Brandon Gimbel (00:00)

Unlike many clinicians, including myself, who tend to consider EF coaching to be synonymous with ADHD coaching, you're saying, slow down. There's actually a lot of nuance here. There's 12 different, what did you call them?

Maggie Schwalbach (00:16)

EF skills. The skills. Yes.

Brandon Gimbel (00:18)

Thank you. There's 12 different skills that we're looking at and evaluating to figure out how to specifically help each individual person.

Maggie Schwalbach (00:27)

Can I let you in on a little secret actually? Oftentimes, the first skill that we're building is not sustained attention. It's not focus. Very rarely am I starting with focus. I'm not. I'm looking at, as we were describing, what are the 12 different executive functions? I'm looking at other things like organization. Let's look at organization. Let's look at time management. If you're rushing through things where your sense of time is very nebulous, that that still seems very conceptual, it's not concrete, well then, of course, it's gonna be hard for you to get started on something and pay attention to something. Inhibitory control, there's another one. If it's hard for you to focus, is it hard for you to focus or are things dinging around you that are distracting you? We know that they go together.cPeople will come saying I need, or my child needs, or my loved one needs to get better at this skill. And I'll say, look at what environmental modifications we can make and let's look at what skills we can make robust so that the focus takes care of itself."

Brandon Gimbel (01:23)

It's interesting. In an analogous way, I think we psychiatrists have a similar experience. We will get a question from a patient: "I think I have ADHD. Can you evaluate? Can you help me?" What becomes apparent during the evaluation is this person is also extraordinarily anxious and anxiety, in my descriptions to people and my own experience with it, is draining. It is emotionally draining, psychologically draining, physically draining. And anybody who's drained by anxiety knows their executive functioning is not tip top.

Maggie Schwalbach (02:04)

I'm so glad you brought that up because I'll say What's the number one interrupter of executive function? The number one interrupter is mental health. So exactly what you're saying: depression, anxiety, overwhelm, stress. We're not accessing the prefrontal cortex.