Join Lindsey and Sucheta Kamath, SLP for a fascinating and dynamic episode of SPEDtalk. See why executive functioning is fundamental to the success of every student, child and company executive. The complexities of the brain are endless, yet Sucheta presents the challenges and constant developments students face in a clear and down to earth manner. Learn practical ways to keep students engaged and focused on sessions and classwork. This stimulating and enlightening SPEDtalk with Lindsey promises to educate and inspire.
Lindsey:
Good morning, Facebook. How’s everybody doing today? Thank you so much for joining our episode of SPEDtalk. I’m your host Lindsey Kucich, Lead Mental Health Therapist at Global Teletherapy. Thank you so much for joining us today as we talk about executive function in children. And if you’re new to the show, drop a comment, let me know where you’re watching from and as always comment and ask questions throughout the show, because we want to hear from you.
Lindsey:
So I see a few of you already logging on, so thank you, Janet and [Dottie 00:02:09] for joining us, [Elana 00:02:10]. It’s great to see you guys. I love that you guys join every week. It’s so nice to see you. Also remember take a minute right now and share this video so that we can reach as many viewers as possible. Last week’s episode set our record and we received 2,000 views in just 24 hours. So thanks for sharing and spreading the word. And if you’re watching the replay, comment #teamreplay. And if you’ve missed any of our awesome shows, you can always find them at Global Teletherapy’s YouTube channel. Don’t forget to follow us on Instagram and LinkedIn. Just search for Global Teletherapy, and then you’ll be able to stay up to date with the latest news that’s going on.
Lindsey:
So are you guys ready for today’s show? I’m so excited to introduce you to our guest, Sucheta Kamath. She is an expert in the field when it comes to executive functions. She is the founder and CEO of ExQ, a TEDx speaker and a world award winning speech language pathologist. As an edtech entrepreneur, Sucheta has designed a digital learning management system. It’s called ExQ, and this empowers all learners to develop self-awareness and strategic thinking skills through the mastery of executive functions and social emotional competence. Additionally, in her weekly podcast, Full PreFrontal: Exposing the Mysteries of Executive Function, she interviews world renowned experts across various fields, including cognitive neuroscience, developmental psychology and education. Sucheta is currently working on mindfulness meditation teacher certification and is a long time avid reader and chef. So I’m really excited to have her on the show to talk to us about this topic. So thank you so much, Sucheta, for joining us. How are you doing? Don’t have audio. Try, oh, hold on. You’re covered.
Sucheta:
Okay. I’m so happy to be with you, Lindsey and I’m feeling fabulous.
Lindsey:
Wonderful. I’m so excited that you’re here to talk to us about this topic because it comes up in therapy all the time and it’s a buzzword. We always talk about executive functioning and skills and things like that. But how do you describe executive function to parents or even children so you can make it more user friendly?
Sucheta:
Thank you for asking that question. It’s a really great question because executive function, as you said, on one hand is a buzzword, but it’s also a very confusing word because it really sounds like executive of a company. So what is it really? So to me, simple way to describe executive function is how you get things done, whatever it is that you want to get done. And that requires something that you have something in mind, you take actions and you achieve goals. So there’s something, a self at the center of it.
Sucheta:
Another way to think about executive function, and there are a lot of analogies people use, but the one that I like, is when you call it a conductor of an orchestra guiding the other instruments or people who are playing different instruments. But the conductor is guiding how to set the stage or which tune to play at what time. Another analogy that I really like is the air traffic control analogy at a very busy airport. So imagine if you’re trying to get things done, we have to figure out what to focus on, how to ward off distractions, how to hold onto information while working on it, how to switch gears, particularly if something unexpected comes in. And this is exactly what happens at the airport, so the air traffic control is helping planes land and depart while a man is monitoring the weather, as well as monitoring the landscape.
Sucheta:
One last thing that comes to mind about executive function is most often executive function is like breathing. It’s not something on top of the mind for people. We are only aware of executive function in its absence. So what happens is somebody’s late, we know executive dysfunction. If somebody is losing their temper, if somebody is not getting things done in a timely way, somebody is starting too many times, but not finishing. So executive dysfunction is more prevalent than executive function.
