Full PreFrontal

Ep. 192: Arthur L. Robin, Ph.D. - Parent-Teen Communication

November 11, 2022 Sucheta Kamath Season 1 Episode 192
Full PreFrontal
Ep. 192: Arthur L. Robin, Ph.D. - Parent-Teen Communication
Show Notes Transcript

Raising children, which was always hard, has become harder; not because of the work that goes into changing diapers, preparing meals, taking kids to soccer or piano, or all the laundry that one has to do; but because not everyone is good with children. On top of that, in modern times and in modern living, parents’ abilities to control what children have access to has fundamentally changed, requiring parents to deal with difficult information and ongoing conflict in motives between what the parents think is appropriate versus what children desire. All this amplifies the ongoing tension and erodes relationships between contemporary parents and their teens while the complex world never ceases to be complex.

On this episode, ADHD and parent-teen relationships expert, author, and clinical psychologist, Dr. Arthur Robin, discusses how to build better communication, problem solving, and realistic thinking in interpersonal relationships. A key ingredient to Executive Function development and mastery is effective interpersonal communication and self-initiated problems solving and hence, parents play a vital role in facilitating that for their children.

About Arthur L. Robin, Ph.D.
Since receiving a Clinical Psychology Ph.D. from the State University of New York at Stony Brook in New York in 1975, Dr. Arthur Robin’s 47 year career has included clinical practice, teaching, 37 years as a pediatric psychologist at Children’s of Michigan and Wayne State University School of Medicine, research, and writing.  Specializing in parent-teen relationships, ADHD in adolescents and adults, and eating disorders in adolescents, he has authored/ coauthored five book and many chapters and journal articles and spoken often throughout the United States and elsewhere on these topics.  Common across all of his books is Dr. Robin’s emphasis on building better communication, problem solving, and realistic thinking in interpersonal relationships.  A licensed psychologist in Michigan, at present Dr. Robin maintains a small clinical practice evaluating and treating adolescents and adults with ADHD and related disorders at Dennis, Moye, Branstetter and Associates in Bloomfield Hills, Michigan.

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About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

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Sucheta Kamath: Welcome back to Full PreFrontal exposing the mysteries of executive function. I'm your host Sucheta Kamath. And we keep these conversations about executive function fresh. And to the point, and most importantly, relevant to your everyday application. One of the topics that interests me deeply is communication. As you all know, I'm a speech and language pathologist. I've specialized in impaired communication, but to me, you know, communication, whether it's verbal communication, nonverbal communication, interpersonal, and written communication, I'm very, very interested in. And the second topic that's dear to my heart is parenting children, and how to raise child self reliant children. So what comes to mind is raising raising children is really hard not because of the work that goes into changing diapers or preparing meals, or taking children to soccer or piano or even the whole lot of laundry that you have to do. But Parenting is hard. Because some people are not good with little people, they find it very intimidating to talk to children or to instruct them or raise them or with kind of boundaries and instructions and support. Sometimes parents tend to get very permissive, very accommodating, sometimes they get very authoritative. Sometimes they just don't know what how to yield cooperation. So with that in mind, I have been so fortunate to discover the expertise of our guest today. So it's a great privilege and honor to introduce today's guest. Since receiving a clinical psychology PhD from State University of New York at Stony Brook in New York in 1975. Dr. Arthur Robin has a sprawling career 47 years which has included clinical practice teaching 37 years as a pediatric psychologist at Children's Hospital in Michigan, and Wayne State University School of Medicine research and writing, specializing in parent teen relationships, ADHD in adolescents and adults and eating disorders in adolescence. He has authored and co authored five books, many chapters and journal articles and spoken often throughout the United States and elsewhere on this topic, one of the topics that interests me deeply is his approach to conflict resolution and building coalitions and teaching parents effective strategies to manage children who may be dysregulated, such as ADHD. So it's a great pleasure to have you on the show today, Arthur, how are you?

Arthur L. Robin, Ph.D.: Very good. Thank you. And I appreciate the opportunity to be on your show. Thank you very much.

