Producer: Alright, this is Full PreFrontal, welcome back. We’re here to expose the mysteries of executive functions. I am here with our host Sucheta Kamath.

Good morning, Sucheta, always good to be with you. So you know, as we record this, I’m broadcasting from Chicago and we’re all big fans of William “The Refrigerator” Perry on the Super Bowl champion Bears in 1986.

Today, we’re going to talk about The Fridge, we’re going to talk about his Super Bowl ring, and self-reflection. Tell me more.

Sucheta Kamath: Well, thank you for that introduction, Todd. Guess, I don’t know if you know but debt, disease, drugs, divorce, and death are some of the reasons why people sell their championship ring, and you’re right, I am going to talk about William “The Refrigerator” Perry who you nicely introduced, was a superstar. Unfortunately, he, in 2008, got diagnosed with Guillain-Barre Syndrome where the body’s immune system attacks part of the peripheral nervous system which is an extremely debilitating condition.

So a 10-year old boy from Pittsburgh, his name is Cliff Forest saw the ring, this championship ring, at the Mickey Mantle restaurant in New York City for sale, and he really, really wanted it, so what he did, which is going to blow your mind, is he took out $8,500 out of his college fun without his dad’s approval, but approval from his mom and bought the championship ring. Eventually, once he had it in his possession, he read a little bit more about The Fridge and found out about his disease and that really touched his heart, and he gave a little thought to it and he was so moved by it that he kind of urged his parents and said to his dad that, “Can I please, please give this ring back to him since he is going through rough times?” and of course, Perry was so grateful for that and he gave the little boy two autographed jerseys that read “The Fridge, Thanks.”

So there’s no doubt that the most powerful human organ in the brain is certainly equipped with many power tools that help us navigate through daily decisions and learning from mistakes. The prefrontal system in the brain operates like a remote control, letting us fast-forward to the future, rewind back to the past, to revisit things that haven’t worked out well, and most importantly, it lets you pause for reflection. This boy in the story, you know, Cliff really reflected on the situation that Perry was going through and with great thoughtfulness, he returned the ring back to William Perry, “The Refrigerator”, and so learning ways to use the pause button turns out to be a life-long commitment, and today, our guest, a very special person, Dr. Stephanie Carlson is going to talk about this very specific thing.

She is a distinguished McKnight University professor and Director of Research at the Institute of Child Development University of Minnesota, the number one ranked department for developmental psychology as we have found out. Dr. Carlson is an internationally-recognized leader in the study of executive function, she has developed innovative ways of measuring executive function in very young children, and has made discoveries about the role of executive function in other important aspects of human development. Dr. Carlson’s current research focuses on the ways to promote executive function through physical health such as nutrition and sleep. Caregiving practices and preschool curricula, her work has been supported by the National Institute of Health, Institute of Education Sciences, Robert Wood-Johnson Foundation, John Templeton Foundation, just to name a few. Dr. Carlson is a fellow of the American Psychological Association, and the Association for Psychological Sciences. She serves on several editorial boards and is a vice-president of the Jean Piaget Society and is a member of the Human Capital and Economic Opportunity Global Working Group.

So her work has been featured in several media outlets including the New York Times, the New York Times Magazine, National Public Radio, etc. I’m very thrilled to have her on the show today.

Producer: Yeah, no, it promises to be a fascinating conversation with Dr. Carlson and I’m still touched by your story about William Perry and that child. Unfortunately, those stories about athletes such as him going through post-stardom struggles is unfortunately very, very common. What a great story.

Alright, well, let’s get to this conversation with Sucheta and Dr. Stephanie Carlson.

Sucheta: Welcome to the podcast, Stephanie. Thank you so much for your time.

Dr. Stephanie Carlson: Thank you for having me.

Sucheta: So before I get started, I wanted to ask you about your interest in executive function, how did you come into this field or what piqued your interest?

