Full PreFrontal

Ep. 175: Dr. Milton J. Dehn - Working Memory and Executive Function

January 10, 2022 Sucheta Kamath Season 1 Episode 175
Full PreFrontal
Ep. 175: Dr. Milton J. Dehn - Working Memory and Executive Function
Show Notes Transcript

Working memory is the most vital component of strong Executive Function as it allows for processing multifaceted information and tracking new systems we deploy to manage change or challenge with adaptive flexibility. For example, greeting people with a handshake or a hug was thrown out the window during the pandemic. In the fall of 2021, when people began to return to business-as-usual, people needed a new system to communicate their level of comfort with social proximity and interpersonal space. Some proposed a three-dot system - green dot for hugs, yellow for elbow bump, and the red for keeping a distance. By thinking on their feet,  creative marketers and  event organizers created bracelets, stickers, and dots on their lanyards so that the participants could show who’s comfortable with what level of touching and handshaking.

On this episode, retired school psychologist, Associate Professor, School Psychology Program Director at the University of Wisconsin-La Crosse and current Test Development Project Director for Schoolhouse Educational Services, Dr. Milton J. Dehn, discusses the link between working memory and metacognition and Executive Function and ways to support and promote the development of these skills to improve the learning experience of children and functional outcomes for all.

About Dr. Milton J. Dehn
Milton J. Dehn, Ed.D., was a practicing school psychologist, an Associate Professor, and School Psychology Program Director at the University of Wisconsin-La Crosse until his retirement. Currently, he is the test development project director for Schoolhouse Educational Services. His interests include assessment of cognitive abilities, memory, dyslexia, and executive functions and using a pattern of strengths and weaknesses approach to the identification of specific learning disabilities.



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.

Support the show

Sucheta Kamath: Welcome to Full PreFrontal exposing the mysteries of executive function. As you know, this podcast is all about how to craft goals, how to create a plan, how to organize our life, and how to achieve, and particularly if we are responsible for other people, such as children, who are, who we are guiding and helping to become most effective, successful, and greatest problem solvers. So, one of the topics that often comes up when we talk about executive function is working memory. And I'm going to tell you a quick story about this. Because, you know, I love the show Family Feud, primarily because it always illustrates people's poor executive function skills, in a way or greatest executive function skills. So many of you know what the show is about. But here's a quick recap of the process, you know, at the end, in the final round, for the winner, the winning team sends two representatives who get the same questions. And the first person answers the questions and the other person is in the back. And then they flip flop and then the person who was in the back comes out and answers, but they don't get to hear each other's answers. And the interesting thing about that setup is you have to not only give a correct answer to the questions in this rapid format, but you also have to consider what the audience member might have thought about the answer to be because these are not correct answers. But these are aggregate of audience members consensus about commonly thought answers. So one of the interesting things is, it's always about juggling your working memory, to think about what other people are thinking, think about how to answer this question correctly. And in once a funny round I witnessed, there was a rapid round where husband and wife were the team. And the husband was asked several questions he answered, and then the wife was asked, and obviously, it's, of course, you cannot answer the question that the husband has given. So here are some questions which were will tickle you a little bit, which is, if you are getting divorced, who would you tell first? So the husband said, mom, and the wife said, friend, and of course, a friend probably has a better answer, because you are trying to think who will be the right person? So you have to kind of think, and the last question that cracked me up, because the question was, what's the most popular salad dressing that is a name of a language. And the wife said, French, which is actually a dressing and the husband said Russian. So of course, Russian is a language but not a dressing. So that's a great illustration of use of working memory. And this is something you don't get to master in a minute, or particularly on a show. And there are a lot of people who have spent their lifetime understanding how the working memory works, and what are the ingredients to making it more efficient and successful. So with that in mind, it's a great pleasure and honor to invite my fantastic guest, Dr. Milton Dehn, he was a practicing school psychologist and associate professor and school psychology program director at the University of Wisconsin-Lacrosse until his retirement. Currently, he is the test development project director for schoolhouse educational services. His interests include assessment of cognitive abilities, memory, dyslexia, executive function, and using a pattern of strengths and weaknesses approach to the identification of specific learning disabilities, which is a fantastic approach and can wait to talk to him about it. So welcome to the podcast. How are you today?

Dr. Milton J. Dehn: Well, thank you, and thank you for inviting me in for this opportunity.

Sucheta Kamath: Well, you have so much wealth of knowledge. So I'm thinking that and I hope this experience proves to be quite enticing for you to come back because I would love to talk about self awareness as well. But since we are going to talk about working memory today, before we do a deep dive, I often ask my guests who are experts in cognition executive function, such as working memory, and you're a psychologist, educational psychologist, I'm a little curious about your own skills and talents, or your own learning strengths and weaknesses when you were younger, a student and a learner can you tell us a little bit about that?

