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Today’s podcast, I am excited about. I have a fantastic guest, Dr. Ellen Braaten. Dr. Braaten has been in the field for many years. She is currently the associate director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, director of the Learning and Emotional Assessment Program at MGH, and an associate professor of psychology at Harvard Medical School.
She got her master’s in clinical [00:01:00] psychology from the University of Colorado and her PhD in counseling psychology from Colorado State University. She is widely recognized as an expert in the field of pediatric neuropsychology and psychological assessment, especially with learning disorders and attention disorders.
Ellen has written the books, The Child Clinician’s Report-Writing Handbook, which is fantastic, and the book that we’ll be talking about today, which is, Bright Kids Who Can’t Keep Up. She’s been at it for a long time and she has contributed to the field in so many ways. So I’m going to be talking with Ellen all about processing speed today. I think you’re going to enjoy this.
All right, let’s do it.
Hello everyone and welcome [00:02:00] back to another episode of The Testing Psychologist podcast. I am Dr. Jeremy Sharp. Today, I’m thrilled to be talking with yet another CSU alumni. We’ve had a run of CSU folks over the last four to six weeks but I think of all the folks that I’ve talked to so far, Dr. Ellen Braaten, is the most famous, I don’t know. You’re a published author, would you call yourself famous?
Dr. Ellen: I don’t know that I would but that’s very kind of you.
Dr. Sharp: Let’s go with it. So Dr. Braaten, she is the author of Bright Kids Who Can’t Keep Up. It’s a book all about processing speed, which is a topic that is near and dear to a lot of our hearts that comes up in discussion all the time and it plays a big role in the assessments that a lot of us do.
So Ellen, welcome to the podcast.
Dr. Ellen: Oh, I’m so delighted to be here.
Dr. Sharp: Thank you so [00:03:00] much for coming on and I’m really excited to be talking all about processing speed.
Dr. Ellen: Me too.
Dr. Sharp: I remember actually when I got the book, back then I was a lot more active on Twitter. I’ve kind of given it up since then, but I tweeted out a picture of the book and said I’m probably a little too excited to get this book right now. It’s a small audience but I think those people who are reading it can really appreciate it. So I’m excited to be talking with you about it.
Dr. Ellen: Yeah. Well, it’s a topic that is very near and dear to my heart so I love talking about it.
Dr. Sharp: That sounds great. We can dig into it. Before we totally jump into the book and your work that you’re doing right now, could you talk just a little bit about your training and how you got where you are now and what your day-to-day looks like in terms of clinical [00:04:00] versus research and what your life looks like.
Dr. Ellen: Sure. Going back to the beginning, I actually started out, my undergraduate degree was in special education, and so I started out as a special education teacher for a number of years before I went back to graduate school. One of the things that was always of interest to me was this intersection of clinical counseling psychology and kids, and because kids are in schools, I was always very interested in how that intersection between school and psychology was.
And so one of the areas clinical interest for me had always been in the testing realm. When I went off to do, I loved my time at CSU, it’s a such an amazing place to develop your own voice and to figure out where you want to specialize. When I came to Mass General in `Harvard Medical School, I [00:05:00] had the opportunity to focus more on assessment.
And so that’s been the assessment of learning disabilities, ADHD, autism spectrum, that’s where my clinical interests lie and then also my research interests as well. I’ve been here for 20 years, which makes me sound very old but what I do at Mass General now for about the last 10 years is, I have three parts to my job; one is the clinical work, evaluating kids. The other is doing research. Both of these things, research and clinical work, happen in the Learning and Emotional Assessment Program, it’s called LEAP.
We are following kids over longitudinally to see a lot of different things. We want to know about resiliency and the trajectory of psychiatric issues along with learning and attention issues. And then another part of my [00:06:00] work at Mass General is also through the Clay Center for Young Healthy Minds and that’s a web-based center where we disseminate information that we are able to do mostly for parents but also other professionals.
So my days are mixed with research and clinical and doing outreach and media things like this. I think educating the public is an important role that you and I and other psychologists have because that’s … I feel we’re going to make the biggest impact is having a well-informed other clinicians but also parents, teachers, and all other kinds of people who interact with kids.
Dr. Sharp: Yeah. I’m right with you. It sounds like y’all are doing quite a bit of that. I spend a lot of time on social media, particularly Twitter. You all have a fairly active social media account and you’re working hard to spread the word.
Dr. Ellen: Yeah. The Clay Center is something that’s relatively new but it’s one of those things. We’ve only [00:07:00] been active for two years, but that is something that we feel pretty passionate about is spreading information. It’s going to make the biggest impact.
