This is the unfiltered continuation of Episode 10, a real clinical conversation, twists and all, about how executive functions actually come together. The thread that ties it up is almost startling: the same in-and-out saccadic eye movement we use to find a face is the foundational pattern that builds the attention networks, which is exactly what was happening when that little boy kept finding Cory across the swing.
A heads-up Cory gives at the top: this is the genuine, slightly twisty continuation of last episode, the kind of real clinical wrestling they almost left out. We start by separating two things that often get lumped together, executive functions and effortful control. Effortful control is the more emotional, motivational engine, the why am I doing this, while executive functions do the organising, holding the goal, planning, shifting, responding to change. They are tandem networks, and disentangling them matters for clinical reasoning.
From there we get practical about complexity, which is really just multiple skills having to fire at once: driving a car, eating at the table, playing soccer. We look at automatic versus volitional motor control, and the clinician’s key question when a child repeats and repeats, are they stuck on the complexity, or are they actually mastering automaticity and we should let them? Tracy ties it together through the saccadic eye movement, the in-to-midline and out-to-the-world pattern that lays the foundation for the attention networks, which is exactly the rhythm Cory was building with the swing in Episode 10. We finish on scaffolding stretch points, why kids perseverate (safety, regulation, language load), and how state and allostatic load change what any of us can take on day to day.
Lightly edited for readability. Speaker labels and chapter markers match the published episode.
Cory: Hello, wonderful listeners. This episode is an extension of Episode 10, and in the first segment you can hear Michelle and me grappling with the concepts of praxis, automatic motor functions, complex processing, and how all of that relates to executive functions. We honestly were not sure we were going to include all the parts from today’s episode, purely because we were not convinced it would be easy for anybody else to follow along, as Michelle and I work to embed the concept of executive functions into what we already know. But we set out to record real clinical conversations, and this is often what they are like. So, keeping it authentic, you are getting our real conversation, with all the twists and turns, as we learn. Here is to the process of engaging in deep learning, and hopefully you find some hidden gems along the way. Hello, we are back. Hey Michelle, hey Tracy, how are you guys going?
Michelle: Cory, I am awesome. I am really glad to be investigating more of the executive function and complex processing. What about you, Tracy?
Tracy: I am so glad to be back with you guys, and really excited to talk about the next layer of understanding. Executive functioning is complicated, but almost every child we end up working with, at the end of the day, we have to tap into it, because it is such an instrumental set of skills for everyday life, from all the planning and problem-solving we have to do, to being able to stay regulated as we move through it and keep the coordination of all the systems, that grand orchestration that happens. So executive functions end up being really involved in most of our goals, and they can be affected by almost all of the sensory-motor disruptions we commonly see. So it is a really important topic for us to spend some time on.
Cory: It was so helpful last time, and I am excited to get a bit further down the line this time, once the capacity has built a little more. What might we see, even in the everyday average person, of how executive functions play out? Tracy, you have talked in my presence before about complex processing, and how, if that is not as robust a skill, processing the world in a more complex way can really have an impact on our ability to use our executive functions and effortful control. I wanted to clarify one thing: when I say executive function, is effortful control a separate element to that, or is it under the umbrella of executive function? How do you classify those two things?
Tracy: That is a question that, depending on who you read, is still up for debate. The way I tend to think about it now is as tandem functions, and that is really related to the neural networks involved and the resources each draws from. Effortful control functions tend to be a bit more emotional in nature. They draw a lot from the social-emotional circuitry in a really specific way, because of that motivational system and how it juices you up and connects you to, why am I doing this, what is my purpose? Executive functions draw from those effortful control functions to help organise you, to help you hold onto your goal set, plan, organise, shift, and respond to changing conditions, and be really fluid in it. So when we self-regulate and have self-control and move into being the self we want to be in the world, those self skills are supported by both executive functions and effortful control. They are tandem, collaborative skills that draw across a lot of different networks. Sometimes people just use the term executive function to refer to all of it, but as the science unfolds, there is an important set of different networks involved in each component. I think it is important to disentangle them, mostly because in your clinical reasoning it matters where you are holding your intention and goal. So in the Spirit tool we put in the information drawn from the research that tells us the core things to think about to guide really efficacious intervention.