Dr. Milton J. Dehn: Well, learning was probably too easy for me. So I was my weaknesses as an adolescent would have been initiating my my homework and projects and assignments and once they were initiated, I was very persistent at finishing things. In retrospect, my planning and organization could have been a little better as well. I would often just begin a project without thoroughly planning it through and then would have to retrack to adjust my plan as I went. I think I was a good problem solver, with novel problems, and so on. And you know, in general, I think my executive functions were pretty good. It's interesting as you age, you become more aware of them. And I just recently turned 70. And so you can see more challenges and a decline in your executive functions. And, in particular, in your working memory, you realize it's a normal decline going on. And I want to add that more recently, about seven weeks ago, I received a pretty good concussion in kind of a freak accident. And so for the first time in my life, I not only gain more empathy for individuals with concussions and a deeper understanding of what's involved, but also my working memory took another step in retreat, and it's pretty well recovered here six, seven weeks later, but I still not 100% What I was prior to the accident. So, um, you know, that'll say, and you don't miss something until it's gone? Yes. You know, it's you become more aware of it, because you know, what you had, and, you know, it's not there. And so I had to resort to some working memory modifications, such as more note taking throughout the day. But there's my brief personal history. Thank you. Regardless of where executive functions are, in general, developmentally, it just depends on the immediate challenges of the day and how we respond to those.

Sucheta Kamath: I love that. And first of all, let me say I'm so sorry, for your concussion. And it's so interesting to me, because my journey, my work as a speech language pathologist, my specialization is cognitive rehabilitation. So my wheelhouse was concussions and traumatic brain injuries, particularly mTBI, mild traumatic brain injury. And always one of the striking difference between those with developmental problems, such as ADHD, and dyslexia, and learning disabilities versus concussions, is always a little bit benefit. Or they brought in a little bit insight, particularly those who had skills in lost it had much more motivational alignment that was so much different than people who didn't don't have insight are not typically aware of their lack of awareness, tend to be much difficult to coach. So, yes, and having that expertise for you to become the observer of yourself, you probably were able to quickly guide yourself and kind of, you know, even adjust some of the approaches to your daily needs. So that brings us back to this very profound distinction that you pointed out that executive function, two things I often say just the way you describe that these are palpable in absence, not in presence. So when executive functions are working well, person is proficiently navigating the world and the responsibilities and the facets of life life are met. It's only when we stop meeting them, then we become aware, there's something wrong. And second thing you said there contingent upon the demand on your performance. So they're contextually specific if the mom and dad are kind of packing the backpack and putting the homework for the child or calling, texting the kid 10 times about what the homework should be or what they should do. There's no need to manage. So how would you for our audience, define executive function from your long history as an educational psychologist? And what is what what role does society play in designing expectations and removing those or making those expectations invisible, so that you still meet and become independent?

Dr. Milton J. Dehn: Well, the definition is a challenge because there are many different models. So I will, I will keep it to the basics. In my definition, I think Executive functions are broad and they include many sub skills. But primarily it involves self-regulation and self-awareness are the two main components. And in as applied to all aspects of life, our work life academically or work or social, emotional aspects as whatever type of functioning were involved, executive functions will come into play. It's often been equated with a metaphor of a board of directors, for example, but it's not just one thing. There's a board of directors helping you to self regulate, but in a sense, it's it's this decision making, you know, at a higher level. For example, you know, deciding which cognitive strategy am I going to use in this particular instance to solve this problem would be an example of executive functions. But it is complex, especially because we've tied all sorts of things under it attention and working memory that stand on their own as constructs. But neurologically, of course, are connected with executive functions in general. So it's more than just a control center and self regulation, I think the self-awareness is a significant part of it. And I just want to insert that, you know, I, I started researching and thinking and working about working on executive functions when I was in grad school on a doctoral dissertation in the mid 80s. And the funny thing was, I was not aware, I was working on executive functions, because we called it metacognition, and I was focused on the awareness. Oh, executive functions. Um, and your question about society and the role there? Would you repeat that question, please?

Sucheta Kamath: Yeah, no, I was just thinking, one of the ways that, as you mentioned, you know, the self awareness and self regulation, if you think about transition, from elementary to middle school, middle to high school, and then college and career readiness, maturity, one of the biggest shift that happens is that others have expectations of me. And then am I meeting them? Or am I failing to meet them becomes a gauge of progress, right, personal progress. But the eventual real trick or skill? is I have these expectations of me, and then am I meeting them or not? And and I find that one of the, and you have a very long view of the societal changes. I'm wondering if you're seeing any shift in 21st century where the expectations from children to demonstrate self regulation to me have gone down a little bit. And there's so much help and support that is offered that sometimes if you don't regulate yourself, is okay. So I'm just wondering if we as a society play any role in that? Or can we shift it to more independence?