Dr. Sharp: That is fantastic. I would like to talk as much as we can about your book. I’m curious what led you to write this book in the first place, why a book on processing speed out of all things?
Dr. Ellen: Well, that’s an excellent question. The shortest answer is that I was seeing kids, regardless of their diagnosis, struggle more than others. What I was finding was the kids with the slower processing speed that seemed to be having the most difficulties. I also was frustrated because I felt like we didn’t really know much about processing speed at all.
I’ve seen a fair number of kids who met criteria for no diagnosis [00:08:00] whatsoever, but who had a lot of trouble in school. And when you looked at their neuropsychological or neurocognitive profile, what you find was slow processing speed sometimes in the context of really strong intellect in other areas and perhaps other areas that were timed test, timed math facts, sometimes timed reading, but maybe they did not have a learning disability in any classic sense of the word.
I’ve been doing this for 20 years and you start to think like, where are the kids who keep coming back even after they’ve supposedly launched for college? And it seemed to be the ones who had this slow processing speed. So I published two books for Guilford Press and I was talking to my editor at one point, well, it’s time to write another book, what do you want to write about?
This would be probably close to eight or nine years ago when we first had this idea and ironically, it took us a [00:09:00] very long time to write a book about how long it takes to get things done. I said, well, I’d love to do something on processing speed and she said, “what’s that?”
This is an editor who all she does is publish books on psychological, psychiatric issues and it’s something she’d never heard of. And she said, what about working memory? That’s much more of a sexier topic. It’s all about working memory. And I said, oh, I think working memory is, yes, it’s interesting but it’s been done a lot and I’m interested in processing speed because we don’t know much about it.
So I plunged into writing this book. I had a postdoctoral fellow at the time who co-authored it with me. I started on it and as I was producing information that my editor kept saying, I don’t know that you have a book here. I don’t know if there’s enough information here for you [00:10:00] to write about. And so we had to start looking at our own data set almost prematurely because we needed to know more so we’d have more for the book because when I searched the literature and what I wanted to do was search literature and then translate this to child, people who are working with kids, parents and other professionals.
What I found was there wasn’t a lot to look at and what little was there was done with adults who were losing the ability to process information. So basically adults who were in the process of having dementia. And some of it was applicable, but a lot of it wasn’t. And so we just started looking at, well, what do our kids look like who have this?
And we’re continuing to look at that now and have been following the same group of kids now for a 10 years.
Luckily, we did pull together enough for a book. What’s been interesting is I [00:11:00] thought it was just going to hit a nerve for those of us who do testing and evaluations and for parents whose kids had significant issues but what I’m finding is there’s something about it that strikes a nerve to a lot of parents whose kids may just have a bit of a learning or attention difference not even a disability in any sense of the word because our society is so fast that even kids who are normal in this are in the wrong environment, seemingly they’re having a lot of struggles with this.
So it’s been interesting that I think there’s just this time in our lives where processing stuff fast is so important and relevant. By important I don’t mean like it necessarily it should be important but it’s important if we want to get through a day.
Dr. Sharp: Sure. Do you think we’ve gotten to a place where it’s [00:12:00] more important or more emphasized than it has been in the past?
Dr. Ellen: I do. I just think there is so much in a given day that we have to do and whether it’s just remembering 10 different passwords to get through our morning commute, our phone, the email, the bank ATM. There’s so much that we have to process that we just have to churn out a lot.
And when we’re talking about processing speed, what we’re really talking about is that ability to process the simple stuff. It’s not about how to think big and conceptually and deep, it’s about how to keep track of things, how to write down something quickly, it’s that quick processing that we’re bombarded all the time with.
Like you were saying, Twitter, Facebook, we could be churning through information as very [00:13:00] quickly, and in order to even, for instance, get through a difficult night of homework. There’s some high school students that have to check five different websites or more from their teachers to find out what the homework assignment is and where to turn it in and uploading this and that. It’s just a lot of stuff.
And so again, what would have been in a different generation, a normal weakness, it’s now more of an impairment. And for those who have true impairments, it’s really impairing in terms of their ability, especially to get through school.
Dr. Sharp: Sure. I think that makes sense. We hear anecdotally that education is getting harder and harder and there are higher expectations. I think for kids in particular, it’s like the trickle-down thing, as parents get busier and more frantic that spreads to their kids who are being rushed out the door in the morning and [00:14:00] trying to get things done more quickly and more efficiently. It’s hard.
Dr. Ellen: It’s really hard. We just have a lot of things that are pulling for our attention. And when you have a limited ability to process that, it makes life harder. I’m not sure that’s necessarily the case once you’re out of school, because you can find, as you grow, the right environment.