Michelle: As you are saying that, Tracy, it makes me think I can have effortful control to focus on something I am already really interested in, and it is only when I add additional executive function resources that I might take it to the next level of mastery and develop it further. Otherwise I am sustaining attention, perhaps in a repetitive way, but not expanding it.
Tracy: That is exactly right, and that is because these complicated skills are vulnerable to getting sticky, which is the easiest way to describe it. If you are really working on something and start to be taxed by the complexity of what is required, then either the thing that is hardest for you or the thing you are best at, in either direction, is going to catch you. If you are super good at something, you get stuck on the thing you are super good at and it is hard to shift off it. Or if something is super hard, you keep tripping over it and tripping over it. So we see that repetitive error, or being stuck, for either reason, but it is really because we do not quite have the resources to navigate the complexity we are faced with. Executive functions and effortful control are made up of all these sub-skills, and each sub-skill in itself is more circumscribed, sometimes described in the literature as simpler. Combined together, you end up with complexity. So complexity is really just when you have multiple skills that have to be deployed simultaneously, and you have to navigate that.
Tracy: What is interesting is that life is complicated. The task of driving your car down the street is really complicated, because you have to have the motor control and sensory awareness to keep all the pieces in mind, but you also have to remember the rules of the road, the rules of society, think about other people and safety, think about where you are going, and maybe think, oh, I am late, or I am early, or I have to park, or I forgot something. So a skill that, once we have mastered it, like driving, feels fairly simple, is actually very complicated in what you are doing and how you are managing it. Car accidents tend to happen when a person doing a fairly simple task for them gets cluttered, maybe multitasking too much, or a condition surprisingly changes and something unexpected happens that they have to respond to. So something that feels straightforward is never quite that straightforward, and our daily life as human beings is this dance of complex and simple, meandering and moving us through being effective at accomplishing what we want to accomplish, and doing it in a way where we feel we could meet the challenge, or even feel proud of it. Even still, if I park my car in a really tricky spot, I feel really proud of myself at the end of that moment.
Cory: Yes, like if you do a really tricky reverse parallel park.
Tracy: Totally, so even something we have mastery over can still bring a sense of, I did that.
Cory: That is a good example of complex processing, because sometimes I think, what does that actually mean? Driving a car for an adult is complex processing. Something like a kiddo playing a game of soccer, we say soccer in Australia, you say soccer in America, but everybody else says football, so we have adopted that one, Australia takes bits from everywhere, is a fairly complicated thing too. Knowing the spatial bounds of the field, where is out, where can I go, am I onside or offside, where are my teammates versus my opponents, how far or close am I to the ball, where am I planning to go with it. And like in the car, you have to coordinate and sequence your legs and arms, so similarly in soccer I need motor skill, but I also need spatial processing. I am trying to think of where, if the load got too big, it breaks down, because it seems to go from being complex processing to being more automatic if you practise it enough. Is that the idea?
Michelle: And there is also the quality of it. My example of complex processing is eating at the dinner table with a family. Eating is super complex, and it is that quality. You can have a kiddo who vaguely knows the direction they are going on the soccer field, but cannot balance on one foot and keep their eye on the ball and grade the force of the kick to get the right angle. So it comes down to the quality. A lot of people, adults included, me included, can get away with the basics, but the quality drops, and then if the load gets even harder, a rainy day, that is where you see it.
Cory: Or the soccer example: I can orient my eyes to the ball, shift my weight, hold my balance, and kick to my teammate when I am in practice and it is a straight line directly opposite me. Then you put me on a field with multiple other players and distractions and peer pressure, and suddenly I cannot do that skill anymore.