Dr. Milton J. Dehn: Yes, I think societal expectations are playing a role in the not just the development, but the performance of executive functions, how independent we're expected to be how much structure is provided, how much support is provided, there's numerous ways of looking at that. But I would think of the working memory example right away in that we have all this technology, that in great part eliminates the need to rely so much on our working memory, you know, beginning with calculators and not needing to do it mentally. Um, and so there's been some concern among working memory accurate experts, for example, that our technology and what we're currently valuing is making our working memory weaker. And I think that would apply to other aspects of executive functioning as well. Even how well we independently initiate projects, we have all sorts of technology to remind us and support us with beginning of project and, and so on. So yes, I think, um, there could be a good argument made for the technological aspect, and just society's expectations in general may be reducing in slowing executive functions, compared to where they might have been 50 years ago. So I haven't thought too much about that lately. But I, I think it is a concern.

Sucheta Kamath: So now that...

Dr. Milton J. Dehn: Culture as well influences that as well.

Sucheta Kamath: Yeah, and and I think now that you mentioned working memory, and these assisted external working memory tools that we have, let's dive into the concept of working memory. What how would you define working memory and, you know, I used to give this example like, and again, this has also become moot because, you know, people used to call when people call us and left a voicemail, you would actually take a pen and paper to write down the number they left, right. And now you have a visual voicemail that the number can pops up, and you can actually even press on it for the call to go. So that takes away this ability to retain those seven digits of number. So help us define that for us. What is working memory and how does it work?

Dr. Milton J. Dehn: Well, simple definition I like to give to parents is that it's thinking and remembering at the same time, such as you're thinking about what you're just reading and remembering what you're just reading so that you can comprehend it. Or doing mental arithmetic is thinking and keeping that information in mind. And so it's a it's a short term kind of memory, but it's more than short term memory. So stepping up a level what the definition a simple equation is that it is processing information while retaining that information in the short term. So it's short term memory plus processing equals working memory. And then all models, what we refer to as short term memory, that short term retention of the information. All models have that embedded within working memory. And even neurologically, they're closely tied together, of course. And so, sometimes to keep it simple, we may say to a parent, well, it's short term memory, but most of them will get it, you know, it's thinking about it, and remembering what you're thinking about. So it's processing your thinking while keeping it in your short term memory.

Sucheta Kamath: And so, yeah, continue. Oh, go ahead. No, so I'm curious, is it fair to think about working memory as as a system, and which has this component of processing, but choosing or selectively paying attention to information that matters, which is that discernment? But what role does attention play in that, because you may have great working memory, but you may be choosing to pay attention to information. That's irrelevant, right.

Dr. Milton J. Dehn: And there's a great deal of overlap between how we define attention and the behaviors, not just the construct, but even neurologically, they're both controlled in the prefrontal cortex. And so it's sometimes quite difficult to differentiate between attention and working memory, for example, and a huge research project on working memory in United Kingdom, the number one thing classroom teachers reported about students who had working memory deficits is that they have attention problems. And so the behaviors are very similar. But obviously, for working memory to do its job, we need to focus our attention on the task at hand, or that information that we want to process and so often say that attention is a necessary, but insufficient prerequisite for good working memory functioning. That makes a lot of sense in that relationship. So you could have good attention in terms of sustaining attention focusing dividing your attention, but on the other side of it, you could still have weak working memory capacity, and then you would see that in poorly performing working memory. But the problem is, sometimes our poor working memory performance really goes back to the input side, that focus of attention on not being what it should be. So that's why kids with ADHD, you're generally can be tested, and they're going to appear to have a working memory and attention deficit at the same time. And so but I think we can sort it out, you know, try to have their attention, for example, whenever you're presenting items on a working memory test, so we can reduce the confound, that attention might be causing. So we could say, well, all behaviors indicated, this child was fully paying attention and still struggled on the working memory performance, we have no other indicators of attention problems. So that's quite interesting. And a challenge to differentiate sometimes we just have to conclude. It's, it's some of both it's it's a double weakness, in a sense.

Sucheta Kamath: And you just alluded to this concept that it is really complex. And it has many layers, as you said, levels of impact. One of the things I was thinking about that, you know, working memory is really, really essential in holding on to two or more conflicting ideas. And particularly when we have weighing options and determining, you know, decisions, right, and the dissonance, or even complex or contradicting ideas that we know somebody whose views we like, but they have also said that and then we begin to weigh that. And if we don't do the weighing, well, then that can make us very rigid and inflexible. So do you see working memory playing a role in that way? Not kind of having enough bandwidth to weigh differently, calibrate information?

