Executive functions are essential not just for effective learning but also for applying that learning to various contexts eventually contributing to development of adaptive mindset. The important place in our lives where we adapt is in the social context. The difference between naïve and devious is all the “intent” and those who have the capacity to read others’ intent are called mind-readers. Take a look at this video.

To understand this meaning, one must “read” the little girl thoughts, “read” the police officer’s confusion and “read” the overall of situation to determine who fooled who and why.

The social world entails subtle, complex, layered and multifaceted information, which calls upon a contextual evaluation to determine the social script and subsequently, the process of selection of an appropriate response. This involves generating “other-oriented” thoughts and inhibiting or putting one’s own “self-oriented” thinking on hold.  When we encounter a social situation we must do three things, which contribute to social dexterity:

1. Inhibit our impulsivity to wander off (so that we don’t  miss anything)
2. Update information (compare current information with the past knowledge)
3. Generate new responses that are more in sync with social and cultural needs (so we are appropriate)

Take an example of a bunch of 5^th graders socializing during a lunch break. Even though social interactions tend to be unstructured, it requires that we detect structure, generate common goals and then socialize by adapting in the given circumstances by performing the acts of “mindreading”.

John, Tom, Adam, Jeff, Jason and Ryan were sitting around the table during their lunch break. Tom wanted to share a riddle with all.

(Note: this was the riddle/joke that Tom had read and remembered and was keen on sharing. In order to be effective in presenting a riddle or a joke one must have decent linguistic competence to capture the group’s attention and engage their imagination. The riddle went something like this: A man wants to go home, but is afraid to go home because of a man in a mask, and something that he has. WHERE DOES HE LIVE? -hint- you’ve seen his house, and probably have been there.)

As often is the case, social situations don’t go per plan. As soon as Tom expressed the desire to share the riddle/joke three others boys had the same idea who jockeyed for the position by all talking at once. They all had to negotiate (congenially) as to who was going to go first. As soon as Tom secured his turn he butchered the set up, “There is a man in a mask running to get home.” Before Tom could get to the next part of the joke or “set up” the joke Jason butted in and blurted out, “I already know it,” breaking one of the golden implicit social rules – “allow” as an act of cooperation.

Tom: (his face drops) Aww!

Jason: Oh I got it. I know this one.

Tom: Never mind…..

Jason: (persistent – and oblivious to Tom’s facial expressions) Is that a psycho killer?

Tom: No (picks up again but loses the punch line as he had already botched the opening)……

Researcher Judith M. Rumsey in one of the articles in the Journal of Autism and Developmental Disorders (1985, 15, 23-36) commented on the similarities between executive functions and social functioning. According to her, they both call upon “Integration and weighing of multiple contextual variables, selective attention and inductive logic”.

My girlfriend was describing her observations about her 5 year old twin boys Aaron and Mason and here’s what she said: The boys were playing hide and seek around the house with two other kids whose families had shown up for a play date. It was Aaron’s turn to count while the other kids scrammed to hide. After the count up to 6 one of the parents in the living room told Aaron that he didn’t need to go all the way up to 20 as no one was around. This prompt to stop counting and start looking for others was good enough hint for Aaron to move on to the next thing- look for kids who were hiding. When it was Mason’s turn to close his eyes and do the same, the adult in the room intervened again and told Mason to take advantage of the fact that no one was around and to get on with his search. However, bound by rules, Mason was not able to “shift sets” and was somewhat fixated on completing the counting till 20 and only then starting his search. At age 5, this minor incidence does not wave any alarming flags about Aaron or Mason but this vividly captures the flexibility in the prefrontal system to adapt as shift as the need changes in the social context.

In my practice, I see many young kids, college students and young adults with social impairments with or without explicit disability or justifiable diagnosis. Many symptoms of such social impairments include interruptive behaviors, disengagement in conversation if the topic is personally of no interest, a lack of empathy, socially embarrassing behaviors, circumscribed interest, negative reactions to environmental changes or inflexibility of thinking, preoccupation with own thoughts and ideas or perspectives, and fixated mindset. These individuals are noted to not have many friends or know how to keep friends and nurture relationships. They are often are ignored/ neglected, picked on or ostracized because of their annoying, irritating, overindulgent, apathetic or disengaged presentation.

