1. Every Child's Brain
is Different
American Association of University Women
May 10, 2010
Steve Hughes, PhD, LP, ABPdN
Assistant Professor of Pediatrics and Neurology
University of Minnesota Medical School
www.GoodAtDoingThings.com

2. What is a neuropsychologist?
! Clinical psychologist
! Postdoctoral training
! Assessment of brain functioning
! Children with medical, emotional, behavioral,
developmental problems impacting brain
development, learning, cognitive functioning, or
behavior
! Consult to parents, educators, physicians
! Research: Attention; poverty, lead exposure,
Montessori education
! Private practice in St. Paul, MN

6. Experimental interactions
with the environment

8. Learning and the brain

10. Haier, R.J., Siegel, B.V., MacLachlan, A., Soderling, E., Lottenberg, S., Buchsbaum, M.S. (1991). Regional glucose metabolic changes
after learning a complex visuospatial/motor task: a positron emission tomographic study. Brain Research, 570, P 134-143.

11. Haier, R.J., Siegel, B.V., MacLachlan, A., Soderling, E., Lottenberg, S., Buchsbaum, M.S. (1991). Regional glucose metabolic changes
after learning a complex visuospatial/motor task: a positron emission tomographic study. Brain Research, 570, P 134-143.

12. Haier, R.J., Siegel, B.V., MacLachlan, A., Soderling, E., Lottenberg, S., Buchsbaum, M.S. (1991). Regional glucose metabolic changes
after learning a complex visuospatial/motor task: a positron emission tomographic study. Brain Research, 570, P 134-143.

13. Haier, R.J., Siegel, B.V., MacLachlan, A., Soderling, E., Lottenberg, S., Buchsbaum, M.S. (1991). Regional glucose metabolic changes
after learning a complex visuospatial/motor task: a positron emission tomographic study. Brain Research, 570, P 134-143.

14. Brains learn what you
teach them

17. http://piclib.nhm.ac.uk/piclib/webimages/0/41000/400/41489_big.jpg

18. Adele Diamond

19. /February2000,Volume71, Number 1, Pages 44-56
Child Development,January
Close Interrelation of Motor Development and Cognitive Development
and of the Cerebellum and Prefrontal Cortex
AdeleDiamond
Motor development and cognitive development may be fundamentally interrelated.Contraryto popular
notions that motor developmentbegins and ends early,whereas cognitive developmentbegins and ends later,
both motor and cognitive development display equally protracteddevelopmentaltimetables.When cognitive
development is perturbed,as in a neurodevelopmentaldisorder,motor development is often adversely af-
fected.While it has long been known thatthe striatumfunctionsas partof a circuitwith dorsolateral prefrontal
cortex,it is suggested here that the same is true for the cerebellumand that the cerebellummay be important
for cognitive as well as motor functions. Like prefrontalcortex, the cerebellumreaches maturitylate. Many
cognitive tasks that requireprefrontalcortex also requirethe cerebellum.To make these points, evidence is
summarized of the close co-activationof the neocerebellumand dorsolateralprefrontalcortex in functional
neuroimaging,of similaritiesin the cognitive sequelaeof damage to dorsolateralprefrontal cortexand the neo-
cerebellum,of motor deficits in "cognitive"developmentaldisorders,and of abnormalitiesin the cerebellum
and in prefrontalcortexin the same developmentaldisorders.
INTRODUCTION thought to be critical for the most complex cognitive
In general, motor development and cognitive devel- abilities, whereas the cerebellum has been considered
critical primarily for motor skills. In keeping with the
opment have been studied separately. They have gen-
lofty status of dorsolateral prefrontal cortex, its pro-
erally been viewed as independent phenomena, al- tracted developmental timetable and dramatic ex-
though occurring in the same organism over the same
time period. Indeed, cognitive development, as befits pansion during primate evolution have been empha-
sized. The fact that the neocerebellum, which also has
its exalted status, has generally been viewed as the
last aspect of development to fully mature. Develop- undergone dramatic expansion during primate evo-
lution, is late-maturing as well has received less atten-
mental psychologists have tended to forget that motor
tion, although there has been evidence for over 55
development is equally protracted. Fine motor con-
years (see Dow, 1942) that phylogenetic development
trol, bimanual coordination, and visuomotor skills of the neocerebellum and of prefrontal cortex have
are not fully developed until adolescence, just as the
most complex cognitive operations such as accurately proceeded in parallel.
It is suggested here that the cerebellum is impor-
representing transformations, flexibly manipulating tant not only for motor functions but also for cogni-
information held in mind, and simultaneously taking tive functions. Indeed, the cerebellum is important
into account multiple facets of a problem show devel- for the very same cognitive functions for which dor-
opmental improvements into adolescence. solateral prefrontal cortex is critical. Most cognitive
Motor development and cognitive development
tasks that require dorsolateral prefrontal cortex also
may be much more interrelated than has been previ-
require the neocerebellum.
ously appreciated. Indeed, they may be fundamen-
tally intertwined.
Similarly, until very recently, prefrontal cortex and genetically newer regions of the cerebellum. These regions ma-
ture later during ontogeny than other cerebellar regions and are
the neocerebellum were not thought to participate in
interconnected with the cerebral cortex. The neocerebellum in-
similar functions.' Dorsolateral prefrontal cortex is cludes the posterior lobe of the lateral hemispheres of cerebellar
cortex (lobules HVI through HVIII, Larsell & Jansen, 1972), lob-
ules VI and VII of the vermis in the medial portion of cerebellar
1The
region of prefrontal cortex on which this paper focuses cortex, and one of the deep cerebellar nuclei (the dentate nu-
is the "dorsolateral prefrontal cortex," i.e., Areas 46 and 9. In the cleus). Like the rest of the neocerebellum, the dentate nucleus
human brain, dorsolateral prefrontal cortex extends above and has increased in size in parallel with prefrontal cortex.
below the superior frontal sulcus, past the medial frontal sulcus
to the inferior frontal sulcus. It is bordered posteriorally by Area 8
and anteriorally by Area 10. The portion of the cerebellum on ? 2000 by the Society for Research in Child Development, Inc.
which this paper focuses is the "neocerebellum," i.e., the phylo- All rights reserved. 0009-3920/2000/7101-0006