Sucheta Kamath: Well, the audience is really up for a treat because of your expertise in particularly the practical advice you're going to share. But before I begin, begin, I thought I would ask this question, and you as a clinical psychologist with deep knowledge of executive function will be very comfortable answering is this podcast is about executive function, which entails this goal directed persistence, adaptive flexibility, managing focus, and emotions, and above all, really exhibiting this problem solving attitude. So you as a child, when you were a teenager, now, what kind of child or a teenager were you? And what was your self awareness like and your self management skills were like at that age?

Arthur L. Robin, Ph.D.: I think as a child and teenager, I had pretty good executive functions. But I think what I struggled with what would have been the self-restraint, trying to control the impulse to not do things like interrupt others, or speak when I needed to be quiet, or wait long enough, be patient. So I needed to and that, that I struggled with as a child, I still struggle with as an adult, because there's consistency across the lifespan with executive functions and those who struggle with. So as a child and teenager, I also struggled a little bit with working memory. It took a long time to memorize things. I had to learn a variety of strategies to do that. So self-restraint, and working memory would be two executive functions. That as an adult child and adolescent I recall struggling with And those troubles did stay with me across the lifespan.

Sucheta Kamath: That's so interesting, you know, as I'm listening to you, I also I'm reminded of my executive function, strengths and challenges. I always had phenomenal organization incredible goal directed persistence, you know, putting effort and relentless effort if needed, but I do, I do remember myself being impatient interruptive and add Indian culture to the to the mix, and you know, everybody interrupts everybody, so my interruption wouldn't stand out so much. But I think when I came to from India to us, definitely I looked way interruptive than most people in conversation, particularly, and very eager to kind of already think about what people are thinking and kind of, you know, second guess and move forward. So as we talk about our own abilities and skills, let's dive into your clinical expertise. As a researcher as a practitioner, can you set the tone for what is ADHD and people sometimes referred to add, and often I find one problematic presentation. In, in medical community that pediatricians, for example, if they diagnose, they talk about the attention piece, but they never talk about executive function. So can you share a little bit with with us the definition and its relationship to executive function?

Arthur L. Robin, Ph.D.: Well, to start, the classic definition, which isn't sufficient anymore, would be that ADHD is the disorder of attention, impulsivity, and hyperactivity. But that definition, again, doesn't really cover the waterfront or the concept. And so researchers and clinicians have come to a definition which goes something like this, that ADHD is a neurobiological disorder of self regulation, self regulation of the mind, of behavior, of emotions, and for some people of activity level. And if a person is having trouble self regulating himself, this gets in the way of all aspects of life, during childhood, adolescence, and it continues for a good 70 to 80% of individuals into adulthood. Now, where executive functions fit in, is first, we need a definition of executive functions. A broad based definition would be the executive functions, or processes of the brain that guide all of our thoughts, feelings and actions that are central to good self regulation. So if ADHD represents a disorder of self regulation, and you use the few minutes ago, the word dysregulation, children, adolescents and adults who have ADHD, their behaviors, thoughts, emotions, and actions are often dysregulated. So executive functions are processes that guide all of our behaviors, feelings and actions, then the executive functions are dysregulated, or not working efficiently, or in an organized manner in ADHD. Now, a simple way to understand this is the metaphor that Dr. Tom Brown who you've actually had on your podcast, and came up with the metaphor of the conductor of an orchestra, and the conductor picks the musicians selects the music rehearsals, them. And then during the concert guides, the musicians tells them guys to when to start, when to start, which musicians instructions to play. And if he picked high quality musicians, and guided them properly, the music sounds terrific. If not, it may not. So if you think of the brain's executive functions, like the conductors of the orchestra, the brain conducts our day to day moment to moment actions. And if the conductor isn't doing a good job, or didn't pick quality musicians, then the music doesn't sound of harmonious. And so in ADHD, it's as if the conductor namely the executive functions are not in synchrony are not working well. And so the brains music isn't coming out well, and or the specific of components, like the musicians aren't highly skilled who aren't playing correctly. So I often describe use Tom Brown's metaphor and talking about that. I could talk about specific executive functions if you like, or we could pause it depends what we're what you want to do next.

