james b. hale, phd, med, abpdn, absnp - masp.mb.ca · reduced activation in right orbitofrontal...

School Neuropsychology of Behaviourand Psychopathology

James B Hale PhD MEd ABPdN ABSNPProfessor of Education and Medicine

University of Calgary

halejbucalgaryca

Kelly Ryan Hicks MScRegistered Psychologist

School Psychologist Calgary Board of Education

Manitoba Association of School Psychologists14-15 November 2013

bull Phineas Gage was a railroad foreman who

had a tamping pole blown through his

orbital and dorsolateral prefrontal regions

bull He was walking and talking a few minutes

after the injury but vomited sending more

brain tissue to the floor with swelling

leading to coma

bull Recovery was slow mood was variable

and he was disinhibited contentious and

socially inept so ldquono longer Gagerdquo

bull Frontal lobes and limbic system ldquoSeat of

Personalityrdquo and psychopathology (not far

off)

The Strange Case of Phineas Gage

Physiological Basis of Psychopathology

bull Eysenck (1967) Theory of Autonomic Arousal Internalizing and externalizing dimensions

Internalizers have cortical overarousal Cope by limiting environmental stimuli

Externalizers have cortical underarousal Cope by seeking environmental stimuli

Hemispheric Functions and Psychopathology

bull Sackheim (1982) review of hemispheric functions and psychopathology

Left hemisphere lesionsanesthetization and catastrophicdepressive reactions

Right hemisphere lesionsanesthetization and euphoricindifferent reactions

bull Davidsonrsquos (2000) work in brain functioning in typical populations

Left hemisphere activation = Positive affect The ldquoapproachrdquo hemisphere

Right hemisphere activation = Negative affect The ldquoavoidantrdquo hemisphere

bull Implications for discordant-divergent (new relationships) and concordant-convergent (known relationships) thought

Cortical-Subcortical Circuits and the Third Axis

Oculo-motor

Motor

BasalGanglia

Thalamus

Cingulate

Cerebellum

Working memory memoryencoding amp retrieval

Attention concentrationactivity and impulse control

Plan organize strategize implement monitor evaluate modify and amp change behaviour

Anterior Cingulate Circuit and Psychopathology

bull Cognitive Functions ndash arousal motivation performance monitoring switching behavioral initiation posterior-anterior communication online data processing manager (like RAM)

bull Dysfunction Psychopathologies ndash depression bipolar ADHD schizophrenia autism

bull Associated Neuropsychological Deficits ndash Internal state executive skills

Apathy or poor motivation

Poor response control and shiftingswitching behavior

Difficulty with decision-making

Lack of enjoyment ndash anhedonia

Poor response to reinforcement

Slow processing speed

Limited idea generation and creativity

Dorsolateral Prefrontal Circuit and Psychopathology

bull Cognitive Functions ndash planning organizing strategizing monitoring evaluating shifting and changing behavior working memory memory encoding and retrieval strategy generation and hypothesis testing

bull Dysfunction Psychopathologies ndash depression schizophrenia ADHD autism

bull Associated Neuropsychological Deficits ndash External task-oriented executive skills

Difficulty with hypothesis generation and problem solving

Limited or excessive interest in environment

Poor sustained attention

Mental inflexibility

Decreased verbal and design fluency

Encoding andor retrieval from long-term memory deficits

Poor planning organization and checking behavior

Orbital Prefrontal Circuit and Psychopathology

bull Cognitive Functions ndash indirect influence on tasks emotional and behavioral self-regulation inhibition empathy social control integrating emotions into contextually relevant behavior

bull Dysfunction Psychopathologies ndash obsessive compulsive disorder anxiety disorder bipolar disorder conduct disorder


Perseveration or disinhibition

Tactlessness

Irritability

Sexual deviance (extreme interest or disinterest)

Antisocial or asocial behaviors

Inappropriate feelings (eg sadness or euphoria)

Orbital Prefrontal Circuit and Theory of Mind

bull Theory of Mind ndash the ability to take the perspective of others or feel empathy

bull Does empathy only require perception or does it also require Action

bull Posterior systems linked to affect perception

Parietal lobe and ldquomirrorrdquo neurons

Temporal lobe and face recognition

bull Why then is theory of mind linked to the frontal systems

Pars opercularis and imitation

Medial orbital cortex and theory of mind

bull Are posterior systems related to affect perception while anterior systems related to empathy

The Often Neglected Cerebellum Motor Functioning or The Mini Brain

bull Cerebellum is ldquomini-brainrdquo involved in most cognition

bull Ipsilateral ldquocheck and balancerdquo for cortical functions

bull Important for fine motor and gross motor control

bull Higher level functions include timing precision learning coordination amplification of mental activity or ldquoscriptsrdquo

bull Cerbellar vermis and frontal-subcorticalinterpretative axis damage leads to ldquocognitive-affective syndromerdquo

bull Koziol Budding and Hale (2013) argue cerebellar automaticity functions could play into routinized psychopathology (eg personality disorders)

The Third Axis Regulating Brain Function

Inferior

Superior

-Executive Efficiency-Precision in Motor and Language Action

-Executive Regulation and Supervision

Emotion and Behavior Cortical-Subcortical Interactions

Prefrontal cortex

Limbic system

bull Limbic system for emotion registration and awareness

bull Right hemisphere and emotion processing perception of facial affect prosody and mirror neurons

bull Orbital prefrontal for emotion regulation and theory of mind for empathy

bull Should cortical disorders be treated with cognitive behavior therapy but subcortical disorders be treated with behaviouraltherapy Cerebellum