20. /February2000,Volume71, Number 1, Pages 44-56
Child Development,January
Close Interrelation of Motor Development and Cognitive Development
and of the Cerebellum and Prefrontal Cortex
AdeleDiamond
Motor development and cognitive development may be fundamentally interrelated.Contraryto popular
notions that motor developmentbegins and ends early,whereas cognitive developmentbegins and ends later,
both motor and cognitive development display equally protracteddevelopmentaltimetables.When cognitive
development is perturbed,as in a neurodevelopmentaldisorder,motor development is often adversely af-
fected.While it has long been known thatthe striatumfunctionsas partof a circuitwith dorsolateral prefrontal
cortex,it is suggested here that the same is true for the cerebellumand that the cerebellummay be important
for cognitive as well as motor functions. Like prefrontalcortex, the cerebellumreaches maturitylate. Many
cognitive tasks that requireprefrontalcortex also requirethe cerebellum.To make these points, evidence is
summarized of the close co-activationof the neocerebellumand dorsolateralprefrontalcortex in functional
neuroimaging,of similaritiesin the cognitive sequelaeof damage to dorsolateralprefrontal cortexand the neo-
cerebellum,of motor deficits in "cognitive"developmentaldisorders,and of abnormalitiesin the cerebellum
and in prefrontalcortexin the same developmentaldisorders.
“Motor development and cognitive
INTRODUCTION thought to be critical for the most complex cognitive
development may be much more interrelated
In general, motor development and cognitive devel-
opment have been studied separately. They have gen-
erally been viewed as independent phenomena, al-
abilities, whereas the cerebellum has been considered
critical primarily for motor skills. In keeping with the
lofty status of dorsolateral prefrontal cortex, its pro-
tracted developmental timetable and dramatic ex-
than has been previously appreciated. Indeed,
though occurring in the same organism over the same
time period. Indeed, cognitive development, as befits pansion during primate evolution have been empha-
sized. The fact that the neocerebellum, which also has
its exalted status, has generally been viewed as the
last aspect of development to fully mature. Develop- undergone dramatic expansion during primate evo-
they may be fundamentally intertwined.”
lution, is late-maturing as well has received less atten-
mental psychologists have tended to forget that motor
tion, although there has been evidence for over 55
development is equally protracted. Fine motor con-
years (see Dow, 1942) that phylogenetic development
trol, bimanual coordination, and visuomotor skills of the neocerebellum and of prefrontal cortex have
are not fully developed until adolescence, just as the
most complex cognitive operations such as accurately proceeded in parallel.
It is suggested here that the cerebellum is impor-
representing transformations, flexibly manipulating tant not only for motor functions but also for cogni-
information held in mind, and simultaneously taking tive functions. Indeed, the cerebellum is important
into account multiple facets of a problem show devel- for the very same cognitive functions for which dor-
opmental improvements into adolescence. solateral prefrontal cortex is critical. Most cognitive
Motor development and cognitive development
tasks that require dorsolateral prefrontal cortex also
may be much more interrelated than has been previ-
require the neocerebellum.
ously appreciated. Indeed, they may be fundamen-
tally intertwined.
Similarly, until very recently, prefrontal cortex and genetically newer regions of the cerebellum. These regions ma-
ture later during ontogeny than other cerebellar regions and are
the neocerebellum were not thought to participate in
interconnected with the cerebral cortex. The neocerebellum in-
similar functions.' Dorsolateral prefrontal cortex is cludes the posterior lobe of the lateral hemispheres of cerebellar
cortex (lobules HVI through HVIII, Larsell & Jansen, 1972), lob-
ules VI and VII of the vermis in the medial portion of cerebellar
1The
region of prefrontal cortex on which this paper focuses cortex, and one of the deep cerebellar nuclei (the dentate nu-
is the "dorsolateral prefrontal cortex," i.e., Areas 46 and 9. In the cleus). Like the rest of the neocerebellum, the dentate nucleus
human brain, dorsolateral prefrontal cortex extends above and has increased in size in parallel with prefrontal cortex.
below the superior frontal sulcus, past the medial frontal sulcus
to the inferior frontal sulcus. It is bordered posteriorally by Area 8
and anteriorally by Area 10. The portion of the cerebellum on ? 2000 by the Society for Research in Child Development, Inc.
which this paper focuses is the "neocerebellum," i.e., the phylo- All rights reserved. 0009-3920/2000/7101-0006

22. “The hand is the prehensile organ of the mind.