Sucheta Kamath: Well, I would love to put a pin in here. And if I may comment so that you can proceed further is one thing that I really love that you pointed out for all of us that, that when you use regulation as a framework, and not just attention deficit, I think it is. hyper focus and under focus, both can be taken into consideration. Because this is a common argument, right? That my child loves to play video games, and I can't peel him off, or my child loves to, when she's doing a particular activity, I can't peel her off. But then when it comes down to doing something that he or she doesn't, like, we can't even get any attention, right. So that one aspect, you talked about regulation. But the second piece also I love is this emotional dysregulation, which is crying easily or having incredible fit of anger for a small trigger, and then having apathy or generally having met feeling for something that you'd be concerned about. So I was wondering if you could maybe just talk a little bit about this, I like to call it as a Goldilocks effect, effect, you know, not being just right. So either you're too engaged, or you're not engaged enough, you're too reactive and not calm, or hyper indifferent. So maybe you can talk a little bit about why such presentation comes? And how does that influence people's interactions with our children's or adolescents or adults interactions with those who don't have this dysregulation problem?

Arthur L. Robin, Ph.D.: Well, I think part of what you're saying, and you could tell me if this is addressing it, is which executive functions are off, those are on pace. I think the ADHD brain craves high stimulation. And so activities like video games like texting, like, like certain types of movies, and music, they provide immediate and high stimulation. And so the ADHD brain that craves this kind of stimulation, attaches to those very quickly, and doesn't get satiated on them can do that for long, long periods of time. Other activities, which don't provide high and immediate stimulation, like chores, like homework, like turning off the video games and coming to the dinner table, like helping to clear out the basement or the garage. Those kinds of things don't provide that stimulation. And so the youngsters as well as the adults with ADHD, I see this in the patients I work with across the lifespan, don't engage in those kinds of activities. And so the example you gave, which I was thinking of giving anyway, of mom telling Johnny or Sally, turn off the video games and come either to start your homework will come down for dinner, the high stimulation of the video games is compared to the low stimulation of coming down to dinner. The low stimulation activity of coming down to dinner is not going to compete with the high stimulation of the video games, especially for the person with ADHD who crave stimulation. That's also true for people who don't have an ADHD type brain. But it's even more true for the person with ADHD. So I think what you're calling the Goldilocks effect has to do with different types of brains that crave, highly stimulating immediately gratification are immediately gratifying activities, selecting those activities and being hooked on them and having a hard time breaking away for them. And then also gets to there are genetic, the base differences in how the brains are for folks with challenges like ADHD, which make them more prone to getting stuck on such activities. So, to me, that's how I understand and how I explained that to parents.

Sucheta Kamath: Brilliant. I think it speaks to my heart. And now if we can take a minute to connect executive function and communication. So one of the biggest challenge, which we started kicked off this episode with is interpret personal relationships. So developmental disorders such as ADHD particularly has a significant impact in how you relate to people and that parent child relationships or yielding cooperation or even expressing warmth and compassion or responding to somebody's requests. Maybe there may be a gap, I'll give you a quick story of a family that I worked with the father himself had ADHD I think mother also had inattentive type ADHD, and they had this firstborn with significant ADHD challenge. And a situation arose that the fall it was a heavy pouring, fall day in Atlanta and dad was driving the son to school, he was already late. So he was half dressed in a shirt untucked, you know, one shoe on socks on, and a bowl of yogurt with granola was in his lap, because the father said, we are getting in the car, and we're driving to school and you can eat in the car, and some conflict happened. And of course, dad pulled over and threw the kid, this 14 year old out of the car, and told him to walk to school because he got so mad. So dad's impulsivity made met with this teens inappropriate comment. And instead of showing gratefulness to dad for driving and apologizing for causing delay. So this kind of head butting is very common, at least in my practice, or the bane of a lot of families existence. So I was wondering if we can start with what is the relationship between the executive function challenge and its impact on interpersonal communication?

