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Here I will post interesting questions that have come up in presentations or with parents, along with my answers.
Q What is the relationship between intelligence and executive function (aka EF - see separate question below for definition of executive function)?
A Most of us have an intuitive sense of what intelligence is, but when it comes to defining the concept it is not so easy. For example, one commonly accepted measure of intelligence—I.Q.—is an attempt to quantify some related skills. However, as Howard Gardener points out in his theory of multiple intelligences, intelligence is really a much broader concept, and perhaps there is no such thing as a single “intelligence” as presumably captured in the psychological concept of “g”.
I think of general intelligence as involving the ability to grasp complex concepts, and to be able to problem-solve in a flexible and creative fashion. This would include mental adaptability and the ability to switch among contexts. Often we think of a speed factor as well—as in quick-witted—and there has been increasing recognition of such ideas as emotional and moral intelligences. And then there other many other convolutions such as what is the relationship between existing knowledge (or experience) and raw processing power in problem solving, what is added by the idea of wisdom, and so on.
Similarly, executive function is not a unitary thing, but a collection of mental processes as described in part below. Since executive function includes abstraction, conceptualization and problem solving (including flexibility) there is obviously some overlap between the concepts of EF & intelligence. Interestingly, EF measures have been found to correlate only moderately (in the range of .20 to .40) with IQ tests, probably because IQ tests also measure many things that are not exclusively related to executive functions. Though I couldn’t locate any relevant studies, I would imagine that some EF tests would correlate at higher levels with specific IQ subtests that involve more abstraction and flexible problem solving (such as Similarities or Matrix Reasoning). So the best we can say at this point is that EF involves processes that contribute to intelligence—especially in the realms of creativity, mental organization and flexibility—but intelligence is a broader, more inclusive concept.
Q How can I tell if I should have my child evaluated?
A
This is an important question that parents often ask, and the answer can be difficult to define. Often a conversation with a competent professional is the best way to start figuring out what's best for your child. Behavioral pediatricians and pediatric neuropsychologists generally have simultaneously the broadest and most specific training and experience to help you decide. While there's always a chance of suggesting an assessment for a kid who turns out to be fine in all areas, this is more the exception than the rule. Usually if at least one parent or teacher is concerned, there's something worth looking into. And as Sally Shaywitz (one of the leading dyslexia researchers in the world) at Yale points out, "If we elect not to evaluate a child and that child later proves to have dyslexia, we cannot give those lost years back to him." This is true of all learning differences - the longer they go on, the more the child misses and the longer the young person goes before starting to learn how to deal with their differences and/or getting the remediation they need. Moreover, there are often emotional consequences as well in terms of anxiety, depression, and self-esteem, all of which become harder and harder to turn around the more they become entrenched.
In general, if any of the following apply you should consider an evaluation:
- Significant areas of academic weakness
- either in one skill area compared to the others, or across several areas
- including (at the early stages) difficulty acquiring reading or numerical skills
- A pattern of declining academic performance
- Distractibility, inflexibility or organizational difficulties sufficient to interfere with school and/or home life
- Academic weaknesses that are not responding to intervention as they should
- Behavior that is problematic for either the child or for others, or social difficulties (including trouble making or keeping friends)
- A collection of odd or unusual behaviors that are problematic
The recommendation to seek an evaluation becomes stronger:
- If more than one of the above criteria are met
- If there is a family history for similar problems (in parents, grandparents, aunts, uncles or siblings)
- If there were any significant birth complications, delayed milestones, head injuries, or other potentially contributory factors
When in doubt, call a qualified professional. If all's clear then you'll get some peace of mind, and if there is something significant there's no better time to start than now.
Q We've learned a lot about our child's learning differences, but how do we deal with our frustration and our child's frustration and other feelings that come up?
A This is a huge issue. It is really too large and complex for a simple answer. It is so big and important that I have created a workshop to address it, which you can find at the bottom of my Services page under the Presentations heading. Even this workshop is just the tip of the iceberg, but it should be enough to give you a foothold to get started. Nonetheless, let me sketch a skeleton outline here. First you as parents have to know and take care of yourselves. To use the example that I give in my workshop: in the airline safety briefings they always tell you to put on your oxygen mask before you put the mask on your child. The reason is that if you lose consciousness you will not be able to help your child at all. In fact instead of helping, you'll be a multiple-liability to him or her. Similarly, to the extent that you are not taking care of yourself emotionally it will interfere directly and indirectly with your children's emotional health. So first you must learn to recognize when you are frustrated and stressed and know how to manage those things for yourself. Once you have tools for taking care of yourself (of which I teach some simple ones in the workshop) then you can learn some tools for helping your children with their frustrations and other feelings. Some of these are intuitive to varying degrees for different parents but it is always helpful to review and practice skills that help us meet our children where they are emotionally at a given moment in time (also in the workshop). If you learn well from books and want to do some research on your own about the second part I especially recommend the following book (also see other parenting books linked under Library on the Resources page):
How to Talk so Kids Will Listen and Listen so Kids Will Talk
by Adele Faber and Elaine Mazlish
Q Does watching too much TV as a young child lead to ADHD?
