In my last article I mentioned that working memory is another factor to consider when looking at anxiety in our children. Bob Doman, founder and director of NACD, has been at the forefront of understanding working memory and its impact on global function since the early ‘80s. It is a big deal. It is not just big, but huge, gargantuan, as it is the foundation that permits us to think. It not only permits us to think, but it also plays a role in our ability to regulate our emotions. Let’s spend some time on working memory, defining its role in our ability to handle stress.

Let’s first review how the brain works in a simple way. Information comes into the brain through our senses. If our sensory channels are functioning normally, the information gets perceived correctly, then it gets processed through our short-term memory. Our working memory is what allows us to think about this information along with taking information that we already know out of long-term memory. For example, if I am sitting in a class and I am listening to a lecture, I am taking in what that teacher says, hearing the information, processing what they are saying, and using my working memory to think about what I already know about that topic, how what they say impacts what I already know, what client comes to mind when I think of what the teacher is saying, etc. I am visualizing, conceptualizing, and developing an opinion or my own thoughts about that particular topic and how it may or may not benefit my work.

According to Bob Doman, “Working memory is the foundation for global neurological maturity and function. It essentially encompasses most of what we think of as ‘thinking.’”

“The NACD model of cognitive function recognizes various components of thinking and learning. Of all of these functions, working memory, including executive function, encompasses the areas that impact simple and complex behavior regulation and problem solving the most. The development of various parts of executive function appears to be a good indicator of future academic success, as well as future life success. Mathematics, reading, and critical thinking are all affected by how well various components of executive function develop and work. Not only do these neurological functions impact academics, but NACD and researchers also find that they impact social skills, job skills, and the skills needed for a child or adult to navigate daily life independently. Time management, time awareness, goal setting and planning, organizational skills, social awareness, financial planning, running a household, writing a research paper, writing a paragraph, and forming thoughts into conversation are all functions that depend on this higher cognitive level referred to as working memory and executive function.” (Doman, 2016)

So what does all this have to do with anxiety? When we think of our kids, anxiety can creep up when they have too much information coming in through their senses, but not enough short-term and working memory to manipulate the information. Have you ever seen a World History textbook? If you have a smart kid who wants to do well in school, but doesn’t have well developed short-term and working memory abilities, they are very likely to get anxious just looking at the book. The pieces that allow them to manage their time with material, organize their studying, and plan how to work through the material are not where they need to be in order for that child to be successful. Now if we have that same kid with five or six classes, with similar amounts of material, imagine how much more anxiety can develop.

Many of the anxious children on our caseload, who may be pre-adolescent age and are struggling with school to the point of shutting down, have poor working memory and conceptual thought. They simply don’t have the ability, YET, to be able to perhaps even process the information coming into their brain, let alone manipulate it and problem solve, think and reason through all that is being presented to them. Let’s also take into consideration what is happening with their bodies during this time frame. They become so overloaded they shut down. With our kids that have good short-term memory but poor working memory, rather than solve a problem that they are facing, sometimes these children may ruminate on the problem itself. Rumination is simply rehashing a problem in their head over and over without having the working memory that permits them to organize their thoughts and reach a conclusion, therefore creating increased anxiety. The more developed a person’s working memory is, the more likely they are able to solve and reason through their problems.

The more a child can reason, the less likely they are to get stressed and shut down. If we look at a neurotypical 3-4-year-old, they are just learning how to reason and problem solve. If they encounter something that is stressful to them, they don’t have the working memory to process the situation and are likely to dart or hide behind their mom versus using conceptual thought to reason as to how best to approach something. The same can be true for a child who is 12 years old but has the working memory of a 3-4-year-old. The same behavior happens, only it looks more problematic because it is an immature behavioral response for a child at that age.

We also have very bright individuals on our caseload who are also anxious because of their incessant need to be the best, to be perfect, to be the straight A student. When does academic pressure, measuring kids, too much testing, and narrow competition get recognized as potentially one of the greatest causes to mental health issues in our kids? Stay tuned to next month’s article.