Arthur L. Robin, Ph.D.: Okay. Any communication between parent and teen or any age child, like the interaction that you described, you need you have a speaker, let's just stick with a dad. For simplicity, like the one you mentioned, you have a speaker and you have a listener, the speaker needs to send for good communication between a speaker and a listener in your example, the speaker was a parent and the listener was a teen, the speaker needs to send a message that is clear and understandable. And the listener needs to be paying attention enough to get that message needs to be able to decode and understand the message. And then they need to change roles. So that then the listener becomes the speaker and sends a message back. And it's clear, and the new listener now can understand that, okay. Now, for each of those people to carry out their roles, they are when carrying out their roles, that they are using executive functions, they cannot by definition, brain processes that guide all of our behavior by definition, or guiding the behavior of the speaker and the listener. So, executive functions, by definition have to guide speakers and listeners and communication interchanges. So any difficulties that either a parent or a child have, or any strengths that a parent or a child have, because we don't want to just focus on difficulties. We want to be strength base to strengths or difficulties, or degree of strengths or degree of difficulties that the parent and child have, including the diet you mentioned, an executive functions will impact what happens when they communicate with each other. That's for starters, how I see the relationship is so as a psychologist, when I do communication training, which is one of the cornerstones of behavioral family therapy, that I do a lot with parents and teenagers, by definition, I am teaching executive functions every time I teach anything about communication training. So when the dad said, I don't know what his words for get out of the car and walk. And you mentioned impulsive, who was showing weakness and self restraint. Okay, yeah, he was showing, perhaps weakness and working memory if he had Add memory about what are different parenting strategies that you could be using. He might have been showing weakness in getting organized activated. As to thinking of a parenting strategy. There were at least three or four executive functions that we may see as in possibly being in deficit at that moment, even if they're not in deficit in the long range. When the steps that led to the teen there was a 14 year old, the teen getting in the car would you say one sock one shoe. And the

Sucheta Kamath: Yogurt and granola in a real bowl, all late.

Arthur L. Robin, Ph.D.: Right. All those things, they're late, lost, and unprepared, one of my favorite books for parents, brilliant. All those things that led up to the teenager being speak to the teenager's weakness, and about an all of the six executive functions that are on Dr. Tom Brown's list of core executive functions and deficit for people for ADHD played into that. And the fact that that 10 had those weakness led to reciprocal negative reactions from his dad. So one person's weaknesses executive function triggered in the communication into change, reciprocal reactions from the other person. So executive functions are intrinsic to any communication interaction. And since genetics are involved, even if the dad didn't have a clinical diagnosis, maybe this youngster did have a clinical diagnosis of ADHD or something the dad may not have, he might still have subclinical weaknesses in similar executive functions, or so when one member of the family has a weakness in executive functions. Others do too, because the genetics, again, even if the others don't have a clinical diagnosis. So it's impossible to avoid strengths and weaknesses, degree of skill and executive functions, when anybody is communicating with anybody else. So I see them as completely overlapping. Any intervention designed to change communication, or any intervention designed to change executive functions, you change the one, you're changing the other or unavoidably, even if you don't plan it that way. So for many of the years of my career, in the 70s, and 80s, and even the early 90s, but certainly the 70s and 80s, I was not familiar with the executive function framework, but I was working with communication and problem solving. I didn't realize I was changing the executive functions, but I was because I was changing communication and problem solving between parents and teens. That's a long answer to your question.

Sucheta Kamath: Well, it's so onpoint. And I think I relate to it myself, because when I started my career, you know, 25-30 years now, executive function was not even a term we used a right hemisphere dysfunction. But being a communication expert, as a speech and language pathologist, understanding, you know, listener stands, understanding, a conversational repair, understanding how to read between the lines, those are the skills we taught people to have effective relationships, because even if you run into infractions, because of inattention, or lack of working memory, or in flexibility, if you turn around and come back and say I'm sorry, my bad, I was a little stubborn there, or I was rigid there, people are likely to forgive you. But another thing that coexists with executive dysfunction that impacts communication. I was wondering, what are your thoughts about this lack of self awareness, and lack of ability to understand the minds of others? So kind of what do other What are other people thinking? What are they thinking about my thinking? Am I How am I presenting to them? So when you fail to think about or take those things into consideration, a lot of these communication problems intensify further. And I would love to hear your point of view on that.

Arthur L. Robin, Ph.D.: Well, I agree with you. And I, I look at that as to a great extent, certainly too, as well, to a great extent that that is a teachable deficit is that you can help parents and teenagers remediate that too, and that may follow from chronic deficits in executive functions. Particularly? Well, first of all, if we take children and adolescents, adolescents in particular, the developmental tasks of adolescence are very self focused. Okay? So it's relatively common, that adolescents are not as empathetic as people, other stages of life, like adulthood, so that I find almost all the adults most a lot of the adolescents I work with, have a hard time understanding other people's point of view, developmentally...

Sucheta Kamath: And don't you know some people who are stuck in that adolescent stage, even in their late adulthood.

