Q&A with Dr. Joyce Cooper-Kahn, 2018 Diamonds Conference Keynote Speaker

2018 Diamonds in the Rough Conference welcomes our featured speaker, Dr. Joyce Cooper-Kahn, author of the ground-breaking Late, Lost, and Unprepared: A Parents’ Guide to Helping Children with Executive Functioning. WEG is proud to present a conversation with Dr. Cooper-Kahn on current understanding of these critical life skills, the schools’ role in addressing them, and the obstacles that children and teens still face.   

Q. Dr. Cooper-Kahn, I’d like to start with a simple question. What are executive functioning skills and how do they impact children and teens?
It’s easier to describe than to truly understand, but executive functioning is an umbrella term for the processes and skills that allow us to manage ourselves and our resources in the service of a goal. Executive functioning is critical to the development of mental control, as well as emotional and behavioral regulation.

Q. You are serving a dual role this year at the Diamonds in the Rough Conference, providing an in-depth training on March 9 and serving as the conference keynote speaker on March 10.  What can attendees look forward to in both of these presentations?
The Saturday keynote will focus on what we know that helps kids with executive functioning and what gets in the way of good intervention. The focus will be on the sorts of interventions that can easily be incorporated into the general education classroom and that meet the needs of most of the kids with executive functioning delays. With just a little bit of tweaking of the typical classroom, we can meet the needs of about80 percent of the kids with executive functioning delays.

We’re also going to talk about what gets in the way of intervention and why this happens. I am planning on staying for the whole day, because the Diamonds Conference has so many great speakers that I want to hear too. So, I’ll be around to answer questions later in the day.
The three-hour workshop on Friday gives us time to dig in a little deeper. We will talk about interventions for the general education classroom, but also look at more intensive interventions for those that need more. We’ll talk about the principles of intervention, and then we’ll look at specific strategies for how you apply the information in the classroom and at home.  These longer workshops are always really fun because there is time for interaction—time for participants to share their expertise and their questions. There are always great questions, because most people come with a whole backlog of experience, and we learn from each other.

Q.  It’s been ten years since Late, Lost, and Unprepared was first published. How has our understanding of executive functioning skills changed in the last decade?
It’s a very exciting time for people who are interested in executive functioning. There have been huge changes in our understanding. There’s been rapid growth of data on executive functioning, so on a neurological level we have better brain imaging techniques as the years go on, and we have the advantage of having these super large databases. Researchers can now share data digitally and have these cooperative agreements to share data around the world. So instead of studies with 150 subjects, we have some studies with 20,000 subjects. That allows us to see patterns with confidence that we might never have seen otherwise.  
There used to be a primary focus on the prefrontal cortex of the brain, and even when we wrote that book, that had already started to change. Now, we have more and more data about executive functioning and how it operates based on new understandings of neurological development. We know that executive functioning depends on structures, connections, and communications within the brain. It is really a much more complex process.

We have seen new data in the area of neurological functions that affect executive functioning development, and we’ve also seen increased research in specific diagnoses, and how they seem to affect the patterns of weaknesses. There are new findings in the way that executive functioning unfolds in typical development. That’s something we need as a yardstick for atypical development, and we haven’t had that in the past.

Clinically, there’s been an explosion in research on interventions.

But in some ways, the current situation mirrors the situation we had when we wrote that book. There’s no absence of data to guide us in addressing the problem, the problem is getting it into the hands of the people on the front lines. It’s important that we distill that information down so it is useful to people who are trying to help kids on a daily basis. The goal is to put this new information in the hands of parents and teachers. Being able to bring research and theory to practice is one reason the Diamonds in the Rough Conference is so tremendously important.

Q.  What do you think is the schools’ obligation to work on these skills with their students?
Schools definitely have an obligation to work on these skills if you work from the legal requirements. There was a clarification letter from the Office of Civil Rights in Education in 2016 that defined ADHD more specifically in order to give guidance to schools. In it, they stated that one of the symptoms of ADHD is that students often have difficulties organizing tasks and activities. That may not seem like much, but it is. And the last iteration of IDEA specifically talked about preparing students for independent success post-high school. So, how can you do that if you cannot organize your effort?

To me, it is inherent in the legal requirements for schools. However, the problem has been how we approach this with the schools. Schools are designed to educate kids, and they are designed to do that according to the unfolding of typical development. Special education was introduced into the content areas, but until recently there was little talk about delays in these processes of learning So, when we began to include executive functioning in educational plans, we sort of tried to create a separate category.

But in fact, I think the way that it works better is to focus on the content areas, what schools know best, and use them to teach executive skills. Because you cannot teach executive functioning in the abstract, you need content. The school content and the curriculum goals give you the way to work with them.  Many of us have to shift what we are asking of the schools.

If you look at the Common Core standards, embedded into those standards are executive skills and assumptions about what students can do. There are all sorts of ways that you can build goals and objectives, using the curriculum standards as they exist. That way, you are helping the child and you are speaking a language that the schools understand. I have had much better success with that, then telling a school, “This kid does not organize well. So, my goal is for him to get better at organization.”  

I think good special ed teachers have been helping kids with executive functioning for ages. And if you look particularly at first and second grade teachers, their whole skill set involves teaching kids how to be students. They are great at teaching routines and habits. So, now the next step is, how do you systematically build a plan of support in order to move the child forward in his or her development of executive skills? How do you monitor their current level of functioning and help them according to their own readiness and timetable, to get to that next, more independent level? We don’t want to be in the business of just supporting kids, we also need to teach them to manage their demands when they are their own.

