In this insightful episode of Heal Your Roots Podcast, host Kira Yakubov is joined by Dr. Karen Wilson - a Clinical Neuropsychologist, Director of West LA Neuropsychology, PC, the founder of ChildNEXUS.com.
They delve into the complexities of children's mental health, discussing common learning disabilities, processing disorders, and the intricacies of diagnosing ADHD, Autism, and Learning Disorders in children. Dr. Karen explains the importance of neuropsychological evaluations, early detection of language-based issues, and the differences in how boys and girls present learning disabilities and Autism symptoms.
Kira and Dr. Karen also explore the challenges parents and teachers face in identifying and addressing mental health issues in children, discussing the crucial role of gathering information from multiple sources and creating a neurocognitive profile for each child. They emphasize the importance of empowering the child and the whole family through understanding and intervention.
The conversation also covers the overlap between Autism and ADHD and recommendations for school interventions and modifications. Dr. Karen sheds light on the impact of the frontal lobe on fine motor skills, the transition to independent living, and the importance of self-advocacy and self-care during the emerging adulthood period - particularly when going off to college.
Finally, they discuss Dr. Karen's company, ChildNexus, and how it provides parents with reliable information and resources to navigate the world of children's mental health.
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How do you diagnose a child’s mental illness? 4:38
What neuropsychological evaluations are and why they are important.
Common struggles children face.
A holistic and systemic approach to ADHD diagnosis.
Anxiety and adhd are two different treatments.
Differences between boys and girls with learning disabilities. 9:00
Differences between boys and girls with learning disabilities.
Girls with autism camouflage symptoms.
Types of assessments done with children.
Early indications of language-based issues and developmental milestones.
What are parents seeing at home? 13:19
What parents are seeing at home vs school.
What teachers are observing in the classroom.
Gathering information from parents, teachers and rating forms.
A neurocognitive profile of a child.
The process of collecting and analyzing the data. 19:11
The first step in the assessment process.
The importance of understanding why reading is difficult.
Empowering the child and the whole family.
Finding a name for dyslexia as a child.
Language processing disorders in Adhd.
Language-based disorders and language processing disorders.
Mood disorders and anxiety in autistic individuals.
Family history and timeline of difficulties.
40-50% of kids with adhd also have a learning disorder.
The overlap between autism and Adhd. 28:27
70 to 80% of autistic kids meet criteria for adhd.
Interventions for children with ADHD.
Cognitive behavioral therapist for parents and teachers.
Recommendations for intervention and modifications at school.
The frontal lobe and fine motor skills. 33:51
Adhd, inattentive and clumsy.
The frontal lobe and its impact on fine motor skills.
Transition to independent living and self-advocacy skills.
A three year delay in the development of frontal lobe.
What happens when you go off to college? 37:20
The executive functioning demands of college.
The importance of self-advocacy in college.
The emerging adulthood period between 18 and 25.
Mental health during this time.
The importance of adequate sleep and self care. 43:10
Importance of adequate sleep and self-care practices.
Karen shares her company, childnexus.
Where parents can get reliable information.
How to get more information about Karen's work.
Karen Wilson 0:00
I wish that we had found you five years ago when their son was in second grade. And the father who was sitting on the call said to me, I wish I had found you 40 years ago, because he realized from my discussion about what his son was experiencing that he also struggled with the same thing, but didn't have a name for it when he was a child.
Kira Yakubov 0:18
Hi, I'm Kira Yakubov, Licensed Marriage and Family Therapist and founder of Heal Your Roots Wellness practice. Every episode, we talk with a professional from the mental health field to learn more about their approaches and specialties, and also their journey of becoming a therapist. In this podcast, we'll uncover a deeper look at the world of therapy from new perspectives. You'll meet the therapists of Heal Your Roots Wellness practice, and trusted colleagues from the community tackling mental well being. We're your go to Network for practical and professional insight in mental health. Subscribe for new episode releases every other Wednesday.
Kira Yakubov 0:24
Hi, I'd like to welcome our guest today Dr. Karen Wilson. She is a clinical neuropsychologist, Director of West LA neuro psychology and the founder of childnexus.com. She also specializes in the assessment of neurodevelopmental disorders in children, adolescents, and I cannot wait to pick your brain today. Karen, thank you so much for coming on today.
Kira Yakubov 1:06
Thank you so much for having me, Kira.
Kira Yakubov 1:09
Kira Yakubov 1:10
So every episode, we start with really diving into the practitioner, share a little bit about your background, and what made you get into mental health. And specifically in being a child psychologist,
Karen Wilson 1:41
I think probably from the age of nine, I knew that I wanted to be doing something in the medical field, I thought I was going to be a pediatrician. And then when I got to undergrad, I realized that I probably didn't like the sight of blood. And so I was gonna have to find something else to do. I actually had taken psychology as my elective and just fell in love with the study of the behavior study of the brain. And then when I found out about neuro psychology, that really piqued my interest, and there was like no turning back from that point forward. So I kind of took all the courses on brain and behavior, neuro endocrinology, neuro psychology, neuro anatomy. And then when I was applying to graduate schools looked into clinical psychology programs that focused on neuro psychology as a sub discipline.