Reprinted by permission of The NACD Foundation, Volume 32 No. 9, 2019 ©NACD

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To be proactive is to anticipate, prepare, and intervene based on a long-term vision and perspective. When anticipating the future, you react accordingly before it actually happens.

To be reactive is to respond to a situation, rather than creating or controlling it.

How does this relate to what we do with our children? What we do in the short term affects the long term; and that myopic/short-sighted intervention can have a negative impact on outcomes.

One contributing cause is lack of a vision, lack of hope, and a willingness to accept a short-term possible solution. Another underlying issue is that most teachers and therapists are not involved for the long term and are not aware of the long-term results or consequences of their interventions. The third contributing factor is a lack of awareness and knowledge of the whole child. When looking only at pieces, one cannot perceive, acknowledge, utilize, or evaluate the impact on the gestalt of the individual.

Armed with decades of experience working with tens of thousands of “Whole Children”, it is relatively easy for us at NACD to look at your children and to be proactive. Being proactive requires looking at a child’s strengths and talents. In addition we must look at weaknesses and issues, determine what pieces we need to put together or issues we need to resolve, in what order, and in what priority to produce a good ultimate outcome. One of the benefits of working with “Whole Children,” working with the full spectrum of children, and working with individuals (often for decades) is that we have the benefit of experience and perspective.

Working with “Whole Children”

I have spoken at length about the importance of working with “Whole Children.” Working with “Whole Children” simply means we are working with all aspects of the child from their health, sleep, sensory function, social function, behavior, speech, language, fine and gross motor function, cognition, and academic development to their attitude, self image, etc. I don’t know if it is possible to be truly proactive without working with the whole child. Most children have disconnected individuals addressing various aspects of their lives, coming and going; and the more issues a child has, generally the more people there are working reactively, not proactively, with them. Working “reactively” means they are reacting to what is perceived as an immediate issue or need, without an historic or long range, long-term vision.

In discussing all of the people who can be involved with your child, you are tempted to associate them all somehow, to call them a team or an army, suggesting that they are somehow a cohesive unit working together. The reality is that they are individuals working with pieces, more often than not in virtual isolation. Such individuals are often working reactively, not proactively. They are working with their one piece generally in virtual isolation and establishing their piece as their priority and generally from a perspective that they are only going to be involved for a relatively short period of time. Working with children for only a few months, or even years, does not permit one to gain a long-term perspective and to understand the implications of what is in reality short-term, reactive intervention.

Proactive Intervention

To help clarify what it means to be proactive, it is best to look at the antonyms or words that are essentially the opposite of proactive. Those words include such things as myopic or short-sighted or improvident. Another way to look at this is to say we are being reactive as opposed to proactive.

Reactive Intervention

If we are being reactive, we are reacting to problems; if we are being proactive we are looking forward, into the future, so as to prepare for the future. As parents with limited experience, it’s often difficult to be proactive. It’s difficult to be proactive if you have not had the experience and knowledge to know the degree to which what is happening today, or not happening today, is going to influence tomorrow, next week, next year, and the future. Sadly, many therapists and educators do not work with individuals over long periods, as in decades, to understand what issues can be created by working perhaps hard, but not working from a long-term, proactive perspective.

Some common examples of being reactive rather than proactive would include things like teaching young children with Down syndrome to sign. (link to Signing contra-indicated for DS) The perception is that Johnny isn’t talking and is frustrated, so let’s give him a means of communication that he can use soon–signing. Looking at the short-term results, which may be the child being able to communicate a few basic needs and being perhaps less frustrated, reinforces the use of signing. But if looked at long-term and proactively, we discover that we have had a negative impact on the child’s ultimate ability to communicate verbally, and even more significantly, have had a negative impact on the development of the child’s auditory processing, with resulting adverse affects on the child’s cognition and global maturity. Reactive intervention is not the best intervention.