Dr. Milton J. Dehn: Absolutely. Um, we can compare and contrast to way to do the reasoning involved. We need to hang on to those pieces of information that we're considering in our working memory. And certainly, that plays a huge role. In fact, I wrote an article on that a couple years ago, the role that working memory plays in fluid or logical reasoning. Yes, and I can forward the link and you can share that with your viewers later on. But absolutely, the neuro psych evidence indicates That, that's again, working memory is a prerequisite for that type of thinking, weighing back decision making all of that. Even good planning goes back to having the working memory ability to do those planning steps and problem solving steps. And then with reason, deductive inductive, whatever type of reasoning we're doing, working memory is required to support that.

Sucheta Kamath: So you kind of maybe you have alluded this to this already, but can you then summarize for us the, how our working memory, executive function and attention all related?

Dr. Milton J. Dehn: Right, well, to begin with, they are interrelated neurologically, because their controls are in the prefrontal cortex. And so neurologically, they have that similarity. And you can even see that when a child is taking medication for attention, as if that working memory performance will improve along with that. And it might be an outcome of better attention, but it's also directly impacting the working memory control center with with the medication. And to back up to load it back up to what do working memory deficits and attention deficits have in common the most, the research tells us that the underlying weakness might be a weakness in inhibition, which is negative function. So we're not we often talk about inhibition, weaknesses in children with ADHD, but the research tells us that we need also need good inhibition for working memory itself to function well. And so in that way, they're all related. Now, of course, there's aspects of executive function that play less of a role in interaction with working memory. But the big three that interact with with working memory would be inhibition, shifting, flexibility, and, of course, attention in general. Those are highly interactive. And so part of their backup executive functions, executive functions, because it's not just one thing, different aspects of executive functions can be a different levels developmentally. But it all is tied together, especially in the big three, inhibition and shifting, and flexibility.

Sucheta Kamath: I love that. And as I was thinking, you know, I often use this metaphor of a bouncer, you know, getting into the club. So if you think about what information finally reaches that higher order processing unit, and we need some levers that get put otherwise, no riffraff will enter. And so is that a fair way to think about working memory acting as a bouncer for information processing? Or is it the entire club? 

Dr. Milton J. Dehn: Well, of course, attention plays a role there and even making a conscious decision as to what to focus on. And that's why with poor inhibition, you have distractibility, entering both internally and externally. And that will derail what to hold in working memory and finished processing, more multitasking, you're trying to do at the same time, you're going to be losing more information before you finished processing it. So it is it is complex. Did I address that question? 

Sucheta Kamath: You did, you did and so maybe it's a great time to maybe give some examples of everyday, everyday examples of working memory? Where would people see I kind of alluded to that my family feud long set up, but that is a kind of, you know, thinking about other people's answers, thinking about your wife's answer, then coming up with the answer that's not a repeat, and doing it all fast. That's a good example. So do you have some other life examples? Examples from everyday life that pertained to we needing working memory?

Dr. Milton J. Dehn: Well, I'm referring to what knowing what other people are going to say almost goes under your acquired knowledge or automaticity. So the more expertise you have, the more knowledge you have, the more that reduces demands on working memory to deal with that right here and now is novel information. So that's a good thing. automaticity and mastery, reduce demands at working memory, even personal conversations, you know, you know how your wife feels about it, what she's going to say, it takes less working memory to maintain that conversation, discussing something new that you've not really hashed out before. So um, the other aspect of that personal life of course, the most common thing is what did I What was I just going to walk into this room and I for that, why menu, what was I doing? What was I going to say? And we often try to mentally retrace our steps. There was actually a research article I heard about where they say if you walk into a room forget while you're there retrace your steps physically. Go back into the room where you began. And then through that door again, it might cue or prompt. You know what, what you were planning to do. And it often does, it often comes back, we make an effort to retrieve or say thinking about, and it comes back, but I'm in conversation, it can show up, you know, forgetting what you were going to say, or, you know, what the question was, for example, at parts of the question. And just lots of things like that, that, especially when you're multitasking to drop the ball, you don't realize it till later, oh, I was thinking about that earlier, I forgot to do it. And then I finished this other task that I had in mind at the same time. So I think, you know, when you start talking to parents about, you know, they'll, they'll start talking about short term memory and attention, and I think you can weave that into higher elements and working memory. Um, you know, can the child you know, chew gum and talk at the same time, almost, it's not that simple. But it's, I think the multitasking is a huge part of it, you know, the stronger your working memory, the more successful you can be at multitasking. And everyone's doing that with the technology nowadays. So is the child able to multitask even on routine activities? Course, the obvious thing is multi step directions, if you give the child two three step directions at home, just like in school, you know, they forget two steps before they get to them. So it's pretty easy to see in daily life, I think, especially in a work environment, it's it's pretty obvious too.

