Rush NeuroBehavioral Center’s Educational Services Department has developed an Executive Functions curriculum based upon organizational strategies that help a child become successful in and out of school. These strategies emphasize organizing materials, managing time, developing study skills, and setting goals. We know that these skills readily transfer into life beyond the classroom. They tend to be the top criteria employers look for in their employees. With summer fast approaching we would like to take the opportunity to share some ways in which you can encourage children to increase their overall potential.

The first thing to take into consideration when helping a child further develop any ability is how you can provide purposeful feedback. Carol Dweck has studied the effects of a fluid mindset (the belief that an individual has control over their success) on how children learn. Her research shows us the benefit of acknowledging the effort children put forth, rather than their accomplishments and final products. This not only helps to point out the skills and qualities that help children be successful, but also encourages them to overcome challenges and raise their effort level. For example, with a younger child, rather than telling them their drawing is beautiful, sincerely tell them what you like about their drawing. With older children, compliment them on the implementation of a well thought out study plan rather than the grade they receive on the test. For a short introduction into Carol Dweck’s work, read the article How Not to Talk to Your Kids by Po Bronson.

Giving children responsibilities around the home can increase their self-esteem if it’s approached with the right mindset. Children of various ages can take part in helping around the home by keeping their room clean, sorting laundry, planning and preparing a meal, caring for a household pet, or maintaining a garden. There are factors that need to be considered to ensure a successful outcome and a parent or adult helping out is an essential part of the process. With your children, identify and discuss their responsibility. Then come up with a plan that breaks the activity into small steps. Make sure to write the plan down by putting it into the family calendar.

Groundbreaking research also helps us understand the tremendous positive impact of exercise and mindfulness (a form of meditation not to be confused with mindset) on brain functioning. Both have been shown to cultivate an ability to sustain attention, increase problem-solving abilities and decrease stress. Take the summer to help children develop new habits and routines that include 30–45 min of aerobic exercise each day as well as time to engage in mindfulness. The book Spark: The Revolutionary New Science of Exercise and the Brain by John J. Ratey and www.mindful.org/mindful-magazine are excellent resources for gathering more information.

We hope you find these suggestions helpful and easy to use over the summer. For further information on how the Educational Services Department implements our Executive Functions Program in schools, classrooms and on an individual student basis, please click here.

Luckily, there is always summer, with its emphasis on fun and flexible schedules and following one’s interests, with less “I must” and “I should” and more “Might as well try it” and “I’d love to…”

Over the years I’ve come to marvel at how much better the children I see feel by the end of August, and at how many of them, during those golden months, develop a special interest that endures and shapes their lives for decades. One little boy’s going away to camp in Colorado became a life long interest in fly fishing and hiking. Another child went to ecology camp and developed a consuming interest in biology. But the transformation of a third child, whom I’ll call Audrey, has been perhaps the most joyful and surprising of all.

That is possibly because Audrey has come the farthest. I knew her first at the age of eight. She was one of five children in a remarkable family— socially adept, musically gifted, bright, and athletic. The father had been a pro basketball player; the mother had been a gymnast. All Audrey’s siblings were honor students. Her older brother skied competitively: her younger brother was an excellent golfer. One sister was a gymnast like her mom, the oldest girl had already graduated from a conservatory and played violin with a symphony orchestra. Each child had an area where they ruled—except Audrey. She was a very bright little girl, but she was also diagnosed with ADHD and had some reading issues. In school she struggled. Shy and self-conscious, she also struggled socially. Her self– esteem was not so great.

To the credit of Sally, her very busy mom, Audrey was not lost in the shuffle. After the child was evaluated, I recommended she get help in areas of school work that were difficult for her, and she gradually gained some sense of mastery of the things that had loomed so large and threateningly in her school day. As she read better, she gained more confidence, and she tried harder. It was great.

But as her mom pointed out, as wonderful as it was to see Audrey progress, it was a qualitatively different experience helping Audrey do her necessary but not thrilling reading exercises, than it was watching her son compete in a golf tournament or her oldest daughter play with the symphony. “She tries hard, she’s getting better, but it’s not like she looks forward to doing it. What I want for Audrey is what I want for all my kids,” Sally told me. “I want her to be so gripped by something that she doesn’t notice it’s hard, doesn’t mind the effort she’s putting in. I want her to get good at something because she loves it.”

