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Amodio D and Frith C (2006) Meeting of minds: the medial frontal cortex and social cognition. Nature Reviews Neuroscience, 7(4), 268277 Davidson MC, Amso D, Anderson LC, and Diamond, A (2006) Development of cognitive control and executive functions from 4 to 13 years: evidence from manipulations of memory, inhibition, and task switching. Neuropsychologia, 44(11), 2037-2078. free, PubMed
Martha S. Burns, Ph.D., ccc-slp NAASE September 2010
Diamond, A. (2005) Attention-deficit disorder (attentiondeficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attentiondeficit/hyperactivity disorder(with hyperactivity). Dev Psychopathol. 2005 ; 17(3): 807–825. Diamond A, Barnett, WS, Thomas J, and Munro S (2007) Preschool Program Improves Cognitive Control. Science 318(5855) 1387-1388 Ophir E, Nass C, Wagner, AD. (2009) Cognitive control in media multitaskers. PNAS 106(37) 15583-15587
Rueda MR, Rothbart MK, McCandliss BD, Saccomanno L, Posner M (2005) Training, maturation, and genetic influences on the development of executive function. PNAS 102(41) 14931-14936 Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, Greenstein D, Clasen L, Evans A, Giedd J, and Rapoport JL (2007) Attentiondeficit/hyperactivity disorder is characterized by a delay in cortical maturation. PNAS 104(49) 19651-19654 Stuss DT and Knight RT (2002) Principles of Frontal Lobe Function. Oxford: Oxford University Press.
PHINEAS P. GAGE – a century and a half of progress
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Frontal
lobes - 1/3 of hemispheres - three parts Motor and PreMotor Paralimbic sector ventral medial anterior cingulate parolfactory gyrus posterior orbitofrontal Heteromodal Heteromodal + Paralimbic = Prefrontal Cortex
Profane, slovenly, grandiose, irascible Loss of spontaneity, initiative Apathetic Blunted feelings, mentation, drive, behavior, curiosity Erosion of foresight, judgment, insight, delayed gratification, capacity for remorse impaired abstract reasoning, problem solving, mental flexibility Problems with planning and sequencing complex events, risk management, shifting focus, flexibility, inhibition, multi-tasking
Frontal abulia - dorsolateral frontal lobes apathy and emotional blunting Frontal disinhibition - orbitofrontal and medial frontal lobes impulsive loss of judgment, insight, foresight attentional problems - working memory distributed network ―on line maintenance of information‖ prefrontal and posterior parietal ―off-line = central executive - volitional manipulation‖ dorsolateral
Includes inferior frontal gyrus – ―bridge to the pre-frontal lobe‖ Broca’s area in the left hemisphere Brodmann’s areas 44, 45 and 47 Involved in:
Tool use and other complex sequences - LH Mirror mechanism – RH & LH Lexical retrieval, morphological and grammatical marking – LH Supression of emotional memories – RH (right medial and inferior frontal gyrus, see Depue et al Science (2007) )
Brodmann’s area 46
Phonological working memory - LH Visual-spatial scratch pad (working memory) - RH
Smith E &Jonides J, Science (2009)
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BA 44 and 45 (and their cortical-cortical pathways) are not specific to aspects of human speech – they participate in the neural processing role shared by human and non-human primates that ultimately evolved into the human capability for speech. The existence of area 44 and 45 in the monkey ventro-lateral frontal lobe implies fundamental role is not limited to human language, rather a general cognitive role that was adapted in humans to serve linguistic processing as well
Ventromedial – includes anterior limbic system Theory of mind (mentalizing) (with R TPJ) Self-perception Motor monitoring Self-monitoring Important in delayed gratification Empathy
Dorsolateral – Executive functions (cognitive control) Organization, planning, flexibility Task switching Inhibitory control Working memory Processing speed
Ventromedial Pre-frontal Cortex
Limbic System
Amodio et al. Nature Reviews Neuroscience 7, 268–277 (April 2006) | doi:10.1038/nrn1884
