Producer: And welcome back to Full PreFrontal where we are exposing the mysteries of executive functions. I am here with our host Sucheta Kamath.
Good morning, Sucheta, today, we’re going to talk about sports heroes and Seinfeld, and we’re going to talk about Spare a Square which is one of my favorite memories of Seinfeld, but we’re also going to talk about tantrums by sports stars. So please explain.
Sucheta Kamath: Sure, good morning to you, Todd. I’m so excited to launch today’s episode. I believe the talent for every day problem solving is kind of underrated, and it certainly is overshadowed by the stories of courageous rescues or glamorous situations, and out of this world moments of glorious problem solving, but we’re really leaving those simple situation kind of, you know, we are not paying attention to them, but we all face challenges on a daily basis where we need to adapt and shift our thinking and processes to get to a desirable solution or to even avoid unfavorable or unforeseen consequences. Take the example of Spare a Square. In a humorous way, the show Seinfeld captures a classic dilemma that Elaine faces when she gets into the stall in a public bathroom and notices that the toilet paper has run out, and how does she solve that problem? And that’s the whole episode, isn’t it? So failing to face roadblocks graciously when the smooth sailing is interrupted can have a significant impact on the social, emotional, as well as the future welfare of every individual. So take another example of John McEnroe as a tennis superstar. He had to do tennis-related every day problem solving, for example, when he showed up for a tournament. He had to stay focused when tired – that’s a type of problem solving, he had to deal with a bad call, he had to keep his emotions under control or under wrap after missing the strong serve, or ignore the crowd as the spectators booed him or even favored his opponent, but not young McEnroe. At 25, he was failing to do all that which gave him a title of ‘Bad Boy of Tennis.’ Adrian Dater in the Denver Post writes that McEnroe used to make people feel nervously awkward when he played. They were never sure when the next profane blistering tirade at an umpire might come. It partially overshadowed his brilliant, as brilliant career as a player, and a seven-time Grand Slam champion – that was all overshadowed. So now, at 53, I think, McEnroe was interviewed again and he said, “I definitely don’t take myself seriously as I used to.” So this is what a mature prefrontal system looks like and it lets us hang back and take a perspective, and calm ourselves down while solving everyday problems.
Today, my guest is going to talk about the skill and talent that lets us navigate daily spectacle that we call life and help us negotiate with every day bumps and obstacles that make living a challenge but fun. His name is Dr. Sam Goldstein. I have had the privilege to meet with him and hear him speak on several occasions. He’s phenomenal, people are going to love his talk. He is an adjunct assistant professor at the University of Utah School of Medicine. He’s a clinical director of neurology learning and behavior Center. Dr. Goldstein has authored 50 books as well as over three dozen book chapters, and 30 research articles. He has also co-authored six psychological tests which is incredible. He currently serves as editor-in-chief of the Journal of Attention Disorder and sits on the editorial boards of six peer review journals.
Currently, he has three books and four psychological tests in development. I’m sure they’re going to come out pretty soon. Dr. Goldstein has served as executive producer for a number of film and training video projects, including the award-winning documentary Tough Times: Resilient Kids. He speaks nationally and internationally on topics such as resilience, child development, autism, neuropsychological disorders, and attention deficit and hyperactivity disorder.
Producer: Yeah, no, it promises to be a great conversation, Sucheta. This one’s going to speak to me because I’ve always felt that I don’t handle situations very well, like what Elaine faced when there was no toilet paper. I would put me in a panic mode, and then I don’t know if you noticed but I did play competitive tennis and I played that in the era of Johnny McEnroe, so he was sadly – he was an inspiration to me and I used that tactical advantage of attitude to try to distract my opponents, so I don’t know if that was sort of the smartest move I made but it was definitely part of my game. So this promises to be quite fascinating, so very much looking forward to it, let’s get to it. Here’s Sucheta’s conversation with Dr. Sam Goldstein.
Sucheta: Welcome to the show, Sam. I’m so excited to have you and I’m going to get started right away. My first question was, average person is still unclear what exactly executive functions mean. It has come to be this umbrella terms that covers many different abilities, such as attention, organization, planning, self-monitoring, etc. How do you define executive function and how would you explain to a layman in simple possible way if you can share that, that will be great.