But when we’re talking about students, they don’t have the option of trimming it down, slowing it down and you’re right, everything is upped and we have higher standards, and a lot of times that doesn’t necessarily mean more complicated thinking, it means more stuff that needs to be produced.
You’re in an AP class, you have to write seven papers as opposed to three. I’m probably just overly exaggerating here but a lot of it means that you have to [00:15:00] produce more. So that is the problem.
Dr. Sharp: Sure. I wonder if we could zoom out just a little bit. You gave an offhand definition of processing speed, but I’d be curious to hear how you would define processing speed, both in terms of a layperson’s definition but also from a neuropsychological perspective. How would you define that?
Dr. Ellen: The simplest definition in terms that I say to lay people is that it’s just how long it takes us to get stuff done. It’s how long it takes us to do a particular task in a particular amount of time. Neuropsychologically, the way we measure that is on timed tests.
Our own research has shown that the best test that we have is coding from the WISC that it correlates so highly with other indicators that we could [00:16:00] almost use it in and of itself as a measure of oh when someone does poorly on coding and this is a gross generalization, but really when somebody does very poorly on coding and it’s a valid, accurate member, there’s a lot of reasons why you might not do well on coding, but they’re probably going to struggle on a lot of different things. Neuropsychologically, the processing speed factor on the on the WISC is a very important measure.
The other things that I like to use are measures of visual and verbal and motor processing as well. Coding has some motor processing embedded in the task because you’re writing things, Symbol Search, less so, but it has some. But we want to know when we’re looking at a child’s processing speed if there is within the visual, the verbal, the motor, and also the academic realm, academic fluency, if there are areas within there that seem to be more troublesome, because if there are then we can help tailor recommendations to that.
[00:17:00] So when I’m looking more psychologically within the verbal realm, I want to look at verbal fluency, for example, things like the verbal fluency tests from the D-KEFS or the F-A-S or those sorts of tests. I also want to look at, within the motor realm, even things like being able to put pegs in a board. How fast are fine motor skills? And these are two examples.And then I also find that academic fluency tests are really important to include in a neuropsychological evaluation of processing speed. So I like to look at math fluency skills, reading fluency, written fluency and being able to compose a number of sentences in a given period of time, or even being able to compose a paragraph in a given period of time. Any timed test basically is really a measure of processing speed, and we have a lot of timed tests within a typical neuropsychological battery.
I like to include measures of [00:18:00] academic fluency because a lot of times these kids don’t meet criteria for a particular diagnosis. They might not meet criteria for ADHD or a learning disability yet may still have trouble in the actual doing of these tasks, in being able to do math fluently, or being able to even read a paragraph fluently outside of having a learning disability.
You find that they’re fine decoders, they understand what they’re reading but yet when it comes time to actually fluently digest information from page, they have difficulties with that. That’s a very practical measure that you want to make sure you get.
Dr. Sharp: Mm-hmm. Yeah, that makes sense. Let me jump back, what do you like for visual fluency?
Dr. Ellen: Oh, I love to use the Stroop, for example, and just say that’s a very simple measure of being able to read words on the page. Any test that’s [00:19:00] visual speed of processing, like there are a few on the NEPSY and the D-KEFS, also the Differential Ability Scale, there’s a test of any sort of visual naming.
I think those are all, it’s a combination of visual and verbal but even something as simple as on the Stroop, I find that kids with processing speed issues often times do poor on the word reading portion of the Stroop where they just have to read red, green, and blue over and over again in different orders and color reading but sometimes they do fine on the actual Stroop part of it where they have to inhibit a response and name the color instead of reading the word. And that’s because sometimes the more complex processing speed, there’s a benefit to being slow and cautious but what I find is that they do much poorer on that visual [00:20:00] processing.
But then there are also other issues that, once they read well, things like on the Woodcock-Johnson, there’s a reading fluency but then there’s also like a word reading fluency, right? Find two words that match. All of those, even though there’s a language issue, it’s hard to find a good test of visual processing speed without some kind of either visual motor component or a language component, but all of those things.
Lastly, on the continuous performance tests, many of them have a speeded number that goes along with that and looking at how quickly someone is able to just respond to a particular target that also tends to be a good measure sometimes on like the Conners CPT. The measure of the ability to respond quickly is also a measure of very simple visual processing.
Dr. Sharp: Sure. [00:21:00] That makes sense. So when you’re talking about coding being a test that’s pretty indicative of processing speed concerns, from your perspective and knowing the research, what sets coding apart from Symbol Search as a predictor there?