The Three Axes InterpretationLeft Hemisphere-RoutinizedDetailedLocal-ConvergentConcordant-Crystallized Abilities

Right Hemisphere-NovelGlobalCoarse-DivergentDiscordant-Fluid Abilities

AnteriorSuperior-Executive Regulationand Supervision-Motor Output

Posterior-Sensory Input-Comprehension

Inferior-Executive Efficiency-Precision of action

Executive functions are essential for all academics and adaptive behavior

Differential Diagnosis of Childhood Psychopathologies

Halersquos Balance Theory

Frontal-Subcortical Circuits and Psychopathology Regions of Interest

DLPFC = Dorsolateral Prefrontal Cortex OFC = Orbital Frontal Cortex SMA = Supplementary Motor Area FEF = frontal eye fields ACG = Anterior Cingulate Gyrus CB = Cerbellum CC = Corpus Callosum Basal Ganglia CN = Caudate Nucleus PU = Putamen GP = Globus Pallidus (from Roth amp Saykin 2004)

Balance Theory and Psychopathology(Hale et al 2009)

InattentionDistractibility

ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager

CircuitUnderactivity

CircuitOveractivity

Regulation problem of cortical-subcortical circuits

Rubia (2002) fMRI ADHD vs Schizophrenia Hypoactive and Hyperactive in Response

Significant differences in MR signal response between ADHD Schizophrenia and Controls Yellow = increased MR signal in controls Blue = increased MR signal in schizophrenia

Rubia (2002) The dynamic approach to neurodevelopmental psychiatric disorders use of fMRI combined with neuropsychology to elucidate the dynamics of psychiatric disorders exemplified in ADHD and schizophrenia Behavioral Brain Research 130 47-56

Balance Theory and Internalizing Comorbidity

bull If one circuit is dysfunctional does the other provide compensatory balance

bull Example Anxiety comorbidwith depression What about anxiety with depression and poor response inhibition

bull Decreased dorsolateral and increased amygdala in depression (Siegle et al 2007)

bull Increased orbital frontal amygdala and anterior cingulate in GAD (McClure et al 2007)

Yoursquoll like Mr Woolford he has an Attention-Deficit Disorder

So what IS ADHD

The question is WHAT TYPE of attention-deficit disorder

Using Neuroimaging Techniques to Examine Psychopathology in Children

Anxiety Disorder Neuroimaging FindingsStudy Sample Characteristics Clinical Group Circuit Findings

Krain et al 2008 Generalized anxiety disorder social phobia and control groups

Increased frontal-limbic region activation that reported higher intolerance of uncertainty

McClure et al 2007 Generalized anxiety disorder amp control groups

Increased activation in ventral prefrontal anterior cingulate and amygdala

Monk et al 2006 Generalized anxiety

disorder and control

groups

Increased activation in right ventrolateral prefrtonal

assocaited in response to angry faces and attention bias

away but reduced anxiety compensatory response

Anxiety Disorder

Obsessive Compulsive Disorder

Study Sample Characteristics Clinical Group Circuit FindingsSzeszesko et al 2004 Children with OCD and

controlsIncreased cingulate gray matter volume

Viard et al 2005 Adolescents with OCD amp control group

Abnormal activation in parietal temporal amp precuneus regions hyperactivity in anterior cingulate amp left parietal subregions

Woolley et al 2008 Adolescent males with OCD amp control group

Reduced activation in right orbitofrontal cortex thalamus cingulate amp basal ganglia during response inhibition

Yucel et al 2007 Adolescents with OCD and controls

Hyperactivation of medial frontal cortex compensatory for reduced dorsal anterior cingulated

Nakao et al 2005 Patients with OCD pre and post-treatment

Hyperactivity in orbital frontal and cingulatereduced with SSRI medication treatment

Rosenberg amp Keshavan 1998

Children with OCD and controls

Increased ventral prefrontal

Mood Disorder Neuroimaging Findings

Study Sample Characteristics Clnical Group Circuit Findings

Forbes et al 2006 Youth with MDD anxiety disorder amp control group

Decreased amygdala and orbital frontal cortex in response to reward inconsistent with anxiety group

Grimm et al 2008 MDD (unmedicated) amp control group

Hypoactivity in left dorsolateral hyperactivity in right dorsolateral prefrontal correlated with depression severity

Steingard et al 2002 Adolescents with MDD amp control group

Decreased white matterincreased gray matter in frontal lobe

Wagner et al 2005 MDD (unmedicated) amp control group

Hyperactivity in rostral anterior cingulate gyrus amp left dorsolateral prefrontal cortex in during Interference phase

Major Depressive Disorder

Bipolar Disorder

Study Sample Characteristics Clinical Group Circuit Findings

Adler et al 2005 Children with Bipolar Disorder with and without ADHD

Children with comorbid ADHD showed decreased ventrolateral and cingulated activity

Blumberg et al 2003 Adolescents with Bipolar Disorder amp control group

Increased left putamen amp thalamus depressive symptoms and ventral striatum positively correlated

Adler et al 2005 Youth with BD + ADHD amp BD groups

Decreased activation of ventrolateral prefrontal cortex amp anterior cingulated (BD + ADHD group)