Lindsey:
I really like how you described that. And we don’t ever really hear the term executive dysfunction. So that’s really interesting that you put it that way and that’s a new way for us to reframe it. Because like you said, we really aren’t aware of when we’re doing it, but we’re aware of when we’re not doing it. So I can see how that can come across. And that’s really helpful.
Sucheta:
I can give you an example, a parallel between adult executive function and a childhood executive function. So executive function skills are crucial building blocks for early development of both cognitive and social capacities. So, take an example: An adult preparing lunch, was simultaneously helping children do their homework, while being on the phone and jotting down an appointment with a pediatrician and then putting that in the calendar. That requires what we call multitasking, but it is multi-goal management. Now, how does this translate into a child?
Sucheta:
Imagine a child who’s working on his iPad and finishing homework while ignoring the little sister in the background who’s throwing a fit, as well as realizing that the charge is low in the iPad. So running to another room, looking for the iPad charger, bringing it back, charging it, and then getting back with the assignment, all that requires executive function.
Lindsey:
Yes. And it sounds like it’s super complicated for sure. But you talk about in children. So how does the executive function skills, how do they develop? Can we track them along with other developmental milestones?
Sucheta:
Absolutely. Another brilliant question. And the reason this question is really important is because executive function needs change based on age you’re in, age group you’re in, or the needs you’re trying to meet. So to me, two important things that come to mind. One is, are your peers functioning at that level of competence? And second, is there a need that you are not meeting and that’s creating a disadvantage for you? So with that in mind, we can think about executive function as a skillset that every child is born with the potential to develop, but these capacities are shaped by experience. So developmental disorders such as ADHD or Asperger’s or language-based learning disabilities, the fragile system in the brain is that prefrontal system, which is still emerging.
Sucheta:
So a 9 year old is more proficient than a 7 year old, but a 16 year old is a lot more proficient than a 9 year old. So in, in terms of how it presents itself, and by the way, now that we have probably 20 to 30 years of research, documented research, that says that these executive function skills shape throughout early childhood adolescence, adulthood, and even old age. So I like to describe this as gas in your car. So, the more you drive, the less gas you have, so you have to replenish it. So you, yourself, can have great executive function in the morning. That means you’re focused, you know the intent, you are organized, and then you experience a lot of setbacks or stressors or a barrage of emails come in, or your computer voice doesn’t work or the sound doesn’t work. And then you begin to deplete your mental energy to monitor yourself and monitor your goals.
Sucheta:
So let’s quickly walk through some examples of how this will exhibit itself in younger age earlier than school age. So for example, if you are a two year old, two to six year old age range, so in the early years, it’s impulse-driven, distraction-driven and a lack of perseverative in nature. That means you’re stuck. You’re stuck in a loop. So there’s a lot of repetition, a lot of getting stuck and a lot of not knowing what the bigger picture is. So, by three years old, a child begins to pay attention to their environment. They are developing some sort of verbal fluency and they are beginning to show signs of impulse control, but they really don’t have any intent management.
Sucheta:
But by four or five years old, the child is now able to follow simple directions, which requires working memory, by the way, and the language is beginning to emerge. So you also show signs of something called internal speech. Internalized speech is one of the ways we manage instructions or information to hold onto it while we apply the rules to it. But that requires verbal working memory. So that begins to emerge. And by around six, when the child is about to enter or is already in pre-kindergarten, the child is able to show some self-restraint and is less impulsive. And also is able to track information through attention. So multiple speakers, multiple ideas, they’re able to follow. So you’re sitting in a circle time and John is fiddling with a pencil and teacher is talking about something. The child is able to track.
