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AHC Neurocognitive Study


AHC Neurocognitive Study Joshua Magleby, PhD Integrative Neuropsychology Inc. Consulting Psychology Inc. – PowerPoint PPT presentation

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Title: AHC Neurocognitive Study

AHC Neurocognitive Study
  • Joshua Magleby, PhD
  • Integrative Neuropsychology Inc.
  • Consulting Psychology Inc.

AHC Neurocognitive Study
  • Examined the neurocognitive, behavioral and
    adaptive functioning in AHC
  • In 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 found
  • 41 participants
  • 20 males, 21 females
  • Mean age 11.33 years
  • Mean age of diagnosis 3.23 years
  • 2003-2006

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AHC Neurocognitive Study
  • Below age expected scores were the norm for
    participants with a low FSIQ
  • Wide range of performances of participants with
    higher FSIQ scores from markedly impaired to
    intact or better
  • Neurocognitive 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
  • Medication status did not appear to influence
    participants scores
  • However, 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 Management
  • Joshua Magleby, PhD
  • Integrative Neuropsychology Inc.
  • Consulting Psychology Inc.

  • The ABCs of behavior
  • Influences on behavior
  • Behavior modification and management
  • AHC behavior data

Shocking News
  • 98 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 example
  • Behaviors of a typical 4-year-old boy
  • Inattentive, hyperactive, impulsive
  • ADHD
  • Noncompliant, oppositional, argue
  • ODD
  • Behaviors of a typical 12-year-old girl
  • Sad, irritable, moody
  • Mood Disorder
  • Behaviors of a shy child with misarticulations
  • Atypical language, poor social skills
  • PDD

Developmentally Typical
  • Many behaviors that a parent or school might find
    disruptive, obnoxious or strange are
    developmentally typical
  • That is, these behaviors typically occur in
    individuals of that age
  • Impulsivity, Tantrums, Moodiness, Fidgeting, etc
  • E.g., tantrums in a 3-year-old child
  • That DOES NOT mean that interventions shouldnt
    be tried or wont be successful
  • Shaping

What is Behavior?
  • It is the response of the system or organism to
    various stimuli or inputs
  • B.F. Skinner
  • How the individual operates on their
  • All behavior serves a function
  • The trick is to figure out what that function is

  • 3 important factors to consider are
  • Antecedent
  • Behavior
  • Consequence

Behavior Chain
  • Main behaviors are made up of a chain of mini
  • These mini behaviors build upon one another to
    cause main behavior
  • Breaking the chain stops main behavior from
  • 1------gt 2------gt 3------gt 4

What Influences Behavior?
  • External
  • Environment
  • Home
  • Classroom
  • Temperature
  • Sound
  • Visual
  • Internal
  • Individual
  • Genetics
  • Development
  • Temperament
  • Sleep
  • Diet
  • Activity
  • Beliefs
  • Emotional distress
  • Anxiety

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The Child Brain
  • All behavioral development has to do with the
  • Brain development is dependent upon both
    experience and genetics
  • The brain has a great deal of plasticity and can
    recover over time
  • Frontal lobes are the last to develop, taking
    upwards of three decades to complete this process
  • Primary location of behavioral and emotional
    regulation, impulse control, etc.
  • Often but not always more impaired in
    individuals with neurological disorders

Influence of Medications
  • Medications can improve or worsen behavior
  • E.g., Keppra
  • Works well with stopping seizures in children
  • However, also increases emotional/behavioral
    dysregulation and aggression
  • Flunarizine
  • Drowsiness, anxiety, depression

Influence of Lack of Sleep
  • If sleeping and dreaming do not perform vital
    biological functions, then they must represent
    natures most stupid blunder and most colossal
    waste of time
  • Evolutionary Psychiatry, 1996, 2000
  • Alertness and arousal decrease
  • Concentration decreases
  • Motivation for activity decreases
  • Emotional/behavioral regulation decreases
  • Fidgeting/overactivity increases
  • Hypnogogic experiences
  • Sleep deprivation in kids has been linked to what
    are assumed to be entirely unrelated phenomena,
    including lower IQ, obesity and ADHD

