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Ep. 92: Hanna Bogen Novak - Stuck in the Middle No More

October 21, 2019 Sucheta Kamath Season 1 Episode 92
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Ep. 92: Hanna Bogen Novak - Stuck in the Middle No More
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Ep. 92: Hanna Bogen Novak - Stuck in the Middle No More
Oct 21, 2019 Season 1 Episode 92
Sucheta Kamath

In their song “Stuck in the Middle With You,” Scottish folk rock band Stealers Wheel’s lyrics go something like  this –”Yes I’m stuck in the middle with you, And I’m wondering what it is I should do, It’s so hard to keep this smile from my face. Losing control, yeah, I’m all over the place.” These words capture the plight of a young and developing brain that often gets stuck in black and white thinking when caught in the throws of daily challenges, emotional setbacks, and unexpected wrenches. Simple redirection and cajoling is not enough to unhook that brain from the debilitating inflexibility and emotional stickiness.

On this episode, our guest Hanna Bogen Novak, M.S., CCC-SLP, Speech-Language Pathologist, Division Director at the Center For Connection, and co-creator of a curriculum called the Brain Talk Curriculum, will discuss the secrets of self-regulation, how best to understand the metacognitive needs of children with Executive function challenges, and how to provide strategies and resources that can enrich their lives.

About Hanna Bogen Novak, M.S., CCC-SLP
Hanna Bogen Novak, M.S., CCC-SLP is a Speech-Language Pathologist and Social-Cognitive Specialist based in Los Angeles, CA with a primary focus on interventions that support self-regulation, social communication, executive functioning, social-emotional development, and speech and language deficits. Hanna is the owner of Bogen Speech & Language Therapy, The SLP Division Director at The Center for Connection, and the co-creator of The Brain Talk Curriculum. In addition to clinical work, Hanna provides trainings and consultations to schools, therapy teams, and parents to support greater understanding of her focus areas, as well as to provide strategies and resources professionals can use with students.

Websites:

Show Notes Transcript

In their song “Stuck in the Middle With You,” Scottish folk rock band Stealers Wheel’s lyrics go something like  this –”Yes I’m stuck in the middle with you, And I’m wondering what it is I should do, It’s so hard to keep this smile from my face. Losing control, yeah, I’m all over the place.” These words capture the plight of a young and developing brain that often gets stuck in black and white thinking when caught in the throws of daily challenges, emotional setbacks, and unexpected wrenches. Simple redirection and cajoling is not enough to unhook that brain from the debilitating inflexibility and emotional stickiness.

On this episode, our guest Hanna Bogen Novak, M.S., CCC-SLP, Speech-Language Pathologist, Division Director at the Center For Connection, and co-creator of a curriculum called the Brain Talk Curriculum, will discuss the secrets of self-regulation, how best to understand the metacognitive needs of children with Executive function challenges, and how to provide strategies and resources that can enrich their lives.

About Hanna Bogen Novak, M.S., CCC-SLP
Hanna Bogen Novak, M.S., CCC-SLP is a Speech-Language Pathologist and Social-Cognitive Specialist based in Los Angeles, CA with a primary focus on interventions that support self-regulation, social communication, executive functioning, social-emotional development, and speech and language deficits. Hanna is the owner of Bogen Speech & Language Therapy, The SLP Division Director at The Center for Connection, and the co-creator of The Brain Talk Curriculum. In addition to clinical work, Hanna provides trainings and consultations to schools, therapy teams, and parents to support greater understanding of her focus areas, as well as to provide strategies and resources professionals can use with students.

Websites:

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Producer: And welcome back to Full Prefrontal where we are exposing the mysteries of executive function. As always, I’m here with our host, Sucheta Kamath. Good morning, my friend. As usual, so good to be with you. Very much looking forward to today’s conversation.

Sucheta Kamath: Same here, Todd, great to be here with you as well, and I’ve been thinking about our topic of executive function and recently, I did a talk to almost 100 teachers, and in preparation, I had sent them a survey, and the question I asked is, what percentage of your everyday interactions with your students involve executive function? And to my surprise, most of them rated somewhere between 0% to 25%. That just was very shocking to me, and one more question I had asked is, how many of your children struggle with attention? And boom, that number went very high. So, what surprised me about that answer is more importantly, the attitude that one harbors with respect to executive function. Unless the term or official diagnosis is involved, most educators are not comfortable with the term executive function. However, their description of the most problematic learner or most challenging kid in the classroom is the one with executive dysfunction, and that is what’s so exciting about today’s guest.