Dr. Ellen: That’s a really good question. Coding has, I think it includes visual processing and also motor processing, whereas Symbol Search is more just visual processing. Coding also has a bit of a working memory component to it, visual working memory. If you’re looking at the top of the page and trying to remember from the top of the page what to write below the symbols and I’m assuming your listeners know about that, what the task looks like but you do better on it if you can quickly get that information into working memory, if you can quickly just get the [00:22:00] pen or pencil across the paper.
And so there’s something about the complexity of that task, a little bit of visual working memory, a little bit of that knowing where to start even with some of the symbols that you’re drawing. These are symbols that aren’t things that we don’t typically draw. Many of them are unusual little symbols. And so you have to quickly be able to get into that portion of the task.
And that’s where I find kids with processing speed issues sometimes just, again, it’s that simple thing. This is a great example that parents often give is just something as simple as what do you want for breakfast? Well, how does that relate to coding? It’s like here you need to do to this. There’s not much of a decision-making tree here, but you need to do it and make a decision and move on.
Coding forces you to one at a time, be looking, discriminating, and [00:23:00] moving on. You can’t go back and redo it. It’s got a little bit of a number of things. It’s one of those tests for instance, Trails B is such a great test for looking at older adults in terms of dementia and their ability to be able to cope with demands in life. I feel like coding is one of those tests for younger students that relates to their ability to do those sorts of things that you have to do when you’re in school which is take notes from the board, remember where you start with your pencil.
It’s even small things like that, like where do I start on the paper? Coding forces you to figure out quickly, in order to make these symbols very quickly, it’d be better for me to start in this corner of the box as opposed to that corner. I think it taps into those very quick decisions that our brains make when we’re trying to do simple [00:24:00] things quickly.
Dr. Sharp: Sure. I like that. Even that piece you mentioned about where to start on the page with your pencil, that’s an interesting piece there.
Dr. Ellen: Yeah.
Dr. Sharp: Bringing all this together, processing speed is wrapped up in a lot of things, how would you articulate the relationship between processing speed and working memory and attention and executive functioning? Where does it fall in all those terms?
Dr. Ellen: So the way I think of processing speed is not just as another executive function and it’s always been thought of that. It’s just lumped in that group of planning and organization and working memory and set-shifting and initiation and I think that processing speed is like, if you think of executive function skills as the car, that processing speed is the engine [00:25:00] that allows the car to run efficiently.
Without good processing speed, I’ve seen many kids with terrific executive function skills in every sense of the word but poor processing speed, and they still can’t use those fantastic organizational skills. Their initiation, they’re able to stick with a task and self-monitor but it takes them so long to get it done. They’re driving a Cadillac or a Mercedes but their engine is more like a Ford Fiesta or whatever or vice versa, you can have kids with very fast processing speed but really poor executive function skills and that comes with a different set of challenges.
So I see processing speed is without that, we’re not able to use any of the executive functioning skills that we have. I see working memory and processing speed, what we’re finding in our own research, and we’re only at the beginning of this, [00:26:00] is that there definitely is an association between the two. And when you think about it, working memory is that, it’s our brain’s scratch pad. And so we only have so much room on that scratch pad before that information starts to decay. If it’s hard for you to take in that information quickly, then it’s not allowing it to get into working memory so you have that to play with.
You can have really decent working memory skills but really slow processing speed or you can have pretty good working memory skills but eventually, if you have slower processing speed, it’s going to limit your amount of information that you can get into working memory because I think of it as one of those tapes, when we used to have answering machines, there was always so much tape on that and it would start to erase itself. That’s the way working memory is, and if that tape is playing at a certain speed, you [00:27:00] only have so much room to get on that tape. It’s not the perfect analogy, I guess, but they are related to one another. They’re not dependent on one another completely. It’s not a perfect correlation between the two by any means.
Dr. Sharp: Sure. I see what you’re saying. I think people totally understand that analogy. That’s it. So for you, it’s a driver. Processing speed is a building block for a lot of these.
Dr. Ellen: It’s the engine. It allows us, and it’s like some people use this term and I’ll bring this up now because people always ask about this, the sluggish cognitive template. To be honest, neither of these terms, even processing speed, are super well-defined. I tend to think of processing speed as something that neuropsychologically we can measure. We can measure how long it takes people to do certain tasks, come up with a word in a given period of time, to connect dots [00:28:00] at a certain period of time.
I should have mentioned Trails too when we were talking about Tesla processing speed. There also is another good one, Trails A and B. Processing speed is one of those things where if you don’t have a well-functioning engine, you can’t get from point A to point B quickly. It doesn’t necessarily mean that you can’t get there at all, you can get there just fine, but it might take you a little bit longer.