Dr: Carlson: Well, actually, I was trying to solve a different problem. I was in graduate school and I was interested in the development of Theory of Mind so that is the development of the ability to take somebody else’s perspective. That’s really important for things like peer relations and conflict resolution and it’s just a basic developmental milestone to be able to take somebody else’s perspective, and many, many researchers and well-respected researchers around the country and in fact, the world were puzzling over this problem of why is it that young children have such difficulty taking somebody else’s perspective and fail these laboratory tests that have been designed to measure the ability to take someone else’s point of view. So through my research in graduate school, came to think about some child characteristics, other aspects of development that might be really important for this ability to develop and started to investigate the development of executive function, and so this refers to the development of self-control, including the ability to control your thoughts, your feelings, and your actions or behaviors, so it was really in order – in the service of solving a different problem, that I started to look at how difficulties or the slowness of the development of executive function may be in fact what’s hindering children’s ability to acquire Theory of Mind.

Sucheta: Oh, I did not know that. That is such a cool story. I can completely understand how that executive function goes into perspective-taking process but also, once you develop – so you regulate yourself but you eventually regulate your relationship with others and regulate your responses in social context, and to regulate that in social context, you need a huge understanding or have developed Theory of Mind. That is really wonderful.

So you already defined what executive function means, so when do these skills emerge in children or can you explain how they are progressive in nature and all of those components don’t develop simultaneously? So how do you see them?

Dr: Carlson: Well, so we see the very nascent beginnings of the development of executive function in infancy and even a young infant, four months of age, who can’t speak or crawl, or apparently do much of anything yet, they can control things like turning their head away from something that’s sort of bothering them, like a sibling that’s kind of poking at them or something like that. They self-regulate in a deliberate way and that becomes increasingly more and more conscious and intentional, and then we see the progression to toddlers who are starting to  get some conscious control over their thoughts and feelings, and actions, and some of the tantrums that you see in toddlerhood are a sign of this struggle, the inner struggle that they’re having to deal with strong feelings, having really strong feeling and being unable to have total control over the environment or the situation, or to have whatever they want right now. So you see that kind of gradual development – getting emotions under control and with preschoolers, it develops even further to where they have the ability to kind of reflect more and realize that they have maybe multiple ways of solving a problem or that they have choices and how to act, think, or feel, and that reflection feeds into this ability to make better choices and delay gratification, and maybe postpone some kind of temptation for later, so that they can have maybe the larger reward later.

So all of these things are kind of building from infancy through toddlerhood and then through preschool period, and they involve both kind of every day sorts of problems where there’s not really a reward at stake or it’s just kind of an everyday problem that’s at hand or sometimes, it involves really high stakes, so it’s something that feels really high stakes to the child, like a reward that they’re trying to wait for and it feels like the end of the world if they can’t have it right now.

Sucheta: Got it, so this, as you mentioned earlier, when it starts with some intentional control, some kind of tinge of that, and then as they progress and develop, you become more control of your intentions, thoughts, as well as actions, and then you start influencing your outcome. How does that help? So executive function have been shown to have great implications for developmental outcomes, not just limited through the school readiness but even later life and social functioning, overall welfare, well-being. Can you talk a little about that?

Dr: Carlson: Yeah, so there’s a growing body of evidence to suggest that really, individual differences in executive function and self-regulation have long-term consequences for academics and school success, as well as health, wealth, and well-being, so my students and colleagues, and I are interested in investigating just how that works, how that pathway or those pathways can work. So I think that individual differences in executive function, even though they should just back up a little bit and say even though there is this really predictable set of milestones in the development of executive function that we all go through, of these typically developing individuals who go through, there are also really big individual differences at any age. So we kind of capitalize on that by looking at relatively good versus poor executive functioning and then in turn, how is that related to academic or other aspects life success and achievement, and I think it could be direct, sort of to the extent that there is a causal pathway. It could be direct, so for example, paying attention, so being able to attend especially for long periods of time and to sit still is an important aspect of executive function. It’s one manifestation of executive function and that is going to be important for being able to learn things in the school environment or a school setting. So taking in information, working with it in your mind, so that’s called working memory and being able to retain information, and use it again in the appropriate context or execute on it in another context, or transfer your learning from one context to another, all of that resting on executive function skills could be kind of a direct pathway for how these skills influence learning, but there could also be a lot of indirect ways in which executive function influences these outcomes. So by, as we discussed earlier, having stronger peer relations. When we have stronger peer relations and you feel more of effective or efficacious at school. school’s a more positive for you if teachers like you and we do know from quite a bit research that teachers do prefer children with higher executive function skills. They’re easier to teach, they’re more attentive, but then when teachers like you better, you like school better, and all of these things can have a cascading effect on the individual child’s learning environment and ultimately, there’s success in a school setting. So both direct and indirect effects could be at play here.

