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ADHD Science episode 5 with Alex Hendry
137 Plays1 year ago
A corker, this one. We talk to Dr Alex Hendry from Oxford University (see her lab site here: https://www.psy.ox.ac.uk/people/alexandra-hendry.
We discover the link between toddlers trying to get hold of sweets and ADHD, and Tess has a wild opinion about pianos!
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Transcript
Are Pianos Too Big?
00:00:07
Speaker
Okay, hello! Hello! Tess has just been sharing her opinions on pianos. They're too big. No one uses the keys on either end of the piano. They're useless. People only use them to add dramatic effect to a song. And then they go back to playing the nice keys that sound nice. In the middle. So they're what? Pianos are too big.
00:00:24
Speaker
Yeah. Matt, you heard it here first.
Episode Introduction with Alex Hendry
00:00:26
Speaker
Welcome to episode five of the ADHD Science Podcast. Hell yeah. Hell yeah. We are going to speak today to Alex Hendry from Oxford University, and she's going to talk about basically toddlers looking for sweets. Yeah.
What is Executive Function in ADHD?
00:00:45
Speaker
uh very much and she does sound like she's got the cutest uh experimental protocol known to science oh absolutely not even a question and yeah we had a really good chat and um i think executive function is such an important aspect
00:01:04
Speaker
of ADHD and it's not because it's quite hard to measure it's not really talked about and it's not one of the kind of criteria so therefore it's not really targeted but perhaps we should the difficulty is how we target it and people like Alex and our next week's guest
00:01:24
Speaker
yeah little spoiler um are really looking into the uh things that we can do and on an everyday level to improve executive function but more on that later oh yes in a week's time thank you Tess right before no more further ado we're gonna go before no more further ado shush we're going to talk to alex henry alex henry
00:01:55
Speaker
Okay.
Research on Autism and ADHD Overlap
00:01:56
Speaker
Hello. Hello, we are here. It is the third time we've attempted to do this. What about transparency? Although I'm not seeing through.
00:02:06
Speaker
Thank you. Thank you very much. We are here with Alex Hendry, research fellow at University of Oxford, and that's so far. Yes, thank you, Alex, for bearing with us. So when you were doing your research, what kind of questions were you asking? What did you want to find out about? OK, so I'm really interested in two things, one, the kind of the overlap between autism and ADHD. What are the kind of things that are common across both conditions and
00:02:34
Speaker
I'm also interested in finding strengths and difficulties and using strengths to maybe help support children to address some of the difficulties, particularly those shared difficulties that might be experienced by people who are autistic and have ADHD or who either are autistic or have ADHD. And what does that mean in practice for you? How do you go about doing
Defining Executive Functions
00:03:00
Speaker
that?
00:03:00
Speaker
Okay, so the kind of the area that I hit upon fairly early in my PhD research was executive functions. So probably you'll be very aware of what executive functions are, but just to kind of break it down for anyone who's not, when we talk about executive functions, we mean kind of
00:03:19
Speaker
Those skills that help us plan and work towards goals. So they're kind of really useful in everyday life. They're the kind of skills that require us to take turns, to wait sometimes, to hold multiple pieces of information in mind, to think flexibly and act flexibly in response to a changing situation. And we kind of lump all of these really complicated and hard skills together under this banner of executive functions.
00:03:47
Speaker
And there was plenty of research suggesting that both autism and ADHD are associated with some differences, often described as difficulties in executive function, but maybe not always difficulties, maybe some strengths as well.
00:04:04
Speaker
And some people kind of have suggested that possibly that might be a genetically influenced link and actually then that might be a more meaningful thing to study than actually trying to put autistic people in one bucket and a separate bucket of
00:04:20
Speaker
of people with ADHD because, you know, as you'll know, actually lots of people who are autistic have ADHD and vice versa. So maybe it makes more sense to think about executive function as this common thing. So that's where I started from and then I kind of got really interested in understanding well, how does executive function develop? What does it look like when children are struggling with their executive functions and what might we do about that?
