Welcome back. We will start Part 3 with an example of how EF works keeping the domains or brain circuits mentioned at the end of Part 2 in mind. This will be a longer post than most so grab a cup of coffee.
Dr. Barkley essentially says that at its heart Executive Function is about affect regulation. Recall the student above who received an accommodation letter because of an apparent inability to regulate emotion. The higher EF brain centers (like the prefrontal cortex) “talk” to the middle brain centers (like the brain’s main fear center the amygdala). The amygdala is about “here and now” responses like “There’s a lion! RUUUUUUN!” In response to this kneejerk reaction the PFC may say something like:
“Wait a second, that does not seem like a lion to me. Let’s think about this. And is running in our best interest? Can we outrun a lion? I do not think so. You know, that looks like a teacher. And I think we can reason with this teacher rather than run away. Admittedly running would serve the here and now; reasoning, on the other hand, would further our future plan and goal of graduating. Reasoning would hopefully get us connected to our hopes and dreams for the future. Feeling a bit better I hope? I know I do.”
Simply, the PFC is engaging in a bit of critical thinking, a bit of reflection (among other EF skills). It’s also engaging in a bit of self-soothing, which is part and parcel of emotional maturity. However, if the PFC cannot “calm down” the amygdala, then little to no critical thinking can take place.[1] So it’s entirely possible that a student who wishes not to be called on (or the student’s therapeutic treatment team) knows that any level of emotional response will overwhelm the functioning of the PFC. But should a professor be put in this position, to know that if NOx readings are not correct, a shutdown process may take place (using the above analogy from Part 1)? This hypothetical professor is being asked to in essence create a therapeutic environment and possibly work with a treatment team that remains largely hidden. Getting murky.
Again, the amygdala is about here and now responses whereas the PFC is about responses that serve the future. This implies that not only is a person able to imagine the future but also to hold those images in mind during stressful times. Here and now responses, which require no images of the future, take very little time and are often colored by high levels of emotion, often negative ones like fear. The opposite could be said of PFC responses: deliberate and often colored with pleasant affect, say, the affect associated with achieving a goal. Now, don’t get me wrong. If a lion is actually chasing you, planning for your or your kid’s future matters not. Let’s return to my diesel car analogy for a moment
After going through an episode (like I did) with their diesel-powered car, some car owners elect to do what are known as “system deletes.” They will simply delete the SCR system and go on their way. By doing so they are bypassing some of the emissions control systems of their car. System deletes are about the here and now and essentially say “environment be damned.” Maintaining your SCR system is about protecting the environment for future generations. In essence the EPA (environmental protection agency) is acting as a form of societal PFC or prefrontal cortex, which fits with Barkley’s evolutionary model. As Barkley puts it in his book Executive Functions, “EF/SR [executive function/self-regulation] extends outward as a phenotype to become essential to social exchange (reciprocity) and trading, as well as to ethics and economics.” Speaking of ethics and economics, I should also point out that the EPA is forcing car manufacturers to “internalize” or take responsibility for the cost of reducing air pollution as opposed to the common practice of externalizing those costs onto the general public.
So, are there thing like “system deletes” for the brain? Sadly, there are. Allow me to list a few:
- Arguably the granddaddy of system deletes for the brain has to be the practice of performing frontal lobotomies, a surgical procedure that destroyed portions of the frontal lobes. According to our friend Wikipedia, “The use of the procedure increased dramatically from the early 1940s and into the 1950s; by 1951, almost 20,000 lobotomies had been performed in the United States and proportionally more in the United Kingdom.” Lest you think that this gruesome procedure has gone away, Ernest Keen in his controversial 2000 book entitled Chemicals for the Mind, suggests that a chemical version of the scalpel has returned in the form of certain types of psychotropic drug use, both legal and illicit.
- How about the current so-called “delete culture” on one side, or attempts to ban books on the other? If we are to believe Barkley then we must believe that where goes culture so too EF. Are we then throwing out the EF baby with the culture bathwater? Now, one could argue that this is the point of making certain cultural deletes, to throw out EF and, along with it, critical thinking. Frankly, I’m not aware of such arguments. In my opinion, I’m not seeing any level of critical thinking in either case of “delete culture.” I’m not sure I see the reasoning behind turning back the evolutionary clock on EF, but that’s in effect what is being done.
- What if I told you that we as a society are in the process of deleting procedural memory? What? Procedural memory is what you use when you ride a bike or drive a car (for those of us who are still driving). Recall from Part 2 that working memory has both verbal and non-verbal components (typically images). Procedural memory is a form of non-verbal memory. Why do I say it’s being deleted? This is the central thesis behind Nicholas Carr’s 2015 book entitled The Glass Cage: How Our Computers Are Changing Us. Carr argues that we are systematically turning our brains over to the influence of various automated systems (AI being chief among them). As a result, procedural memory in humans is eroding. As an example, Carr points to several airline crashes that made headlines where it was determined that the flight crew was unprepared to manually fly their aircraft (procedurally speaking) during an emergency situation that caught them off guard.