It is important to understand that social situations are dynamic in nature. Social engagements are in a state of constant flux and very much depend on their participants. As an individual pursues a personal goal of wanting to express an idea, or tell a joke or share facts, each individual participant must coordinate and navigate that intention or desire in accordance with other people’s goals of a similar nature. This tango that we perform in social situations demonstrates our social dexterity.

When social proficiency is at its best, it leads to a deep-seated understanding of others and eventually leads to intimacy which is the ultimate human connection. I love this exchange from Jennifer E. Smith’s book The Statistical Probability of Love At First Sight:

“He looks at her and smiles. “You’re sort of dangerous, you know?”
She stares at him. “Me?”
“Yeah,” he says sitting back. “I’m way too honest with you.”

If you are unwilling to allow others to pursue their social goals by constantly interrupting without listening, or teasing without consideration, or horsing around without serious side to self, then others will not reciprocate with enthusiasm or interest.

In conclusion, social navigation requires a complex set off executive abilities and a tremendous amount of flexibility of thinking when both of these sets of skills are impaired or are under-activated then that individual often is excluded or sidelined and that can lead to a profound sense of loneliness. Every individual aspires to becoming independent, however that does not mean becoming solitary. Our prosocial behaviors or behaviors that promote socialization and connectivity are the most effective adaptive social skills.

One of the African proverb says, “Alone you’ll go fast but together you’ll go long.”

I invite you to leave a comment and share this post with your friends. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com or contact me at Sucheta@cerebralmatters.com.

It’s March and I’m looking for the whispering signs of spring. Just thinking about Paris puts a smile on my face. In her book How Paris Became Paris, Joan Dejean describes the innovative and adaptive mind of Henry IV. Until that point, the cities around Europe, for practical and economical reasons, were connected with bridges that were lined with houses on both sides. It served a functional purpose and allowed trading. But Henry IV decided to change that. With vision, resourcefulness, and determination he constructed bridges that transformed the desolate city of Paris into the modern city that we have come to love. The sidewalks on the bridges made it possible for the poor and the rich to walk in the evening, watch the sunset, and bask in the glory of the river.  Even to this day, the “new bridge” of the Pont Neuf reminds us the innovative and flexible mind, which inspired change in many – people and places.

When accomplishing goals, the Executive Functioning ability constantly updates the input from the environment and assesses the circumstances to see if the goal can be met. This process requires an individual to sustain attention and engagement, relate new information to prior knowledge, detect what’s implicit and finally, reconstruct or reconstitute the goals. Take an example of charging your laptop. If it’s a regular day, you have a fixed place next to your bed where you may be plugging your laptop charger. But if you are at Starbucks or at the airport, you have to look around and scout out the area to see where the outlet is. Then you have to negotiate with the space and people to figure out when it’s all right to plug in.  This is where your adaptive skills play an important role.

To become successful at adaptive skills, one must appreciate the role of habits, routines or structure, which create a strong backbone for effective adaptation. Carrying out part of the day with a predetermined sequence of events allows automation. Hence, everyday habits or routine environments provide structured guidance, which take away the pressure of thinking of goals or plans. On the other hand, novelty or changes in the environment or newly added constraints interrupt the habitual sequence, which then forces the brain to employ adaptive thought.

A word of caution: novel rules may be particularly challenging in the context of over-learned habits or routines because they require people to adjust familiar behaviors and routines or engage in set shifting to achieve the same goals in the face of interruption or a road block (Schutz & Wanlass, 2009). This requires engaging in problem solving from the perspective of  “self” by detecting a breakdown and coming up with alternatives.

Researchers in field of developmental disorders including Russell Barkley (whose focus is ADHD) have identified a link between behavioral inhibition and 4 neuropsychological functions in the area of executive function, which put constraints on adaptive behaviors. They include:

1. Working memory,
2. Self-regulation of affect–motivation–arousal,
3. Internalization of speech, and
4. Reconstitution (behavioral analysis and synthesis)

Here’s a description of one such a young boy with ADHD. His mom wrote to me, “He is a very charming, delightful child who wants to do well but spends a lot of his time frustrated and crying because he has trouble following directions, remembering steps and getting started with tasks. He falls apart when things don’t go his way or when there is a small change in the plan”. I assume he would be one of those children who would stop doing math because his pencil tip broke or one who would have a massive meltdown because parents changed their plans to go to the movies and visit grandma who happened to be sick that day.