So Audrey and I talked, and I noticed that that she lit up describing the time she went to the circus with her grandparents. It had been magical, enchanted– especially the aerial artists and the tightrope walkers. Her mom Sally and I discussed it, and by June Audrey was enrolled in a circus arts class that taught unicycle, trapeze, rope walking, and juggling. “I am a baaa-aad juggler,” Audrey told me at the end of the summer, giggling, “but I’m getting better on the trapeze.” The classes she’d begun in the summer led to regular Saturday classes during the school year. Soon she was telling me the difference between the slack rope and the tight rope. The family aptitude for gymnastics became evident in her performance.

During the course of two years, Audrey was transformed. She became confident, more sociable, more academically successful, and yes, she had found a passion—for tight rope walking! Almost every day after school she headed to the practice rooms and balanced on the tight rope, walking, turning, kneeling, doing a handstand. She was the star of circus class. Her interest only grew stronger over the course of a decade.

At the end of high school she auditioned and was accepted for a prestigious college of circus arts in France. Tightrope walking became the activity where she ruled. And summer vacation—with its long hours to devote to a chosen interest—had been the gateway.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the criteria for diagnosing mental health disorders and is used throughout the medical community by therapists, physicians, and insurance providers. In May 2013, an updated version of the DSM will be released with changes in several diagnostic categories.

The new DSM-5 makes significant changes to the diagnosis of Autism Spectrum Disorders (ASD). The current DSM-IV defines ASD across several categories, including Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS). However, the DSM-5 proposes to combine these disorders into a single diagnosis of Autism Spectrum Disorder. This change was made due to the significant overlap and lack of differentiation among the previous subcategories.

The DSM-IV outlined three primary areas in the diagnostic criteria for Autism:

• Language deficits
• Social difficulties
• Repetitive behaviors and stereotyped interests

The upcoming DSM-5 proposes to reduce these primary areas into two core areas of diagnosis for ASD:

• Communication and social interaction deficits, which include difficulties related to social reciprocity, nonverbal interaction, and maintaining social relationships
• Repetitive behaviors and stereotyped interests

The proposed changes in the DSM-5 impact the diagnosis of ASD in several ways. First, social skills and communication have been combined due to the high level of overlap between the two domains. A deficit in communication typically has a significant impact on a child’s ability to initiate and engage in social interactions. Also, children with autism are no longer required to have a language deficit. The new criteria do not require language delays and abnormalities. Furthermore, children with ASD who have a language deficit will now be given an additional diagnosis to explain the language difficulties.

The DSM-5 has also changed the criteria for communication disorders. Under the new proposed diagnostic criteria children can be diagnosed with three possible communication disorders: speech disorder, language disorder, and social communication disorder.

• Speech disorder is used when children have difficulty with articulation and pronunciation of speech sounds.
• Language disorder refers to children who have trouble understanding and/or formulating language.
• Social communication disorder is a new diagnosis that captures children with pragmatic language difficulties related to reciprocal conversation and repetitive, stereotyped use of language. These types of language deficits are often identified in children with ASD, but were not previously considered a separate diagnosis.

As these proposed changes to the diagnostic criteria evolve, it will be important for parents to ask questions and rely on their providers for additional information about the impact of these changes on their child. Each child will be uniquely impacted by these upcoming diagnostic changes; however, it is important to remember that these diagnostic changes should not impact the quality of care for your child. Although criteria and labels may change, your child’s treatment should still remain focused on their unique pattern of strengths and challenges.

A lot of things affect how well a child with ADHD fares in society. One big factor is the set of criteria used for diagnosis. Most physicians and psychologists rely for their diagnostic standards on the DSM-IV, a manual issued by The American Psychiatric Association. The edition about to be released (DSM-V) contains a substantially broader standard for defining Attention Deficit Hyperactivity Disorder.

The new criteria are both positive and potentially problematic. Up until now, according to the DSM-IV, ADHD symptoms had to be observed before the age of seven for a diagnosis to be given. Also, the condition had to be severe enough to “impair” the functioning of the child. Under the new guidelines, the child must be diagnosed before the age of twelve, and his or her life need only be “impacted” by the condition. These are a big changes. On the plus side, it means that children with milder symptoms will be able to receive treatment that could mean a world of difference—fewer missed assignments, lost belongings, and flubbed tests. It means fewer children will constantly feel they have failed or “messed up.” Fewer children—and their teachers and parents—will struggle with a perpetual sense of frustration.