24. “One of the greatest mistakes of our day is to think of
movement by itself, as something apart from the higher
functions… Mental development must be connected
with movement and be dependent on it. It is vital that
educational theory and practice should become
informed by this idea” Montessori (1949).

25. Children learn with their
hands

27. Mary
Sam
Juan
Markus
Jennifer
Keiko
Danika
Sept Oct Nov Dec Jan Feb April May June

28. The Louisville Twin Study: Developmental
Synchronies in Behavior
Ronald S. Wilson
University of Louisville School of Medicine
WILSON, RONALD S. The Louisville TwinStudy:Developmental Synchroniesin Behavior. CHILD
DEVELOPMENT, 54, 298-316. The Louisville Twin Study includes nearly 500 pairs of
1983,
twins and their siblings who have participated in a longitudinal study of mental development,
beginning in infancy and extending to adolescence. The results show that individual differences
in intelligence progressivelystabilized by school age, and each child followed a distinctive pat-
tern of spurts and lags in mental development. Monozygotic twins became increasingly con-
cordantover ages and matched each other closely for developmentaltrends. By contrast,dizygotic
twins regressed to an intermediate level of concordance, comparable with that found for sib-
lings and parent-offspring sets. A comprehensivehome assessmentwas performed to identify the
home/family variables that contributed to mental development. The overall results pointed to
a strong developmental thrust in the growth of intelligence, which was principally guided by
an intrinsic genetic ground plan. Qualitative features of home and family did, however, add
significantlyto prediction of offspringIQ. The results are interpretedin the context of Wadding-
ton's developmentalmodel, and some recent advances in neurobiologyand genetics are surveyed
for their implications for developmental behavior genetics.
"It is most important to appreciate that It explicitly acknowledges that phases of
the influence of genes is not manifested only neural differentiation and growth may be
at conception or at birth or at any other switched on and off in accordance with in-
single time in the individual's life history. structions in the genetic program and sug-
Developmental processes are subject to con- gests that there are functional parallels at
tinuing genetic influence, and different genes the behavioral level. Developmental processes
are effective at different times" (McClearn, thus give expression to the dynamics of pre-
1970, p. 61). "Note first that any concept programmed change, constantly incorporating
applicable to development must be one which new episodes of growth into the preexisting
involves progressive change as time passes; phenotype and being selectively attuned to
thus we are thinking not of a constellation certain dimensions of environmental input.
of processes which just persists, but of a
'pathway of development"' (Waddington, Twins and Development
1971, p. 19).
If physical growth is taken as a model,
In capsule form, these two quotations the study of developmental processes in twins
express the essence of developmental behav- furnishes a powerful resource for examining
ior genetics. As a specialty, it focuses on the the role of gene-action systems in guiding the
emergence and development of behavioral course of growth. While there is a steady and
processes, and it inquires into the role played rapid progression from birth onward, the
by genetic factors in promoting behavioral growth rate is not entirely uniform for a
development. The operative concepts are given child; rather, it moves in episodes of
drawn from evolutionary theory and develop- acceleration and lag. The timing of the
mental genetics, which keep attention focused growth spurts follows a distinctive pattern for
on development as a continuous dynamic each child, and consequently a child who
process. may be smaller than average at one age may
Preparationof this report has been supported in part by a grant from the John D. and
Catherine T. MacArthurFoundation. I am indebted to the many co-workers who have con-
tributed so much to this program over the years, particularly Dr. Adam P. Matheny, the as-
sociate director. The pioneering contributions of the prior directors, Drs. Frank Falkner and
Steven Vandenberg, are also gratefully acknowledged. Requests for reprints should be sent to
Ronald S. Wilson, Child Development Unit, Health Sciences Center, University of Louisville,
Louisville, Kentucky 40292.
[ChildDevelopment, 1983, 54, 298-316. @ 1983 by the Society for Researchin Child Development, Inc.
All rights reserved. 0009-3920/83/5402-0020$01.001