Sucheta: I see. When we talked last time, you said something very insightful. You said executive function is most conspicuous when lacking. Can you tell us a little bit about that and how does that play in – you mentioned that already in the classroom, but in terms of the child’s own ability to take control of his own learning that can really set him back if he doesn’t have these capacities, right?

Dr: Carlson: Yeah, for sure. So executive function is most conspicuous in its absence and so you sort of see it when it’s not there, most obviously, so when children or students are lacking in the ability to hold information in mind, to control their impulses, and when they’re lacking the ability to think flexibly or to be reflective on their thoughts, actions, and feelings, we notice it and so we notice it because they’re more likely to act out in class or importantly, another manifestation of low executive function could be a student who actually flies under the radar, not acting out in class but is really not following what’s going on, in part because they’re lacking some of these key attention and self-control skills, so it actually could go either way with acting out or going unnoticed. Typically, we think of the sort of more ADHD end of the continuum of a classic executive function impairment, but it is a continuum, so even children with mild deficits or delays in executive function can begin to experience school failure at a very young age. That’s why a lot of our intervention efforts have been focused on children who, for one reason or another, just don’t have a leg up on the development of these skills to the same extent that their peers might in those areas.

Sucheta: Can you elaborate on that a little bit, like why is mild impairment also causes disruption in that learning progress versus severe? Why does that show it like that?

Dr: Carlson: Well, so again, I think there could be both direct and indirect things at play, so let’s say you’re learning to read and you have relatively poor working memory, so it’s not anything that has caught the attention of a kindergarten screening or has been an obvious difficulty requiring an IEP but you have relatively low working memory. It’s harder for you to retain the information from the beginning of the sentence to the end of a sentence or from a beginning of a passage to the end of a passage. You might have to reread it multiple times, but if you don’t have the strategies to know that that’s what’s going on and the reflection ability to realize that “Oh, I just got through a whole page and I don’t really understand what I just read. I should probably go back and reread it.” If you don’t have that reflective capacity which is a major part of executive function, you’re unlikely to take that step, that metacognitive step of going back and rereading the sentence or the passage, and instead, you just continue on not fully comprehending the text. So that’s just an example of how even mild difficulties in this area can really accumulate over time to where you’re not reading at grade level, for example.

Sucheta: Yeah, that makes sense. So, many researchers describe hot versus cold executive function. Can you talk a little bit about that?