Dr. Sam Goldstein: Thanks for having me here today and I appreciate the opportunity to weigh in on this often confused topic, and I find your comment about laypeople’s confusion really humorous because I think that professionals are even more confused about what exactly is executive function. There are probably more theories about it as perhaps any other single psychological phenomena. There are some theorists who think it’s one thing, there are some who think it’s four or five, there’s one theorist – and I use that term ‘theorist’ because it’s a theory, not necessarily proven fact – who believes that it is 40-plus different things. It’s a concept that’s in pop psychology now, long on opinion and theory, and unfortunately, much shorter on good science from which we try and derive an understanding not only of what it is and how to measure it, but perhaps the impact of either being proficient or being deficient at it, and perhaps the idea that it’s malleable, that if you’re not good at it, we can make it better for you which downstream might reduce your impairment and improve your quality of life. It is in some ways sort of the new ADD and people now, instead of talking about ADD, now, we’re talking about executive functioning. I will tell you, there is no diagnosis, none of the manuals have diagnoses of, you know, is there a diagnosis for executive function disorder?
Sucheta: There’s none.
Dr. Goldstein: And in our work – and I’ll let you ask some questions – but in our work, one of the things Jack Naglieri and I did for our textbook, we authored a major textbook on executive function and invited everyone with a theory or science to contribute, but what we did is try and examine all these different theories, and then creating our tests for executive functioning which is a self-report and an observer instrument about reflecting real life, so it’s not a face-to-face test. We looked at every behavior and every concept and attempted to answer the question in a statistical way rather than in a descriptive way, trying to determine whether or not the idea that there are four executive functions or eight executive functions, or 40, whether you could prove that in a scientific way, and as I commented, it’s a very popular topic and I think part of the reason it’s a popular topic is because it’s not a pathology yet. There’s isn’t a diagnosis for it which makes people much more open to considering that they might have it, meaning a problem with it or makes them more open to believing that it’s malleable and they can improve their functioning. So it’s not surprising that people are gravitating both in describing children and in themselves as adults are gravitating towards that and would prefer to say, “I have executive functioning problems,” than say, “I have ADHD.”
Sucheta: Exactly. So what is it? What would you say it is?
Dr. Goldstein: Ah, well, let me summarize and I will apologize to listeners who are more scientific because I’m not going to take the time to cite researchers and I’m going to cite some other people’s work but I’m not necessarily going to cite those people, but one of the major research group has hypothesized that it’s one of three things. It’s either a set of behaviors we use to negotiate life, to solve problems like working with memory or planning, or attention to detail, all of which helps us go about problem solving. It’s either that or it’s some master controller, some executive as it were that controls all of those behaviors, so those behaviors that I just mentioned a few of, they in themselves are just behaviors, they are not executive functioning, and executive functioning is the regulator: the orchestra leader, to quote my friend Tom Brown, that coordinates it, and then the third possibility is it’s both, that it’s a set of behaviors that we use to negotiate life successfully and strategically but it’s also an executive, a controller that regulates all of that.
So that’s one way of looking at it. If you look at it scientifically and check, and I did that in developing our screener for executive functioning and our adult instruments that goes from age 18 to 75 will be coming out next month, so we’ve now looked at these behaviors across the population, and the way you do it as a good scientist is you don’t start with a theory and try and prove it. You start with a set of behaviors and you examine how they present in the general population. What do people say about their working memory or their planning, or their attention to detail, or how flexible they are, or how well they initiate or organize, or problem solve. You ask people to respond or you ask parents to respond about their children. We did that with 8,000 children between the ages of 5 and 18. We all did that with 6,000 adults.
Sucheta: So this is now you’re talking about the comprehensive executive function inventory CFI that you developed with Jack, right?
Dr. Goldstein: Correct.
Sucheta: Got it.
Dr. Goldstein: Correct.
Sucheta: So just a quick overview to our listeners, it’s a 100-item rating scale which goes from age 5 to 18 for 12 to 18 days of self-report component but otherwise, parents and teachers, or observers are commenting about these nine areas, right?
Dr. Goldstein: Correct.
Sucheta: Okay, okay, got it. Continue.
Dr. Goldstein: Correct, and now, as I mentioned, we now have an adult version.
Sucheta: Oh, you do?
