Trauma Informed Schools Part 2

[MUSIC] Annick, totally, I get a lot of third graders and sixth graders, especially sixth grade boys referred to me in my practice. And then I just think back to the schools, like what, I mean, when I was doing groups or skill-based groups, like who was I working with? A lot of third graders. It was, it was a lot of third graders. Third grade boys. Yeah. And that's a good one. Yeah, it's an important transition. Right, it's an important transitional time. Third grade, sixth grade, even, you know, ninth grade, tenth grade high school. My experience is with teaching freshmen in college and teaching them just how to navigate college. And you could see the difference in the ones who were sort of ready for the challenge in terms of their whatever e-effabilities I could gather just by talking to them, you know, I didn't measure anything. Obviously, and the ones who sort of weren't quite ready for that challenge because they weren't fully able to handle the transition well of what compared to their peers. Yeah, I believe that. And that's the thing about that with college. And this is why I'm like a huge believer in, you know, go to a community college or take a couple years off or take a class or to it a time while you work is, that's a huge gamble. Like, I just keep thinking, okay, so we're going to have something and roughly it costs $20,000 a year. And we're going to put all of these people who have not yet developed their executive functioning skills in one environment with minimal supervision and like high stakes because it's $20,000 a year. And we're just going to see what happens. And then like, let's throw some alcohol in there too. And let's hear how this pyramid works out. Yeah. It doesn't make any sense to me. I don't know why we do that. Yeah, it's really funny that, you know, we just mentioned about how the brain is not fully developed until you're mid to late 20s, depending on your gender and things like that and a lot of other variables. But then at 17, 18, 19, you're expected to be this self-reliant functioning individual taking on the challenges of school and a new social environment and, yeah, alcohol and all kinds of other substances. And without really a lot of supervision or responsibility or accountability in many senses. And no skill training. And it's a bit of a recipe for disaster for people. One people handlet just fine, but a lot of students don't. Yeah, it's a crazy system. Well, and it's kind of high stakes because it's like, you know, 20 grand a year if you release it, see you, right? Like, it's a very expensive experiment. Yeah, so I kind of feel like instead maybe we should scaffold those skills. And I will say that one thing I've seen when I work with college students in my practice of ADHD is when they have a job, they do better. So fewer classes and a job because it almost sets up a structure for them and they're getting all that input they need. Yeah. So, you know, the thing about EF is gold directed problem solving behaviors that are not previously learned or automatic. So the more structure you have where you can experience these new experiences in a sort of a controlled environment, the better you're going to do. Yeah. So yeah, having that disc length and that structure, even if it's external, does wonders for people compared to just sort of being left to your own devices and go figure it out, you know. Yeah. And I just, that's why I think jobs are actually pretty important for people with ADHD. I know some people, their guests might be okay. I don't want you to have the distraction of a job, you know, really want you to focus. Well, they can't, right? Like, they cannot focus generally on their own for as many hours at a time as it requires for a full load of classes. So, yeah. Before it was kind of a problem before there was healthcare reform because, you know, like you had to be full time to have healthcare. And now I feel like, okay, now we have a little more breathing room, which is so good. Yeah. Sorry, were you going to say something? Well, I was just going to say, I think, you know, having a structured day with classes that are, you know, these specific times, I always have class at nine o'clock, eleven o'clock, and one o'clock. And then at four o'clock, I go to my work. When you have those anchor points in your day, you don't have to do a lot of sort of figuring out what am I going to do with my time. And having that structured, it really helps, especially people with ADHD, students with ADHD, because you don't, there's not as much of a load on your brain to figure out, okay, what do I do next? Right. I know what you have to do next, yeah. Right, because if you think about it, what that's requiring is mental flexibility and working memory. Okay, yeah, I have something. Yeah. That's right. Okay, wait, what am I supposed to do? But what's that other alternative? Wait, what was that thing I was just thinking about? And so it's like, you know, you