One of the more glaring areas where we often see disastrous effects of reactive intervention is in the area of mobility and walking. We sometimes have children come to us who never developed the neurodevelopmental or the structural foundation that can ultimately produce a child who is a functional walker. Being proactive, we know that we have to follow a typical sequence of development, which among other things, requires the neurological, tactile, proprioceptive, and structure pieces of the child going through the necessary developmental stages before working on standing and walking. Children in walkers who had been “helped” to stand before they had the strength and structure to do it themselves, or do it properly, and then “assisted” to walk using various apparatuses to hold them up so they could move their legs, usually end up not being able to walk independently. Often they have created structural issues that even numerous surgical interventions cannot properly address. Children you see walking with walkers or braces and crutches almost always end up in wheelchairs. Yes, the goal is walking; but can we achieve it by circumventing the foundational pieces?

An example of a reactive approach in education is encouraging children to write before they neuro-developmentally are ready. Sixty or seventy years ago, it was not uncommon to make left-handed children in kindergarten and first grade, at five or six years of age, write with their right hands. This practice was stopped because interfering with the natural development of handedness resulted in a plethora of neurological and even emotional problems. Today this isn’t happening; but today we have preschool education, which is even creating more problems by making children write before they developmentally have even firmly established a dominant hand. A child may be leaning toward the right hand, for example, at three or four, and if encouraged to write with the right hand, establish a skill set for writing with the right hand. Ultimately such a child may turn out to be left-handed. Because the skill set for this specific function was established, the child will tend to continue to write with the right hand and is generally encouraged to continue to write with the right hand, resulting in all of the issues that were created 60 years ago, including poor handwriting.

The Reality of Education

The reality of education in general is that the very structure and organization of school as we generally know it almost defines reactive intervention. Education is generally perceived from the short-term perspective of needing to get specific curriculum material into a child’s brain, whether or not the material is targeted to the specific child’s present knowledge base, to their level of processing and understanding, let alone their interests. The net result of reactive education is very often poor outcomes, children often learning to dislike or “hate” school, which becomes synonymous with hating learning; and often because of the abnormal environment of narrow competition, leaving the system with a damaged self-image and lacking a perspective of who they are and what they can be. Proactively it’s not difficult to understand that at the foundation of education we should have the goal of teaching the child to love learning and to make them feel that they are smart and can learn. Is anyone shocked to hear that children do well learning things they love and struggle with what they hate? If the goal of education is to produce adults who are actually educated, who become not just lifelong readers, but life long learners with the confidence to pursue their hopes and dreams, then the system needs to be re-evaluated and made proactive not reactive.

Educational & Therapeutic Perceptions

There are numerous examples in educational and therapeutic intervention that demonstrate the negative aspects of reactive intervention. The problem is ubiquitous, and it doesn’t seem to be changing anytime soon. Proactive intervention implores us to look at the child from a long-term perspective and with a vision and a plan to produce better outcomes. If existing outcomes are perceived as actual reflections of an individual’s potential, there is no motivation for change.

Perception of potential is a reflection of one’s experience. I recall a colleague correcting me many decades ago when I referred to someone as having twenty years of experience. He told me that the reality was that they had a year of experience twenty times, not twenty years of experience. I have been extremely disappointed to see how incredibly slow change in traditional education and therapeutic intervention has been. But doing the same reactive things year after year and producing the same limited results has not stoked change, but has reinforced the perspective of limited potential, and has encouraged many educators and therapists to keep doing the same things, producing the same inevitable outcomes.

Proactive intervention is stimulated by a need to do things better and to improve outcomes, all of which is perpetuated by a vision of what can be and what should be.