I am going to be talking to somebody who understands this deeply and brings this into her work. One of the things that is smashing above this guest is she gets it. I have been in the field for 20 years and I have seen a sort of evolution. First, people didn’t even know the term frontal lobes or let alone knowing that there are two of them, not one, and eventually, it has evolved into describing socio-emotional difficulties, and then self-regulation, self-awareness, metacognition, and then we have landed in this zone where we are describing executive function as an umbrella describing lots and lots of skills.

So, today, what we are hoping to do is, of course, understand this better, and who better than a fellow speech and language pathologist? And it’s my total delight to introduce Hanna Bogen Novak. She is a speech and language pathologist and a social cognitive specialist based in Los Angeles, California with primary focus on interventions that support self-regulation, socio-communication, executive functioning, social emotional development, and speech-language deficits.

Hanna is an owner of the Bogen Speech Language Therapy Practice. She has a new position as SLP Division Director at Center For Connection, cofounded by Tina Payne Bryson and she has co-authored a book with Daniel Siegel which is amazing, and Hanna is also the co-creator of a spectacular curriculum. We will talk about that today. It’s called the Brain Talk Curriculum, and in addition to her clinical work, Hanna provides training and consultation to schools, therapy teams, parents to support greater understanding of her focusing areas as well as providing strategies and resources to professionals.

So, welcome, Hanna, to the podcast.

Hanna Novak: Thanks so much. I am really excited to be here.

Sucheta: So, I have been asking this question to a lot of my guests. Since you specialize in executive function, do you mind telling us a little bit about your own executive function skills and do you give yourself an A+? So, start there. What do you describe your skills to be?

Hanna: I have to think about how I would grade myself first, and then I’m going to explain my grade. I would like to think that I would give myself an A. Maybe not though because I have spotless perfect executive function thinking skills. Though I would say what I do really well as I understand what my strengths are and what my challenges are, and I know how to compensate, and I actually think that that’s a really helpful way for us to maybe think about and talk about executive function thinking skills with the kids, because all of us have deficits, all of us have areas that are more difficult, all of us have these relative strengths and relative challenges, and for me, I can tell you also that one of my relative challenges is working memory.

Sucheta: Mine too!

Hanna: Yeah, I think a lot of us. I think a lot of us who specialize in executive functioning know this better, a lot of us have memory working memory challenges, but on the outside, we don’t necessarily appear like we have these huge deficits, and I think it’s because we know how to seek the support that we need, we know how to use the right interventions, we know how to outsource when we get a little overwhelmed with how much stuff or information we are holding onto, and so we look pretty darn functional, and I also admittedly am totally Type A. I love to be in control, so I’m a sucker for all of the more classic, surface level executive functioning strategies, like I love planners and color-coded folders and calendars, like I’m an alarm queen, I email myself reminders of things all the time because I figured out that that actually works for me.

Sucheta: Hanna, I’m sorry to interrupt you, but let’s tell people, my executive function training skills literally come from all the tools and gadgets I know how to use and I have taught myself to use, and not to brag, but I’m really awesome at it.

Hanna: Yeah, oh, totally! I mean, this is why we can go out and teach this stuff to other people because we’ve kind of figured it out but it means that we’ve had to figure out what was hard for us in order to actually make it easier, and I think that’s what’s missing from the interventions that we do with kids, and not even kids, it can be with teens, adults, with whoever you might be working with, but we just don’t spend any time helping them be aware of their own kind of constellation of strengths and challenges, and so it’s really hard for them to know why they would need any strategies, what would I need to initiate a strategy, how to use it, and then how to reflect on it because that’s a big part of figuring out what works. I’ll do something, like a new planner and I look at myself and say, gosh, I didn’t even look at that after the first week. I love putting all my stickers in it and filling it out with different colored pens, but I’ve got to find something that becomes more effective for me.

So, here we go, I’m going to be gentle with myself and give myself an A.

Sucheta: [6:59], Hanna, knowing how –

Hanna: [6:59] from underneath it.

Sucheta: How [7:02] retentive you sound, you should have given yourself A+++ but –

Hanna: Ah, right. Well, then I’ll give myself an A++ with a fantastic stamp on top.

Sucheta: So, one more question about that. You and I, our work is metacognitive in nature and exfoliating the mind so that you discover the true nature of your approach, to me, I think the most fascinating skill is self-devised strategic thinking, and so my question is, is there anything in formal years of learning that you discovered your strategies that you were told or that kind of it became this aha moment for you, and it may not have been, but I’m just curious, did you, as a learner and a thinker at a young age, when did you discover this connection between your abilities and your own thinking about your abilities?