Michelle: You cannot hold it all together at once.
Cory: I have the skill in a less complex environment, I can do it where it is less complex. But does the motor skill itself also shift in complexity, Tracy?
Tracy: It is drawing from the automatic motor skills we have. We can stand upright against gravity, shift our weight and move through space. But now add the complexity of moving through space while kicking a ball, while moving around other people, toward a target. So something automatic can become really complex fairly quickly. We have automatic processing and more volitional, planful processing, and those different kinds of motor processing operate simultaneously. When you are playing footy and trying to score the goal, and somebody comes in front of you and you have to adjust your speed and timing online, if you do not have great automatic motor control you will have a much harder time finessing that. People who are super athletic are really good at coordinating the automatic and the planful, and shifting between them in a nanosecond. People who are a little less finessed and less practised, you can almost see it break down, where the automatic switch into planning and back has a groping quality, I cannot quite stop the automatic thing from happening to do the more careful thing I want to do.
Michelle: Does it all happen from, do you have to get that automatic processing first? I am thinking about kiddos who have the problem-solving, which is part of executive functioning, to fake to the right but kick the ball to the left, which is a more executive capacity. Do I have to have all the basics of the sensory-motor system automated to do those things? And like executive functioning skills, can I shift attention laterally, come up with another idea, fairly quickly? Does executive function happen automatically as well, so it flows as fluidly as the body shifts? Does it give me another idea and motor plan so I can do that in the moment?
Tracy: What you are drawing from, Michelle, is how executive functions in this way are really part of our praxis network. They are part of our ability to become super skilful at using what is available to us, the affordances from our own body together with what is out there to do, syncing those things up in a way that makes us really efficient and fluid. So that is the broader umbrella of a praxis function, but it draws from the executive functioning network and from the effortful control network as well. So when we think about more motor-based examples, driving a car, eating at the table, playing soccer, we are drawing from the praxis function too. Any human occupation we perform in daily life, playing a game, getting dressed, driving, getting on the bus, all of it, these are complex skills that become automated on many levels, but we have the ability to fine-tune them and get better and better. So we are always drawing from each of the resources that make it complex, sometimes the cognitive network, sometimes the social functions, sometimes language-based or spatial functions, or basic motor or sensory functions. Anytime we do a complex skill, all those resources are available to enrich and inform it. Executive functions are partly what is orchestrating that and keeping us on track: what I am trying to do here is play footy, and sometimes I am on offence and sometimes defence, sometimes going for the ball, sometimes helping my teammate go for it. That kind of shifting that happens really quickly within a game is really hard for the kids who come to us, because they cannot often navigate all that shifting and complexity simultaneously. So you will see them have one, two or three domains that are stronger and one or several that are weaker, and it breaks down. And it is not just a matter of practice, you can try to practise, but you cannot reinvent every complex situation.
Michelle: That is where splinter-skill training comes in. We could get you to be an amazing striker, versus working at the underlying function skills that are not yet firing up.
Cory: In the example I gave, that child has mastered kicking the ball to their teammate in that simple situation, but as soon as you add all the elements of complexity in a game, pieces break down. With the automatic control you mentioned, say I have automated just dribbling a ball, keeping it in front of me. Now you add a defender, and I have to use my executive functions to stop and inhibit the automatic thing I am doing, then plan a different choice given what is in front of me. So that is the praxis element, this is what is in my environment, I have this automatic skill but I have to adapt it and use something else in my repertoire to adjust to the complexity. And you will see the breakdown, the kids we work with sometimes just keep dribbling straight into the defender and the defender takes it, you do not see the adjusting in the moment. Or you are catching the bus and suddenly do not have your tap card, and you have to plan around how to get a ticket, what is in my environment, do I ask the bus driver. Often I see it in session as just the repeating of the same skill, but not adapted to an environment that has asked for something different. They offer out the same thing.
