PROVIDENCE – Adele Diamond speaks in a rapid-fire, sing-song voice, often with an inflection, asking questions as a statement, colored by a heavy New York accent. It is not what one would necessarily expect from a world-renowned researcher and a founder of the school of Developmental Cognitive Neuroscience.

But Diamond is effective in making her points – with scientific clarity, wrapped in a common-sense, street-smart wisdom.

“By the way, I may be living in British Columbia now, but I’m a native New Yorker, and I talk at a New York pace; nobody can write as fast as I talk, so don’t try,” Diamond began, speaking at her presentation on Oct. 2 at the Providence Marriott, entitled: “What executive functions skills are, why they are important, and how to improve them in young children: insights to help every child thrive.”

Instead, she urged her audience to listen, promising that an electronic copy of her presentation would be made available to participants.

Diamond’s presentation was the centerpiece of a three-hour symposium, sponsored by Rhode Island Kids Count, The TRI [Teaching, Research Impact]-Lab at the Swearer Center at Brown University, and Ready To Learn Providence. More than 175 professionals in health care, day care, social work, education and policy gathered to hear Diamond.

Diamond was introduced by Stephen L. Buka, professor of Epidemiology and director of Population Health and Clinical Epidemiology at Brown University, Elizabeth Burke Bryant, the executive director of Rhode Island Kids Count, and by Kate Nussenbaum, a student at Brown University.

Following Diamond’s talk, she was joined on stage by Bethany Carpenter, the education director at Ready To Learn Providence, Jane Myers, an education consultant at Collaborative Education Services in Northampton, Mass., Dr. Ailis Clyne, medical director of the Division of Community, Family Health and Equity at the R.I. Department of Health, Michele Palermo, associate director of Early Childhood Education at the R.I. Department of Elementary and Secondary Education, and Dimo Amso, assistant professor in the department of Cognitive, Linguistic and Psychological Sciences at Brown University. Leanne Barrett of Rhode Island Kids Count served as moderator.

The interactive dialogue with the panel and the audience offered a chance for advocates and policy makers to share information about how strategies embracing promotion of executive functions could be better integrated into existing Rhode Island programs, with Diamond providing feedback and suggestions.

As the policy brief produced by the TRI-Lab at Swearer Center detailed, the formula for success in healthy early childhood development is promoting the growth and connectivity of a group of cognitive processes that enable a person to carry out goal-oriented actions central to everyday life – what are termed “executive functions” by Diamond.

These include: working memory – the ability to hold and manipulate pieces of information in your mind; inhibitory control – the ability to inhibit a particular behavioral response or mental process; and cognitive flexibility, the ability to switch rules or change perspectives.

Individuals often use all three executive functions simultaneously, making it difficult to decipher where one begins and another ends.

What research has clearly delineated is that the healthy development of executive functions is a critical factor to enable children to succeed in school and the workforce – and in relationships.

In mental health, in physical health, in school readiness, in school success, in job success, and in public safety, research has shown that executive functions were critical to future success.

Similarly, research also showed that executive functions are impaired by many mental disorders, including addictions, attention deficit hyperactivity, depression, obsessive-compulsive disorders and schizophrenia.

In addition, research has shown that executive functions predict both math and reading competence throughout the school years.

Gathering of the researchers, advocates
Earlier that morning, Buka had convened a meeting of researchers and advocates at the Metcalf Research Center at Brown University for a more informal dialogue with Diamond.

In an off-the-cuff talk, Diamond said that it was important to bring in relationships, front and center, and the importance of attachments, particularly in dealing with early trauma and stress.

“The word attachment hadn’t been coined when Erik Erikson talked about basic trust,” she said. “But whether you talk about attachment or you talk about basic trust, it’s the cornerstone for everything that comes after.”

She continued: “All parents start out wanting to be good parents. There’s not parent who starts out wanting to fail. Every parent starts out – and we have an enormous opportunity at the beginning – everyone is motivated. I think we need to partner with obstetricians and pediatricians more, and work with mothers when they’re pregnant and work with families when they first give birth.”

Diamond lamented the lack of training for parents, saying: “You don’t get training in being a parent; you get training in all these things like, how do you use a cell phone, but you don’t get training in how to be a parent.”

Diamond praised the work of researchers who showed that parents with infants born prematurely needed to better understand that what would be normal stimulation for a full-term birth was over-stimulation for a premie. “So it’s not that a premie is not reacting to you, but rather it’s not reacting to you in the time frame that your expect,” she explained. “You’ve got to go a little more slowly, then once you get the dance going, the dance will go on its own.”