have to be able to have pretty good functioning working memory and mental flexibility in order to make everything successful without those anchor points or that structure. Yeah. So that's a really good, that's a really good example. Okay, so my next question is, so we know that we see EF difficulties in certain neurodevelopmental disorders, right? And so what might a profile, I mean, and I know this is very generalized, but if what would a profile look like for somebody with AST? So autism spectrum disorder versus ADHD versus fetal alcohol or brain injury? What would be some differences? Just generally. Yeah, so there are some differences. In autism, when you look at the building blocks of that disorder, how, you know, the fundamental components of that disorder, a lot of it has to do with difficulty with flexibility. You know, difficulty being able to shift from one topic to another, difficulty seeing a different point of view or looking at the same problem from a different angle in a very basic fundamental way that is a feature, a characteristic of autism spectrum disorder. However, what we find is what research has found is that we don't have, we don't see as much evidence of difficulties in impulse control or working memory. A lot of students with autism spectrum who are on the spectrum, they are of typical intelligence. You know, there's a very big difference between cognitive impairments and autism spectrum disorder. So impulse control is not that heavily impacted. However, mental flexibility planning some of the more meta-cognitive things do seem to be highly impacted in that particular population. Now. I was going to add, from my experience anecdotally, so not based on research, emotional regulation I would add to it. Yeah, absolutely. Now emotional regulation seems to sort of show up in all of these four that we've mentioned. It kind of forms the basis for all of this that we're talking about anyway, but yeah, the difference between autism and something like ADHD is ADHD is characterized by difficulty with impulse control. And that's a very big distinction between that and people who are on the autism spectrum. So for ADHD particularly, you definitely see problems with impulse control. Now obviously it depends on the type of ADHD you have if you have an attentive type or a rectify or combined type. But impulse control seems to be a big difficulty for students and individuals with ADHD. You also have difficulty with attention which then creates problems with working memory. If you're not paying attention to the information, it's not even getting registered in the way that you can hold on to the information and then manipulate it, which is what working memory is. So that is a pretty hallmark feature in terms of EF deficits in that particular disorder. Now things get a little fuzzy with fetal alcohol and. Can I back up a second though just because. So that's if you only have ADHD or only have AST, but as we know, a lot of people with autism also have ADHD. So then I'm just putting that out there for people who wouldn't know that. But you might. Yeah, we haven't even. Oh, yeah. Yeah, we haven't even talked about comorbidity with any impulse yet. So yeah, absolutely. Yeah. And things get a little fuzzy with TBI and fetal alcohol syndrome or fetal alcohol exposure. A lot of times it looks like ADHD, but then when we try to intervene in the way that we would with somebody with ADHD, we don't see the results that we would expect. And part of that has to do with fetal alcohol syndrome as the name suggests is exposure to alcohol when you are in the womb and that interrupts your brain development. It has a negative impact on your brain development from a very, very young age. And depending on the degree of exposure and how. What sort of impact it has had on your brain development, your EF profile is going to look different. So it is very likely that you would probably see difficulty with impulse control and working memory, some of the foundational ones that we talked about, cognitive flexibility. And then the combined effect of those on your. The bigger executive functions, the metacognitive ones like planning and organization and task monitoring and things about nature. And the similar thing happens with prionic brain injury depending on the severity of the injury. depending on sort of the location of the injury, depending on the type of the injury, your executive functioning profile can look different. So for example, somebody who has a mild, traumatic brain injury, what people often call a concussion, that profile is going to look different from somebody who had a car accident or somebody who was shaken as a baby. Because the injury is different. So the EF profile is going to be a little bit different. And I was actually going to add with fetal alcohol, syndrome one thing. So I mean, I didn't read this in like a book or a peer reviewed article. But I remember when I was studying for the E-Triple P to become