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ADHD rethought as executive functioning deficit disorder

Posted on May 19, 2013 at 5:43 PM Comments comments (107)
Russel A. Barkley is an expert in ADHD [Attention Deficit Hyperactivity Disorder]. In His 2o12 Burnett Lecture Prof Barkley describes ADHD as Executive Function Deficit Disorder. He says that this new reconceptualisation has profound implications over how ADHD should be tested in the USA. 

His theory is extremely interesting; I question his conclusions as he seems to over-emphasise medication [he is a consultant for pharmaceutical companies who produce the drugs that are used to treat ADHD in children]. The over-use of drugs is a problem as many children out-grow this developmental gap. 

The lecture is available on Youtube: Part 1 and Part 2

Summary of the theory of ADHD as EFDD

There are five brain structures involved in executive functioning: the medial prefrontal cortex, the dorso-lateral prefrontal cortex, the basal ganglia [striatum], the amygdala and the cerebellum. Together they create three distinct neural circuits, which are dopamine based [Javier Castellanos]

The frontal-striatal circuit: associated with deficits in response suppression, freedom from distraction, working memory, organisation and planning, known as the "cool" EF network

The frontal-limbic circuit: associated with symptoms of emotional discontrol, motivation deficits, hyperactivity-impulsivity and proneness to aggression, known as the "hot" EF network

The frontal-cerebellar circuit: associated with motor coordination deficits, and problems with timing and timeliness of behaviour, known as the "when" EF network

[For a longitudinal study of the development of the ADHD brain see the research of Philip Shaw.]

These three circuits are associated with the following functions: timing of actions and behaviour [as well awareness of self in time], goal orientated behaviour, coordination and gracefulness of our movements [and thoughts], working memory [a memory of what I am here to do], emotional inhibition and meta-cognition [self-awareness, planning, problem solving, self-regulation. 

What is executive functioning?

Dimen [198o] describes EF as the seat of social intelligence without which cooperation, reciprocity and group living would not be possible. 
EF is self-regulation [self-control]. Self-control is anything we do to ourselves to change our behaviour. Through EF in the present we are trying to change a distant outcome. [exercising now to get fit and toned in the future], or changing behaviour to change the future that comes towards us. 

There are seven different executive abilities. These abilities develop in a sequence and they are observable [externalised] in young children. In adults they become symbolic/private, unless we are alone and we are less inhibited and give ourselves commands out loud. 

Private self-speech 
o-3 years - no self talk
3-5 years - audible self-speech [no voice in the head]
5-7 years-  the child gives himself commands out-loud but starts suppressing the vocal cords and later the face movements
after 7 years - the voice in the head/the voice governs our behaviour privately

Emotional and motivational self-regulation
Self-talk helps us create and manage emotions and if we can manage our emotions we can manage our motivations. Anticipating pleasure in the future can motivate us to tolerate the time delay in getting the reward. 

Self-awareness 
Starts at around three months of age and takes ten years to mature. Involves turning attention and sensing to self; self-monitoring; self-watching 

Self-restraint or executive inhibition [stopping self from performing an action, resisting distraction]

Non-verbal working memory: 
is the visual imagery system [theatre in the mind] that guides us to our goals. We resurrect images of our past to guide us towards the future. 

Planning and problem solving 
Children's play solves as a template for problem solving because it involves analysis/synthesis, the source of all human imagination and invention [Daniel Coleman- Thinking fast and slow]

Acting at a distance: interacting towards the future and preferring delayed rewards to immediate ones. 

The pre-frontal cortex only fully matures in our early thirties. The older we get the more we expand our window to the future [anticipation of future events, thinking months and years ahead]. EF helps us create a scaffolding with the group and culture requires: being methodical, self-reliant, self-determined, resisting being manipulated by others to their advantage, being able to put a 'wall or filter' between yourself and others so you cannot be manipulated, self-defensive, reaching out and interacting with others, building friendships, reciprocity, sharing, turn-taking, initiating cooperative enterprise which is the basis of communities and government. 

Understanding ADHD in adults
Time blindness - are nearsighted to time, adrift in time, are "getting pulled along by the 'now'". 

