Brain budsThis past weekend, I was fortunate enough to speak at the Beyond IQ 2013 conference.  It was full of brilliant and enthusiastic kids, parents, and professionals, and I am incredibly excited to see what next year’s conference will bring.

I’m including the text of my talk below, with links for further explanation.

The Paradox of Giftedness:  When potential doesn’t necessarily predict performance

What are executive functions?

Here’s one definition:  self-directed actions functional to self-regulation and the coordinated planning of present and future actions and goals toward distal objectives. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488938/)

What is a distal goal?  A distal goal is a goal that is distant, in either time or space.

Dr. Thomas Brown’s view of executive functions includes six categories:

  1. -activation
  2. -focus
  3. -effort
  4. -emotion
  5. -memory
  6. -action

http://www.drthomasebrown.com/brown_model/

What part of the brain controls the executive functions?

The prefrontal cortex, which is located right over the eyes, is the part of the brain that controls the executive functions.  http://en.wikipedia.org/wiki/Prefrontal_cortex

Conditions that can cause EF deficits:

Russell Barkley, a prominent ADHD researcher, tells us that ADHD is primarily a disorder of the executive functions, causing him to term it EFDD.  http://www.weinfeldeducationgroup.com/1/post/2011/10/understanding-adhd-with-russell-barkley-part-i.html Most of the information that I will use in this presentation will come from research into ADHD, since it deals primarily with EF deficits.

Executive functions are also compromised during panic attacks, for a slightly different reason.  When the amygdala is engaged and the fight-or-flight instinct is in effect, bloodflow and oxygen is shifted from the PFC to the amygdala, causing us to think less rationally and act more rashly.

Putting emotions into words activates the PFC and bypasses the amygdala. http://www.jneurosci.org/content/30/49/16673.full

How do we know if executive functions are compromised?

DSM-IV contains the diagnostic criteria for ADHD.  http://www.cdc.gov/ncbddd/adhd/diagnosis.html

DSM-V will change the guidelines.  http://www.additudemag.com/addnews/70/6914.html

In addition to the DSM, Ari Tuckman has come up with a list of “soft signs” which are different behavioral manifestations of the formal diagnostic criteria. http://books.google.com/books?id=fI6oUHy4TcAC&lpg=PA28&ots=A8M–pyjzZ&dq=ari%20tuckman%20soft%20signs&pg=PA28#v=onepage&q=ari%20tuckman%20soft%20signs&f=false

What about stimulant medications? Are they universally awful?

Since the brain works by means of electrical signals, it makes sense to think of neurotransmitters as affecting signal (how much comes in) and noise (how clear the signals are).  Increased amounts of norepinephrine boost signal, and increased amounts of dopamine decrease noise.  http://www.ncbi.nlm.nih.gov/pubmed/3925395

Stimulants increase one or both of these neurotransmitters, either by increasing it directly, by improving reuptake efficiency, or both.  Many people report having a “quiet mind” while taking stimulant medications, and report being able to accomplish uninteresting tasks for the first time in their lives.

Most executive function deficits show up at work or school, since interesting tasks are not subject to EF deficits.  Interesting tasks basically create their own dopamine, making them rewarding in ways that are difficult for uninteresting tasks.  This leads to EF deficits often being viewed as a moral issue.  Frequently, teachers and parents will say things like “why can’t you try harder?  We know you CAN produce wonderful things, why can’t you do that all the time?”

How do we test executive functions?

One way is the Connors scale for diagnosing ADHD.  A questionnaire is given to the patient, their family, and their work or school.  http://www.attentiondeficit-add-adhd.com/adhd-connors-test.htm

A thorough psychoeducational evaluation will use several methods of testing EF.  http://en.wikipedia.org/wiki/Executive_functions#Assessment_of_executive_functions

Occasionally, even if school and parents know there is a problem, testing will show that there isn’t one.  This can happen because the novelty of testing and the one-on-one attention from the tester can cause EF symptoms to not show up.

What do we do once EF deficits are diagnosed?

Stimulant medications are one option, but as the common saying goes, “pills don’t teach skills.”  All they do is level the playing field so skills can be learned more easily.

Lev Vygotsky was a 19th-century Russian educational theorist who coined the term “zone of proximal development,” or ZPD.  It refers to the idea that the best learning takes place when the learner is attempting a task just beyond their comfort level, assisted by an expert learner such as an adult or accomplished peer.  http://en.wikipedia.org/wiki/Zone_of_proximal_development

Vygotsky died two years after coming up with this theory, so it was fully developed by other people such as Jerome Bruner.  Bruner came up with the idea of scaffolding, which is his name for the support that the accomplished learner offers in the ZPD.  http://en.wikipedia.org/wiki/Instructional_scaffolding

How does this apply to EF deficits?  We would not expect small children to accomplish things such as time management and organization on their own.  We assist them and model successful strategies for them, and then we slowly remove support as our children become more accomplished and encourage them to practice on their own.  This is what we should do with a child with EF deficits – meet them where they’re at, not where they SHOULD be, and provide the support and modeling necessary to assist them until they develop the skills on their own.

POSITIVE PSYCHOLOGY

Kids with EF deficits are usually well aware of the things they don’t do well.  With a psychoeducational evaluation in hand, it’s possible to capitalize on their strengths, rather than trying to convince them to strengthen their weak areas.

http://www.adhd-federation.org/fileadmin/user_upload/10_2012_Abstracts/Treatments/Positive_Psychology_and_Self-Ef_cacy_-_Potential_Bene_ts_for_College_Students_with_ADHD_and_Learning_Disabilities.pdf

Mindfulness

One thing that we’ve learned from mindfulness is that paying attention to what we’re paying attention to improves our attention!  This is very related to metacognition, the executive function that enables us to assess how we’re doing.  http://www.ncbi.nlm.nih.gov/pubmed/17672382

Mindfulness also improves emotional regulation, which can be a huge issue in EF deficits.  http://www.dr-fleischmann.com/wp-content/uploads/2012/08/Chambers-Gullone-Allen-2009.pdf

Different techniques for approaching meditation, which can often be hard for people with EF deficits:

-”blue sky” – the idea that, like clouds, emotions will pass if we simply observe them and let them exist http://www.buzzle.com/articles/vipassana-meditation-touching-the-blue-sky-within.html

-labeling intrusive thoughts to encourage them to pass http://www.oprah.com/oprahsbookclub/Meditation-Techniques-Labeling-Thoughts

-walking meditation http://www.insightmeditationcenter.org/books-articles/articles/instructions-for-walking-meditation/

-using breath as a touchstone http://www.tricycle.com/blog/breath-meditation-instructions-sharon-salzberg

Educational accommodations?

Educators have done a lot of thinking about how best to support executive functions.  The Universal Design for Learning Guidelines has an excellent section that includes concrete tips for supporting students with EF deficits. http://www.udlcenter.org/aboutudl/udlguidelines/principle2#principle2_g6

Russell Barkley says that interventions must take place at the “point of performance,” which is when the actions that need changing are being performed.  Since executive functions make it difficult to keep future consequences in mind, behavior modification must take place regularly and instantly, in the actual situations that the behavior is usually displayed.  http://www.russellbarkley.org/factsheets/ADHD_EF_and_SR.pdf

Self-compassion

Self-compassion is another major component of executive function coaching, and also of being a parent of a child with EF deficits.  This is hard!  It’s incredibly important to be kind to ourselves, for having a hard time, for not always succeeding, and for trying to live up to “shoulds.” http://www.self-compassion.org/

Please let me know by email if there is anything else that you would like me to address in future posts or talks!  Thanks for reading.