative model). From a macro-level, educational policy can have a cascading effect, influencing the availability of resources, the content of teacher training courses, and therefore determining PSTs’ levels of knowledge and classroom experiences. Consistent with prior research (Gilmore & Cragg, 2014; Nyroos et al., 2018; Rapoport et al., 2016), the present study indicates that educational policy in Ireland does not currently prioritise EF or related neuropsychological issues. While Irish educational policy specifies that children with special education needs must receive adequate individualised support to ensure full inclusion at school (Government of Ireland, 1998; 2004), a gap remains between such policy and everyday practices (Young et al., 2017). Moreover, policy does not explicitly address EF, nor does it acknowledge the need to foster EF

development in all children. From an international perspective, the need for an increased focus on EF is highlighted by researchers in the United States (Ackerman & Friedman-Krauss, 2017; Zelazo, Blair, & Willoughby, 2016), the United Kingdom (Gilmore & Cragg, 2014), Sweden (Nyroos et al., 2018), and Israel (Rapoport et al., 2016). Systematic reviews of existing policy documents at an international level may be required to inform the development of educational policy changes addressing EF. The current lack of priority at a policy level appears to have resulted in PSTs having a limited understanding of EF terminologies and evidence-based classroom supports. This affects resource allocation and the content of training courses. Consequently, PSTs face barriers when attempting to implement interventions in the classroom or access funding to support relevant ongoing training. Furthermore, there does not appear to be a point of contact for PSTs experiencing difficulties in this domain. There is recognition amongst PSTs that they play a key role in fostering EF development, but the systemic issues outlined here limit the extent to which they can carry out this role. 4.4. Implications for early intervention These findings have implications for students experiencing executive dysfunction. Positive findings of this research are that PSTs recognise the importance of EF for students and also believe that they play a key role in shaping skill development. However, while such beliefs influence teaching practices, several external factors determine the extent to which perceived roles and responsibilities are carried out in the classroom (Assen, Meijers, Otting, & Poell, 2016). The research presented here suggests that PSTs attempting to foster EF skills and translate recommendations are being constrained by systemic issues beyond their control, which may indicate that necessary interventions are not being implemented at a stage where they would be most effective. This is a concern that warrants further investigation and new initiatives. Efforts to promote EF in the classroom into the current system may result in poor adherence rates due to the systemic issues outlined above. Indeed, there is evidence that PSTs’ adherence to new initiatives is limited in Ireland currently, with time constraints and curricular demands emerging as clear barriers (McMullen, Martin, Jones, & Murtagh, 2016). This may suggest that changes must first be considered at a systemic level before piloting new initiatives. 4.5. International relevance and recommendations With training and classroom realities differing internationally (Sciutto et al., 2016), the conclusions drawn from this study are of relevance to international stakeholders. The specific aims of the study are unique, but one overarching finding is consistent with research conducted in the United Kingdom (Gilmore & Cragg, 2014), Sweden (Nyroos et al., 2018), and Israel (Rapoport et al., 2016): EF remains largely unaddressed in the education system. The novel use of focus groups in this investigation has allowed for more complex explanations behind teachers’ knowledge and experiences. Importantly, the in-depth analysis of relevant issues at a systemic level acts as a first step towards the development of recommendations that may be beneficial internationally. Based on the current findings and prior research, it may be necessary to explore potential changes with teacher education, neuropsychological report writing, and addressing specific difficulties expressed by teachers (e.g. time constraints).

Fig. 2. Model of findings: A systems approach.