Sucheta Kamath: Yeah, and I think even, you know, like you mentioned, taking a message, or even if you're in a group setting, or maybe you know, on a Zoom, and you're tracking conversations, or different points raised by different people, particularly if you're the person who's taking minutes, you have to really kind of not only keep track of what is being said, but also decide what would the readers of these minutes like to, you know, get out of this notes that I'm keeping, and not write down every single thing that was discussed? And so that requires working memory. And so, in academic life, I can think in many ways this, you know, working memory and executive function plays very important role. We talk a lot about that. Can you share from your wonderful knowledge and expertise as a school psychologist, where have you seen working memory deficits show up in in students ability to succeed or become independent learner?

Dr. Milton J. Dehn: This is a very important topic, because two things up front, just two general categories, acquiring the skills, the achievement reading, math and writing, etc. And then the performance side. And the interesting thing about working memory is it impacts both. And I'll tie into the learning disability research on the achievement just a moment. But I want to go to the performance side because people often misattribute performance problems. It takes him three hours to complete simple homework, you know, and he's constantly asking for help. He's spinning his wheels, if we get signs, they're spinning their wheels, and they're otherwise motivated, and don't necessarily have ADHD. It could be working memory shortcomings, because we forget what we're going to say what we're going to write with, forget the directions, we forget what step we were on. And they have to keep recycling gets pretty frustrating takes a long time. So that's more of the performance side. I think we have to remember that a child that's underachieving has the intelligence and skills but then poor performance. Don't just attribute that to social emotional behavioral factors. It could be a cognitive executive fact that we're going to make that point up front. But most of the research absolutely hundreds of articles, on connect research, strong correlations with develop main academic skills across the board in all areas. There's just an abundance of evidence there. More recently, one summary that in evidence is by Dr. Richard Woodcock, we took 6000 clinical learning disability cases and analyze their cognitive processing strengths and weaknesses. And the one that stood out the most across all areas of achievement was working memory. There wasn't any doubt about that. Some of our other processes, it's debatable, you know, phonemic awareness, for example, may not be a weakness for mathematics very much. But when it comes to working memory, it's going to cut across the board. And so that my favorite researcher on this is Lisa Swanson, who a professor at UC Riverside wrote dozens and dozens of articles. documenting that kids have specific learning disabilities, whether they're 3D math or writing and dyslexia, there's just no question that working memory deficits are a significant aspect, and likely cause one of the major causes of their learning disabilities. So overwhelming data there. And so I think one other stunning statistic I want to insert here, again, from that United Kingdom research, which had a huge number of subjects and schools in it, they found that about 10% of students had a working memory deficit. But the more stunning statistic was that 90% of those 10% students with working memory deficit 90% of them had significant learning problems, or would go on in the near future to have significant learning problems. Wow, that was a huge finding.

Sucheta Kamath: Wow, you know, I really love the way you have framed this, to understand that learning to begin with means not knowing, and not knowing comes with this burden of how do I go about knowing right? And once I know, how do I show I know. So both parts are inherent to become being a successful student, but I love the way you framed it as acquisition is different than production. So when we acquire, we are following we are responding or asking questions. But we are also making meaning we are creating abstract constructs or connecting all the ideas that we are acquiring to prior knowledge. And then when it comes to this performance, we have this, you know, show what I know. And that's showing can be, you know, true false, it can be matched the definitions, it can be write a narrative answer or produce a paper or take a test. And I also see, and you and I have seen this in our work with children, particularly with disabilities, that their performance varies based on the type of ways they're asked to show what they know. So can I ask you one more follow up question on this idea of performance? Some people are great test takers, and some people are great. You know, homework producers are terrible test takers. Is there any? Or how do you understand or explain this difference, you know, being good at test taking, but not just having the other elements of performance, which is turning your homework on time or, you know, participate in, in a project group project. And they may be some of our children with disabilities do a terrible job, but they're fabulous at test taking. So how do you see that we are learners who have to demonstrate all these abilities?

Dr. Milton J. Dehn: Well, I think, as learners the more self aware we are of what's going on. Because usually when I would test adolescents and discuss working memory to them, it was known as a concept that they were totally unfamiliar with, they would think memory is just one thing. And they were basically talking about long memory, or they would think short term memory lasted all day. But in test taking, for example, obviously, working memory can play a role. Because when you're trying to retrieve the facts, is this the answer to the question, evaluating what you've retrieved. And analyzing it with reasoning, it's going to take working memory already mentioned for the reasoning part of it. But it also takes working memory, to evaluate what we retrieved and to do an active search. So you think, Oh, I know this fact, I studied it, and I'm having difficulty retrieving it, and you actively try to retrieve it. Oh, I was reading it. I saw it on this page. That's your working memory supporting retrieval. So this is a new aspect we haven't talked about there is an interface between working memory and long term memory, not just in getting it in there, supporting the learning, we hold the information long enough, make sense of it make associations for long term memory and get it encoded, but also in the act of retrieval. And, and so that's how it can affect performance in the moment with retrieval. There's other variables such as test anxiety is a significant issue with students nowadays, the more anxious we are, the more that's going to interfere with good working memory functioning. Because we're not able to inhibit that enzyme becomes a distractor in and of itself. So there's there's lots of relationship there in terms of that type of performance, performance based tests, for example. So we may know the information habit skill, but, you know, in the moment, we need working memory, functioning well, to demonstrate those skills. I certainly certainly agree with that.