When routinized life is met with flexibility of thought, daily life becomes manageable. For parents of ADHD kids or adults with ADHD or other neuro-atypical individuals the key to successful adaptation lies in well practiced adjustment to last minute changes and working flexibly with unpredictable circumstances.

Here are a few tips to promote the development of adaptive brain:

• At home, play a familiar card game with a slight change in a previously learned rule
• Make a weekend plan on Wednesday and then forgo that plan on Saturday (followed by a small discussion)
• Throw a small intentional wrench in your plan and brainstorm a novel alternative for your children to adjust to
• Take an alternative route to work or change the recipe with small adjustment in an ingredient (without sabotaging the taste)

Real-life situations are unpredictable, consistently changing and unstructured. Here, one cannot just rely on internal habits or the environmental cues which may not be present. In fact, habits may act in opposition to essential adaptive decision making. Novel conditions require getting rid of routine steps and making adjustments to the familiar behaviors. Engaging in set shifting to achieve goals is crucial ingredient to life-long success.

I invite you to leave a comment and share this post with your friends. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com or contact me at Sucheta@cerebralmatters.com.

One of the National Geographic documentaries on the human-like behaviors of chimpanzees has managed to capture one such instance. The ingenious invention and use of tools by chimpanzees to retrieve tasty treats, termites, from their mounds is fascinating. See it for yourselves.

A developed prefrontal system is able to innovate and replace a tool with another one in case one doesn’t work. The strength of the adaptive brain or the executive system lies in its ability to suppress a previously learned rule and modify or ADAPT to the new situation. For example, let’s take an example of a 3-year old and a straw. In one scenario, you drink from a straw and in another, you blow bubbles in colored soapy water to make art… if you don’t inhibit the impulse to suck from a straw during bubble painting activity, you’ll end up with a mouthful of soapy water!

Day-to-day activities are riddled with an influx of opportunities to adjust responses, tweak or adapt behaviors. Growing up in India, 3-4 months of monsoons a year definitely made me attuned with the need to adapt to the rainy day (literally not metaphorically) forcing me to be on the look out for things that would serve as an umbrella when I did not carry one. Ideally, an umbrella is what you need when it rains as it protects you from getting wet. However, in case you don’t have an umbrella handy, the adaptive brain kicks in. Here are a few examples of that.

While a protagonist in a good literary piece shows us how he, in his special ways, circumvents a monumental roadblock, we in our small ways adapt every single day. This may range from cutting the edges of a burnt piece of toast to taking a different road once you hit a traffic jam. Researchers Sparrow, Balla and Cicchetti in 1984 defined Adaptive functions as the ability to ‘perform daily activities required for personal and social sufficiency’. It is an individual’s actual performance on a variety of daily tasks including

• Self-help (waking up, taking a shower, tying shoe laces etc.)
• Independence (navigating through home, school and community without supervision)
• Self-knowledge (knowledge of personal information including address, phone number etc.)
• Motor skills (using craft scissors, replacing lead in the mechanical pencil etc.)
• Social knowledge (knows how to tell time, how to relate to others, read expressions etc.) and
• Language and communication skills with others (saying please and thank you, can answer questions, can follow directions etc.)

Research shows that children with ADHD (with delays in development of prefrontal cortex) are known to experience notable difficulties in the area of adaptive skills and over time, experience a significant breakdown in forming habits and in establishing self-sufficiency. One can imagine, the students who suffer from inattention and poor self-control never quite master the ability to “know” what to do next in case things don’t go per plan.

In conclusion, the signature Executive Function ability is to shift thinking to meet the rules, adapt behaviors and restructure actions during novel or unfamiliar or unstructured situations. This ability allows us to finesse a LAST MINUTE CHANGE!

I invite you to leave a comment and share this post with your friends. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com or contact me at Sucheta@cerebralmatters.com.

