Producer: All right. Welcome back to Full PreFrontal: Exposing the mysteries of executive functions. I am here with our host, Sucheta Kamath. A second conversation with Dr. Peg Dawson, looking forward to that. But before we go there, Sucheta, you need to tell us a story the story about Guy Richie. I’m looking forward to that.
Sucheta: Yes, Todd. I am going to share a story about Guy Richie. So not everyone at age 9 knows that thy want to be a firefighter or a doctor or the president of the United States. In fact, many youngsters struggle in finding themselves. It’s our brain’s maturation that truly holds them back. Recently, I heard Guy Richie’s interview. He’s the famous filmmaker whose first film “Lock, Stock and the Two Smoking Barrels” was a breakout hit. He talks about his own story this way. So growing up, Guy Richie struggled with dyslexia and attended a number of different schools. Eventually at age 15, he dropped out of school for having been caught using drugs. That’s the main reason he was asked to leave. When asked about his dream of becoming a filmmaker at a young age, Guy Richie says, “I’m not sure I was so focused as to thinking about being a filmmaker at that time.” Rather, he said, “I was focused on dropping out of school.” So after dropping out of school, Guy began to sell drugs and he finally says that “It’s very hard to be a successful drug dealer as I found out. If you ask me, the very thing that is needed to be successful in school is also needed in selling drugs and making a profit.”
So interestingly, after bouncing from one place to another and one idea to another, Guy Richie finally landed in the film industry at around age 25. His first gig, in fact, was a tea boy. He brought tea to people. And of course, you can imagine that’s very British thing to do. “I was enthusiastic about it, literally from day 1. Once I started, I did not stop working.” That’s what Guy described about his transition from a tea boy to eventual small productions and the short film that he produced after that. I heard Guy Richie say that “In nothing else did I sustain any motivation or interest. But as soon as I got interested, as soon as I started in the film business, I was off to the races.”
So Guy Richie’s story is a testimony to maturing prefrontal system. Once it comes on, it provides focus, engagement, and a desire to persist. Guy Richie said in his closing conclusion during his interview that “If there is one piece of advice I would give anyone, it is do not sweat until you’re 25.” There seem to be something that takes place in the brain at 25, when you have had a quarter of century of arsing around and learning about life.
So our guest, Peggy Dawson, is going to talk about the journey of struggling children and youth who need more than just life’s bumps to ultimately discover their strengths or to be able to channel themselves towards personal success. I would love to introduce you to Dr. Peg Dawson for her part 2 of the interview. She is an outstanding school psychologist and she has done some very impactful work in this field of executive function and diagnosis and treatment. Dr. Dawson has worked at the center for learning and an attention disorder in Portsmouth, New Hampshire for over 25 years, where she specialized in the assessment of children and adults and with learning and attention disorders. Dr. Dawson is most known for her Amazon bestseller book “Smart but Scattered” which she co-authored with Dr. Richard Gere. A book every parent and educator must read. They also have a new book that has just come out which I highly recommend as well. Dr. Dawson is a past president of both National Association of School Psychologist and International School Psychology Association. In 2010, Dr. Dawson was a recipient of the International School Psychology Association’s Distinguished Service Award, and in 2006 she received a Lifetime Achievement Award from the National Association of School Psychologists. In closing, I want to just remind people that her work is informed by her personal experiences, not just as a school psychologist but raising two boys who also struggled a little bit in the area of executive functions, and she as a parent learned a lot from them. I can’t wait for our conversation with Peg Dawson.
Producer: Yes. Me as well. Fascinating story about Guy Richie. I did not know that about his background. I too am looking forward to your second conversation with Dr. Peg Dawson. And boy, thinking again about Guy Richie, my career took a big change at around 25 years of age as well. So that’s a fascinating tip itself. All right. Let’s get to it. So this is Sucheta’s second conversation with Dr. Peg Dawson.
Sucheta: Welcome again, Peg, to our show. Thank you so much for taking time away from your busy schedule. So let’s get started. In this segment, I want to talk about executive function and managing executive dysfunction. What will happen if we don’t intercept in the process of developing executive functions, particularly when they’re falling behind?