Sucheta Kamath: So then, I know this is something we need a lot of people are thinking about this, but what is the relationship between working memory and mental health or the mental health crisis? We are we are encountering, is there then some merit to addressing working memory to alleviate some of the mental health difficulties?

Dr. Milton J. Dehn: Okay, well, the research tells us when you have mental health difficulties, that is going to be impairing impacting your working memory, whether it's schizophrenia, or anxiety, as I just mentioned, or depression. Most disorders, they're, you know, there's an interactive effect there, it's going to least temporarily, you know, impair your working memory. For example, if you're in a, you know, depressive episode, your working memory is not going to be functioning at par. And so there are strong relationships there. Autism is a little puzzling, and some children with autism have exceptionally good working memories. So there's a disorder entity we can make a categorical statement about. But in a lot of disorders, even down syndrome, for example, you know, compared to the child's overall cognitive functioning, Down Syndrome, they found within that disorder, there's a high risk and a likelihood that working memory is going to be a weakness relative to your other cognitive abilities, even at that level. So in general, I think anything that is impacting neurological performance in general is going to impact working memory. And you know why? Because we're memory is not just in the prefrontal cortex, our performance and working memory depends on integrated wiring, if you will, and all the connections. And so the more interconnectivity we have, the better our working memory functions, because it's interacting with aspects of short term memory and other processing and encoding and retrieval. And that's why I'm working memory goes south, and we have a concussion. One of the main aspects of concussion injury is stretching and tearing that connectivity, and it needs to repair itself. For working memory really to do well. I just want to insert this. So an interesting study to go in Japan found that when they did intensive working memory training, and they improve working memory performance significantly, you know, what they measured in the brain, they measured the growth, significant growth in white matter, in other words, increased connectivity in the training, and that led to better performance. And so anything that's impairing connectivity in the brain is going to hurt them, including slow processing speed. So if we have slow processing speed, it's similar to attention and that the processing speed is a necessary, but insufficient prerequisite for working memory. That got me excited.

Sucheta Kamath: So exciting. And you know, I think it just kind of reminded me of the fluid intelligence work, right? Because that, that interconnectivity is, is it's not just information, access to information, it is really making meaning and that the sources of that storage is in different parts of the brain. And that's why most lit up brain is likely to be managing the information most proficiently, right. So interesting. I love the way you're, you're explaining this. So let me ask you this. Can we talk about the neurodiverse students and the need to promote their executive function and working memory? What can we do? And you alluded to that. So we know now that we can't really expand working memory, but we can definitely improve the way we manage information by learning a lot of meta processes. So how so set is set a set of stages stage up for us? How should we approach interventions when it comes to working memory or supporting or promoting executive Oh, working memory and executive function?

Dr. Milton J. Dehn: Well, first of all, and making the case with neuro cognitively diverse students. Executive functions can help us realize our capabilities better. And I'm reminded early on in my career, seeing you know, two students had both had an IQ of 80 to 85. One was failing most classes and the other was passing and doing really well in most classes. And even then I recognized what was the difference? It wasn't just motivation or support. And even looking back on it, I'm quite clear, it was their executive functions. The students with the same IQ, same ability level, the one that was failing, the executive functions were delayed sub are none, you know, the very successful student the same ability level, and well developed executive functions allowing that student to better perform and reach their potential. And so executive functions in general, I think it's important to point that out that this isn't just something on the side that if we just focus on achievement skills that we don't tie into executive functions, you know, we're not completely helping that child. And with working memory itself, it's the same thing. You know, people might say, well, you're on test scores show that the child has average working memory, why should we work on that? Because working memory is a core cognitive and executive process. And if we strengthen working memory, it will help the others. And a good example of that is in my memory work where you know, we have TBI or some other documented cause. And we clearly have long term memory impairments, you know, maybe damage to the hippocampus due to a health condition, whatever it might be. And people will say, well, we want help with long term memory. Well, yes, we can work on that. And a lot of that is strategy based. But at the same time, if we make working memory is stronger than it is right now, it can better support your long term memory weaknesses, even I've seen that in my case studies. And so that's where we get started with that making the case for it. Now, where would you like to go with intervention ideas? What would you like for a follow up there?

