|Publisher:||American Academy of Pediatrics|
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Child Development and Brain Organization
The concepts and recommendations described in Raising an Organized Child are directly or indirectly supported by years of scientific evidence about how the brain evolves with age and how organizational skills develop over time. This chapter focuses on the scientific discovery and fascinating process by which clinicians grew to understand the organized brain and provides background on the evidence that supports the practical teachings discussed in this book.
As a result, the material discussed in this chapter is a bit more technical in nature than the rest of the book. The material is being provided for any readers who wish to further their understanding of the scientific rationale for the importance of cultivating an organized mind. Because, as every parent knows, even your preschoolers will ask, "Why?" to most of your requests since even they know that the explanation is important. This chapter focuses on the "Why?" and the following chapters address the "How?" As such, this chapter is not necessarily critical or essential to your understanding of the practical advice and suggestions provided in subsequent chapters.
Organization of Cognitive Functions
Organized thinking covers more than just being messy or late. An organized child has not only the neurodevelopmental capacity (memory and thinking skills) to store and retrieve sequential and spatial observations and data (information about order, shape, and size), but the ability to process multiple layers of information simultaneously. The organized brain is capable of higher-order cognition, including conceptualizing, perspective taking, creativity, and complex decision-making. These mental tasks require a very complicated system of neurological integration (brain wiring that connects thought).
The brain relies on an intricate network of interconnected brain functions. The brain's organization is similar to the layout of a large city. Cities are divided into districts, such as industrial, residential, shopping, and entertainment. In a city, crisscrossing highways connect these districts and carry traffic back and forth.
The brain is similarly divided into regions Of neurodevelopmental function, such as memory, language, spatial and sequential processing, and motor control. Skills that a student must perform, such as writing a name, remembering homework, and playing dodgeball, require communication between these brain districts, or neurodevelopmental functions. For instance, consider a simple skill such as getting dressed in the morning. This task requires the sensory and motor systems to work in unison because coordination and balance are needed to put on clothes; dressing requires memory, for example, to remember that underwear should be worn before the pants, and so the brain creates a "getting dressed plan" that is stored and accessed each morning; attention must be given to details such as zipping the zipper and remembering to tie shoes; and tying shoes requires an element of sequential processing, because a number of steps are needed to make a proper bow. So, to complete even simple tasks such as getting dressed, a child's brain must network a complicated series of functions that occur in different regions of the brain. When one looks at it that way, it is almost a miracle that children make it to school each day!
Nerves in the brain serve the same function as do roads in a crowded city. They create a channel for communication between brain centers. The neural network is much more complicated than the congested Los Angeles freeway system. In fact, there are trillions of brilliantly orchestrated nerve highways where information travels at unimaginably high speeds. These nerves allow for different brain functions to communicate. With so much traffic, traveling at such high speeds, one would think that traffic crashes would frequently occur. If "crashes" happened in the brain, which they do, what would that look like? Picture a child who raises his hand in class in response to a teacher's question, and then, when called on, he forgets what he wanted to say. Consider a student who cannot help blurting out answers when the teacher is talking or interrupts his parents when they are on the phone. Remember the child who emotionally falls apart when he does not have situations go his way. Another common mental crash occurs when children are unable to pull themselves away from the television set or computer in order to get ready for school in the morning. These crashes occur in all people, but they happen more frequently when a person's brain is insufficiently organized.
Neurodevelopment of the Brain
The intricacies of the human brain and how it functions are a never-ending adventure. Each new discovery leads to even more questions. Research over the past century has provided insight into how the brain supports organizational skills. We can now point to a few specific regions of the brain that work together to support organized thoughts and actions. Some discoveries have been serendipitous (helpful even though they were made by chance, when looking into something else), such as those that result from assessing unintentional brain injuries. More-recent advancements in our understanding of the brain have come from exciting new technologies, such as brain imaging scans. Brain imaging technology allows researchers not only to take pictures of parts of the brain but also to watch how blood flows inside the brain while patients perform different types of mental tasks. The understanding is that brain regions that are activated require blood to deliver more oxygen. Elements of the executive functions (brain skills needed for planning, task completion, and self-regulation) can be measured with specific pencil-and-paper and thinking tasks. This allows clinicians to observe planning and organizational functions in a clinician's office. By using these tools with people who struggle, and with those who have savant or gifted abilities, scientists continue to expand the collective understanding about the efficient functioning of the brain. These tools, when applied to children of different ages, help us create a set of developmental organizational milestones that parents can use to guide their children's intellectual and functional growth.
