Dr. Mark D'Esposito

But there's, you know, the frontal lobe probably has 25 different sub-regions within it.

And so, grossly, we think about the frontal lobes as the lateral portion of the frontal lobes, which is involved in these executive function, probably supports these executive function abilities.

But then we've got another part of the frontal lobes called the orbital frontal.

Cortex was probably involved more in social and emotional behavior.

So, you know, when we think, again, when we think about frontal lobe behaviors, they kind of, you have to break, there's so many different types of frontal lobe behaviors.

So that type of behavior, which may be involved in sort of being able to inhibit, you know, your motor movements or maybe not being distracted may reflect that that system is a little bit delayed, but it could be that another system, the one that's involved in planning and organizes

You know, it's more developed.

And I do think they develop at different trajectories.

Right, because that's a pretty common example of our patients that they don't follow the rules.

If you're sitting in the doctor's office and the phone rings, you know not to pick up his phone, but the patients don't.

They may pick up the phone.

There's this Dr. Lamit who's a...

A neurologist from France published these beautiful papers in the 80s of all these things that patients did that just broke the rules and just kind of pulled to their environment without having any context to it.

If he put a pair of glasses on the table and didn't ask them to put them on, they would put them on even if they had a pair of glasses on already.

Or he took them to their apartment and they saw the bed and they jump into the bed and

go onto the covers or he saw he had a nurse and she he put a blood pressure cuff there and she picked up the blood pressure cuff and just start taking his blood pressure again not asking him to do any of these things and so they they they just don't follow sort of the social rules but they're there they they haven't lost rules if you ask these patients was that the appropriate thing to do they'll say no no they know it's they know it's appropriate yeah they say no i'm not supposed to

answer your phone but... Oh wow, so they know better but they can't control the impulse.

Exactly, so it's not a breakdown that the rules disappear, it's that they can't apply the rules properly.

And that's true for a lot of patients, even with kids, you know, you tell them

don't have anything to eat before dinner because we're having dinner, and then they're sitting there having a sandwich, and you say, what did I just tell you?