Dr: Carlson: Yeah, so I eluded to this earlier where sometimes, we need to consciously control our thoughts, actions, and feelings in many different way kind of throughout the day. We also self-regulate in a lot of non-conscious ways throughout the day too, like our digestion and our breathing, and heart rate and so forth, so the executive function is like those other aspects of self-regulation in many ways but it’s also very much unlike it in that by definition, executive function is conscious and deliberate so when something that we need to regulate is effortful is kind of when we engage our executive function skills which are largely associated with prefrontal cortex, but occasionally, you might be solving a problem, a math problem, and normally, you solve it one way like you’ve learned one routine for how to solve this problem or one operation like addition, and now, you’re faced with a new operation. You’re trying to learn something new like multiplication. If you continue on with the old way of how you work with these numbers, you’re going to get the answer wrong. So like, you’ve learned addition and you’ve learned 3 + 3 = 6, but now, you’re switching to multiplication and it’s a different operation. You have to think about 3 x 3 instead and you will get a different answer, and that’s a relatively cool situation, so unless it’s maybe a math test or something, or you’re kind of feeling stressed and the stakes are high, it’s a relatively cool situation where you are just thinking through this problem and there’s no reward at stake, there’s no maybe high or intense emotional setting or context associated with it, so we call that cool executive function and we measure that in kids and adults, actually, with task-switching measures. So for example, something that we developed called the Minnesota Executive Function Scale, it’s a cool executive function task where kids using a tablet game, they have to sort cards by one dimension like their color, and the after a few trials of doing that, they’re told to switch and sort the same cards by their shape, and it’s a challenge because you have to hold in mind this new rule, you have to inhibit or suppress the old rule, and you have to switch flexibly from one way of playing this game or thinking about this game to a new way of thinking about the same game, but again, there’s no real high stakes or emotion involved, so those are cool measures or cool – yeah, for executive function.

With hot executive function, the difference is that the context is more emotional somehow, so there is a reward at stake or there’s some kind of heated emotion, it’s sort of like in the heat of the moment when you have to make a decision and use your executive function skills that we call that hot executive function. So the marshmallow test kind of a classic delayed gratification test like that would be an example of hot executive function.

Sucheta: Got it, so this happened to me recently. I was flying back from New Mexico and our flight was on the runway and we were getting delayed because the weather just was not cooperating and the person sitting in the next seat across the aisle started huffing out loud. The more announcements the flight attendant made, the more audible his huffing got. I mean, he must have been in his late 50s and the last, third time when she came out, he slammed the book that he was reading and he stomped his feet just like a child. That’s kind of not tolerating the emotional burden. Is that what you’re saying?

Dr: Carlson: Yes, exactly. I mean, these are the most fun measures to use in the lab because kids really do the funniest things. So we do the marshmallow test quite often and in fact, what kids do in that situation to regulate themselves has inspired a whole line of research that my students and I have done, and so what we noticed, kids do really funny and different things to try to endure the delay where they are faced with a marshmallow or whatever tempting treat they’ve chose and they have to wait for the experimenter to come back, and if they wait, they can have two marshmallows or whatever the larger reward is, so it’s very tempting and it’s very difficult especially for some children more than others, those individual differences again, but what helps some children succeed is that they spontaneously engage in strategies. So they might, for example, start singing to themselves. One child started singing, he made up a song called I am waiting and either just kind of went into this sort of rap routine about waiting. It was really cute, and some children will – it’s kind of like ‘know thyself,’ like if you know that this is going to be tough for you, it’s going to be a tough situation, some children will engage in these spontaneous strategies, like one child just turned around in her chair and she knew that by not having a line of sight on the marshmallow, that she would be able to delay gratification longer, and then we had another child named Jane who started talking to herself during the delay and she was reminding herself of the rules but she used the third person which we thought was really interesting. She had just turned three and she said, “Jane wants to eat those raisins,” so she had chosen raisins for her treat. “Jane wants to eat those raisins. Is Jane going to eat them?” And then she said, “If she has one –“ you could have one raisin now – then she said, “Then Jane is not going to have all of these,” and she pointed to the larger reward, and then she said, “Because she might choke.” She’s kind of working it out in her mind and coming up with a rationale for why she shouldn’t have the one raisin now. So that actually inspired a whole line of research where we thought it was so interesting that she used the third person and what that does is it sets up a little bit of psychological distance from the self and we know that that is helpful for things like emotion regulation and this is an example of a hot executive function task like I mentioned.

It’s so much easier for example to help somebody else, a friend or a family member through an emotional problem, emotional upset that they might be having because for you, you’re not immersed in it. For you, you have a little bit more perspective, you’ve got more of a bird’s eye view on the situation. It’s easier for you to see the choices that this person has before them for how to overcome this challenge, and so it’s the same kind of thing. We thought maybe what she’s doing here is making it a little bit easier for herself by distancing so we, in turn, my students and I collaborated with Angela Duckworth and Ethan Cross and we applied for a grant together and we’re successful in that and did a series of studies to show that in both children and adults, this psychological distancing can be very effective for improving performance in both cool EF and hot EF context.