Chang et al 2004 Youth with Bipolar Disorder and controls

Increased activation in anterior cingulated left dorsolateral prefrontal right inferior and right insula

Gruber et al 2003 Bipolar Disorder and Controls

Increased dorsolateral and decreased cingulated

Nelson et al 2007 Adolescents with Bipolar Disorder and controls

Increased left dorsolateral prefrontal and premotor activity interfere with flexibility

Rich et al 2006 Adolescents with Bipolar Disorder and controls

Greater putamen accumbens amygdala and ventral prefrontal with emotional face processing

Effected Systems in ADHD Cingulate and SuperiorLongitudinal Fasiculus White Matter Deficiency

Makris et al (2008) Attention and Executive Systems Abnormalities in Adults with Childhood ADHD A DT-MRI Study of Connections Cerebral Cortex 18 1210-1220

Diffusion Tensor Imaging ADHD lt Controls in fractional anisotropy (white matter integrity) findings for anterior cingulate and superior longitudinal fasciculus R more deficient than L

Dickstein et al (2006) The neural correlates of attention deficit hyperactivity disorder An ALE meta-analysis Journal of Child Psychology and Psychiatry 47 1051-1062

Dickstein et al (2006) Activation Likelihood Estimation (ALE) Meta-Analysis

bull ADHD lt controls in right dorsolateral inferior frontalorbital cingulate striatum thalamus and parietal regions

bull For response inhibition inferior frontalorbital anterior cingulate and precentral gyrus underactive in ADHD

bull Overactivation in several regions (left insula occipital middle frontal gyrus right precentral gyrus) may reflect compensatory strategy to overcome underactive regions

bull ADHD is not just right frontal-striatal hypoactivity but hyperactivity of compensatory regions as well

bull Result suggest balance of dysfunction and compensatory activity

Are Oppositional Defiant DisorderConduct Disorder Findings Different from ADHD

bull De Brito et al (2009) ndash increased grey matter in conduct disorder in several areas (ratio of white-grey matter important)

bull Sterzer et al (2005) ndash hypoactivation in response to negative pictures in the dorsal anterior cingulate and left amygdala in CD

bull Rubia et al (2008) ndash ldquoPurerdquo ADHD had reduced ventrolateral and increased cerebellum in sustained attention while ldquopurerdquo CD showed decreased anterior cingulate insula and hippocampus reward condition they showed right orbital frontal hypoactivity

bull ADHD is ventral-lateral and cerebellar while CD is orbital-paralimbic

Externalizing Disorders Neuroimaging FindingsAttention-DeficitHyperactivity Disorder


Booth et al 2005 Children with ADHD amp control group

Decreased activation in inferior middle superior amp medial fronto-striatal regions caudate nucleus amp globus pallidus

Cao et al 2008 Adolescent males amp control group

Decreased activation in frontal (middle amp superior frontal gyrus) putamen amp inferior parietal lobe

Durston et al 2003 Children with ADHD and controls

ADHD underactivated ventrolateral prefrontal anterior cingulate and caudate during response inhibition

Pliszka et al 2006 ADHD treatment naiumlve amp previously medicated groups amp control group

ADHD treatment naiumlve less cingulate and left ventrolateral activation during impulsive responding than controls

Rubia et al 2005 ADHD adolescents amp matched controls

ADHD less right inferior frontal activation during inhibition

Scheres et al 2007 ADHD adolescents and matched controls

Reduced ventral striatum activity during reward anticipation

Schultz et al 2004 Male adolescents with ADHD amp control group

Increased left amp right ventrolateral inferior frontal gyrus left amp right frontopolar regions of the middle frontal gyrus right dorsolateral middle frontal gyrus left anterior cingulate gyrus amp left medial frontal gyrus

Tamm et al 2004 Children with ADHD and controls

Hypoactivation of anterior cingulated and hyperactivation temporal compensatory regions

Vaidya et al 1998 Children with ADHD and controls

Frontal activity possible compensation for striatalhypoactivity normalized with stimulant treatment

Autism Neuroimaging Findingsbull Koshino et al (2005) ndash autism use right parietal but

controls use left parietal for verbal working memory task and (2008) autism less left frontal and right temporal for face working memory plus processing faces as objects suggesting asocial face processing style

bull Luna et al (2002) ndash autism showed lower dorsolateral and posterior cingulate functioning during spatial working memory task suggesting poor executive control and communication across hemispheres rather than ldquopurerdquo spatial deficit

bull Pierce et al (2001) ndash autism face processing outside the fusiform region including the primary occipital region and prefrontal cortex suggesting they process faces as objects or parts of objects not as faces

bull Dapretto et al (2005) ndash autism showed less activity in pars opercularis (mirror neurons area) important for imitation and empathy (theory of the mind)

bull Allen amp Courchesne (2003) significantly more motor activation (neocerebellum) and less attention activation (vermis) in cerebellum

Is Asperger Syndrome on the ldquoSpectrumrdquo

bull In 1944 Hans Asperger described ldquoautistic psychopathyrdquo cases with ldquonormalrdquo intelligence with peculiar social skills pedantic speech and preference for routinized activities

bull Myklebust (1975) ndash Social judgment and reciprocity impaired due to misperception of external cues and internal experiences

bull Denckla (1983) ndash Right hemisphere developmental learning disability Affects cognition academic and psychosocial functions

bull Rourke (1989) ndash Nonverbal learning disabilities due to white matter syndrome poor visual-spatial-motor and novel problem solving both internalizing and externalizing psychopathology

