Seniors in high school think that the language of launching is: “Where are you going to school?” “What will you major in?” “Are you excited?” “Are you ready?” Parents think that the language of launching is: “Have you finished your essays?” “Which schools do you want to visit?” “How are your grades?” “What are you going to do without me?” These questions are the dance that young people and their parents do as they get ready for college. They are not the language of launching.
The questions that need to be asked are more like: “What are your goals?” “How are you going to get there?” “If you don’t have goals, what are ideas that you have to figure it out?” “What skills and abilities do you need to develop before you leave home?” These questions are about executive functioning.
The key to successful launching of young adults, with and without risk factors such as ADHD or learning differences, is the development of executive functioning. According to Jack Naglieri, Ph.D., in a November 2017 APA-sponsored webinar, executive functioning allows us to figure out “how to do what we choose to do to achieve a goal.” Executive functioning involves the frontal lobes and is the last major growth spurt of the brain. It occurs roughly between 17 and 27 years of age.
According to Naglieri, “How you do what you decide to do’ demands … Initiation to achieve a goal, planning and organizing parts of a task, attending to details to notice success of the solution, keeping information in memory, having flexibility to modify the solution as information from self-monitoring is received and demonstrating emotion regulation (which also demands inhibitory control) to ensure clear thinking so that the task is completed successfully.” These are the skills that comprise executive functioning.
Young people with ADHD and LD are more vulnerable to being derailed by the lack of these skills than their peers with more neuro-typical development. The stakes are much higher when failure occurs in the post-high school years rather than during high school. Society gives much more leeway to high school kids messing up than to young adults messing up. For these reasons, I encourage parents and teens to use high school as the training ground for executive functioning.
There are two parts to Naglieri’s definition: the how of a task, and the ownership of the task. Usually, parents can figure out how to get something done more easily than their teens. The life experiences of adults make many things automatic, making it very easy to tell a teenager how to go about most anything. This can include: how to complete community service hours, the Eagle Scout project, returning a package, doing homework, preparing for the SAT, or completing college applications. It is not important, however, that the parent can take care of these tasks. It is important that the young person takes ownership of the goal and then problem-solves and learns how to go about doing what they need to do to make it happen.
We have learned in the past eight years that there is much room for improvement in the selection of medication and treatment of ADHD in children and adolescents. EEG and qEEG technologies provide identification of neurobiomarkers and are proving to be valuable tools for experienced physicians how know how to interpret the findings and use published research suggestions to avoid medications that are likely to make their patients worse, and consider empirical trials of research-supported medications. Read the rest of Dr Swayzyna's article published in NeuroConnections Spring 2014 in pdf form here.
“There is an endless war of nerves going on inside each of our brains. If we stop exercising our mental skills, we do not just forget them: the brain map space for those skills is turned over to the skills we practice instead. If you ever ask yourself, ‘How often must I practice French, or guitar, or math to keep on top of it?’ you are asking a question about competitive plasticity. You are asking how frequently you must practice one activity to make sure its brain map space is not lost to another.”
-Norman Doidge in The Brain that Changes Itself
The brain has a “critical period” in infancy and early childhood in which the brain is so plastic that its structure is easily changed by simple exposure to new things in the environment.
For decades, the prevailing scientific view held that the brain was a finely tuned machine that operated within a fixed scope of ability once the critical period had passed. During the 1990s, Dr. Michael Merzenich discovered that our brains change well past the critical period, and throughout our lives.
Neuroscientists now believe that if we do activities that target memory, attention, and timing and processing for extended periods of time, it is likely that it will be beneficial for improving the brain’s capacities and make changes in the neuro map of a brain. Neural learning is the process in which neurons “fire” together and thus “wire” together, which results in structural changes in the brain. Timing is key to creating a neuron map.
The space allotted to a neural map evolves over time. When learning is taking place, a relatively larger space is allotted. Once a skill is established, the neurons become so efficient that fewer are needed and some map space is available for new learning.