But it means some less positive things, too. The trouble is that you can’t do a quick, sure test for ADHD as you can for strep throat. Most children are diagnosed on the basis of their teachers’ and parents’ reporting. These are likely to be loving and responsible people, but not trained professionals. Many physicians who make the diagnosis and write the prescriptions are not highly trained in this specific area of expertise. Under these circumstances, errors creep in. A little boy who runs, leaps, shouts, defies authority, and has no use for book learning could have ADHD or he could be a hero in a book by Mark Twain. Children in western societies are being asked to live more sedate and sedentary lives. Many experts contend that the mounting number of cases of ADHD for which children are medicated in part reflects an adult desire to enforce docility or enhance academic performance.

Fortunately there are ways to improve the accuracy of diagnosis, which we use at RNBC. These include a carefully administered battery of tests to quantify attention skills, executive functions and processing speed as part of a broader evaluation looking at intellectual ability, achievement, cognitive processing, as well as social and emotional status. We can then tell if a child has trouble maintaining focus or shifting focus, or whether a child’s attention is disturbed by something auditory or visual in the environment. More importantly we can discover if the problem is actually an issue with attention or with something else. Children often appear to have ADHD when they are suffering from anxiety or depression or a learning disability. It is hard to pay attention when you are anxious, or can’t make sense of the letters on the page, or if your depression causes you to feel a general indifference to everything around you. Even more common, in my experience, are children with multiple issues, who are struggling to cope with ADHD plus one or more of the conditions listed above.

Without a proper assessment, the child may simply receive medication with a drug such as Ritalin, Adderall, or Vyvanse. The quality of attention may improve. But other problems remain undiagnosed and untreated. The child’s progress, performance, and sense of well being may still be constrained.

A secondary but serious problem is that these drugs have a large potential for abuse. Even in children without ADHD, these pills can cause a big improvement in focus and productivity. They can boost performance in class and on tests. They are, in the words of one expert, Dr. Ned Hallowell, “Mental steroids.”

When my patients who take stimulant medications are transitioning to high school we have a conversation about friends or fellow students who might want to “borrow”—or offer them money for —their medications. We discuss how carefully we diagnose and assess each patient’s condition to establish the right medication and dosage, and how scrupulously we watched for any side effects. I point out that this would not be true for an unauthorized, undiagnosed user, which is why selling your medication to others is dangerous and actually illegal.

When the child enters college we have another conversation about whether the patient wants to be open about the use of these medications. I hope my patients can be honest about their condition and feel comfortable discussing it. But their openness can put them at risk of fellow students offering to buy—or even stealing—their medication.

By some estimates, one third of the medications prescribed for ADHD end up being given or sold to others. These medications are used recreationally or to enhance the performance of students who don’t really need them. And it’s not only the kids who are trying to obtain them. Recently I got a phone call from a father of a teenage boy. “My son has to take the SATs in a couple months, and I know he’ll do better if he’s on meds for ADHD,” he told me.

“At what age was your son diagnosed?” I asked him.

“He hasn’t been diagnosed with anything,” the father said. “He just needs meds for testing.”

“Oh, I see. Well, I only treat patients whose attention and self regulation issues have a negative impact on their performance in school and their social well being. My patients have a well-diagnosed disorder.”

There was a silence. Then the dad tried again. “You know, Dr. Lipton, this isn’t a big deal. Doctors do it all the time in New York.”

“Fine,” I said. “The area code is 212.”

Q: Data released from the CDC shows that since 2007, prevalence of autism spectrum disorders (ASDs) has nearly doubled, while ADHD diagnoses rose 1.5% in school-aged children. What do you believe is the underlying reason(s) for these increases?

A: The big question is are these increases real or are they the result of a social or cultural phenomenon? In the case of ASDs, it seems to be a bit of both. A recent study suggests that older fathers are more likely than young fathers to have a child with an ASD. Men are having children later, increasing the likelihood that they’ll have a child with an ASD. However, I don’t believe that this alone created the explosion in diagnoses. Other contributors, in my opinion, are increased awareness, decreased stigmatization around having a neurobehavioral disorder, and improvements in diagnostic technology. These factors have compelled parents to seek out an evaluation when in years past they may have never considered that course of action. So really, what we are seeing is an increase in identification rates rather than a true increase in prevalence.

Q: The DSM-V is set to include new criteria that would allow more adolescents and adults to qualify for an ADHD diagnosis. With recent studies showing that 11% of school-aged children are medically diagnosed, do you view the new criteria as positive or negative? 