Is Asperger Syndrome on the ldquoSpectrumrdquobull OrsquoNeill (1999) describes Aspergerrsquos as ldquolittle

professors who canrsquot understand social cuesrdquo donrsquot understand gist of social discourse

bull Klin et al (1996) compared neuropsychological profiles and found Asperger gt autism on verbal measures reverse was true for nonverbal (visuospatial visuomotor and visual memory) concluding profile in Aspergerrsquos was similar to NVLD and distinct from high functioning autism

bull Volkmar et al (2000) describe ldquoRobertrdquo good reader but eccentric and clumsy high anxiety levels and poor social and adaptive functioning found right hemisphere white matter lesion

bull Bryan amp Hale (2001) ndash DiscordantDivergent processes affect nonverbal (spatial-holistic) and verbal (implicit language) functioning

Specific Learning Disabilitiesand Psychopathology

Psychopathology in SpecificLearning Disabilities

bull Byron Rourkersquos ldquononverbalrdquo SLD right hemisphere dysfunction and the ldquoWhite Matter Modelrdquo of psychopathologyProsody implicit language neglect of self and environment limited recognition of facessocial cues integration of complex stimuli poorResults in both internalizing and externalizing psychopathology (under socialized delinquency) no distinction of anteriorposterior

bull VerbalLeft Hemisphere DysfunctionRourke says no but early childhood internalizing problems and delinquents show LEFT hemisphere dysfunction (Moffit 1993 Forrest 2004)

Could shift from internalizing to externalizing reflect environmental causes (eg socialized delinquency)

Differentiating Right Hemisphere Functions

bull Attention to Environment

bull Attention to Self (Body Awareness)

bull SpatialHolistic Processing

bull Left Hand Sensory Feedback

bull Object Recognition

bull Facial Perception

bull Affect Recognition

bull Contextual Comprehension

bull Implicit Comprehension

bull Discordant Comprehension

bull Receptive Prosody

bull Social Comprehension

Right Posterior Region

bull Sustained Attention

bull Planning

bull Strategizing

bull Evaluating

bull FlexibilityShifting

bull Immediate Learning

bull Working Memory

bull Memory Retrieval

bull Novel Problem Solving

bull Divergent Thought

bull Implicit Expression

bull Expressive Prosody

bull Social Adaptability

Right Anterior Region

ADHD-Inattentive TypeAsperger Syndrome

ADHD-Combined Type

bull 155 children age 6 to 16 (M = 1086 SD = 280) with SLD by school district and Concordance-Discordance Model criteria

bull 42 excluded for not meeting processing asset and deficit (eg Hale et al 2006)

bull WISC-IV BASC-2 TRS and achievement scores in average range with mild impairments but heterogeneity masked significant profile differences

bull Average linkage within groups variant of the unweighted pair-group method arithmetic average (UPGMA) revealed six neurocognitive SLD subtypes

VisualSpatial (VS) (n = 14) Fluid Reasoning (FR) (n = 10) CrystallizedLanguage (CL) (n = 15)Processing Speed (PS) (n = 30)ExecutiveWorking Memory (EWM) (n = 19)High FunctioningInattentive (HFI) (n = 25)

SLD Psychopathology StudyHain Hale amp Glass-Kendorski (2010)

Participants

Results

Preliminary Study of SLD Subtypes and Psychopathology

bull Participants and Methods

bull 124 students ages 6-11

bull All underwent comprehensive evaluations in two Canadian school districts

bull Students were divided into three groups based on concordance-discordance methods (CDM) to determine significant patterns of processing strengths and weaknesses

bull C-DM identified three specific subtype groups Working Memory (n = 24) Processing Speed (n = 32) and No SLD Disability (n = 32) subtypes

bull Specific LD subtype domains were examined further comparing subtype groups to specific cognitive academic and psychosocial domains

CDM-Determined SLD WISC-IV Cognitive Results

CDM-Determined LD Psychosocial DimensionsEternalizing Behaviors

No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460

CDMndashDetermined SLD Psychosocial DimensionsInternalizing Behaviors

No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011

Note a Greater than No LD group b Greater than WMI group

CDM-Determined SLD Psychosocial DimensionsAdaptive Skills

No LDn = 15

WMIn = 17

PSIn = 18

F P

Overall Adaptive SkillsMSD

4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040

Functional CommunicationMSD

4387 714

3881 638

3694a

854368 033


Relevance of School Neuropsychological Assessment for Intervention

Recognizing Brain Functioning in the ClassroomBrain Area Possible Effects of Left

Hemisphere DamagePossible Effects of Right Hemisphere Damage

Occipital Lobe Slow reading poor spelling with letter substitutions difficulty with visual discrimination of details

Limited comprehension and writing when visual imagery required object recognition limited

Dorsal Stream Poor leftright orientation sound-symbol association (ie alphabetic principle) and letter reversals

Poor handwriting and math from spatial deficits poor awareness of self and environment during social

Ventral Stream Difficulty recognizing sight words poor reading fluency object naming limited

Difficulty with sight words and perception of affect and faces

LateralMedialTemporal Lobe

Canrsquot remember facts and words due to difficulty with long-term memory poor categorization

Limited understanding of context metaphor multiple word meanings and humor

Superior Temporal Lobe

Frequent requests for repetition poor word reading poor auditory and phonological processing