I left my office on Friday and walked to my car. I put my laptop, a book and printed notes in the back seat and put my handbag on the front seat. Nonchalantly, I drove to pick my son from soccer. Afterwards we went to Publix and picked up some groceries and we got home. I gathered my handbag from the front seat and groceries from the trunk and felt I had no apparent reasons to open the door to the back seat. In fact, if I had done that, I would have seen the laptop and the paperwork and would have taken it inside the house with me.. It wasn’t after two hours when I sat down in my bed to check possible flights to San Francisco with the thought of planning out the summer that I realized that my laptop was still in the car. The thought of using the laptop made me think of the laptop still being in the car. I know this is a long-winded story, but does this happen to you?

Forgetting to pick up the laptop from my car and bringing it in is a minor glitch but if I run into such ‘failure to remember to do’ glitches 17 times during the day it could be a nightmare. That is what happens to folks with Executive Function Disorder.

Teaching thinking and study strategies to students with Executive Function Disorder requires me to train them to acknowledge the fact that “they will forget”. This very ability to remind oneself to remember to remember is called Prospective memory. During the day, our brain is bustling in ideas that need a follow up at a later time. For example:

• Call Stacy back after getting home
• Get started with the paper on Sunday before 3pm
• Return the library book (to avoid late fee) by Saturday
• Set the recording for a new TV show before it airs on Monday
• Get email address for John and his wife so that you can send them an e-vite for dinner
• Reply to Anne’s email about carpool for next Friday

Prospective Memory is an internal process of remembering to perform an intended action in the future at a specific time without any direct prompt from the outside world. There has to be a strong intention to pursue the initial intended thought.

The idea occurs to us at “Time 1” but it needs to be executed at “Time 2”. The act of remembering to remember from “Time 1” to “Time 2” is called rehearsal. Here’s how Prospective Memory works:

• a.   TIME 1 = Form an intention (example, I would like to pick my prescription from CVS)
• b.    CHOOSE TIME 10 = Set out a future time frame (example, I would like to do this on Thursday after lunch but before my meeting at 4pm)
• c.    TIME 2-9 = Engage in rehearsal (example, remind yourself to remember from now until Thursday, from Thursday breakfast till Thursday Lunch….)
• d.    TIME 10 = DO the intention action (example, actually go to CVS and pick it up at 3:40pm as you are driving to John’s office for a meeting)

When an individual suffers from Executive Function Disorder, they run into several glitches during Time 1, Time 2-9 and Time 10 because of inattention, poor judgment or poorly formed intentions.

Daily conversations are riddled with casual references to memory, reminders, and forgetfulness where people often use these terms interchangeably. However, it is important to distinguish Prospective Memory from Episodic Memory or Semantic Memory.

Episodic Memory refers to autobiographical memory for events and experiences that can be recalled. For example, recalling what you did over summer of 2012, remembering what gift you gave Suzie at her wedding etc.

Semantic Memory refers to the mental record that we create of facts and concepts, which help build our knowledge about the world around us. For example, remembering how many ounces in a liter or recalling the MVP of last Super bowl.

It is a fact- we all forget. But forgetting to pick up a present for your wife at least a day ahead is different from forgetting your wife’s date of birth or for that matter, forgetting that you HAVE a wife!

Research describes two important and yet different types of Prospective Memory tasks:

• a.    Event-Based Prospective Memory Tasks where a person has to remembers to do something in response to a target prompt which can be an image or an event. An example,
  • How well we remember to carry out Event-based tasks depends on its familiarity, specificity and uniqueness.  Of course, it also helps if there is a strong mental association between the target event and an intended action.

• b.    Time-based Prospective Memory Tasks where a person has to remember to do something after a certain time interval. For example,
  • Take out cookies from the oven in 17 minutes or
  • Renew your driver’s license by August 23^rd, which is in 7 more months.
  • Submit your college application at 11:59 pm on December 15^th

Research suggests that once an intention is firmed up in your mind and a memory trace is created people rehearse without any apparent external triggers. They do this more so for time-based tasks than for event-based tasks.

Treatment of Executive Function Disorder must entail training of Prospective Memory skills. Breaking the process down and helping students understand how to create futuristic intentions can yield success. The training process needs to address explicit rules of ‘remembering to remember” and modeling of “how-to” and engage in three distinct rehearsals.

So next time, if you have a disorganized yet brilliant student who has a dazzling memory and can name capitals of most of the countries, state obscure facts about puffer fish or quote Shakespeare; get him to accept the baffling truth about his own Executive Dysfunction: “I don’t always remember that I often forget to remind myself to remember!”