Kira Yakubov 2:30
That's awesome. I always loved my neuro psychology classes in Psych as well. It's so fascinating to learn about the brain and all the different things that it does. It's so powerful.
Karen Wilson 2:41
Kira Yakubov 2:42
Can you share a little bit more about how you became a psychologist and how specifically working with children. Like if that was always something that you were interested in?
Karen Wilson 2:49
it wasn't actually my initial focus when I entered psychology, you know, when I was in graduate school actually chose to do an adult emphasis. So a lot of my instruction initially was in working with adults. I actually wanted to do geriatrics and study Alzheimer's disease and memory impairments and did some work in that area for a long period of time. And then it wasn't until I was on my clinical internship. The year before I graduated that I did a rotation in child psychology, child neuropsychology, and I was evaluating kids who were struggling with learning challenges with, you know, medical issues that were impacting their cognitive and emotional functioning. And I just thought this is such a great opportunity to be able to provide support early on, and I just didn't look back from that point forward.
Kira Yakubov 3:39
That's wonderful. And I think it's so amazing that in these programs, we have that hands on learning to recognize that and learn that because you might have continued in, you know, researching and helping people with Alzheimer's and may not have recognized that that would be your passion is working with children.
Karen Wilson 3:54
Absolutely, absolutely. I think that's one of the benefits of being in those types of programs where you do get to rotate in different areas, the medical psychology field, I did work in HIV and AIDS, I did some work in transplants. So there's a number of areas where I got to explore and have these experiences, and then really determine where I wanted to spend my time and where I was thinking about a career move.
Kira Yakubov 4:21
Yeah, that's incredible. These are amazing careers that help so many people I'm so honored to have you on today and hear your insight and knowledge. And so Karen, can you share a little bit about some of the most common learning disabilities or processing disorders that you work with while you're helping evaluate children for families?
Karen Wilson 4:38
Absolutely. So in my practice, we do evaluations, neuropsychological evaluations, psycho educational evaluations, and when parents bring their kids to us is typically because their kids are struggling in some way. And oftentimes they don't know why their kids are struggling. So oftentimes, the parents will say, you know, the pediatrician said that we should make an appointment with you, or the school is concerned, or the parents are seeing something at home, that is worrisome. They've talked to other family members. And they've recommended an evaluation. And so generally in those instances, their child is struggling at school or at home. It can be behavioral struggles, it can be struggles that are that are impacting their academic functioning. common struggles are, you know, difficulty staying seated, paying attention, accessing the curriculum at school, it can be some mental health challenges, maybe there's anxiety that's really interfering with the child's ability to do what they need to do, perhaps, you know, they don't want to go outside, and they don't want to interact with peers, because they're so nervous. And they're the worries are excessive. And there are significant fears. And with school, it can be, you know, comments from teachers that you know, your child is very bright, but we can't get him to focus, we can't get him to engage with us. They're having difficulty following instructions directions, or they're behind academically, you know, they some, oftentimes, parents or teachers will say, you know, when I asked the student, the question, they know the answer, they're the first one with their hands up, but then when they have to write it down, or they have to read that they can't do it, or they can't demonstrate their knowledge. So there seems to be a disconnect between what they seem like they're able to do, and then their output, or their ability to do specific tasks, whether that be reading, writing, or math. And so when individuals are coming in, and kids are coming in to see us, it's because parents want to know, you know, why is my child struggling? Why do they seem to be having more difficulty than the peers their age? Or why is it so hard for them to do what I asked them to do at home? Is there some processing issue that is interfering? And that's our job is to figure that out for the family, and then provide them with information about, you know, whether or not this is a neurodevelopmental disorder, what that means provide some psychoeducation. And then, you know, develop a plan, create a plan for that child, what are some things that we can put in place to provide support at home at school? Are there clinicians, therapists, other allied professionals that this child should work with to really help that child reach their full potential, and that's our job and also to make recommendations for accommodations or modifications at the school as appropriate?
Kira Yakubov 7:26
Yeah, so it sounds like it's really important to have everybody on board, parents, teachers, doctors, any other supports, maybe relatives as well, friends, so that everyone's kind of on the same page. sounds like a very, like holistic and systemic way of approaching this.
Karen Wilson 7:43
Absolutely. Because you want to make sure you know, when you're making a diagnosis, that's it's very serious, right, we want to make sure we're not diagnosing someone with something they don't have. And so there's a lot of checks and validation of what it is we're seeing, you know, oftentimes, even to in order to make a diagnosis, you can't have symptoms or the behaviors in just one setting. For example, with ADHD, you can't just be seeing hyperactivity and impulsivity at school, and not at home or anyone else anywhere else, you know, and that's to validate that this is a pervasive issue that's impacting, you know, many aspects of an individual's functioning, because if it's only happening in one area, then we certainly want to look at that area, maybe there's something about the school that is anxiety, provoking the academic environment, the home environment, the demands placed on the child. And so we want to be able to look at everything to make sure that if we're making a diagnosis, if we're saying this is what's causing the struggle that it is accurate, and that the plan fits, what it is that we're finding, the last thing we want to do is to say something is ADHD, when in fact, it's anxiety because anxiety and ADHD have two completely different treatments and approaches for intervention.