A: Whenever the criteria for a disorder change, there are potential benefits and drawbacks, and the outcome of this change remains to be seen. Assuming that the new criteria will expand the pool of kids diagnosed, time will tell whether those kids will have the same level of impairment as kids meeting stricter criteria. If they do, I’ll feel more comfortable that we’re finding kids who were going undiagnosed before, and we may find that those kids need and benefit from treatment as much as those with more severe forms of ADHD.

Q: Do you believe there are there effective measures in place to determine who among those diagnosed should receive medication?

A: No – we know that in general kids who meet diagnostic criteria for ADHD tend to benefit from medications. Our new medication assessment service can help parents and physicians find the medication and dose that has the most benefit and the fewest side effects. Kids with ADHD can also benefit from “super-parenting” at home and behavioral reward systems at school. The trick to modifying home and school environments is to stick with the program and apply it consistently. This means, among other things, that parents who consult with a behavioral parent coach need to hang in there. It often takes some time and tweaking to get it right.

Q: Why do you believe such a gap exists between school-aged boys and girls in regards to ADHD and ASD diagnoses?

A: No one really knows. The higher severity and prevalence in boys may be a caused, in part, by sex differences genetic makeup. Girls have the good fortune of having a spare X chromosome, which may confer protection against some problems. It also seems likely that cultural factors, such as expectations about what is appropriate behavior for boys and girls, play a role. In some ways, ADHD is an extreme version of “boys being boys.”

Read more about the results of the CDC study here.

Watching Tory later in less structured activities I noticed that although her classmates made it easy for her to join in on the playground, she more or less went about her own business. Tory observed the other children yet was unable to find just the right moment to join in. Often refusing invitations to play tag and jump rope, she finally agreed to play horses with another little girl using a jump rope for reins. It seemed to me that she felt she wasn’t very good at the more challenging activities and participated only when she felt she could perform well.

I also noticed that her interactions were not driven by social interests. She didn’t seem to care whom she played with or to have particular friends—but chose activities solely on the basis of whether she was willing to engage in a particular game. This can be one of the signs of a difficulty with social-emotional learning.

But the heart of the problem, Tory’s parents had said, was her behavior with the teacher, Ms. Mardian. “I’ll ask her to do something and she just doesn’t do it,” Ms. Mardian explained. “It’s as if she doesn’t hear me. I tell her to do something and I’ll find her drifting around, still not doing it. I will actually feel myself getting angrier and angrier with her, but she doesn’t seem to care! She just goes on doing whatever she feels like. She doesn’t respond to what should be a real warning!”

I speculated, and testing later verified, that there were several issues involved. The learning and attention issues that I diagnosed had clearly mattered less in first grade and had been minimized by a teacher alert to her learning style and needs. Tory’s first grade teacher had been an excellent fit for her. She had picked up on her difficulty with writing and recommended an occupational therapist. Tory could dictate her ideas rather than struggle with her fine motor writing skills. And in her first grade class problems with attention mattered less.

Most of all it was the social-emotional issues that were causing Tory’s problems with her second grade teacher. She was a child who had trouble with understanding “faces, places, and spaces.” There was information in her surroundings that she wasn’t taking in. Tory’s first grade teacher had been extremely demonstrative. She didn’t just smile, she beamed! If she was impressed with a child’s work, she put her hand to her heart and staggered backward, as if overcome. If she was unhappy with a child’s behavior she frowned deeply, put her hands on her hips, and shook her head. The visual cues she offered the class were extremely clear and hard to miss. And they were reinforced by verbal cues as well. “I’m thrilled with how good this is!” “I love it!” “I’m sorry. This is not okay. Let’s try this way.”

I went back to second grade and this time I observed not the child but the teacher, Ms. Mardian.

She was a reserved and understated individual. Ms. Mardian rewarded a good effort with a faint smile, she quelled noise with a slight downward motion of one hand, and when she received a wrong answer she winced and paused, then went on as if she hadn’t heard it. Ms. Mardian’s visual cues were in fact extremely subtle and difficult to read. Tory had a great deal of trouble with understanding non-verbal information. Her skills were not as fully developed as those of many of her peers. Tone of voice, gestures, and facial expressions needed to be powerful and straightforward for her to understand them. She had known exactly where she was with her first grade teacher, hence she was more responsive, and and felt more confident as a result.