• Early developing - Pathways linking occipital and inferotemporal cortex with the frontal cortex • Inferior Longuitudinal Fasciculus – ILF • Inferior Fronto-Occipital Fasciculus – IFO • Later developing - Pathways linking the posterior parietal cortex with the frontal cortex • Three branches of the Superior Longitudinal Fasciculus - SFI, SFII, SFIII • Anterior projections of the IFO • Pathways linking the Superior Temporal Cortex with the frontal cortex • Arcuate Fasciculus - part of the SF • Extreme Capsule • Uncinate Fasciculus - UF
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Michael Petrudes abd Deepak N. Pandya (2002) in Stuss and Knight, Oxford University Press
Inferior
Longitudinal Fasciculus – occipitotemporal stream – underlies object perception; the occipito parietal stream for spatial perception Superior Occipitofrontal fasciculus likely important in visuospatial processing
Petrides and Pandya (2002)
Superior
Longitudinal fasciculus is the major association pathway that links the parietal cortex with the frontal lobe It has four major divisions –
SFI – allows for selection of competing motor acts SFII – allows for selection between different locations SFIII – goal directed actions and working memory Arcuate Fasciculus – arches around sylvian fissure and course with SFII – language and audiospatial processing
Variety of sources including Petrides and Pandya (2002); John G. Kerns, Science, 2004
Uncinate
– self regulation, higher cognitive functions Cingulum bundle – the anterior cingulate – involved in conflict management, performance monitoring, and implicated in many neuropsychiatric disorders including schizophrenia and PTSD
Recruiting cognitive control. Using fMRI, Kerns et al. (Science, 2004) examined activation of the ACC and LPFC in consecutive trials of the Stroop test in human subjects. (Left) When the word presented to subjects is in a different color from the color the word denotes--an incongruent trial (i)--the resulting conflict regarding which action plan to execute induces an increase in ACC activity. (Right) When the first incongruent trial is followed by a second incongruent trial (i + 1), there is increased activity in the LPFC due to recruitment of cognitive control during the first trial, resulting in a shorter reaction time for the test response. The authors propose that detection of conflicts between plans of action by the ACC leads to recruitment of cognitive control in the LPFC
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Critical Four
Supported by increased sensitivity to ionizing radiation
Huttenlocher, 2002
Neuron formation (neurogenesis) –between postovulary day (POD) 52-140
―optimal‖ Periods – major divisions:
reduced neuronal number in cerebral forebrain causes microcephaly and mental retardation
Neuronal Migration – Second trimester Dendritic and Synaptic development –third trimester and first four postnatal years Myelination – through adulthood
Genes in Migration and Axon Growth (Galaburda et al, 2006)
Blom et al. Nature Reviews Neuroscience 7, 724–731 (September 2006) | doi:10.1038/nrn1986
Protein domains and possible functions
Common
genetic variants on 5p14.1 associate with autism spectrum disorders Wang et al, Nature 2009 For example - CDH9 and CDH10 Are
very important for the development of the obito-frontal cortex
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14240–14245 PNAS September 19, 2006 vol. 103 no. 38
Structural Architecture of the Human Cortex pre-natal to 16 years
Plots of grey-matter density are based on data by Gogtay et al. 2004 and illustrate the local grey-matter density in the mid-dorsolateral prefrontal cortex in red, in the angular gyrus of the parietal cortex in blue, in the posterior superior temporal sulcus of the temporal cortex in purple, and in the occipital pole in green.
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The yellow shaded area indicates a section of the dorsal mPFC that is activate d in theory of mind
Figure 2 | Activation of the medial prefrontal cortex (mPFC) during mentalizing tasks decreases during adolescence.