00:04:46
Speaker
And to what extent is executive function a single thing? It's kind of, it's both a single thing and it's many, many, many, many lots of different things. So it's a single thing in that anything to do with goal-directed action kind of requires this umbrella of executive functions. And to a certain extent, in the real world, you kind of can't
00:05:14
Speaker
break it down too discreetly because you've just got problems to solve you don't sit there and go okay well first I am going to engage my inhibitory control I'm going to wait and hold off this response and then I am going to plan and then I am going to change my response of course you're doing all of those things at the same time
00:05:34
Speaker
But so in some senses, it is one big jumbly mess, particularly in children, perhaps. But at the same time, it does seem to be the case that some people have strengths in one aspect of executive function, like they might be particularly good at waiting, but really struggle holding multiple items in mind. That's my particular area. I have got the worst working memory in the world, particularly vulnerable when I'm tired or stressed like most people.
00:06:04
Speaker
But actually my inhibitory controls is all right. Other people, they might have kind of difficulties across the board. So that's really interesting in itself, I think. And with regards to autism and ADHD,
00:06:19
Speaker
it classically got described that, you know, people who have ADHD might have particular difficulties in the inhibitory control and working memory, whereas autism might be classically defined as difficulties with thinking flexibly and responding flexibly. But what happens if you have both? What happens if you're just kind of neurodivergent and it's all mixed together? What does that mean for your executive functions?
Understanding Inhibitory Control
00:06:43
Speaker
How would you describe the, um, what was it? You said it was like inhibiting function. How would you describe that inhibiting? So that's basically stopping doing something. And sometimes we stop, stop doing something and that's, that's the end of it. So I might have a big plate of biscuits in front of me and I'm using my inhibitory control.
00:07:03
Speaker
to just eat one and not eat all of them. So the action there is just stop eating all the biscuits. But sometimes we use inhibitory control. And now I can just not, I'm totally thinking about biscuits. So I'm having to use my inhibitory control to stop thinking about biscuits and dry biscuits. No, I'm thinking about biscuits. Yeah, we're all thinking about biscuits now. It's really, really hard. So we use our inhibitory control in our attention as well. That's really important. But sometimes we use our inhibitory control to stop an action and produce a different action.
00:07:33
Speaker
One example I give is if you're walking through like a massive long office block or hospital and you've got a series of doors and they're all pull doors, pull doors, pull doors, and you're walking down this long corridor and after the fourth or fifth pull door you hit push door, instinctively you start to pull it and you have to use your inhibitory control to override that strong, what we call a pre-potent or over-learned response to produce a different response. Right. Okay. That makes sense.
00:08:02
Speaker
a little bit. So another example is if you're a tube user, if you live in London, I used to live in London and use an oyster card and you get used to kind of getting your oyster card out and bashing it on the thing and then sometimes I would get to my place of work and try and use my oyster card to tap into my office building. It's just it's a habit thing yeah. It's a habit thing exactly yeah. And so
00:08:29
Speaker
What did you, how do you study that? What do you actually do to study executive function in children?
Studying Executive Functions in Toddlers
00:08:35
Speaker
What are the experiments that you kind of carry out? What does it look like? So I'm really interested in the list children. So my area of interest is naught to three-year-olds. So that's challenging for two reasons. One, executive functions are really only just starting to develop in this age group.
00:08:55
Speaker
And two, lots of other skills are only just starting to develop in this age group.
00:09:05
Speaker
So yeah, so you've got children who are maybe still learning their language skills, who are learning to control their bodies. So all of the classic tests that were developed for older children and adults, you can't do. You can't get them to sit still and produce snow. And that's in part because of their weak executive functions, right? You need your executive functions to sit still, but then also you've got to be understanding complex instructions and
00:09:34
Speaker
And maybe classically, you get people to tap different letters on a keyboard. That's not going to fly with a toddler. So we have to be really, really imaginative. And so we've developed, me and my colleagues at the University of Oxford and previously at King's College London, have developed a lot of different tasks. So some of them are object based. So we play with kind of shape sort of type things where you have to put a thing in one hole and then
00:10:00
Speaker
move it and you have to put it in a different hole, so it's kind of tapping into the kinds of things that toddlers like to do. Another thing that they like to do is they like to play on touch screens, so we have a lot of touchscreen games.