Dr. Goldstein: Yes – goes all the way to age 75 and as I just mentioned, we looked at 8,000 children, we looked at 6,000 adults, and we don’t have any pre-existing framework that we’re trying to fit the data into. That’s called ‘exploratory factor analysis.’ We don’t say executive function is six or ten, you mentioned nine sets of behaviors, we’ll talk about that in a minute, but we just let the data tell us and we let the data tell us whether we’re measuring one thing or six things. For example, if I ask a parent how often the child has trouble sitting still at a meal or sitting still in the classroom, or sitting still in the car, that’s three questions but it’s measuring one thing: how much trouble the child has sitting still, and so these questionnaires as you mentioned are instruments, about 100 items, that doesn’t mean we’re measuring 100 things, and the question is, what are you measuring? In an ADHD, when we do it, we’re really measuring two things: attention and hyperactive impulsive behavior. Hyperactive impulsive behavior goes together, you can’t separate them in a statistical or scientific way. When we measure autism in our autism spectrum rating scale, we’re measuring three things. Even though they’re 80 items, they’re really calling for information about three things: social communication, unusual behavior, and self-regulation. So the question we ask is, what is executive function from a statistical perspective? If you have parents and teachers, and adults, answer these 100 questions, do we discover again applying a statistic, it’s called ‘factor analysis,’ ‘til we discover that we’re measuring one, two, three, six things. How many things are we measuring? And without going into great detail about factor analysis, I can tell you that the best fit for the data for executive functioning is one factor. That is all of these nine sets of behaviors: planning, emotional regulation, initiation, attention, working with memory. While they’re distinct in some ways, they’re very predictive of each other on a large group basis. Now, that doesn’t mean that every person is a Stepford wife, it doesn’t mean that –
Sucheta: Two people are going to be alike.
Dr. Goldstein: Right, but when you put enough people together and you match the senses, you discover that these behaviors are very predictive of each other, so in the end, answering the question scientifically and statistically, executive functioning is made up of one behavior: executive function. Executive function is comprised of all kinds of other phenomena. So let me go back and so not to confuse the listener: we talk about executive functioning and for me, that means how you negotiate everyday life, how strategic you are, how organized you are, how planful you are in solving problems. We call upon our executive function to help us solve problems. It’s a singular phenomenon, executive function, but it’s made up of lots of behaviors, and as we look at those behaviors in a different kind of statistic, we call that ‘confirmatory factor analysis,’ we could group the items together. So for an individual, we might find someone who’s good at organization but not good at initiation – getting started. Someone else might initiate well but not be very organized. There is really individual differences and it’s important to understand those but the important question we ask is, are there different executive functions or is it one phenomena, executive function – it’s how you do what you do and those behaviors are the equivalent of strategies that you use to be more functional and more effective in everyday life, and we are not – yes, we have the largest sample but we’re not the only group that argues for one factor. In all fairness, I will say that behavior regulation inventory, the brief, which has been out for oh, 10, 11, 12 years and they just did a second edition, their initial version had two factors: regulation of emotion and regulation of behavior. Now, they have three and I’m not familiar with their statistics but it’s clear, there are not 25 executive functions. It’s clear that not every behavior the brain does can be differentiated as an independent predictor of what’s going to happen. Does that make sense?
Sucheta: Yes.
Dr. Goldstein: Yes, it isn’t the case that I need to, that in asking all of these behaviors, I’m asking about nine different things, no. I’m asking about one thing that you go about doing by harnessing nine different kinds of behavior for 10 or 12, or whatever.
Sucheta: Sam, I really like how you and Jack Naglieri defined executive function which is executive function is how efficiently you do what you decide to do, so I liked that self-directedness in it, I liked that problem solving for self is included in it, and it also explains the execution that means doing of it, not thinking of it or just having grand idea but really materializing them, and so these nine parameters, for example, just that you gave a wonderful overview, are ultimately funneling into this process as you’re explaining, is how do you affect the outcome for yourself, right?