Kira Yakubov 9:00
So it's very thoughtful and methodical process of going through this. And so do you see there's a difference among genders? How that might show up in certain, like learning disabilities, or how that presents in a social way, depending on kind of the expectations or like the stereotypes that we might think about, especially for like ADHD, right? I know, it's kind of thinking about, at least for me, it's like the stereotype is a little boy not being able to sit in their seat when it's a lot more than just that.
Karen Wilson 9:30
Yeah, I think it can, it can definitely manifest in both boys and girls differently. There's some research to suggest that there might be some more inattention in girls and more hyperactivity and impulsivity in boys, but it also, when you have a boy who is rambunctious oftentimes, some of those behaviors can be interpreted as boy behaviors, and not as ADHD. Right. And girls who are you know, compliant in the classroom and sitting still and doing well, They might say, Well, that can't be a ADHD because she's able to sit there, she's not getting out of her seat. She's not impulsive, she's not interrupting. But that same girl could be sitting there looking like she's paying attention, and daydreaming about what she's going to do after school and missing a great deal of the information presented. So I think that that can happen. And there's also some research to indicate that girls, autistic girls can camouflage a lot of their, their their symptoms of autism, better than boys, the social demands are different for girls than there are with boys in terms of how they interact, how they socialize, the things that they do when they spend time together is very different. And so, you know, there's some belief that some of the criteria we even have for autism is really based on a boy model, because a lot of the research the early research is based on on autistic boys.
Kira Yakubov 10:52
That's really interesting to hear. So I mean, I know about masking for people who have ADHD, but I didn't know necessarily about kind of the masking or camouflaging for females who might be on the spectrum,
Karen Wilson 11:03
Kira Yakubov 11:03
Because that is kind of thinking about more expected of females to care more about friendships, and to show up in a particular way, and to be more agreeable, versus if you think about stereotypically younger boys and that way
Karen Wilson 11:17
Kira Yakubov 11:18
Would you be able to share the type of actual like assessments that you do with children to evaluate to like, differentiate or rule things out when it comes to this?
Karen Wilson 11:27
Yes, absolutely. So the process is pretty comprehensive. I mean, it starts with, you know, sitting down with parents and going through the child's history. You know, when we're sitting down, I want to know everything from pregnancy, birth and delivery to you know, what's happening with your child at this particular moment, because some things that might happen early on might be risk factors, you know, significant stress during pregnancy. And early delivery of a premature birth with a low birth weight puts kids at greater risk for neurodevelopmental disorders. So we want to know that, we also want to know if there's anyone in the family who has ADHD, who has autism, who has anxiety, depression, dyslexia, because those neurodevelopmental issues, mental health challenges are heritable, you know, and so they put, again, individuals, kids at greater risk for having struggles in those areas, when there's a family history.
Karen Wilson 12:26
And then we want to document developmental milestones. Oftentimes, if kids, for example, are having difficulty with reading, you know, it may manifest and become something we recognize as dyslexia. For some individuals, there's an early indication of language based issues. You know, there's a higher number of kids diagnosed with dyslexia, who had speech and language problems when they were younger. So we know that that's a risk factor. That's why doing that clinical interview with parents is so important. So we find out, okay, there's an early history of speech and language issues, there's a family history of dyslexia, there's a family history of anxiety. So we know that some of the behaviors might be associated with those disorders, and, and also knowing that that child is at higher risk because of the family history and their own developmental history. So that's all part of the process. And then we want to know, what parents are seeing at home, because some parents will say, you know, the teacher is saying X, Y, and Z. But we want to know well what are you seeing at home, and parents will sometimes see things differently than the teacher see, and that, and that would be expected because the home environment, school environments are very different. You know, you have 20, sometimes kids have 23 25 other individuals in a classroom setting. Very few families have that many people at home, right in one place. And so the distractibility factor is much higher at school than it is at home. But then at the same time, the school also provides more structure in terms of what the day looks like. And a lot of homes may not have that same level of structure.
Karen Wilson 14:03
So knowing how kids navigate those two different environments is often very important. And getting that information from parents is really helpful in identifying, you know, what are the challenges for a child at home? Are they similar to what the teachers are seeing at school? sometimes in home environments, kids are able to compensate or at school, they're able to compensate for areas of struggle, because of an inherent structure built into the home environment or the school environment and then sometimes parents will say, for example, with homework, the teacher will say, well, the child is getting the homework done, but what they don't see is the amount of effort that is needed to get that work done. So the parents might say, you know, the teacher says, These are 30 minute assignments that my child is supposed to do on a weekly basis, but it's taking my child three hours. So that indicates that it might be a processing issue. So the teacher gets the homework, and it's complete. It's accurate. It might be perfect, but They don't see the effort or know the effort that was needed, and the support that might have been needed from the parents in order to keep that child on task to complete the assignment. And then also the amount of time that it took and the effort that it took to actually get that assignment done. And so that information from a parent is so important. Because really, what we're looking at are processes and what's involved in completing tasks. So that's a little
Kira Yakubov 15:26
Wow, that's so involved
Karen Wilson 15:26
bit about that information, it's very involved and that's only a parent interview, because then what I want to do is I also want to speak to teachers, I want to know, what are the teachers observing in the classroom. And oftentimes, I'm speaking to more than one teacher, because inherently in a lot of kids, there'll be one class where they do really well. And then one where they're struggling, particularly if kids are struggling more with reading, one with sciences or more with math, then, you know, speak with language arts teacher and a math teacher, to see if their observations are different in the classroom.