Arthur L. Robin, Ph.D.: That's, that's true. 

Sucheta Kamath: They continue to be self focused. Yeah, sorry, I didn't mean to interrupt you. But yeah.

Arthur L. Robin, Ph.D.: But as they move into young adulthood, adulthood, many folks develop a much better sense of empathy, and understanding of other people's point of view. And those who don't, can be helped up to a point to learn that by life experiences. But they're also great individual differences. And  how well people are able to attend, be empathetic and understand other people's differences. So I've looked at that one, from the point of view of individual differences to assessing that political and three, trying to help people increase their sense of empathy and understanding of were other people's points of view.

Sucheta Kamath: So I think this makes really good sense for us to now move on to the challenges, you know, that are so they have even accent been accentuated in the contemporary climate, so to speak, you know, there's a researcher James Garbarino who talks about social toxins, you know, he talks about, that the modern parents have to navigate a lot of complex challenges, including, you know, the parent, or the the notion of parents having control over their children's lives by the information they choose to expose them to, is also gone out of our hands now, simply by, you know, children having access to the internet, you know, having, the more increased socio economic inequalities become very evident which of parents can protect the kids from in the silo that they may choose to live in, and also, this very broad visual presentation of the line between childhood and adolescence and young adulthood is blurry, so that what is appropriate, what is not appropriate that parents may have less sway than their peers and social media might? So I would love to know, from your point of view, how do you see these common problems of raising teens in these complex times?

Arthur L. Robin, Ph.D.: It is much more difficult for parents today than 20, 30, 40 years ago, to raise children. And I mean, what I see practically from these challenges is that parents have a lot less control over teens today. And a lot earlier age, because as you said, of all the factors that you mentioned. So parents need to form strong bonds of affection and strong relationships, and keep them strong at an early age. And also, I teach parents, with teenagers, if I'm lucky enough to be working with them, when the youngsters are just moving into adolescence. But I do this at any age in adolescence, a clear difference between negotiable and non negotiable issues. Because with all the challenges you mentioned, parents, teenagers have, as you well know, a huge sense of entitlement, because society teaches that people can pick their own families today. That too, and, and there's a sense of teens are entitled, ought to be entitled to anything and everything. And so they come to expect the world, and they're entitled to everything and anything. And they because they see that that's an attitude in society. And so unless the parents have brought them up, to have a different kind of attitude or approach, they expect that of their parents. And so parents really need at the outset of adolescence to have this clear distinction between what's negotiable and what's not negotiable, so that they could hold on to what's not negotiable, and be able to still impose their standards for morality, and for appropriate conduct on those things that are non negotiable. What do I mean by non negotiable for one, it's a should be a relatively short list. And it should be basic rules for living in a civilized family and society. The ones that we might think are obvious, but today are not so obvious. No violence at home may be only for self defense, which you do is violence. No really nasty, bitter language, at home, or perhaps not in society, no drugs or alcohol. Each family has to decide about things like smoking, hopefully, no vaping. Like all families might need to decide about that. Like, you will do your homework, although I teach families, they could have pairs and negotiables are non negotiables, that you will do your homeworks and are negotiable, the conditions when where can you listen to music, and so on those in negotiables, when they get old enough, having a curfew, but the conditions for curfew, when you could say out later for a special event and so on, but having no more than seven or eight at most 10, non negotiables. But again, if these aren't established by age 12, or 13, these days, parents won't be able to establish them. And then I teach them to use whatever they can, as consequences, both positive and negative for preaching nice. It's hard to do this, if parents haven't been consistent. When the children are younger. If I'm working with the children who are younger, and their parents, and they've had difficulties, I'm teaching them to use discipline with love and behavior management to manage that. Now, this side of what I've done in my career connects with co authoring with Dr. Russell Barkley several books on defiant teens, which is one of the things that I've done, but basically, helping parents make a distinction between negotiables and non negotiables. This doesn't completely answer your question about the challenges that parents have. They have lots and lots of challenges. But this is part of as a therapist, how I and some other psychologists have tried to set parents up at the outset of adolescence, because adolescence is the time that these challenges of modern society pose the greatest risk for families of you know, for success. Anyway, I'll pause here.