Dr. Dawson: Okay. So the brain is constructed so that executive skills do mature gradually over time as the brain develops new capacities. But some kids do better than others on this. When kids fall behind in terms of executive skill development, they become increasingly disadvantaged in school. Because the longer you stay in school the more school requires you to use not only executive skills in general but requires you to use higher level executive skills like time management, planning and organization, and those kinds of things. So if kids fall behind then there is a mismatch between teacher expectation and what kids are capable of doing, and then they may start failing. But they also start feeling frustrated. Their parents are frustrated and they’re not able to keep up with the academic demands because those academic demands rest on proficient executive skills.
Sucheta: In my experience, what we see is if they are not managed, first of all, if you don’t call it what it is, people are left to reconcile to think that these problems of not me managing me is more indication of something being less in me. So people either implode or people explode. So there are a lot of behavioral mismanagement that emerges if you don’t address it. Do you often see that?
Dr. Dawson: Yes. And I see it in two ways. There are the more externalizing kinds of manifestations. So those are kids who become disruptive or visibly frustrated. And then there are kids who stop producing or producing at a slow rate or producing poor quality. Those kids, we often end up calling lazy. Of all the words out there used to describe kids with executive scope challenges, I think I bristle most of the word lazy because it implies that it’s a character flaw as opposed to probably some weak executive skills, that if we focused on them, maybe we could bolster them and the child would stop appearing lazy after a while.
Sucheta: I hope our listeners really understand that it’s extremely essential that we do everything in our capacity to promote development of executive functions and more support we offer is going to expedite or even prevent in some cases of falling behind. What is the framework you conceptualize when we are managing executive function challenges? How should we go about it?
Dr. Dawson: Well, I think we’ve got three options. One is, we can look at that mismatch between the environmental expectations, be they from parents or teachers and the child’s executive skill level and say, okay. We have to support this child so that he’s not failing. And so we don’t necessarily try to change the child at this point. We just adapt our expectations and adapt tasks to better meet what the child is capable of. So if a child really has trouble with sustained attention and asking him to spend 30 minutes on a classwork assignment or a homework assignment, that may be unrealistic. So can we break it down into smaller segments? Can we build in small breaks? Can we build in something to make the task more appealing to the child? So we’re not trying to change the child at that point, and that’s always where we start. We say, what can we do to make the environment more supportive or less punishing of the child?
Sucheta: This is different from lowering expectations?
Dr. Dawson: Yes. It is. Because our goal is always to get the child to his most competent independent self. But if start by expecting more than he’s capable of doing, then all we’re going to do is produce failure. We may start out with the child, eventually, we want to get you to be able to do all your homework within a reasonable amount of time but we’re going to take it slowly initially and build up to there.
Sucheta: I like the way you distinguish that we are not talking just modifying the environment, which is turn up the TV or create a quite space. You’re talking about environmental modification includes modifying expectations. I really like that. What was the second option —
Dr. Dawson: So the second option is to actually look at the behavioral skill deficit and say, “Can we put a routine in place that will help this job get through this?” So let’s say you have a child who has a terrible time getting ready for school in the morning because he gets distracted, he dawdles, or he forgets what he’s supposed to do. So if we create a checklist or even use a smartphone app and there is some good ones out there that help a kid get through a morning routine. If we have the child go through that routine again and again and again, he’s actually learning the routine. So the routine actually supports task initiation, sustained attention, planning everything else. That’s the second way.
And in Smart but Scattered, we have a whole chapter devoted to teaching strategies that are built around common every day routines that kids need to learn. We identify which executive skills are incorporated into those routines but there are things parents can actually use almost off the shelf. So that would be the second way.
Sucheta: Got it. So here’s my observation which I have a perspective on this that if you came up with a list of things for the student or the child and if the child has to follow, then your executive functions went into it. And one of the things that might prevent transfer or generalization to other situations is the child has never learned the principles of how to come up generate that less. How do you propose we compensate in break downing that?
Dr. Dawson: Yes. I’m so glad you asked that question because that’s how our thinking has evolved, actually, since we wrote “Smart But Scattered” because we realize there are two ways of teaching kids executive skills. One is to give them the routine or walk them through the routine. But the other way, which we do think is better, is to say, “You know what? We’ve got a problem with getting ready for school in the morning. Let’s think about what needs to go into that and let me get your ideas on how we could work on that.” And so now you’re actually engaging the child at the problem solving level or the planning level, rather than you just handing them a plan. You’re saying, “We need to come up with a plan.” And the child has some input into that. In fact, some of my favorite ways to talk to kids if they present a dilemma or problem is to say, “Well, what’s your plan? Do you have a plan for that?” And that sort of puts it back on the so they have to generate the strategy.