Hanna: That’s a great question! I don’t know that I could pinpoint a moment, but I can tell you about what that transformation maybe looks like. So, in high school, I was in a pretty rigorous academic program, and I remember, I was surrounded by a lot of peers who are, without question, phenomenal test-takers, phenomenal tes-ttakers. I mean, they were really right, they were and they still are, and I definitely, I wasn’t a dull [8:22] in the box, but I also wasn’t maybe sharpest when you compare it to everybody in the program, but I think one of the big differences is that I realized that it wasn’t just about sort of this exceptional underlying intellectual capacity that allows you to be successful or allowed me to be successful. A lot of it was the amount of effort or work, or sort of organization that I have to be able to produce at the end of the day. It was both the process and the output, and the product, and a good friend of mine from high school, we went off to different colleges, and we’ve had our own experiences but we kept in touch for many years, and she talked about the challenges that she faced despite being a really, really intelligent individual, the challenges that she faced just managing the experience of the college and that she was actually flunking out of one of her classes and she said, “It’s so frustrating because I passed, I’ve done all, every assignment, I’ve done all, every exam, but I didn’t show up for certain in-class activities because I didn’t realize they were happening,” and she said, “Now, I’m grappling with this mismatch between what I know and how I performed.”

So, I guess it was this journey of awareness that for me, a lot of the strengths in executive functioning and then my interest in executive functioning came out of realizing that there was a real difference between underlying intellectual capacity and your ability to produce something and produce it well, and a lot of that had to do with the process itself, like did you have the right kind of mental graphic organizers, if you will, to get yourself from point a to point b and could you see both the forest and the trees? I guess it’s a lot about just thought processing and shifting between the big picture and the details, and sometimes, people with really high intellect struggle with that and it’s that ability maybe to use all these different tools that were helpful for me to be successful and actually be able to produce, if you will, and I use that term loosely. I think that we can be talking about production of the assignment itself in college, but also, social success is sort of an outcome or a product of effort put into a particular interaction or conversation, and so yeah, I think my awareness of those strengths came from seeing other people who are also very bright or far brighter than me but who struggled with that process, and ultimately, it impacted the outcome.

Sucheta: Yeah, and I think that’s such a wonderful insight as a clinician because that has probably shaped a lot of your approaches, is to really – almost opening the lid so people can peek into their own selves.

So, let’s jump right into this idea of there’s so many complex ways people talk about executive function. There’s confusion whether is executive function same as self-regulation? Where does attention fit into this? And then, where is your thinking about your thinking? So, tell us from your point of view where you sit and you, just like me, treat people with challenges, what functional framework do you use to describe executive function?

Hanna: Well, I definitely agree with you. I think that there are subtle and sometimes a little more glaring, but often very subtle differences between how we define executive functioning among different professionals, and I think a lot of that has to do with the lens through which you’re looking. So, somebody who is really concerned with their neuroanatomy may have a slightly different lens than somebody who is really focused on day-to-day behavior. Not to say that there isn’t an intersection between those folks, but somebody thinking more about structure might have a slightly different definition than somebody thinking more about behavioral function. I really jive with Russell Barkley’s big model of executive functioning which is a melding or maybe not even so much a melding but almost a dissection of the executive functioning to acknowledge that self-regulation is a critical component of executive functioning. So, in a nutshell, Russell Barkley tends to say executive functioning or executive functions are a set of thinking skills that we use in order to engage in deliberate self-regulated goal-directed behavior which I love because that definition makes sense to parents, it makes sense to teachers, if you work with adolescents or teens. You’re using language that I think is digestible for a wide audience, and I agree with him. He’s right that when we are getting ourselves off of autopilot, suddenly, we have a goal in front of us, the behavior is deliberate and you are regulated from the bottom up, or thinking about overall brain regulation, your survival brain feels regulated, your emotional brain feels regulated, and your thinking brain is now available to engage, that is when we are sort of present and available to engage with our executive function skills. So, that’s kind of the big picture approach that I have for executive functioning.

Sucheta: Yeah, and what I love about, and thank you for sharing that you, too, love Russell Barkley’s theory, and what I appreciate there is if you take any and every skill or when you attach self-directed, so if you say goals, it’s a device by means for me. When you talk about actions, devised by me for me, if you talk about problem-solving, devised by me for me, so if you keep referencing to the self aspect to it, because otherwise, I see a lot of – and tell me if you do too, but in my practice, I see a lot of really bright students and the biggest dilemma the parents or educators have about these bright students is why are they still unsuccessful? Because they have the capacity to problem solve but they never direct that ability towards self. They can solve those problems but they’re not solving their own problems. I’m late, how do I not make myself late? But if you are late, they have great suggestions for you.