Sucheta Kamath: No, I think it's such a great point you're seeing I just love the simple framework of negotiable and non negotiables. I often tell my parents, the parents that I work with, you know, like my last name is Kamath. So these are Kamath rules. I don't have to explain to you how and why I came up with this. But this is the camera rule and that's what we follow. This is the family ethos. This is who we are. This is what we do, including one of my biggest pet peeves is when we travel. I always have asked my children to dress well. It's just something I grew up with. It's just you elevate the environment of travel, you get better treatment, and you also have put that effort prior to leaving for a long trip because So, anyway, it just takes more effort to be well prepared or looking, well prepared. I'll give you an example. And I would be very curious to see what your thought would be. So of course, you know, families begin to seek help when things get a little bit out of hand. And by then, I think a lot of rules become too annoying to the team, or because they have not been raised with those teams. One family I worked with once the mother came and said, I don't know what to do. Sucheta, my son shows up completely naked to the kitchen, early in the morning. And, and so for that to happen at 16, what was happening for last 16 years is the biggest question, right? And so somewhere, I mean, how to behave in public spaces. So not even having the distinction between public versus private space was that non negotiable thing. So somewhere even at 14, something like that must have happened. So I'm just curious that people don't take take small infraction seriously, until they become big infractions. One of the stories in your book, or you write about this, a child with the parents have disagreement about how to approach but the child has, is, you know, jumping out of the window at night and hanging out with friends, bringing girls to his room during lunch hour, and then even gets gets in trouble with police because he gets pulled over. But the parents wake up to start thinking about what to do now, after he gets pulled over by the cop. So it's an interesting phenomenon. What kind of threshold you recommend parents to have where you, you know, kind of say, Oh, my goodness, I need to get a riegn on this situation rather than you know, going too far. And then compelled because now there's some legal ramifications and things like that.

Arthur L. Robin, Ph.D.: So what parents should do if they're in that situation at age 16, and the youngsters coming into kitchen, nude Yeah, and no, I'm already there.

Sucheta Kamath: What I'm saying people begin to consider reconsider their any strategic approach with there's no strategy only when things become really, really difficult. And by then to meet so late, because the kids kids have gotten used to you not having any rules. And so I'm just saying how, so there's one is crisis management, which is like riegning things back in. But how do you reestablish your authority over children who kind of start challenging you because you have never set the set any boundaries earlier on?

Arthur L. Robin, Ph.D.: You have to start with, you can't re-establish it all at once. Yeah. So you have to start with one thing at a time. In a situation like that. I would be having the having the mom start probably, actually modesty and clothing. Probably I don't know that family situation. But it might be easier to deal with modesty and clothing than all the other things that teen might be doing. If that's what the mom is noticing. My guess is there's a whole bunch of more intense things that the teen is also doing, which will be much harder for the mom to reestablish authority over. So you have to start who I would have loved the family. Well, in case like that, I would be working a little bit with the mom and the teen separately before we get the family together. The more dire the situation, the more likely I am as a therapist, to work with parents and teens, separately and concurrently before I put them together because I don't want explosions until I know what I'm dealing with. And I come up with a hierarchy, from least to most provocative of the challenges that that the teenager is giving to the family, in terms of least the most provocative, and then I help come up with trying to reestablish parental authority on the least provocative ones first, going up the hierarchy to the more provocative ones, and I'd come up with some of positives. See if I could come up with any positives, incentives that could be added, as well as things that need to be taken away, but first have to come to understand how that came to be. And what I asked myself, this is when another component of behavioral family therapy comes into play. A, which we haven't mentioned, which is the strategic structural family therapy component, I need you to understand what is the function of the problem behavior in the family system. So their skills, communication skills and problem solving skills, his belief systems, extreme beliefs, and his structure and function, when a 16 year old shows up nude in the kitchen, I'm have to know, or figure out what's the function of the behavior in the system? Because it's a provocative behavior. And I can't simply ask what is the function of the behavior in the system, I figure out functions and family structure for meeting with family members together and an apart over several meetings, sometimes it takes more than several, if the function is to call attention to sexuality, that could be one function is the function to make some statement about some provocative statement. Once I know what the function is in the system, I then have to decide am I going to change that function in the system? Or am I going to find a less provocative way less maladaptive way for that family to carry out that function? Okay.

Sucheta Kamath: Perfect sense.