Researchers have shown that when seven year olds do a simple computer-based exercise that targets working memory for just a few minutes a day for a few consecutive weeks they show improved working memory (we would expect that) but also improved reading comprehension compared with children in their classrooms who received reading instruction but did not do the working memory activities (Loosli, 2012). Or, aging adults in their 70’s who did computer-based processing speed exercises a few minutes a day for six consecutive weeks so they could do things like react faster when driving showed improvements in processing speed (again we would expect that) but also in memory when compared to adults who did other exercises but not the processing speed exercises, and the improvements lasted for ten years without doing additional exercises (Rebok, 2014). A study at Cornell University demonstrated that students who used a Fast ForWord computer program achieved significant improvements in their language and reading.
Our current understanding of how the brain changes itself when we do activities that challenge areas of the brain such as memory, attention, time and processing opens the door to endless possibilities for improving our brains and its capacity to learn.
Neuroscientists who study brain plasticity have determined that there are ways to enhance the beneficial effects of brain exercises to maximize the efficiency and positive outcomes so that children or adults can specifically target some capacities over others in a short period of time. And controlled research is showing these targeted exercises have benefits on other brain capacities as well.
The question, then, is what are the critical active ingredients neuroscientists have found that need to be “built-in” so brain exercises effectively build targeted skills compared to the benefits we get from just using our “noggin” in everyday activities? And, more important, how is a parent or consumer to get through all the hype and determine which brain exercises have the important design features shown to be effective?
Fortunately, neuroscientists who have thoroughly researched this have published excellent summaries in respected scientific journals. Below are the key elements to look for in brain exercises:
- High & low – exercises are most effective when they include challenging high-level tasks (i.e. exercises that require a high degree of speed and accuracy) while also including low-level exercises that improve our ability to perceive similar sounds or images more distinctly (Ahissar et al, 2009). We might call this the Sherlock Holmes effect – you must see the details clearly to solve difficult problems.
- Adaptability-Exercises should increase or decrease in difficulty based on how you perform so they continuously adapt to your skill level (Roelfsema, 2010).
- Highly intensive training schedules – The relevant ‘skills’ must be identified, isolated, then practiced through hundreds if not thousands of trials on an intensive (i.e., quai-daily) schedule (Roelfsema, 2010).
- Attention grabbing – In order to maximize enduring plastic changes in the cortex, the learner must attend to each trial or learning event on a trial-by-trial basis.
- Timely rewards – A very high proportion of the learning trials must be rewarded immediately (rather than at the end of a block of trials or on a trial-and-error basis) (Roelfsema,2010).
The Tarnow Center offers three programs which implement the key elements the neuroscientists found to make brain exercises effective. Merzenich, Paula Tallal, Torkel Klingberg etc, as well as other scientists have provided a strong research basis for these programs.
Fast ForWord
Language and reading mastery are among the most difficult challenges a child faces. When a achild listens, talks, or reads, he or she must use multiple brain areas.
But for some children, this process can be laborious and often lead to low self-esteem and years of academic struggle. While there is nothing that can replace the benefits of a supportive environment, neuroscience research has proven that if a child’s brain is ready to learn, he or she will learn.
Fast ForWord products develop the cognitive skills essential for learning and reading success. Fast ForWord software’s unique neuroscience products develop and strengthen the cognitive skills of:
- Memory
- Attention
- Processing Rate
- Sequencing
The strengthening of these skills results in improved critical language skills, which in turn lead to improved school performance particularly reading and listening.
A study at Cornell University demonstrated that students who used Fast ForWord programs achieved significant improvements in their language and reading.
Cogmed Training
Cogmed working Memory Training is an evidence-based program for helping children, adolescents, and adults sustainably improve attention by training their working memory. The program is based on strong scientific research, is delivered under the supervision of a Tarnow Center Clinician and can be done either in the convenience of the client’s home or at our center.
Cogmed is:
- Computer-based training, using a Mac or PC.
- The program adjusts complexity level for each exercise in real time, for maximized training effect.
- 25 training sessions of 30-40 minutes each, done over 5 weeks.
- Supported by a Cogmed Coach who leads the training, tracks results, and gives support and motivation.
Studies consistently show that most people with attention deficits have a working memory deficit. That holds true for attention problems due to ADHD, traumatic brain injury, normal aging, or general deficits from working memory overload; it is also true for milder concentration problems.
Research also shows that deficits in working memory are related to poor academic or professional performance. Conversely, strong working memory capacity is closely correlated with fluid intelligence.