00:10:11
Speaker
we play hide and seek and having to remember different kind of routines where you tap on one side and then another and you have to kind of keep track of where you tap to find the reward. And my favourite one, one that I developed as part of my PhD is called the problem solving box task and there the child has to
00:10:34
Speaker
get at three rewards so we hide these little treats in and we give the child the one treat first normally a smarty but you know if their parent doesn't want them to have smarties it could be grapes whatever um we give them a treat and then we say look here are three more can you get them
00:10:50
Speaker
they don't even have to understand that instruction because they can see it. This is a clear box and they can see in there three more smarties so pretty much every toddler that you've ever met will be like smarties yes please and they will go for it right but this is a trick box so to get at these three different rewards they have to
00:11:09
Speaker
respond in different ways, so one of the lids lifts, two others are stuck down and they have to pull in different directions. And so what you see is children thinking flexibly, coming up with lots of different responses, having to inhibit, so hold off that response that maybe worked last time, that if the lid lifted you might expect it to work again, so you have to stop
00:11:32
Speaker
with your lid lifting and you have to be persistent and persevere when it gets hard and manage your emotions. That's another really important part of executive functions is managing your frustration and things like that.
ADHD and Problem-Solving Strengths
00:11:45
Speaker
It's knowing when to stop but it's also knowing when to keep going. Yes and so one of the reasons I really like this task is a cool finding from my PhD work
00:11:56
Speaker
was that children who have a family history of ADHD seem to show strengths in this task. So historically, researchers have banged on and on about all the executive function deficits associated with ADHD. And I'm not saying there aren't challenges, right? But consistently, as I've replicated this in two different samples now, we find that children who have a family history of ADHD, so they may or may not go on to develop ADHD themselves,
00:12:25
Speaker
But this group, they are more flexible, they come up with more strategies and they are more successful as well. So they get more rewards than their peers who don't have a family history of ADHD. This is great. I have ADHD so I'm going to get more smarties than everyone else.
00:12:47
Speaker
Unfortunately, the rest of your family also have ADHD. 80% of the people are on the same level and then there's mum.
00:13:01
Speaker
She'll never get the smarties. She never gets the smarties. It's literally true. We get sweets and this is completely off topic. It's not completely off topic at all. Actually it's not, is it? We get sweets and chocolate into the house and my poor mum, she's so busy working, she comes downstairs, they're all gone. She just told them all.
00:13:19
Speaker
Yeah and I think this also speaks to another reason that maybe children with ADHD haven't classically done that well or performed the way that researchers might expect them on executive function tasks is because they weren't super motivated by the tasks that the researchers came up with. So if you get a child to to do a bunch of arbitrary rules and respond in a certain way just because a researcher said so you know there's going to be a category of children that go
00:13:50
Speaker
maybe not people in neuro divergent people generally are going to be more likely to be like that there's it's often said and I think it's probably chimes with my experience anyway that people with ADHD
00:14:05
Speaker
they need more rewards. I don't want to sort of slip into sort of pop psychology dopamine stuff, but people with ADHD, we need more immediate, more tangible rewards in order to motivate us, however you want to think about that. So that makes sense, doesn't it? Yeah, exactly. And then once you are motivated, my goodness, the creativity, the problem solving. So if that's something that we can build upon,
00:14:29
Speaker
And I think it's got kind of a lot of potential there because it suggests that maybe we've been underrating children who have either a family history of ADHD or ADHD.
00:14:42
Speaker
Yeah, full stop. But also it gives us an opportunity to think about, well, what can we do to build this child's self-esteem? Can we set up tasks in a way that are motivating and engaging for children so that they do want to succeed at them and then they do? And so that builds this kind of positive cycle of the child starts to feel good about themselves compared with where they were before when it's just constantly, oh, you can't sit still, you can't do this than that. So I think it's a much more
00:15:10
Speaker
positive and optimistic way to try and engage with young children. Okay, so you said that these children are around like three, right? Yeah, yeah. So the PhD work that I was doing was with two and three year olds. And so I found find that group difference at both age points. Now the intervention that I'm running, the program called Start, that's designed for children who are between 21 months and 27 months.
00:15:39
Speaker
So this real kind of exciting toddler period, because that's when executive functions are really blooming. Because I was wondering if you thought that possibly some of the differences between the children who don't have ADHD families and the children who do might be because of the way they were raised or if they're too young for that to have a big effect on them. Yeah, that's such a cool question.
00:16:01
Speaker
Probably a lot of the parents that we speak to would suggest, yes, that's the case. Sometimes parents like, oh, but he's like that because he sees me being like that. He's really kind of creative and tries different solutions because he sees that's how I tackle tasks. Well, brilliant.