Tracy: For clinicians, one of the things you want to do is ask that question. If you see somebody stuck and repeating, are they repeating because they are trying to master the automatic? If that is true, we want them to master it, we in a way want them to be stuck. If they are into catching and have not mastered it yet and are stuck on it, that is not necessarily something we want to shift. We want to help them stay flexible with it, not have it done in a super rigid, exact repeat way, but the automatic function could be what they are actually working on mastery over. And you often have to have mastery of automaticity in order to finesse higher-level problem-solving and responsiveness to conditions. In the dynamic system we are dealing with, they are simultaneous, but in the clinic you want to ask yourself: is this child stuck because the complexity is making it hard, so what can I do to manage that? Or are they stuck because they are really working on automaticity and not even paying attention to the complexity, because they are dialled in at a different level?
Cory: That really made me think of a recent situation. A child came up with the idea for me to throw these little light balls at them, and they would stand across the room and hit them back. The game was, you throw the balls and try to get them past me, and I will just hit them back. Straight away I wanted to make the game more complex. But stopping to think about it now, I realise, you are not very good at throwing and catching, and you are probably just trying to master, an object is coming towards me, how do I time my hand and align it with the object? I tried to curiously wonder what else we could do, and it just was not flying, it was, no, just throw the ball. So I let go of my, what are we doing here, and said, okay, there is something in this you want to do, and maybe it will get more complicated, or you will move on when you are ready. Talking about it now, Tracy, you reminded me, wait a second, he was working on the automatic function of just knowing how to handle objects coming towards him, and I was not meeting him there, I was ready for a more complex game. And this kid totally struggles with executive functions. A really good reminder that you do not always have to be at the complex level, sometimes you go back and refine the automatic.
Michelle: My tendency is to want to wrap it into a game that transports to the playground, so they are connected a bit more socially. But that kind of would not fly in a school playground for very long without swapping turns or a personal best. So that is my urge, oh, then we could. And it is, whoa, whoa, there is no game, Michelle, we are not in the playground, we do not have to help this kiddo have a play schema that becomes transportable yet. That is my stop-and-think: this is just part of this, it is not a social piece right now, this is just sensory-motor automaticity.
Cory: Like learning a skill. So how would I, I am thinking for that situation or others where they are learning a skill, is it more in the curiosity, and they start to open up? I am thinking about the shift from automatic to more complexity. Like we talked about way back in our praxis episode, if I offer out the curiosity of, oh, I wonder how else we could play that, and they go with me, is that an indication they feel a little more mastery over the automatic function? Or how would I know it is starting to shift?
Tracy: As you have more command over the automatic pattern, hitting the ball, catching, kicking, dribbling, then your own drive, that motivational bias system, is going to ask, what else is there, what next? When we have mastery, we want to use the mastery for a purpose. Automaticity serves purposeful action, it underlies it. So when something is, I have got it, I have got it now I want to use it. For our kids who get stuck in loops and patterns, it is really noticing a couple of things. One, when somebody is acquiring a skill, it does not look as fluid and easy, and we are really good at observing quality of movement, the grading, timing, positioning, alignment, and holding the eyes, head, neck and posture in alignment to the thing they are trying to do. So when kids struggle with automaticity, you almost always see something that does not look quite refined, and that unrefined quality tells you either where difficulties lie or just that they do not have it pulled together yet. That is when you want to hold off on adding complexity. But a caveat: in the dynamic system, sometimes the higher-level thing is what syncs it up. I remember a little boy who really wanted to learn baseball. His dad had been working with him hitting the ball off a static stand, we call that T-ball here, and it held him in a rigid posture, trying so hard to hit it off the thing that everything felt stuck and harder than it needed to be. When I hung a ball from a string so it was more dynamic and moving in space, he could hit it, and it freed him up. He had been holding the bat so tight he could not find his midline. It was too static and oversimplified, and he needed it to be more contextual. So automatic motor skills play a really pivotal role in executive and effortful control skills. In their development, the whole prefrontal system comes together because of sensory-motor signals, and a lot of it is around eyes into midline, out, tracking, back to midline, out, tracking. That synergy organises our ability to take in the world to our midline and put our limbs out into space. This coming in and going out is a saccadic eye movement that is really clearly documented to be the foundational pattern that sets up the attentional networks. When we work with kids, we see this coming in and going out, and it reminds me so much of the kiddo you were treating last episode, Cory, where that rhythmic movement and sharing space was such a cornerstone for helping him get into the executive system. It is a total mirror to how it unfolds. So we are talking about sensory functions, motor functions, executive functions and daily occupations all at once, which is why we need a tool like the Spirit, so we can track our thoughts and figure out what to do.