Benefits for children and adults
Children – Research and clinical data show improved grades following Cogmed Training. Parents and teachers also report improved social skills, taking initiative, remembering instructions, and completing assignments more independently.
Adults – By training your working memory you will be better able to stay focused, ignore distractions, plan next steps, remember instructions, and start and finish tasks.
Interactive Metronome
IM is an assessment and treatment tool used by therapists and other professionals who work with pediatric and adult patients with neurological conditions that affect cognitive and motor functioning.
IM is an evidence-based, engaging therapeutic modality that improves cognitive and motor skills. The design of the program ensures that patients recognize progress as it is occurring, increasing their motivation toward therapy and their ultimate recovery. IM is used to improve:
- Attention
- Coordination
- Language processing
- Reading and math fluency
- Control of impulsivity/aggression
There exists a growing body of literature describing the neural timing deficits in ADHD, Dyslexia, Autism, Reading Disorders, Auditory Processing Disorder. By addressing timing in the brain with Interactive Metronome (IM) alongside functional therapy interventions you are not only addressing areas of ability that impact achievement and independence but also the heart of the problem, that of deficient neural timing within and between regions of the brain that are underlying many of the problems you are working on in therapy.
The world has been hit with a plague. COVID-19 has killed so many. At first, these deaths were just anonymous -- people in distant lands. But then the deaths and illness came here. It keeps getting closer. First friends of friends, then friends and coworkers, then family. COVID-19 left a trail of loss as it crept closer and closer. The devastation to our economy. The loss of our income, savings, and retirement. The loss of our friends’ jobs, then family members’, but hopefully not our own. But how can we know for sure? This then disrupts the illusion that our lives are predictable. Now everything is uncertain. This Pandemic has caused a major disruption to our society. It will never be the same. It will change us forever.
COVID-19 has caused the loss of the illusion that our lives are secure. There is an old Jewish proverb, “Man plans and God laughs.” Well, this is now very real. We do not have the same freedoms. We cannot travel or meet in large groups. We can’t go to our social groups or religious sanctuaries. It has highlighted the cracks in our society. We now must look at each other wondering will this person infect me, kill me? The losses are great and very personal. However, as a society, we are grieving these losses.
Each country has different repercussions that are dealt with based on its history and leadership. Similar to individuals, nations are heavily influenced by past coping. The social context is crucial during this pressing time to predict both present behaviors as well as future coping. Awareness allows us to better develop a plan. As for the American experience, we are steeped in individualism and grit. The country’s diversity has unintentionally set the precedent that a crisis is what it takes to develop a sense of community and self-sacrifice. I see the psychological reaction to the COVID-19 Pandemic following the 5 Stages of Grief defined by Elizabeth Kübler-Ross, a Swiss- American psychiatrist. This is how humans cope with loss and grief. During such a changing time full of unknowns, we must go through these stages to process reality and act with resilience.
The first stage is DENIAL. When we hear of a death or other tragic news our automatic reaction is to reject the news by uttering “no!” These words hold much more gravity than we think, as our minds truly do not want to accept the news. Our brains shut down. The shock is overwhelming. We resort to protecting ourselves in a psychic womb while our brains start to function in a more primitive state. This creates numbness as we are in shock. Our brain tries to cope but is shut down. This can take many forms: “I don’t believe this is real,” “It is a hoax,” “It is no big deal; it will just wash over us and be gone,” “It is just like the common cold or at worst the flu.” These are quotes from our national leaders.
Rather than setting the tone towards acceptance and growth, the United States spent at least a month in this stage. We didn’t know what to do because we couldn’t tolerate the news or accept reality-we didn’t want to leave work; we still wanted to go eat out with friends. We denied the truth of the potentially fatal virus and clung onto our usual ways of living for dear life. We wouldn’t wear masks or social distance. We wanted to believe that if we weren’t considered ‘at risk’, it wasn’t a big deal. But the reality is that COVID is traveling in a domino effect, eventually making its way to someone who is at risk. Fortunately, scientists studying the virus gave us the necessary information to better understand the repercussions of the virus. But still, this stage is so primitive that we became stuck. We wouldn’t believe them, or rather, didn’t want to believe them.