Reprinted by permission of The NACD Foundation, Volume 32 No. 5, 2019 ©NACD

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We have all heard it a thousand times: eating better, sleeping better, getting physical exercise helps our overall health. While this is something that our NACD families in general are very conscious about with their children with developmental issues, it is not uncommon to hear that those rules don’t really apply to everyone in the family. Let’s face it, it is easier to be more lenient on our neurotypical kids or ourselves, but does that help everyone in the long run? It is important to really get serious across the board about our overall physical health in the family, as that impacts our mental health significantly.

Sleep is such an important part of one’s life. According to the National Sleep Foundation, children ages 6-13 years old need 9-11 hours of sleep each night to be at their best. Teenagers ages 14-17 need 8-10 hours of sleep to be at their best, and adults should have between 7-9 hours of sleep per night. This is good, quality sleep! Not being in bed on your smartphone scrolling, but actually ASLEEP! Unfortunately for most teens, their biological clocks shift during that stage, where they tend to have more energy at night, increasing the desire to stay up later and sleep in longer. If your children are like mine, they start school at 7:20. They are up and out of the house before 7am. This can leave them already sleep deprived as they aren’t always ready to fall asleep by 10pm the night before. A study from the British Medical Journal in 2015 researched the effects of screen time and lack of sleep in a substantial sample of adolescents, over 9000. They found that the more screen time the subjects engaged in each day, the longer it took for them to fall asleep. If they had four or more hours of screen time per day, they were 360% more likely to have less than five hours of sleep a night and 49% more likely to take over an hour to fall asleep (Hysing, M. et al, 2015). When our brains are tired, mental health issues such as depression and anxiety increase. We are not able to think as clearly and have more difficulty handling stress than when in a rested state. NACD recommends consistent nighttime bed routines starting when children are little, such as no screens in the bedrooms, and devices are to stay with parents. We suggest having at least an hour to an hour and a half of no screens prior going to bed. We also encourage very dark rooms (blackout shades or curtains) and white noise to help facilitate a good night’s rest.

I hear many times “my kid has a balanced diet; they eat some of everything every day.” But how much of those foods happen to be processed? Have extra or hidden sugars? Artificial ingredients? More and more research on the foods we eat are targeting how they impact our mental health. “In recent years, a direct relation between the occurrence of anxiety disorders, sleep disturbances, and mood disorders has been observed as a consequence of poor or inadequate diet. Eating habits in Western societies have greatly changed in recent decades, with an increase in the consumption of foods low in vitamin and mineral content, high in caloric value, and rapidly prepared and easily consumed.” (Fernandez-Rodriguez, M., et al., 2017) There is a direct interrelationship between physiological health and neurological function. NACD has known this since its inception in the ‘70s. Time and time again our clients have shown that those who eat better function better. In general, diets rich in plant based foods, healthy fats (in the form of plants, nuts, seeds, and fatty fish like salmon), and lean meats are far superior in promoting mental function. In contrast, diets high in sugar, dairy, breads, and processed foods have been shown to be related to depression, chronic inflammation, and anxiety. This isn’t just for adults! According to Natalie Kling, a Certified Clinical Nutritionist from NACD’s Professional Advisory Committee, “the human body is always moving towards homeostasis, or perfect balance. When a body is out of balance, we see or experience symptoms (physical AND mental). We can soothe symptoms by giving the body the interior environment it needs to return to balance. Rest, hydration, oxygen, nutrients, detoxification, and a healthy and loving environment provide the ingredients the body needs to repair, regenerate, and reorganize. In contrast, when we introduce processed foods, sugar, not enough sleep, chemicals, environmental toxins, or stress, we push the body out of balance and create obstacles to the body’s ability to thrive.”

Personally, I have noticed a great difference in my son’s “teenager attitude” when he doesn’t eat these foods. When his diet is clean, whole food based, there is a positive difference. Often times I see parents eating healthy, but their kids are eating foods loaded with sugar and the “bad stuff” because “they’re kids.” NACD suggests to parents to develop a palate for healthy food with their children in infancy. NACD recommends to our families to work with one of our nutritionists if you need help in getting started. Natalie Kling, who also happens to be an NACD mom, has suggested that parents can start by just focusing on getting more vegetables into your kids. Smoothies (without added sugars and dairy), homemade sauces, etc., are ways to start that process. If you are a new parent with young children, keep their diets high in plant-based foods so that they develop a taste for it. If you are a parent with a picky eater, they don’t have to be. By giving the brain and body the correct fuel it needs, this can help to improve your child’s physical AND mental health as well.