More recently, studies of patients who have brain injuries, particularly strokes, have helped scientists isolate brain function throughout the brain. A stroke occurs when blood supply to a portion of the brain is impaired; sometimes these incidents can affect very specific parts of the brain. When patients have a blockage, or a leakage, to a blood vessel in the prefrontal cortex (the front part of the brain responsible for executive function control), physicians can correlate daily life function with the specific location of the brain injury. Daily life function (eg, cooking, housekeeping, taking medication as prescribed) requires a significant amount of planning, and it tends to be compromised after certain types of cerebral vascular injuries (eg, stroke). The effects of brain injuries to the prefrontal cortex have been described in rehabilitation settings. The Allen Cognitive Level Screen (ACLS) rates performance on a variety of executive tasks, and scores correlate with performance on activities of daily living that require planning. Thus, with imaging technology and measures such as the ACLS, scientists have been able to map specific regions of the brain with performance on pencil-and-paper and thinking tasks and with daily life function.
Scientists have imaging studies that allow us to take live pictures of the thinking brain. These technologies allow scientists to track the flow of oxygenated blood through the brain's blood vessels while children think (eg, perform math or solve puzzles), and this allows them to postulate where, in the brain, different types of thinking take place. Also, quantitative electroencephalographs are used to track the brain's electricity during brain work as axons in the brain carry electrical messages to stimulate thought. The precision of this testing begs the question, why not just do a brain imaging study of every child to see whether the child might have attention-deficit/hyperactivity disorder, autism spectrum disorder, or some other condition?
The answer to this question is complicated. Aside from the small medical risk that accompanies certain medical tests, the fact is that at the time this book was published, the data suggest that these tests, in most cases, are not any more accurate in finding a diagnosis than an interview by a good clinician. The difficulty in making a diagnosis stems from the fact that each brain is unique in its wiring and connections. It would be easy to make a diagnosis if brains were identical and imaging could detect a clump of nerves that were out of place, but the reality is that each brain has its own architecture.
One way to explain the variability in brains is to describe a scatterplot. A simple example might be estimating the sex of a person by plotting the length of his or her hair. Most of the girls would be on the long hair side of the scatterplot, and most of the boys would be on the short hair side, but there would be plenty of girls with short hair and many boys with longer hair than most girls. Therefore, the length of an individual's hair can be used only as an estimate of a person's sex. Similarly, a SPECT scan or an electroencephalogram, at this time, can offer only an estimate of the origin of a person's behavior using the typical wiring pattern of a brain.
We know from studies of brain injury in young children that one must use the word typical carefully when describing brain wiring since brains are plastic. Plasticity refers to the capacity of a brain to change or adapt. When a child, for instance, has a stroke that affects his ability to move his arm, through physical therapy the brain can recruit new pathways to control that function. Since the brain is capable of structural change when challenged, at this point it is difficult to rely on a computerized technology that is based on an average or typical presentation to make a diagnosis. Still, technology studies form an important avenue for future research and discovery. Your pediatrician should be able to advise you on the pros and cons of new diagnostic techniques.
The organizational brain functions occur most notably in the prefrontal lobe, a section of the brain located about 2 in (5 cm) from the front and top of the brain. This organization center of the brain, commonly referred to as the "executive function center," commands self-control, sequential and spatial organization processing, shifting thoughts, and simultaneous processing. Sequential processing describes order and timing. Spatial processing covers location. Shifting allows the brain to smoothly flex from one thought to the next. But the concept of simultaneous processing is more complicated.
Simultaneous processing refers to the brain's ability to think about more than one thing at a time. It is also sometimes referred to as the working memory of the brain. Consider the working memory as a mental whiteboard that holds on to multiple pieces of information at a time. For example, on a whiteboard it is much easier to write out a math calculation than to remember the steps in one's head. Likewise, when dialing a phone number, one might forget the number during the act of dialing unless she writes it down. When the working memory is intact, the brain can manage multiple simultaneous thoughts.
So how does this apply to organization? Well, most organized thought can be traced through the working memory center of the brain. It is like the Grand Central Terminal for organization in the brain. Planning involves the working memory, because it allows a child to think about multiple steps at a time. The working memory is also involved in taking perspective. For instance, when a child shares with a friend, that child is not only thinking about his desires but also using his mental whiteboard to consider the perspective of his playmate. The working memory helps children make choices, because the mental whiteboard works like a dropdown menu of options.