Americans finally came to know and understand the very real and potentially fatal virus, and began to determine just how this would affect their lives. Then appeared Stage 2- ANGER. “It’s China’s fault,” “They did it to cause us harm,” “They were so incompetent that they unleashed it from their secret lab.” “The Chinese markets unleashed this plague,” “It’s the news trying to scare us,” “Fake News,” “My political opponents are perpetuating this,” “The government is trying to control me,” “It is a plot by Bill Gates to control us with his vaccine,” “Our political leaders are inept and not protecting us” “Not everyone is at risk for the virus, so why is everyone being punished?”
The mass demonstrations in the US were, in part, an expression of the frustration and anger about being cooped up for months in fear; being taken away from work, social outings, and school-the safety precautions were perceived as punishments. When animals are afraid, they either fight or flee. It is biological, built into our nervous system. We react from a primitive level and our thinking is survival on its most basic level. We think like animals, utilizing not much higher-level thinking and logic. Anger serves a purpose to defend against the feelings of uncertainty and fear. Anger is an action. By being angry you get to leave your feelings of uncertainty and inadequacy for a while. It helps you feel certain, clear, and confident.
However, anger is a defense mechanism masking what our brain registers as threatening. Anger becomes a problem when it is sustained without the use of other positive coping skills. Unmanaged anger can erupt into aggressive behavior against others. In anger, we refuse to wear masks or social distance. I believe that the Black Lives Matter demonstrations and the Government overreach were not just a cause, but also an expression of our pent-up anger over the loss of our freedom. During quarantine, we experienced significant social change. Due to the circumstances of COVID, it was difficult to get out and help make a difference, thus, adding to our anger. National leaders were blaming spikes in COVID cases on the protests and rallies supporting BLM. At this point in time, the virus is forcing us to lose our livelihood. In times of anger, we huddle together in our tribes to get solace and power. We huddle together and look to our leaders to tell us how to cope. But what if those leaders get stuck in this stage? Or use that anger for political gain? Furthermore, how do we handle anger when the source of the emotion is only being exacerbated as the virus becomes more widespread? Understanding the stages of grief will help move past anger.
The third stage is BARGAINING. We test different coping techniques, try to think the dilemma through, and come up with strategies. We believe there must be an answer, which can be positive if you let it be, almost like a sense of hope. In this stage, in the case of COVID- 19, societal bargains were rather depressing: shutting society down, closing the borders, isolation, quarantining, masks in public, social distancing, and waiting on medication and vaccination. These stipulations added to previous feelings of grief: “But I hate masks, they’re so hot!” “I can’t live like this!” What happens then? We go back into the ANGER stage. Some people will ping pong between anger and denial. Some will go back to bargaining and try new coping techniques. But what happens when new attempts don’t work? What if the reality is too big and overwhelming?
We then go into the fourth stage, DEPRESSION. I believe that is where we are heading. This stage can shut our brains down again in a continuous cycle. Our brains make time feel slower; there is a lethargy. We have problems thinking about the future because the reality we are living in does not project a pleasurable future. Thus, we stop planning and live for the moment. Bad decisions can be made as a result because we do not take care of ourselves. We eat poorly, stop exercising, and become self-indulgent. If we cannot handle this stage, we will regress to a previous stage, like DENIAL or ANGER or BARGAINING. If we can grieve and stay with Depression, we can get past it into ACCEPTANCE. So how can depression be helpful in this process? Depression makes you think deeply. You evaluate your life in relation to the loss. What did we do or not do to make it worse? What is the deeper meaning of what we lost? How will live without these things? Depression is a stage of evaluation. If we can grieve and stay with Depression, we can get past it into ACCEPTANCE.
What is ACCEPTANCE in the Age of COVID-19? Realizing that this virus is a reality. Doing what we can to be content with where we are. The results of the pandemic will not just wash over us and go away; rather, our lives are never going to be the same. School, work, restaurants, shops, will be forever changed. Just like when a teen reaches pubescence and has reached their menstruation or beard and muscles. For these reasons, we must create a different vision of our lives. What do we need to learn? What do we need to do to thrive? We must dig deep into ourselves and our neighbors to create a new society. We start to use the highest levels of our brains. If we can work to this stage of acceptance, not only will we better our own lives, we will better society. If not, this virus will crush us. Acceptance allows us to be creative. The old is gone, so what can we create?