Based on a review of all the structural and functional neuroimaging literature that was available, Jung and Haier proposed the parieto-frontal integration theory of intelligence (P-FIT), which is arguably the best available description of how intelligence is distributed in the brain. The figure shows Brodmann Areas (BAs) involved in intelligence, as well as the arcuate fasciculus (shown in yellow) as a promising candidate for a white matter tract that connects the involved brain regions. BAs shown in green indicate predominantly left-hemispheric correlations and BAs shown in pink indicate predominantly right-hemispheric correlations with intelligence
Childhood to Adolescence
Adolescence to Adulthood
(Sowell et al, NeuroImage, 1999)
(Sowell et al, Nature Neuroscience, 1999)
Ian J. Deary, et al. 11, 201-211 (March 2010)
Shaw, et al., 2007 1. Estimated cortical thickness from 824 magnetic resonance scans acquired prospectively on 223 children with ADHD and 223 typically developing controls 2. Found maturation to progress in a similar manner groups, with primary sensory areas attaining peak cortical thickness before polymodal, high-order association areas 3. However, there was a marked delay in ADHD in attaining peak thickness throughout most of the cerebrum: • the median age by which 50% of the cortical points attained peak thickness for ADHD group was10.5 years (SE 0.01), • this was significantly later than the median age of 7.5 years (SE 0.02) for typically developing controls 4. The delay was most prominent in prefrontal regions important for control of cognitive processes including attention and motor planning
Note
that in ADHD development, especially of the prefrontal lobes (and perhaps right hemisphere significantly lag behind) – especially during adolescence (Shaw, 2007)
ADHD brain development 1.mov
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Diamond, A. (2005)
My
Videos\RealPlayer Downloads\ADHD brain development 1.mov
Note
Hyperactive, always on the go, impulsive
Primary deficit in response inhibition
ADHD
that in ADHD development, especially of the prefrontal lobes (and perhaps right hemisphere significantly lag behind) – especially during adolescence
Core
problem in ADD is in working memory
Complex span and dual task dichotic listening can detect this Rather than being distractible they may be easily bored, their problem more in underarousal than inhibitory control Primary disturbance in the frontal-striatal loop of ADHD Primary disturbance in ADD is a frontalparietal loop
A significant subset are hypoactive and sluggish and have slow response speeds Primary deficit in working memory, especially prominent in auditory processing because of the demands it places on working memory ADD
Now write down as many words as you Click toYou begin epic pill can recall. have rose kind moose weathervane natural photo soap sip mistake unlikely statue district direct one minute.
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Often insufficiently self-conscious Social problems because too assertive and impulsive: butt in, take things belonging to others, fail to wait their turn, and act without first considering the feelings of others
Tend to be overely self-conscious Social problems because too passive, shy, or withdrawn
ADHD
ADD
Respond positively to methylphenidate (Ritalin) Most respond positively to methylphenidate in moderate to high doses. Those with ADHD are more likely to smoke than are those with ADD.(There are marked similarities in the neurobiological and psychological effects of nicotine and methylphenidate.)
A significant percentage are not helped by methylphenidate
Those who are helped by methylphenidate often do best at low doses.
A significant subset are helped by amphetamines which affect both the reuptake and release of catecholamines. (A marked deficit in the release of DA and NE might cause sluggishness and underarousal.)
Converging evidence for a primary disturbance in the striatum* Polymorphisms in the DAT1 (dopamine transporter gene) are associated with ADHD. This is consistent with the centrality of the striatum in ADHD because DAT plays a particularly important role there. It is also consistent with the efficacy of methylphenidate because DAT is the primary target for the clinical action of methylphenidate. ADHD
ADHD
ADD
ADHD
Tend to be extroverted Externalizing behaviors, such as conduct disorder, aggressivity, disruptive behavior, and even oppositional defiant disorder are far more commonly comorbid with ADHD than with ADD.
More likely to be introverted Internalizing disorders, such as anxiety or depression, are somewhat more common in children with ADD than those with ADHD. ADD children tend to be socially isolated or withdrawn. Reading and language deficits and problems with mental mathematical calculations are more commonly comorbid with ADD than with ADHD ADD
A primary disturbance in prefrontal cortex is implicated. The 7-repeat allele polymorphism of the DRD4 gene is more strongly linked to ADD than to ADHD. This is consistent with the centrality of prefrontal cortex in ADD because the D4 DA receptor is present in prefrontal cortex but not in the striatum in humans.