Younger children have less control of their working memory and therefore demonstrate more disorganized thinking. Quite often, young, and some older, disorganized thinkers react to new situations in only one ineffective manner, sometimes referred to as reflexive negativity. One mother of a patient said that her son's first response is always no, regardless of what she asks him to do. Whether she remarks, "Please take out the trash" or "Let's go to a movie," his first response is to say no. It does not matter how much he may enjoy going to movies — even if the movie is about his favorite thing — he always says no. Quite often, reflexively negative kids have faulty "drop-down menus." The drop-down menus of the brain are analogous to how computers are organized. When an organized child is confronted with a dilemma such as free time, he should have access to a metaphorical mental drop-down menu of options. But when this menu does not spontaneously appear, a disorganized child chooses to respond with the first action that pops into his mind, which these days is often a computer game or social media. Reflexive negativity is commonly observed in 2-year-olds, because 2-year-olds are by definition disorganized. Their response is usually no. When this behavior continues beyond the age of 5 years, it is problematic and should be discussed with your child's pediatrician.
Sometimes when kids get older, a lack of a functional, instantaneous drop-down menu system is associated with boredom. Children often appear bored, because they cannot consider a mental list of activities to do.
The cognitive executive functions, including simultaneous processing, sequential and spatial processing, and cognitive shifting, allow for the following complicated organizational thought and more:
Flexible thinking (considering and creating multiple responses or behavior options)
Demonstrating insight or grasping the big picture
Transitioning smoothly from one task to the next
Coordinating movements while participating in a sport (a motor plan)
These organizational skills become increasingly important as children grow into young adults, and fortunately, brain development usually meets the increasing demands. Because the demands change, students who may perform adeptly at one level can suddenly struggle at the next. We often see this in middle school students who excel through elementary school but are not ready for the organizational expectations of middle school. When discussing organization in children, it is important to describe not only the roles of organization but also the developmental expectations. The later chapters of this book demonstrate the expected development of organizational skills by age, but when reading forward, remember that by age 5 years, there is already a tremendous variability among children in their organizational skills. Therefore, the best way to use this book is to identify the level of your child and use the strategies for that age to propel her forward.
Development of Organizational Skills
As children grow, so do their organizational skills, yet each child progresses at his or her own rate. This section highlights some of the research that demonstrates how organizational capabilities grow with age. Early signs of executive functioning are evident before a child turns 1 year. A toddler can follow a brief plan or make simple decisions using one piece of available information. Three-year-olds can complete tasks that require them to make a decision between 2 separate rules. They demonstrate the flexibility to make choices and maintain focus despite the distractions of performing a task. By the time children enter preschool, they are often capable of following a group plan. They can execute plans independently when cued by subtle signs made by the classroom teacher and can ignore distractions for 15 to 20 minutes while they participate in circle time.
The A Not B Task
Many studies have demonstrated the growth of executive functions during the first years after birth. A pioneer in child development, Jean Piaget, performed an experiment called the A Not B Task with young children aged 7 months and older. In this experiment, the children are shown an eye-catching toy. The toy is placed into Box A, within the child's reach, and the child is allowed to search for the toy. This action is repeated several times. Then, while the child is still watching, the toy is placed into Box B, also within the child's reach. What Piaget found is that children younger than 12 months consistently went to Box A to find the missing object. The theory is that the introduction of the second box was too much for them to consider. It overwhelmed their processing. Unable to focus on more than one thing at a time, the children perseverated on the 1 box that had become familiar to them, Box A. Children closer to age 12 months were not distracted by the rehearsals and were able to consider other possibilities (Box B).(Continues…)
Excerpted from "Raising an Organized Child"
Copyright © 2019 Damon Korb, MD, FAAP.
Excerpted by permission of American Academy of Pediatrics.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction. A Parents Predicament in Supporting a Growing Childs Organization xi
Chapter 1 Child Development and Brain Organization 1
Chapter 2 The 5 Steps to Raising an Organized Child 19
Chapter 3 Raising an Organized Infant: The Bonding Years 41
Chapter 4 Raising an Organized Toddler: The Great Explorer 53
Chapter 5 Raising an Organized Preschooler: The Years of Great Brain Growth 71
Chapter 6 Raising an Organized School-aged Child: The Master of Routines 105
Chapter 7 Raising an Organized Teenager: Preparing for Launch 159
Chapter 8 Organized Children Are Raised 191
Appendix A Misunderstood Minds 197
Appendix B Creating Mini Routines 207
Appendix C Mind Mapping 213