What will your new life look like? You can’t resist this new reality. It is not a new normal, because nothing will be normal again. It will be different. Let go of the past. Focus your energies on creating a different self, society, and world. Different relationships, different job functioning, and a different life. Let the old go and create the new; there is no choice. Was this God who sent this plague? Was it nature? Was it because man has changed our world and this is the outcome?
Acceptance is so important and yet so hard to achieve going forward under the ongoing impact of COVID-19. Accepting and not fighting the reality. You try to do this, but encouragement is not enough; depression avoids embracing the enemy and living with that, as it is not something you can get past without deep acceptance. Do not be discouraged by what is not making sense. The COVID-19 pandemic is not marking our end, but rather, kick-starting new beginnings that we must learn to cope with.
Jay D. Tarnow, MD
© Tarnow Center for Self-Management 2020
“There is an endless war of nerves going on inside each of our brains. If we stop exercising our mental skills, we do not just forget them: the brain map space for those skills is turned over to the skills we practice instead. If you ever ask yourself, ‘How often must I practice French, or guitar, or math to keep on top of it?’ you are asking a question about competitive plasticity. You are asking how frequently you must practice one activity to make sure its brain map space is not lost to another.”
-Norman Doidge in The Brain that Changes Itself
The brain has a “critical period” in infancy and early childhood in which the brain is so plastic that its structure is easily changed by simple exposure to new things in the environment. For decades, the prevailing scientific view held that the brain was a finely tuned machine that operated within a fixed scope of ability once the critical period had passed. During the 1990s, Dr. Michael Merzenich discovered that our brains change well past the critical period, and throughout our lives.
Neuroscientists now believe that if we do activities that target memory, attention, and timing and processing for extended periods of time, it is likely that it will be beneficial for improving the brain’s capacities and make changes in the neuro map of a brain. Neural learning is the process in which neurons “fire” together and thus “wire” together, which results in structural changes in the brain. Timing is key to creating a neuron map. The space allotted to a neural map evolves over time. When learning is taking place, a relatively larger space is allotted. Once a skill is established, the neurons become so efficient that fewer are needed and some map space is available for new learning.
Researchers have shown that when seven year olds do a simple computer-based exercise that targets working memory for just a few minutes a day for a few consecutive weeks they show improved working memory (we would expect that) but also improved reading comprehension compared with children in their classrooms who received reading instruction but did not do the working memory activities (Loosli, 2012). Or, aging adults in their 70’s who did computer-based processing speed exercises a few minutes a day for six consecutive weeks so they could do things like react faster when driving showed improvements in processing speed (again we would expect that) but also in memory when compared to adults who did other exercises but not the processing speed exercises, and the improvements lasted for ten years without doing additional exercises (Rebok, 2014). A study at Cornell University demonstrated that students who used a Fast ForWord computer program achieved significant improvements in their language and reading.
Our current understanding of how the brain changes itself when we do activities that challenge areas of the brain such as memory, attention, time and processing opens the door to endless possibilities for improving our brains and its capacity to learn. Neuroscientists who study brain plasticity have determined that there are ways to enhance the beneficial effects of brain exercises to maximize the efficiency and positive outcomes so that children or adults can specifically target some capacities over others in a short period of time. And controlled research is showing these targeted exercises have benefits on other brain capacities as well.
The question, then, is what are the critical active ingredients neuroscientists have found that need to be “built-in” so brain exercises effectively build targeted skills compared to the benefits we get from just using our “noggin” in everyday activities? And, more important, how is a parent or consumer to get through all the hype and determine which brain exercises have the important design features shown to be effective?
Fortunately, neuroscientists who have thoroughly researched this have published excellent summaries in respected scientific journals. Below are the key elements to look for in brain exercises:
- High & low – exercises are most effective when they include challenging high-level tasks (i.e. exercises that require a high degree of speed and accuracy) while also including low-level exercises that improve our ability to perceive similar sounds or images more distinctly (Ahissar et al, 2009). We might call this the Sherlock Holmes effect – you must see the details clearly to solve difficult problems.
- Adaptability-Exercises should increase or decrease in difficulty based on how you perform so they continuously adapt to your skill level (Roelfsema, 2010).