- Deleting families and neighborhoods. This is a trend that is described in Robert Putnam’s 2000 book entitled Bowling Alone: The Collapse and Revival of the American Community. Suffice it to say that families and neighborhoods could (and should) act as surrogate PFCs. Dr. Giedd in his article The Amazing Teen Brain makes the observation that puberty is starting at earlier ages worldwide (as early as age 10). He further observes that the PFC is taking longer to fully develop, typically around age 25. As a result, teens need cognitive scaffolding from adult minds during this “at risk” period. Where goes families and neighborhoods so too cognitive scaffolding, the need of which continues to grow. (See footnote 2 in Part 1 for the Giedd reference.)
- How about deleting bricks and mortar colleges and universities in favor of online or virtual learning. Yes, brick and mortar colleges and universities are expensive to run and administer. However, their very physical presence plays a large role in not only preserving the long legacy of higher learning but also provides a foundation for Executive Function and it’s development. Heck, colleges and universities are an outgrowth of EF development across the generations. As Dr. Barkley puts it, “Cooperatives [such as colleges, universities, and even the towns and cities that surround them] require a higher level of cognitive EF development to contemplate, organize, initiate, and sustain, yet they give rise to a greater payoff.”
- OK, I am about to touch the proverbial “third rail.” Day care. Back in the 1990s attachment researcher Jay Belsky sounded the alarm that extensive use (more than 20 hours per week) of low quality day care could adversely impact the neurological development of infants and young children. Dr. Belsky was personally and professionally crucified for his research and its results. For more on this see Belsky’s 2003 article entitled The Politicized Science of Day Care: A Personal and Professional Odyssey that appeared in Family Policy Review. Today there is overwhelming evidence that Belsky was right to sound the alarm. Neurobiology and attachment researcher Allan Schore presents copious data in support of Dr. Belsky’s position, and talks about its implications in his 2019 book entitled The Development of the Unconscious Mind. Dr. Schore tells us that “Because of its lack of support of a national policy of parental leave, unique within the industrialized world, and the poor quality of its early childcare, U.S. culture is now acting as a source generator of significant increases in the amount of mental problems in its child, adolescent, and adult citizens. That said, the science now exists to formulate evidenced-based models of early intervention and indeed prevention of mental disorders.” The EPA attempts to protect the environment. How about forming the Brain Development Protection Agency or BDPA? I would argue that it will be exceedingly difficult for professors and other educators to work with brains that are damaged or otherwise compromised in some way.
- Continuing on with this theme of brain damage, what if I told you that we are currently in the midst of a “pandemic of developmental neurotoxicity.” Dr. Schore points to the 2014 work of Grandjen and Landrigan as he summarizes this toxic situation thus:
Neurodevelopmental disabilities, including autism, attention-deficit hyperactivity disorder, dyslexia, and other cognitive impairments, affect millions of children worldwide, and some diagnoses seem to be increasing in frequency. Industrial chemicals that injure the developing brain are among the known causes for this rise in prevalence.
I could go on but I think you get the point. Today Evolution is under attack. Heck, science itself is under attack. Moral and ethical systems are under attack. It would appear that democracy itself is (literally) under attack. Any one of these attacks by itself is cause for concern. But when you take them together and consider that the common denominator is the erosion of Executive Function, I am beyond shocked.
In many respects we are externalizing the cost of care; care for families, care for neighborhoods, care for our kid’s education, care for institutions of higher learning, care for our first responders, care for our medical personnel, care for brain development, and on it goes. It’s no wonder we have teacher shortages, police shortages, bus driver shortages, psychiatric bed shortages, nurse shortages and on it goes. In my opinion we are asking so many institutions to in essence create ad hoc therapeutic triage units. Teachers have to be mental health professionals. Police have to be mental health professionals. Bus drivers (both public and school) have to be mental health professionals. Professors and other higher education instructors have to be mental health professionals. Firefighters and EMTs have to be mental health professionals. The COVID pandemic undoubtedly brought the externalization of care to a boiling point. Indulge me for a moment as I try to drive this point home because I think it is that important.
In doing a Google search for “accommodation letters” (mentioned in Part1) I found a 2021 article over at the web site for NBC News entitled The Great Attention Deficit: More Parents Seek ADHD Diagnosis and Drugs For Kids to Manage Remote Learning by Olivia Solon.[2] Apparently up until the pandemic hit, kids living in Delaware, Ohio, were doing reasonably well in school. But once the pandemic brought along with it the need for remote leaning, all hell broke loose. Here’s how one mother describes her 12-year-old daughter after she received a language arts assignment that had to be done remotely: “She was crying and screaming and hyperventilating and started to get some tics, moving her head and flapping her arms. She had never had them before. That’s when we started to consider that it might be ADHD.”