ADD
*oldest part of cerebrum = caudate n. + lentiform n. (putamen + globus pallidus) part of extrapyramidal system
Type
or intensity of 14 months of treatment for ADHD in childhood (at age 7.0-9.9 years) does not predict functioning 6 to 8 years later
Journal of the Academy of Child and Adolescent Psychiatry 48:5 May, 2009
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parent
and teacher mean ratings of ADHD and ODD symptoms with the Swanson, Nolan, and Pelham Rating Scale (SNAP; adhd.net); parent and teacher mean ratings of aggression based on DSM-4 parent-reported mean rating of overall functional impairment with the Columbia Impairment Rating Scale (CIS) Wechsler Individual Achievement Test (WIAT)23 reading and math standardized scores
J Atten Disord. 2003 Sep;7(1):1-9. A chart review study of the inattentive and combined types of ADHD. Weiss M, Worling D, Wasdell M.
Abstract retrospective chart review data detailing the clinical characteristics of the Inattentive (IA) and Combined (C) subtypes of ADHD in 143 cases of ADHD-IA and 133 cases of ADHD-C. The children with ADHD-IA were older, more likely to be
female, had more comorbid internalizing disorders and learning disabilities. were two to five times as likely to have a referral for speech and language problems. rated as having less overall functional impairment, but did have difficulty with academic achievement. less likely to be treated with stimulants. One eighth of the children with ADHD-IA still had significant symptoms of hyperactivity/impulsivity, but did not meet the DSM-IV threshold for diagnosis of ADHD-Combined Type. ADHD-IA children are often seen as having speech and language problems, and are less likely to receive medication treatment, but respond to medical treatment with improvement both in attention and residual hyperactive/impulsive symptoms
Burns, 2010
Concentration (matching cards – regular deck or Old Maid) N – Back tasks I am going to say a letter, tell me when a letter is the same as you heard _____ back I am going on a trip(using alphabet or numbers) Scavenger hunt with a mental list
First find the rock with next to the dandelion Then follow the arrow you find under the rock to a large tree Look behind the large tree and find a clue about the bridge Follow the clue to find a prize
Following Directions – Strategies (say it to yourself), visualize what I say then follow your visual map, Imagine doing it
A display of toys or a list of words ----remove one or more. What is missing? Retelling stories – plan ahead for the kind of information that will need to be retold
From ―Visuospatial Working Memory Span: A Sensitive Measure of Cognitive Deficits in Children With ADHD,‖ by H. Westerberg, T. Hirvikoski, H. Forssberg, and T. Klingberg, 2004, Child Neuropsychology, 10.
Selective
attention – inhibition of yellow dots information in mind while executing another mental option Updating the information held in mind on each trial Temporal order memory Holding
Character list, chronology, chapter headings etc.
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How
How
many white dots?
many white dots? Last time?
How
many white dots? How many last time?
How
many white dots? Last time?
Findings
on the overlay of language to the motor sequences of tool use Video
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Part 4
Rizzolatti, et al., 2009
Mirror neuron system (MNS) (red) and its main visual input (yellow) in the human brain. anterior area located in the inferior frontal cortex, A posterior area in the rostral part of the inferior parietal lobule (IPL), Together, these three areas form Iacoboni a 'coreand Dapretto Redgrave Nature Reviews Neuroscience 7, 942–951 (December 2006) | doi:10.1038/ nrn2024 circuit' for imitation
Mirror
mechanism - neural system that unifies action perception and action execution Mirror mechanism is organized into two main cortical networks, formed by
the parietal lobe and premotor cortices the insula and anterior cingulate cortex
Role
of the Mirror Mechanism - to provide a direct understanding of the actions and emotions of others without higher order cognitive mediation
―action understanding‖ theory
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NOT JUST VISUAL – Kohler et al (2002) Hearing Sounds, Understanding Actions: Action Representation in Mirror Neurons. Science 297, August 2.