a licensed psychologist, one of the things that they were talking about or want like a fun fact that I'm not fun. But a fun fact, so to speak, that I learned, is that fetal alcohol syndrome is the leading cause of intellectual disability. Oh. So that's the E-Triple D flashcard. So I could be wrong, but I remember being-- No, it makes sense. Yeah. Yeah. Yeah, it seems to make perfect sense. I mean, I think anything that's going to impact your brain development in such a young age, very not easily, but it's likely that it's going to cause a whole host of deficits, including cognitive impairment. Yeah. Right. Or maybe your perceptual reasoning is OK, right? Or maybe your verbal abilities are OK. But then your processing speed is really-- which isn't-- we're not talking about that. We would talk about working memory, which we would also measure with a contest. But maybe your processing speed is really slow, really impacted, right? Yeah. We don't seem to see that. And that's sort of where it gets a little fuzzy. It looks like ADHD, but it is not ADHD. We don't see the incredible slowing of processing speed in ADHD as much as we would with fetal alcohols in their own or traumatic brain injury. And that creates a whole different set of educational challenges for teachers and caregivers and parents, because it can be a bit frustrating. The student is able to learn, however, it takes them a very long time. And in the amount of time it takes them to encode the information, maybe things are falling off to play before it gets fully encoded. And that looks very different from a student who is having impulse control difficulties or working memory difficulties. And it can get kind of confusing to what do I do about this? How do I help this student? Yeah. And just so that people know processing speed is how quickly you're thinking, essentially. If you-- and then not just thinking, but then coming up with a response. So it's a silly example, but the best example I can give is in Zootopia, the Sloth. Do you remember the Sloth? [LAUGHTER] And in like he takes a while, and the bunny is already on to the next question. But if you think about it, somebody who's taking a little bit to answer or really thinking about something, taking a bit to really process your question, that could look like they're not paying attention. Yeah. Yeah. And then-- yeah, so I was going to go off from a whole different tangent. But no, that's the challenging thing. Of-- I mean, it's challenging for educators. Obviously, you have to keep in mind that this is way more challenging for the students themselves. Yeah. And then constantly getting in trouble for not paying attention for being told that you're off task when really you're trying your best to process the information. That's just-- I can only imagine how difficult that might be for somebody who's going through that. And how it-- I mean, you're a kid, right? And so you're still developing your self-concepts so how it makes you think about yourself, too. And then that expectation that you don't do well with x, y, or z. So then it sort of becomes like a self-fulfilling prophecy based on how people respond to you, right? Yeah. Yeah. And that changes the trajectory of how things are going to look, and how things are going to go for you in the future. That stuff makes me pretty sad. Like that. That's the within the field of education. I just-- that's the stuff where I feel sad for kids. And a lot of the people I see in my practice are pretty solidly middle class or upper middle class. I'm thinking about the kids who are living in poverty and maybe have a single parent who's working to jobs or maybe doesn't even know about this kind of stuff or doesn't even know the first place to look for it or maybe has a learning disability themselves. And the reading would be too hard to find out about this. Those kids don't really have anybody advocating for them. Yeah. That makes-- Yeah, it's just one risk factor on top of another on top of another on top of another. And it's very difficult to be resilient. I mean, resilience is fantastic. And people still-- there's some examples of people making it out of that. But it's very difficult and exhausting to be resilient in the face of so many risk factors. It's not just about your brain development. It's about your environment. It's about who's taking care of you and what their lives look like. I mean, can you imagine what that's like for a small child in seven years old? Oh my gosh. No. It would just be like, you want to put your hands up to your ears and go, ah, like, it's too much, right? I mean, that's what-- Yeah. --what I picture as an adult. So then, what is a kid who is not fully developed? How are they experiencing that? Yeah. OK, is there anything else you want to add to our interview? Um, I do want to add one thing. It's very easy to talk about executive functioning in the context of education and the context of these specific disorders. But one thing we have