Sucheta: One of the ways I introduce this concept of planning and creating. So to list is something that to me is a predetermined sequence that repeat themselves and I’d like to contain them to five steps. And then we go through this process of what is in violet. If you are in crisis and you are running out of time, out of those five steps, which two steps can never be let go? And so helping kids to do that, problem solving. So when they generate the list, that this principle is kept in mind. I find that that helps develop that underpinning cognitive ability.
Dr. Dawson: Yes. I like that. That’s great.
Sucheta: What’s the third option?
Dr. Dawson: The third option is actually finding ways to motivate your child to use the strategies that you’re trying to teach them. And so we talk about, can you use incentives? I mean, one of the most powerful ways to encourage kids to practice is to build simple routines like first work then play. So first, they practice whatever skill they need to practice. And then whatever is on their preferred list of activities that follows that. One of the most effective is, kids love to play video games. That’s fine. You can play half an hour video games but first you get your homework done. Or you get your homework done by 7 o’clock if you’re working on kids working in an efficient fashion. And if you do get your homework done by 7 o’clock, then you get to play half an hour video games. And then sometimes it comes down to the child does his homework by 7:00 but it’s a mess and it’s full of mistakes. So then as a parent, you say, “Okay. Homework has to be done by 7 o’clock and when I glance at it, I don’t want to see more than two or three mistakes.” And so those are ways to build in consequences that encourage the child to engage in or practice whatever behaviors we’re working on. A lot of parents have resistance to that because I hear parents all the time saying, “I don’t want to pay my kid to do something they should want to do anyway.” But my feeling about the use of incentives is we’re trying to build in practice, we’re trying to entice kids to spend time practicing skills that may not be easy for them, that actually may be aversive to them. And if incentives enable them to get that practice time and then to me, they’re worth considering.
Sucheta: When you say incentive, it could be an actual financial reward, it could be a sticker, or it could be time given to play a video game. So it’s a very specific concrete reward given immediately after completion. Correct?
Dr. Dawson: Yes. Although we also, whenever possible, are building in social reinforces as well.
Sucheta: Can you tell us a little bit about that?
Dr. Dawson: Well, that would be letting the child know what he’s done. You stuck with that homework. You didn’t get distracted. You got it done on time. Terrific. So now what you’re doing is you’re giving the child positive feedback about the behaviors that are associated with the executive skills you’re trying to teach or trying to encourage. So the more specific you can be in terms of positive feedback to kids, and you can even use terms like goal directive persistence. That puzzle was tough for you. You tuck with it. You know what that’s called? That’s called goal directive persistence. I’m impressed with how hard you worked. Those kinds of statements.
Sucheta: What I find about this work, it required parents and educators to be so pro psychology. They need to have a deeper understanding of human behavior, and many people struggle with that, Peg. Do you find that they’re not as intuitive as one might think?
Dr. Dawson: Yes. I agree with you. I mean what the research shows in terms of positive feedback is that if you can achieve a ration of three positives to every corrective feedback, that alone can change behavior which sounds very simple but in actual practice, it’s something that even skilled people don’t necessarily achieve. My colleague went into preschools a few years ago and looked at the ratio of positive to corrective feedback in preschools and most people think preschool teachers as being the most positive people out there, because the demands for academic performance that you find once kids hit elementary school. But what they found was the typical ratio was 3 correctives to 1 positive and the best teachers they came across were ones who had a 1:1 correspondence. So it is something that doesn’t come naturally. On the other hand, when I’ve talked with other people who’ve managed to persuade parents or teachers to use that strategy, they report very quick results. So it’s not something that comes naturally but it is something that can be learned and it can produce pretty dramatic results in a pretty short time.
Sucheta: I use the lengths of social psychology and social cognition research, my favorite reference that I bring in is Baron Cohen’s research which is “Empathy Erosion.” That means when we start the day, for example, we have great empathy and compassion and our empathy erodes with time and roadblocks and particularly negative responses or pushback. And so a parent who starts with a great gung-ho and great desire to provide these incentives and feedback experiences empathy erosion and they become impatient and intolerant of faux pas. That’s when the real crux of the matter id how do you redirect yourself going back to your reference in the earlier podcast about one’s own executive functions need to be kept in check when you are reacting or redirecting somebody’s executive function responses. So how do parents themselves incentivize themselves so that they can be more appropriate when they’re responding to challenging situations?