Sucheta Kamath: Yes, so a few questions about so when I think what I'm hearing you say this idea that number one insight, right, like executive function is the pathway to insight. And I love your work from that perspective, because you are really kind of unlocking the access to one's own potential, which comes from inside, like I am weak at is not a bad thing to know about yourself, or I am good at can be helpful. But that good ad can be used to improve what I'm not good at. So I love that approach. So is this how we can think about in my work, which is exactly what how you described is really educating children and adults about the way the brain works, and how our brain is subjected to challenges or faux pas, based on even day of time that amount of rescue have gotten, why tell this information because it becomes a tool that they can use to navigate the landscape of demands. So is that a good way to think about metacognition as a first step to intervention or support? Right?

Dr. Milton J. Dehn: Metacognition is important, I won't do any intervention with automatic cognitive components. Because you start with identifying where your strengths and weaknesses, you know, what does this mean, and how that works for most people, and how it works in your brain understanding that. But the last step, we don't want to leave out. So as you teach some strategies, or even cognitive rehab exercises, they need to understand what the purpose of this is. But yeah, if you can demonstrate that it's working for them. One things I like to do in early memory interventions is, okay, you, you memorize this list like you normally do, and typically they'll just do it in real fashion. And then I'll introduce, you know, a basic strategy to enhance memorization coding. Now, we've got a comparable list, you try it this way. And I win 99% 90% of the time that their recall jumps from 50% to 90%, simply using a new strategy. And we point that out right away and say, look at that, you know, that works for you, you know, can we make that work, you know, in your studies. And so it's kind of like self efficacy, if you want to begin to grow and improve. That's the hook for them. You know, it's like teaching seventh graders study skills, and they pay no attention, they see no value in it, because no one ever pointed out to them. If we study this way, use this study skill. Look how that improves your performance or saves your time. And so that's the on the end of the metacognitive continuum. It's so important that this not only this works for me, but what works for me going back to the neurological boy, if you can make those connections, you've got a committed, committed trainee, and they're going to get a lot more out of it.

Sucheta Kamath: I love that. So let's talk about the middle. So you set the stage in the beginning about the metacognition, this is why you're struggling, what is working memory, this is how it works in the brain. Different people have different brains, so it works differently. That's the setup, then the strategies and then hey, look at the data. It worked for you and this is why I love that. So what is it actual that people do and some of the research work that I have come across is the barefoot working memory movement. You know, the research some recent findings show that walking or running barefoot? It can also improve working memory or some of these alternative paths of you know, using some oils, rosemary and peppermint essential oils have shown to improve because they have acetylcholine. Is that something we should be thinking about other than the actual cognitive strategies? So I want to talk about both. But what are your thoughts about that?

Dr. Milton J. Dehn: Well, I don't know anything about the barefoot aromatherapy a little bit, but it's similar to two things. Good aerobic physical exercise helps both working memory long term memory because it helps cognitive functioning generate general by increasing the blood flow to the brain. The other thing that helps memory in general, especially the hippocampus is good blood sugar levels. So the reason kids benefit from breakfast at school is that if you go to school on an empty stomach, you don't learn and remember as well, you know, until you get some food and you get your blood sugar up to a higher level. A lot of people are very unaware of that. So there certainly are physical things such as exercise and diet, that make a difference for both working memory and long term memory. Um, some of these other therapies to be quite honest, I'm less familiar with. I don't think they can do any harm. But I'm not sure the exact relationships. And it's kind of like the controversy. I don't know, if you're going to go that, you know, there's a controversy over, you know, all of this online working memory trading, really, is it effective or not, you know, yes, or no, children get better at that activity online, you know, does that transfer over to working memory in general, you know, less evidence of that is a transfer all the way over to achievement, even less evidence. But I would argue that, you know, it causes no harm. And, you know, it's like a muscle, you know, the more we make it work, you know, there's no harm in that it may become stronger. And also, I think, you know, the critics of the online training, they're not looking at how it might impact daily performance. But I know when cod made a lot of their early research, they were documenting what happened in the home environment, the child became more attentive and successful in the home environment. So we shouldn't just be looking at achievement as the bottom line I, I had to insert those.

Sucheta Kamath: No, I think, you know, if I can just circle back to that point. My personal experience and familiar with the tools, I myself have created an entire online executive function curriculum. But I like to really the distinctive factor about ExQ, is metacognitive approach that means talking, building efficacy, not building a random set of skills that has no bearing in life. So self efficacy is do I know who I am? Do I know how my brain works? Do I have some agency over the the demands on my functioning? And can I guide or redirect myself to become more effective in in the context of need, to me that is more valuable to empowering the children with that, then a particular activity that may have bearing on a one particular part of cognition? I mean, yes, you know, I can also memorize like, you know, list of 70 items, but where in my real life, I'm required to now remember, 70 items, but what I am required is to keep up with a list of 70 items over a period of two weeks. And do I have navigational strategies? So is that a good way to think about any type of support or training that we offer?