Dr. Sharp: Right. I think that’s such a good point. I was doing feedback with a family, I don’t know, four or five years ago, and the dad actually said something that I’ve used many times since then in other sessions. He said, “It was a really big moment for me when I realized that I could be slow and smart at the same time.”
Dr. Ellen: Oh, I love that.
Dr. Sharp: It’s great, right?
Dr. Ellen: Yeah.
Dr. Sharp: Yeah. [00:29:00] It plays a huge role in many different cognitive functions. I’ll sometimes talk with parents about, it’s only an issue if it’s an issue, like you have to be quick. There is that expectation to move really fast, but if you have the time that you need, it may not show up as much. So let’s talk about ways to address that issue.
Dr. Ellen: You said talk about ways to address that issue, one thing I think we have to think about, and I really want to get back to this point that you just said, which is how to get kids integrating that into their thinking and into the way that they interact with the world, one of the things we are finding both in our sample but also in a lot of the research that’s going on ADHD is really looking at time perception. We’re finding that kids with ADHD have very poor time perception and that actually may be the case too for kids with slower processing speed.
And so [00:30:00] when you’re talking about that father that you were just describing that he has this idea that being, how did he say that again?
Dr. Sharp: That he could be slow and smart at the same time.
Dr. Ellen: Yes, exactly. In fact, sometimes I think some of the smartest people in the history of the world have probably been slower processors because that’s how they came to different kinds of conclusions because it takes time to think about complicated issues.
So that’s one thing to just keep in the back of our minds, but a lot of kids with processing speed issues have time perception issues as well. And so helping them develop a concept of time is really important, how long does 10 minutes feel? How long does 30 minutes feel? What can you accomplish in a given period of time?
I think coming to grips with the fact that you can be smart and it can also take you a long time to get things done, first you have to grapple [00:31:00] with the idea of how long does it take to get things done? And so one of the first things that I will … suggestions that I have for parents is to help them get a sense of what time is because once you value time, you could learn to value your own ability to get something accomplished in a given period of time.
I find that a lot of times kids who haven’t integrated that sense think like, oh, I’ll get that done. They tend to underestimate how long it will take them to get something done or even underestimate how long it would take the average person to get something done in a task that will take them even a bit longer than the average person.
So I think helping them to get that concept of time is an important way to help them understand that time is just one function of, I [00:32:00] wouldn’t even say their ability level, it’s just something that you have to learn to manage and use. So that’s an important key.
Someone asked last week, I was speaking at a conference and somebody asked, why should my child get extra time on tests because they’re going to get in the real world someday and they’re not going to be able to have extra time? I said to them, it’s because they’re not going to be taking tests like that in the real world. What we want to find for these kids is a pathway for them to find the perfect job for them, the perfect way of living.
And that’s our key. We need to give them accommodations now so that they won’t necessarily need accommodations in the future because they figured out, oh, I need to be in the environment where deeper, slower thinking or the [00:33:00] skills that I have that don’t require me to get through a major amount of paperwork in a day is important. That’s what we’re striving for eventually.
I’ll say kids with slower processing speed can be doctors. They’re great doctors but they may be more likely to be a radiologist or an oncologist or something where they’re thinking about a fewer number of patients as opposed to an emergency room doctor or the kind of doctor where you need to see many patients in a very short given period of time.
So I think helping them think through those issues are important. It starts with helping them realize the value of time now and value what they’re capable of doing within that given period of time. It’s really about quality versus quantity.
Dr. Sharp: That makes so much sense. I like that we’re starting to shift into the accommodation realm.
Dr. Ellen: I know. I [00:34:00] didn’t know if you wanted to shift through that yet. Everybody’s question after what do we do, it’s how do we fix it?
Dr. Sharp: Sure. So I could go back and start with that piece about helping them figure out a sense of time. How do you actually do that in practice?
Dr. Ellen: One of the simplest things you can do as parents or even as teachers is to get a stopwatch and to help them keep track of how long it takes to do certain things. So get a stopwatch. How long does it take us to get to school? What’s the average in a week of how long it takes us to get to school? Is it the same amount of time that takes us to get home from school? Let’s time that too.
Timing, for instance, for one take 10 minutes, how many sentences can you write in a given period of time, or how long does it even take you to brush your teeth, or take a shower, or eat dinner? All of those things are important.