29. The Louisville Twin Study: Developmental
Synchronies in Behavior
Ronald S. Wilson
University of Louisville School of Medicine
WILSON, RONALD S. The Louisville TwinStudy:Developmental Synchroniesin Behavior. CHILD
DEVELOPMENT, 54, 298-316. The Louisville Twin Study includes nearly 500 pairs of
1983,
twins and their siblings who have participated in a longitudinal study of mental development,
beginning in infancy and extending to adolescence. The results show that individual differences
in intelligence progressivelystabilized by school age, and each child followed a distinctive pat-
tern of spurts and lags in mental development. Monozygotic twins became increasingly con-
cordantover ages and matched each other closely for developmentaltrends. By contrast,dizygotic
twins regressed to an intermediate level of concordance, comparable with that found for sib-
lings and parent-offspring sets. A comprehensivehome assessmentwas performed to identify the
home/family variables that contributed to mental development. The overall results pointed to
a strong developmental thrust in the growth of intelligence, which was principally guided by
an intrinsic genetic ground plan. Qualitative features of home and family did, however, add
significantlyto prediction of offspringIQ. The results are interpretedin the context of Wadding-
ton's developmentalmodel, and some recent advances in neurobiologyand genetics are surveyed
for their implications for developmental behavior genetics.
"It is most important to appreciate that It explicitly acknowledges that phases of
the influence of genes is not manifested only neural differentiation and growth may be
at conception or at birth or at any other switched on and off in accordance with in-
single time in the individual's life history. structions in the genetic program and sug-
Developmental processes are subject to con- gests that there are functional parallels at
tinuing genetic influence, and different genes the behavioral level. Developmental processes
are effective at different times" (McClearn, thus give expression to the dynamics of pre-
1970, p. 61). "Note first that any concept programmed change, constantly incorporating
applicable to development must be one which new episodes of growth into the preexisting
involves progressive change as time passes; phenotype and being selectively attuned to
thus we are thinking not of a constellation certain dimensions of environmental input.
of processes which just persists, but of a
'pathway of development"' (Waddington, Twins and Development
1971, p. 19).
If physical growth is taken as a model,
In capsule form, these two quotations the study of developmental processes in twins
express the essence of developmental behav- furnishes a powerful resource for examining
ior genetics. As a specialty, it focuses on the the role of gene-action systems in guiding the
emergence and development of behavioral course of growth. While there is a steady and
processes, and it inquires into the role played rapid progression from birth onward, the
by genetic factors in promoting behavioral growth rate is not entirely uniform for a
development. The operative concepts are given child; rather, it moves in episodes of
drawn from evolutionary theory and develop- acceleration and lag. The timing of the
mental genetics, which keep attention focused growth spurts follows a distinctive pattern for
on development as a continuous dynamic each child, and consequently a child who
process. may be smaller than average at one age may
Preparationof this report has been supported in part by a grant from the John D. and
Catherine T. MacArthurFoundation. I am indebted to the many co-workers who have con-
tributed so much to this program over the years, particularly Dr. Adam P. Matheny, the as-
sociate director. The pioneering contributions of the prior directors, Drs. Frank Falkner and
Steven Vandenberg, are also gratefully acknowledged. Requests for reprints should be sent to
Ronald S. Wilson, Child Development Unit, Health Sciences Center, University of Louisville,
Louisville, Kentucky 40292.
[ChildDevelopment, 1983, 54, 298-316. @ 1983 by the Society for Researchin Child Development, Inc.
All rights reserved. 0009-3920/83/5402-0020$01.001

30. The Louisville Twin Study: Developmental
Synchronies in Behavior
Ronald S. Wilson
University of Louisville School of Medicine
WILSON, RONALD S. The Louisville TwinStudy:Developmental Synchroniesin Behavior. CHILD
DEVELOPMENT, 54, 298-316. The Louisville Twin Study includes nearly 500 pairs of
1983,
twins and their siblings who have participated in a longitudinal study of mental development,
beginning in infancy and extending to adolescence. The results show that individual differences
in intelligence progressivelystabilized by school age, and each child followed a distinctive pat-
tern of spurts and lags in mental development. Monozygotic twins became increasingly con-
cordantover ages and matched each other closely for developmentaltrends. By contrast,dizygotic
twins regressed to an intermediate level of concordance, comparable with that found for sib-
lings and parent-offspring sets. A comprehensivehome assessmentwas performed to identify the
home/family variables that contributed to mental development. The overall results pointed to
a strong developmental thrust in the growth of intelligence, which was principally guided by
an intrinsic genetic ground plan. Qualitative features of home and family did, however, add
significantlyto prediction of offspringIQ. The results are interpretedin the context of Wadding-
ton's developmentalmodel, and some recent advances in neurobiologyand genetics are surveyed
for their implications for developmental behavior genetics.
"It is most important to appreciate that It explicitly acknowledges that phases of
the influence of genes is not manifested only neural differentiation and growth may be
at conception or at birth or at any other switched on and off in accordance with in-
single time in the individual's life history. structions in the genetic program and sug-
Developmental processes are subject to con- gests that there are functional parallels at
tinuing genetic influence, and different genes the behavioral level. Developmental processes
are effective at different times" (McClearn, thus give expression to the dynamics of pre-
1970, p. 61). "Note first that any concept programmed change, constantly incorporating
applicable to development must be one which new episodes of growth into the preexisting
involves progressive change as time passes; phenotype and being selectively attuned to
thus we are thinking not of a constellation certain dimensions of environmental input.
of processes which just persists, but of a
'pathway of development"' (Waddington, Twins and Development
1971, p. 19).
If physical growth is taken as a model,
In capsule form, these two quotations the study of developmental processes in twins
express the essence of developmental behav- furnishes a powerful resource for examining
ior genetics. As a specialty, it focuses on the the role of gene-action systems in guiding the
emergence and development of behavioral course of growth. While there is a steady and
processes, and it inquires into the role played rapid progression from birth onward, the
by genetic factors in promoting behavioral growth rate is not entirely uniform for a
development. The operative concepts are given child; rather, it moves in episodes of
drawn from evolutionary theory and develop- acceleration and lag. The timing of the
mental genetics, which keep attention focused growth spurts follows a distinctive pattern for
on development as a continuous dynamic each child, and consequently a child who
process. may be smaller than average at one age may
Preparationof this report has been supported in part by a grant from the John D. and
Catherine T. MacArthurFoundation. I am indebted to the many co-workers who have con-
tributed so much to this program over the years, particularly Dr. Adam P. Matheny, the as-
sociate director. The pioneering contributions of the prior directors, Drs. Frank Falkner and
Steven Vandenberg, are also gratefully acknowledged. Requests for reprints should be sent to
Ronald S. Wilson, Child Development Unit, Health Sciences Center, University of Louisville,
Louisville, Kentucky 40292.
[ChildDevelopment, 1983, 54, 298-316. @ 1983 by the Society for Researchin Child Development, Inc.
All rights reserved. 0009-3920/83/5402-0020$01.001