Dr. Goldstein: Right. Now, let me add one more thing, my dear friend and pioneer in ADHD Russell Barkley has argued that perhaps ADHD really is EFDD, that it’s really executive function disorder, right? And if that was the case, then you ought to be able to distinguish people with ADHD on an instrument for people with depression or anxiety, or autism, and the reality is, at least in our studies, if you take any phenomena, any phenomena that disrupts the person’s every day functioning, whether it’s an internalizing problem like anxiety or depression, whether it’s a learning disability, whether it’s an externalizing or disruptive problem like ADHD or oppositional defiance, you get reports of decreased executive functioning which makes sense because if you’re depressed, if you’re anxious, if you’re language-impaired, if you’re socially impaired, you’re going to be less efficient in negotiating every day activities. So from our view, executive function is not a diagnosis. It’s a fluid phenomenon. In one of our validity studies, we look at depressed teens and found that when they were in the midst of their depression, parent and even self-report rating from the teams for these executive functioning behaviors were low, and as their depression lifted, the reports on these behaviors got better, if that makes sense. So when we’re treating – and we’ll talk about that – the first thing we look at is, what might be depressing your executive functioning? And for some, they have ADHD. For others, they have depression. Now, again in all fairness, the folks who do the brief, they generated some data to suggest that perhaps there are different profiles for kids with ADHD versus depression, versus anxiety. We haven’t found that in our data.
Sucheta: So then for our listeners who may not have a deep background in your psychology or cognitive neuroscience, can you share some real life situations or activities that require executive function and as you said, lack of sleep or increased stress, or a lot of environmental and experiences that create or have great influence on shaping executive function. So can you comment a little bit on that, how to understand that?
Dr. Goldstein: Well, I guess one way to put it is, if you get out of bed and you leave your executive function on the pillow, you’re not going to get out of the bedroom because again, think of these behaviors: planning, initiation, getting started, organization, regulating your emotions, paying attention to detail – not paying attention but paying attention to what’s important right now which we find kids with autism have a difficult time doing; they pay attention to the wrong things – planning which we find impulsive children have a hard time learning how to do. Again, we’re not arguing that biology is destiny here which is the nice part; it’s a malleable phenomenon meaning we can manipulate it. We’re arguing that if you’re inefficient in organization, there’s all kinds of things you can do, from trying to be a better organizer, to prosthesis meaning devices or things to help you organize that reduce your impairment. Increasingly in psychology and applied psychology meaning clinical psychology or neuropsychology – anything where we’re trying to help people – we increasingly recognize that the target is impairment. So if you tell me that you’re inattentive or disorganized, but also tell me that your life is just fine, then you don’t want any kind of diagnosis. You may not even warrant any treatment. On another podcast, we should talk about impairment because it is the increasing focus in our field, and the majority of people’s functioning in the world is not predicted by our test scores or their diagnoses, or their symptom severity. The fact of the matter is, we don’t really know sometimes why someone that ought to not be doing well is doing fine and someone that should be doing fine isn’t doing so well, and I explain that to parents all the time. Two people could be equally depressed on a scale and one doesn’t leave the house, and the other one goes to work. So there’s a shift in our field asking real world questions and when you do that, the connection between test scores and symptoms, and behaviors, and diagnoses, the connection between that and the real world is executive functioning. Executive functioning, how you do what you do, tends to explain more of what goes on out in the world than diagnoses and test scores.
Sucheta: Yeah, it makes so much sense to me. So in closing, you talk a lot about student success in classroom and beyond, and how it depends on learning to balance and having resilience. So is there any correlation or relationship between resilience and executive function? Isn’t executive function which means your adaptive and adjusting ability also is core of resilience?
Dr. Goldstein: Yes, so – and again, I come back to answer it scientifically so it’s not just my opinion – if you look at an instrument like the DECA, the Devereux Scales of Resilience, what you’ll find is that there’s a very high correlation between executive functioning and resilience, and that makes sense because resilient people are able to continue functioning under adversity. Well, how do they do that? They employ these behaviors. They’re more stress-hardy, they’re more resistant to being distracted, or to decompensate in the face of these other risk factors, and again, executive function is one of our validity studies, when we looked at reading and math achievement, and even performance on an intelligence test, a significant amount of the explanation for the performance was explained by behaviors related to executive functioning. It’s not enough to know the information, to understand how to put a puzzle together, or to assemble blocks to show somebody you’re smart. You have to have a strategy to get from me putting the blocks in front of you to you making the design, and we found that executive function contributes 25% to 30% of performance in everyday life, of performance in the classroom, of academic performance, of yours and my behavior out in the world. These behaviors are a bridge between what we know and what we do.
Sucheta: Only 25% to 30%? I’m surprised by that. I thought it would be more because there are so many demands on having to attend and adjust, and monitor, and inhibit, and redirect your own focus.