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com. For any further communication, leave me a note here or contact me at Sucheta@cerebralmatters.com.

• In my opinion, there are two parts to developing cognitive and executive habits

• Stop or get rid of old bad habits
  • Example, try and get rid of a bad habit of shoving papers into the bag pack right before you leave the class (thinking that you don’t have time to put it in the right binder or folder)
• Learn and employ new habits that don’t exist
  • Example, get into a habit of writing down what happened in each class at school as a way to trigger your memory. The idea is that the written reminder will trigger your thoughts about the content

In the book The Power of Habit the author Charles Duhigg discusses neurobehavioral elements of habit formation. According to the scientists he interviewed, the neurocognitive process called the Habit-Loop has three parts:

1. The cue – the brain gears to get into an automatic mode

2. The routine – the sequence of actions or the behavior itself

3. The reward -remember this pattern for the future

What we know about habits is that each and every habit has its own cue, routine and reward. Mr. Duhigg suggests that in order to change the automatic behaviors that we call bad habits we must do mindful search of what the cues and rewards are and then slowly start changing them. As you can imagine changing habits that work on brain’s reward system can be delayed, obscure and sometimes intangible. One has to learn its structure with a high level of motivation and a great amount of self-awareness. Developing Executive Function habits of organized thinking, planning and problem solving need effort and deliberate thought, all of which is not fun.  Using organizational tools and methods can make a person less scattered and more productive but that feeling is only sustained as long as ongoing continuous effort exists.

Experts agree that, in order to develop new mental habits, one has to go beyond simple experience of new skill. Research psychologist from Florida State University, Dr. K Anders Ericsson, (2006) says, “Until most individuals recognize that sustained training and effort is a prerequisite for reaching expert levels of performance, they will continue to misattribute lesser achievement to the lack of natural gifts, and will thus fail to reach their own potential.” One has to turn these new experiences into something called deliberate practice where they have to concentrate on going beyond their current ability (as described by Ericsson).

In conclusion, forming new habits cannot be just founded in observation of disappointing performance or difficulties in experiencing success. Rather, high motivation to improve performance seems to do the trick. Many students with Executive Function Disorder do not have that kind of awareness or understanding about their lack of skills or good habits. And on top of that, they lack the motivation to do things differently. People like me who coach, train or guide these students have to keep that fact in mind.

I always say to my students, “An expert student engages in deliberate practice without rest for an hour at a time, and their ability to concentrate on the new habit is the most crucial thing that seals the deal.

So, my parting message to all the students I work with is:

• Know that deliberate practice creates “Experts”
• Awareness is the key to making changes
• Learn the routine or steps involved in organization so procedures become automatic
• Keep a written log of new habits that you are trying to form to see what’s working and what’s not
• Engage in introspection or reflection
• Share or communicate with others about your goals to form new habits
• Use positive self-talk for motivation
• Allow time for new skills to get synched

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com. For any further communication, leave me a note here or contact me at Sucheta@cerebralmatters.com.

Allow me to indulge in the concept of Self-Regulation with respect to Executive Functions:

During the Christmas break, my family and I visited Japan. Among many of its natural and cultural gifts, I was awestruck by a concept called Meiwaku, which refers to causing trouble or nuisance to others. Beyond its literal meaning, in its broader sense, Meiwaku refers to bringing shame to a group by the actions of an individual who behaves inappropriately. Right from the start, Japanese are taught that their actions are not only reflective of who they are as individuals but are representative of their family, culture or even their entire country.

In his blog, Jeffrey Hays (http://factsanddetails.com/japan.php?itemid=615) writes, “When Yoko Ono took her first trip to the United States as a little girl she remembered her mother telling her, “If you’re naughty, no one’s going to think, ‘Yoko is a bad girl,’ they’re going to think the Japanese are bad. So you must be careful. Each of us is a diplomat.” Thomas Dillon, in his article in Japan Times (http://www.japantimes.co.jp/text/fl20070217td.html) writes, “To me, meiwaku means being a burden. I don’t want to be meiwaku because I don’t want to inconvenience others. The way to live is not to complain, but rather to focus on my own contributions.”