Sucheta:
So now, though, when you go into elementary-aged school children, there’s some emergence of planning and the child is also able to follow multi-step directions by then, and then they are-
Lindsey:
I think those are really important pieces, but those are some really big, big skillsets that take time to develop. I mean, as we rattle them off, there just seems to be like, gosh, they’re just so complicated at each step. And so even when you think about that, going back to the age around four, when you talk about developing that internal voice and how important that is just to manage what’s going on. And then when you’re in like kindergarten, and you mentioned that circle time, and being able to pay attention to the different things, because I mean, kindergarten classes, they’re getting a little bit larger now, like some classes, 20, 30 kids, that’s a lot of kids to manage. And they throw one teacher, four teachers, but as we get called in, oftentimes to help and we start seeing the behaviors because of that distraction and that impulsive thing. So, having these development… knowing, being aware of these different developmental stages really helps, and understanding how they manifest in kids so that they can meet these demands of everyday life is so important.
Lindsey:
And understanding what each of these everyday tasks really require the student to do. So just even in the younger years, they’re just developing this before we even have access to them, before we even know what’s going on. And then if there was some sort of a delay that occurred, I could see the trickle-down effect in the school setting. So then once they do require any of our services, we really have to look back and see where that hole and that gap was. So once they’re in elementary, like you said, so now we’re around that eight, nine year old development. What does it look like there?
Sucheta:
Yeah. And I think what’s so remarkable about your comment is, I think, again, these are so intertwined with early development of language and cognition. So we tend to hang back a little bit and to see if something more will emerge. So we are not really sure if we should intercept, but I think research is showing these are skills just like learning to tie shoelaces that we can actually learn, recognize, acknowledge, and develop by propelling them in the right direction. So take up that seven to nine year old developmental trajectory. You’re now showing some maturation of these attentional systems. And one of the critical things that begins to develop is this ability to learn from mistakes and this ability to alternate strategies, which is a huge component of school age regulation. It’s not just attention control. Now you’re managing goals.
Sucheta:
Now, still the goals are designed and developed by others for you, but you have to cooperate. So the cooperation skills begin to emerge as well. And then comes this complex, a slight emerging complex goal management. So here there is a need for planning. There’s a need for problem solving. And there’s some need for organization at a complex level. But it is not self-driven yet. But now you take that into early adolescence and young adulthood. So the entire late middle school and early or entire high school, as well as early college. Now you’re needing to show multi-goal oriented effort. And that multi-goal oriented effort needs to be combined with multi-strategy efforts. So in that context, you need to be cognitively flexible. You need to have abstract language that means metaphor analogies in between the lines. So that idiomatic expressions, why?
Sucheta:
Because now, the instructions become implicit and expectations become embedded. And lastly, I will say about this transition into adulthood; the executive function here now is saying who you are as a person, what you stand for and how you manage to pursue your goals in an enlightened or intelligent self-interest way and not a selfish way. So you can call a friend and say, “Hey, can we hang out and have some beer?” But if the friend says, “No, I have to work on my project.” And then you said, “Oh shoot, I too have a project.” Instead of watching midweek and playing beer pong, you being able to shift your attention to the project and motivating yourself by your friend is another wonderful ability that we begin to emerge, which is managing our social relationships.
Lindsey:
And I love that you’re talking about this management and then this motivation. And so, as you talked about, and there is, just so we’re learning the skills to manage and create those goals, but just because we have those skills, doesn’t mean we’re motivated to actually implement those goals that we set. There’s a very big distinction between that. And it is, it’s a developmental stage. And so that helps us understand as to why they’re maybe not just doing that. Why do I have to constantly tell you to do something? Well, because we’re not motivated to do it. So that might help with some parenting tips. And then, really, as that adulthood understanding, making those choices. We think about, you mentioned selfishness, and you think about like adolescents, middle schoolers… so selfish.
Sucheta:
Or bullying or being teased or ragging somebody or just not letting out. Those kinds of things. Yes.
Lindsey:
Those are all part of it. And that makes sense as to why we see these different behaviors at different age levels. And it really is linked back to these skills of the executive function. So, and I love… So, Christine put in a comment and this is fantastic. I love this. So you get it from a parent point of view, but she says, “My five-year-old told me, ‘I hear a voice in my head.'” Right. So that’s that inner talk and it’s right at that developmental mark, so that’s fantastic. So, as parents, you’re trying to mark your own kid and see like, are they developing appropriately? And what should I be looking for? So this is very helpful to us as therapists to know what to look for in session, but also using that on the back end of monitoring our own children as well. So that’s fantastic.