4.5.1. Changes to teacher education Initial teacher training courses tend to be highly practical in focus and debate has been ongoing regarding the extent to which theory

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should be included in curricula (Furlong, 2013). These findings suggest that incorporating neuropsychological theory into initial teacher training courses would be beneficial, allowing PSTs to better understand EF, neuropsychological reports, and make informed decisions when selecting individualised supports and evidencebased interventions. As Gilmore and Cragg (2014) found that it can take up to ten years of teaching experience to recognise the importance of EF for students, featuring EF in initial teacher training courses can provide PSTs with practical solutions early on in their careers. Importantly, PSTs can then determine which interventions are most appropriate for students’ developmental needs (Jacob & Parkinson, 2015). This may result in a wider, more consistent promotion of EF skills across different schools and classrooms, which is likely to be rather mixed at present (Little, 2016). A desire for increased transparency regarding assessment tools was expressed by some PSTs involved in this study. As such, it may be beneficial to train PSTs in the use of assessments evaluating EF in students. Drawing upon the current findings, the guidelines for such assessments may be tailored towards PSTs by removing technical terms, ensuring clear explanations, and if possible, including information regarding specified experts to consult. However, given the time constraints and resource limitations PSTs have reported in this investigation, a more concrete focus on EF skills at primary school level may be required before such changes become feasible. 4.5.2. Changes to neuropsychological reports The issues identified with neuropsychological reports warrant careful consideration and potential reform. In terms of specific changes to report writing, a recent study by Baum et al. (2018) found that neuropsychologists can successfully produce reports that are more user-friendly and readable while still maintaining indepth information. This suggests that a transition to short, clear reporting of neuropsychological assessments is feasible. In relation to the apparent lack of symbiosis between PSTs, psychologists, and parents, the need for psychologists to collaborate proactively with schools has been recognised internationally (Anderson, Klassen, & Georgiou, 2007; Avant & Swerdlik, 2016). Drawing upon insights from this investigation, more active involvement of psychologists providing reports may lead to increased clarity and understanding. Importantly, this could facilitate the writing of teacher-friendly reports with more feasible recommendations. Future changes may benefit from further research to more closely examine some of the issues presented here. In particular, further investigation is required to establish how EF and its subcomponents are specifically described in neuropsychological reports. As teachers are often the first step in a student's referral for evaluation, it is worth exploring the relation between teachers' reasons for referring an individual child and their interpretation of reports from that referral. 4.5.3. Addressing time constraints Time constraints emerged as a clear barrier to providing adequate support to students. Reducing class sizes may allow for a studentteacher ratio that is more conducive to addressing the wide range of needs in a classroom (Blatchford & Webster, 2018). Team teaching is another possible solution e a technique that has been shown to be feasible in mainstream classrooms (Murchú & Conway, 2017). This may involve dividing students from one or more classes on a weekly basis, formulating lesson plans that target EF components that are most relevant to the class. By grouping students with similar needs together, specific components of EF can be targeted and worked on. Whole-class activities appeared to be desirable to the PSTs involved in this study. As group-based interventions for EF show effectiveness