Dr. Dawson: Let me come at that from a different direction because I’m often asked by parents how to help manage their kids when they recognize that they have executive skill challenges. I will have a parent say to me, “You know what? I have ADHD. I have an attention disorder. My kid has an attention disorder. I’m not sure I’m going to be able to carry out all the strategies that you’re suggesting there.” And so I generally have two responses. It’d be interesting to get your reaction on this. First response is, stop beating yourself up, because none of us are perfect. In fact, I remember my mentor in graduate school, I observed him teaching parenting classes one semester and he said one thing to the students that has stuck with me ever since. He said, “A good parent is a parent who makes the right decision 51% of the time.” Who knows, I’m sure he just drew that percentage out of his head but as a parent, you immediately react and say, “Well, I can do that.”
The other recommendation I give to parents because, again, anyone who’s read our book will that there are all kinds of strategies out there that may take considerable time in order to use them effectively. But I often tell parents rather than using an elaborate system that might involve rewards or might involve kids earning points or money or whatever, can you think of something that you could do every day that wouldn’t take more than 5 or 10 minutes that you could continue to use as long as you need it to? That is more effective than the most elaborate reward system because you can’t keep those up over time. And so basically, as an example, the way I got my son with attention disorder through high school was, first of all, I narrowed my goal. When I thought about all the things I wanted him to accomplish by the time he graduated from high school, I zeroed in on two. I said, I’d like him to complete his homework on time and hand it in. Those were the things I focused on through high school. When he came home from school every day, I asked him two questions. What do you have to do? When are you going to do it? It was rarely more than a five-minute conversation but I kept it up day in and day out. I think I faded it by senior year because he didn’t need me to be asking that anymore. I told the story a lot. So if anybody’s listening to your podcast, they will hear the story again. I had no idea what strategies were effective with my son because I was using all kinds of things until he was 28. And at age 28, he told me the story that enlightened me. I mean he basically said — and he was really irritated when he told me the stories — he said, “It was until I was 25 that I stopped going through this mental homework checklist at the end of every day.” And then he graduated from college at 22 and didn’t start graduate school until 26 so there were three years in there where that mental homework check was useless to him and that’s why he was telling me that way. But that was where the light bulb went on for me. I said, “Okay. So that was something I did five minutes a day from eighth grade through his senior year in high school and obviously it paid off.” I just talked to him a few months ago. He’s 37 now and he said, “You know mom, even now when I‘m stressed, I fall back on that mental homework checklist.”
Sucheta: I love it, Peg. I think your point is absolutely right. One thing that I have found useful, particularly parents who really gets stressed out, about not knowing how exactly to be effective is I highly recommend people to video record their children as a feedback and not to watch it right then and there but to create “let me show you what I see and what is it that you want me to do about it.” So bringing them back into the problem solving for themselves but from a perspective of many people, not just for himself. Because it’s so easy to resist mom or dad. But when you see what mom and dad are going through when they’re dealing with you, maybe there is an opportunity to resist the situation with greater compassion.
Dr. Dawson: I like that.
Sucheta: That is such a wonderful discussion, Peg. Thank you for your wisdom and so many point we didn’t get a chance to talk about. But I really appreciate you explaining from a perspective of handling executive functions from being an expert as well as a mom. Any parting thoughts regarding what is one thing that you always want people to remember when they think about dealing with complex set of skills of executive functions?
Dr. Dawson: Again, let’s look at this as skills that can be strengthened as opposed to character flaws that you blame kids for. If we can do that, then I think we’re on the right track.
Sucheta: Well, thank you for ending with a message of hope that this can be managed and this can be learned and this can be developed. If people want to reach you, what’s the best way to get hold of you?
Dr. Dawson: I think the best way is to go to our website which is SmartButScatteredKids.com. There is an email link that you can contact me but there are also a lot of other resources on the website including links to our books and descriptions of the books if people want those. But also some free downloadable materials as well, so they may want to take a look at that.
Sucheta: Thank you, Peg, for being on the show. I really enjoyed our conversation.
Dr. Dawson: Likewise. Thanks for contacting me.