Poor perception of rate and pitch or prosody difficulty with complex sentence processing

Anterior Parietal Lobe

Poor right hand grasping writing too light or dark complains after writing that ldquohand hurtsrdquo

Poor left hand grasping and limited bimanual coordination skills

BOLDED Items reflect processes that could lead to psychosocial concerns

Recognizing Brain Functioning in the Classroom

Brain Area Possible Effects of LeftHemisphere Damage

Possible Effects of Right Hemisphere Damage

Occipital-temporal-parietal crossroads and WernickersquosArea

Difficulty connecting sounds (phonemes) with symbols (graphemes) difficulty connecting numbers with quantity and math algorithms limited comprehension of explicit language

Poor math problem solving and comprehension of implicit language complex language poetry difficulty with new learning and integrating different types of information poor understanding of humor

Posterior Frontal Lobe

Difficulty with dressing drawing and handwriting limited or no motor skill automaticity

Difficulty with learning new motorskills and sports requiring fine motor difficulty with using both hand simultaneously

Brocarsquos Area Halting speech with little output and difficulty with articulation and syntax even impulse control

Poor verbal prosody and word substitutions verbose but limited pragmatics

Dorsolateral-DorsalCingulate

Poor encoding for storage limited decision making rigid and inflexible thinking difficultywith concordant and convergent thought

Poor retrieval from long term memory sustained attention and novel problem solving difficulty with discordantdivergent thought

Orbital-VentralCingulate

Depressive symptoms and avoidancewithdrawal excessive emotional control

Disinhibition and indifference aggression and or conduct problems

The Cognitive Hypothesis Testing Model

Source Hale J B amp Fiorello C A (2004) School Neuropsychology A Practitionerrsquos Handbook New York NY Guilford Press

Theory

Hypothesis

Data Collection

Interpretation

1 Presenting Problem

2IntellectualCognitive Problem

3 AdministerScore Intelligence Test

4 Interpret IQ or Demands Analysis

5 Cognitive StrengthsWeaknesses

6 Choose Related Construct Test

7 AdministerScore Related Construct Test

8 Interpret ConstructsCompare

9 Intervention Consultation

10 Choose Plausible Intervention

11 Collect Objective Intervention Data

12 Determine Intervention Efficacy

13 ContinueTerminateModify

Comprehensive Evaluation for Disability Determination and Service Delivery

Choosing Tier 3 Interventions for ADHD and Other Psychopathologies Affecting Attention

bull Determine whether a what problem (cortical-cognitive behaviour therapy metacognitive strategies) a whenproblem (basal ganglia-social skills role playing) or a how problem (cerebellar-behavioural intervention) GOAL Move from subcortical to cortical

bull Medication likely for cortical andor subcortical problems consider agonist vs antagonist issues and cortical hyperactivityhypoactivity

bull Adaptive strategies (self-monitoring metacognitive strategies problem-solving conflict resolution social skills planners organizers routines response inhibition flexible brainstorming empathy instruction working memory computer games)

bull Importance of monitoring treatment response

Instructional Strategies for Children with Psychopathology

ndash Keeping lesson objectives clear

ndash Deliver the lesson at a brisk pace

ndash Encourage collaboration among students

ndash Use meaningful materials and manipulatives

ndash Prompt student answers after five seconds of wait time

ndash Vary the tone of your voice and model enthusiasm

ndash Break up long assignments by chunking content

ndash Encourage regular student responding

ndash Reduce amount of work on assignments for good performance

ndash Provide extended time on assignments and exams

ndash Ensure success in responding assignments and exams

Barkley 2006 DuPaul amp Stoner 2004 Majewicz-Hefley amp Carlson 2007 Toplak et al 2008 Barkley Edwards Laneri Fletcher amp Metevia 2001 Klingberg amp Forssberg 2002 Lonigan Elbert amp Johnson 1998

Executive Deficits Metacognition and Learning Strategies ldquolsquoThe individuals own awareness and consideration of hisor her cognitive processes and strategiesrdquo (Flavell 1979)

bull Learning strategiesPaired Associates Rehearsal Mnemonics Visualization Notetaking Self-Talk Brainstorming Checking Scaffolding Outlining

bull Ask metacognitive questions during the day (thinking about your thinking)

bull Give kids models to help them evaluate their workbull Teach a problem-solving procedurebull Give assignments that require evaluative skillsbull Demonstrate ldquothinking aloudrdquo during lessonsbull Working memory training (eg CogMed)bull Attention training


Working Memory Training and Improved Cognitive Functioning

Takeuchi et al 2010

bull N-Back task

bull Increased working memory performance

bull Changes in regions near intraparietal sulcus amp anterior corpus callosum

bull Amount of training correlated with increased fractional anisotropy (changes in white matter)

CogMed Working Memory Training(Brehmer et al 2011)

bull Working Memory training and adults

bull Improved working memory performance with CogMed training

bull Decreased activity in frontal and parietal areas

bull Increased activity in subcortical regions (thalamas amp caudate)

bull Suggests more efficient working memory and cortical-subcortical circuit functions

Coping with ADHD Behavior Problems Proactive or Reactive

Scheduling

ldquoOn taskrdquo behaviors decrease during day more academic instruction mornings

and more non-academic afternoon activities

Productive Physical Movement

Allow opportunities for movement (eg office trip sharpen pencil stand at desk

assist with class duties movement in assignments)