Dr. Goldstein: When you asked a good question from a layman’s perspective. The fact of the matter is, if I can explain even 1% or 2% of the variance, that’s a big deal. If I could explain 2% of the move of the stock market, we wouldn’t be on the telephone. 25% to 30% is a very big deal. It’s a very big deal.
Sucheta: Oh, from a variance point of view, I see, I see.
Dr. Goldstein: From a variance point of view, it’s a very, very big deal. If I can influence the variance even 5% on how one thing predicts another, look, what do we know about parents’ influence on kids? All kinds of things influence kids but the 5% or 10% of the variance that is explained by parenting is the difference between a child who stays in school and is emotionally health and a child who struggles and drops out. It’s a gigantic phenomenon, even when we say it’s a small part of a variance, it makes a significant contribution.
Sucheta: I got it. So I’m very glad to hear you mention to our audience and listeners the malleability or how pliable, or how we can influence executive function and that even small shift can have a significant improvement in quality of life.
So as we come to an end of this interview, Sam, if people want to know more about your work and want to reach out to you, what’s the best contact for them?
Dr. Goldstein: They can just go to my website which is just samgoldstein.com.
Sucheta: Fantastic. Thank you so much for your time and wonderful insight into executive function.
Dr. Goldstein: You’re welcome. Thanks for having me.
Producer: Alright, as I suspected, Sucheta, a great conversation with Dr. Sam Goldstein, really enjoyed that discussion. Care to give us a quick rundown of some of your initial thoughts, please?
Sucheta: Thank you, Todd. I too enjoyed that immensely. As a clinical neuropsychologist, researcher, and a scientific mind, Dr. Goldstein’s approach and insights are very thorough. What I loved about his work is that he has dedicated himself to delineating how best to study and then describe executive functioning as an evidence-based concept. Dr. Goldstein and his colleagues have been concerned about the ongoing debate in the field of cognitive neuroscience and they have recognized the subtleties and complexities that pose challenges in evaluating and standardizing the framework we use to talk about when we refer to executive function. It’s really unfortunate that there’s no single behavior that can itself be tied to executive function or clearly signify executive dysfunction. Clinicians and researchers are unsure as to what exactly a child with executive function impairment might not be able to do. Some of my previous guests such as Stephanie Carlson has commented on this, that executive function is evident in its absence.
So even the traditionally, there’s a strong focus on the frontal lobes, but recent progress in neuroscience has shown that executive function system is far more distributed across the cortex rather than just being concentrated in the frontal lobe. Testing executive function deficit in a laboratory setting is also a very big challenge. So a lot of thoughts that we have had or we had constructed as a way to grasp the concept of executive function is getting clearer day by day but it is also busting the myths about what we have thought about it to be in the past. So those who study executive function from a clinical context know that patients or clients with executive function deficits are riddled with limited awareness of their own problems, they’re impulsive and often, they’re emotionally unstable. Their behaviors are frequently aggressive and all that makes it difficult if not impossible to assess. So going back to John McEnroe’s example, he was impulsive, he was emotionally unstable, he was not aware of his own problem or the way he presented himself, and there was a point, of course, maybe at a certain point in his career that he recognized that being so dramatic and over the top got him a lot more fame and attention, and he began to thrive on it which may not be executive dysfunction as such but it certainly didn’t help him become more successful or more stable. Patients I have worked in my practice with severe deficits and significant breakdown in day-to-day executive function, research shows that they may be able to do paper, pencil, or laboratory-based tests in flying colors, so that again is very confusing. I have seen many patients after a neuropsychological test who have not shown any deficit and high intelligence, and they come to me and they’re saying, “I’m falling apart. My marriage is falling apart,” or if it’s a child, the parents describe that the kid is failing in his least favorite subjects but he’s in an advanced course in the most favorite subject.
So this is why executive function system is hard to define, and it’s nice to hear Dr. Goldstein talk about this framework of executive function as a unifying system rather than executive functions.
Producer: Alright, but I heard him explain why we should call these skills executive function and not executive functions, S, plural. What are your thoughts there?
