AHC Neurocognitive Study

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AHC Neurocognitive Study

• Joshua Magleby, PhD
• Integrative Neuropsychology Inc.
• Consulting Psychology Inc.

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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
  functioning
• 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

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Behavior Assessment, Modification Management

• Joshua Magleby, PhD
• Integrative Neuropsychology Inc.
• Consulting Psychology Inc.

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Agenda

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

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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.

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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

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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

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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
  environment
• All behavior serves a function
• The trick is to figure out what that function is

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Factors

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

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Behavior Chain

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

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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
• 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

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Influence of Medications

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

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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

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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
  either

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Behavior Modification

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

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Behavior Modification

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

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Modification Techniques

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

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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
  words

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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

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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

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AFC Family Data

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

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Ideas

• 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

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Ideas

• E.g., physical aggression
• A being corrected for something they know is
  wrong
• 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

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Ideas

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

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Ideas

• 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
  calm

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Important Points

• Differentiate developmentally typical vs.
  atypical
• 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

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Resources

• Websites
• www.apa.org/releases
• www.behavioradvisor.com
• www.asha.org
• Books
• Parenting the Strong-Willed Child by Forehand
  Long
• Helping the Noncompliant Child by Forehand
  McMahon
• 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