She also praised the development of an animal mobile for a young infant that was fastened to her foot, allowing her control the stimulation and interaction and motion with the mobile. “I wonder if that might help babies to appreciate that they can make sense out of their chaotic world,” she said. 

Diamond also stressed the importance of bringing parents into the equation as equals in the conversation. “We have to bring the parents into the conversation,” she said. “And when we bring the parents in, we have to remember, the learning goes both ways. They may be poor, but it doesn’t mean that they’re dumb. They may have a lot of wisdom that we can learn from. And we have to treat people with respect, instead of thinking that we’re the experts and you’re the dummies.”

One-on-one with Diamond
After the symposium concluded, Diamond spoke briefly with ConvergenceRI one-on-one, talking about the potential Rhode Island has as a community to bring its early childhood education resources into a more collaborative initiative.

ConvergenceRI: How do we become an engaged community around these issues?
DIAMOND: I think all of Rhode Island is a community. The family is a community; the school is a community. It is all community. All of us can play a role. I mentioned how the retired person can go into school and play a role. An experience mom can help mentor a first-time mom.

There are opportunities everywhere. If there’s something you’re really good at, something you have a passion for, maybe share it with some kids. Kids are going to enjoy it, no matter how esoteric your interests are.

ConvergenceRI: We now live in a digital world, so everything is shared on line. How do we redefine community in the digital world?
DIAMOND: That’s a great question. I don’t have a great answer. You know, I think that kids are spending too much time with technology, and not enough time with human interaction. So, that’s a very good question.

I’m sure there are ways to build in community more online, and to train executive functions more online. But I’m really worried about the loss of time outside, the loss of time with other kids and the loss of unscripted social time.

ConvergenceRI: The hazards of lead poisoning dramatically affect the educational capability of those afflicted with elevated levels of lead. How do you connect the focus on executive functions with the problems of unhealthy homes that may be causing the deficits?
DIAMOND: If you can convince the health insurance companies that it does have relevance, because these kids are going to grow up and cost them more, if they don’t do something about it when they are kids.

I think there’s an opening. What we need is for people to be willing to take more of the long view, because the kids aren’t voters yet. The politicians are so used to taking the short term view it’s hard to get them to take the long-term view

ConvergenceRI: Is there an economic equation to help in convincing the politicians – and the health insurance companies?
DIAMOND: Jim Heckman has [an economic equation], not for lead poisoning, [but for early childhood intervention]. He’s shown that if you get in there early, the payoff is exponentially larger than if you go in later.

ConvergenceRI: James Heckman, the University of Chicago economics professor?
DIAMOND: Yes, Jim Heckman, the Nobel laureate. He has a graph – and it’s based on scientific data – on the return on investment. The return on early investment is something like 15-18 percent – you never get that later.

ConvergenceRI: Does there need to be more of a focus on the first two years of life?
DIAMOND: Yes, it’s about prevention. You don’t want those problems to develop later in life. For example, the health insurance companies are beginning to realize the importance of prevention, in maintaining healthy people, as opposed to trying to heal unhealthy people.

And that’s the perspective that we’ve got to get. We got to get that the value is in prevention. And prevention is never as sexy as going in and dramatically rescuing the people in the problem, right?

ConvergenceRI: So, the Equalizer is not going to solve our problems?
DIAMOND [laughing]: Right. It’s not sexy if it doesn’t get you on the front page of the paper.

If you prevent the fire, nobody knows. If you go in and dramatically put out the fire, you’re on the front page.

So, we need to develop an appreciation for how much more it costs to have the problem [rather than preventing it], right?

My mother used to glue plates together after they broke. And she did a terrific job. But the plate never, never looked as good as it did before the plate was broken. And, it wasn’t as strong after it was broken.

So, even if we are successful in putting the plate back together, it’s never going to be as good as if the plate hadn’t been broken in the first place.

ConvergenceRI: Do you think that Rhode Island has an opportunity to develop a new kind of collaborative approach to early childhood education, bringing together researchers and policymakers and practitioners and advocates – the people who were here today?
DIAMOND: I think there’s growing momentum nationally to do the kinds of things that Rhode Island is doing. I see it in Washington state, I see it in Oregon, even Massachusetts.

So I think there are more and more states that are seeing the wisdom to get away from the silos and getting in there early and [fostering] the connections between health and education. They’re all connected.

ConvergenceRI: How do we involve the parents more?
DIAMOND: First of all, I think we should get in there early, with the pediatrician and the obstetrician. Everybody starts out wanting to be a good parent. No one starts out wanting to fail.

That’s a huge opportunity to get in there and help them because we don’t come with training manuals. Parents want to be good but they don’t know what to do; they look for guidance, for the doctors that can help.