Hanna: Right, and I do think that that is the crux of – I don’t want to say where we failed in supporting executive functioning challenges with kids but I think where there is still so much a room for us to grow and develop interventions which is, we have wonderful, what I’m going to call “strategic thinking tools for kids,” right? There are books written about this, there are curricula that are out there, so the tools themselves that we would give to a student in order to produce something, right? Sort of an outcome or an actual product or a paper, whatever it might be, but if they can’t figure out how it applies to them and what their own deficits are and have that reflective review skill in place, then they end up the students who are constantly dependent upon some other person to say, “Ooh, wouldn’t it have been really great if you had used XY and Z tool?” or “Gosh, I wonder why you were so unsuccessful,” and the student can regurgitate why they just can’t initiate in the moment, and one of the things that I love about the Berkley framework is that infusion of self-regulation which, it’s funny, if you ask a group of parents or even a group of teachers or a group of whoever, what do you think when you think of self-regulation? You’ll hear answers like it’s impulse control or it’s anger management, or it’s sort of these very narrow views of what regulation means, and I have had the pleasure of being able to do a lot of collaboration and work with a really brilliant educational therapist by the name of Carrie Lindemuth who is the co-author and cocreator of the Brain Talk Curriculum, and she has thought a lot about self-regulation as it relates to executive function, and she and I really grappled with this, and the way that she describes it is as this multifaceted concept that I think gets at what you are emphasizing a few minutes ago with the need for strategies for executive functioning to be at the end of the day, me-oriented, like I need to be self-directed in my use of them. So, she says self-regulation is about self-regulation or TEAM which is an acronym – I am a lover of acronyms, I think that they are the best –

Sucheta: Talk about that.

Hanna: Yup, this is how, again, like working memory deficits, so acronyms save me. TEAM is broken down like this: T stands for your thoughts and attention, so bigger self-regulation requires regulation of your thoughts and attention. You mentioned it in the intro story that teachers are really concerned about their students’ attention, right? Ding, ding, ding, off the bat, we’ve got an element of self-regulation and bigger executive functioning going on. The E is emotional regulation and I’m going to be really careful about what I’m talking about when I say emotional regulation. I am not saying that we are teaching kids how to control the emotions they feel. That’s a pretty futile effort. I think that there are strategies – mindfulness is a really great way to get more acquainted with your emotions and as mindfulness practice has become more commonplace in the educational setting, more and more, we are talking about emotions and emotional regulation as it relates to learning, but what I’m talking about with emotional regulation is being able to manage how you behave, regulate your action despite what you are feeling, and that is not always easy, it’s not always easy as an adult with relatively decent executive functioning. The A in the acronym is regulating your actions, so this is going to get into impulse inhibition, but it’s not just ‘don’t push the red button’ style of impulse inhibition. We are also talking about how can a student maybe shifted away from something preferred to something less preferred, right? So it’s not just about how do they initiate, it’s also how do they stop or shift ? Modulation gets brought under this bigger umbrella, so are you working with students who are real 0 to 60 kids? Like, they are either hot or cold, but they really struggle to be somewhere in between and kind of match the situational demands? That also falls within this idea of regulating action, and then the — this is what I love about Carrie, like she’s so brilliant because she says that’s where most people stop, TEA, what they’re missing is the M and the M is motivation, regulation of motivation, and how often, as a clinician do you work with a student and you are super motivated for them to have strong executive function skills, right? Like, you really want them to be successful in whatever the endeavor or goal is that you have for them, and then even maybe they think they have for themselves, but at the end of the day, something about motivation just gets in the way. Maybe they were never motivated to do the English paper to begin with or maybe they were but it was way too far into the future. So, bringing that piece in, I think, gives us this much more interesting and useful lens to start to think about executive functioning before we ever get to now, what’s the actual tool that you’re going to use? All these other things have to be regulated first.

Sucheta: Yeah, oh my God, so many things to talk about here. I think one important thing about your message, and it speaks to my heart and I share the same philosophy and principles, we are not doing it to kids. We want the kids to be able to do it to their future goals, so this idea of fixing somebody is totally wrong in aiding somebody to become in charge of their brain. So, my favorite line is, is your brain in charge of you or are you in charge of your brain? And so, this idea about a teacher-directed, parent-directed, or other directed parent regulation is not self-regulation, so let’s not even waste time saying we are helping develop self-regulation, but I am in charge of it. So, if you don’t have the meta process with it, you can’t really succeed.

The second point you really talked about and I would love to see if you can elaborate each individual aspect of this self-regulatory, getting a handle on your team in terms of the metacognition, what would the strategies look like when you are regulating thoughts, when you’re regulating emotions? And, if you can just also help our listeners understand that from a therapeutic point of view, we have to literally isolate each individual strength to polish it, develop it, and then master it before we put it back, and so to speak, into the big picture, but how does that look like in a scene when it’s a dynamic situation, when the kid is expected to manage their thinking, redirect their thoughts, redirect their actions, so what then does the journey look like?