00:16:19
Speaker
But possibly it's genetic too, also fine. And to a certain extent, as far as the child is concerned, maybe it doesn't matter. Maybe all we need to really understand is what's life like for the child? What strengths do we have to build on? And where might they need extra support? So personally, I'm slightly less interested in why did they get to that point right now? I'm more interested in
00:16:44
Speaker
Given the point that you're at, what can we do to support you to flourish? So we don't have to have the nature nurture discussion. Good. Let's not have that. What is your intervention?
What is the START Program?
00:17:00
Speaker
Right, so it's called START, which stands for, bear with me because I need to take a deep breath for this. So the title info is supporting toddlers with a family connection to autism or ADHD to develop strong attention, regulation and thinking skills. So if you... That's a stretch. That's a stretch. Exactly. Yeah. So it's...
00:17:29
Speaker
It's an acronym for pirates. Sorry, say again. It's an acronym for pirates. It's an acronym. Starred. Yeah, I'm Cornish, so I like to put some rolling Rs in there. Yeah. So as well as being a short name for a very long title, it's called Start because we're trying to start at the beginning. We're starting when executive functions, these thinking, attention and regulation skills are first starting to emerge.
00:17:58
Speaker
It's a parent-toddler programme, so the first kind of principle of start is it must be fun because parents and toddlers, they don't want to be sat doing, you know, boring learning by rote. That is not going to fly. Especially not neurodivergent.
00:18:14
Speaker
Yeah. And so the second principle of start is it must be inclusive. It must work for neurodivergent people kind of at its broadest. So that means we wanted to develop a program that was going to work for maybe parents who were feeling a bit anxious.
00:18:30
Speaker
children and parents who might have sensory difficulties or differences, and kids who are really, really shy, but also kids who are really, really active. So we've done a few pilots now and we have absolutely had
00:18:49
Speaker
both sides of that coin. We've had the kind of the child who needs to spend the first 15 minutes. You're raising your hand. You're the child who runs around the room, yeah? No. Pilot studies are mini versions of the study that happen before the big study. Pilot studies. Yes. Thank you. Yes. Pilot studies are the main versions. Yes. Yes. So we run
00:19:14
Speaker
Well, we're kind of on our third kind of pilot. So the first pilot we did, I just kind of went out there with my bag of toys and did a version of the program with a general, what we call a general community sample. So just people who live in a particular area of Oxford, I specifically chose an area of Oxford where there's lots of socioeconomic deprivation because we know that that is also associated with executive function difficulties.
00:19:42
Speaker
and just to try out these games and see do toddlers like it because the best feedback from that you can get is from a toddler who's looking at you going like no this I don't want to do this activity then they'll just walk off so instant feedback and so kind of I did that a few times and then then went through this big long process took a year but it was really really rewarding of
00:20:05
Speaker
refining the program with neurodivergent families, particularly mostly neurodivergent parents who, so parents who themselves are autistic or have ADHD, often raising neurodivergent children, sometimes raising neurotypical children, but then the occasional parent who's neurotypical raising a neurodivergent child. So a real mixture of perspectives and I kind of got them to pick holes in all the different activities and go
00:20:28
Speaker
what would we need to change here to make you feel comfortable with this? Are we sending the right message? Does this challenge anything that you feel strongly about? And, you know, one of the great things about working with neurodivergent parents is they'll often be in a really kind way, knowing, no, this isn't right.
00:20:49
Speaker
Yeah. So that was fabulous. And then we've since run two more pilot rounds with neurodivergent families from beginning to end. So it's a 12-week program. So in proper pilot one, we ran a 12-week program with seven families, and then pilot two, another 12-week program with six more families. And now we're at the feasibility trial stage.
00:21:15
Speaker
which is basically running not only the program, but the evaluation of the program from beginning to end. So checking that the measures that we're using to assess executive functions are acceptable to families, that we can get toddlers through it without exhausting them too much, that we pick up useful information about children. So yeah, so that's where we're at at the moment.
00:21:37
Speaker
And is the idea that you, I mean, obviously you start off, the idea is that you start off not knowing what's going to happen because you knew what was going to happen and what's the point of doing the research. People find that hard to get their heads around, but you know what I mean. But the idea is that the hypothesis is that you will find an improvement in some aspects of executive function, overall executive function. Is that right?
00:22:01
Speaker
Yes, yeah, you're exactly right. So I guess I have kind of two big questions about this trial. My question number one is, is this okay? Am I really, really sure that I'm doing no harm here? Am I really, really sure that this is acceptable to families, that this fits in with their life, that they're willing to give it a go and feel good about it afterwards? Incredibly important.