Choice Making

Provide student with menu of potential tasks to choose

Alter Environment

Provide control through preferential seating or teacher proximity

Task Duration

Brief assignments and immediate feedback long assignments broken down into

smaller parts

Prompt Appropriate Classroom Behavior

Visual auditory verbal or physical cues

Specific Rules and Reminders


Changes in Brain Functioning withPsychological and Medication Interventions

bull Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder (Freyer et al 2011 OrsquoNeill et al 2011)

ndash Decreased activation in orbitofrontal cortex and right putamen

ndash Metabolic changes in anterior cingulate and thalamus

bull Social Skills Therapy for Autism (Bolte et al 2006)ndash Increased activation in parietal and occipital lobe

ndash Suggests a compensatory mechanism for emotion recognition

bull Medication Treatment for Attention-DeficitHyperactivity Disorder (Pliszka et al 2006 Hale et al 2011)

ndash Normalized cingulate functioning following medication treatment even without medication

ndash Only children with ADHD and executive dysfunction show stimulant response best dose for cognitive functioning lower than best dose for behaviour


Differential Reinforcement

DRO ndash Other behavior

DRA ndash Alternative behavior

DRI ndash Incompatible behavior

Time Out

Time out from learning extinction of negative attention

Duration is equivalent to studentrsquos age

Do not remove student or allow other reinforcing activities

Token EconomyContingency Contracting

Students earn tokens or points for meeting behavioral expectations and lose points

for poor behavior

Points can be exchanged for privileges

Effective at home and school

Tokens- chips class money stickers

Self Management

Requires students to monitor andor evaluate their own behavior over time

Teacher identifies target behaviors expected provides scale with criteria for self-

ratings and teaches student to chart behaviorBarkley 2006 DuPaul amp Stoner 2004 Majewicz-Hefley amp Carlson 2007 Toplak et al 2008 Barkley Edwards Laneri Fletcher amp Metevia 2001 Klingberg amp Forssberg 2002 Lonigan Elbert amp Johnson 1998

Choosing Therapeutic Interventions Based on Neuropsychological Functioning

Inferior

Superior



Automatized Behaviors(eg operant conditioning

desensitization)

Executive Problem(eg Cognitive Behavior

Therapy Learning Strategy Instruction)

Get Parents Involved

bull Home based reinforcement program

bull Allows child to earn privileges at home based on positive school behaviour

bull Home-school report card - accomplished through notes between teacher and parent

bull Contingency contract specifies academic performance and classroom behavior expected and privileges that can be earned

bull Most effective if earned daily rather than weekly

bull Start with criteria that is easy to accomplish and slowly build to more challenging goals

Conducting Executive Function Interventions


Hale et al (2011) ADHD Study

Executive Impairment Determines ADHD Medication Response Implications for

Academic AchievementJames B Hale Linda Reddy Margaret Semrud-Clikeman Lisa A Hain James Whitaker Jessica Morley Kyle

Lawrence Alex Smith and Nicole Jones

AbstractMethylphenidate (MPH) often ameliorates attention-deficithyperactivity 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 ldquocoolrdquo executive-working memory (EWM) and ldquohotrdquo 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 a double-blind placebo-controlled

MPH trials with baseline and randomized placebo low MPH dose and high MPH dose conditions EWMSR

measures and behavior ratingsclassroom 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 EWMSR impairment yet

response was poor for those with adequate EWMSR 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

copy Hammill Institute on Disabilities 2010

httpjournaloflearningdisabilitiessagepubcom

Medication Treatment and ADHD

bull Approximately 2000000 treated with stimulants

bull Medication effective in 70 to 90

bull Medication wakes the ldquobrain managerrdquo (ie reduces frontal-striatal hypoactivity)

bull Dopamine agonists (eg stimulants) affect striatum

bull Norepinephrine agonists (eg Strattera) affect prefrontal cortex

bull Improves classroom behavior performance and interactions

bull Few serious side effects (appetite sleep irritability and headache ndash not common and typically decrease)

bull Best dose for behavior may be higher than best dose for cognition

bull Behavioral diagnosis and titration limit treatment efficacy

Double-Blind Placebo Protocol(Hoeppner et al 1997 Hale et al 1998 2005 2007 in press)

bull Children diagnosed and referred by physician diagnosis independently confirmed by psychologist

bull Weekly neuropsychological testing parent and teacher behavior ratings and classroom observation for 4 weeks

bull Baseline then randomized placebo low and high dose conditions

bull Child parent teacher and graduate research assistant blind

bull Physician psychologist and pharmacist not blind (safety)

bull Data rank ordered across conditions

bull Nonparametric randomization tests determine separate cognitive and behavioral response

bull Results graphically depicted and reported to referring physicians for subsequent clinical decision-making

Hale-DencklaCancellationTask X

XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X

Trail-MakingTestPart B

StroopColor-WordTest

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoBluerdquoldquoRedrdquo

ldquoBluerdquo

Drug Trial Example Lisabull Lisa was a 6 year 10 month-old friendly and outgoing girl who

thrived on adult attention

bull Academic and social concerns in the first grade included

Inattentive easily distracted fidgety and frequently off task

Attentional difficulties during whole-group instruction and independent work

Poor writing skills including difficulties with grammar and illegible handwriting