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€rhi, & Aro, 2017), these could be in classrooms (Paananen, Aro, Na incorporated into such lessons. Given the demonstrated window of opportunity that emerges between the ages of three and five, it may be most beneficial to focus efforts towards addressing EF in the early primary school years e in Junior and Senior Infants e or their international equivalents (see Appendix). Finally, ensuring parental co-operation may increase the effectiveness of these in-class efforts, resulting in improvements at a faster rate. This topic did not emerge in the focus group discussions, but remains an important consideration given the role of parental involvement in EF development (Blair & Raver, 2012; Clark et al., 2013). It may therefore be beneficial for parents or caregivers to receive information on EF and neuropsychological issues more generally, providing insights into current developmental stages and suggestions for at-home supports (Stockall, 2017; Vandenbroucke et al., 2017a, 2017b). 4.6. Strengths and limitations Key strengths of this research come from the explicit efforts made to ensure the involvement of teachers at each stage of investigation, from initial design to the final write-up. Providing important quality assurance and rigour to the findings (Schuiling & Kiewiet, 2016), this also acts as a crucial first step towards bridging the gap between research and practice. Another strength of this research is its qualitative design. Unlike previous studies, the use of focus groups has uncovered systemic issues existing beyond PSTs simply having limited understanding of EF and neuropsychological terms. Whether or not the participants involved in this study are an accurate representation of the PST population in Ireland requires consideration. Firstly, the sample was fully comprised of female teachers. However, the over-representation of females within the Irish education sector is a recognised issue, with 87 per cent of the 32.8 thousand qualified Irish PSTs being female (Eurostat Press Office, 2016). Secondly, seven out of the ten PSTs involved in the focus group discussions were currently teaching Special Education or Special Classes, meaning they would have had frequent exposure to children with additional needs. These PSTs are more likely to read neuropsychological reports, tend to have more direct exposure to students with executive dysfunction (Rapoport et al., 2016), and therefore may be more informed in this domain than the general PST population. While participants were located across four different counties in Ireland and had a wide age range (28e56), it remains possible that issues mentioned regarding neuropsychological reports may be due to shared experiences over a number of years with a select number of psychologists. Finally, as training and practice varies both across and within countries (Sciutto et al., 2016), international research is required to yield country-specific findings and recommendations. 4.7. Future directions and conclusions These findings have highlighted the prevalence of executive dysfunction in Irish primary school classrooms. PSTs display gaps in knowledge regarding EF, neuropsychological reports, and evidence-based interventions. Despite a lack of training, they recognise their role in fostering students' EF development. However, the identified gaps in knowledge e compounded by wider systemic issues e limit PSTs’ abilities to provide classroom-based interventions. The current Irish Primary School Curriculum does not make reference to EF and although it emphasises that the learning context should be adapted for children with special needs, there is no direct training for teachers on how to identify children

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with neuropsychological issues and incorporate appropriate supports. International policies tend to follow this trend with an emphasis on literacy and numeracy widely encouraged and a lack of focus on EF in addition to a lack of professional training on the topic. This is despite the growing evidence over the past two decades for the integral role of EF in successful academic and social outcomes. An increased focus on the topic of EF could particularly result in bridging the gap for disadvantaged children. Future efforts should concentrate on exploring the issues presented here with the end-goal of translating research findings into practice and policy. Acknowledgements The authors would like to thank the teachers who participated in this study. This research was supported by the Teaching Council Ireland John Coolahan Research Support Framework and UCD Seed Funding. Appendix Primary school education in Ireland: Structure and key terms. Primary school education in Ireland is provided across an eightyear cycle, beginning with “junior infants” and ending with “sixth class”. The typical ages of students in each of these classes is outlined in Table 1 below. Each year, teachers in primary schools are assigned a class to teach (in smaller schools, teachers may be assigned two classes). Table 1 Typical ages of students in each class at primary school Class

Typical ages of students

Junior infants Senior infants First class Second class Third class Fourth class Fifth class Sixth class

4/5 to 5/6 years 5/6 to 7/8 years 6/7 to 7/8 years 7/8 to 8/9 years 8/9 to 9/10 years 9/10 to 10/11 years 10/11 to 11/12 years 11/12 to 12/13 years

Extra support can be provided in classrooms where there are students with additional needs. For example, they may be assigned a special needs assistant (SNA). In addition to the classes described above, students with certain disabilities that impact learning in their mainstream classes (e.g. dyslexia, ADHD) are eligible to receive extra support from Special Education Teachers. This support is provided a specified number of times each week, one-on-one or in small group settings at the school. Additional support classes are also provided to students with English as a second language, allowing students who have recently moved to Ireland from a nonEnglish speaking country to integrate into an English-speaking mainstream classroom. For students with more significant disabilities, they may attend a “special class”. These classes may be attached to a mainstream school (e.g. as an autism unit) or be provided by a “special school”. More information can be found on the Irish Department of Education and Skills website, which provides an in-depth document explaining the education system in Ireland: https://www. education.ie/en/Parents/Information/A-Guide-to-the-IrishEducation-System.pdf. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.tate.2019.102912.

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