Frontal-subcortical circuitry in social attachment and relationships: A cross-sectional fMRI ALE meta-analysis.

Researchers have explored the concept of attachment in multiple ways, from animal studies examining imprinting to abnormal attachment in psychopathology. However, until recently, few have considered how neural circuitry develops the effective social bonds that are subsequently replicated in relationships across the lifespan. This current cross-sectional study undertook a fMRI Activation Likelihood Estimation (ALE) meta-analyses to examine the neurocircuitry that governs emotional and behavioural functions critical for building effective social relationships in children and adults. Results suggest that dissociable dorsal cognitive ("cool") and ventral - affective ("hot") frontal-subcortical circuits (FSC) work together to govern social relationships, with repeated social consequences leading to potentially adaptive - or maladaptive - relationships that can become routinized in the cerebellum. Implications for forming stable, functional, social bonds are considered, followed by recommendations for those who struggle with cool and hot FSC functioning that can hinder the development of adaptive prosocial relationships.

Neuropsychological Profiles of Written Expression Learning Disabilities Determined by Concordance-Discordance Model Criteria.

Children with specific learning disabilities (SLD) have disparate neuropsychological processing deficits that interfere with academic achievement in spelling, writing fluency, and/or written expression (WE). Although there are multiple potential causes of WE SLD, there is a paucity of research exploring this critical academic skill from a neuropsychological perspective. This study examined the neuropsychological profiles of WE SLD subtypes defined using the concordance-discordance model (C-DM) of SLD identification. Participants were drawn from a sample of 283 children (194 boys, 89 girls) aged 6 years to 16 years old (M(age) = 9.58 years, SD = 2.29 years) referred for comprehensive neuropsychological evaluations in school settings and subsequently selected based on C-DM determined spelling, writing fluency, and WE SLD. WE SLD subtypes differed on several psychomotor, memory, and executive function measures (F range = 2.48-5.07, p range = .049 to <.001), suggesting that these children exhibit distinct patterns of neuropsychological processing strengths and weaknesses. Findings have relevance for differential diagnosis of WE subtypes, discriminating WE SLD subtypes from low WE achievement, and developing differentiated evidence-based instruction and intervention for children with WE SLD. Limitations and future research will be addressed.

Evaluating orbital-ventral medial system regulation of personal attention: a critical need for neuropsychological assessment and intervention.

Attention to self and environment form the basis of effective social exchange and relationships. Although implicit in this basic social competency is the ability to be self-aware and responsive to the circumstances of others, many neuropsychologists have yet to understand or measure its basic functions, let alone recognize the brain-behavior relationships that govern this area. Several years ago, interest in "emotional intelligence" rose to the forefront of popular psychology, but we are still unraveling the cortical, subcortical, and neurocellular interactions that produce this nebulous construct, and we are determining how dysfunctional frontal-subcortical and cortico-cerebellar circuitry can lead to aberrant social dynamics and ultimately psychopathology when maladaptive patterns become routinized. In this article, we explore the orbital-ventral medial circuitry thought to govern emotional attention, personal self-regulation, social concern and exchange, and affective aspects of interpersonal relationships. Our examination notes both the dearth of and need for neuropsychological research on the biological basis and measurement of executive regulation of emotional attention, behavioral regulation, and social competence. We conclude with a call for development of neuropsychological measures and methods that can foster differential diagnosis and targeted treatment strategies for children with orbital-ventral medial circuit dysfunction.

Reconsidering "inattention" in attention-deficit hyperactivity disorder: implications for neuropsychological assessment and intervention.

Attention-deficit hyperactivity disorder (ADHD) does not exist. This explicit statement needs elucidation of course given ADHD is a common neurodevelopmental disorder, but it provides the reader with the impetus to reconsider long-held beliefs about this condition and its treatment. Surely, there is a disorder called ADHD from which this thesis is framed, but primary attention and hyperactivity-impulsivity problems are mediated by different albeit interrelated brain systems. Like many neurodevelopmental disorders (e.g., learning disabilities, autism spectrum disorder), the medical and psychological professions have used a single, large inclusive ADHD diagnostic category to represent children with different etiologies for their overt symptoms. Despite neurobiological differences among children diagnosed with ADHD, the clinical position that attention-deficit or primary attention problems are sufficient for ADHD identification undermines clinical practice. This commonly accepted dubious position not only undermines the diagnostic utility of our neuropsychological measures, but it attenuates treatment effects as well. Supported with evidence from our ongoing ADHD research program, this data-based review will support these contentions and provide implications for diagnosis and treatment of children with attention problems.

Psychosocial and Adaptive Deficits Associated With Learning Disability Subtypes.

Children with specific learning disabilities (SLD) have deficits in the basic psychological processes that interfere with learning and academic achievement, and for some SLD subtypes, these deficits can also lead to emotional and/or behavior problems. This study examined psychosocial functioning in 123 students, aged 6 to 11, who underwent comprehensive evaluations for learning and/or behavior problems in two Pacific Northwest school districts. Using concordance-discordance model (C-DM) processing strengths and weaknesses SLD identification criteria, results revealed working memory SLD (n = 20), processing speed SLD (n = 30), executive SLD (n = 32), and no disability groups (n = 41). Of the SLD subtypes, repeated measures MANOVA results revealed the processing speed SLD subtype exhibited the greatest psychosocial and adaptive impairment according to teacher behavior ratings. Findings suggest processing speed deficits may be behind the cognitive and psychosocial disturbances found in what has been termed "nonverbal" SLD. Limitations, implications, and future research needs are addressed.