Noncompliant behavior with teacher

Limited social skills and frequent conflicts with peers

bull Recurrent discussions and removal of privileges did not help

bull Comprehensive neuropsychological evaluation revealed cognitive neuropsychological academic and behavioral data consistent with ADHD

bull Following consultation with parents pediatrician referred Lisa for double-blind placebo controlled trial of methylphenidate

Neuropsychological Medication Trial Results for LisaBaseline Placebo 5 mg MPH 10 mg MPH1

Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)

SRTM Word Storage 41 (35) 41 (35) 53 (1) 48 (2)

Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)

Stroop Color Word Correct 14 (4) 17 (1) 15 (3) 16 (2)

SRTM Consistent Retrieval 24(3) 21 (4) 43 (1) 36 (2)

TOMAL Digits Backward 10 (4) 12 (3) 20 (1) 14 (2)

Hale-Denckla Cancellation Correct 13 (4) 18 (3) 26 (15) 26 (15)

Hale-Denckla Cancellation Time 172 (2) 199 (4) 163 (1) 191 (3)

Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)

Connersrsquo CPT-II Omissions 65 (4) 62 (3) 55 (1) 60 (2)

Connersrsquo CPT-II Commissions 60 (3) 64 (4) 43 (2) 34 (1)

Connersrsquo CPT-II RT Block Change 57 (3) 61 (4) 44 (2) 41 (1)

Connersrsquo CPT-II RT ISI Interval 57 (3) 69 (4) 51 (2) 42 (1)

MEAN RANK 343 303 143 210

Auditory-VerbalMotorMeasures

Visual-MotorMeasures

1Order =Baseline10mg MPHPlacebo5mg MPH

Connersrsquo CPT-II Reaction Time 41 (3) 47 (1) 54 (2) 63 (4)

Behavioural Medication Trial Results for LisaBaseline Placebo 5 mg MPH 10 mg MPH1

CPRS-RL Cognitive Problems 89 (4) 81 (2) 72 (1) 87 (3)

CPRS-RL Hyperactivity Index 87 (4) 84 (3) 80 (2) 70 (1)

HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)

SERS Parent 0 3 0 21

CPRS-RL DSM-IV Hyperactive-Impulsive 83 (2) 90 (4) 89 (3) 75 (1)

CPRS-RL DSM-IV Inattentive 90 (4) 80 (2) 74 (1) 84 (3)

CTRS-RL Cognitive Problems 89 (35) 81 (2) 76 (1) 89 (35)

CTRS-RL Hyperactivity Index 77 (4) 74 (3) 71 (2) 70 (1)CTRS-RL DSM-IV Inattentive 82 (4) 72 (2) 66 (1) 74 (3)

CTRS-RL DSM-IV Hyperactive-Impulsive 73 (2) 80 (4) 79 (3) 65 (1)

SSQ-R Mean Severity 65 (4) 60 (2) 63 (3) 46 (1)

APRS Learning 18 (25) 18 (25) 16 (4) 22 (1)APRS Impulse Control 15 (3) 15 (3) 15 (3) 18 (1)APRS Academic Performance 22 (2) 21 (3) 18 (4) 28 (1)

SERS Teacher 7 11 12 18

MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings

Classroom Observations

RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)

RAT Plays with Objects 20 (3) 25 (4) 5 (1) 10 (2)RAT Fidgeting 33 (3) 38 (4) 28 (2) 15 (1)

RAT Out of Seat 3 (2) 5 (3) 10 (4) 0 (1)RAT Vocalizes 13 (35) 10 (2) 13 (35) 3 (1)

CTRS-RL Oppositional 65 (35) 58 (1) 63 (2) 65 (35)

CPRS-RL Oppositional 60 (35) 52 (1) 56 (2) 60 (35)

Lisarsquos Response to Stimulant Medication

40

30

20

00

10

Baseline Placebo 5mg MPH 10mg MPH

Note Lower Ranks = Better Performance and BehaviorOrder of Conditions = Baseline 10mg MPH Placebo 5mg MPH

Cognitive Response

Behavioural Response

Mean

Ran

k

0

2

4

6

8

10

12

14

None (+1 SD or more) Low (+99 to 0) Moderate (0 to -99) High (-1 SD or less)

Inattentive Type

Combined Type

Frontal-Subcortical Impairment and Diagnosis

of

Pa

rtic

ipa

nts

Medication Response for No Impairment Group

30

Baseline Placebo Low Dose High Dose

Note Lower Ranks = Better Performance and Behaviour

Cognitive Response (NS)

Behavioural Response (BgtPLH)

25

20

15

10

5

0

35M

ea

n R

an

k

Medication Response for Low Impairment Group

30



Cognitive Response (BPgtLH LgtH)

Behavioural Response (BgtPLH PLgtH)

25

20

15

10

5

0

35M

ean

Ran

k

Medication Response for Moderate Impairment Group

30



Cognitive Response (BPgtLH)

Behavioural Response (BgtPLH PgtLH)

25

20

15

10

5

0

35M

ea

n R

an

k

Medication Response for High Impairment Group

30




Behavioural Response (BPgtLH)

25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response

Cog or Beh MPH Response

Cog and Beh MPH Response

Medication Response by Subtype and Impairment Group

Inattentive Type ADHD

Combined Type ADHD

Solution Should We Put Ritalin in the Water Supply

Question is not WHETHER medication should be used for ADHD but rather WHOM do we use it for HOW do we monitor it and WHAT dose should we use (in conjunction with other interventions)hellip