Producer: All right. We are back and wow, another great conversation with Dr. Peg Dawson, Sucheta. She has been a joy to have on this show. One of the things that you two talked about was this idea that executive functions have become much more relevant for success in school and of course beyond. Dr. Dawson certainly warrants that if we do not help our children with these issues, they can have severe consequences. Right?
Sucheta: They certainly can. As you saw the way I asked the question, that what is the risk that we run when we don’t intercept, when we know the child is struggling or is having difficulty in becoming independent or skilled? She was quite clear that even though we understand that these skills take time to mature and they don’t emerge at the same time, the biggest risk we run in formal years of learning is the child will fall behind and increasingly, this can create a great sense of stress and disappointment with the child’s progress and success. This things that I’m most concerned about is that during the formal years of learning, at least the skills that we are needing to see emerge are in the area of executive functions but a lot of formal educational components are also mastered through practice through executive function mastery. So these students when they leave high school or leave college, they may come out at the other end without truly having mastery. And that can create a disadvantage for their workforce entry or their capacity to become a gainfully employed citizen of this world.
Producer: Well, what I thought was a very important segment of your second conversation with Dr. Dawson was she presented three options to help manage executive functions. I think it would be great if you would review those with us.
Sucheta: Certainly. I would be happy to. One thing, again, our listeners need to really take it to heart that her message, my message and all the experts that are out there who do important work with executive function, there’s a great, great common mistake that happens, which is, students who are underproducing, underachieving, or they are producing poor quality of work or they stop producing altogether often run a risk of being called lazy. Lazy is a character flaw. Lazy indicated that you have all the capacity and skill you are choosing to defy. You are choosing to resist. You are choosing to oppose. That is not true. That’s why we need to pay careful attention to how we support.
I love the framework she gave. The first takeaway of managing executive functions is to environmental expectations, to modify environmental expectations. One thing that she means by that is to really teach students or kids how to adapt the response to the task that they are work with. If the entire task is too large, then what is allowable and unproducable? For example, if you expect your child to make the bed and if the child is not making the bed, then the first step and maybe you make the bed and have the child put the pillow on it. What you are doing is you are maintaining the task engagement but you have taken away the load. This taking away the load is guaranteeing engagement; and second, it’s also breaking it into a smaller part. I see that as a very valuable way of managing the productivity and having a place where you can always start. She also pointed out that this is not lowering expectations. In fact, it is opposite of that. It is actually creating expectations. So you are creating skills that go into meeting the expectations.
The second takeaway, I thought was really, really, critical, is the actual skill development. She believes that one can do that through managing behaviors and promoting the skillset that compensate for the deficit. She has some really nice suggestions about that.
The last part she talks about is how to work on motivation and how do we motivate the child to engage in strategies. This is another very critical part in managing executive functions. In my talks and in my work, I always point out that it’s very easy to tell kids what to do. If you are telling the kids what to do, your own executive functions go into it. That’s not what’s going to help the child to develop the executive functions needed. She has nice suggestions to engage the child’s motivation, to see value in the strategy that I provided and eventually a possible way of shifting that focus so the strategic thinking can be taught through problem solving as well.
These were the important takeaways that I found that were very relevant. The last part, I will say, which is a takeaway for parents, that parents might find themselves ineffective working with students or children with executive function challenges because there’s not consistency and quite often, to be honest with you, there is a lot of resistance. She has some suggestions for parents that (1) she said not to beat up on yourself. If you’re not getting cooperation to be forgiving of yourself. The second point that she made was also very important, which is, where are you going to be consistent? So focus on the area where you can guarantee your own consistency. So coming up with elaborate systems that you cannot keep up with probably is not the best idea. So something simple where you can be effective simply because your consistency is a great, great takeaway.
I think it’s a wonderful conversation. I recommend those who have missed the previous conversation to go back and listen to part 1. But Todd, it was a really empowering conversation that can add great value for our listeners.
Producer: Well, I couldn’t agree with you more. If I’m a parent or frankly even an educator who’s dealing with children or students that have issues with executive functions, this was in fact a great conversation to really give you some keen insights as to how to move forward. So great stuff. All right. Well, that is it for today’s episode and our second conversation with Dr. Peg Dawson. On behalf of our host, Sucheta Kamath, and all of us at Cerebral Matters, thanks for listening today and we look forward to seeing you next week on Full PreFrontal.