Performance disorder: doing what you know and not knowing what to do; having a lot of knowledge but not being able to use it. It's a problem with knowing when to do and where to do rather than what to do and how

Using the past at your point of performance - the place and time where you should have used your skill but didn't

It is an intention deficit disorder.

Treatment recommendations: Working at the point of performance. Neuro-genetic therapy [using drugs to work at the level of molecular mechanisms, a form of genetic treatment]. Make rewards positive and concrete; visualising and imagining rewards; time-management training - make time concrete through the use of clocks and timers; breaking down long tasks into small chunks; breaking tasks and taking breaks every ten minutes to allow for refuelling [EF depletes our resources]; keep the sugar levels in the bloodstream up; routine aerobic exercise to oxygenate the brain; make problem-solving physical [manipulating objects]; positive self-statements; biofeedback.

Stimulation key to brain development. Guardian science article

Posted on November 20, 2012 at 5:48 PM Comments comments (103)
Childhood stimulation key to brain development, study finds 
By Alok Jha (published in the Guardian on the 14th of October 2012) 

Twenty-year research project shows that most critical aspect of cortex development in late teens was stimulation aged four. 

Brain scans of participants aged in their late teens showed a correlation between cognitive stimulation at the age of four and a thinner, more developed, cortex Photograph: David Job/Getty ImagesAn early childhood surrounded by books and educational toys will leave positive fingerprints on a person's brain well into their late teens, a two-decade-long research study has shown.

Scientists found that the more mental stimulation a child gets around the age of four, the more developed the parts of their brains dedicated to language and cognition will be in the decades ahead.It is known that childhood experience influences brain development but the only evidence scientists have had for this has usually come from extreme cases such as children who had been abused or suffered trauma. 

Martha Farah, director of the centre for neuroscience and society at the University of Pennsylvania, who led the latest study, wanted to find out how a normal range of experiences in childhood might influence the development of the brain.Farah took data from surveys of home life and brain scans of 64 participants carried out over the course of 20 years. Her results,presented on Sunday at the annual meeting of the Society for Neuroscience in New Orleans, showed that cognitive stimulation from parents at the age of four was the key factor in predicting the development of several parts of the cortex – the layer of grey matter on the outside of the brain – 15 years later.

The participants had been tracked since they were four years old. Researchers had visited their homes and recorded a series of details about their lives to measure cognitive stimulation, details such as the number of children's books they had, whether they had toys that taught them about colours, numbers or letters, or whether they played with real or toy musical instruments.The researchers also scored the participants on "parental nurturance" – how much warmth, support or care the child got from the parent. The researchers carried out the same surveys when the children were eight years old. When the participants were between 17 and 19, they had their brains scanned.

Farah's results showed that the development of the cortex in late teens was closely correlated with a child's cognitive stimulation at the age of four. All other factors including parental nurturance at all ages and cognitive stimulation at age eight – had no effect. Farah said her results were evidence for the existence of a sensitive period, early in a person's life, that determined the optimal development of the cortex. "It really does support the idea that those early years are especially influential."As the brain matures during childhood and adolescence, brain cells in the cortex are pruned back and, as unnecessary cells are eliminated, the cortex gets thinner. 

Farah found that the more cognitive stimulation a participant had had at the age of four, the thinner, and therefore more developed, their cortex. "It almost looks like whatever the normal developmental process is, has either accelerated or gone further in the kids with the better cognitive stimulation," she said.The most strongly affected region was the lateral left temporal cortex, which is on the surface of the brain, behind the ear. This region is involved in semantic memory, processing word meanings and general knowledge about the world.Around the time the participants had their brains scanned in their late teens, they were also given language tests and, Farah said, the thinner their cortex, the better their language comprehension.

