I couldn’t begin to do justice to summarizing this recent special on Frontline about pediatric psychiatry (though as promised, I did take copious notes, which are replete with my own secret shorthand that no one can read). Thankfully, PBS has done an excellent job of summarizing it for me. The essence of the film is an attempt to explain the 4000% increase in the diagnosis of childhood Bipolar Disorder and the controversy over the use of anti-depressants and anti-psychotic medication in children. It is an eye-opening program.
Fortunately for you, thanks to the magic of the Internet and PBS sponsors, you can see the program for yourself online.
If you are very busy and do not have time to watch the program, here is a nice written summary about Childhood Bipolar and the pros and cons of using medication with children with additional references.
Showing posts with label Biological Psychology. Show all posts
Showing posts with label Biological Psychology. Show all posts
Sunday, 13 January 2008
Tuesday, 8 January 2008
Attention Deficit Disorder: The Golden Years
Recently, I saw a movie in which two kids, about age 10, were walking along a path and the following dialogue ensued:
Young Boy: So what’s new?
Young Girl: I found out I have Adult ADD.
Young Boy: Don’t you mean you have ADD?
Young Girl: Somehow, I got the adult kind.
So what is the difference between “Regular ADD” and “Adult ADD”?
Like many areas in our field, the diagnostic criteria and how the disorder progresses across the lifespan is clear as mud. Researchers have long debated whether ADD is due to a brain “deficit” or rather a “delay” in development. That is, can one grow out of ADD or is it a permanent deficit?
A recent study led by Dr. Philip Shaw at the National Institute of Mental Health may shed some light on this issue. Basically, the researchers compared brain scans from two groups of children: one with Attention Deficit Disorder (ADD) and the other without. The scientists tracked the children from ages 6 to 16, taking multiple scans on each child. They found that on average, certain areas of the ADHD children’s brains developed more slowly that the non-ADHD groups’ brains. The delays were centered in areas of the brain that control higher-order executive functions, such as the regions that suppress inappropriate actions and thoughts, focus attention, remember things from moment to moment, work for reward and control movement. The lag in development in the ADHD group ranged from 3 to 5 years later than their peers. On the positive side, the motor cortex matured faster in the ADHD children, presumably because they are always on the go.
The researchers concluded that ADHD likely involves a delay, and not an abnormal brain. They indicated that about 3 in 4 children do grow out of the problem by early adulthood, but caution that more research is needed to uncover why some kids grow out of it and why some don’t. There were methodological issues present as well, such as 80% of the sample had been on, at some point, stimulant medication. Stay tuned for the next 100 years or so when it is uncovered what the effects of stimulant medication on children are. Brain chemistry and development could not be less complex. Shoot. There goes our parsimonious explanation for why Johnny can’t sit still.
Perhaps my PBS special tonight will shed some light on the matter. Don’t fret. You know I’ll take notes and get back to you.
Young Boy: So what’s new?
Young Girl: I found out I have Adult ADD.
Young Boy: Don’t you mean you have ADD?
Young Girl: Somehow, I got the adult kind.
So what is the difference between “Regular ADD” and “Adult ADD”?
Like many areas in our field, the diagnostic criteria and how the disorder progresses across the lifespan is clear as mud. Researchers have long debated whether ADD is due to a brain “deficit” or rather a “delay” in development. That is, can one grow out of ADD or is it a permanent deficit?
A recent study led by Dr. Philip Shaw at the National Institute of Mental Health may shed some light on this issue. Basically, the researchers compared brain scans from two groups of children: one with Attention Deficit Disorder (ADD) and the other without. The scientists tracked the children from ages 6 to 16, taking multiple scans on each child. They found that on average, certain areas of the ADHD children’s brains developed more slowly that the non-ADHD groups’ brains. The delays were centered in areas of the brain that control higher-order executive functions, such as the regions that suppress inappropriate actions and thoughts, focus attention, remember things from moment to moment, work for reward and control movement. The lag in development in the ADHD group ranged from 3 to 5 years later than their peers. On the positive side, the motor cortex matured faster in the ADHD children, presumably because they are always on the go.