The other thing [00:35:00] or fun I should say, and important, and kids usually love doing those sorts of things, and the younger the better, too. And then also teaching them how to read an analog clock. Kids don’t often know how to read a clock. It’s that visual component of being able to see time pass on an analog clock in the seconds, the minutes, quarter hours, half hours, is very important and very concrete.
And so that’s one of the best things you can do is to teach them how to do that because that’s integrating the concept of fractions and just being visually able to see that time is passing and moving. And then you really can’t teach a lot of those executive functioning skills that happen around calendar use if you don’t really know how much time [00:36:00] passes. We’re always asking kids, plan out your day, if they don’t really know what 10 minutes feels like versus an hour, it’s hard to hold them at fault too, for not being able to keep to that time frame.
Dr. Sharp: That makes sense.
Dr. Ellen: I think those are the things that we should do, and that doesn’t mean you shouldn’t be doing that kind of planning out, but you can’t expect them to integrate that until they have a really good concept of time. I would even say, too, even big picture time things like the days of the week, the months of the year, a generation ago, you’d go into a kindergarten class and they’d have calendar time, and they’d be everyday go over the days of the week and the months of the year.
We’ve gotten away from a lot of that sort of rote learning at the very young ages and I think that’s done a disservice to these kids because they benefit from overlearning concepts so that they’re automatic. That’s another way that you [00:37:00] get faster and another accommodation is to be able to overlearn a concept.
And so I’ve seen 16-year-olds who are very bright and aren’t sure if Christmas always happens in December and when is December? Is that before or after November? It’s funny how they don’t use time as a way of organizing their world, which then also makes them vulnerable for other disorganization in many other areas of their life. So that’s one thing.
I think also thinking about making life as efficient as possible is also important. Anytime you can make a task more simpler in terms of the execution of it, the better. So that relates to even things like home routines, class routines, breaking things down into smaller pieces with more deadlines.
I feel like these kids really benefit from showing not just what a completed project looks like before they [00:38:00] begin, but also what different steps of the project look like during the process. I think that that really helps them manage that very limited time frame and know what they can do in that given period of time.
I also think that we have to keep track of how we talk to kids and to be able to speak in a way that allows them to digest the information. They’re typically not the kinds of kids that you can say five different things and sometimes that’s also the working memory at play, but sometimes it’s not, it’s just that they’ve heard too much information too quickly and it’s hard for them to take it all in. So we have to be careful of that as well, how we present information.
And then also when you’re talking about accommodations, the most common one is extra time. [00:39:00] Providing extended time for tests and for homework when it’s appropriate, even being able to allow them to do less homework and judge more on the quality than the quantity, it could be very much a game changer for them.
Dr. Sharp: Sure. That makes sense. I’m glad you answered that question of, when parents ask, well, what’s going to happen when they get in the real world. I get asked that a lot. And so just being able to say, we’re preparing them for the real world. We’re giving them the path to the real world where they can be successful.
Dr. Ellen: Yeah. And like I said, luckily they won’t have to take the SATs in the real world and it’s our job to help them figure out a job and a career where taking the SATs, there are some jobs where you do have to do a lot of paperwork that maybe that might not be the best path forward for them, or if it is, they need to have their eyes wide [00:40:00] open and know what kind of accommodations they, at that point, as adults, we have to figure out how to accommodate ourselves. And so that’s the whole idea behind this.
Dr. Sharp: Mm hmm. Yeah, of course. I think a lot of what you’re getting at is the idea that parents need to adjust expectations to some degree and know their kid as much as they can and know that as much as we would like, and I’m guilty of this, of course, I would like my children to get at the door as fast as humanly possible but that’s just not always doable.
Dr. Ellen: No, I’ve had a lot of parents come in my office and I’ll explain the profile and a number of times they’ve said to me, oh, so it’s just going to take longer to get them to do a lot of stuff like, for example, what’s he going to have for breakfast in the morning, it’s Pop-Tarts or Wheaties, and [00:41:00] that’s the only choice, so just pick one. So knowing that it’s going to take longer for them to get stuff done just makes everything easier.
It’s funny how knowledge leads to change in our behavior and our feelings about what we’re able to accomplish. And that’s, I feel like as neuropsychologists, it’s one of the best things that we can do is to help parents know their kids better. If we’ve done that, then they’re ahead of the game. The whole point of adulthood is not the point, but that process of adulthood is one of being able to know ourselves. And so the earlier we can jump on that, the better.
Dr. Sharp: Absolutely. So let me throw another question at you that parents ask me a lot, which is, how do we fix low processing speed?