Many children and adults struggle with anxiety due to lack of physical exercise. If we sit back and look at our lives today, we lead more sedentary lifestyles. We watch our TVs, screens, sit and scroll through our phones, many of us work all day at a desk, and many of our children are in school for 6+ hours (sitting for a huge chunk of that), many without daily physical exercise. According to the US Department of Health and Human Services (2018), children ages 3-5 years of age should engage in at least 3 hours of physical activity with varying degrees of intensity. Children ages 6-17 should engage in moderate to vigorous physical activity (aerobic, muscle, and bone strengthening) for 60 minutes DAILY. Adults should have a similar amount. Do you get that? Do your children? Exercise stimulates endorphins in your brain that allow for improved executive function, attention, and mood. Essentially, it allows you to handle stress better and not let it handle you. NACD recommends families make an effort to include physical exercise as part of your day. Schedule it in. In fact, on some of our programs we will write screen time = chore time = exercise time. For my children, the screens, homework, and chores don’t happen after school until physical exercise does. It might be going to the gym or doing an online video. Sometimes it is going for a run or even a fast walk. Snow or sun, we make it a priority.

In conclusion, it is important that as parents we really understand how significant lack of sleep, poor diets, and lack of physical exercise impacts our children’s physical and mental health. They work together, impacting one another. NACD looks at the whole child and sees this as a huge piece to impacting the global mental function of a child.

Reprinted by permission of The NACD Foundation, Volume 32 No. 1, 2019 ©NACD

References

Fernández-Rodríguez, M., Rodríguez-Legorburu, I., & López-Ibor Alcocer, M. I. (2017). Nutritional supplements in anxiety disorder. Actas Espanolas De Psiquiatria, 45(Supplement), 1.

Hysing, M., Pallesen, S., Stormark, K. M., Jakobsen, R., Lundervold, A. J., & Sivertsen, B. (2015). Sleep and use of electronic devices in adolescence: Results from a large population-based study. BMJ Open, 5(1), e006748-e006748. doi:10.1136/bmjopen-2014-006748

How Much Sleep Do We Really Need? (2019). Retrieved February 5, 2019, from https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-we-really-need

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

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Growing up in small town Idaho, anxiety was rarely expressed as an issue with children and adolescents. Anxiety was something that adults had. Even in college 20-24 years ago, stress was an issue when papers were due, or it was finals week. The talk of anxiety and panic attacks was never common, and medication was not needed to help my fellow college companions cope. Having said that, it is hard to know if childhood friends or college roommates had these issues all along but didn’t know what it was? How many of them turned to substance abuse to cope? How many of them are now dealing with debilitative mental health issues that could have been resolved when they were younger?

While anxiety may not have been a significant issue then, it is now. With suicide rates climbing at lightning speed in our youth, we cannot ignore the growth of children and adolescents being diagnosed with anxiety and other mental health disorders. NACD is all about helping children reach their full potential so that they can be happy, contributing, productive adults to our society. As such, we must evaluate the various factors that could be impacting our children’s stress levels both at home and at school. Research in the area of anxiety in children and adolescents has grown and includes possible contributors to this epidemic.

Over the next several articles, I will discuss the following as anxiety contributors and offer suggestions from a neurodevelopmental perspective:

1. overall physiological health of children today from sleep deprivation to diet and exercise
2. avoidance behaviors in children that lead to increased anxiety later
3. children who never learn how to do basic living skills and the significance of developing working memory
4. smartphones and too much screen time
5. children not being present or “mindful”
6. lack of social connection and community
7. high stakes testing, school pressure, and narrow competition.