The researchers concluded that ADHD likely involves a delay, and not an abnormal brain. They indicated that about 3 in 4 children do grow out of the problem by early adulthood, but caution that more research is needed to uncover why some kids grow out of it and why some don’t. There were methodological issues present as well, such as 80% of the sample had been on, at some point, stimulant medication. Stay tuned for the next 100 years or so when it is uncovered what the effects of stimulant medication on children are. Brain chemistry and development could not be less complex. Shoot. There goes our parsimonious explanation for why Johnny can’t sit still.
Perhaps my PBS special tonight will shed some light on the matter. Don’t fret. You know I’ll take notes and get back to you.
Monday, 15 October 2007
Caught in the Middle: Part I
Biological Factors
It’s super daunting to distil the gigantic field of biological psychology into a post. But here goes. There are two schools of thought on this: 1) there are anatomical differences in the “teen brain” that drives behavior. 2) The “teen brain” is a myth. Experiences create changes in the teen’s brain. Both camps do agree that there are anatomical differences in the brain that are occurring from childhood to adolescence and on to adulthood. What is the hotly debated issue is if these anatomical changes in the brain result in more risk-taking behavior.*
Anatomical Changes in the Teen Brain
Remember the process of executive functioning? Recent studies indicate that the prefrontal cortex—which is responsible for executive functioning--may be one of the most important distinctions between the teenage and adult brain. Recent fMRI studies show that from childhood (ages 8-13) through adolescence (14-17) and adulthood (18-30), the prefrontal cortex is used more during complex tasks. Additional regions of the brain (usually higher-order thinking skills) are also used more as the child ages.
Anatomically, the brain is undergoing synaptic pruning (eliminating unnecessary connections between the neurons) and increasing myelin (essentially insulation) around the axons that send signals from neuron to neuron. As a result, how the prefrontal cortex “communicates” with other areas of the brain is more efficient.
The general idea is that as you get older, your brain can distribute the workload of the decision making to many different areas of the brain. This is especially useful under stressful conditions, because one can recruit more areas than just the prefrontal cortex to take over.
So it’s conceivable that my tough guy student impulsively got in a fight because under stress, could not efficiently use his prefrontal cortex and other regions that help to inhibit behavior or evaluate long-term consequences.
Does the difference in the teen’s brain really cause his/her behavior?
Herein lies the controversy. There is a group of researchers who believe that the risk taking, novelty seeking, and impulsivity that are characteristic of adolescents may be hardwired in the brain. Remember that the pruning of grey matter in the brain does not reach the forebrain until adulthood, and the forebrain is where the planning, reasoning, and impulse control occur (remember, pruning is good, it increases efficiency). The brain-behavior connection is drawn based on subsequent studies of adolescents’ risk assessments, which are thought to require these areas of the brain.
A recent study showed that for adolescents, the perceived benefits of an action tend to outweigh and offset the risk. So basically the payoff of having your friends think you are the best coke drinker in the school outweighed the cost of puking. Likewise, the benefits of fighting a peer at lunch and keeping your “tough guy” image outweighs the cost of having to see the school psychologist and potential suspension.
And, because nothing is every that simple when dealing with adolescents, another group of researchers believes that the “Teen Brain” is a myth. The argument goes something like this: Snapshots of brain activity and their associated behaviors do not necessarily mean that the brain causes the problems encountered by teens. Considerable research shows that a person’s emotions and behaviors continuously change brain anatomy and physiology (e.g. stress, enriched environments, nutrition, exercise, and even meditation). So did the brain cause the behavior, or did the behavior alter the brain?
Further, anthropological research reveals that teens in many cultures do not experience these “teen problems” (at least not until Western schooling, movies, and television were introduced), making the “hardwiring” of the teen brain not universal. So in the case of my tough guy, the stress about his fight perhaps created hypersensitivity in dopamine-producing neurons, which altered his brain chemistry. And my happily chanting girls somehow escaped the teen problems because of their nurturing, healthy, and stress-free experiences.