Limited
development of the mirror mechanism seems to determine some of the core aspects of autism spectrum disorders There is a recently demonstrated link between limited development of the mirror mechanism and that of some aspects of the motor system
children with and w/o autism on fMRI while they observed or imitated facial emotional expressions (a). children with autism show reduced activity in (MNS) lin the pars opercularis of the inferior frontal gyrus. Thix Iacoboni and Dapretto Redgrave Nature Reviews Neuroscience 7, 942–951 (December 2006) | doi:10.1038/ correlated nrn2024 with the severity of disorder
this suggests that rehabilitation in children with autism spectrum disorder should take into account both motor and cognitive strategies
Psych Batteries and Tests that can be used by SLP’s
Dots
incongruent vs. dots congruent pointing task Piaget’s A not B task (the well test – see Diamond video) Object or picture sorting where the sorting rule is switched Self-ordered
In the congruent condition, the correct response is to press the dot on the same side as the stimulus. In the incongruent condition, the response and stimulus are on opposite sides. In the mixed condition, equal numbers of congruent and incongruent trials are randomly intermixed.
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Each time an item is touched, the screen is refreshed, and the items reappear in the same grid. However, the location of any item in the grid will have changed, so previous responses must be encoded by the appearance of the stimulus, not by location. Choosing the same spatial location repeatedly would not result in a good score.
Behavioural Assessment of the Dysexecutive Syndrome in Children(BADS–C)
Hazel Emslie, F. Colin Wilson, Vivian Burden, Ian Nimmo-Smith, Barbara A. Wilson Author(s):
Administration: 35 to 45 minutes Qualification level: B-Level Ages / Grades: 8 to 16 years Norms: 259 U.K. controls, 8 age groups, 3 ability bands, aged scaled scores and percentile ranks Product Summary Overview BADS-C is a scientifically valid and reliable battery of tests of executive functioning for children and adolescents, with neuro-developmental disorders such as ADHD, Pervasive Development Disorder and Traumatic Brain Injury. BADS–C: Standardized child-friendly administration Standardized scoring Comprehensive norms
Contextual Memory Test
Delis–Kaplan Executive Function System™ (D–KEFS™)
by Joan P. Toglia, M.A., OTR Assess awareness of memory
Dean C. Delis, Edith Kaplan, Joel H. Kramer Assess key components of executive functions within verbal and spatial modalities
Author(s):
Administration: Flexibility in test selection; 90 minutes if all nine tests are administered; hand scorable; individual administration Software Available: Yes Qualification level: C-Level Publication Date: 2001 Ages / Grades: Ages 8 through 89 years Norms: Normed on over 1,500 individuals demographically and regionally matched with the U.S. population
Product Summary Overview Assess memory capacity, strategy of use, and recall in your adult clients with memory dysfunction. Use with a variety of diagnoses, including — Head trauma Cerebral vascular disorders Multiple sclerosis Depression Schizophrenia Chronic alcohol abuse Based on sound current theory, this standardized assessment is easy to use. You'll have extensive reliability data, scoring, and interpretation material. A-level product; see Ordering Information
Holding information in mind while inhibiting a prepotent response
Day-night Tapping ( When I tap once you tap twice) Appearance-reality (clouds)
http://www.nytimes.com/interactive/2010/06/ 07/technology/20100607-distraction-filteringdemo.html?th&emc=th
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Card sorting Go/no-go (Simon says)
Can increase complexity to increase task switching
http://www.nytimes.com/interactive/2010/
06/07/technology/20100607-task-switchingdemo.html
Say
―day‖
Say
―night‖
Understanding
the main idea the main idea Synthesis of information – including part-whole relationships and categorization Story formation Planning Problem solving Gestalt in conversations – the social importance of gestalt processing Explaining
Red
plus
Green
tree
Select
topic/theme main idea Generate vocabulary Generate sentence for each vocabulary word Connect sentences to main idea Select
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Simple story formulation activity
Cat
Food
Fish
Toys
Dog
Vet
Story: I want to have a pet. I could have a cat or a dog. I could also have a fish. I will need to feed my pets. Pets like to have toys, like a ball. If my pet gets sick I will take it to the Vet.
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