00:22:23
Speaker
And then question number two is, does it look like it's actually going to help? Because, you know, we've all got limited time and often parents who. So, yeah, if parents have got a family history or a connection to autism or an issue, they've often got other stuff going on that's really, really important that they're juggling. So, you know, if they're going to give up an hour of their time to go to the sessions plus do these activities at home, we need to be really confident that
00:22:51
Speaker
that it might help. So that's, yeah, that's exactly the second question that we're asking. Do we see an improvement in children's executive functions as a consequence of being part of this? You were talking about what this means for the parents and families of children. What does that mean for those people as well as clinicians who are helping to look after these kids?
00:23:13
Speaker
So what I'm hoping to get to a point with families is that if they've been a part of START, they come away from it, A, feeling good about themselves and their child. So this is a neurodiversity affirming program. So it's about not saying, all right, we're trying to make your child less autistic or less ADHD. It's actually about saying, we're trying to help you recognize
00:23:35
Speaker
the brilliant individuality of your child, notice the extra supports that they need when they need it, and also notice where they're really thriving already so that you can celebrate that with them. So I hope one practical implication is that we've put out into the world a new thing that actually maybe helps families feel better about things. But then the second practical implication that I'm hoping is that
00:24:05
Speaker
we're raising a new generation of children who maybe have slightly less struggles than children who went through. Yeah, I mean, incremental things. Didn't get that support, yeah. So a lot of the parents that were involved in the co-refinement of the programme and the first pilots, they were like, oh, I wish this had been there for the older child, because they're really struggling now at school.
00:24:29
Speaker
If we can get the new children, the children who've been through START, to the point where they're not struggling, that they recognise their strengths and their weaknesses and know what supports to ask for,
00:24:44
Speaker
And the parents and the teachers know how to make the environment a little bit comfier So that executive functions aren't always being overloaded because it's it's not just about changing the child That's a really another really important thing about I think that's gone This is a shortcut to a process that takes years and years and years of self-acceptance Getting your friends and family and teachers to accept who you are Throwing out your strengths your weaknesses and how to like
00:25:14
Speaker
Oh God, accommodate for these weaknesses and this just stuff that like based on our other podcasts where we talk about people's like life stories, stuff that takes like decades. So that is really, really helpful. So we're hoping to get in there for the toddler so that to start that journey early, but also to help parents who are on that journey because of course a lot of the parents themselves will be neurodivergent.
00:25:42
Speaker
and we're giving them an opportunity to chat with other neurodivergent parents and go, oh, actually, we're not doing so bad. And I've got this expertise and oh, I've already figured this bit out and I get to share it with someone else and feel good about that.
00:25:57
Speaker
Yeah. What I think is really exciting and different about your approach, genuinely, is that it's partly about improving skills, but it's also just about improving confidence in a funny way and improving confidence in the and celebrating the strengths and confidence, the strengths of the of the child. And confidence, if you think about a toddler, it's not just the confidence of the toddler, it's actually intimately bound up with the confidence of the parent. You can't talk, I don't think you can talk about one without talking about the other.
00:26:27
Speaker
Yeah, because when you're a coder, you basically are your parents. Yeah, I mean, to an extent, in the way that you interact. That was incorrect. Please don't keep that in. In the way that, no, it is. No, we're looking at this in psychology. I'm not correct. You interact with the world as a unit. You are not identical to the person, but you interact with the outside world as a unit. I suppose that's the way of putting it.
00:26:48
Speaker
So, but that's really, really important and it's embarrassing. It took me a lot longer to get to that point than you've got to in the 20 minute chat.
00:27:00
Speaker
During this process of co-refinement with parents, we were talking about, well, how do we know if Start is working? Well, of course, we need to look at, have we changed things for the parents? And immediately, then, parents start going, what now? You're going to start scoring me, judging me? I do not like that. No parent likes to feel judged. And you're a diverging parents. Oh, my goodness. They've had it kind of ram down their throat from day one.
00:27:28
Speaker
Yeah, so what we did as a kind of direct consequence of that was we applied for some funding and got some funding to develop new measures of neurodiversity affirming measures of parenting that don't start from the point that
Evaluating Neurodiverse Parenting
00:27:44
Speaker
there's this warm way of good parenting and it looks like neurotypical white middle class parents that actually start from the point that there are lots of great ways to parent, there are lots of great ways to interact with your child and there are lots of great ways to feel as a parent. So we've got two measures, one's about what we call parental self-efficacy but it's confidence really, it boils down to confidence.