NSF Data
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Influence of Fear and Anxiety
  • Fear
  • An emotional response to a perceived threat
  • Related to escape and avoidance behaviors
  • Anxiety
  • To vex or fear
  • Related to situations perceived as uncontrollable
    or unavoidable
  • Both can manifest in ways that do not indicate

Behavior Modification
  • In order to modify behaviors, ABC must be known
    in detail if possible
  • Modification also depends on a number of other
  • Age
  • Disability
  • Previous experience
  • Neurocognitive functioning
  • Presence of co-occurring issues
  • Reduce target behavior versus increase
    replacement behavior
  • Whats more important?

Behavior Modification
  • Working with a professional
  • Problem identification
  • Problem analysis
  • Intervention development
  • Intervention implementation
  • Intervention monitoring and tweaking
  • Habituation

Modification Techniques
  • Positive reinforcement
  • Giving something that increases or maintains a
  • Teaches the replacement behavior
  • E.g., child is given a tangible for staying on
    task or for kindness to sibling

Modification Techniques
  • Negative reinforcement
  • Behavior (response) is followed by the removal of
    an aversive stimulus, thereby increasing that
    behavior's frequency
  • E.g., removing being grounded for using kind

Modification Techniques
  • Response cost
  • Consequence rather than punishment
  • E.g., If you dont put on your shoes you wont
    be able to go to the movie
  • Taking a marble out of the jar when physical
    aggression occurs
  • Stepwise - consequences increase
  • As natural as possible
  • A word about punishment
  • Can be effectivebut
  • Does not teach the replacement behavior
  • Tends to be short-lived
  • Can worsen the behavior

AHC Family Data
  • Behavior questionnaire 15
  • Behavior
  • Aggression 12
  • Property destruction 3
  • Temper tantrums/rages 3
  • Mood swings 3
  • Indecision 2
  • Attention seeking 2
  • Overly dependent 2
  • Impulsivity, leaving without permission,
    echolalia, eating problems, shyness, O/C,
    attention problems, yelling/screaming, toileting
    problems, transitional problems

AFC Family Data
  • Interventions
  • Removal from environment 4
  • Ignoring 3
  • Lecture 3
  • Sleep 2
  • Holding
  • Time Out
  • Tangible
  • Patience

  • Know the ABCs of the behavior
  • E.g., physical aggression
  • A frustration
  • B aggression
  • C holding
  • Reduce frustration situation, praise/tangible for
    keeping their cool, remove from situation,
    prompt before situation begins

  • E.g., physical aggression
  • A being corrected for something they know is
  • B aggression
  • C taken to room and allowed to calm down
  • Praise for appropriate behavior, give a
    prompt/cue that behavior may become
    inappropriate, maintain calm, maintain distance

  • E.g. crankiness
  • A waking from a nap
  • B crankiness
  • C held, comforted
  • Soothing waking, primary reinforcer immediately
    upon waking, patience

  • E. g., irritability/personality change
  • A physical discomfort headache
  • B irritability/personality change
  • C medication and rest
  • Early identification, collect data on headache
    incidence e.g., frequency, pattern, maintain

Important Points
  • Differentiate developmentally typical vs.
  • Can my child perform this behavior, based on
  • Age
  • Impairments
  • Experience
  • RememberAHC kids are just thatkids
  • RememberALL kids have bad days
  • Know the chain of behaviors, so you can stop
    progression to more extreme behavior
  • Be consistent with your responses
  • Be flexible in your interventions
  • RememberYOUR behavior influences THEIR behavior
  • Stay calm
  • Stay vigilant
  • Stay consistent

  • Websites
  • www.apa.org/releases
  • www.behavioradvisor.com
  • www.asha.org
  • Books
  • Parenting the Strong-Willed Child by Forehand
  • Helping the Noncompliant Child by Forehand
  • SOS! Help for Parents A Practical Guide for
    Handling Everyday Behavior Problems by Lynn Clark
  • 50 Great Tips, Tricks Techniques to Connect
    With Your Teen by Debra H. Ciavola
  • maglebyphd_at_gmail.com
  • www.ini.org
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