Hanna: So, I’m a big believer that the journey begins always through a metacognitive lens. I think metacognition has really picked up in scene, right? It’s gotten traction lately as a big buzzword which is great because it is an important term as it relates to executive functioning, but just to make sure if I’m on the same page with you and the listeners are on the same page, the basic idea of metacognition is your ability to not only think about your own thinking but have kind of this introspective awareness, the self-awareness of – I’m going to go back to this phrase, your constellation of strengths and challenges, right? We’ll have things that are relative strengths, relative challenges, and by understanding what those are, we begin to understand where we need support, and ideally, my understanding, me myself as potentially the client is consistent with the understanding that somebody who is supporting me also knows how I think and how I function and what my strengths and challenges are.

So, regardless of the age, right, we need to be approaching interventions through a metacognitive lens. If you work with really young students, and I do work with really young kiddos, I do some early intervention work, there is still a place for this kind of self-awareness and bring learning to come into therapy, and certainly, as kids either get older or sort of more developmentally capable, we can do a lot more, we can dive a lot deeper into them understanding themselves, so I’d really start with students hearing the same message that I’m saying in this conversation which is that they have a regulation team, like we start with what does your brain look like? Let’s get sort of a general sense of what’s happening in your brain when you feel an impulse to react versus what’s happening in your brain when you are able to thoughtfully or mindfully respond, and that takes time and we might just focus on that for a while or we might be doing that alongside with other interventions, and as we go through that, we begin to go through this process of a client meeting themselves, like they need to understand what’s going on on their own self-regulation team.

So, if you are thinking specifically about thoughts and attention, a really nice place to start is beginning to have a client acknowledge, when is my attention shifting away from whatever the task is or whatever my goal is, and am I able to come back? And depending on the curriculum or the approach that you pick up, there are a lot out there, you might be framing this in different ways. So, if you’re coming at this from a social communication/social regulation approach and you’re really familiar with the social thinking kind of world of support, you might be using the term “Is my brain in a group?”

Sucheta: Do you mean the we thinkers curriculum?

Hanna: Yeah, so we thinker – there’s other curricula within the social thinking umbrella that would reference the idea of your brain being in the group as well, so that relates to attention, your ability to attend to the salient thing, whether that’s a specific task that you’re doing or whether that’s something important or a social interaction. Other people like to use, there is a neat little book that is kind of its own curriculum called Hunter and His Amazing Remote Control, right? I’ve seen that one get used, and this idea of your brain is kind of like a remote control and we have the ability to control what channel we are on, and I actually really do like that metaphor, I guess, when you’re working with younger kids, like “Oh, gosh, what channel is your brain on right now? Because we are all over here on the Math channel, I wonder what channel your brain is on?” and we are always doing this in a neutral sort of observational way because if you say to a child, “What channel is your brain on, Jackson?” and Jackson says, “Oh, it was on the SpongeBob SquarePants channel,” and you immediately sort of go after him, right? It’s an immediate punitive concept , like “We are supposed to be on the Math channel and you’re not with the group.” Jackson is never going to want to tell you what channel his brain is on again, right? We have now associated this self-awareness with a really punitive outcome when in reality, what I believe the ideal response is like, “Wow, I am so proud. You have figured out what you were thinking about. You figured out what your attention was stuck on. That’s really cool.”

Here’s the thing, right? We are going to borrow some language from like, Ross Green’s collaborative problem-solving script. I love that phrase. Here’s the thing: “We are over here on the math channel. I wonder how we can help your brain shift,” or “I  wonder how we can help you come back to the group plan,” or again, whatever language it is that you’re using therapeutically, I think you can fit that in, and so then the next step with an intervention is, kids have to be able to understand, is the distractor that they are experiencing internal or external, right? Is it something that’s kind of environmentally-driven, like holy cow, the fact that I sit right next to the door in my classroom and every time a group of student walks by, my attention is pulled away and I have such a hard time shifting back, that would be an external distractor, or it could be internal –

Sucheta: Can I quick –

Hanna: Yeah.

Sucheta: Can I quickly ask you about this, so self-awareness is a double-edged sword, isn’t it? So, the more aware you become, the more depressed you’re likely to become to the fact that I suck. I say that with great love for our young learners, so you’re right. I think how do you see, when you’re bringing somebody to discover this about self without feeling discouraged, but also when you begin to exfoliate this or address those in a group setting as everybody’s asked to take temperature of their own selves, what if you’re so way off that it becomes a source of embarrassment rather than inside? And as you know, a lot of our kids who struggle with self-awareness are also emotionally labile; they tend to cry, they tend to lose it easily, so do you have some ideas how to redirect that particular aspect?