Sucheta:
And if I may add one point, Lindsey, regarding a role of stress and development of executive function. So there are some threats to development of executive function and stress is one of them and deprivation or other, kind of neglect, all those. But think about in the context of pandemic, the stress is just not having any structure or not getting a chance to have a play date with your friend or having to navigate parents, having to navigate their children’s learning while they’re trying to also manage their jobs.
Sucheta:
So there are two things that really emerge. One is the positive response to stress and a negative response to stress. And a positive response to stress, of course, we call that resilience. So in psychology, and you’re a psychologist, so you know this already, but it’s called the mature defense or transformational coping. But a negative response to stress is called neurotic defense or regressive coping. So what may happen is that some children are doing okay, they’re teetering at the border of emerging skills and they’re not advancing their executive function development, they’re not behind, but then boom, a stressful event or ongoing stressors continue to stay in that child’s life. And then they are not able to cope effectively. And their response to this ongoing stress tends to be immediately after this, after the stress. They either withdraw, they deny they need help, they become self-blind and then they’re resistant to self and support.
Sucheta:
And the final, if this continues, they give up very easily. Talking about motivation that you were talking about, and they are not able to scale their abilities and skills in the context of need, which is a big disservice to a child who’s learning to learn and learning to develop skills, because there needs to be a combination of hope and self-regulation and motivation to engage when things are not easy. So I just wanted to throw that in as well as we think about executive function.
Lindsey:
We know, I mean, students and children struggled with executive functioning skills before this pandemic occurred. And we can only imagine what’s going to be happening now because of this. So stress is going to cause a struggle, but there’s other reasons for children to struggle too. So when we look at, let’s say, an elementary age child, and we look at some areas of weakness. So they typically struggle with impulse control and task engagement. Well, why is that such a struggle?
Sucheta:
Well, thank you, Lindsey, for honing down into some smaller portion of this conversation, because there are so many things we can talk about, but I think particularly therapists like us, we are really trying to get engagement from our children no matter what age, because to me, attention is the gateway of information processing. If the gate is closed, information can’t even enter. So think about defining attention as your ability to not just sustain mental effort to pay attention, but it’s also knowing what to pay attention to and what to pay attention to that matters. So, because failure in paying attention is kids not knowing what to pay attention to in the given moment.
Sucheta:
So it’s not that, and the example I might give is that you send the child to go upstairs and change into PJ’s. The child is about to go upstairs and on the stairs, he sees a piece of Lego. Now, suddenly he is in his toy room looking for the entire box of Legos to see where this Lego piece goes. So now he’s fully attentive. So to accuse that child of not paying attention is really not right. What’s happening is the child is not knowing what to pay attention to.
Lindsey:
I think that’s so important. You hit it on the head. So many times they just don’t pay attention and it’s no, they are paying attention, just not to you, not to what you want them to pay attention to, but they are paying attention. So, it’s not necessarily an attention issue. So this falls under an executive function control.
Sucheta:
Yeah. So this is called executive attention or attention control, as you mentioned. So what needs to happen is these are… So I like to think about a brain that controls and guides the brain. So there’s a boss brain and there’s a worker brain. That’s how I describe it to kids. And the boss brain needs to guide the worker brain to do the right stuff. So the worker brains are fully capable of doing, but they’re just waiting for instructions. And if the boss brain is sleeping, then of course the worker brain looks like they’re wasting time, but they just don’t have instructions.
Sucheta:
So the most critical piece of getting started with therapy, no matter what the exhibition of the symptoms may be or what your line of therapy material may be, or therapeutic goals may be, you need to help children access that opening up the gate to information processing. So I like to call that task specific attention. And if I can introduce one quick framework to think about. So in the brain, we have two systems, a task positive network and task negative network. And the task negative network, that means I don’t have a specific thing to focus on, we call that a default mode network or mind wandering. And often, children, particularly children with ADHD and neurological developmental delays, are shown to have their inability to regulate their attention from stopping the attention from switching into default mode network.