A This is a great question because it is illustrative of how careful one must be in accepting media reports of new findings. Many people have heard or read about a 2004 study connecting TV watching with ADHD. The study found that parental estimates of average daily time spent watching TV at ages 1 and 3 was associated with attentional problems at age 7. However, interpreting these findings is tricky. The measure of attentional problems was a five item scale that only the parents completed. Although the scale has some empirical support, it's a tiny sample of behavior (five judgements) and from only one source (the parents). So bearing in mind that "attentional problems" is a rather loosely defined concept here, the study did find a strong relationship with time watching TV at those younger ages.
The major area for misinterpretation has to do with whether the TV viewing causes ADHD. This is the implication that media reports tend to make, but which the authors themselves point out is unwarranted. There may or may not be a causal relationship, but this study (nor any others I know of) is not constructed in a way to determine that. It could be that the way these kids' brains work led to both watching more TV and to later attentional problems. Or, it could be that the parents had attentional problems as well (ADHD has a strong hereditary component) which resulted somehow in them leaving their kids in front of the TV for longer periods. Or there could be other explanations.
However, having said all that, I agree with pediatric guidelines and common sense that lots of TV is not the best thing for kids. Among other things there are fairly solid associations (though again not necessarily causal) between amount of TV viewing and overweight, aggression, and possible diminished reading skills. Why take chances on any of these things? Moreover, TV viewing is a mostly passive activity which displaces all kinds of more interesting, nourishing and creative ones. Make up a list of alternate activities (reading, art projects, outdoor exploration, etc.) with your kids that they can refer to if they can't think of anything in the moment.
Prudence suggests:
- Under two years of age children should watch virtually no TV.
- For older kids, limit total TV/video-game/computer-game time to no more than 1 or 2 hours per day - preferably only a few hours a week and usually not on school nights.
- Parents should monitor and focus TV/video-game/computer-game time on high quality, low-violence programming.
Here's a link to a PDF version of the original study from the journal Pediatrics:
Early Television Exposure and Subsequent Attentional Problems in Children.
Q People with dyslexia have problems with reversing letters, right?
A The term dyslexia may be used differently by different folks, but usually it refers to a specific reading disability. Current research indicates that the brains of people with dyslexia process sounds differently from most people's brains, in a way that makes it much harder for them to "decode" or translate text into language. This sound processing is referred to generally as phonological processing. As a result, a number of areas can be impacted, from reading to spelling and writing, to other domains. Sometimes what might appear to parents and teachers to be an attention problem can turn out to be dyslexia. While transformations of letters and words (such as reversals) may occur, they are neither necessary nor central to dyslexia. See the SchwabLearning and Dyslexia websites on my Resources page for more information.
Q Are people with ADHD at greater risk for car accidents?
A It is quite well documented that people diagnosed with ADHD are generally at greater risk for automobile accidents. Studies have also shown that driving performance and ratings of driver safety improve with standard stimulant medication. Aside from the other benefits of medication, this is one of the strongest arguments for medication treatment for those diagnosed with ADHD who wish to drive. Conversely, one might argue that people who have been diagnosed with ADHD and are not taking medication should drive as little as possible, or not at all, due to the increased risk of hurting themselves and others.
Q What is executive function?
A Executive function is an umbrella term for a variety of cognitive mechanisms that have a controlling or higher-order influence over other cognitive processes. The boundaries of executive function are not entirely defined at this time, but commonly described components include such things as organization, planning, abstraction, inhibition (at neural or behavioral levels), cognitive flexibility, and aspects of creativity, generativity, and initiative. You can see this concept covers a lot of ground! As a CEO makes the higher decisions in a company, so the executive functions regulate and manage other brain operations. So called "working memory" (for temporary storage of information) may or may not be included in executive function, but is a closely related cognitive process. Difficulties with executive functioning are frequent among people with ADHD, Asperger and nonverbal learning disorders, and bipolar disorder, to name a few. I present more detailed explanations of executive function, working memory, other closely involved elements and their interrelationships in my “Attention” talk listed on the Services page.
Q Have you heard of the "Anonymous Organization" (name disguised) and their programs for ADHD (which also claims to treat autism, dyslexia, other LD's, Tourette's, and brain injury)?
A There are a million programs out there purporting to help a myriad of conditions. I'm sure this one, like many, are well meaning (though some may unfortunately have more self-interested motives). While many may also have helped some people, and have testimonials to attest, most of them lack solid empirical research to back up their claims. This particular "Anonymous Organization" appears to be involved in some brain scan research attempting to substantiate their work, but the results are apparently not available, and to be really sure you would want to see well-designed, replicated studies using control groups. I'm also wary of any treatment that can be applied to so many different conditions.
For example, let's take a deeper look at what "Anonymous Organization's" website says about dyslexia. They discount phonological processing and mostly talk about visual processes. However, as some of the leading researchers (the Shaywitzes at Harvard) point out, "...a deficit in phonology represents the most robust and specific correlate of reading disability [and forms] the basis for the most successful and evidence-based interventions designed to improve reading." The Shaywitzes admit that "other subtypes may account for some cases of dyslexia," and indeed other processes may be contributory to varying degrees, but current informed thought is that visual problems are secondary in the majority of cases.
Some might argue that if a treatment has helped anyone it might be worth a try. But given the limited resources of the average family, doesn't it make sense to try the most reliably established treatments first, rather than risk a higher probability of misplaced expense, energy and disappointment? Even worse is the possibility of losing the opportunity for meaningful treatment while pursuing alternatives that are less likely to be effective. Unfortunately, this is a special danger with dyslexia, which appears to have an optimum developmental window for remediation.
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