The effects of methylphenidate on cognitive function in children with attention-deficit/hyperactivity disorder.

Focusing on behavioral criteria for attention-deficit/hyperactivity disorder (ADHD) diagnosis leads to considerable neuropsychological profile heterogeneity among diagnosed children, as well as variable response to methylphenidate (MPH) treatment. Documenting "cold" executive working memory (EWM) or "hot" self-regulation (SR) neuropsychological impairments could aid in the differential diagnosis of ADHD subtypes and may help to determine the optimal MPH treatment dose. In this study, children with ADHD inattentive type (n = 19), combined type (n = 33), and hyperactive-impulse type (n = 4) underwent randomized controlled MPH trials; neuropsychological, behavioral, and observational data were collected to evaluate the children's responses. Those with moderate or significant baseline EWM/SR impairment showed robust MPH response, whereas response for those with lower baseline impairment was equivocal. Implications for medication use and titration, academic achievement, and long-term treatment efficacy are examined.

Estimating base rates of impairment in neuropsychological test batteries: a comparison of quantitative models.

Neuropsychologists frequently rely on a battery of neuropsychological tests which are normally distributed to determine impaired functioning. The statistical likelihood of Type I error in clinical decision-making is in part determined by the base rate of normative individuals obtaining atypical performance on neuropsychological tests. Base rates are most accurately obtained by co-normed measures, but this is rarely accomplished in neuropsychological testing. Several statistical methods have been proposed to estimate base rates for tests that are not co-normed. This study compared two statistical approaches (binomial and Monte Carlo models) used to estimate the base rates for flexible test batteries. The two approaches were compared against empirically derived base rates for a multitest co-normed battery of cognitive measures. Estimates were compared across a variety of conditions including age and different α levels (N =3,356). Monte Carlo R(2) estimates ranged from .980 to .997 across five different age groups, indicating a good fit. In contrast, the binomial model fit estimates ranged from 0.387 to 0.646. Results confirm that the binomial model is insufficient for estimating base rates because it does not take into account correlations among measures in a multitest battery. Although the Monte Carlo model produced more accurate results, minor biases occurred that are likely due to skewess and kurtosis of test variables. Implications for future research and applied practice are discussed.

On the importance of a cognitive processing perspective: an introduction.

Children with learning problems require early intervention. If it is evidence based and implemented with integrity and intensity, it will accelerate the academic progress of many students. This is the hope and expectation of the many supporters of responsiveness-to-intervention (RTI). A minority of children, however, will not respond sufficiently to such intervention because of learning disorders like specific learning disabilities (SLD). Some RTI models do not include research-backed methods to identify these children, nor do RTI practitioners often produce the data necessary to develop individualized instruction for them. The authors suggest practitioners go beyond typical RTI assessment data documenting responsiveness/ unresponsiveness to conduct comprehensive evaluations of these most difficult-to-teach students and to include in their evaluations carefully chosen cognitive measures. This special issue presents the work of teams of researchers, which suggests that cognitive and neuropsychological assessments can provide information to further understand SLD, which in turn can guide development of promising interventions.

Executive impairment determines ADHD medication response: implications for academic achievement.

Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to indirect informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed.

Development and validation of an attention-deficit/hyperactivity disorder (ADHD) executive function and behavior rating screening battery.

Attention problems are ubiquitous in clinical practice, commonly found in many childhood learning and behavior disorders. Practitioners need cost- and time-effective methods for determining whether children have attention problems due to attention-deficit/hyperactivity disorder (ADHD) or numerous other conditions. This study examined the utility of a 15-minute ADHD screening battery designed to differentiate ADHD (including inattentive, IT, and combined, CT, subtypes), specific learning disability (SLD), and typical child samples. Results for the 368 children (age 6 to 12 years) revealed that the Trail Making Test-Part B (Time/Errors), Hale-Denckla Cancellation Test (Time/Correct), and Child Attention Profile (Inattention/Overactivity) teacher ratings discriminated between typical and ADHD groups (87% correct classification; sensitivity = .64; specificity = .92) and differentiated between IT, CT, and SLD groups (80% correct classification; IT sensitivity = .82, and specificity = .96; CT sensitivity = .84, and specificity = .82). Discriminant function and Bonferroni post hoc results revealed different neuropsychological and behavioral patterns among groups.

Interpreting intelligence test results for children with disabilities: is global intelligence relevant?

School psychological and neuropsychological evaluations typically include intellectual and other standardized assessment tools in the identification of children with disabilities. The clinical utility of intellectual assessment in the identification and treatment of these children has been repeatedly challenged, with alternatives such as a response to intervention or global intelligence score interpretation offered to replace the long-held tradition of idiographic interpretation of intellectual factors or subtests for the purpose of differential diagnosis and individualized intervention. Replicating previous work, this study examined the structure of intellectual functioning for children diagnosed with Learning Disability (LD; n=128), Attention-Deficit/Hyperactivity Disorder (ADHD; n=71), and traumatic brain injury (TBI; n=29) using regression commonality analysis. Across groups, results provide substantial evidence for a multifactorial representation of intellectual functioning for children with LD, ADHD, or TBI, with little shared variance among factor predictors of FSIQ in each analysis. As global intellectual functioning, represented by the shared variance among all predictors, was largely absent and instead composed of several discrete elements with the requisite specificity for individual interpretation, idiographic interpretation appears to be warranted for children with disabilities.