Sucheta:
Now, default mode network, by the way, is very essential and crucial for creativity. However, to me, if the child is not getting things done, then those creative ideas never manifest themselves. Now, the task positive network is a deep dive into doing taxes. You know, how boring, and you get a headache after that, but that kind or like answering an essay question by handwriting the answer, that requires to get off the default mode network and organize your thoughts and sequentially plan and do writing. So writing is a great example of tasks requiring incredible amount of task positive network.
Sucheta:
So when the child is enabled to do that, that’s what is called the difficulty in sustaining engagement or sustaining, or that specific goal oriented-ness to complete tasks.
Lindsey:
Those are really great points. And what it brings to mind is that, as adults, we have already developed the skillset and we probably don’t remember developing them as a young child. And so we don’t really remember the struggle that we may have gone through. So I think it’s really important, as therapists, to be patient with children and realize that they’re struggling because they just haven’t had enough exposure or time to develop these skills and now they need to go back and have more practice at them. And maybe that’s why they don’t catch on so fast. I know sometimes we have these IEP goals and we think that the child should be able to meet them at this time, but they’re not doing the work. And their worker brain is just doing playing and other things, because their boss brain-
Sucheta:
But it’s busy, but it’s not under guidance.
Lindsey:
[inaudible 00:25:08] but their boss brain isn’t the one that’s developed enough to get them to be motivated to do this. So I really think it’s important as therapist that we are aware of those differences and that we just be patient as the child is developing. So that brings me up to, so what strategies can we implement or do you recommend that therapists use to try and help their client redirect their attention and effort to gain that independence? Especially if it’s during a therapy session when we can really target, because we can identify this as being that area of weakness.
Sucheta:
Absolutely. So just so you know, I’m going to send a little handout to Lindsey at the end, and that’s a PDF with lots of links to some videos that I have created and some resources. So stay tuned. And I’m going to start off by establishing this idea. So let me dive deep into the strategy. So I’m going to share some tools that I have. Thank you for giving me some space there, Lindsey. So, first thing I would say is to simply create this and I’m setting the stage for elementary age children, and I’m also using Zoom or Teletherapy for now. And until we switch to in person, some of you may have already done that, but I like to create with these simple cards. I hope you all can see this. Yeah? Okay.
Sucheta:
So this is thumbs up and thumbs down. So this is one of the ways to, you can start by saying to a child, “Do you understand me? And show me.” So, one of the things we want to focus on is working memory, which is, can you hold on to instructions while thinking about the action to take? And you are working on, let’s say, multiple-step processing, multi-step directions. Now, in order to achieve that proficiency, you need to instruct the child. And the instructions themselves may be a little bit a burden on working memory.
Sucheta:
So start off by focusing on some way to get reciprocation. And I would stop engaging verbal reciprocation, but visual reciprocation. So you can send these little images of thumbs up, thumbs down. You can have the child to do it themselves with their thumbs up, thumbs down, or you can have a parent draw it on a chalkboard and the child holds it.
Sucheta:
So what you’re doing is engaging or responding in a nontraditional way, which is yes, do you understand me? Yes. So we don’t want that. Second thing is I love to do this little experiment and you can modify this. So I place, if I’m doing a therapy virtually, I place four boxes at my end. I don’t have them here right now and a little bit, not planned and prepared for this to show you, but you can have four boxes, have a mom or parents have four boxes and you put two M&M’s, four M&M’s, five M&M’s, and seven M&M’s in these four boxes and label each box one, two, three, four.
Sucheta:
And now the child gets to choose which box they want to have M&M’s from. But you get to choose how many M&M’s you will put in each box. So you can have one M&M in box one, two M&Ms in box two, such a thing. Now what you’re doing is interspersing your therapy with a timer. And I love to use this visual timer, as you can see, I hope you can see this. And the idea there is that when the timer goes to 15, you can, and this is too long a session, so that will, maybe if you have a half an hour session, you can say, “Okay, when the timer goes to 30, you get to go open first box. You need to tell me, are you ready?” And so, now what you’re doing from task one until the break, when they get to open the box with M&Ms, they have to wait and engage with you.