00:28:06
Speaker
So we've got a questionnaire that's been developed with parents to think about, well, what does that mean in the context of neurodiversity? And then we've got this other measure of parent-child interaction that starts from the point of, well, what does it look like to be responsive and attuned when you or your child may or may not be neurodivergent? So should we just rule out eye contact as a prerequisite for, you know, being attuned?
00:28:34
Speaker
Shall we not assume that warmth requires cuddling? And I mean, it was interesting in the focus groups. Lots of neurodivergent parents talked about the importance of a big, deep cuddle for their child. But then other parents were like, no, that's not how I show warmth. I show warmth in a very different way. So we're developing this measure to be much more open to all the wonderful ways that parents can support their children so that when we're evaluating start, we can see, have we
00:29:03
Speaker
empowered parents in those regards as well. Yeah. Yeah, that's so exciting. And it's so that's so different to the usual approach, ensure you're aware that you'll just drag up some kind of 1980s era questionnaire and kind of push it through the parents so that you can kind of get a publication. That's the usual way of doing it.
00:29:28
Speaker
Isn't it though? Here it is. I really wasn't asking you, Tess. I was just non-verbally apologizing to you for the fact that my gesticulations were getting a little bit wild. He just fully slapped the computer. He was doing some wide gestures. He just absolutely backhanded the computer. Anyway, so there you go. That's what happens when I get excited. I backhand the computer. What's notable by its absence and
00:29:58
Speaker
I think this is a great thing but I wonder if you want to talk about is notable by its absence is any mention of diagnosis or prevention or reduction in future diagnosis that
00:30:09
Speaker
Well, let's just talk about that a little bit. Yeah, it's definitely not an accident. So, yeah, we are we are not trying to make a child less autistic or less have fewer ADHD traits. We are not trying to put children into groups. You know, it's particularly hard at this young age anyway.
00:30:41
Speaker
And so what what we do and we
00:30:51
Speaker
When we're recruiting families in, we ask about, you know, is there a diagnosis of autism or ADHD? But we also include people who are like, no, I'm not diagnosed, but I'm pretty confident because, you know, you know, if you're neurodivergent. And so we've got some standardised questionnaires and we have this big disclaimer about how, you know, the
00:31:12
Speaker
they are still using the deficit model but that's not that's not the way we think it's just those are the measures that we're kind of almost forced to use to be able to develop stuff within this space. So yeah so families can come in whether they suspect themselves to be neurodivergent or whether they've got a clinical diagnosis but also within the study
00:31:35
Speaker
We are monitoring the children. We do an ADOS, so that's the Autism Diagnostic Observation Schedule. That's the standardized thing that any child would go through if they're on an autism diagnostic pathway. We do kind of ratings of ADHD-like traits.
00:31:53
Speaker
but we're not doing that to go oh have we checked that the numbers have gone down at the end we're doing that so that we can understand is start working in different ways for different children because if it turned out that actually it wasn't very suitable for children who.
00:32:09
Speaker
have extremely high autistic traits because just the sensory demands of being in a group setting are just too much. We need to know that. We need to understand our population, but we're not looking to bring those scores down. The other reason it can be quite useful to do this is because you'll know that it's really, really hard for families to get access to diagnosis at the moment.
00:32:35
Speaker
and diagnosis is the gateway to support, unfortunately. So whilst we don't give a clinical diagnosis at the end of the full start trial, what we can do is share the raw scores so that if a child is scoring really high, they can go back to their GP or health assistant and say, I've got a strong case here. Could you support me?
Benefits of Early Childhood Interventions
00:32:59
Speaker
Yeah.
00:33:00
Speaker
I don't know what the average health visitor would make of an ADOS score, but I know exactly what you're saying. They could be pointed in the right direction. So what do you think is your next question? What are you looking into next?
00:33:10
Speaker
Oh, I don't know. I think Start's going to keep me busy for quite some time. This particular program is going to be running until 2026. So I can't really think more than three years ahead. But that said, every kind of step of this project has taken me off in some new directions. I didn't think I was going to start developing new measures of parenting in neurodiversity, if I'm in context. So who knows is the honest answer.
