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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

  • (M[SD])

    Range

    General Intellectual Functioning (via WASI)

    FSIQ

    62.52[14.00]

    50-94

    VIQ

    69.15[15.88]

    55-104

    PIQ

    63.65[15.35]

    53-103

    Matrix Reasoning

    27.50[10.40]

    20-53

    Academic Achievement (via WJ-III)

    Reading

    Rapid Picture Naming

    54.88[24]

    13-101

    Letter-Word ID

    60.83[27.37]

    19-140

    Passage Comprehension

    45.10[26.22]

    6-92

    Word Attack

    51.06[28.40]

    1-91

    Mathematics

    Calculation

    51.40[22.40]

    18-97

    Applied Problems

    62.46[29.87]

    36-139

    Language

    PPVT-III

    62.44[19.82]

    40-112

    WASI Vocabulary

    29.40[12.45]

    20-57

    WASI Similarities

    30.12[10.16]

    20-50

    Attention

    WISC-III: Digit Span-Forward

    68[8.51]

    60-85

    Executive Function/Memory

    CVLT-C

    Trial 1

    79.33[18.24]

    55-115

    Semantic Clustering

    96.22[20.01]

    63-123

    Learning Slope

    78.67[14.37]

    55-100

    Recall Consistency

    71[26.81]

    55-100

    Perseverations

    88.9[7.55]

    78-100

    Primacy

    119.27[42.02

    55-175

    Recency

    108.44[38.91]

    55-175

    Trial 5

    63.25[27.67]

    25-108

    Long-Term Recall

    60.5[19.17]

    55-93

    Recognition

    88.4[12.70]

    63-108

    Discriminability

    64.1[31.40]

    25-108

    Total

    61[9.15]

    40-112

    WISC-III: Digit Span-Backward

    66.15[13.10]

    55-100

    WISC-III: Digit Span-Total

    63.08[12.17]

    55-90

    CMS Faces: Immediate Recall

    67.5[17.65]

    55-95

    CMS Faces: Delay Recall

    67.23[18.79]

    55-105

    Visual Perception/Visuomotor Integration

    Clock Drawing

    47.32[11.12]

    40-81

    VMI

    60[17.45]

    45-95

  • Broad

    Independence

    Motor Skills

    Social Interaction /Communication

    Skills

    Personal Living

    Skills

    Community

    Living Skills

    Total SS

    32.44[25.05]

    26.05[22.46]

    59.77[27.65]

    44.96[29.29]

    36.32[26.59]

    Total Range

    1-97

    1-86

    1-113

    1-110

    1-91

    Total Age

    5.27

    3.63

    6.88

    5.64

    5.85

    INDEX/Skill

    Total T

    (M[SD])

    Total

    Range

    % At-risk or Clinically Significant

    EXTERNALIZING

    54.53[12.81]

    18-83

    25

    Hyperactivity

    63.93[16.88]

    30-92

    39

    Aggression

    49.43[9.05]

    27-69

    10

    Conduct Problems

    48.03[12.55]

    10-79

    10

    INTERNALIZING

    53.33[12.79]

    16-76

    25

    Anxiety

    46.55[10.93]

    29-73

    7

    Depression

    52.37[12.75]

    7-72

    25

    Somatization

    59.37[13.63]

    36-94

    37

    BSI

    57.23[12.71]

    12-76

    34

    Atypicality

    59.63[12.10]

    43-97

    25

    Withdrawal

    56.60[16.00]

    9-88

    34

    Attention Problems

    59.40[13.52]

    7-76

    41

    ADAPTIVE SKILLS

    42.93[12.85]

    21-85

    39

    Adaptability

    43.50[13.01]

    22-74

    50

    Social Skills

    48.14[14.52]

    20-97

    20

    Leadership

    37.33[8.15]

    21-58

    15

  • 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

    Antecedent

    Behavior

    Consequence

  • 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

    InternalIndividualGeneticsDevelopmentTemperamentSleepDietActivityBeliefsEmotional distressAnxiety

  • 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

  • NSF Data

  • 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