This got me thinking about the plight of the children and students who suffer from ADHD and other developmental disorders, whose cognitive and executive function development is delayed such that they are unable to control their impulses, often leading to inappropriate social engagement. This lack of impulse control and poor self-regulation causes disruption to others and influences others’ opinion of that individual.

• In her article, “School Transition and School Readiness: An Outcome of Early Childhood Development,” Sara Rimm-Kaufman, Ph. D. (http://people.virginia.edu/~ser4x/) pointed out that parents and teachers use two different sets of parameters to describe school readiness in children entering Kindergarten. Dr. Rimm-Kaufman observed that parents emphasize knowing letters and numbers in order to take on Kindergarten, while teachers look for readiness in the social domain. They were keenly interested in the child’s ability to focus and follow directions, attributes indicative of self-regulation in the social context.

Executive Functions evolve with maturity, training and dynamic learning. However, social awareness and interpersonal boundary plays an important role in understanding rule-based aspects of Executive Functions. Teaching self-regulation and rewarding behaviors that reflect attentional control can be a family business and a cultural phenomenon. Expecting that not just our children, but we ourselves should not cause inconvenience to others can lead to a path of thoughtful and mindful behaviors impacting learning and social reciprocity.

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com. For any further communication, leave me a note here or contact me at Sucheta@cerebralmatters.com.

“You know how swimming pools have a separate time for adults to swim during which kids are not allowed. Similarly, on Comedy Central they have a series of half-hour animated sitcoms that are meant for adults or rather, have adult content. Collectively they are called Adult Swim.” Listening to this explanation, my friend says, “Wow, you’re like an interpreter for the culturally impaired”! That was such a fascinating comment because it relates beautifully to what I do.

As part of my training I have learned many foundational principles related to language development, structure and use. The field of linguistics, which addresses Morphology, Syntax, Semantics and Pragmatics can be thought as dull and drab, but it speaks to me. Professionally, I deal a lot with Pragmatic disorders, which refer to one’s inability to use language to yield social connectivity or the inability to navigate through the social world using verbal and non-verbal communication.

A socially incompetent child or adult is like a gazelle in the savanna. Their more savvy or proficient peers act as lions and may pray on this gazelle. Unlike the animal world where the gazelle gets eaten, in human world, the gazelle may be subjected to neglect (being ignored or treated as an outcast) as much as being attacked (picked on) or they may simply get left out. The ability to influence the social world with use of language and non-verbal skills is one of the most striking feature of early child development and lays the foundation for developing friendships and becoming “likable”.

In a recent phone call with a mom of a 6^th grade girl, I uncovered the social disorder I am describing here. The mom described her daughter’s inability to navigate through the middle school and not finding a fitting place amongst her 7^th grade peers. The mom described a laundry list of observations or complaints that she felt were putting her daughter out of the social scene:

• She is far more immature for her age than her friends
• One time, she was bothered by a comments that her classmates made that she “meows like a cat”. Mom thinks that her daughter probably does do that but is unaware of it.
• She loves dragons & fairies, gets carried away in pretend play for hours while her friends have moved on to Facebook and boys
• Her best friend is one who is two years younger than her since their interests match
• She bosses her best friend around and gets away with it because the other girl can’t really protest
• She is messy and doesn’t think it’s important to present herself well. In the cafeteria you can see her eating awkwardly or sloppily
• Academically, she does not study at all nor is she overly concerned about her grades but if she has true interest in the subject matter she will do very well
• Since the beginning of the school year, she has started talking about being lonely and not having friends but she does not see how that goes hand in hand with what she’s doing

This type of phone call is very common in my practice. In essence, individuals with deficits in pragmatics and social cognition appear to be culturally impaired. They are somewhat behind their peers and they don’t fully grasp what they are not doing right or how it makes them stick out like a sore thumb. As you can imagine this may lead to social typecasting and eventually to social isolation. My role then is to become an interpreter of social-cultural barriers and translate them in a meaningful way.