Kira Yakubov 15:58
Karen Wilson 15:59
And that also speaks to the extent to which these behaviors and these concerns are showing up in different environments, and how they show up.
Karen Wilson 16:08
And then so we're gathering information from parents, we're gathering information from teachers, I'm speaking with them, they're also completing rating forms. So what the rating form tells me is whether or not these parents and teachers are reporting more problems, more behaviors that are typically seen in children of that child's age. And then the child comes in for testing. And that can be anywhere from, you know, six to 10 hours of testing over, you know, two to four days, depending on the age of the child, depending on the concerns. And I'm, you know, talking to the child about their experience, at home at school, what's hard for them, what's easier for them what they like, what they don't like, and then they're doing, they're doing tests, and we're coming in, and they're, we're looking at their general cognitive abilities, their ability to problem solve and think through tasks. We're looking at their academic skills, we're looking at reading and writing and math, all the things that they are asked to do on a daily basis at school.
Karen Wilson 17:09
And then I'm going to look at the processes that go into completing tasks. So things like attention, paying attention to things you should versus things that you see, right, those are two different, they're both attention, but they're processed in different areas of the brain, the ability to be able to remember information you see versus information that you hear your ability to process language, how well does a child understand what they hear what is said to them? And are they ability? Are they able to express their thoughts and ideas in a way that comes out the way that they intended? Is their language sequences organized? Are they having trouble finding the right words for things? All of that is important. Because again, we're ruling out is this a language based issue? Is this an attention issue? Is this a reading impairment? Is this a math disability? And so we want to be very comprehensive in our approach.
Karen Wilson 18:00
And then we're looking at social emotional functioning, the parents and teachers are completing forms about whether or not they're seeing signs of anxiety or depression or poor self concept. And then the children who come in are also answering questions and completing their own questionnaires, about their feelings about themselves, and about their experiences.
Karen Wilson 18:19
And then we put all of that information together to get a nice picture, a neurocognitive profile of that child, their strengths, their weaknesses, areas of concern, and, and then we, from that information, we can determine whether or not there's a neurodevelopmental disorder, if and then what those strengths are, because it's not enough to just identify where the problems are. So, you know, if it turns out that the child does have ADHD, it's important to know that because there are treatments that we can recommend and things that we can put in place at home and at school to support that child. But we also want to know, well, what are the strengths in this child? What are the child's strengths? Because oftentimes, those strengths are things that that child can use to compensate for areas of weakness. So it's just as important to be able to identify the strengths as it is to identify areas of weakness.
Kira Yakubov 19:11
Wow, that is an incredible process. I mean, that is a lot of data to be collecting. And then, yeah, so it sounds like this is over. I mean, maybe the course of a few weeks before you just get all of this data before you kind of sit and look through and analyze to see what it is. And that's just like, part of the first step is identifying and then being able to think about like, what do we do next? How do we reform everybody now to create like a very safe and supportive environment for this child to thrive and not have low self esteem and not kind of beat themselves up in comparison to their classmates or siblings?
Karen Wilson 19:51
Right, absolutely. And, you know, part of that process, like I said, you know, when people think about assessment, they think of just the testing piece, but assessment is the parent interview, it's the conversations with the child, it's the testing, it's conversations with teachers, that's analysis of the rating forms. And it's the feedback meeting, it's having that follow up meeting with the family to say, this is what we found. And this is what we're recommending, and having a conversation with the child to say, you know, these are things that you do really well, these are areas where you're so strong, but this is harder for you. And this is why we're gonna get you support in this area, that's often a big relief for kids, because oftentimes, they may not understand why this is so hard.
Karen Wilson 20:36
You know, I think about those kids in the classroom, if you think about, you know, entering, i don't know when's the last time you entered an elementary school, classroom, classroom or school, but everybody's work is on the board. And while everybody's on the bullet, everybody's work is put up on the bulletin board for open houses. And kids who struggle with writing are often you know, embarrassed when their work is up there, and they've got their peers have, you know, three paragraphs of text put up on the board, and they've got three lines, right. And so, yeah,
Karen Wilson 21:07
it can be some embarrassment about their difficulties. They, you know, a lot of kids who have struggled with reading will say, the most terrifying point of part of their day is when they have to take turns reading out that because they worry that kids will snicker, and they will laugh, they'll stumble over words, and they get embarrassed. And that can create anxiety, it can create sadness, it can create, contribute to a low self concept. And it can make kids feel like they're not smart, and that something is wrong with them. So to explain that to a child, that your brain is just wired differently. But here are areas where you are really strong. And you know, we can provide you support for reading now that we know why this is so hard for you. It's often a big relief for students.
Kira Yakubov 21:51
Yeah, I can imagine. I mean, it sounds like really playing up the strengths, because that's important. And leaning into that, and using that to help in those other areas. So they're not feeling down and feel empowered, like the child and the whole family. And everybody involved feels a lot more empowered. And it's not walking away feeling kind of sad, or disappointed, but relieving. Like you're saying like, okay, knowledge is power. So you can start doing different things with this information.