Dr. Ellen: Oh, that’s the worst question because I don’t have a good answer to that question. I was at a [00:42:00] conference and just talking to some major researchers, psychiatrists who really are at the forefront to Joe Biederman and Tim Wilens and Tom Spencer. We were all talking about whether or not processing speed can be fixed at all with any of the medications we have. None of us are finding that as a rule, the medications that we have don’t really work very well at speeding up processing speed. There’s really nothing we know of that can actually speed things up with the exception of when we were talking before about making life more efficient.
What I found in my own research is that there are some kids who do get a little faster compared to peers and I think that might be due to the fact that we don’t really know what’s [00:43:00] causing, it’s just processing speed is one of those normally distributed things that are within the population.
Some kids I do find do get faster. They jump the curve in some ways. I think maybe they’re the ones who we’re talking about more of a, maybe a white matter issue that has just been delayed, maybe white matter process or myelination process that may cause them to, oh, they’ve caught up but for most it doesn’t.
I mentioned being more efficient. I also think helping them practice a specific skill is really helpful. And you have to find that sweet spot between not getting caught up in the nitty-gritty of practicing, overwhelming them with that, but also helping them practice something that it becomes more automatic. And then also work on that planning, time management, organizational skills.
And then also, [00:44:00] there are many kids who have processing speed issues and other comorbid issues, and many of them have more than one. For instance, they may have ADHD and anxiety, or they may have ADHD and a dyslexia. I think making sure that you are treating those comorbid conditions as best you can and intensively as you can is really important.
And when I see a child with dyslexia, for example, also has slow processing speed as part of their neuropsychogical component, I will recommend that if I’m thinking like, oh, they should get tutoring two to three times a week, if I see the slow processing speed, I might say, let’s try three to four times a week.
If I see a child with ADHD and slow processing speed, I might say, we might want to try medication to treat the attention so that we can maximize some of these other accommodations for the processing speed. When I see that as part of a child’s neurocognitive profile, I’ll usually [00:45:00] say, let’s go a little bit further with the possibilities sooner, because I feel like these kids are at increased risk for not doing as well over time. So we need to intervene as quickly and as intensively as possible.
Dr. Sharp: Yeah, absolutely. I have two questions. I know we’re getting close time wise but I wanted to ask you about the relationship to ADHD and processing speed and if there, well, we’ll just leave it at that. The relationship there. Let’s start with that.
Dr. Ellen: So our research shows that there is, it’s funny because before I started thinking about this, I just pretty much thought if you had slow processing speed, you had ADHD. What we’re finding is about 61% of the kids in our sample with slow processing speed have ADHD. So [00:46:00] there’s a strong relationship here, but it doesn’t explain it all.
And so there are definitely kids who have slow processing speed who have attention issues. There are also kids who have slow processing speed and very good attention but they have trouble getting it done. Basically what we’re finding so far is there’s a relationship between the two. It’s not a perfect one.
I think there’s a lot that needs to be done but we also know that the kids who have that as part of their ADHD profile probably are at greater risk for school failure, for other kinds of delinquency and those sort of things that come along with ADHD than if they didn’t have the slow processing speed.
Time will tell but they’re at just much more risk of getting in trouble for things sometimes that they didn’t do [00:47:00] because they’re late in the game to figure it out. And when I’m talking about that, I’m really talking more about as they’re getting into adolescence, high school.
And again, just watching these kids develop over time, we just find that if they haven’t had that early intervention, that we need to still intervene as intensely as possible but they are at greater risk.
Dr. Sharp: I got you. I did want to ask you too, how you see the relationship between anxiety and depression and processing speed and I think maybe more importantly how you would tease out “innate” processing speed weaknesses versus anxiety-driven.
Dr. Ellen: Anxiety, I think a good neuropsychologist can usually figure that out in terms of a lot of that is behavioral observations when we’re looking at a child in particular with anxiety and processing speed and we’re looking at how obsessive they are. [00:48:00] There’s a big qualitative issue here when we’re diagnostically trying to tease that out in a particular child.
What we have found is that anxiety and processing speed have a very strong relationship at either side of the curve. That kids with high levels of anxiety are more likely to have slower processing speed and higher processing speed. So there’s something about anxiety and the relationship being, it’s this bimodal distribution.
It’s interesting to think about that if you’re at risk, if you’re a really fast processor, you’re at higher risk for anxiety, which may come from, I don’t know, it’s a chicken and egg thing. We only know it’s a relationship but does a faster ability to get things done make you more anxious that you’re not getting things done or, we don’t know but then we just know right now it’s an association.