SNAP-FIT (Student Neuropsychological Assessment Profiles for Innovative

Teaching) Kai Case Study

ldquoOpen exploration of multiple viewpoints breathes life into disciplinealternatively ignoring or minimizing that discourse only suffocates itrdquo (Hale 2007)

Together we can help all children learn and behave

THANK YOU QUESTIONS COMMENTS

Find us online wwweducucalgarycabraingainFollow us on Twitter braingainlab

Like us on Facebook wwwfacebookcombraingainlab

bull Phineas Gage was a railroad foreman who

had a tamping pole blown through his

orbital and dorsolateral prefrontal regions

bull He was walking and talking a few minutes

after the injury but vomited sending more

brain tissue to the floor with swelling

leading to coma

bull Recovery was slow mood was variable

and he was disinhibited contentious and

socially inept so ldquono longer Gagerdquo

bull Frontal lobes and limbic system ldquoSeat of

Personalityrdquo and psychopathology (not far

off)

The Strange Case of Phineas Gage














Oculo-motor

Motor

BasalGanglia

Thalamus

Cingulate

Cerebellum































Tactlessness

Irritability






















Inferior

Superior




Prefrontal cortex

Limbic system

















ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager


CircuitOveractivity











So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD























Oculo-motor

Motor

BasalGanglia

Thalamus

Cingulate

Cerebellum































Tactlessness

Irritability






















Inferior

Superior




Prefrontal cortex

Limbic system

















ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager


CircuitOveractivity











So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD





































Tactlessness

Irritability






















Inferior

Superior




Prefrontal cortex

Limbic system

















ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager


CircuitOveractivity











So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD




























Inferior

Superior




Prefrontal cortex

Limbic system

















ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager


CircuitOveractivity











So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











Prefrontal cortex

Limbic system

















ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager


CircuitOveractivity











So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD






















ImpulsiveBehavior

Hyperactivity

InattentionFixation

RepetitiveBehavior

Hypoactivity

Brain

Manager


CircuitOveractivity











So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD



















So what IS ADHD










groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD


















groups




Anxiety Disorder


























Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD





















Bipolar Disorder























































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD

















































































bull Planning

bull Strategizing

bull Evaluating



bull Working Memory









ADHD-Combined Type







Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD
















Participants

Results










No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD



















No LDn = 15

WMIn = 17

PSIn = 18

F P

ExternalizingM

SD59001427

5629 1113

5872 1150

25 784

HyperactivityM

SD59931536

6082 1401

5933 1221

05 950

AggressionM

SD60931738

5459 1136

5850 1095

93 401

Conduct ProblemsM

SD54271053

5206837

5667 1296

79 460


No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











No LDn = 15

WMIn = 17

PSIn = 18

F P

InternalizingM

SD5847 1167

5547 1136

6417 1634

189 162

AnxietyM

SD5587 1177

5718 1282

5944 1447

32 730

DepressionM

SD6180 1461

5971 1426

6917 1963

159 215

SomatizationM

SD5227 1093

6917 1963

5517 1633

207 138

WithdrawalM

SD5713 1229

5718 1106

6861ab

1343498 011



No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











No LDn = 15

WMIn = 17

PSIn = 18

F P


4367 814

4153 710

3622a

429568 006

Adaptability MSD

4520 1273

4524 1126

3789ab

890258 087

Social SkillsMSD

4613 990

4447 852

3856a

634394 026

LeadershipMSD

4593 689

4263 552

4089a

413345 040


4387 714

3881 638

3694a

854368 033








































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD
















































Theory

Hypothesis

Data Collection

Interpretation







































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD


































Takeuchi et al 2010

bull N-Back task











Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD

















Scheduling






Choice Making


Alter Environment


Task Duration


smaller parts



















Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD
























Time Out






for poor behavior




Self Management





Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











Inferior

Superior




desensitization)























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD






























































XX X

XX

X XX

X XX X

X XX X

XX

X XX

X XX

XX X

X X



ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD












ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoBluerdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoRedrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo

ldquoGreenrdquo


ldquoBluerdquo













Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD






















Go-No Go 17 (4) 21 (3) 27 (1) 26 (2)


Stroop Errors 4 (3) 4 (3) 2 (1) 4 (3)






Trails B Errors 6 (4) 3 (3) 1 (1) 2 (2)

Trails B Time 534 (4) 56 (2) 44 (1) 60 (3)





MEAN RANK 343 303 143 210








HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD













HSQ-R Mean Score 74 (35) 75 (35) 74 (2) 69 (1)










MEAN RANK 319 276 226 179

Parent Ratings

Teacher Ratings


RAT Off-Task 28 (2) 35 (4) 10 (1) 33 (3)






40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











40

30

20

00

10



Cognitive Response


Mean

Ran

k

0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD










0

2

4

6

8

10

12

14


Inattentive Type

Combined Type


of

Pa

rtic

ipa

nts


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











30





25

20

15

10

5

0

35M

ean

Ran

k


30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











30





25

20

15

10

5

0

35M

ea

n R

an

k


30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD











30





25

20

15

10

5

0

35

0

2

4

6

8

10

No MPH Response





Combined Type ADHD










0

2

4

6

8

10

No MPH Response





Combined Type ADHD










james b. hale, phd, med, abpdn, absnp - masp.mb.ca · reduced activation in right orbitofrontal...

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