00:33:38
Speaker
I'm so privileged to be able to kind of be changing as a researcher as a consequence of this kind of co-design practice that would almost be just too naive of me to think that I might even predict where I'll get to in three or five years. I suppose I'd ask that question in a slightly different way. If you had a spare researcher, what's the question you haven't got time to look into that you'd like to send that imaginary free researcher funded by
00:34:07
Speaker
some mysterious benefactor. You're acting like you didn't write these questions. Yeah, but no, but I just think in this particular context, it can be asked in a different way. What question would you send that person off to look at? Yeah, I think if I had unlimited resources, it would be and unlimited access to families. It'd be really interesting to understand more about what is the most useful timing. There's a lot of kind of discussion that earlier is always better.
00:34:37
Speaker
And, you know, I'm an infant and toddler researcher, I kind of am strongly leaning towards that. But do we really have the evidence base to support it? I don't know that we do because we've tried different things at different time points. So to actually do a neurodiversity affirming intervention to support executive functions at different points in children's development, I think would be
00:34:58
Speaker
Yeah, really enlightening. I mean, surely there's that thing of the earlier you go, the less developed they already are. So the less likely it is to have a big effect. Does that make any sense? If you're trying to do this process on a newborn, it's probably not going to be as effective as if you did it on a toddler. That would be too soon because they've got no executive functions to build upon. But equally, it's almost, it's almost I'm trying, I'm trying to be fair about this, but it's almost
00:35:26
Speaker
just accept it as an article of faith that the earlier the better in intervention and developmental problems. I think the earlier the less harm done.
00:35:35
Speaker
possibly, but maybe not. I mean, if you do something very harmful early in life that can have devastating consequences. Yeah, if you're restricting them from important other opportunities, yeah. I think the thing about early intervention is that you're getting in there soon enough to be part of a positive cascade of effects. So I used to use in kind of presentations, the marble run that my kids used to play with.
00:36:01
Speaker
where if you change which direction the marble goes in early, that can make a massive difference. It will go off in a completely different direction than if you just get in there late, there are only a few directions to go in. And because we know that executive functions are important for social skills, for academic skills, for
00:36:25
Speaker
you know, everything, just getting on a train and getting to your destination, it requires executive functions. Being at school requires executive functions, it kind of makes sense that if you can get those skills as strong as possible, as early as possible, then you have more opportunities to have all these other great outcomes. But just because something makes sense, this doesn't mean we know it to be true, so I would really like to test that out.
00:36:52
Speaker
Yeah and of course you're preventing negative uh cascades so yeah that's what I was thinking with the confidence thing so you know the cascade of of children who might start school very confident but lose confidence and I see again the the parents thing yeah the earlier you get in there the the earlier you can begin to have the parents accept them
00:37:13
Speaker
So that when there are really key stages of development, the parents know what to do, rather than getting in on these stages of development where the parents have already been maybe a little bit confused or not really know where to turn. And then something might have happened during that time that's really affected how they grow up.
00:37:30
Speaker
So that's where I was saying the earlier the less harm done not because they're going to get like oh I see what you're saying yeah yeah just because the less harm has been done already yeah so we know another area where executive functions are really important is mental health so you know if you're
00:37:48
Speaker
struggling with your executive functions you're more likely to be anxious you're more likely to be depressed and there's lots of reasons for that partly because you're constantly being criticized by other people and that impacts your self-esteem but also because we use our executive functions to kind of
00:38:03
Speaker
move past anxious thoughts or depressive thoughts. So again, the thinking is if you can get in there early, then you might circumvent some of those problems. And also, like you say, if you can get in there early and support parents, we know without a shadow of a doubt that parental mental health is super important for children's development.
00:38:22
Speaker
So if we can get parents in a situation where they've developed peer support networks, developed skills and confidence and have got a whole bunch of tips and techniques up their sleeve, then that ought to improve their mental health and therefore their child's outcomes as well. And it's good that you picked up that, sorry, well, I meant to pick up earlier this idea of peer support.
Importance of Peer Support for Parents
00:38:46
Speaker
Because I think it's so powerful for the parents of neurodivergent children it's something that's absolutely I mean fundamental to what we try to do in Lambeth, where I work, is setting up and supporting peer support because it's the one thing that I always recommend.
00:39:02
Speaker
whenever I'm making the diagnosis of any neurodevelopmental condition, peer support is always the one thing that's always a good idea. Yeah, so something I've not really spoken about yet is that I didn't do this all by myself, right? So I've partnered with a charity called People, P-E-E-P-L-E, and the reason that I... Is that a bunch of other people that you've hidden? Yeah, exactly. We're not the stronger one here.