31. Mary
Sam
Juan
Markus
Jennifer
Keiko
Danika
Sept Oct Nov Dec Jan Feb April May June

32. Development is not
continuous

34. A neuropsychology haiku

35. Every brain different…
Nature and nurture conspire
…to build a snowflake.

36. Domains for assessment....
! Intelligence ! Vocabulary
! Visual attention ! Fine motor skills
! Auditory attention ! Visual-motor integration
! Academic achievement ! Mood
! Executive functions ! Personality
! Visual memory ! Parent/teacher info
! Verbal memory ! Review of relevant
! Expressive language academic/medical
! Receptive language records

38. Sources of information
•Parent report
•Teacher report
•Behavioral and school history
•Medical history
•Behavioral observation
•Objective test data
•Neurological examination in some cases
•Integration of findings

40. Why make a diagnosis?
! A diagnosis provides a model that guides
treatment and which facilitates thinking about the
child
! Provides a basis for expectations of growth and
helps to evaluate treatment efficacy
! If intervention is not successful, reconsider the
diagnosis (maybe you are using the wrong model)

41. Accurate assessment guides
effective intervention

42. Learning Disability

43. Learning Disability
• A condition that prevents or hinders a
person from learning basic skills or
acquiring information at the same rate as
most people of the same age
• The affected person learns differently than
most people, and learning is more difficult
than it is for most people.

44. Typical criteria:
• Significant discrepancy between overall cognitive ability
(IQ) and achievement (Achievement Test)
• Evidence of a processing deficit is present that directly
contributes to underachievement
• The weakness must negatively impact the person’s
academic performance
• The underachievement is not primarily due to factors
other than a processing deficit, such as a head injury or
epilepsy, physical disability, or sensory impairment, (vision
or hearing), mental retardation, lack of appropriate
instruction, or psychological disturbance.

45. Common signs of a learning
disability:
• Inconsistent learning and school performance
• Difficulty remembering today what was learned yesterday
• Short attention span (restless, easily distracted)
• Persistent letter and number reversals
• Poor reading
• Persistent confusion about directions and time (right-left, up-down,
yesterday-tomorrow)
• Personal disorganization (difficulty in following simple directions/
schedules; has trouble organizing, planning, and making best use of
time; frequent loss or misplacement of homework, schoolbooks, or
other items)
• Impulsive and/or inappropriate behavior (poor judgment in social
situations, talks and acts before thinking)

46. Common signs of a learning
disability:
• Poor performance with written work but not oral work (or vice
versa)
• Speech problems (immature language development, trouble
expressing ideas, poor word recall)
• Difficulty understanding and following instructions
• Social immaturity / difficulty making friends
• Trouble remembering what just told
• Poor physical coordination
• Difficulty interpreting body language, facial expression, or tone of
voice
• Difficulty developing sound/symbol correspondence.

47. Dyslexia

48. Dyslexia
• Overwhelming evidence indicating a “circumscribed
deficit in phonological processing that impairs
decoding and prevents word identification” in the
vast majority of cases (Shaywitz, 1996)
• A lower order linguistic function that blocks access
to higher-order linguistic processes and acquisition of
meaning from text
• Verbal language comprehension and meaning making
are intact
• (Reading problems can also be due to deficient Rapid
Automatic Naming)

51. Activation
Normal
Reading Brain
Dyslexic
Reading Brain
Simos et al., 2002 (in Fletcher, 2006)

52. Before
Intevention
After
Intervention
Simos et al., 2002 (in Fletcher, 2006)

53. Brains learn what you
teach them

54. Dyslexia Interventions
• Accurate diagnosis
• Multisensory instruction
• Focus on developing phonological processing skills
• With improved decoding, also focus on fluency
development through “repeated oral reading with
feedback”
• Orton-Gillingham, Lindamood-Bell, Wilson, others…
• Review great material at www.balancedreading.com

58. !"# $% ,(3+'10
&'(2'*3+10% &'()*+*' !90:9/
,*'+(- "*+*'
,*'+(- ,*'+(-
.*'/*01+('10
&'(2'*3+10%
,*'+(-
432('5*'%
67(3+'*01+('108
&'(2'*3+10%
,*'+(-
Slide courtesy of Dr. Adele Diamond

59. Executive Functions

60. Inhibitory Control
• The ability to resist a strong inclincation to do
something and instead do what is most appropriate
or needed
• Makes it possible for us to resist acting on our first
impulse so we do not do something we’ll regret
• Helps us pay attention, and stay on task despite
bordom, difficulty, or temptation
• Necessary for SELECTIVE or FOCUSED
ATTENTION
Material courtesy of Dr. Adele Diamond