Hanna: Well, I think that this is where we as speech and language pathologists really can either borrow from or get actual support from some of our related professional colleagues, like this is where we start to dip into understanding the importance of safe attachment and safe relationships, which may be a therapist or a support person and a student, so that we develop this safety net, right? Like a very real emotional safety net where a child can be vulnerable with us and know that it’s okay to acknowledge that something might be challenging. I think in the process as well as identifying what might be going wrong, we have to be really conscientious that we are also identifying their strengths, and I’m not saying this from the –

Sucheta: Yeah, I love that.

Hanna: [29:03] everybody has something they are good at and everybody – sure, whatever, but I mean, in a very real sense, everybody does have something that they are sort of capable of doing and we all know as therapists, you have to use what a student can do well to facilitate what’s challenging for them. We all kind of know that and I think we have to make that very apparent to students as we are working with them. Everything is challenging and if you’re hearing that language from students, “Everything is hard, I’m not good at anything,” like “I’m  the worst,” you’re hearing that really extreme language, that could be a red flag and if there is a bigger emotional regulation challenge going on or there is a bigger sort of perceptual challenge going on, right? That’s kind of that black or white thinking, it’s the all or nothing language, and all of us can buy into that at different times in our life, so you may need to take a little side trip to really explore, is that like a one time, I was frustrated and I was triggered and I kind of went there as a client, but I’m able to be pulled back and once my thinking brain kind of turns back on, I can challenge what those extreme beliefs are, or is that a place that your mind is getting really stuck? And if you are someone who has the training and expertise, and ability to go down that path for the client to maybe walk with them at their pace and really support that emotional regulation peace along with the maybe attention focus that you have, that’s great, and if not, that’s a really good time to refer or bring in another expertise, because I do think that many of our students who struggle with executive functioning have something going on with anxiety or depression, right? Because they, in many cases, we are talking about a production deficit here, like it’s not that they’re incapable of coming up with a goal or that they have nothing that motivates them, or that they don’t get that they are being unsuccessful, in many cases, we are talking about this population of kids who tend to be chronically unsuccessful and sometimes can tell you exactly what they should have done or would have done. It’s that they are getting hijacked, their thinking brain is getting hijacked by their survival and emotional brain through dysregulation, and they just can’t access the strategies that they have been taught as they’ve been taught strategies.

So, I think we have to really care for the emotional well-being as we explore some of this and be very intentional about helping students identify where their strengths do lie, and that’s across-the-board, that whether [31:41].

Sucheta: Absolutely, and I really like it. Thank you for really roping this in this idea of the dysregulation that you’re going to bump into that is going to give an impression that you’re having a setback or the child is having a setback, but yeah, it is a group of deficits that create these barriers in adjusting and adapting, and flexibly moving on to the mind’s demands. One interesting thing you said about the children when they are stuck, I think often, a lot of times, clinicians come in with an agenda or teachers come in with an agenda as a way to support the child and there is a pushback about the way the support is offered, and the support has not even begun, but there is a resistance to the support, and many clinicians I have spoken to and I trained, and the teachers I train talk about that they suddenly become annoyed, and then their own emotional dysregulation steps in and it creates a miniature havoc.

Hanna: Oh, yeah, dysregulation totally breeds dysregulation, and I said at one point, admittedly, I don’t know how articulately, but I think what I said earlier is, a student ideally needs to have a consistent awareness – actually, the awareness that we as a support person have, and in many cases, that is not where we start, right? So, a student may not even realize how much support they’re getting to be successful. They may think they are being relatively independent, or they may not even realize how independent they could be, right? There’s this mismatch. There is a tool that I love to use when I’m doing trainings through big groups, but also when I’m in a more consultative setting and I’m working with maybe, let’s say a parent meeting between parents and teachers, and a student and it’s called the PAP In Support Scale and PAP stands for Point of Performance which is –

Sucheta: I love that.

Hanna: Yeah, which is a term that references how much support do I need the moment that I am executing a task? That’s what point of performance report would be, and so everybody should picture in your thought bubble a five-point scale, like a basic 5 at the top all the way down to 1, and the idea is we are moving from 1 up to 5 in the intensity of how much support a student needs to be successful, and how we would fill that in, of course, very student-to-student and by age or by developmental level, right? Like an older student might have more access to technological support than, say what a four-year-old would have, but generally speaking, the big tenants are theses: if you are at a 1 or a 2 level support, then that means in this PAP In Support Scale that you yourself are able to somehow manipulate some kind of tool or strategy in your environment in order to be successful. You understand that you are outsourcing to some extent, but you are the one doing it and you remember to do it, and you’re successful doing it. So, a good example of that is when I put an appointment in my own calendar on my phone, and then I add an alert to remind me about it five minutes before it happens. That’s me manipulating my own environment using strategies to be successful, right?