Karen Wilson 22:17
And that's exactly it. And I sat down with parents, you know, probably a month ago, now, and they had a child who was, you know, in middle school, and was getting diagnosed with dyslexia for the first time, and had been brilliantly compensating, by memorizing what words look like, for that long, exceptionally bright kid, but had dyslexia and didn't understand that you just memorize what words look like, didn't know that you had to sound out words, actually said, I thought everybody did that. And the parents said to me during that feedback session, you know, I wish that we had found you, you know, five years ago, right when their son was in second grade. And the father, who was sitting on the call said to me, I wish I had found you 40 years ago, because he realized from my discussion about what his son was experiencing, that he also struggled with the same thing, but didn't have a name for it when he was a child.
Kira Yakubov 23:14
Sure. I think that's a really interesting part too. Because as you're getting this family history to see if it's hereditary, anybody else in the family has it. And if they've never even had the opportunity to explore this, or know what this is even called, or what this might be like, it's kind of like a shock for everybody involved. They're also getting this new diagnosis, and this new information decades later in their life,
Karen Wilson 23:38
Kira Yakubov 23:39
while helping their child move through it too.
Karen Wilson 23:42
Kira Yakubov 23:42
Karen Wilson 23:43
Yeah, I can't tell you how many parents have said, you know, do you do you assess adults? Because when we're going through their child history and explaining why they feel this way, why they're behaving this way, why they're, you know, learning in this manner, and why this is so hard, they realize that, you know, they had the same struggles, but it just was never identified.
Kira Yakubov 24:03
Wow. So you do such powerful work. I'm so inspired, because this is like
Karen Wilson 24:06
Kira Yakubov 24:07
you see all of it, and bring it together and help so many people through this process. And so I know we touched a little bit on you kind of see kids who have ADHD, Dyslexia, maybe on the spectrum. Are there some processing disorders that maybe people haven't heard of, but are very common for you while you're evaluating children?
Karen Wilson 24:28
Yeah, I think that there are definitely language language based disorders, which is a processing disorder.
Karen Wilson 24:33
So language disorders can be in, in a couple have and people who have language disorders can struggle in a couple of areas. One is just your ability to understand information that you take in, you know, oftentimes they have an understanding what words mean, you know, they may have a more limited vocabulary, they may have trouble kind of organizing their words when they're speaking. Choosing the right word to say when they need to They may seem more shy or more quiet in situations because they spend so much time trying to figure out how to say something, that by the time they get it, the conversation has moved on. And so you know, that can create some anxiety as well. So there's definitely language processing disorders that we see.
Karen Wilson 25:16
And you know, ADHD is an attention, processing disorder, it's a difficult. It's someone who has difficulty with processing information, its struggles with the the ability to, you know, persist with tasks, the ability to stay focused over an extended period of time, the ability to inhibit distractors in your environment, and also to manage even complex tasks, because we know the executive functioning system, that process and those processes that are part of that executive functioning system are often impacted in individuals with ADHD also for autistic individuals, and you see some difficulties in mood disorders and anxiety as well. So there's a lot of overlap too in terms of, of processes that are impacted when there's a neurodevelopmental disorder or even mental health challenge.
Kira Yakubov 26:06
Yeah, and I imagine they're like, you're seeing a lot of overlap that there's going to be comorbidity, right, like someone may have ADHD inattentive, and also be on the spectrum and may experience anxiety too
Karen Wilson 26:17
Kira Yakubov 26:17
Is that something you find common? like being able to identify that there are several things happening? And how to like, separate that and treat them separately? Or I'm assuming there might be some overlap in the treatment as well?
Karen Wilson 26:29
Yeah, there definitely can be some overlap in the treatment. And then we also the timeline in terms of when these behaviors when these challenges started, kind of help us figure out what came first. You know, sometimes, like I said, kids can experience anxiety because of their struggles, right. And then there are other kids who have always been described as anxious kids, they had separation anxiety, when they're in preschool, parents will say, you know, I had to sit in that preschool classroom for the first month and a half that my child started. And so we know that that's a long standing issue.
Karen Wilson 27:01
And so again, that's why that family history, and that timeline of difficulties really tells us, you know, kind of what came first, what came second, and also helps us determine, you know, a course of treatment. We know that
Karen Wilson 27:14
with neurodevelopmental disorders like dyslexia and ADHD, there's in 40 to 50% of kids, they have something else. So 40 50% of kids with dyslexia also have ADHD. And the reverse is true 40 50 percent of kids with ADHD also have a learning disorder. And so we know that there's a lot of comorbidity. And we know that kids who struggle with learning are at greater risk for mental health challenges, like anxiety, for self concept, and depressed mood. And so and that's one of the reasons why we do these comprehensive assessments, because we want to be able to identify if there is more than one thing going on, so that we address everything. You know, if a child has dyslexia, and we only look for dyslexia, and we miss the ADHD, then, you know, when we're recommending intervention, you know, how are you going to recommend, and we're going to recommend, you know, an hour a day of reading intervention, or two hours, you know, a day of reading intervention for a kid who has undiagnosed inattentive type of ADHD, it's gonna be really hard for that child to pay attention to the intervention. So being able to identify that both are present helps you determine the course of treatment that is most effective for that child and their specific neurocognitive profile.