61. Working Memory
• Hold information in mind while mentally working with
it
• Critical to make sense of anything unfolding over time
• Makes it possible to consider things from different
perspectives
• Understand what reading or listening
• Remember big picture, good intentions, “why” we are
doing something
• Allows us to see connections between things
Material courtesy of Dr. Adele Diamond

62. Cognitive Flexibility
• Easily and quickly swith perspectives or attentional
focus
• Flexibly adjust to changed demands
• Think outside of the box
• Demonstrate creativity
• Critical for creative problem solving
Material courtesy of Dr. Adele Diamond

63. Executive Functions
• Executive Functions are more important for school
readiness than IQ or entry level reading or math
(Blair, 202; 2003; Blair & Razza, 2007; Normandeau &
Guay, 1998)
• Many children begin school with poor executive
functions (Smirnova, 1998; Smirnova & Gudareva,
2004)
• Most educational approaches do not foster
development of executive functions
• Weaker in 5-year-olds than 50 years ago!
Material courtesy of Dr. Adele Diamond

64. Executive Functions
• Depend upon genes and environments
• Can’t be taught in the traditional sense
• Developmental environments foster growth in
executive functions
• Traditional school experiences offer very limited
opportunities for development of executive
functions
• Hands-on learning, opportunities for motivated
engagement, and environmental “press” for self-
control
• Essential for effective goal-directed behavior

66. Quick Quiz:
What do these all have in common?
• Depression • Auditory processing
• Oppositional defiant disorder
disorder • Language disorder
• Anxiety disorder • Physical or sexual abuse
• Learning disability • Post-Traumatic Stress
• Tourette disorder Disorder
• Poor social history • Executive dysfunction
• Lead poisoning • Head injury
• Poor hearing • Neurological disease.
They are all routinely mistaken for ADHD.

67. Attention Deficit
Hyperactivity
Disorder

68. Inattention
• Often fails to give close attention to details or makes careless
mistakes in homework, work, or other activities
• Often has difficulties sustaining attention in tasks or play activities
• Often does not seem to listen when spoken to directly
• Often does not follow through instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)
• Often has difficulties organizing tasks and activities
• Often avoids, dislikes or is reluctant to engage in tasks that require
sustained mental efforts
• Often loses things necessary for tasks or activities (e.g. toys, school
assignments, pencils, books)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

69. Hyperactivity
• Often fidgets with hands or feet or squirms in seat often leaves seat in
classroom or in other situations in which remaining seated is
expected
• Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
• Often has difficulty playing or engaging in leisure activities quietly
• Is often "on the go" or often acts as if "driven by a motor"
• Often talks excessively

70. Impulsivity
• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupt or intrudes on others (e.g. butts into conversations or
games)

71. Subtypes of ADHD
• Predominantly Hyperactive Impulsive
• Predominantly Inattentive
• Combined Type

72. Additional criteria
• Some symptoms present before age 7
• Some impairment from the symptoms occurs in at least two or more
settings
• Clear evidence of clinically significant impairment in social,
academic, or occupational functioning
• Occurrence is not exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia or other Psychotic Disorder
and are not better accounted for by another mental disorder

73. http://www.ucdmc.ucdavis.edu/welcome/features/20071128_mind_adhd/photos/fMRI.jpg

74. http://ltgovernors.com/wp-content/uploads/2009/09/Injuries-and-Hospital-Use-in-Children-and-Adolescents.png

75. Effective Treatments
• Accurate diagnosis
• Parent and child education
• Specific behavior management techniques (“selective
reinforcement!”)
• Stimulant medication
• Appropriate educational program and supports
• Review material at www.chadd.org
• New: Working Memory Training

76. Medication and Performance on the
Test of Variables of Attention
Normal performance
Text
Ritalin

77. Optimal learning Optimal behavior (+ maximum heart rate!)
Heart Rate
Academic Task
Social Behavior
Placebo 0.3 mg/kg 1.0 mg/kg
Sprague & Sleaton (1977). Methylphenidate in hyperkinetic children:
Differences in dose effects on learning and social behavior. Science, 198,
1274-1276.