Sucheta:
Now, another thing that I like to do to ensure engagement is, is using playing cards. And this is really simple. So you can also ask parents on the other side, if you’re doing this on Zoom, or if the child is in your session, personally, that all you have to have to do is a matching card. So, you know they are engaged in the task that you’re working on. So for example, these are three queens. Yeah. I’m just still trying to figure out where my camera is, and you have three Kings yourself. Now ignore me because I don’t have this. I have spades king, but I don’t know have a spades queen.
Sucheta:
So if I showed this card, the child has to actually show this card back to me. And this is intermittent checking in. This is not task specific. This is called reciprocity, attentional reciprocity. So you want to make sure that the child is engaged in the task. Now, what I have found when you do these kinds of things, you’re kind of setting a sub goal. So there’s a main goal to a therapy and sub goal is to engage in therapy. So the sub goal keeps changing, but the main goal doesn’t change.
Sucheta:
So you may have all the language activities, your social, psychological work that you’re doing, but intersperse those activities with attention goals. So that way you are confirming there’s engagement, you’re confirming the engagement is motivational and conforming that engagement requires a response that tells you that they are paying attention. And last quick strategy I’ll share with you is this strategy of Zoom screen. Sorry, Lindsey, last one.
Sucheta:
So I have these couple of screensavers that I create, and this particular setup didn’t allow us to show a screensaver, but I can say to the child that when you see fox, you’re going to do this, but when you see rabbit, you’re going to do this. So the idea there is to engage the children to look for change in the environment because regulation works, Lindsey, you can come on board back again, thank you for being patient with me. But the idea there is that changing context should require change in behavior. And the context is embedded as a tool and method of self-regulation, but it is not the main goal. And this is one of the ways that you can enforce and ensure that executive attention stays on top of the mind for therapy.
Lindsey:
Those strategies are fantastic. There’s simple behavior strategies that really are targeting that attention. And you’re giving a direction to your boss brain to be on the lookout for these things. So we’re keeping it engaged. So that way the student can then, “Oh, there it is.” And then it’s like a game for them to be like, “When is it going to happen?” So-
Sucheta:
Exactly.
Lindsey:
… it’s really exciting for them. And it’s so simple. Those screensaver, or just the deck of cards, especially if you’ve got someone that likes to fidget with things and you’re noticing them and you hold up your card, they can hold up their card to make sure they’re matching. And just those visual cues are so powerful. So those are fantastic, great strategies to help not just with the behavior component of it, but really teaching that skill and training that boss brain how to behave. I think that’s fantastic. So thank you for sharing those. Those are-
Sucheta:
[inaudible 00:32:17] those attachments, so that people can just use the screensavers that I’ve created. So I’ll share that.
Lindsey:
So everybody, you will be able to access these handouts if you are on the Facebook group, The Therapist Hub. So if you’re not on that, just do a Google search for it, ask to join. It’s open to all therapists. You can be a traditional therapist or a virtual therapist. And then you’ll be able to download and get access to these materials from the file section. So feel free to keep a look out for that as well. Well, Sucheta, thank you so much for joining us today and giving us your expert opinion on some executive function in children and strategies to help them. We really appreciate you joining us on the show today.
Sucheta:
It was my pleasure. It was great talking with you, Lindsey.
Lindsey:
Thank you. And everybody who joined us, thank you so much for sharing and giving those tips. Feel free to share this video after the show. And you want to make sure that we remember we are always working to be kind first and there’s definitely uncertain times. So what can you do to help is show us what your hashtags are. Tell us how you’re being kind first, #bekindfirst, teach that to your kids, teach it to anybody in your therapy sessions as well. And next week we have a fantastic show, again, which is going to be about a wellness center and what that is and how you can make that a part of your school. So stay tuned for more. Thank you so much for joining us today.