Sucheta: Exactly, so self-identified and self-evaluated, like efficacy of it.

Hanna: Exactly.

Sucheta: Okay, great, great, yeah.

Hanna: Yes, exactly. The minute that you moved from a 2 to a 3, you’re going to cross something that we – when I say we, I’m saying Carrie Lindemuth, the brilliant educational therapist I mentioned before who actually really developed, like figured this scale out, so when she and I talk about this, we say when you cross from 2 to a 3, you have crossed the ‘big divide,’ and the big divide is the difference between I, me and myself are managing the strategies until someone else just got involved. So, when you’re at a level 3, someone else is now supporting me but they’re doing it in this distant way, so if I need my mom to send me a text message when I get home from school in order to remember to let the dog out, that’s a level 3, like my mom has now stepped in but with a little bit of support, I’m able to be successful.

When you move from a 3 to a 4, you have crossed the ‘little divide.’ The little divide means not only is someone else involved, but now, they have to share space with me. So, a 4 is they need to share space with me to get me started on whatever it is I’m doing, and again, you can think about this as isolated task-specific or social interaction-specific. If you’re a therapist who does group therapy or really focuses on social communication, you’re like, look, this doesn’t apply to me. You are wrong because how often are you sort of helping your student initiate the social interaction, and then you’re pulling away, right? Like we are talking about scaffolded support here. So, at a 4, you’re with that child getting them started or the child himself needs support, and by the time you reach a 5, they need someone consistently with them in order to be successful, and I love to use this scale, like I will sit down with it with a group of people, ideally with the student present if it’s appropriate, and we really talk about like, “Gosh, what are we seeing?” Everybody has a different sense of what’s going on and we need to figure out where we are starting, and it’s okay if a student needs level 5 support, like there’s nothing inherently wrong with level 5, and in fact, all of us as functional adults need level 5 support sometimes. When we do something totally new, like if I had to change the air filter in my car, I would need level 5 support. I would need somebody with me sharing space with me, walking me through it the entire time. Does that mean I would need level 5 support forever? Probably not but I definitely would at first, and that’s okay.

The problem lies in a moment where a child is saying, “I’m totally cool with level 5 support across the board,” and the people supporting them say, “I hear you and we cannot offer you level 5 support,” so that’s one issue. The other is, if a child thinks that they’re way down at a 1 or a 2 and if someone else is leasing out their frontal lobes to be the child’s executive functioning, right? Like they don’t even realize that they are actually providing a much higher level of support and we now need to grapple with okay, where are we starting and where are we going? And so, we say to students, independence does not come from being at a 1 for everything or a 0, right? “I don’t even need strategies, I just remember everything.” That is not the goal. The goal is that you know what amount of support you need and you effectively access it. That is self-efficacy. That is effective. It’s definitely functioning and it is metacognition. It’s like everything and it’s just the starting point.

Now, we are ready to actually intermediate, right? And so, my philosophy is it’s all about backing up. It’s about saying, we’ve got a really nice house that we are building but we are doing it with a really crummy foundation, and so we’ve got to back up if you want this house to stand around for 100 years.

Sucheta: Amazing! You have addressed so many important questions and concerns I often have when people zealously support kids who are struggling with one outcome in mind which is let this child demonstrate his true potential, and I’ve always argued that supported true potential isn’t really true potential because somebody else is doing the job of the frontal lobes while the child is doing the job of the worker brain, the slogger brain.

So, before we come to an end, I mean, I could talk to you for hours, as we come to an end, I was thinking about, I bet you are consumed with the thought of how poorly executive function is understood. My podcast is a simple measure to get people to understand the wide applicability and universality of these skills, and you and I were talking about this yesterday as well. So, why do you wish that more people knew about executive function and why is it so critical for us to become executive function savvy as a society?