78. Medication Dosage Effects on Attention
and Behavior (Schematic)
Normal performance

79. Different medication doses
have different effects

80. Cogmed working memory training
www.cogmed.com

81. REPORTS
disease (15, 23, 24). We have also shown that 12. A. Pain et al., Proc. Natl. Acad. Sci. U.S.A. 98, 1805 26. We thank M. Cozens for flow cytometry support;
inhibition of platelet activation abrogates the (2001). D. Senyschen, G. Panoschi, and F. Rodda for technical
13. F. Peyron, B. Polack, D. Lamotte, L. Kolodie, support; the Australian Red Cross Blood Service for
protective effect, which could explain the delete- P. Ambroise-Thomas, Parasitology 99, 317 (1989). providing purified red blood cells; S. Jackson for advice;
rious effect aspirin may have on malarial out- 14. B. Polack, F. Delolme, F. Peyron, Haemostasis 27, 278 R. Anders for providing the P. falciparum parasites; and
come (25). (1997). C. Flowers for manuscript preparation. Funding support
15. G. E. Grau et al., J. Infect. Dis. 187, 461 (2003). was from the National Health and Medical Research
16. J. Lou et al., Am. J. Pathol. 151, 1397 (1997). Council of Australia (Program Grants 490037 and
References and Notes 17. M. R. Yeaman, A. S. Bayer, in Platelets, A. D. Michelson, 461219), Australian Cancer Research Foundation, and
1. G. Min-Oo, P. Gros, Cell. Microbiol. 7, 753 (2005). Ed. (Academic Press, Burlington, MA, 2007), Howard Hughes Medical Institute. Statistical Analysis.
2. A. D. Adedapo, C. O. Falade, R. T. Kotila, G. O. Ademowo, pp. 727–755. P values were calculated by means of two-tailed t tests,
J. Vector Borne Dis. 44, 266 (2007). 18. W. S. Alexander, A. W. Roberts, N. A. Nicola, R. Li, except where specifically mentioned. Ethics approval for
3. U. Hellgren et al., Bull. World Health Organ. 67, 197 D. Metcalf, Blood 87, 2162 (1996). animal experiments was received from the Royal
(1989). 19. H. J. Weiss, L. M. Aledort, S. Kochwa, J. Clin. Invest. 47, Melbourne Hospital, Melbourne, Australia (2002.053),
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Infect. Dis. 35, 243 (1999). A. D. Michelson, Ed. (Academic Press, Burlington, MA, Research Ethics Committee (Tasmania) Network
6. M. D. Oh et al., Am. J. Trop. Med. Hyg. 65, 143 2007), pp. 319–346. (H0009004).
21. S. Rex, J. E. Freedman, in Platelets, A. D. Michelson,
Supporting Online Material
(2001).
7. F. J. DeGraves, H. W. Cox, J. Parasitol. 69, 262 (1983). Ed. (Academic Press, Burlington, MA, 2007),
8. R. D. Horstmann, M. Dietrich, U. Bienzle, H. Rasche, Blut pp. 251–280. www.sciencemag.org/cgi/content/full/323/5915/797/DC1
42, 157 (1981). 22. M. Cattaneo, in Platelets, A. D. Michelson, Ed. (Academic Methods
Press, Burlington, MA, 2007), pp. 201–220. Figs. S1 to S6
9. S. Ladhani, B. Lowe, A. O. Cole, K. Kowuondo,
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C. R. Newton, Br. J. Haematol. 119, 839 (2002). 23. G. E. Grau et al., Eur. Cytokine Netw. 4, 415 (1993). References
10. P. Gerardin et al., Am. J. Trop. Med. Hyg. 66, 686 (2002). 24. S. C. Wassmer et al., J. Immunol. 176, 1180 (2006). 23 September 2008; accepted 4 December 2008
11. K. Chotivanich et al., J. Infect. Dis. 189, 1052 (2004). 25. M. English et al., Lancet 347, 1736 (1996). 10.1126/science.1166296
Changes in Cortical Dopamine D1 Dopaminergic neurotransmission has a cen-
tral role in WM performance (13–16), and cor-
tical dopamine release has been observed in
Receptor Binding Associated with humans during the performance of WM tasks
(17). In nonhuman primates, locally applied D1
Cognitive Training agonists, as well as antagonists, affect both per-
formance and the neuronal firing patterns of
prefrontal neurons when information is kept in
Fiona McNab,1 Andrea Varrone,2 Lars Farde,2,3 Aurelija Jucaite,2,3 Paulina Bystritsky,1 WM (18, 19). The effects seem to be dose-
Hans Forssberg,1 Torkel Klingberg1* dependent (15, 16), with evidence of an optimal
level, so that either too much or too little stimu-
Working memory is a key function for human cognition, dependent on adequate dopamine lation of D1 receptors results in reduced WM per-
neurotransmission. Here we show that the training of working memory, which improves working formance or tuning of prefrontal activity (18–21).
memory capacity, is associated with changes in the density of cortical dopamine D1 receptors. The availability of dopamine can lead to the
Fourteen hours of training over 5 weeks was associated with changes in both prefrontal and translocation of dopamine D1 receptors from the
parietal D1 binding potential. This plasticity of the dopamine D1 receptor system demonstrates a cytosol to the plasma membrane (22), and down-
reciprocal interplay between mental activity and brain biochemistry in vivo. regulation of striatal dopamine D2 receptors has
been shown to occur after 7 days of motor
W
orking memory (WM) is the ability to Intensive training on WM tasks can improve
retain information for short periods of WM capacity (8–12) and reduce cognitively re- 1
Neuropediatric Unit, Department of Woman and Child
time and is important for a wide range lated clinical symptoms (10). Training-related Health, Stockholm Brain Institute, Karolinska Institutet,
of cognitive functions (1, 2). Reduced WM ca- improvements in WM have been associated Stockholm, Sweden. 2Department of Clinical Neuroscience,
Psychiatry Section, Stockholm Brain Institute, Karolinska
pacity is associated with neurological and psy- with an increase in brain activity in parietal and Institutet, Stockholm, Sweden. 3AstraZeneca Research and
chiatric disorders (3, 4) as well as normal aging frontal regions linked to WM (9), but the bio- Development, Södertälje, Sweden.
(5). Several of these conditions are also associ- chemical underpinnings of cognitive training are *To whom correspondence should be addressed. E-mail:
ated with impaired dopamine transmission (6, 7). unknown. torkel.klingberg@ki.se
Fig. 1. Maps of baseline D1 and D2 BP, averaged across 13 human shows absolute D1 BP). (C) Overlay of (B) on (A). (D) D2 BP, measured
volunteers. (A) The averaged MRI, normalized to MNI space. (B) D1 BP, with [11C]Raclopride, averaged across participants (the bar shows
measured with [11C]SCH23390, averaged across participants (the bar absolute D2 BP). (E) Overlay of (D) on (A).
800 6 FEBRUARY 2009 VOL 323 SCIENCE www.sciencemag.org

