PEELING BACK THE LAYERS OF THE “I” FROM A NEUROPSYCHOLOGICAL PERSPECTIVE October 19 th , 2013 3 rd Annual DIR/ Floortime Coalition of California Conference Dr. Jonine Biesman. MAIN POINTS TO TAKE AWAY: #1.
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PEELING BACK THE LAYERS OF THE “I” FROM A NEUROPSYCHOLOGICAL PERSPECTIVEOctober 19th, 2013 3rd Annual DIR/Floortime Coalition of California ConferenceDr. JonineBiesman
LOCALIZED MODELS OF BRAIN FUNCTION AND CATEGORICAL MODELS OF DIAGNOSIS (DSM and ICD) SERVE NO UTILITY IN OUR UNDERSTANDING AND TREATMENT OF NEURODEVELOPMENTAL DISORDERS.
COMPLEX BRAIN SYSTEMS REQUIRE COMPLEX, MULTIDIMENSIONAL INTERVENTION MODELS!
WE WILL BENEFIT FROM EXPANDING OUR UNDERSTANDING AND ASSESSMENT OF THE “I” IN OUR OWN DIR MODEL.
NONE OF THE ABOVE IS REALLY RELEVANT UNLESS WE TAKE WHAT WE ARE LEARNING ABOUT BRAIN FUNCTION AND THEORY AND TRANSLATE THIS INTO DAY TO DAY PRACTICE TO BEST GUIDE INDIVIDUALS AND FAMILIES.
ACT ONE:LOCALIZED MODELS OF BRAIN FUNCTION AND CATEGORICAL MODELS OF DIAGNOSIS (DSM and ICD) SERVE NO UTILITY IN OUR UNDERSTANDING AND TREATMENT OF NEURODEVELOPMENTAL DISORDERS.
Seeks to identify the brain regions, systems, and/or networks that generate behavior
Defines diagnosis by a set of behaviors that are assigned to a category
ON A BETTER PATH
Looks Different from Our “I”:-Regulatory Capacities-Motor Planning-Auditory-Verbal: Receptive & -Expressive Processing-Visual Spatial Processing-Praxis- EF Prefrontal CortexHmmmmm??
SO SORRY CORTEX… IT IS NOT ALL ABOUT YOU. YOU HAVE TO BE GRATEFUL FOR YOUR SUPPORT SYSTEM, BECAUSE YOU RELY ON THEM…HEAVILY!
“The cerebral cortex cannot drive all behavior independently. Rather, the brain usually drives behavior by functioning as an integrated whole that requires interactions between the cerebral cortex, the basal ganglia, and the cerebellum. “Top-down,” higher level cognitive and behavioral functions only occur with “bottom-up” subcortical support. –Koziol et.al, 2013
The cortex, basal ganglia, and cerebellum operate in parallel to generate adaptive behaviors.The basal ganglia and cerebellum play important roles in deciding what information is or is not “used” by the cortex
-Koziol et. al, 2013
IN DOING SO, THE CEREBELLUM REGULATES THE QUALITY OF BEHAVIOR BY ALLOWING AUTOMATED BEHAVIORS TO BE ADAPTED TO CHANGING SITUATIONS.
They Consist of:
THEY SERVE AS A MASSIVE INHIBITORY SYSTEM. IN ESSENCE, THEY TELL WHAT REGIONS OF THE CORTEX TO BECOME ACTIVE WHEN– A GATING FUNCTION.
WE HAVE COME TO UNDERSTAND THAT A WIDE RANGE OF BEHAVIORS CAN BE EXPLAINED ON THE BASIS OF BASAL GANGLIA PRINCIPLES OF SELECTION AND INHIBITION.
Way more than coprocessors of movement….It is theorized that the brain evolved to control action and movement. These same neural circuits are involved in cognition, emotion, & motivation. The mapping of frontal-basal ganglia connections demonstrates the neocortex does not function alone!
DESPITE THE BEST ATTEMPTS OF CORTEX, A DISTURBANCE WITHIN THE BASAL GANGLIA WILL COMPROMISE TOP-DOWN VOLITIONAL CONTROL. CARRYING OUT INTENTIONS REQUIRES THIS ADDITIONAL BOTTOM-UP SUPPORT.
THE BASAL GANGLIAThe basal ganglia are associated with a variety of functions, including voluntary motor control, procedural learning relating to routine behaviors or "habits" (e.g., eye movements, cognitive,and emotional functions.Involved in action selection, or the decision of which of several possible behaviors to execute at a given time. Experimental studies show that the basal ganglia exert an inhibitory influence on a number of motor systems, and that a releaseof this inhibition permits a motor system to become active.
Since at least 95% of what we do during the day as humans requires us to function automatically and without thinking, when the neural circuits that allow for this are disrupted, learning and adaptation become affected. Namely, we operate with two systems -- one that is automatic and one that requires cognitivecontrolfor novel situations. When we are faced with those tasks for which we cannot rely on our automatic responses (because they do not work for a particular situation), we must make adjustments. Then upon making and practicing such adjustments, we then become more skilled in the situation or task that was novel.