Solon observes: “Data from specialists involved with diagnosing and treating ADHD show just how much parents are struggling to get help: They are flooding an ADHD support line with questions, and ADHD diagnoses and prescriptions for related medications have soared.” Apparently schools in this area of the country were doing so well accommodating certain learning challenges by in essence creating a therapeutic environment that when that environment was taken away almost overnight, it revealed two things: 1) parents were not seeing behavioral issues so they assumed that everything was alright, and 2) the therapeutic scaffolding that teachers were creating was not being internalized to the point that students could self-regulate (pulling from Barkley’s model).
First, kudos to that school or school system. It’s too bad that it took a pandemic to reveal how much therapeutic work they were doing. But even with schools doing a good job of creating a therapeutic environment, we have a six-year-old shooting his teacher yelling afterward, “I killed the bitch dead.” One of the big complaints teachers have is a lack of respect on the part of their students, especially young ones no more than six years old. Despite teachers’ best efforts it’s clear that we still have big EF deficiencies to deal with, deficiencies that are starting at young ages.
Second, this article started me thinking about geology and other field sciences like marine biology or archaeology. Let’s assume that a professor is able to create a therapeutic learning environment for his or her (or other’s) students in both the classroom and in the lab (no small feat mind you). Now take these students out into the field where this scaffolding no longer exists. Something as simple as a van breaking down (which, being a geologist, I know happens quite frequently) has the potential to create a reaction not unlike the one described above for that 12-year-old student. Can you imagine a student psychologically decompensating at a remote field study area or miles offshore on a boat.
In discussing therapeutic interventions Barkley talks about point of performance (a topic touched on in Part 2). As Barkley puts it, “Not only is assistance at the ‘point of performance’ going to prove critical to treatment efficacy, but so is assistance with the time, timing, and timeliness of behavior, not just in the training of the behavior itself.” By design, training in the field sciences involves different points of performance: from classroom, to the lab, to the field, and possibly to the professional conference environment. How then should professors structure scaffolding so that it’s effective in all environments and for all students being accommodated? This would be tough even for a seasoned therapist. “Disorders of EF pose great consternation for the mental health, rehabilitation, and educational arenas of service,” Barkley reveals, “because they create disorders mainly of performance rather than knowledge or skills.” It’s the field or conference lecture hall where performance will really be put to the test. Here’s Barkley’s bottom line: “Mental health and education professionals are more expert at conveying knowledge and skills—how to change and what to do; far fewer are expert in the ways to engineer environments to facilitate performance—where and when to change.”
Pulling from my counselor training, if you or a group is charged with creating a therapeutic environment, then you or the group has a responsibility for that environment.[3] As an example, when families decide to take on the huge responsibility of providing therapeutic foster care in their homes, not only do they receive training but they are certified and monitored by the state. Turning off therapeutic scaffolding rapidly can cause undue stress as the pandemic demonstrated. Are professors, and teachers, and police, and first responders, and bus drivers taking on this responsibility for therapeutic scaffolding without knowing or being fully prepared for it? I’m not sure I have the answer. We’ll take a look at a few possible solutions in the final part of this series, Part 4.
NOTES:
[1] – Allan Schore has spent his career looking at the connection between early attachment relationships and the ability of the amygdala (and other mid-level brain components) to “cooperate” with the PFC in the dynamic process of emotion regulation. According to Dr. Schore’s research, when early attachment relations are either abusive or neglectful, these toxic relational environments may damage the structures of the amygdala in such a way that the dynamic process of emotion regulation between amygdala and PFC is difficult. Try as the PFC may, it’s possible that it will be unsuccessful in its attempts to calm down the amygdala. Dysregulated emotion and a diminution of EF may result. Sorry, I said I wasn’t going to talk about the attachment-EF connection. For more on this see Allan Schore’s 2019 book entitled The Development of the Unconscious Mind.
[2] – You can find this article by navigating to:
[3] – Back when I was practicing as a psychotherapist in the 1990s, the idea of delivering counseling services remotely via the Internet was a new and controversial idea. Ethicists worried that the therapeutic environment could not be properly monitored and maintained remotely. Today there are myriad online counseling and mental health services. Honestly I’m not sure the issue of maintaining the therapeutic environment has been resolved. I’m guessing but it is highly likely that this burden falls to individual therapists working through these online services while these services wash their hands of this ethical dilemma. More externalizing the cost of care I wager. One thing is for sure: the online therapy genie is out of the bottle.