Michelle: And it helps us choose which one to lean into. Thinking of the kiddo we spoke about last episode, we have taken sensory-motor away for a little bit at the moment to firm up the executive functioning, the intentional working memory systems, going with the motivational system. And then we will have to layer it back in, because when he is walking around freely he does not hold it yet.
Cory: I guess we have not necessarily taken sensory-motor away. What you mean is, when you are not working on building that as a skill, you are not directly building sensory-motor functions, you are using what he presents in his current capacity to inform what you give him to support the sensory-motor skills. So containment, being on the swing, linear input, all of that anchors him. The sensory-motor piece is there, but I am not challenging it, I am supporting it, and using the motivational bias of wanting to be with, and the rhythm, to build the stop-my-thought-about-the-window, come back to Cory intentionally.
Michelle: Yes. You were working in midline, that approach and back, but we are not going bilateral yet.
Cory: And Tracy’s whole thing about coming in and going out, that saccadic eye movement, because nowhere in my session am I getting out pen lights or ocular things for him to track. But he is coming into his midline and orienting to me, getting eyes on me, then his eyes move away, and then he inhibits that eye movement and comes back to me, which is literally the definition of a saccadic eye movement, isn’t it, Tracy?
Michelle: It certainly is, and as you come and go, he is converging and diverging, staying on.
Cory: That is really cool, because I did not even think about that in the last discussion. It is refining your ability to actually observe what is going on in this moment with this child, and how it relates to the neurology of why I am building this capacity.
Tracy: That is exactly right, and it is the adaptive response. What we are talking about, and this is my passion, is helping clinicians find the threads of, here is where this child is, here is the adaptive function I really want to strengthen, and how do I connect the dots between those things, in the activities and experiences we share in treatment and daily life. It is not just practising a splinter skill, it is understanding the whole network and how to bring it into the next level of capacity.
Cory: So for the example of directing my eyes, I know early on that is usually driven by a social interaction, I want to find your face. I am thinking about next steps. For my kiddo, he is starting to do this. As that neural capacity develops and the pathways get more robust, would the next step be to think about that same activity but wonder, what happens if I am a little further away, or tweak the activity to see if he can hold the capacity at a greater adaptive challenge?
Michelle: So that is scaffolding, taking it to the next level. And which bit do you scaffold? I am wondering about your affect. If I tone my affect down and do not join in singing the nursery rhyme, do his eyes, his ocular-motor system, stay on, does his attention stay on when you turn affect down?
Cory: I am laughing because I did this yesterday, and he said, you are not singing.
Michelle: There you go, so that is not the one to pull back yet.
Cory: So I said, oh okay, let’s sing. Which is really cool, because he told me, come on, you are not singing, so I did not lose him. Maybe the next step is going further away, or is it the swing itself, do I offer slightly less postural stability, can you still organise your whole system to find me in space?
Michelle: Or move him close to the window so the lure of the distractions is bigger. Can we go wrong with which bit we choose to challenge?
