Back to School Tip #5: Lost at School – Literally?

If your child is changing schools, and especially if they are going into a new middle school or high school, they may be very anxious about not knowing their way around.

Although all kids have some level of anxiety about going to a new school — and you can remind your child that all kids are a bit nervous about the first week — kids with Executive Dysfunction really have more cause to be concerned, as their risk of getting lost navigating the new building and changing classes is higher than other kids’.

Here are some tips to help your child deal with the “What If I Get Lost or Am Late for Class” Anxiety Disorder:

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Gender differences in executive functioning in youth with ADHD

A new study finds that there are some gender differences in executive functions between boys and girls with ADHD when it comes to response inhibition and planning. Here’s the abstract:

The majority of research on neurobehavioral functioning among children with Attention-Deficit/Hyperactivity Disorder (ADHD) is based on samples comprised primarily (or exclusively) of boys. Although functional impairment is well established, available research has yet to specify a neuropsychological profile distinct to girls with ADHD. The purpose of this study was to examine performance within four components of executive function (EF) in contemporaneously recruited samples of girls and boys with ADHD. Fifty-six children with ADHD (26 girls) and 90 controls (42 girls), ages 8-13, were administered neuropsychological tests emphasizing response inhibition, response preparation, working memory, and planning/shifting. There were no significant differences in age or SES between boys or girls with ADHD or their sex-matched controls; ADHD subtype distribution did not differ by sex. Compared with controls, children with ADHD showed significant deficits on all four EF components. Girls and boys with ADHD showed similar patterns of deficit on tasks involving response preparation and working memory; however, they manifested different patterns of executive dysfunction on tasks related to response inhibition and planning. Girls with ADHD showed elevated motor overflow, while boys with ADHD showed greater impairment during conscious, effortful response inhibition. Girls, but not boys with ADHD, showed impairment in planning. There were no differences between ADHD subtypes on any EF component. These findings highlight the importance of studying boys and girls separately (as well as together) when considering manifestations of executive dysfunction in ADHD.

Reference:
O’Brien JW, Dowell LR, Mostofsky SH, Denckla MB, Mahone EM: Neuropsychological Profile of Executive Function in Girls with Attention-Deficit/Hyperactivity Disorder. Arch Clin Neuropsychol. 2010 Jul 16.

Using cognitive functions to diagnose ADHD

Researchers at  Westmead Millennium Institute, University of Sydney in Australia have been testing a new method of diagnosing Attention Deficit Hyperactivity Disorder (ADHD) and claim that it is more effective than existing systems.  Here is the abstract from their study:

Measures of cognition support diagnostic and treatment decisions in attention deficit hyperactivity disorder. We used an integrative neuroscience framework to assess cognition and associated brain-function correlates in large attention deficit hyperactivity disorder and healthy groups. Matched groups of 175 attention deficit hyperactivity disorder children/adolescents and 175 healthy control subjects were assessed clinically, with the touch screen-based cognitive assessment battery "IntegNeuro" (Brain Resource Ltd., Sydney, Australia) and the "LabNeuro" (Brain Resource Ltd., Sydney, Australia) platform for psychophysiologic recordings of brain function and body arousal. IntegNeuro continuous performance task measures of sustained attention classified 68% of attention deficit hyperactivity disorder patients with 76% specificity, consistent with previous reports. Our additional cognitive measures of impulsivity, intrusive errors, inhibition, and response variability improved sensitivity to 88%, and specificity to 91%. Positive predictive power was 96%, and negative predictive power, 88%. These metrics were stable across attention deficit hyperactivity disorder subtypes and age. Consistent with their brain-based validity, cognitive measures were correlated with corresponding brain-function and body-arousal measures. We propose a combination of candidate cognitive "markers" that define a signature for attention deficit hyperactivity disorder: "sustained attention," "impulsivity," "inhibition," "intrusions," and "response variability." These markers offer a frame of reference to support diagnostic and treatment decisions, and an objective benchmark for monitoring outcomes of interventions.

While such markers make some sense in terms of the diagnosis for inattention in the DSM-IV (and DSM-V proposal), are all of those markers really "attention" issues or are some of them more appropriately subsumed under executive functions? Neither the DSM-IV nor DSM-V proposal have a diagnosis of Executive Dysfunction (EDF), probably because there has not been enough research on it and no clear consensus in the literature as to what constitutes a definition of executive functions or criteria for diagnosing dysfunction. That said, anything that improves the accuracy of diagnosis and discriminating one condition from another is generally a good thing.

Reference:

Williams LM, Hermens DF, Thein T, Clark CR, Cooper NJ, Clarke SD, Lamb C, Gordon E, Kohn MR. Using brain-based cognitive measures to support clinical decisions in ADHD. Pediatr Neurol. 2010,  42(2):118-26.

Assessing Executive Functions in Psychoeducational Domains

Michael Decaire, M.A. of Harcourt Assessment prepared a PowerPoint overview on assessing executive dysfunction in psychoeducational domains. Although some of the slides are missing as they would display test item content, and there has been additional research since 2006, the presentation may be of interest to school psychologists:

Executive Functioning Assessment in Psychoeducational Domains

Seeing yourself through “rose-colored glasses”

Did you ever wonder why your child sees himself or herself as doing “above average” socially when you can see that they are not doing well socially?   The “rose-colored glasses” or “above-average effect” may be related to underactivity in the frontal lobes of the brain – the part of the brain responsible for executive functions. Recently, the University of Texas at Austin issued the following news release:

The less you use your brain’s frontal lobes, the more you see yourself through rose-colored glasses, a University of Texas at Austin researcher says.

Those findings are being published in the February edition of the journal NeuroImage.

“In healthy people, the more you activate a portion of your frontal lobes, the more accurate your view of yourself is,” says Jennifer Beer, an assistant professor of psychology, who conducted the research with graduate student Brent L. Hughes.

“And the more you view yourself as desirable or better than your peers, the less you use those lobes.”

The natural human tendency to see oneself in a positive light can be helpful and motivating in some situations but detrimental in others, Beer says.

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