Kira Yakubov 28:27
Wow. I mean, that's incredible information. I had no idea the numbers were so high for both of those to be existing at the same time, you're saying it's even higher of the overlap as well
Karen Wilson 28:37
the overlap between autism and ADHD. They actually, you know, up until more recently, you couldn't diagnose ADHD in autistic kids, because it was so common to be to find inattentive, and attention, hyperactivity, impulsivity. Now you can diagnose both, but I think the research shows that 70 to 80% of autistic kids meet criteria for ADHD.
Kira Yakubov 29:05
Do you find that parents are like wildly surprised by that, too? I mean, I'm a therapist and I and I'm surprised by that level of, of those numbers and research.
Karen Wilson 29:14
Yeah, well, they, they see it, they're not surprised because they see it, they see that impulsivity they see the executive functioning difficulty and they see the inattention, anxiety is very high as well. And so knowing that these things coexist and our common, it's helpful for parents, so then they can understand what it is that they're seeing, and then they're more highly motivated to engage in the treatment, that would be appropriate.
Kira Yakubov 29:39
Sure, that makes sense. And so Karen, would you be able to share a little bit about some of the interventions or like common things that whether it's you or your team, or like other teachers and clinicians can help families kind of do to manage some of this or to like play on the strengths to bring up some of those weaknesses?
Karen Wilson 29:57
Yeah, I mean, we see kids with so many different presentations of different areas of struggle, you know that they're going to have different interventions. But I can think of, you know, kids with dyslexia, for example, that I mentioned, we know what the research shows, is effective for kids with dyslexia, you know, a multimodal phonics based program is going to have the biggest impact, particularly one that is intensive in nature. And that's typically done by an educational therapist, or someone who has specific training and, you know, this, these multi sensory evidence based approaches to dyslexia. So we know that that is what we would recommend for kids who have that type of learning disorder.
Karen Wilson 30:40
We know that for kids with ADHD, for example, that you know, about, you know, seventy to depending on the research study, but 70 to even 90% of kids with ADHD respond to medication, there were various types of medication, I defer to pediatric psychiatrists in terms of when it's appropriate, and who it helps a lot of parents with with the young kiddos don't want to start with medication, which is understandable. And so there, you know, accommodations we can put in place, there'll be there's behavioral support, we recommend working with a cognitive behavioral therapist, who can coach parents on what they can do to support their kiddos at home, you can write a plan for teachers in terms of where that child should be seated in the classroom. You know, how can we minimize distractions around that child's desk and environment, helping the teacher to know that this is an attention issue and impulsive issue and not a child deliberately trying to be disobedient, or you know, disrespectful. So providing some psychoeducation, to parents and teachers, and then also recommendation if a child is is constantly off task?
Karen Wilson 31:51
How can that teacher redirect that child without causing the child to be embarrassed in front of his peers, you know, and so all of that is part of the recommendation.
Karen Wilson 32:00
So when I think about ADHD, I think about, you know, medication management, you know, cognitive behavioral training for parents, the child having support at home and at school systems in place that support the child. And a lot of times, if kids are taking longer to complete tasks, then extended time, but also guidance in terms of how to use that extended time. Because sometimes if kids have attention issues and executive functioning challenges, they can be given extended time, but no not know how to utilize that, that time well. And so they might need some executive functioning coaching in terms of how to utilize that time. And then also, again, accommodations at school breaking down, you know, large tasks into smaller chunks, getting, you know, stretching breaks and opportunities to, to decompress. So all of those things are all important in terms of, of recommendations, interventions, accommodations and modifications at school, that might be helpful.
Karen Wilson 32:00
A lot of kids with ADHD, also have some fine motor issues, because that front part of the brain that's responsible for attention and sustaining focus and inhibiting distractors, and, you know, executive functioning is also very close to the fine motor areas in the brain in that front area of the brain. And so many kids with ADHD also have fine motor or graphomotor issues. So they're, you know, parents will say that their handwriting is really poor, it's illegible. And so oftentimes, they will benefit from occupational therapy that will address those fine motor, fine motor issues. And so that might be a recommendation if appropriate for a child who has both the motor issues and ADHD.
Kira Yakubov 33:51
Interesting. That's so interesting. So I mean, full disclosure, I have ADHD inattentive type, and I'm super clumsy. And I've seen like through social media, a lot of people say like, oh, I'm clumsy too. And this makes a lot of sense. I just thought, I don't know, like, I get easily distracted by my surroundings. But it sounds like it's a lot more than just that as the fine motor skills that or is it? Could you explain that a little bit more what that means, like, why that might be impacting that?
Karen Wilson 34:17
Yeah, I mean, in the frontal lobe, there's, you know, neuro chemicals are released norepinephrine, dopamine, and they serve the frontal lobe, they allow the brain to, to focus, direct attention, shift focus from one thing to another, again, to inhibit distractors. But that front part of the brain is also responsible for fine motor coordination. There's a motor strip there. And so if that same area of the brain is also not getting enough dopamine, that it's not only going to impact attention and focus and impulsivity, it's going to impact the ability to, you know, to form letters well, right, that fine motor dexterity is also going to be impacted.
