It just sounds cool: Hemispheric Asymmetries

We take a lot for granted during our waking hours: our bodies’ automatic breathing, automatic walking, automatic speech production. In fact, a problem for people with ADHD is the automatic speech production — words get blurted out that they wish had some filtering before exiting their mouths.

Both automatic and volitional actions start in our brains. While we often cannot “sense” this, when there is damage to the brain, we see the actions are impacted. A common trauma to the brain is a stroke. Depending on where the injury happens in the brain, different actions — speech, walking, memory recall — get affected.

This is explained brilliantly in a book by Dr. Jill Bolte Taylor, My Stroke of Insight. The first few chapters describe what happens physically inside the brain organ, where blood vessels can rupture and create damage to the surrounding tissue. For me, the more fascinating aspect of Dr. Taylor’s descriptions are of the differences in perception from alternate halves of the brain.

The brain is shaped symmetrically, sort of like a walnut. There is a right half and a left half, or hemisphere. While it looks similar from the outside, different kinds of activities get processed in specific sites in the brain. That’s why some people who have a stroke have trouble recalling words, while others lose the use of one side of their body (the opposite side to where the stroke happened in the brain, which is interesting). Also, there is a tube that connects the two hemispheres called the corpus callosum that allows communication between the different sites to coordinate.

The term hemispheric asymmetry refers to the idea that specific actions take place in only one part of the brain. We process language on the left side of the brain; we process attention, memory, reasoning and problem solving on the right. There is an interesting article from the American Speech, Language and Hearing Institute on this topic — teaching speech therapists how to help stroke victims recover their ability to communicate. So, while it’s not polite to accuse a person with ADHD as having “brain damage,” it is useful to look at it as a phase in brain development which might need the same kind of attention and training as a person who’s suffered an injury in that part of the brain.

While a stroke is a traumatic event that can be devastating effect on a person’s ability to function, what is hopeful and useful to study about it is the way patients heal, and rebuild skills that were lost. It is really incredible to think that we can re-build networks of thoughts and actions even if the roadway we used previously has been destroyed. We can actually generate new nerve cells as we practice skills! (This post on BrainBlogger gives a good description.) Yet, I cannot help but see how kids with ADHD can also build or rebuild neural networks to help them master the skills they need for daily living.

By looking at improving outcomes for people with ADHD as a brain-based, developmental problem, we can take away the stigma of a person being lazy or unmotivated. After working with people with ADHD, I quickly so how willing and capable they were — but a lot of things simply did not occur to them. Homework just didn’t bubble up as something they had to do. Other things — usually visual — caught the attention of the right side of their brains, and they focused on a TV show or a video game or sports instead. Part of our job to help people with ADHD is to put the things they need to do in front of them.

Virtual Reality Tests Reality of Executive Functions

OK, parents, you’ve decided to take the plunge and have your kid tested for ADHD. How does this happen in the doctor’s office? You’re nervous, your child is nervous, you’re all alone in the room with the doctor, and your child is perfectly still and silent. Where are the signs of ADHD? In a medical setting, how you and your child describe his or her behavior count for most of the diagnosis. The doctor will probably not witness these behaviors him- or herself, but will most likely ask some pointed questions and conclude that your child struggles with attention in a variety of settings, and may prescribe medications.

 However, there are tests, called “psycho-educational” assessments (shortened to “psycho-ed,” a rather unflattering moniker), which probe a bit deeper for some of the real-world or everyday problems associated with ADHD, particularly executive functioning deficits. They also look at some psychological issues, such as anxiety, depression, rule-breaking, etc.

Still, these psycho-ed assessments are also anecdotal, ”paper-and-pencil” tests. An examiner (usually a psychologist) asks you, your child, and/or your child’s teacher, a series of questions, and you answer them with “Always,”  “Frequently,” “Sometimes,” “Rarely,” or “Never”. These tests probe more deeply into whether the student falls within the norms of these behaviors for their age and gender, or whether there are indications of a deficit, disability, or some other dis-word.

taken from http://www.dailymail.co.uk/sciencetech/article-2356854/The-gaming-headset-transforms-video-games-virtual-reality-worlds.html

The authors of a study[1] were verifying whether a virtual reality (VR) “computer game” could predict whether or not a person has deficits in executive functions (EF). A problem with traditional paper-and-pencil assessments of attention is that they are administered in a quiet office, with few distractions, in a one-on-one setting. The examiner does not get to visit the child’s classroom, witness his or her behaviors when trying to control him-/herself in a quiet classroom, becoming easily distracted by someone or something in his/her environment, or forgetting to write down a homework assignment and having no idea what to do once he or she gets come.

I’ll quote directly from the published paper:

 In this study, performance on a VR-Stroop-like task of inhibition correlated with more traditional forms (paper–pencil and parent questionnaires) of EF assessment, but VR performance more accurately reflected everyday behavioral EF.

A “Stroop” task is a brain puzzle where you are shown a name of a color, for example, blue, but it is printed in a different color. When you see this: blue, and you are asked what color is written, you might say “red” because the color you see is red. This is supposed to test how often you can juggle conflicting information in your brain and come up with a correct answer, even when there is interference.