In Tory’s eyes, Ms. Mardian was simply a mystery and a terror. When Tory’s attention issues or inability to do a particular task attracted her teacher’s notice, Tory did not understand the subsequent encounter. Ms. Mardian spoke with so little emphasis that Tory read her instructions as suggestions, and never picked up on Ms. Mardian’s mounting frustration and anger. When it would finally dawn on Tory that she was doing something wrong she had no idea what she had done wrong nor what would make it right. Distraught and lacking confidence, she would instinctively gravitate to the activities that felt most comfortable—and get in trouble again for hiding out in the reading corner when she should have been doing what Ms. Mardian asked.

There were several things I could do to help Tory, including having her work with a therapist who could teach her to read non-verbal cues. And when ready, join a social development group where she could learn these skills with peers in real time. I also explained the problem to Ms. Mardian and was glad to find that she wanted to teach students like Tory more effectively. It is difficult to change one’s level of expressiveness, but Ms. Mardian took on the task. Using a variety of suggestions including video she succeeded in making more emphatic gestures and broader expressions. She had not realized how little she had appeared to approve of her students, and worked to make her positive emotions show. I also suggested that she add verbal expressions of her feelings. “I like that!” “This is making me really frustrated.” “I’m so glad you’re getting this!”

When I saw Ms. Mardian again, she was eager to tell me how things were going. “You were absolutely right about the way children take in information in multiple ways. Since I’ve started showing my emotions more clearly and also putting them into words, the children have started doing it too. We all understand each other better. The children understand themselves better and I do as well. When a child can say, “I’m getting angry!” it’s usually enough to prevent a melt down, especially if we can discuss what the problem is.”

This was good news. Even better was word that the school performance of my young patient, Tory Browning, had improved markedly. Both because of her therapy, her group and because Ms. Mardian’s words were a sort of Rosetta Stone to her expressions and gestures, Tory was getting much better at reading non-verbal cues. She often still played on her own. Arithmetic was still difficult. But as her ability to read faces grew stronger, she learned more, she joined in more, she was more comfortable and self confident.

Children who struggle to make and keep friends often have difficulty knowing how to solve conflicts with peers. Maybe they don’t know what to do or say. Maybe they can’t tell the difference between a good solution and a bad solution. Or maybe they are unaware a problem even exists. Skillful social problem solving includes a complicated process that most of us take for granted. You have to identify a problem, consider the perspectives of those involved, generate solutions, consider potential consequences and finally choose the best solution. Some children learn this process intuitively and are almost unaware that a “process” even exisits. They are able to navigate a problem start to finish with success; maintaining and even deepening friendships despite typical arguments and conflicts. For other children this process will break down in more than one place, which can lead to chronic negative interactions with peers and fair-weather friendships.

Our social groups at RNBC follow the I-SELF (Intervention — Social Emotional Learning Framework)  framework; a comprehensive and developmental approach that directly targets social problem solving and related skills. We need to be calm and regulated before we can productively approach a conflict. Children in our Friendship Groups learn how to recognize when they are becoming more active and inattentive. They learn strategies to manage their behavior and calm their mind and bodies. They also practice active listening skills, which makes them more available to learning social skills as well as being better friends to each other. Once children are attending to their social environment properly, it’s important to help them pick up on all the relevant information and make accurate interpretations. They learn to pay attention to nonverbal cues to consider what others are thinking and feeling, which helps them make better decisions about how to interact and decide the best way to approach a conflict. They are also encouraged to be flexible in their thinking and consider alternative explanations before jumping to conclusions. We also focus on the nuances of pragmatic language to help children successfully navigate social problems. For example, being able to initiate and exit a conversation, organize your thoughts and be a thoughtful listener is challenging for children with social difficulties.

The I-SELF curriculum builds over the course of the school year providing instruction and practice in these prerequisite skills and culminates in the social problem solving model and sportsmanship units. Children are guided to improve cooperative relations and more complex social skills such as sarcasm and humor. Each step of the process is broken down and taught separately and then is modeled as one fluid process through role play and the natural interactions that occur among the children in group. This structured skill development and practice gives children the confidence to solve real conflicts in real time. As the skills become more natural, children are more likely to develop reciprocal and lasting friendships. If you think your child would benefit from our Friendship Groups or would like more information, please contact intake coordinator Nadine Wengroff at 847–763-7944.

Q: How can parents help their children manage technology so it doesn’t become isolating?