Tracy: I do not think you can really go wrong, as long as you are observing the adaptation and following it, and staying in the line of what you are really trying to help him build toward. We are working on his eyes to you and away from you, to you and away, because that is hard for him. If a child has that capacity inherent to them, they just have it and use it, it is pretty robust, and they build from it. The kiddos we see for therapy, some of these automatic capacities that underlie higher-level skills like executive functions, we all have the potential to develop them but we are not born with them, whereas we will all learn to move with anti-gravity control unless there is a sensory or motor reason it is hard. So we will have the ability to move our eyes, but if we do not, that is so foundational that it undermines the next level of complexity. In your clinical reasoning, you are looking for what foundations they have in place, and then the stretch points. Sometimes I teach this through the spiraling continuum from Gilfoyle, Grady and Moore, which we have talked about many times. I really try to think about what is in that landing pad, their zone of proximal development, and where their reference point is. Is his reference point you being eight inches away and fully engaged in order for him to have saccadic eye function serving social connection and executive function? The next stretch point: if it is primarily ocular and postural-motor, that is your stretch point. If it is primarily attention, that is your stretch point. If it is primarily planning and space, that is your stretch point. So it is through clinical reasoning that you figure it out.
Cory: Let me give an example of each. If it is mostly postural-ocular that is not pulling together, then I would stretch him further in that skill within the task. For example, maybe the swing is not the bolster swing, because I want to stretch his postural system, so I shift to a platform swing that does not have the hip support, and see if I can still keep him connected with the saccadic eye movement back to me rather than flitting off. Whereas if it is spatial, do I shift myself into different spatial orientations as we play, and can you still saccadically find me, which also relates posturally, how do you rotate to find me if I am not directly in front. And if it is social, then how do I playfully obstruct or change things, and can you still stay in it. Is that what you mean, Tracy?
Tracy: That is exactly right.
Michelle: I am going to put this on its head, because I have some kiddos who love to sit in the executive function domain they know, presidents of the United States, their heights, dates of birth and death, the order they served. In sessions that is where they want to live, repeating it. It does not feel like it is for mastery, and they are not really going to the automatic, or letting me come in from a social or sensory-motor perspective, I cannot turn it into something else. They are living in executive function, Trace. Some of the kiddos go there, and maybe I do too, to regulate. I wonder if it is a coming back to a safe place. Have I given you enough to help me understand why people live in executive function?
Cory: You just made me think, if I purely focused on the repeating, I would say, oh, they are not shifting, which is one of the executive functions, so they are stuck on this one thing over and over. And if I just thought, how do I shift them away from this, I could miss what Michelle picked up on, which is why. Why are they not shifting, and what is it about this that supports them? You have smartly gone, maybe it is regulating them. So how does sticking to the one thing help us connect executive functions to regulation?
Tracy: It is a new-age question and an age-old question simultaneously, and depending on your discipline and perspective, you might answer it really differently. What I love about how we holistically understand kids is that we do not get too bought into any one perspective, and really try to answer the why. The why is the cornerstone of clinical reasoning, and if we understand the why, we will pretty logically know what to do. For one kiddo with mastery over a topic, sometimes it is, this is something I come back to that gives me a sense of agency, mastery, competence and certainty, and from a place of certainty there is a safeness that establishes my regulation. I know the landscape, because we are talking about something I can talk about, and I do not need to worry about the things I do not know. So for many individuals, getting stuck in a loop is a safety loop. If we acknowledge it is creating a safety loop and address it from a regulation standpoint, let me be with you here, be curious and interested, then when you are feeling regulated and safe, the openness to shifting will probably reveal itself. For another kiddo it could be a different regulatory capacity, painting the landscape for themselves. For another, when they are trying to deal with complexity, it is a regulation issue too, but they are giving you what they know to remove some level of complexity. Sometimes individuals who get stuck in loops, once they get organised enough, can tell you, I really did not want to keep talking about the presidents, it was just the only thing I could pull up. So sometimes it is not, talk to me about the thing I am interested in, it is, help me talk with you, help me be with you. On a regulation standpoint that is what we are always going for, you and me together in a we space, as Dr Siegel would say, where we can co-create the world together. But some kids get stuck in a topic more from an attention and language standpoint, where that bank of information is so big and the other one they are trying to draw from is smaller, and it feels like, I just cannot find my way over to that other content I have. So very often it is more of a language-processing issue, and we need to help smooth that. It comes down to all these multi-component aspects of higher-level skills like attention shifting, and we have to drill down to the why if we can get there.