00:39:28
Speaker
cutting but true. But the reason that I chose to partner with people is their specific ethos is we do with parents not to parents and they start by helping parents recognise for themselves and with each other what they're already doing which is brilliant and just that point of recognising that makes you do more of the good stuff and it makes you feel better about yourself and that in turn makes you do more of the good stuff. So I really really like that ethos and
00:39:57
Speaker
Everything they do is about peer support. It's about learning together through discussion, through play, through having those casual conversations about, oh my God, it was a tough night last night. No one slept. The empathy and the kind of practical problem solving is always going to be better than, you know, a well-meaning so-called expert giving the, you know, the supposed right answer that actually doesn't work for the child in front of you. Exactly. And that well-meaning expert hasn't got the time to
00:40:26
Speaker
and get to know the family in a way that might give them special insight. I think it's incredibly powerful. Are you the well-meaning expert? Quite often, yeah. Well, I turn up and I'm like, well, I don't really have the answers. Can you just... Oh, you poor man.
00:40:40
Speaker
No, but I mean, I think that's a really good way of starting. You've got to start like that because otherwise you end up feeding this kind of dependence on expertise. And then you've only got a certain time slot where you can help them and after that it's really there. It's on to them.
00:41:00
Speaker
It's difficult. It's very, very difficult to kind of get people to feel like they can do their own problem solving and be confident in their solutions, which is why this sort of stuff is really powerful and, you know, really kind of really love it. I love the idea of it. Okay, I think we're probably exhausted. You're kind of kindness. But I just want to ask, you research toddlers trying to get smarties
00:41:30
Speaker
Have you actually got the most adorable experiments in history? Is there anything more adorable?
00:41:38
Speaker
that we can even think of. But I would like to point out that quite often toddlers, well her feet are smarty, enjoy it very much and then put it in my hand. It's a little bit less adorable. Quite a lot of things are cuter than toddlers. You're not a big toddler fan. Thank you. But if you look at a squirrel monkey, I feel like the proportions aren't really there. Toddler every time.
00:42:05
Speaker
And that also, I love my job. But they are exhausting. Exactly. Excellent. Excellent type of work. To be honest, I was in Oxford today and they're some of the cutest kids I've ever seen in my life that day. There you go. Anyway, all right. I think I would prefer squirrel monkeys.
00:42:22
Speaker
You're going to adopt a family of squirrel monkeys. Yeah. We were watching this documentary on Maslow who did the study on the squirrel monkeys. Oh no. She almost cried. You know, anyway. Bad, bad. Thanks very much.
00:42:40
Speaker
figure out if the monkey preferred food or creature comfort. And then they scared the monkey to see which one it would go to and it went to the comfortable one. And I've just when they brought that little
00:42:57
Speaker
creepy monster out to scare the monkey. I just absolutely couldn't deal with it. There's some really horrible stuff that people have done to monkeys. Yeah. Anyway. But not, not on this podcast. No, we have, anyway, Totalisms and Arties.
Conclusion and Listener Engagement
00:43:13
Speaker
Thank you so much for joining us. I told you before we recorded, sometimes we just start rambling because we're tired and that's the point at which we have to stop.
00:43:22
Speaker
I was really lovely chatting with you. Lovely to speak to you and maybe you can come back and speak to us again sometime and you're only local so who knows we'll make you run into each other. But we're not going to tell you where. No we're not going to tell you where. Okay maybe sing in the king's head some other time.
00:43:48
Speaker
Right, great. Chat with Alex. Chat with Alex. Repeating things that I say in a mocking tone is not a humorous test, Davey. I think it is. Actually humorous. Back to Davey. All right, fine. If you want to talk to us on the podcast, make some suggestions for the next season. I'm on, well, I'm sort of on Twitter. I'm slightly taking a rest. At Max Davey. You can give it a try.
00:44:17
Speaker
and at ADHD UK charity and then at the ADHD UK website there's a feedback form where we would like to hear what you have to say and what you want to think and talk about. Yes we would and what you want to think and talk about.
00:44:32
Speaker
Once again, my words are out of place. It's been a long day, Tess, it's been like that. And that's all right. Right, so please, please let us know. I hope you all have a lovely week and we will speak to you next week.