Andrea Danese, a clinical lecturer in child and adolescent psychiatry at the Institute of Psychiatry, King's College London, said the study suggested that the experience of a nurturing home environment could have an effect on brain development regardless of familial, perhaps genetic, predispositions to better brains. Danese added that this kind of research highlighted the "tremendous role" that parents and carers had to play in enabling children to develop their cognitive, social, and emotional skills by providing safe, predictable, stimulating, and responsive personal interactions with children."Parents may not be around when their teenage children are faced with important choices about choosing peers, experimenting with drugs, engaging in sexual relationships, or staying in education," said Danese. "Yet, parents can lay the foundations for their teenage children to take good decisions, for example by promoting their ability to retain and elaborate information, or to balance the desire for immediate reward with the one for greater, long-term goals since a young age."

Bruce Hood, an experimental psychologist who specialises in developmental cognitive neuroscience at the University of Bristol, said his advice to parents was just to "be kind to your children. Unless you raise them in a cardboard box without any stimulation or interaction, then they will probably be just fine."

Zero degrees of empathy

Posted on November 7, 2012 at 8:03 AM Comments comments (99)
Empathy. It is considered an essential skill and a core condition (Rogers) in psychotherapy and counselling. It is the ability to put oneself in another person's shoes, to experience the world as they are experiencing it. In essence when we are being empathic we are recreating in our own mind and body a map of another person's mind, we are resonating with their pain and experiencing it as our own. 

A while ago I read a book by Simon Baron-Cohen "Zero degrees of empathy". Baron-Cohen asked the question "why does evil exist?" and wanted to find a scientific answer rather than a religious one. Baron-Cohen is an expert in autism, a condition which is characterised by a person's reduced ability to pick up and interpret another person's facial and bodily expressions in order to understand what they are feeling. This causes a considerable amount of strain socially. People are unable to gauge whether what they are doing is appropriate to the situation at hand. For instance, they might tell you a story about a subject that they are passionate about and fail to notice that you are drifting off, getting bored and would like them to stop. People with autism feel lost in social situation. They find it difficult and confusing - a minefield. They notice that people frequently get irritated and fed-up and this is scary because they don't understand what they've done wrong. 

People with high-functioning autism (Asperger's) can be helped to manage social situations by being taught about non-verbal communication and the significance of social cues. It's a little bit like learning to colour by numbers. 

There is another category of individuals tthat display zero-empathy. Baron-Cohen suggests that in this category are people on the high-end of spectrum of personality disorders such as borderline personality disorder (BDP), narcissistic personality disorder and antisocial personality disorder. 

Amongst other traits, patients diagnosed with BDP show an inability to connect with the pain caused to others through their self-harming acts and suicidal threats. They do not understand or experience the turmoil and the extreme fear that the other person is overwhelmed with. 

Clients with narcissistic structures are unaware of the other having any needs. They fill up the space with their discourse and tend to put others down. 

Antisocial personality disorder (psychopathy) is a condition rarely encountered in the therapy room. Psychopaths who are also violent and break the law tend to end up in prison. Those who don't break the law may be highly successful professionals. Cambridge trained psychology researcher dr. Kevin Dutton is fascinated by psychopaths. He has interviewed many of these individuals. 

Dutton has a certain admiration for psychopaths. He has found that some psychopathic traits (charm, ruthlessness, low empathy, focus, low stress response under pressure), if  coupled in an individual with high intelligence and low predisposition to violence may be highly useful in certain professions such as surgery, law and the arm and facilitate a high degree of achievement in these areas. (Psychopath in your family is a short film uploaded on his website www.wisdomofpsychopaths.com. I also found this documentary: I am fishead that proposes the thesis that corporate leaders are psychopaths)

The psychopath can accurately create a map of another's mind. He (because it tends to be a man) is extremely good at gauging what the other may be experiencing or thinking. However, the psychopath fails to experience another person's pain and are themselves emotionally under-aroused. Functioning MRI brain scans show that in psychopaths the amygdala (the structure of the brain that gets activated when we experience negative emotion and fear) is under-activated. 

In other words psychopaths cannot display the kind of "hot" empathy that translates into compassion and moral restrain. They are very good at thinking on their feet, focused, driven and because they brain/body rarely triggers the stress response, their verbal and manual performance remains highly accurate even in the most daunting situations. 