Sucheta: Yeah, Todd, that’s the second takeaway, as I mentioned earlier, essentially, executive function and not functions. It’s a singular construct. It is, as Dr. Goldstein described, how you do what you do. It’s how you do what you know, not what you know, particularly how you do what you do in order to be effective, productive, and functional, and it relates to the way we behave and the way we strategize for every day problem solving, so executive function is comprised of many, many components. For example, while we are planning, we are using a concept of connecting actions to goal. When we are organizing ourselves, we are using concepts related to categorization sequencing. When we are strategizing, we are using an internal model of problem solving. All these skills collectively help bring efficiency as we negotiate the demands of everyday life.
Another way to explain this is, take example how we deploy executive function – when we go about daily problem solving. First, we activate an intention to act, then we follow that up with formulating a goal, and we connect the goal with a plan of action which has sequential steps, then we choose certain sequences and let go certain sequences, then in order to execute the plans, we follow the steps very diligently and as we are going through that, we evaluate and reevaluate the outcomes of whether they are directly correlated to the goals or not, and when all that happens successfully, we move forward, but if we don’t move forward and if something fails – a step fails or the plan fails, we rethink and go back three steps, and repeat that process again.
So executive function is a fluid phenomenon which means that behaviors are not static and they fluctuate from high to low based on individual’s capacity but also based on individual’s personal life, as well as demands on those executive function.
Producer: So I also heard Dr. Goldstein say that executive dysfunction is simply disruption of every day function. Can you elaborate on that please?
Sucheta: Yes, and this is another important way to think about executive function and dysfunction, and not to really limit your understanding to clinical environment. Anything that disrupts individual’s every day functioning, may that be being late, being disorganized, taking too long, not getting started, being scattered, being unclear of the goals, not having a plan, or often getting stuck. All those things, there’s an underlying breakdown of executive function there, so it’s a good way to investigate at that point is what is causing that dysfunction? Interesting way this dysfunction shows up is the disruption may or may not be recognized, acknowledges, or associated with long-range ongoing dysfunction if there is no awareness, and this is a very interesting thing that again, in my practice I see, that people who refer these kids or adults, people who recommend them to come to me are less aware than those who are observing these behaviors.
A famous Russian scientist Alexander Luria who studied patients with brain injuries, once said that besides the disturbance of initiative and other aforementionable behavioral disturbances, almost all patients with a lesion of the frontal lobes have a marked loss of their capacity, a critical faculty that is a disturbance of their ability to correctly evaluate their own behavior and the adequacy of their own actions, and this is kind of a self-blind spot that again makes it really difficult to recognize the disruption and its ramifications with respect to other people that are involved in your life, if that makes any sense.
Producer: Yeah, it does. What I’m also understanding is what we know as resilience, it just comes from strong executive function skills, correct?
Sucheta: Of course, Dr. Goldstein’s expertise is kind of helping parents navigate or helping develop children with stronger resilience, so what is resilience? Resilience is your basic ability to bounce back, being very kind of – he call them ‘stress-hardy folks.’ For example, simple things is being more resistant to being distracted, that’s a sign of resilience. Research shows that there’s a high correlation between executive function and resilience. We want our children to have strong resilience skills, their ability to bounce back. Resiliency is also a sign of strong self-regulation which is a way that we are recognizing, identifying the emotions that we feel when we hit a roadblock and redirect emotions so that the problem solving is not deluded or polluted by the murky emotional thoughts.
It’s also, I think ultimately goes back to what I was saying about executive dysfunction, the resiliency is kind of indicated with those who are able to take or make better plans and take different decisions under duress. They are very good at appraising situations that require a new response and somewhere they have to kind of inhibit or suppress the strong habitual response, or more automated response. People who are more resilient are better at resisting temptations and they are able to pursue higher goals. They are also better at detecting errors and correct the errors without any emotional baggage to it. They are much stronger at every day troubleshooting, and finally, they are much better at behaving safely in situations that potentially pose danger or they are much more careful in technically latent situations so they are not creating risks for themselves.
So that’s why it’s really, really important to kind of understand the role of resiliency and how it connects to executive function. So with that in mind, I think children – I had a parent talk yesterday and one of the messages I had was to really focus on that child’s development where the child is a member of household community, a school community, and a larger community where he has a better check on his own internal state of emotions.
Producer: Fascinating stuff. Boy, we packed a lot into this conversation today. Great conversation, again, with Dr. Sam Goldstein.
On behalf of our host Sucheta Kamath and all of us at Cerebral Matters, thank you for tuning in and listening today. We look forward to seeing you again next week on Full PreFrontal. We’ll see you then.