ahc neurocognitive study joshua magleby, phd integrative neuropsychology inc. consulting psychology...
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AHC Neurocognitive StudyJoshua Magleby, PhDIntegrative Neuropsychology Inc.Consulting Psychology Inc.
AHC Neurocognitive StudyExamined the neurocognitive, behavioral and adaptive functioning in AHCIn the one report of detailed neuropsychological evaluation up to that time (2005), pervasive deficits in memory, attention, executive functioning, language, psychomotor skill and psychosocial functioning were found41 participants20 males, 21 femalesMean age = 11.33 yearsMean age of diagnosis = 3.23 years2003-2006
General Intellectual Functioning (via WASI)
Academic Achievement (via WJ-III)
Rapid Picture Naming
WISC-III: Digit Span-Forward
WISC-III: Digit Span-Backward
WISC-III: Digit Span-Total
CMS Faces: Immediate Recall
CMS Faces: Delay Recall
Visual Perception/Visuomotor Integration
Social Interaction /Communication
% At-risk or Clinically Significant
AHC Neurocognitive StudyBelow age expected scores were the norm for participants with a low FSIQWide range of performances of participants with higher FSIQ scores from markedly impaired to intact or betterNeurocognitive functioning appears to decline as an individual ages Frequency and severity of AHC attacks seems to play a role in adaptive functioning Frequency and severity of hemiplegic attacks had variable influences on cognitive and behavioral functioningMedication status did not appear to influence participants scoresHowever, there was also considerable variability in test scores and parent ratings, indicating that AHC is syndromatic in regards to neurocognitive and adaptive functioning
Behavior: Assessment, Modification & ManagementJoshua Magleby, PhDIntegrative Neuropsychology Inc.Consulting Psychology Inc.
AgendaThe ABCs of behaviorInfluences on behaviorBehavior modification and managementAHC behavior data
Shocking News98% Of Babies Manic-Depressive (MARCH 23, 2009, ISSUE 4513) NEW YORKA new study published in The Journal Of Pediatric Medicine found that a shocking 98 percent of all infants suffer from bipolar disorder. "The majority of our subjects, regardless of size, sex, or race, exhibited extreme mood swings, often crying one minute and then giggling playfully the next," the study's author Dr. Steven Gregory told reporters. "Additionally we found that most babies had trouble concentrating during the day, often struggled to sleep at night, and could not be counted on to take care of themselvesall classic symptoms of manic depression." Gregory added that nearly 100 percent of infants appear to suffer from the poor motor skills and impaired speech associated with Parkinson's disease.
For exampleBehaviors of a typical 4-year-old boyInattentive, hyperactive, impulsiveADHDNoncompliant, oppositional, argueODDBehaviors of a typical 12-year-old girlSad, irritable, moodyMood DisorderBehaviors of a shy child with misarticulationsAtypical language, poor social skillsPDD
Developmentally TypicalMany behaviors that a parent or school might find disruptive, obnoxious or strange are developmentally typicalThat is, these behaviors typically occur in individuals of that ageImpulsivity, Tantrums, Moodiness, Fidgeting, etcE.g., tantrums in a 3-year-old childThat DOES NOT mean that interventions shouldnt be tried or wont be successfulShaping
What is Behavior?It is the response of the system or organism to various stimuli or inputsB.F. SkinnerHow the individual operates on their environmentAll behavior serves a functionThe trick is to figure out what that function is
Factors3 important factors to consider are
Behavior ChainMain behaviors are made up of a chain of mini behaviorsThese mini behaviors build upon one another to cause main behaviorBreaking the chain stops main behavior from occurring
1------> 2------> 3------> 4
What Influences Behavior?ExternalEnvironmentHomeClassroomTemperatureSoundVisual
The Child BrainAll behavioral development has to do with the brainBrain development is dependent upon both experience and geneticsThe brain has a great deal of plasticity and can recover over timeFrontal lobes are the last to develop, taking upwards of three decades to complete this processPrimary location of behavioral and emotional regulation, impulse control, etc.Often [but not always] more impaired in individuals with neurological disorders
Influence of MedicationsMedications can improve or worsen behavior problemsE.g., KeppraWorks well with stopping seizures in childrenHowever, also increases emotional/behavioral dysregulation and aggressionFlunarizineDrowsiness, anxiety, depression
Influence of Lack of SleepIf sleeping and dreaming do not perform vital biological functions, then they must represent natures most stupid blunder and most colossal waste of timeEvolutionary Psychiatry, 1996, 2000Alertness and arousal decreaseConcentration decreasesMotivation for activity decreasesEmotional/behavioral regulation decreasesFidgeting/overactivity increasesHypnogogic experiencesSleep deprivation in kids has been linked to what are assumed to be entirely unrelated phenomena, including lower IQ, obesity and ADHD
Influence of Fear and AnxietyFearAn emotional response to a perceived threatRelated to escape and avoidance behaviorsAnxietyTo vex or fearRelated to situations perceived as uncontrollable or unavoidableBoth can manifest in ways that do not indicate either
Behavior ModificationIn order to modify behaviors, ABC must be known [in detail if possible]Modification also depends on a number of other factorsAgeDisabilityPrevious experienceNeurocognitive functioningPresence of co-occurring issuesReduce target behavior versus increase replacement behaviorWhats more important?
Behavior ModificationWorking with a professionalProblem identificationProblem analysisIntervention developmentIntervention implementationIntervention monitoring and tweakingHabituation
Modification TechniquesPositive reinforcementGiving something that increases or maintains a behaviorTeaches the replacement behaviorE.g., child is given a tangible for staying on task or for kindness to sibling
Modification TechniquesNegative reinforcementBehavior (response) is followed by the removal of an aversive stimulus, thereby increasing that behavior's frequencyE.g., removing being grounded for using kind words
Modification TechniquesResponse costConsequence rather than punishmentE.g., If you dont put on your shoes you wont be able to go to the movieTaking a marble out of the jar when physical aggress