Kira Yakubov 34:57
Yeah. Interesting. That's so fascinating. Everything about the brain is just so wild. And so if we can shift gears a little bit, I know we've been talking about more so with children, what does this look like for young adults or adolescents who are about to go off to college, especially if they're moving away, like, sometimes it might be a little bit different if they still stay in their, their home that they grew up in, and they're, you know, just commuting to college and classes, but, or for young adults who are like going to move or there's this huge transition and all their patterns and behaviors and habits.
Karen Wilson 35:32
Right, I mean, again, it depends on that young person's individual neurocognitive profile in terms of what those challenges might be. But for many, again, particularly those students who have had a lot of support at school, and maybe even a lot of support at home, by, you know, an educational therapist and executive functioning coach, you know, accommodations, modifications at school, for many of them, the loss of that structure can can really create problems for them, when they make that transition. It's why it's so important for the preparation for that transition to begin way before 12th grade, right? Way before 12th grade, I want to develop those independent skills, independent living skills, those self advocacy skills are really important. And that's a thing for parents to keep in mind. With disorders like ADHD, you know, oftentimes, there's a developmental delay in the development of specific areas of the brain, particularly the frontal lobe.
Karen Wilson 36:33
And we know the frontal lobe is the last part of the brain to mature and develop. And so all of those functions controlled by the frontal lobe, the ability to organize, plan, prioritize, manage your time, you know, you know, sustain your focus over an extended period of time, particularly, when something's not interesting to you, all of those things get better as you get older, you know, your ability to problem solve, decision make, exercise good judgment, all of those things get better as you get older. But keep in mind that there's a delay in the development of those areas of the brain and individuals with ADHD. And again, that's a general term for some individuals that might, you know, they might be more developed than others with ADHD. But they're trying to be as much as a three year delay in the development of the frontal lobe. And so if you think about an 18 year old, going off to college, but if your frontal lobe is really, you know, a 15 year old, then they're going to have more difficulty than their same age peers, in terms of managing those things.
Karen Wilson 37:34
And the thing that happens when you go off to college is that not only do you lose a lot of the structure that you had in in high school, now the executive functioning demands of life has have increased considerably. Now you're managing your finances, now you're cleaning a home, now you're figuring out how to get your meals made, because you know, Mama's not there anymore. You know, you're doing your own laundry, right, you're making sure you have clean clothes to wear, you're washing dishes, you're doing all these different things that you may not have done, in addition to, you know, staying on top of your Courseload, making sure you're studying for your test. And to think about all the distractions in college, you know, the parties and the organizations. And now you've got a roommate, and, you know, a residence hall, and you may have had a parent, I've had parents say, you know, I still get my teenager up in the morning to go to school, you know, and now you no longer have that physical person telling you, you know, hey, it's time to go, gotta get going. And so it can be a very difficult time for students who are not prepared for that transition.
Kira Yakubov 38:43
Absolutely. I mean, those are so many things to juggle. And for anybody at once, it's adulting. Right? One on one, right? It's tough. Having to figure out what is like how to prioritize all of this, what is the sequence to do these things? Like timing them out, managing, and then also creating friends, friendships, right? Like, there's all these different things that are happening. Yeah. And then managing if you have a roommate, and what that looks like, if you're messy, or they're clean, there's
Karen Wilson 39:12
Kira Yakubov 39:12
a million different things that are going on for somebody during that stage in their life. Wow. Absolutely.
Karen Wilson 39:19
Absolutely. And then, and that's why the self advocacy skills are so important, because they're, they're high school. For many kids who've had the accommodations. The teachers know, the teachers know that they need extended time, you know, they have an IEP and then they go off to college. And if you're not in a, in a, you know, a hall with, you know, 400 other psych students, the professor doesn't know that you need accomodation.
Kira Yakubov 39:43
Karen Wilson 39:43
You have to find your seat in the front of the classroom. You have to register with students with disabilities office, and you have to, you know, let notify the professor that you need extended time, you have to get the paperwork filled out yourself and So there's a lot of self advocacy that needs to take place at college that maybe at this at a level that wasn't needed when a student was in high school.
Karen Wilson 40:09
So what I often say to parents is that, you know, this period of between 18 and 25, we call this emerging adulthood, it's a time when brain development is continuing to occur. I mean, the frontal lobes are not fully matured until our mid 20s. And so many students, particularly those who are neurodiverse, who have these learning challenges, continue to need parental and societal support during this time.
Kira Yakubov 40:36
Yea, that's so important. I'm glad you mentioned that, because we think, or at least, you know, 18 years old, you're an adult, you can leave, do all these things, make your decisions, but you're not even close to having your brain fully developed yet to be responsible. And have the skills and the support to maintain just living and existing a life that is fulfilling and happy and able to juggle all of these things
Karen Wilson 41:00
Absolutely. Absolutely. And then, you know, if you think about students going off to college, there's also again, and they're impulsive, there's so many talked about all the things you could be doing the parties, but they're also it's a very vulnerable period for, you know, again, those early those young adults, right. And those emerging adults, it's a vulnerable period for their mental health, there's higher rates of loneliness, depression and anxiety during that time. If kids never had those mental health struggles, and they're going to manifest, oftentimes, they manifest right in that early adulthood period. And then we also know that, you know, there's, they're at greater risk for substance use, you know, they're being exposed to things that they may not have been exposed to, when they were younger. And now, and if they've got impulse control issues, and then not a fully developed frontal lobe, where That's where their decision making their judgment is, they're gonna make the mistakes, do things that you know, are not in their best interest.