- Highly intensive training schedules – The relevant ‘skills’ must be identified, isolated, then practiced through hundreds if not thousands of trials on an intensive (i.e., quai-daily) schedule (Roelfsema, 2010).
- Attention grabbing – In order to maximize enduring plastic changes in the cortex, the learner must attend to each trial or learning event on a trial-by-trial basis.
- Timely rewards – A very high proportion of the learning trials must be rewarded immediately (rather than at the end of a block of trials or on a trial-and-error basis) (Roelfsema,2010).
The Tarnow Center offers three programs which implement the key elements the neuroscientists found to make brain exercises effective. Merzenich, Paula Tallal, Torkel Klingberg etc, as well as other scientists have provided a strong research basis for these programs.
Fast ForWord
Language and reading mastery are among the most difficult challenges a child faces. When a achild listens, talks, or reads, he or she must use multiple brain areas. But for some children, this process can be laborious and often lead to low self-esteem and years of academic struggle. While there is nothing that can replace the benefits of a supportive environment, neuroscience research has proven that if a child’s brain is ready to learn, he or she will learn.
Fast ForWord products develop the cognitive skills essential for learning and reading success. Fast ForWord software’s unique neuroscience products develop and strengthen the cognitive skills of:
- Memory
- Attention
- Processing Rate
- Sequencing
The strengthening of these skills results in improved critical language skills, which in turn lead to improved school performance particularly reading and listening. A study at Cornell University demonstrated that students who used Fast ForWord programs achieved significant improvements in their language and reading.
Cogmed Training
Cogmed working Memory Training is an evidence-based program for helping children, adolescents, and adults sustainably improve attention by training their working memory. The program is based on strong scientific research, is delivered under the supervision of a Tarnow Center Clinician and can be done either in the convenience of the client’s home or at our center.
Cogmed is:
- Computer-based training, using a Mac or PC.
- The program adjusts complexity level for each exercise in real time, for maximized training effect.
- 25 training sessions of 30-40 minutes each, done over 5 weeks.
- Supported by a Cogmed Coach who leads the training, tracks results, and gives support and motivation.
Studies consistently show that most people with attention deficits have a working memory deficit. That holds true for attention problems due to ADHD, traumatic brain injury, normal aging, or general deficits from working memory overload; it is also true for milder concentration problems. Research also shows that deficits in working memory are related to poor academic or professional performance. Conversely, strong working memory capacity is closely correlated with fluid intelligence.
Benefits for children and adults
Children – Research and clinical data show improved grades following Cogmed Training. Parents and teachers also report improved social skills, taking initiative, remembering instructions, and completing assignments more independently.
Adults – By training your working memory you will be better able to stay focused, ignore distractions, plan next steps, remember instructions, and start and finish tasks.
Interactive Metronome
IM is an assessment and treatment tool used by therapists and other professionals who work with pediatric and adult patients with neurological conditions that affect cognitive and motor functioning. IM is an evidence-based, engaging therapeutic modality that improves cognitive and motor skills. The design of the program ensures that patients recognize progress as it is occurring, increasing their motivation toward therapy and their ultimate recovery. IM is used to improve:
- Attention
- Coordination
- Language processing
- Reading and math fluency
- Control of impulsivity/aggression
There exists a growing body of literature describing the neural timing deficits in ADHD, Dyslexia, Autism, Reading Disorders, Auditory Processing Disorder. By addressing timing in the brain with Interactive Metronome (IM) alongside functional therapy interventions you are not only addressing areas of ability that impact achievement and independence but also the heart of the problem, that of deficient neural timing within and between regions of the brain that are underlying many of the problems you are working on in therapy.
This summer, Lynn Ayres and Linda Narun will be offering these programs as well as interventions that will improve:
- Organization
- Time Management
- Learning Strategies
- Reading, Math, & Writing Therapy
These interventions can be integrated into ACT & SAT tutorials. Please call 713.621.9515 to setup up an appointment or email Linda Narun (This email address is being protected from spambots. You need JavaScript enabled to view it.) or Lynn Ayres (This email address is being protected from spambots. You need JavaScript enabled to view it.) directly with your questions. See our website for more info as well at www.tarnowcenter.com.
By Lynn Ayres, M.Ed. and Linda Narun, M.A., CCC-SLP
© Tarnow Center for Self-Management 2016