Cory: That made me think of kids who, when you ask for a specific assessment task, will just give you what they know. They will say, no, I am not going to fold the puppy, it is a colouring task, where whatever you are asking is too hard, so they just show you what they know. People say, they do not listen, they do not follow instructions, when instead they go, that is so hard for me, I am just going to show you what I can do, because I can do this but I cannot do that. So, why might that be happening?
Michelle: And it is kind of adaptive, you are moving towards something familiar rather than a real moving away. For some people they are harder to understand. So, delightfully, I am going to make the puppy pink instead of cutting the puppy out.
Cory: We all want to show what we can do rather than be failing at something, no one enjoys that experience. I had not really thought about the kids where the language processing is not quite there yet, I can give you what I have in my language here but cannot quite get over there. How would you smooth that out, is that more where we would need a speechie to come in and help, Trace?
Tracy: Definitely. Sometimes it is trying to understand how language development supports all of this, and it is a whole other topic. The Spirit does not have language on it in a particular way, not that we exclude it, it is just developed as an OT tool, and at some point maybe we will add language processing to it, but for now we really need a speech and language therapist to help, because it is a whole level of complexity.
Michelle: What is popping up for me is state dependency. There are different days when I can take different things on, or different levels of complexity, and regulate myself and cheer myself on, you can do this, Michelle, and I front up and draw on all my resources. Other times it is, man, it has been a tough week, the kids fought in the car on the way home, it is raining, there is no food in the house, do not talk to me about tax tonight. I say that playfully about myself, but it is like that for kiddos. They come to us sometimes straight after schoolwork, the weather has been all over the shop, there is flooding happening, lots going on for families, it is harvest time, so there might be stress about rain affecting crops and getting flooded out, am I safe or not safe, get to school, heavy rain so no recess. And I give them the challenge they successfully did last week and it is like, you are out of your mind, Michelle. So, very state-dependent capacity.
Tracy: That is right. Sometimes repetition and perseveration are cornerstones, a window into understanding that a person is not in the most adaptive place, whether for something internal or external is a good question. It could just be, life is hard right now, so I am going to be a little stuck, or a little less able to make shifts or take on new complexity. Being sensitive to that matters, and we have all had to become more attuned to those external factors during this pandemic, where the level of stress and the allostatic load of what we are all holding is a real factor. We could talk about this repetition through so many lenses. It also brings up, in a tangential way, that I often work with individuals and groups around a condition called Fragile X syndrome, and one feature is that people get highly perseverative in their words, thoughts and actions. So at some point I think we will do an episode on Fragile X syndrome and look at perseveration from that perspective too, because some children we work with have perseveration without Fragile X, but lessons from Fragile X can help us understand it. That is partly how I have come to understand it.
Michelle: That would be really useful, looking at it from a more biological function rather than as a quality they are using to adapt, cope and survive. Awesome.
Cory: What another fantastic discussion. Thanks guys, I love the journeys we go on. We will see everybody next time, whenever that is.
Tracy: Thanks, Spirited Conversations, you guys.
And that’s a wrap on today’s episode of Spirited Conversations. We hope this sparks something for you, whether it’s a new clinical idea, a fresh perspective, or just the reminder that you are definitely not alone in this work. If this conversation resonated, we would love for you to share it with anyone on their own learning journey. You can find information about the podcast on our website, and you can join us in the courses and communities the Developmental FX team have put together at developmentalfx.org. And if you’re enjoying listening, please subscribe or leave a review, it genuinely helps more people find us. Until next time, keep the conversations spirited!