Arthur L. Robin, Ph.D.: And so examples of functions that might be going on, and I have no idea what they were in the system. Oftentimes, functions that were teenagers are, the teenagers want more distance from their parents, and the parents are trying to keep more closeness to the teenagers, but the teenagers rebel or do outlandish things, to put more distance between themselves and the parents. So that is an antagonistic function. Teenagers want to individuate, parents don't want to let them do that. And if I find that out to be the function, I try to find a less a more adaptive, less problematic way for them to accomplish that function. autonomy. Right. A second thing is if in a three parent and a two parent family, with one or more youngsters, often fixing a bad marriage, a teenager stuck in the middle and trying to keep the parents bad marriage or bad relationship together is another common function I encounter. If I figure that out over time, then I need to figure out how to get the teenager out of the middle of the parents marriage and get the parents their own help. And, and that might be a number of different strategic moves that I would need to take as as a family therapist, and they'll be different for each family. It won't simply be doing communication, training. So that's the second possible function. There are other functions too. Sometimes the function is to see the teenager trying to call attention to this family stinks. We have problems, and we as a family need help. And that's the teenagers trying to make a statement by an outlandish behavior. And if that's the function, I need to help them publicly acknowledged to each other that a family has problems that go beyond the relationship between the teenager and the parents. So if stifling communication about this family has big problems is the function. I need to help them openly admit that to each other sets a long way of answering your question, which is I would have to get more information before I would assume it's simply a reflection of cultural norms of which it could be. But I wouldn't jump to that conclusion. Until I understand whether or not there's a specific meaning or function for this family.

Sucheta Kamath: Now, I really liked that because I think it's almost like the psychologists laser vision to see behind the flesh, you know, what's the what is the backbone have these collective behaviors and what what role they play in yielding either you know, asserting autonomy or rebelling so that you're pushing away the some forced way of control that others are exerting. This makes really good sense to me. I was just wondering, one of the things that came to mind as you were speaking about this is what if the parents themselves have ADHD and they they cells are inconsistent. And I see that very often. So part of the navigation that the child is trying to do is to deal with either the unpredictability that comes with inconsistency, or a lack of, you know, a sense of trust or a relaxation that comes from knowing things will be predictable, routine and, and reliable. So when you don't have in the house that can create a little bit chaos. So I would love for you to share your thoughts about that.

Arthur L. Robin, Ph.D.: Okay, well, in that case, as soon as I realized, I may be dealing with a dual ADHD family, at least one adult, and at least one child has ADHD, if the parents who has the ADHD is already diagnosed, then I move to step two of what I'm about to say, if I suspect it, but do not yet diagnose or bring to their attention, the possibility and see if they're open to getting going. So we can have it on the table and deal with it. If they are, I would see if they will go through a diagnostic process, either with me or with someone else. Because once they are diagnosed, then if they're willing to be treated for their ADHD, the whole situation could improve faster. Okay. So basically, have all the folks in the family who might have ADHD be diagnosed and be treated for ADHD is there's the step one, if possible, okay, let's assume that happens. Okay. If it happens to turn out that one of the interventions that is being used is medication, sometimes it is, sometimes it isn't, then there's the possibility of the physicians, prescribing medication for the parent and for the child can dose the medication optimally. So that will, part of the dosing of the medication will help improve family interaction between parents and child. An ideal situation is if it's the same physician, like a family doc, who knows a little bit about ADHD or a lot about ADHD. So the family doc, and I would permission stay in touch with each other. So the family doc is dosing medication to the family interaction. Okay, so medication is optimized. And I'll just go on to other things in a moment. But this, if you have this opportunity, it is a great opportunity. When medication is appropriate, and accepted by the parents in a dual ADHD diagnosis thing, to dose medication, to the behaviors that need to change. One consistency for parents and carrying out interventions and parenting and to improving the behaviors the parents are trying to help the youngsters improve. So leaving the medication for a moment, I add to my intervention, a component that's a cognitive behavioral type component for the parents, on helping them learn to organization, strategies to be consistent and carrying out the interventions that I'm teaching them for family improved family functioning. If this is a preteen, I am probably teaching them behavior management interventions. If this is a teenager, I am probably teaching them communication skills and problem solving, and things like that. And so then, as I teach each skill, I do it more slowly. I do it in short, clear sentences. By the I have make sure that the non ADHD spouse if I have a two parent couple is not getting an undue burden, such that the non ADHD spouse would get burned out from the parenting, I make sure that I'm sensitive that it's evenly divided. I also make sure that with the couple that they have the parenting tasks divided so it's playing to their strengths so that the ADHD spouse is not doing all the stuff that requires a huge amount of paperwork for example. Like if this schlepping of kids to sports and so on taking them all over the place. That's often I try to see if we get the ADHD spouse to be doing all of that. If there's checking over the details of homework to make sure it was done right I try to work it out so that maybe the non ADHD spouse is checking over all the details, because it is she spouse is really terrible at that. But the ADHD spouse still could be involved in supervising some things with homework. So all the homework doesn't get dumped on the non ADHD spouse. But I try to get the parent in task, to play to their strengths. The ADHD spouse can be the one putting the youngster to bed if it's the only youngster and they have to do bedtime routines. But the non ADHD spouse might be much better at some functions of homework. So to optimize of playing to the strengths, what they're going to do, and go from here, does this make sense?