Kira Yakubov 42:02
And I think this is so important for people to know, like young adults and parents is that this stage of life, right, while you're figuring all these things out, everything is so new and you're making these mistakes, is to kind of accept where you are, and not have a lot of shame around that. And know that like, part of it is out of your control. And the other part is knowing this information. So you can do the things within your control, and kind of rolling, rolling with the punches while you figure this all out while your brain is still developing, which is really wild to think about,
Karen Wilson 42:33
right. And then making sure that you have things in place to support you, if you know that you're at risk for anxiety and depression, or you've had that in high school, making sure that you're connecting with a mental health professional at your university, knowing that you know, where the health center is where you can get access to mental health services, knowing that if you if you know that you have executive functioning challenges, you know, connecting with executive functioning coach, and educational therapists who can work with you, particularly during that transition, that first year of university, when you're trying to figure out the lay of the land and manage things that you've never had to manage before. And then making sure that you're engaging in all those self care practices that are so important for functioning, you know, making sure you're getting adequate sleep, you know, we know that the brain needs sleep, right? We need sleep, spend so much of our lives in a state of sleep. And because it's important, we need it for optimal cognitive functioning, we need it for mental health.
Karen Wilson 43:34
And then we know that when we're not getting adequate sleep, we're going to be more forgetful, because that's the period of time when we're consolidating our memories. So if a student is at school during the day, and when they go to sleep at night, all of those things that they've been exposed to get consolidated, they go from short term to long term memory when they're sleeping. So if you're getting inadequate sleep, you're going to be if you're getting inadequate sleep, we're going to have more forgetfulness, it's gonna be harder to pay attention in the classroom. So all of those things will be harder, and then you're going to be dysregulated you're going to be emotionally dysregulated because you're not getting enough sleep. So I always say adequate sleep, making sure you're getting enough exercise. mindfulness practices have been really helpful with, you know, helping to address anxiety, stress, lower stress levels, and also increased focus.
Kira Yakubov 44:22
So it sounds like being super proactive about getting all those supports and taking care of yourself, like physically and mentally to set yourself up for success while you're growing and learning all these different things.
Karen Wilson 44:34
Kira Yakubov 44:35
Awesome. And so Karen, I know we're coming close to an end. Can you share a little bit about your company, Child, childnexus.com That directory because I'd love to hear a little bit more and I'm sure the listeners would love to know about that as well.
Karen Wilson 44:48
Absolutely. So I started Child Nexus because I was getting so many parents saying you know, I'm not getting adequate support. I don't know where to go to get information about what my childhood Dealing with and how to provide support. And so I wanted to create a platform where they could get reliable information that they can trust. So parents support services, they can access information about attention difficulties, behavioral problems, they can get information about, you know what interventions work, they can get information about how to request a special education assessment through the school, they can get information about how a school assessment differs from a neuropsychological assessment. And then they can connect with providers, occupational therapists, speech and language pathologist, child psychologists, educational therapists, executive functioning coaches, parent coaches, who can help them get their children the support that they need in order to thrive.
Kira Yakubov 45:43
Wow, that's incredible. So you've created a nice hub.
Karen Wilson 45:47
Yeah, it's a nice hub
Kira Yakubov 45:47
For all the support and all the different ways. Yeah. So everyone can get the help they need and the information.
Karen Wilson 45:53
Yes, yeah. So we provide information we have blogs, on different topics, they can search by topic area based on their the problems or difficulties that their child is struggling with, or they can also listen to our podcasts. We have a diverse thinking different learning podcast, where we invite experts to come in and talk about different things, you know, autism, ADHD, ADHD and girls, autism and girls, language disorder, anxiety, mental health and young people. So we cover all of the things related to struggles that kids who think and learn differently face and how to optimize their cognitive and mental health functioning.
Kira Yakubov 46:31
That's beautiful. I love that. And so for the listeners, can you share how if they want to get in touch with you or work with you or find your website, anything like that they can reach out to you?
Karen Wilson 46:40
Absolutely, they can go to childnexus.com That is the hub where they can get all the information. That's where our blogs are. That's where the link to our podcasts are. If they want to join a parent learning group, you know, they've just been their child has just been diagnosed with ADHD or anxiety or dyslexia. And they want to learn more than they can join one of those groups right on the website. And if they want, they don't know what they need, they can book a consultation, a 45 minute consultation and get some answers to their questions. And if they want to reach out to me directly, they can email me at DrKIWilson@childnexus.com.
Kira Yakubov 47:19
Wonderful. This has been super insightful. All the knowledge and expertise you bring on. I'm really honored to have you on today. Karen, thank you so much for giving us your time and sharing your story with us.
Karen Wilson 47:30
Thank you so much for having me. It's been such a pleasure,
Kira Yakubov 47:33