82. REPORTS
training in developing rats (23). However, the
regulation of dopamine receptors as a result of
cognitive training has not been studied. We thus
investigated the possibility that up- or down-
regulation of cortical D1 receptors and subcortical
D2 receptors is associated with intensive mental
activity during cognitive training.
We used a previously described method of
WM training in which participants perform WM
tasks with a difficulty level close to their individ-
ual capacity limit for about 35 min per day over a
period of 5 weeks (8–10). Thirteen volunteers
(healthy males 20 to 28 years old) performed the
5-week WM training. Five computer-based WM
tests (three visuospatial and two verbal) were
used to measure each participant’s WM capacity
before and after training, and they showed a
significant improvement of overall WM capacity
(paired t test, t = 11.1, P < 0.001). The binding
Downloaded from www.sciencemag.org on March 24, 2010
potential (BP) of D1 and D2 receptors was
measured with positron emission tomography
(PET) while the participants were resting, be-
fore and after training, using the radioligands
[11C]SCH23390 and [11C]Raclopride, respectively
(Fig. 1).
To identify brain regions implicated in WM,
we conducted functional magnetic resonance
imaging (fMRI) on each individual. By compar-
ing activity during a WM task to that during a
control task, we identified regions specifically
linked to WM (P < 0.05, false discovery rate
corrected). This resulted in five regions of interest
(ROIs) (Fig. 2, A to E), which were used to
constrain the analysis of the D1 BP as follows:
(i) A right posterior ROI, which included regions
of the right parietal, temporal, and occipital corti-
ces; (ii) a left posterior ROI, which included re-
gions of the left parietal, temporal, and occipital
cortices; (iii) a right dorsolateral prefrontal ROI,
which included the right middle frontal gyrus and
right superior frontal gyrus; (iv) a left frontal
ROI, which included the left middle frontal
gyrus; and (v) a right ventrolateral prefrontal
ROI, which included the right inferior frontal
gyrus. For calculation of D2 BP, bilateral caudate
and putamen ROIs were defined anatomically.
Although WM activity in the basal ganglia was
not identified from the fMRI data in the present
study, these regions have previously been asso-
ciated with WM (11, 24) and are known to have
a high density of D1 and D2 receptors (Fig. 1D).
Based on suggestions of an inverted u-shape re-
lationship between DA levels and performance,
we analyzed the outcome using both linear
(WM = a + b1BP) and quadratic (WM = a +
b1BP + b2BP2) regression models (where a is
Fig. 2. (A to E) The five posterior (red) and frontal (green) cortical ROIs, identified from the fMRI results
(the contrast of activity recorded during the WM task minus activity recorded during a control task) and the intercept and b1 and b2 are the regression
used to constrain the analysis of D1 BP. The blue lines indicate where the axial and coronal planes coefficients).
intersect. (F to J) The application of the quadratic model for the analysis of change in WM capacity for First we averaged baseline D1 BP across the
each of the ROIs. The x axis shows D1 BP before training, the y axis the D1 BP after training, and the z axis five cortical ROIs and averaged baseline D2 BP
the improvement in WM. The colored surface represents predicted values, with warmer colors representing in the four subcortical ROIs, then analyzed the
higher values on the z axis. The black circles represent the observed data. This model predicted change relationship with overall WM capacity before
in WM capacity in all except the left frontal ROI [right posterior: F(2,10) = 4.87, P = 0.033; left posterior: training. There was no significant association for
F(2,10) = 4.82, P = 0.034; right dorsal frontal: F(2,10) = 7.19, P = 0.012; left frontal: F(2,10) = 0.71, either D1 or D2 BP (D1: linear r2 = 0.09, P =
P = 0.515; right ventral frontal: F(2,10) = 5.38, P = 0.026]. 0.33; quadratic r2 = 0.34, P = 0.12 for the whole
www.sciencemag.org SCIENCE VOL 323 6 FEBRUARY 2009 801

83. Brains learn what you
teach them (again!)

84. www.cogmed.com

86. Summing up:

87. Children learn with their hands
Experimental interaction with
the environment is essential
Development is not continuous

88. Brains learn what you teach them
Accurate diagnosis guides
effective treatment
Executive functions are critical to
school and life success

89. In ADHD, medication can help
but must be dosed properly
Other attention treatments are
available

90. Thank you for inviting me!
Watch a screencast or
download these slides at:
www.GoodAtDoingThings.com
sjh@umn.edu
651-428-8208