Sucheta Kamath: Well, phenomenal. Yes. Thank you for like showing the three different paths here. And, you know, as we come to the end of this discussion, one thing that is so amazing about your insights is one, I think diagnosis is so important. And, and without that, and second, which is also part of the diagnosis, you need an expert. So sometimes I think, instead of just relying on good faith effort, it might be great as a family to consult experts. Second thing is I love the that this distinction between when to bring in medication versus medication plus, because a lot of families I know are their first line of defense. And the only line of defense is medicine. But the medicine doesn't solve a lot of interpersonal habit formation that has happened. But the last thing that you're really touched upon, which is this, there are certain distortions that we all carry. And those cognitive distortions require specific cognitive behavioral approaches. And again, experts, like clinical psychologists, such as yours is really very, plays a very important role. So as we wrap this conversation up now, I would love to know if you have any recommendations for our audience regarding books that you have found influential, and we will be right. I have found your own book, which is ADHD in adolescence. So one of the most influential books for me as a clinician, but wondering if you have a two books to share. Before we wrap up?

Arthur L. Robin, Ph.D.: Well, one I would recommend is by a school psychologist, Chris Dendy, and Teenagers with ADD, ADHD, and Executive Function Deficits: A Guide for Parents and Professionals. Chris Dendy, is really an expert on teenagers with ADHD and how to teach them to improve their executive functions. And she has lots and lots of good advice. And she successfully raised several youngsters who are now grown up adults who worked with her on her own work and presentations. So that would be one for sure. That I would recommend. And the ADD and Adolescent book that you held up is a great book. And it's designed primarily for professionals, one that I collaborated on, which is designed for parents, specifically is Your Defiant Child. So I would recommend that one specifically for parents, Dr. Ross Barkley is the first author of that. And um, the second, that one will help parents with a lot of the strategies, even if the child isn't the font defined for a lot of parenting strategies, like the distinctions between negotiables and non negotiables. I also want to add, just so parents would understand this, a lot of the examples that we talked about, it's not as simple as to do the things that I said that I do this, or I do that. They're really not as simple as they might have sounded, when we talked about them. It takes an awful lot of hard work. And when you look at the books, if Your Defiant Child or Chris Dendy's book, there are lots and lots of illustrations about let you get the feel for how hard it is to make these changes. So I have a great deal of empathy for parents who are in those places, because I'm a parent of two youngsters, who have different types of ADHD as lazy. So I know it's not as simple as we might have made it sound.

Sucheta Kamath: Definitely well. Thank you for your expertise. And listeners. That's all the time we have today. Thank you again to Dr. Arthur Robin for being a guest. And as you see these are very important conversations that we must continue to have Have to deepen our understanding of not just the nature of executive function, but the scope and manageability one of the messages, I hope it struck a chord with you all that these are malleable skills. That means they change with time and expert feedback and coaching. So definitely do not be afraid of executive function challenges. And lastly, you know, if you love what you're listening, definitely keep spreading the word like us on our social media, join us in the movement. Subscribe to our You know, our social media handles and we look forward to seeing you again, right here next time on Full PreFrontal. Thank you, Arthur.

Arthur L. Robin, Ph.D.: Thank you for having me.