GB: As a parent, you may feel somewhat relieved when your child has settled into a video game or computer program for hours at a time. After all, the time spent in front of the screen means he/she is safe and is doing something he/she finds enjoyable. However, extended periods of time spent online or playing video games solo, especially for children with social issues, can be harmful. One approach to this dilemma centers around providing your child with a system built on time management.

This suggestion for parents is aimed at helping their kids develop a personal calendar, creating a timeline of after-school activities, including time for their favorite media pastime within a balanced framework. After brainstorming several choices of things to do after-school, including those “non-negotiables” like homework, family time, chores, etc., children use this list to fill in the open slots in their after-school schedule. Their favorite activities can only be slotted after the “required” expectations have been completed. This approach may also help smooth over those situations that occur during transitioning when a child can be upset when asked to stop one activity and start another. A pre-determined schedule can help ease these transition difficulties that a child may experience. This type of plan also reinforces completing certain tasks before other activities and, thus, prioritizes persistence in both academic and social endeavors, like spending time with family.

Q: How can parents help their children use technology or other interests to foster friendships?

GB: A child’s interest in technology (such as video games) or any other activity can be regarded as a vehicle for communicating with peers. This switch in perspective from a personal focus to a social emphasis can be challenging for many kids, especially those with social issues who may gravitate towards technology for comfort and for self-soothing qualities. For those children, their favorite activity may become part of a world all their own. The key as a parent is to set some social goals around participating in the interest, either formally by sitting down and discussing specific behavioral pathways, or by simply helping the child find ways to discover peers with similar interests. It’s often helpful to enlist the aid of teachers, other parents, or after-school club leaders and see if there could be opportunities to talk about individual interests as a means to establish shared interests.

Socially adept children incorporate this perspective switch from personal to social naturally. Kids who have difficulty with social skills and have very specific and well-defined interests often don’t recognize these activities as social bridges. Instead, they lock into their unique, individual way of pursuing their interests.

Here again, parents and teachers can help children in a variety of ways, including developing lists of interest-related conversational topics, practicing initiating a conversation using these opening statements. Another perhaps more unusual idea is to model this kind of social situation by intentionally setting up a social interaction with a friend or relative, constructed in such a way that the children “secretly” observe the interaction, using a pre-determined list of criteria that can even be printed out ahead of the exchange.

After observing for a set time period, the parent or teacher asks the child to “rate” his/her parent or teacher according to the pre-set criteria. Within this context, children can also be encouraged to offer suggestions about ways the adult could have increased the number of reciprocal exchanges within a timed observational period. These kinds of activities that are fun and participatory, and put the child in the role of evaluator and expert, facilitate partnerships between parents/teachers and kids. Additionally, at the same time that parents and teachers are fostering social growth with their children they are building up two-way relationships based on positive shared experiences.

Q: What are the main goals during the current phase of the trials?

NRP: The primary goal is to show that the tool is valid and sensitive to diagnostic differences. We’re also interested in determining the usability & likability of this iteration of the assessment. We modified certain aspects based on feedback from children during a previous trial–for example, the assessment is now taken with a computer mouse instead of a video game controller–and we hope to learn whether they find it acceptable and relatively easy to understand.

Q: Will this study have an impact on existing research?

NRP: The goal is that it will be useful in research and clinical practice. We want to use the VESIP first as an assessment tool because we believe it will be more reliable and ecologically valid compared to existing tools. Once we’ve established that our tool is effective, we can ask different research questions around children’s social reasoning skills and use those results to inform intervention design. Specifically, we can understand the relationships between different components of social information processing and how that might inform interventions.

Q: How will the VESIP benefit children with Autism-spectrum disorders?

NRP: One of the biggest challenges for children on the spectrum is interacting with peers, so if we can gain a better understanding of specific problem areas we’ll be able to produce better interventions. We developed five different categories of social situations that are challenging for children –for example, entering into a group of other children or interpreting ambiguous actions. While some can identify the challenges of a hypothetical situation, they may break down when the same challenges present themselves in reality. Alternatively, other kids have trouble identifying the issues themselves, so once we’ve identified that distinction it becomes easier to address individual challenges. The tool is designed to break down the steps in the social reasoning process and provide us with very specific information about what to address for individual children.

Q: What distinguishes the VESIP from other assessments of social information processing?