Q.  What’s the biggest obstacle you see right now for young people when it comes to improving these critical life skills?
There are many challenges in helping kids with executive functioning, but I really think that the biggest obstacle I am seeing right now is a failure of compassion and understanding. The kids can be way behind in their ability to meet expectations, and being that far out of sync means that adults can get frustrated and impatient. They may make the mistake of interpreting a lack of success in the child for a lack of caring. And when they do that, they lose the child.

I once had a therapy supervisor that said to me, “Children can forgive a mistake of the head, it’s a mistake of the heart that they have trouble letting go of.” It’s so important that we truly understand the long course of development of executive functioning, and how delays will make that more extended and put kids out of sync. If we can continue to teach and support them, despite the extended length of time it takes for development to take hold, then we can remove so many obstacles for them.

Executive functioning extends into so many aspects of daily expectations for our kids, and it sometimes seems really hard to work with the child instead of in opposition to them. Once adults start feeling helpless, then they want to make that feeling to go away, and the easiest way is to blame the child.

Teachers will diligently teach a way to do a task, and then they will even repeat this a second time, and on the third time that child has that sort of project, they are like, “We’ve already been over this, how come you don’t know it yet?”  We can succeed with students when we teach these step-by-step skills while sitting next to a child instead of across from them, and with an understanding of the pain and the demoralization the child can be feeling. We need to teach students these skills, while accepting that they need the neurological readiness as well as the teaching and support, and that we have no way of predicting when they will be independent.
 
Q.  How do ADHD and ASD impact executive functioning skills?
We know that among the population of youth with delays in executive functioning, two of the largest sub-groups are those with ADHD and those on the autism spectrum---as well as kids with both of those disorders. We also know that there are somewhat different patterns between those groups, as well as within those groups.

The complexity of working with kids who are on the spectrum is that you may have more anxiety. There are problems with flexibility and shifting that you don’t always have with students that have ADHD, although you do with some. However, there’s also a huge amount of overlap in the executive functioning problems and symptoms that you see in the two groups.

We know that cognitive flexibility is more of an issue for folks on the spectrum, and you have a speaker coming to the conference who is one of the leading experts, Dr. Lauren Kenworthy. She is the author of a program called Unstuck and On Target that addresses both executive functioning and cognitive flexibility in the populations of kids who have autism spectrum disorder, and I understand she’s also extended that program to ADHD populations too.
As far as ADHD, that’s more my expertise, particularly in this area of cognitive control. Organization and planning, working memory, initiating tasks, and task monitoring, those are the things that are so often out of whack in kids with ADHD. They need a lot of support and teaching.

No one can tell us with any of these populations how much change will happen because of teaching compensatory techniques verses how much change will happen because of fundamental changes in the neurological underpinnings of executive functioning. We are always in the business of working on both. We work with short-term strategies that help a child to meet the daily demands, and at the same time we are planning our long-term interventions. Those meta cognitive skills are critically important – we need to help children and teens to think not only about what is the task, but also how will I monitor my progress, and how will I adapt my efforts along the way to reach my goals.

Q.  You wrote in Late, Lost and Unprepared that it can be difficult to distinguish between kids with specific learning disabilities in content areas (reading, writing) and those that struggle with the process of learning. Have we gotten better in making those distinctions? How can we help teachers understand these differences?
The problem is separating the content from the process. Executive functioning is a process, it has no content, it is a function. To reach a goal, we run data through our executive functioning processes. You can run math, you can run getting your chores done, through the executive functioning processes. To separate the two out, requires that you look at the content separate from the process and the only way to do that is very fine-tuned evaluations. And that doesn’t mean only formal psychoeducational testing, it also means fine-tuned observations.  

I’ve heard a lot of kids say that they dislike reading, and when I ask them what it is they dislike, they say, they have to answer all of those comprehension questions. Some of them dislike writing and others will say, “I can’t remember what I’ve read.”  This indicates to me that it is not the ability to read that is the primary problem, it is a matter of being able to hold on to the information long enough to answer the questions, or perhaps to organize the information in a way that will allow them to meet the demands.  

The testing really does help, if it is comprehensive, but it’s not the only thing we have to go on. We also have lots of information based on teacher and parent observations. Further, if we ask the kids, they can often describe to us the areas with which they are having trouble.

Q.  Can students struggle with executive functioning skills and not have any significant diagnosis at all? If so, how can any parent help their child improve these skills?    
Yes, of course. My best example of this, although there’s a chance that in this day he’d be diagnosed with ADHD, is the “absent-minded professor.” He’s the guy who is a brilliant scientist but fails to show up at his own wedding because he lost track of time.

All of the characteristics of executive functioning exist along a continuum. There is a point when a person is unable to meet their demands and where it is limiting their success, and that is the place where we call it a pathology. There are lots of people hovering around that border between prepared and unprepared, successful and unsuccessful, and they are going about their lives without a diagnosis.

The way we teach people to function better is applicable to all kids and applicable in a general classroom. We focus on personal best, rather than perfection. We celebrate each movement toward better functioning. We teach habits and routines; that is always the cornerstone of intervention, because once something becomes a habit, it no longer lives in the part of the brain that is responsible for executive functioning. And we focus on helping youth to think about how they will accomplish tasks, teach them strategies for planning and organization, guide them and support them until they perform these strategies independently.

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