COMPLEX BRAIN SYSTEMS REQUIRE COMPLEX, MULTIDIMENSIONAL INTERVENTION MODELS!
“One synapse may contain on the order of 1,000 molecular scale switches. A single human brain has more switches than all the computers and routes and internet connections on earth.”-Stanford University Professor Steven Smith
OR… THINK OF IT THIS WAY:Imagine a bustling city the size of New York. Give every person in that city 10,000 pieces of string. Tell each person to attach each piece of string to a different person. Now make the city a thousand times bigger. This is the incredible tangle we call the… BRAIN!
The continuous formation and remodeling of long-range white matter connections occurring very early in life is a necessary prerequisite for the development of normal cognitive functions.Alterations of this process may be responsible for adverse neurodevelopmental consequences
Sebastian Seung and his lab at MIT are inventing technologies for identifying and describing the connectome, the totality of connections between the brain's neurons -- think of it as the wiring diagram of the brain. We possess our entire genome at birth, but things like memories are not "stored" in the genome; they are acquired through life and accumulated in the brain. Seung's hypothesis is that "we are our connectome," that the connections among neurons is where memories and experiences get stored.
At the TEDGlobal Conference 2010. Seung put forth some “ideas worth spreading”:1) “We are our connectome.”2) It took over 12 years to map the connectome of a worm that has 300 neurons
Seung (cont.)3) The human brain is far more complex with 100 billion neurons and 10x as many more connections.4) The theory was puported that memories, personality, intellect are stored in the connections between neurons
Seung (cont.) 5) Finding an entire human connectome is one of the greatest technological challenges of all time and will take the work of generations to succeed.
Seung (cont.)6) To some extent neurological changes are programmed by our genes, but that is not the whole story…There is evidence that our neural activity is encoding our thoughts, feelings, and perceptions of our mental experiences.
Seung (cont.)THIS MEANS THAT EXPERIENCES CAN CHANGE YOUR CONNECTOME. THAT IS WHY EACH CONNECTOME IS UNIQUE.“The connectome is where nature meets nurture.”
was coined in analogy with the “genome”—the entirety of an organism’s hereditary information
“Historically, we focused on mapping brain structure, but we haven’t spent a lot of time looking at how those structures are wired together, what the connections between them are, and how they function.”
-Arthur Toga, Director of the UCLA Laboratory of Neuroimaging
Well, Yes. We do have Standardized Measures to Access Across a Range of Brain Functions…BUT…It is the process that tells the story, not the numbers. It is the time spent with a child developing a strong relationship and seeing what we see that matters most… Of course, with the benefit of a strong foundation in brain-behavior relationships.
2) They too often get interpreted at face value
3) Limited ecological validity
There Are Inherent Problems with the use of Standardized Neuro-psychological Tests & Measurement Methods in Isolation:
In neuropsychology Go/No-go tests are used to measure a participant's capacity for sustained attention and response control. For example, a go/no-go test that requires a participant to perform an action given certain stimuli (e.g., press a button - Go) and inhibit that action under a different set of stimuli (e.g., not press that same button - No-Go).
How Are those Sticky, Daily Life Problems Best Addressed With a More Sophisticated Understanding of Individual Differences?Meltdowns, homework, stress/hardship, screen time, distractibility, disorganization, non-compliance, aggression, sibling conflict, separation anxiety, fear, obsessions, etc.
Limits will still be established and implemented, but within the framework of understanding, parent education, compassion, flexibility, and skill Modifying the environment around a child with special needs can be one of the most important things we do.
ABA seems likened to old models of brain localization. It often teaches to an isolated skill set that is disconnected in the moment from any meaningful context. In this way, learning seems subpar, not as likely to be meaningfully encoded.
If we have to get to the level of automated functions, what is the best way in which to accomplish this? And how can we prepare children, adolescents, and parents for “cognitive control episodes?”
Not all practice looks the same. Nor, does it generate the same results. Sure, learning involves a level of reward saliency and reward contingency (If this, then that); but we prefer a model that suggests, “If/when you look at me the result is warmth and connection”, versus “good job looking”
USE THE “SYMPTOMS” BEFORE YOU TO THINK IN “SYSTEMS”. START TO PUT THE PIECES OF THE PUZZLE TOGETHER THROUGH YOUR KEEN BEHAVIORAL OBSERVATIONS, AND THINK OF NEURAL SYSTEMS, FAMILY SYSTEMS, PEER SYSTEMS, EDUCATIONAL SYSTEMS AND COMMUNITY SYSTEMS IN CONTRUCTING A WHOLISTIC TREATMENT PLAN
a new point of view in educational theory. Especially in
childhood we misunderstand its nature and a number of
mistaken ideas make us think of it as something less noble
than it actually is. As a part of school life, which gives
priority to the intellect, the role of movement has always
been sadly neglected. When accepted there at all, it has
only been under the heading of ‘exercise,’ ‘physical
education,’ or ‘games.’ But this is to overlook its close
connection with the developing mind” (Montessori, 1949).