NRP: There aren’t many comparable tools – most assessments have been completed via semi-structured interview, where an interviewer would ask children to imagine themselves in a particular situation and then gather feedback based on the responses. The VESIP is expected to more closely approximate what happens when a child is in the midst of a challenging social situation. We designed the VESIP to be an immersive experience, so instead of simply describing a situation and asking for a response, we provide a number of different scenarios in familiar environments that we believe elicits the most complete and reliable responses from children. It’s also designed to be game-like and interactive; children are able to move through the assessment at their own pace. Additionally, very little expertise is required to collect and interpret results from an administrative standpoint.

For more information about the VESIP or to find out how you can get involved, please email RNBC_Research@rush.edu.

Many of us have something of a love-hate relationship with sleep. We’re pretty sure we should be getting more of it. We want to “sleep like a log” every night, but often we find ourselves “tossing and turning” when we finally do “hit the hay,” because we can’t let go of concerns and problems that may have taken center stage during the daytime waking hours. In fact, instead of “sleeping soundly” we end up “losing sleep over it” (whatever the “it” may be) and then we wake up feeling poorly rested and still somewhat anxious.

Obviously, my description of this modern state highlights our many expressions centered on the idea of getting a “good night’s sleep” and our prevailing worries about how to achieve that goal. One common sleep expression, however, will represent the main focus for this article, namely, the recommendation to “sleep on it.” This advice is usually applied to a situation that one is pondering which involves a critical decision or a difficult problem to solve. Recent studies taken from the field of neuroscience demonstrate that the way the brain uses sleep, actually underscores the value of taking a “sleep on it” approach.

This article will focus on two main findings drawn from this current body of research. The first indicates that our brain uses deep, extended sleep as a time to sort through events and information from the day’s activities, reorganizing this input, deciding what to keep and what to discard. Several studies (Stickgold and Walker 2005) demonstrate that especially during the latter part of sleep (stages 3 and 4), our brains work to incorporate recent learning with previously information already stored in our longer-term memory to facilitate future access. In this manner it seems that during extended sleep, the memory systems of the brain move from working memory to longer-term storage. Accordingly, each person’s storage system will differ based on our individually unique set of experiences and related learning. This process is often characterized by stating that sleep has a stabilizing and consolidating effect on newly learned (or experienced) information, rooting it into memories that last and clearing the way for new information to be processed (Breus 2012).

The role of sleep in memory and learning has been documented in studies using a wide variety of topic areas. The areas used in these studies include the following: learning vocabulary, learning musical patterns and passages, learning motor skills, learning math facts, working through logic problems, and many more. Results appear to indicate that, shorter periods of sleep (40-to-90 minutes, often termed “cat naps” or “power naps”) can benefit more factual learning while longer periods of uninterrupted sleep produce a significant increase in performance on higher-level learning tasks and problem solving activities, when measuring performance before sleep with performance after sleep.

A second significant finding from current research indicates that when subjects are given information to learn right before going to sleep at night and told they will be asked to retrieve this information the next day, the brain seems to accomplish what’s termed the process of “differential consolidation,” resulting in more successful recall (Klemm 2011). Researchers discuss the brain’s apparent ability to focus and prioritize memory formation based on instructions given prior to sleep. Additionally, when two research groups (adequate overnight sleep and sleep-deprived) are compared in similar tasks, the ability to discriminate between information labeled as “important” and that stipulated as “not important” suffered the most. This finding would seem to have implications regarding the efficient functioning of our memory systems relative to how sleep influences our decision-making capabilities in everyday life.

(Source: National Sleep Foundation 2012)

Finally, then, we must ask the following question: “How much sleep is enough?” Sleep researchers have measured learning and memory across age groups to determine the average recommended sleep time periods, recognizing that there are individual differences. These findings are listed below, organized by age group.

In case you are wondering, the term “uninterrupted sleep” usually refers to hours of sleep occurring in succession during which there are either no interruptions or interruptions are brief and the sleeper returns to sleep immediately. In other words, getting up for a drink or going to the bathroom usually qualifies. Waking up to work at your computer, answer text messages, etc., usually would not. For this reason, parents are encouraged to take charge (both figuratively and literally) of their children’s cell phones before bedtime to eliminate the temptation to “be on alert” all night for those all-important 2:00 a.m. text messages, as well as other forms of electronic social media related communications that may come in throughout the nighttime and interfere with their child’s getting a good night’s sleep.

The best acknowledgement of the critical relationship between sleep and our ability to develop efficient, high-performing memory systems may be simply to wish everyone, “Sweet Dreams!”