The association between depression and processing speed, we’re also finding high correlations with that. [00:49:00] It’s hard to know with that as well, is it a chicken or an egg thing? There’s some evidence that shows that when you’re significantly depressed, you have slower processing speed. It’s part of depression for a lot of people, significant depression in particular.
But what we’re really talking about when we’re looking at kids is, in our research, we’ve tried to take out the effects of psychiatric issues to look at this issue of processing speed in and of itself and there’s still variability left over once we control for some of these other issues but when we’re looking individually at a child, I think it really still gets down to a good evaluator looking at the ability and the differences on different tests of processing speed.
Typically kids with depression, you’ll see that psychomotor retardation. That’s just there. [00:50:00] That slowing that’s there that goes beyond what we see in a child who’s just having trouble getting their pen across the paper.
Dr. Sharp: Sure. Yes, I’m with you. We have covered a lot of different things and this is all great information. Let me ask you, I’m going to throw in an extra question before I ask about resources and things. Do you diagnose kids with anything if they only have slow processing speed and you genuinely can’t find any other mental health concerns or even a learning disorder?
Dr. Ellen: This is such a tough question and sometimes what I find, because the whole issue here is trying to get them accommodations at school under IDEA. I used to diagnose them with a learning disorder not otherwise specified in DSM. [00:51:00] But now in the new DSM, we don’t have that opportunity.
So what I generally try to find is, I really feel like it’s important to look at that academic fluency, because we actually can use that as a diagnostic criteria, that they have specific learning disability with an impairment in math fluency. It’s not a typical learning disability but it does meet criteria for DSM and also in most school systems will say, yes, that will allow them to get services.
So that’s generally what I do but I also explain to parents, this is not a learning disability in any real sense of the word. The hard thing, and I think this is what you’re asking is, what about those kids who even academically, they’re bright, they can do almost anything in two or three minutes, which is most of these tests we’re talking about, and how do we get the accommodations for them? I think that trying to use an executive function issue but that’s [00:52:00] not a diagnosis.
Those are the hardest kids and I think then it’s really about just explaining their neurocognitive profile. I’m finding that if you give them enough tests of academic functioning, you’re probably going to find where the rub is for them, where it’s crossing the line for them to actually have some sort of functional impairment and that’s what I will try and get at is where’s the functional impairment with this. Is it in math fluency? Is it in writing fluency? Is it an ability to take a test like a Nelson-Denny Reading test in high school? Sometimes that’s where it all falls apart is when things get more complex.
Dr. Sharp: Sure. That all makes sense. I’m so appreciative for all of the knowledge that you have shared here. If there are folks out there who would like to learn more about processing speed or accommodations thereof, I will certainly have your book in our show notes which is fantastic by the way, I highly recommend that [00:53:00] people go check it out. Other resources that you’re aware of that might help folks who want to dig into this a little bit deeper.
Dr. Ellen: There are two websites that I would recommend. One is the mghclaycenter.org. We have a lot of information on processing speed and some videos, some webinars. We have a video on processing speed that we did that talks about this teacher perspective and parent perspectives and parent stories there.
And then I also think that understood.org, which is another great resource, has a lot of information about all kinds of aspects of processing speed. A lot of the topics that we talked about. And even though both of these websites are really written for parents, I still find it really helpful as a professional to look at these sorts of issues.
They really provide a lot of information.
A lot of times as neuropsychologists and psychologists, we’re really [00:54:00] trying to provide information to parents and both of those websites are great for looking at processing speed among other things.
Dr. Sharp: Fantastic. Those are great. I’ve definitely been on Understood. We will link to those in the show notes as well. Well, this is awesome, Ellen. I really appreciate it. Thank you so much for coming on and talking to us through processing speed. I know we just scratched the surface, it feels like. I have all these other questions I was writing down but there’s a lot to explore here. I appreciate everything that you’re willing to share.
Dr. Ellen: Oh, it’s delightful. Thank you so much.
Dr. Sharp: If people want to learn more about you or get in touch with you, what’s the best way to do that?
Dr. Ellen: Probably through the mghclaycenter.org website. There will be a little link that they can click on and they can send an email or questions through that, that’s probably the easiest way to reach me.
Dr. Sharp: Okay. [00:55:00] Well, that sounds great. Once again, Dr. Ellen Braaten, thank you so much for your time today.
Dr. Ellen: You’re welcome.
Dr. Sharp: All right, y’all. Thank you so much for listening to my conversation with Dr. Ellen Braaten. I’m going to have a lot of links in the show notes certainly to Ellen’s books, which are both amazing. And those aren’t all of them. She’s written a few books but the two I’ve seen have been great. So I’ll have links to those, to the places that she works and some of the resources that she mentioned.
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