I don’t know about you all, but it seems to me that this biological psychology lesson is a bit mind boggling.** Now pretend you’re 13 years old trying to figure it all out! Middle school kids are amazing.
*For more detail on the debate, refer to Scientific American Reports: Special Edition on Child Development © 2007. They lay it out quite well and include more detailed information on all the studies.
**Pun intended.
It’s super daunting to distil the gigantic field of biological psychology into a post. But here goes. There are two schools of thought on this: 1) there are anatomical differences in the “teen brain” that drives behavior. 2) The “teen brain” is a myth. Experiences create changes in the teen’s brain. Both camps do agree that there are anatomical differences in the brain that are occurring from childhood to adolescence and on to adulthood. What is the hotly debated issue is if these anatomical changes in the brain result in more risk-taking behavior.*
Anatomical Changes in the Teen Brain
Remember the process of executive functioning? Recent studies indicate that the prefrontal cortex—which is responsible for executive functioning--may be one of the most important distinctions between the teenage and adult brain. Recent fMRI studies show that from childhood (ages 8-13) through adolescence (14-17) and adulthood (18-30), the prefrontal cortex is used more during complex tasks. Additional regions of the brain (usually higher-order thinking skills) are also used more as the child ages.
Anatomically, the brain is undergoing synaptic pruning (eliminating unnecessary connections between the neurons) and increasing myelin (essentially insulation) around the axons that send signals from neuron to neuron. As a result, how the prefrontal cortex “communicates” with other areas of the brain is more efficient.
The general idea is that as you get older, your brain can distribute the workload of the decision making to many different areas of the brain. This is especially useful under stressful conditions, because one can recruit more areas than just the prefrontal cortex to take over.
So it’s conceivable that my tough guy student impulsively got in a fight because under stress, could not efficiently use his prefrontal cortex and other regions that help to inhibit behavior or evaluate long-term consequences.
Does the difference in the teen’s brain really cause his/her behavior?
Herein lies the controversy. There is a group of researchers who believe that the risk taking, novelty seeking, and impulsivity that are characteristic of adolescents may be hardwired in the brain. Remember that the pruning of grey matter in the brain does not reach the forebrain until adulthood, and the forebrain is where the planning, reasoning, and impulse control occur (remember, pruning is good, it increases efficiency). The brain-behavior connection is drawn based on subsequent studies of adolescents’ risk assessments, which are thought to require these areas of the brain.
A recent study showed that for adolescents, the perceived benefits of an action tend to outweigh and offset the risk. So basically the payoff of having your friends think you are the best coke drinker in the school outweighed the cost of puking. Likewise, the benefits of fighting a peer at lunch and keeping your “tough guy” image outweighs the cost of having to see the school psychologist and potential suspension.
And, because nothing is every that simple when dealing with adolescents, another group of researchers believes that the “Teen Brain” is a myth. The argument goes something like this: Snapshots of brain activity and their associated behaviors do not necessarily mean that the brain causes the problems encountered by teens. Considerable research shows that a person’s emotions and behaviors continuously change brain anatomy and physiology (e.g. stress, enriched environments, nutrition, exercise, and even meditation). So did the brain cause the behavior, or did the behavior alter the brain?
Further, anthropological research reveals that teens in many cultures do not experience these “teen problems” (at least not until Western schooling, movies, and television were introduced), making the “hardwiring” of the teen brain not universal. So in the case of my tough guy, the stress about his fight perhaps created hypersensitivity in dopamine-producing neurons, which altered his brain chemistry. And my happily chanting girls somehow escaped the teen problems because of their nurturing, healthy, and stress-free experiences.
I don’t know about you all, but it seems to me that this biological psychology lesson is a bit mind boggling.** Now pretend you’re 13 years old trying to figure it all out! Middle school kids are amazing.
*For more detail on the debate, refer to Scientific American Reports: Special Edition on Child Development © 2007. They lay it out quite well and include more detailed information on all the studies.
**Pun intended.
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