to realize is just think about your own personal experience and how it feels when you feel good, a nice summer day like today, it's sunshine. And then on a day when you wake up with this severe head cold, when you have a headache, and you're tired. And just think about how it maybe takes a second longer for you to process information. Maybe you don't really have the patience that you used to have, that you would have on a regular day when you're feeling OK. You know, you might be a bit more forgetful in that moment when you're not feeling very good. That's all EF that we're talking about. And that's just from being sick. It's not even having a disorder. We're not even talking about that. So, you know, your executive functioning is a bit of a finicky fragile, very powerful, but fragile ability, set of abilities in your brain and things like anxiety, depression, especially the longer they go on. And all other types of challenges that we face, stress, just regular stress of life, they can all impact our executive functioning. And, you know, the longer those challenges stick around and the longer that you're under stress, that's kind of as the recipe for greater deficits and the long run for EF. So, it's not just about ADHD. It's not just about autism. It's not just about trying to win a dream. This happens and we have these, you know, the modulations in our executive functioning on a daily basis based on how we feel and based on how much stress we're under. So, that's how, like, that's a very interesting way and an easy way to understand just how important these abilities are to success and whatever we're trying to do and also just how easily they're sort of thrown off line and off course. - Yeah. And Dr. Pegdosson, right? Yeah. Yeah. All right. Yeah, Pegdosson. Dr. Pegdosson. Like, so I've done a bunch of her professional development stuff. And, you know, one of the things she talks about and has people do is in their, in her, she has like, SmartPet Scattered. She has like a series for like, school age, then adolescents and then adults. And she has an inventory at the beginning of the book. And so what the idea is that if you're a parent, you're doing your inventory and a kid is doing theirs and you're looking at that match of your own profile of strengths and weaknesses versus their, so I mean, it's not like something standardized, like a brief or something, but it's a nice sort of-- - It's not informational. - Yeah, it's not informational. And so, and she actually has people do that in her trainings where you do like your own profile and then you look at how that's gonna impact you through the day. And it just kind of gets you thinking about like, what are my relatives strengths and weaknesses versus like my partner versus my kids versus my boss, you know? And I think that's a really important thing to do. So. - Yeah. Yeah, I mean, and that helps you sort of figure out strategies to, you know, it's like, okay, I know that it's difficult for me to, I'll just talk about my own personal experience. I struggle with implicit and broken times, you know, or initiation getting started on things without needing a million reminders. And I have to set timers on my phone for everything. Literally, if you look at my alarms, I have a timer for everything, you know, hey, this is when you take your medication. Hey, this is when you have to do this. Don't forget to call this person. But, you know, I wouldn't know that if I didn't sort of over time realize that, yeah, you know, I'm not just going to be able to think about this in the moment when I need to do it. I need this extra little help. And thank God for smartphones. - I know. - So, I know. - I know smartphones have really, like, have really changed, like, just how we can manage executive funds. You can teach it, right? Like, this is what a clean room is supposed to look like. Let me take a picture of your bed. It looks like this. Let me take a picture of this, like this. And then you have this reference. So it's not like, I forgot something or, oh, I didn't notice that. I mean, you can like, go back and, I mean, this is a parent. Like, that's just an example. - Yeah. - It's fun. - Yeah, it just. - Sorry, God. Now, it just, you know, it reduces the load on your executive functioning system. So it's just, oh, did I forget something? What am I supposed to do? What's the next step? You just have it right away. Pull out your phone, you know? So, so remembering four things, all you have to do is remember to pull out your phone, and then you have to check this in front of you. Or to take it in front of you. And that really reduces that load on working memory, too, if you think about it. Yeah. Yeah, absolutely. Yeah. Great. Well, it was so nice to talk to you. Thank you. This was a lot of fun. It was very good to talk to you. Yeah, it was good. Okay. Well, so long. Farewell. Adios. Adios. Adios. Okay. Until next time. Until next time. Okay. Good bye. Yes. All right. Bye, Claire.