With this series of articles, my hope is to educate parents and hopefully provide you with some general guidelines to think about as you raise your little humans in this generation.

Reprinted by permission of The NACD Foundation, Volume 32 No. 2, 2019 ©NACD

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The Tucson Children’s Assessment of Sleep Apnea Study was published this year in the journal SLEEP [1]. In this study of 263 youth, sleep study and neurobehavioral data was collected twice, five years apart. Twenty-one of the children had persistent sleep apnea throughout the entire study. These children were six times more likely to have behavioral problems when compared to children with no sleep issues. Parent-reported behavioral problems were significantly higher for the children with sleep apnea; these observed problems included hyperactivity, attention deficits, aggressiveness, poorer communication, lower social competency, diminished self-care, and compromised adaptive skills. The study also reported an association between sleep apnea and lower academic function. The children with persistent sleep apnea were three times more likely to have learning problems and seven times more likely to have grades of C or lower than youth who never had sleep apnea. This study and others [2] conclude that children with sleeping issues may develop learning problems, disruptive behaviors, and other ADHD symptoms if sleeping issues are left untreated.

The National Association for Child Development has known that sleeping issues affect the global development of a child, due largely to a lack of adequate oxygen being delivered to the brain during sleep. Sleep apnea is a breathing problem in which the airflow is limited and obstructed during sleep, resulting in less oxygen to the brain [3]. The importance of oxygen for the brain cannot be overstated. The brain uses about three times as much oxygen as muscles in the body do, and brain function and performance are directly linked to oxygen availability [4]. NACD highly recommends that parents with a child experiencing any symptoms of sleep apnea, such as snoring, take the child to a doctor to be evaluated. It is also a good idea to frequently check the child’s oxygen saturation level. A quick, easy, inexpensive way to track oxygen saturation levels at home is with a pulse oximeter.

To find out more about sleep apnea, including common symptoms and treatments used by doctors, please read our article here.


To find out more about the importance of oxygen for the brain, please read our article here.

To find out more about pulse oximeters, please read our article here.

Sources

1. Perfect, M.M., et al. (2013). Risk of behavioral and adaptive functioning difficulties in youth with previous and current sleep disordered breathing. SLEEP, 36(4), 517-525.
2. Beebe, D.W., et al. (2010). The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. SLEEP, 33, 1447-1456.
3. Riggs, S. (2012). Sleeping and breathing problems. NACD Journal, 25(3).
4. Joo, E.Y. (2010). Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. SLEEP, 33, 235-41.

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It might not be that shocking to find homeschoolers get more sleep than their public school peers, but a new study which featured 2,600 adolescents around the nation found homeschoolers get on average 90 minutes more sleep per night!

Just to put that into perspective, 90 minutes a night over the course of a 5-day school week equates to 1 entire night of extra sleep. Ninety minutes is also the length of an entire extra REM cycle, which means homeschooled students have a huge advantage when it comes to consolidating the information learned the previous day into long-term memory, recovering from the physical and mental demands of the previous day, and having increased vitality and focus to face the next day head-on. It has long been known that when puberty begins, the internal biological clock normally has a sleep-phase delay in which adolescents naturally go to bed later at night, and consequently, wake up later in the morning. Yet, in spite of this understanding, most middle schools and high schools start school even earlier in the day compared to elementary. It’s no wonder only 24.5% of public school adolescents are meeting their daily sleep requirement! Homeschooling simply gives the flexibility in scheduling to allow the child to wake up not when the alarm clock goes off, but when the biological clock goes off. To read more about NACD’s programs for homeschoolers click here.

Source:

Hughes, T. (2013, March 15). Study: Home-schoolers better rested than other students. Retrieved from http://www.usatoday.com/story/news/na5on/2013/03/14/home-school-sleep-study/1986781/ Dawson, P. (2005). Sleep and Adolescents. National Association of School Psychologists.

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