Senior Columnist EdNews.org
Eastern New Mexico University
1) First of all, tell us a bit about your background and education.
I'm a licensed and board-certified clinical psychologist. Interestingly, I never intended to be a psychologist. In the 1980's I was working as an artist near New York City when I started mentoring kids in the neighborhood where I lived. It was a life changing experience! I realized that my true calling was working with others, and spent the next decade getting the education and training I needed to be a psychologist. Later on, I directed a private practice for nearly ten years, but these days my time is spent writing, and doing workshops for schools and community groups.
2) Now, what led you into the field of neurodevelopmental disorder- or should I say neurodevelopmental disabilities?
When I opened my private practice I saw many kids who were diagnosed with a wide range of neurodevelopmental problems. It was quite overwhelming. These were serious problems affecting a very large number of children – and families were desperate for help. I began to ask myself: "What's the common denominator of these neurodevelopmental disorders?" I also wondered, "How is it possible that ten million children in North America could be diagnosed with the same syndrome – ADHD?" To some extent, when that many people are diagnosed with a problem it ceases to be a syndrome – it's just the way we are.
Curiosity and necessity led me to study the brain with special concern for learning and attention problems. The more I learned about brain science, the more things made sense in my clinical work. I dedicated large quantities of time to reading and assimilating scientific research that could aid my work with patients.
One of the unfortunate realities of neuroscientific research is that so little of it gets translated into practical strategies that can be used by parents, teacher, or therapists. My books aim to solve that problem.
3) You have "Eight Pillars of Executive Control " ( what I refer to as " executive functioning"). I would like to address each one briefly and ask you why these often do not develop and how to help parents and teachers develop these skills. Let's start with organization- why is it that some kids have such difficulty organizing their work, their environment and their lives?
The executive thinking skill of organization is all about the management of personal space. For children, this means their desk, room, locker, book bag, folders, etc. Middle school age kids are particularly vulnerable to organization problems because that is the age at which kids are expected to work more autonomously – and some kids just aren't ready to make that leap.
We now have great research that helps us to see that neurodevelopment proceeds at a different pace for different kids. The key is grey matter development in the brain's cortex, which tends to be a little slower in boys. Helping kids with organizational challenges should focus on practical solutions rather than moralizing about "why doesn't he try harder," or ""she just doesn't seem to care." My second book, No Mind Left Behind, explains how to help kids of different ages solve the organization puzzle.
4) Other kids ( in my experience, those with learning disabilities) have trouble with Initiation- is the difficulty level too high or are they just not motivated?
It's important to know that initiation problems are not the same thing as procrastination. A procrastinator doesn't get started on something because she or he dislikes a particular task. In contrast kids with initiation problems are unable to mentally organize a sequence of steps to start and complete a task. Of course, if you have chronic problems with initiation it would not be surprising if you felt less than motivated about starting on various tasks!
Again, the important thing for adults to offer is tangible help rather than scolding, lectures, and unproductive moralizing about "needing to try harder." A child who doesn't initiate typically benefits from a high degree of routine and protocol for important tasks such as homework, assignments, projects, etc.
5) My good friend Norbert Jausovec has written about Flexible Thinking and this is one of your eight pillars- why is flexibility important and how can parents and teachers teach it?
There are two key dimensions to flexible thinking with respect to executive control. First, it aids problem-solving in the sense that flexible thinkers can shift perspective more easily than others, allowing them to perceive different ways of approaching a particular challenge.
Second, flexible thinking also involves adjusting tempo. In other works, kids with flexible thinking skills can speed up or slow down as a situation warrants. This skill makes fitting in much easier. This is a god example of how executive control is just as important to social development as it is to academic performance.
The best way for adults to teach flexible thinking is by providing an optimal example, and then providing lots of opportunity for practice and rehearsal. Great teachers do this almost routinely with various classroom projects.
We can help children build an awareness of tempo by translating time (which is inherently abstract) into something more concrete, There are, for example, several products available which quantify time spatially. These sorts of timers make it much easier for kids to pace themselves accordingly.
As with other executive skills, in vivo coaching of flexibility helps to solidify new learning and reinforces what I call two-tier thinking – being able to focus on completing a task while simultaneously monitoring the effectiveness of one's work habits.
6) Planning is important- some kids wait until Sunday night at 8:00 p.m. to tell parents about a science project or book report due the next day. Is this a reflection on our immediate gratification society or something else?
I would agree that the pull of immediate gratification is part of the equation. And that's exactly why it is so important for parents to teach their kids how to prioritize. However, this has to be taught before the last minute that something is due; otherwise it comes off as a reprimand and the natural defensiveness of a child will prevent him or her from getting the idea. I think parents should emphasize that prioritizing is about making sure there is plenty of time allocated for fun. One of the reasons I am emphatic about kids getting their homework done before dinner is that it compartmentalizes the homework hour – and leaves the entire evening for more recreational activities.
The single most important concept we teach kids with respect to planning is to "begin with the end in mind." Planners, wall charts, and a well thought out school agenda book make good planning skills easier to achieve.
7) Regulating or controlling one's emotions is important in a civil society- yet some kids scream, yell, tantrum and the like. Are parents giving in too much or is this a manifestation of the single parent family where that one parent does not have adequate time to teach these skills?