Dr. Milton J. Dehn: Um, well, again, there's long term memory aspects tied into that, you know, just basics, such as how important periodic review is, but to back up to the metacognitive. Another piece of that, that I think is related to this is knowing when to do something. So I have the memorization skills, but I don't if I don't have the awareness of knowing when it's a good idea to employ those skills, you know, I'm still going to lack you know, acquiring and performing the best that I could. And I think that applies to most executive functions across the board, we can have the skill, so when directed to do it. Sure, we know how to do it, we can do it, but we may not be doing it independently or successfully, because we don't recognize when, from the cues. It's a good time to do this, that we need to do it at this point. And so that kind of ties into it to for success with these strategies and performance, not just knowing how to do it but knowing when to do it is really important. You know, that applies to working memory to you know that, oh, I know, I recognize that. If I, you know, hear a phone number and you know, I don't have a device to enter into a recorded reading to write it down and I want to remember it, you know, that might be time to use that rehearsal strategy of repeating it until I get to somewhere where I can record it. 

Sucheta Kamath: So, right. Yes, great.

Dr. Milton J. Dehn: I hope we're not overloading anyone's working memory, you're challenging my working memory right now, which is good.

Sucheta Kamath: No, it's great. So as we come to the conclusion of this amazing discussion, as as our listeners can see that you and I can talk for hours, I really, really enjoyed every single thing you had to say about working memory and our approach and really thinking big picture. So as we and Dr. Dehn, what do you recommend, what has influenced you are, what books have really helped you to understand, or you have enjoyed that has shaped your own growth and, you know, passions, so to speak, that maybe we can find inspiration in your inspiration?

Dr. Milton J. Dehn: Well, as I mentioned, I began with the metacognitive self-awareness in the mid 80s, and early 90s. And, and as the whole construct and attention, executive functions began to grow, and we began to, to assess it. The at first, the connection was with wireless, primarily related ADHD intention and those kinds of issues. But it continued to grow and expand. And I like the work of George McCloskey.

Sucheta Kamath: I know him. He was a guest.

Dr. Milton J. Dehn: Yes. And George has a very broad in depth view of executive functions. For example, in self regulation functions, he comes up with over 30, which all makes sense, you know, most theories would have no fewer. And he applies it more broadly, academics and social emotional. And so it's not just behavior problems related or it's not just achievement related, cut across several domains. So that I think is an excellent source for broadening your view. In terms of hands on thinking and awareness and applications, especially with more ADHD or behaviorally disordered children, I think the work of peg Dawson, and I'm not recalling the exact title, it's executive functions as in the title.

Sucheta Kamath: Dawson has been a guest and her book is, I think, Smart but Scattered is that the one you're thinking?

Dr. Milton J. Dehn: Yeah, and that that's a good one. That's that's a spin off. But her main title has executive functions in the title, and very good hands on ideas and good insights into what's going on there. And there are others, but those would be the big two. And just, you know, learning more about the neuro psychology of it, you know, which we referred to a little bit here and there, I think, really helps grow your own concept to it. And I guess a final message I want to share, especially with practitioners who evaluate children, it's my strong belief that regardless of the referral concerns, or the problems the child is experiencing, and regardless of how young the child is, that I think a good assessment of executive function should be included in every evaluation, whether or not someone specifically requested it, or whether or not the criteria specifically requested otherwise, we're missing the target. And we end up with, you know, young adults and even older adults economy, but young adults have come to me in their 20s and said, You know, I struggled all the way through school, I wasn't dumb, but they could never figure out what was wrong with me. And I didn't have ADHD, it didn't have anxiety, it didn't have learning disability. And finally, by their own reading and research, as they become young adults, they came to me and said, Well, I think I have an executive functions problem where the working memory problem. And so you know, if we don't pay attention to those issues in our evaluations, we're not helping those individuals as soon as they could be helped. And so that's something I'd really like to advocate for. And to the credit of most practitioners in schools, they are more routinely including the executive functions and assessment, certainly for behavioral and, you know, attention related concerns, but let's include it for all evaluations, including the learning disabled, we found in our own research that learning disabled, were half a standard deviation lower and executive functions across the board, similar to ADHD students, and so hopefully, let's pay attention to that research.

Sucheta Kamath: Well, thank you for these words of wisdom. We are so grateful for your time today. Thank you for visiting us and sharing your knowledge. And everyone. Thanks for tuning in. We love your participation and do share this podcast with your friends and colleagues and family members even. And definitely if you have a moment, leave a review. And thank you for calling in and listening to our podcast from 110 countries. So we are really grateful for your engagement and love for the work we do here. Once again, Dr. Dehn, thank you for being here with me. And until next time, be bold, be brave and have fun, everyone.

Dr. Milton J. Dehn: Thank you. Thank you very much and and you're welcome. And feel free to share my email with them. People can email me with follow up questions as they wish.

Sucheta Kamath: We will definitely include all the information about you in our show notes. So we really appreciate that. Thank you everyone. Bye.