Sucheta: And you’ve also seen that there’s applicability of this research in order to learn, right? So once you teach this self – well, or rather do you teach self-distancing or when they strategize on their own, it’s much more effective?

Dr: Carlson: Yes, seeing them do it on their own, that was really inspiring, and then what we did is to instruct children, so we’ve randomly assigned children and we’ve studied children from ages three to six so far on this and the five and six-year old kind of most reliably show these effects. We call it the ‘Batman Effect’ because what we suggest to be the most distanced from the self is to pretend to be a character, an exemplary character who is really good at games like these or somebody who has really good self-control, and so Batman is one example. It’s one of the options that they have available to them when we ask them like, which character they want to be while they play this game, and what we’ve found in several studies is that when children are pretending to be Batman or whatever exemplary or competent character they have chosen to pretend to be while performing an executive function task, they will perform as if they’re as much as a year older, so for example, five-year olds will perform on the task as if they were six-year olds under normal conditions, so we call that the ‘Batman Effect,’ and what we’re doing now is to just try to understand more about this effect and what’s influencing it, so do the qualities of that character matter and how do they matter? Do some children benefit from this strategy more than others? Those are the kinds of questions that we’re investigating now.

Sucheta: Well, thank you so much for your in-depth explanation and helping us understand this very fascinating topic. Before I end my interview, if people want to find out more about your research or reach you, what’s the best way they can get a hold of you?

Dr: Carlson: Yeah, there are two way to reach me. One is through the University of Minnesota Institute of Child Development and I have a joint lab there with Professor Phil Zelazo and you could reach me through my lab or my email is SMC@UMN.edu, and the Reflection Sciences is a company that Phil and I developed in order to share and disseminate more information about executive function to educators and parents, and to provide tools for assessing it and professional development for ways to learn more about it, so that’s reflectionsciences.com.

Sucheta: Well, thank you so much. We will attach all that information on our website. Once again, I’m immensely grateful for your time and thank you.

Dr: Carlson: You’re welcome. Thank you.

Producer: Okay, we’re back, that was Dr. Stephanie Carlson. Sucheta, what a – gosh – a great conversation with Dr. Carlson. I learned an awful lot from her as I typically do from your conversations. Any immediate thoughts about the conversation?

Sucheta: Absolutely, Todd. Truly, that was fantastic. The first takeaway from me is how deliberate the executive system is. The autonomic nervous system in humans is not under our conscious control. We cannot stop our heart from pumping blood, our pupils from dilating, stomach from digesting food, or the sweat glands from doing their job, but the executive system, on the other hand, is completely under our conscious control and is activated through deliberate effort. So I hope our listeners can take this away with them that this ability of deliberate effort is what helps us turn away from desert, stop ourselves from laughing when somebody trips on the sidewalk, and lets us bite our tongue even when we know our husband was utterly wrong, so executive function skills are present even in infancy but at a very rudimentary way.

I remember my son, Kunal, used to do this all the time when he was a baby. I would try to give him ground up baby food from a jar and he will keep his lips tightly sealed but quickly open the minute I would offer him something like homemade mashed potatoes or something like that. So we need to keep in mind that executive function progressively evolves, allowing children to self-regulate their thoughts and feelings, and actions, and that’s what Dr. Carlson was talking about. Her work, particularly with preschoolers, shows that they have the ability to reflect on behavior, evaluate choices for problem solving, and resist temptations for a larger benefit that’s coming down the road in the future, and this helps them get their emotions under control as well as shape their behavioral response in various novel situations.

Producer: Wow, I can also think from personal experience. Some wives cannot bit their tongue when their husbands are utterly wrong, so I’ve experienced that side of –

Sucheta: Yeah, I wonder if that’s a problem with executive function or a problem with husband-wife relationship.