Why is that? Stress response translates partly into the release of a steroid hormone - cortisol. This hormone triggers bodily reactions that are biased towards facilitating a motor reaction such as running really fast. Prolonged exposure to glucocorticoids however has negative effects on the hippocampus (the part of the brain involved in the retrieval of autobiographical memory). We have all experienced stressful situations in which we feel tongue tied and cannot remember facts that we do know. Cortisol is to blame. In fact, cortisol not only interferes with the functioning of the hippocampus but can also contribute to premature cell death at this site. Prof. Dr. Robert Sapolsky from Stanford University has proved that stress has a negative effect on memory and the hippocampus. (The audio of his talk Stress and memory Forget it! is uploaded on youtube. Ignore the picture of the cat.)

Psychopaths have no such concerns. They are able to withstand extremely stressful situations without their nervous system being overwhelmed and without their body swimming with adrenaline or cortisol. 

Unsurprisingly, it turns out that what all people with zero-degree of empathy have in common is that they are not so good at relationships. The inability to hold someone else's mind in your mind, to respond with compassion is not conducive to being able to form a strong bond with another human being. 

The good news is that we are getting better and better at identifying low-empathy in children and that there are ways to train people in empathy. 

And to end, I found this brilliant short animated history of empathy by Jeremy Rifkin. It is called "The empathic civilisation". Rifkin argues traces the evolution of the empathic brain and argues that our ability to extend empathy to others with whom we don't share the same culture and religion, as well as to other species is essential to our survival on this planet. 

I am my connectome

Posted on October 22, 2012 at 11:42 AM Comments comments (0)
"In the brain, neurons are connected into a complex network. Sebastian Seung and his lab at MIT are inventing technologies for identifying and describing the connectome, the totality of connections between the brain's neurons -- think of it as the wiring diagram of the brain. We possess our entire genome at birth, but things like memories are not "stored" in the genome; they are acquired through life and accumulated in the brain. Seung's hypothesis is that "we are our connectome," that the connections among neurons is where memories and experiences get stored.

Seung and his collaborators, including Winfried Denk at the Max Planck Institute and Jeff Lichtman at Harvard University, are working on a plan to thin-slice a brain (probably starting with a mouse brain) and trace, from slice to slice, each neural pathway, exposing the wiring diagram of the brain and creating a powerful new way to visualize the workings of the mind. 

They're not the first to attempt something like this -- Sydney Brenner won a Nobel for mapping all the 7,000 connections in the nervous system of a tiny worm, C. elegans. But that took his team a dozen years, and the worm only had 302 nerve cells. One of Seung's breakthroughs is in using advanced imagining and AI to handle the crushing amount of data that a mouse brain will yield and turn it into richly visual maps that show the passageways of thought and sensation.

Memory and digital technology

Posted on October 16, 2012 at 7:18 AM Comments comments (0)
Digital devices are changing our memory - but not in the way you may think! 

"Aleks speaks to Grandmaster of memory, Ed Cooke who thinks memory is going out of fashion because of our reliance on digital devices.

Mastermind champion and London cabbie Fred Housego explains how he relies on 'The Knowledge' to navigate London but relies on his wife's short term memory to remember dates for engagements, shopping lists, phone numbers. Psychologist Betsy Sparrow explains that this is known as transactive memory and it's exactly what we are doing with our digital devices. Cyborg Anthropologist, Amber Chase explains that in the past we had physical extensions of ourselves, for example with tools, but we now have mental extensions of ourselves, with our digital devices acting as externalised brains, changing our sense of self.

Aleks discovers that the way we remember is not only changing our perceptions of self but challenging the very concept of intelligence. Aleks hears that the smart kid of the past memorized lots of data but the smart kid of the future will know how to navigate the system and how to understand concepts. This is exactly what 15 year old US high school pupil, Jack Andraka did when he discovered a new test for pancreatic cancer using the internet. With little background knowledge and armed only with what he knew from biology classes he scoured the web for papers that helped him make connections that will potentially save thousands of lives.

The way we use our memory is changing but as Psychologist Betsy Sparrow explains we are only responding to our surroundings and evolving as we always have."