Social cognition and social regulation hinges on executive functions, which are responsible for regulating behaviors and thinking. The critical EF concept behind development of social awareness and reciprocity lies in understanding a complex cognitive process.  Flavel & Miller proposed the concept of Theory Mind (TOM) which contends that people have intentions and they can act as agents to carry out their intentions. Theory of mind allows all of us to make sense of others’ actions, comments and behaviors, which we do by taking into consideration their mental as well as emotional states. Throughout the development, the notion of Theory of Mind undergoes metamorphosis allowing the individual to see others’ intentions as they become more and more veiled or invisible. These intentions get pursued via gestures, body language, tone of voice, eye-contact and implicit language messaging. If the observer or the communicator misses these subtleties then the social intent stays a mystery.

Throughout the course of treatment, I teach skills related to interpretation of actions, intent and social structure.

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com. For any further communication, leave me a note here or contact me at Sucheta@cerebralmatters.com.

Kids are NEVER lazy, spoiled, careless, or unmotivated. They often ARE: Frightened, confused, lacking in skills or information, frustrated, angry, sad, pressured, preoccupied, worried that they are “dumb” or otherwise “abnormal.”

What I liked about this blog was the message that perceptions get in the way of providing the right help in the right way. It is my observation what kids think about their roadblocks to success can be quite different than what parents think. However, watching a student get onto Facebook instead of preparing for a big biology test coming up Friday can be disconcerting for a caring parent.

While working with students who have ADHD (or concussion) and suffer from executive dysfunction, I often notice an unexplainable simultaneous presence of high capacity and underachievement. If a parent happens to casually observe the student’s approach to learning or work, he/she may be tempted to think that the student has an overall lackadaisical attitude or depleted care for one’s own welfare. Using the best tool in the parenting belt, parents get busy with conventional wisdom and find themselves thinking that their kids are being difficult, lazy or even entitled. Once this notion of student’s intentional unwillingness to put the effort and focus in producing work is triggered, no parent feels empathy for that student’s suffering.

In my approach to teaching ‘learning to think’, I like to start with the foundation that executive dysfunction is REAL and is definitely not intentional. Making a choice to go on Facebook instead of working on biology IS intentional but not being able to judge how being on Facebook can cause derailment of goals and lead to a waste of time is UNINTENTIONAL. When a disgruntled parent steps in and prohibits the student from being on Facebook he/she is acting and fulfilling the role of the executive brain. The true disability is the student’s inability to JUDGE what is good and what is bad for his future (immediate or down the road).

A NEW WAY OF PARENTING: It is an essential as well as an urgent therapeutic goal that students with ADHD (or concussion) self-monitor their choices and do so independently. However, parenting must change radically since the conventional wisdom of coming down on them hard or taking the rein of control in their hands is not going to work.

One needs to consider a two-fold approach for managing the problem of executive dysfunction:

1. Create a shared family vision: Before changing habits, families need to work on modifying the vision of family dynamics. Every member of the family must agree to be respectful and patient with the process. The students with ADHD (or concussion) needs to understand the value of parental directive and has to be brought to the level where the advice regarding self–regulation must be honored as a family value.
   • During the discussions, treat each other with utmost respect
   • Cool off before engaging in discussions regarding rules and compliance
   • Visit this question often, “Do you know why I am doing all this?”
   • Send a “heads-up” email to your student in order to prepare him for a discussion regarding failure to be compliant
   • During the family meetings, discuss cause-effect relationship even for positive outcomes and not just for negative ones
   • Establish household protocols of acceptable engagement with timewasters (or essential social detours for teenagers) such as Facebook, videogames, texting etc.
   • Discuss explicitly how cooperation, love and respect has had a positive impact on every family member’s thought process
2. Mediate with collaborative language: When communicating needs, the students with ADHD (or concussion) need to adopt a language that reflects accurate self-judgment.  The language used while seeking help should have a tone of modesty and introspection. Many students with ADHD (or concussion) lack the insight to know how they are under-functioning and how they are presenting themselves they may appear arrogant, apathetic or insensitive towards those who are likely to help. Hence language of self-advocacy has to be such that it eradicates the observer’s belief that the student is disinterested or indifferent but rather is truly suffering from a dysfunction. However, this practice must begin at home.
   • Parents and students alike should exhibit cooperative body language (Non-verbal language is as powerful as verbal directives)
   • Parents should prompt that their kids must use requests with an introspective voice
     • Can you please…
     • Is it possible to get you to…
     • Would it be too much trouble if I…
     • Parents also need to use empathic words such as “it must be quite hard to get down to studying when you are so tired and when it is so late”

Parenting has never been easy but modeling good citizenship is even harder. People who suffer from executive dysfunction have an added burden of compensating for lack of insight and tendency towards generalized apathy towards how others view them.