Producer: Oh, no, I think it’s a problem with the husband because he’s probably utterly wrong a lot more often than he’s probably average. We’ll move on from that discussion. So going back to your conversation with Dr. Carlson, the discussion also touched on how all of us, all together, we have to become very intentional about teaching executive function, right?

Sucheta: Yeah, that’s the second takeaway for all of us here, that it’s not just parents and educators but the whole society needs to be invested in learning how executive function and self-regulation develop because the research shows that it has a strong bearing on long range outcomes, including school success, job success, physical and mental health, marital harmony – as you were just talking about – and overall quality of life, and there’s a clear and distinct individual differences as self-regulation and they are often apparent as early as preschool-aged children but the individual profile may be different.

As Dr. Carlson was talking about, simple things like not being able to sit still in the class and not being able to pay attention or to follow instructions, or not being able to abide by the class rules, particularly the invisible ones can be a red flag and eventually, that’s what results in school failure, not at all the child’s intellectual capacity or ability to recite alphabet or do simple math problems. The very young-aged children, if they experience school failure, that can have a devastating impact and can have chronic effects that last for life. One of my previous podcast guests Clancy Blair’s research shows that in spite of same level of IQ, those with stronger executive function skills tend to do better on measures of math and literacy, so the concern is not just limited to the direct impact of poorly developing executive function and self-regulation, but indirect ones, and that’s what Dr. Carlson was emphasizing.

So I feel that impulsive, distractible, excessively chatty, disruptive children are those who are not with the program, so to speak, and they tend to become a classroom management challenge for teachers and educators, and they are less liked by the teachers, as well as they’re hard to be coached, and then they tend to give hard time to their peers and in return, they become less-inviting members of the classroom structure, so all in all, these kids are likely to get neglected and receive less respect in teaching and learning context, and as a result of that, they, of course, receive less support because of their own poor self-regulation. So it’s a kind of a sad situation that poor self-regulation makes it not advocate for their difficulties and not advocating for  their difficulties makes it receive less help for their poor regulation.

Producer: Mm-hmm, mm-hmm. It just sounds like, Sucheta, that people who are raising and educating children with developmental disorders, they have to understand these issues very well, right?

Sucheta: Yeah, and that’s my last takeaway here, that the development of executive function can be disrupted by many factors including genetics and environmental stressors, and time and again, every guest that I have had has emphasized to really have a holistic approach to looking at that development, and Dr. Carlson was talking about the indirect effects that I just listed, but I myself see that in my practice, that many childhood disorders such as Attention Deficit Hyperactivity Disorder, the spectrum disorders, conduct disorders, Tourette’s Syndrome, or even Obsessive-Compulsive Disorder, they all have a varying presentation of underlying executive function difficulties. Their individual profile may have some additional features specific to that disorder but a unifying factor is poor self-regulation and poor executive function foundation. So now, what happens is, these skills that help you manage yourself don’t emerge properly and there’s an underlying disability that makes them help themselves so these children definitely get left behind, and I think these children who are not meeting the expectations, whether their classroom work performance expectations, classroom behavioral expectations, or interpersonal peer relationship expectation, all in all, they are the ones who suffer the most.

Producer: Yeah, yeah, unfortunately so. Before we wrap this conversation, Sucheta, and final thoughts on this conversation with Dr. Carlson?

Sucheta: Here’s what I’ll say to our listeners, that I think keep a wide lens on learning and teaching, and be very pro-support of child’s understanding of self, and that, as Dr. Carlson’s research shows, is about self-reflection, and I think self-reflection can be a very big tool to understand one’s own limitations and understand one’s own inability of reflecting and recognizing challenges and roadblocks, but that reflection which can be painful will eventually become a path to success.

Producer: Yeah, no, good stuff. Alright, that’s all the time we have for today. On behalf of our host, Sucheta Kamath and all of us at Cerebral Matters, thank you for tuning in and listening today, and we look forward to seeing you again next week on Full PreFrontal.