…the “Virtual Classroom” was originally developed as a controlled environment with varying levels of distraction in which attentional processes can be assessed in children (Rizzo et al., 2000b)… The environment also incorporates systematic and controlled presentations of typical classroom distracters, such as classroom noises and movement of virtual classmates or cars in the street.

Blair Middle School, Pasadena, CA

This idea struck me as quite brilliant. They are simulating a real environment, with distractions, while administering the test. It’s adding an extra level of distraction, which is usually present in everyday situations, so the child’s performance should be equal to or worse than a typical child’s.

…by its ability to explain outcome on well-recognized scales of behavioral EF and externalizing behavior, while a similar paper–pencil EF test (D-KEFS CWIT) failed to predict the same outcomes. These results support the idea that VR does not only look like the real world, it also includes demands that require real world functional abilities.

btw: D-KEFS, the Delis–Kaplan Executive Function System,  is an assessment that has five sub-tests that measure some facet of executive functioning: ability to reason, ability to prioritize, being flexible, juggling conflicting information in working memory, etc. The CWIT is the Color Word Interference Test, which is a version of the Stroop color name/word test.

The researchers concluded that “VR appears to be a strong predictor of everyday life executive functioning and behavior.” While they could not conclude the VR game could predict similar results on all of the paper-and-pencil tests they compared it to, it did at least produce results that confirm that executive function deficits are present in the child.

Finally, another reason to use this kind of technology when looking for indicators of “real” ADHD (and not just anxiety, or some other behavioral disturbance) and EF deficits is that kids like to do it:

VR technology seems to enhance participant enjoyment leading to increased motivation (Rizzo et al., 2004). The use of VR appears to reduce motivation problems and ceiling effects reported in paper–pencil cognitive tests (Rizzo et al., 2004; Schultheis et al., 2002).

So let’s get those goggles going in our doctors’ offices, and help people realize how real – and not virtual – this attention problem is!

---

[1]  “Assessment of executive function in adolescence: A comparison of traditional and virtual reality tools” by Gabrielle Lalonde, Mylène Henry, Anne Drouin-Germain, Pierre Nolin, Miriam H. Beauchamp, who are based in Montreal or Quebec, Canada.

Published January 2013 in the Journal of Neuroscience Methods: 219 (2013) 76–82

1,000 most (81) commonly (423) used (149) words (250) in (6) English (524)

When writing, one way to check to see if a student’s work contains some original words is to see if they are NOT on this list: http://www.insightin.com/esl/1000.php

Truthfully, this brings up a deeper issue of personal originality. People who perceive themselves as “different from the mainstream” usually are (until they hit 35 years old). Many people find their identity in being different and unconventional. Some people with disabilities are so well-adjusted that they demand to be accepted as they are. I have been so impressed with the “Don’t Cure Autism Now” movement that came out as a response to the fundraising organization, “Cure Autism Now!” or CAN. http://winklett.com/about/jonahs-journey-a-journal-3272005-72808/dont-cure-autism-now-62806/ (This is an older blog post from 2006; I don’t know how to cite it correctly.).

Please let me clarify this — I’ve received a comment about it — I am not against research to understand autism, which is the basis of CAN’s work. (CAN is merged today with another organization, and they are called Autism Speaks.) What I admire about the “Don’t Cure Autism Now” is the sense of identity that some people with differences have. They don’t want to be “cured” — they want to be accepted as they are, and are comfortable being defined as “different” and not “neuro-typical”.

However, many people, especially adolescents, who have ADHD wish there was a cure for it. They wish there was a cure that did not mean taking medication for “it”. Having a disability means instantly not belonging to “normal”. Most kids fear this state of being. Particularly in early adolescence, they will do anything to fit in. We have witnessed dire consequences of this kind of thinking, such as taking drugs to fit in with a crowd — even a crowd a person is not really comfortable being in.

A more commonplace experience, though, is fitting in at school, which means (1) not asking questions, (2) not admitting that you don’t understand something, (3) not admitting that you have a learning difference, (4) never letting anyone know that you take medication, (5) not advocating for yourself when you have a 504 plan or IEP in place to support you, and the more than 1,000 variations on this theme of hiding your disability and suffering in silence.

An important process in dealing with ADHD — and any learning disability — is demystification. The family with a person who is different needs some help: the parents must mourn the child they thought they had, and embrace the one they do have. This wise saying has stayed with me for years, and I keep trying to spread it to as many parents as I can. Demystification means learn as much as you can about yourself as well as about a particular disability. Stop looking at it like an unpredictable monster. Start seeing what really is presenting itself. Find out… what is common about it! (I think the Don’t Cure Autism Now adherents also want to understand how their way of interpreting the world is *not* understood well by neuro-typical people. They help demystify the experience of autism by writing about it and sharing their understanding of themselves.)

Since I work with adolescents, I also see their burgeoning self-concepts develop, and they, too, need to know what a typical brain is like, what their brains are like, and how they can compensate when their atypicality interferes with success. Again, that is another, deeper conversation in itself.

But getting back to writing, which is so hard for people with ADHD to accomplish, be as original in your writing as you are in your person! Find some unusual, awkward, blurt-worthy words and use them in your sentences! Embrace that you’re not one of the 1,000 most common students, and thank the Lord/Creative Life Force for that!