Sometimes the emotional outbursts of children reflect problems knowing how or when to discipline, and in that case, parenting education can be very helpful. But we need to recognize that the emotional dysregulation of many other kids is due to a prefrontal cortex that can't sufficiently moderate the emotional signals of the brain's limbic system. For this group of kids, learning to de-escalate is a major challenge.
However, skilled clinicians can teach kids - even children as young as three or four – how to access rational problem-solving skills. When children learn these skills, they are noticeably more confident, and generally feel safer. It is a terrible burden to go through life fearing that your emotions may dictate your behavior at any moment.
I am always inclined to give parents the benefit of the doubt. If parents know how to intervene effectively – they generally will. I just wish that, as a society, we didn't assume that parenting comes naturally. For most people, it requires lots of patience and practice. Great parenting has much more to do with endurance than engineering!
8) You link " Working Memory " to learning- and I concur it is important- but often requires a word I call repetition. Are the schools not emphasizing the repeating, review and rehearsal of information so that it can be learned?
Of all Eight Pillars, working memory is the most important with respect to learning. I think we can reasonably think of working memory as the rocket fuel of the modern mind because working memory is the foundation of our ability to multitask, keep pace, and consolidate new learning. Repetition and rehearsal greatly empower working memory to do its job of building knowledge. Unfortunately, many teachers may find the instructional strategies that bolster working memory to be less stimulating from an instructional standpoint. A more tangential teaching style can be quite creative but doesn't necessarily serve young minds in the best way. However, learning to accommodate working memory deficits makes for a happier classroom.
In the classic scenario, "Johnny" is taught a task on Tuesday, and he does fine following through with the required steps. Then, on Thursday, his teacher asks him to do it again and Johnny just stares like the proverbial "deer in the headlights." Next thing you know, all sorts of negative inferences are being made about Johnny.
"He has an attitude problem." He's being defiant." "He's not trying." All of this misinterpretation leads to hard feelings and a breakdown in the critical alliance between teacher and student.
Repetition and rehearsal literally build networks in the brain where knowledge is stored – this is what makes that knowledge available for retrieval when a child needs it. It is simply impossible to overstate the importance of using instructional strategies that give working memory its best chance to work.
9) Self-awareness is important yet, so few students seem to be aware of their behavior, their actions, their emotional outbursts, how they impact others. Is this a case of minimal or no feedback from others or something else?
This challenge has to do with an underactive right hemisphere – where most of our nonverbal perception and communication takes place. Numerous research studies have demonstrated the prevalence of this problem in boys, and especially in kids who have some type of non-verbal learning disability.
While deficits in attention and organization require management-style intervention, self-awareness challenges require more of a coaching approach. It is particularly useful to emphasize social interaction as a "code" that a child can learn. It's very anxiety provoking to be told you have to be more intuitive – and, in reality, none of us can actually do that. Focusing on self-awareness as a code makes it more tangible. For example: "Did you remember to notice your voice, hands and facial expressions at recess today?"
10) And of course, we come to the coup de grace- attention. In your opinion, is Attention Deficit Disorder a disease, a neurological problem, simply a difference between kids, a skill that has to be taught and learned, or is it something else that we don't understand? And should we be medicated kids with Ritalin, Adderall, Cylert, Concerta, Strattera etc.?
From the perspective of ADHD, attention basically adds up to the ability to block distraction. I would agree that this ability is important, but it barely scratches the surface with respect to the importance and complexity of attention. Being able to sustain attention is an immensely enjoyable experience – I think kids yearn for that ability.
The most valid way to talk about attention is to recognize that it results from an interaction between a person and his or her environment. This explains why kids who are inattentive in the classroom can pay wonderful attention to a video game. The set-point of stimulation changes across different situations.
Still, for the vast majority of children, attention can be accomplished in most situations with enough stimulation. In my workshops I discuss the "ecology of attention." Rule #1 – If attention is not nurtured it will die. Our frustration in schools is that it's so very hard to compete with the level of stimulation kids get outside the classroom.
From a treatment perspective I am not an extremist in any sense. I don't believe one approach to treatment is superior to all others. Without a doubt, I ask that families and schools try "options of first resort" before we try meds, but I think it's wrong to demonize medication – it makes all the difference in the world for some children and teens. However, as has often been said, no one ever learned anything from a pill.
11) Tell us about your books and web site.
"Boys of Few Words: Raising Our Sons to Communicate and Connect" was the outgrowth of a decade working with school-age boys. It discusses the importance of social communication in the 21st century and provides many strategies for helping boys open –up. Top tip: When we reduce vulnerability we make it much easier for boys to talk to us.
"No Mind Left Behind: Understanding and Fostering Executive Control-The Eight Essential Brain Skills Every Child Needs to Thrive" was written to reframe the discussion of what is commonly – and mistakenly – called ADHD. The term ADHD is way too narrow to fully embrace the minds of kids or how much is at stake for kids with executive thinking delays.
Once a parent or teacher engages the concepts of executive control there is no going back to the limiting idea of ADHD. I wrote this book to give people dozens of specific strategies for intervening with specific executive thinking challenges. The response from educators has been tremendous!
My website dradamcox.com is designed as a resource for parents and teachers who want more information about the topics in my books. There are many free articles to download and a Newsletter called Family Matters where I discuss child-family issues in depth. I'm pleased that professionals around the world visit my website daily. Schools and other organizations who would like to host one of my workshops can also find information about program content on the site.
Published December 5, 2007
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