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com. For any further communication, leave me a note here or contact me at Sucheta@cerebralmatters.com.

Here’s an excerpt from Laura Holston’s article:

Mr. Parker, whether by design or impulse, has an almost compulsive need to share whatever is on his mind. When asked whether he used drugs, Mr. Parker dove in, saying, “I definitely don’t smoke weed,” and would have continued if his publicist had not cut him off. (Silenced, Mr. Parker followed up with a less specific response.) He is critical of gossip sites that report on his parties while, at the same time, breathlessly describing why he hires greeters or how he devises a menu. And he brazenly called New York socialites who came to his charity fund-raisers but did not donate “idiots.”

If I did not know the main character described here was Sean Parker I would have easily thought that behaviors of this sort resemble that of individuals who have suffered a brain injury or have been diagnosed with ADHD. In either case, under-functioning prefrontal context can cause havoc.

Prefrontal cortex or the central executive acts as a publicist for the brain. It regulates narrative discourse and directs behaviors and actions by applying a “social filter” which screens the information for its relevance, timeliness and impact.  Just as a real life publicist, prefrontal cortex ensures “positive” coverage of self and choreographs responses so that the self gets a spotlight. Most importantly, this executive director campaigns in order to promote the mission of self.

For example, if I wish to be known as a punctual individual I would provide a logical and decent explanation for running late. If I don’t provide such an explanation, I might be perceived as tardy AND irresponsible. This perceived image could do damage to my “reputation” hence the prefrontal cortex or the central executive would step in to remediate the situation,  prompting me to say, “I am so sorry for being late. There was a terrible traffic jam at the junction of I-75 and I-285. I hope I did not keep you waiting.”

In her book “How to hire the perfect publicist” Joan Stewart describes the following:

So who are the Publicists from Hell?

• They’re the ones who are pushy and obnoxious.
• They can’t take no for an answer.
• They’re clueless that the story they’re pitching isn’t a good match with the media outlet they’re calling.
• They write multi-page, rambling news releases and bury the gist of the story in the 6th paragraph.
• They follow up every news release with an annoying phone call to ask the media outlet, “Did you get my release?”, and “Do you know if you will  use it?” And they do this on your nickel.

Now you can see a parallel in the story of John, a 7^th grader with a diagnosis of ADHD that I am about to describe.

According to John’s teacher, during the math class he was sent into detention for exhibiting general disrespect for the learning environment. Apparently John changed his seats not once but several times without it being essential or permitted. In addition, he made several off-topic comments, which were not only unnecessary but completely inappropriate. Finally, John attempted to entertain a few backbenchers with the antics of putting quarters in his ear causing others to get distracted and derailing the teacher’s focus. Here, John’s “publicist” did not stop him from engaging in these social no-nos. These series of impulsive and inappropriate behaviors eventually led to John’s reputation falling from grace. Of course, John’s intention was to be funny, clever and even cool but his unawareness of rules, protocols and the reaction from the teacher turned out to be unfavorable to him in the long run. Unfortunately, since these are symptoms of executive dysfunction resulting from ADHD, giving John detention would neither improve his self-editing process nor would it teach him the lesson that he really needs to learn.

Providing treatment to remediate social deficits resulting from poor executive filter is an essential course of action, which often gets overlooked.

During the cognitive retraining sessions, restoring the central executive can be attained by providing explicit process-based tools to those with neurological dysfunction or variety of developmental diagnoses. The treatment emphasis can range from teaching problem solving, enhancing verbal reasoning, and instilling cause-effect analysis. The self-editing process can be attained by video recording these individuals in action as well as giving verbal and written feedback.

Restoring and maintaining a strong positive self-image requires attention to social details and careful consideration of actions and their consequences. If any dysfunction or lack of skills is likely to hamper one’s reputation we should intervene.

I invite you to leave a comment and join me in sharing ideas. If you would you like to know more about my practice, visit my website at www.cerebralmatters.com. For any further communication, leave me a note here or contact me at Sucheta@cerebralmatters.com.