Hanna: You know, I don’t know if it’s so much of the specific content that I wish they knew, but it I’ll do what I constantly do, just backing up a little which is to say I wish that there was an across-the-board acceptance of the fact that understanding what’s going on in our brains when we have an impulse to react versus the ability to make a plan or go through this process of mindfully responding, I wish that it was understood that that is important for every single person in their development. No one is harmed by knowing more about their brain – at all, like there’s not a downside to that. There is really only, in my opinion, an upside and a potential, and I think just sort of narrowing the lens and looking at the educational domain for a moment, I do think that we are seeing an awakening to the importance of supporting self-regulation executive functioning in the learning sphere. I hear it more and more. It’s the reason that I have a whole element of my job which is getting to work with teachers to do trainings and coaching and consultation, to really build their awareness. I think where the question is starting to shift is not should we care about the stuff? It’s like, how do we begin to infuse this into an already packed curriculum, right? And how do we support the development of these skills for all students so that everybody benefits and the students who really need the additional support now have a leg up, and I think that there’s a lot of different ways that you can do that. The curriculum that Carrie and I co-created is one of those, right? It’s certainly not the only thing that’s out there, but what we saw was a need for people to have language to be able to describe what’s going on in your brain during the process of neuroconnectivity, right? The conversation of neural integration that allows you to move from I am just reacting to the world around me, like I feel and so I react, to a much more kind of developed mature executive function savvy ability, to I am acknowledging that I feel an impulse, I am able to pause that impulse. You have to insert the pause, and then I can engage in this conversation between my feeling brain and my thinking brain to say okay, here’s what I feel right now inside of the now bubble, and here’s what I want in the future, right? This is a goal that I have, and then I’m going to shift, I’m going to use this beautiful capacity I have as a human being to use mental time travel, right? In the moment, I can think into the future about a goal I want and then I can shift into the past and really say, what do I know from the past in order to help me make a plan for right now? And brains have [43:01] all of this down, we create characters for the amygdala and the basal pleasure of a word circuit, and the kind of prefrontal cortex, also the bigger idea of like the critical thinking aspects of the brain and the hippocampus, right? These major players that tend to be involved in the process of mindful responding. In order to create a narrative that makes sense, I would say for kids, but I actually think that most adults don’t know the stuff.

Sucheta: Everybody needs it.

Hanna: Right? [43:29], and we are simplifying it in a way so that a kid can say, instead of expecting a child to be able to say, “Excuse me, grown up, my amygdala appears to be perceiving a threat. I don’t know whether it’s real or I kind of imagine, but I am getting a [43:46] while I feel this extreme impulse to –” you pick: fight, flight, again, like “I’m  having a [43:51] I’m about to react,” like that’s an unreasonable expectation to have, I think, for someone who doesn’t just breathe this stuff in all day, but a kid could totally learn about the amygdala in a developmentally appropriate way. We call it a “myg” and it looks like a little almond-shaped creature, right? And sort of personify at and be able to say, “I’m having a myg moment,” and that is so powerful, right? This ability to put language to the abstract experience of engaging executive functioning, when you feel an impulse, that is power. That is a tool in and of itself, right? Like the awareness becomes a tool that everything else depends on, and I guess, so to really answer your question, I wish the people both got on board with we have to teach kids about their brains, like this is just as important as a basic math curriculum or a basic literacy curriculum, because our ability to learn everything else depends upon our ability to be regulated, and then we have a sort of an emphasis on doing it in a developmentally appropriate way, which we hope brains have it for a lot of kids, but like I said, there’s lots of programs and strategies out there that do this, and to be consistent in really supporting kids along their journey of developing executive functioning, because it’s going to be a while, right? It takes a while for all of the structures to really mature.

Sucheta: Well, I think you could not have – your passion comes through so beautiful and you could not have explained this more eloquently then you just did. I really hope that we don’t have – separate teaching  self-regulation do not need to be two separate things. They need to be amashed and we don’t need to pick kids out because they are failing, and then intervene. I think if I’m giving a chance to be on my soapbox, that’s exactly why I developed EXQ which is a curriculum designed to directly provide intervention to the children, so that they can develop understanding of self and they can self-redirect using self-devised strategic thinking, so not just knowing who I am, but how do I take this knowledge and now become a better version of myself? But I’m not becoming a better version of myself because I lack something, but this is the journey of life. This is what good people of this earth do.

Hanna: Absolutely. Oh, my gosh, I love it.

Sucheta: And one idea that I have, my metacognitive training is called META which is Mindful Examination of Thinking and Awareness and it has this very complex system, but one thing that you have talked about repeatedly which is self-awareness is impaired for those who need the help with self-awareness because what their self-appraisal is for, then what if you give yourself hundreds of points and call it a day? So, part of this gingerly providing some nudge that say, what if you’re wrong? We need to figure out some amazing behavioral and psychological means to reach out to kids who are not afraid to say, “Yeah, I’m not that great.” That should be our mission as we educate and prepare our children.

So, Hanna, you are brilliant. Thank you so much for coming on the podcast to share your wisdom, and keep up with amazing work that you are doing and I can’t wait to connect again.

Hanna: Thank you so much. It’s been a lot of fun.

Producer: Alright, that’s all the time we have for today and if you’re like me, I took an awful lot of notes, so if you know of someone who might benefit from listening to today’s conversation, and we would be most grateful if you would kindly forward it to them, so on behalf of our host Sucheta Kamath, today’s guest, Hanna Bogen Novak on Cerebral Matters, thanks for listening today and we look forward to seeing you again right here next week on Full PreFrontal.