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Title: Insights from Neuroscience into the Effects of Impulsivity and Early Life Experience on School Readi


1
Insights from Neuroscience into the Effects of
Impulsivity and Early Life Experience on School
Readiness and Social Functioning in Youth
  • Theodore P. Beauchaine, Ph.D.
  • Robert Bolles Yasuko Endo Associate Professor
  • Associate Chair, Department of Psychology

Child Adolescent Adjustment Project
2
Learning Objectives
  • Recognize that impulsivity, the trait underlying
    most cases of ADHD, has well characterized
    genetic and brain bases.
  • Understand that ADHD is as real as any
    psychiatric disorder.
  • Appreciate the role that environment plays in
    shaping impulsivity into more serious disruptive
    behaviors.
  • Be aware that impulsivity places children at risk
    for underachievement, school failure, and school
    dropout.
  • Recognize that impulsivity is not a trait that
    children grow out of.
  • Understand that the costs to individuals and
    society of ignoring the problem are enormous.

3
School Readiness
  • Set of skills, abilities, and other
    characteristics that foster successful transition
    into school (NICHD).
  • Self Regulation.
  • Sustained attention.
  • Inhibitory control over behavior.
  • Capacity to delay gratification.
  • Ability to suppress strong emotions.
  • Social and emotional competencies.
  • Emotion regulation.
  • Prosocial behavior and cooperation.
  • Basic understanding of emotions in self and
    others.
  • Absence of impulsivity, hyperactivity, and
    aggression.

4
Impulsivity Defined
  • Behavior that is swayed by emotional or
    involuntary impulses.
  • Behavior without adequate forethought.
  • Tendency to choose immediate over long-term
    rewards.
  • Engagement in behaviors that are likely to be
    punished.
  • Persistent reward-seeking behavior.

5
ALL young children are impulsive!
6
When is Impulsivity Problematic?
  • When it places a child at risk for injury.
  • When it interferes with social development.
  • When it impedes skill acquisition and learning.
  • When it undermines the education and/or safety of
    other students.
  • When it contributes to school drop out.
  • When it eventuates in drug use, incarceration,
    and criminality.

7
When is Impulsivity Problematic?
  • Functional definitions (DSM-IV).
  • Some impairment from the symptoms is present in
    two or more settings (at school and at home).
  • There must be clear evidence of clinically
    significant impairment in social or academic
    functioning.
  • Statistical definitions (CBCL).

98
2
8
Impulsivity and ADHD
  • Impulsivity is highly heritable. About 80 of the
    variance in impulsivity is accounted for by
    genetic factors (e.g., Price et al., 2001).
  • Most impulsive children have at least one
    impulsive parent.
  • Heritable impulsivity is the core trait
    underlying most cases hyperactive/impulsive ADHD
    (Barkley 1997).
  • Early ADHD predisposes to a host of negative
    outcomes
  • Academic underachievement.
  • Social rejection.
  • Delinquency.
  • School drop out.
  • Alcohol and drug use.
  • Criminality.

9
Impulsivity Across the Lifespan Why Early
Identification is Important
school conduct problems, suspensions
drug use,criminality
academic problems
hyperactivity
oppositionality aggression
disengagement withdrawal
delinquent peer group
incarceration, recidivism
age
preschool
middle-school

adolescence
10
Delinquency
  • Pattern of repeated rule breaking behavior and
    criminality.
  • Disengagement from dominant cultural norms for
    achievement and behavior.
  • Easily bored and often irritable.
  • Frequent risky behavior despite high likelihood
    of punishment.
  • Delinquency often results in incarceration.

11
Growth in US Prison Population
millions
Source Bureau of Justice Statistics
12
Current Incarceration Rates
Citizens per 100,000
Source Bureau of Justice Statistics
13
Disproportionality in Incarceration
US Population, 2000
Prison Population, 2002
14
The Human Costs
  • 20 of black males and 10 of Latinos serve
    prison time.
  • In some poor urban neighborhoods, 50 of black
    males will go to prison.
  • Once incarcerated, limited opportunities for
    upward mobility are all but eliminated.
  • Recidivism rates approach 60 over 5 years.
  • Early intervention is far more effective than
    incarceration when impulsive children are treated
    before delinquency emerges.

15
Current Intervention Approaches
  • Few impulsive or aggressive children receive any
    form of intervention.
  • When intervention is initiated, it is usually
    after ADHD has progressed to delinquency.
  • Those who are treated usually receive some form
    of group intervention.
  • Special education placements
  • Summer school, summer camps
  • Institutionalization
  • These interventions increase delinquency.

16
Group Interventions Iatrogenic Effects
treatment
Teacher-reported Delinquency
no treatment
Source Dishion et al., 1999
17
Intervention Effectiveness by Age
100
50
Responders
0
Preschool
Adolescence
18
The Ecology of Adolescent Behavior
Treatment Provider
Neighborhood
School
Peer Group
Extended
Parents
Child
Siblings
Family
19
The High Costs of Incarceration
  • Delinquency is far and away the most costly
    mental health concern in the US.
  • Cost of incarcerating 1 person for 1 year
  • 23,205
  • Cost of incarcerating 2 million per year
  • 48,000,000,000
  • Many states are spending close to 20 of their
    annual budgets on corrections.

20
Interim Summary I
  • Impulsivity is among the most heritable of all
    behavioral traits.
  • Impulsivity interferes with school readiness and
    places children at risk for academic failure,
    social rejection, eventual drop out, and
    delinquency.
  • Environment plays an extremely important role in
    shaping impulsivity into serious conduct
    problems.
  • Impulsive children who grow up in high risk
    neighborhoods are at especially high risk for
    delinquency.
  • At-risk children need to be identified early in
    life in order to prevent the development of
    antisocial behavior.

21
Brain Bases of Impulsivity

22
Dopamine and Impulsivity
  • Almost all genes that have been linked with
    impulsive behavior affect dopamine (DA)
    neurotransmission.
  • DAT1 gene
  • DRD2 gene
  • DRD4 gene
  • MAO-A gene
  • COMT gene
  • 5HTT gene
  • Genes do not code for specific behaviors. Rather,
    they affect brain functioning, which contributes
    to broad behavioral traits, such as impulsivity.

23
Dopamine and Reward
nucleus accumbens
ventral tegmental area
The Mesolimbic DA System
24
Mesolimbic Dopamine Activity
phasic response
tonic activity
tonic activity
neural firing
time
reward cue
satiation
25
The Mesolimbic DA System
  • Implicated in all motivated (rewarding)
    behaviors.
  • Tonic levels associated with mood states.
  • High tonic DA activity ? positive affectivity
    (Ashby et al., 1999).
  • Low tonic DA activity ? negative affectivity,
    irritability (Laakso et al., 2003).
  • Activity of the system is experience dependent.
  • Repeated phasic activation leads to reduced tonic
    activation and sensitization.

26
Mesolimbic Dopamine Activity
sensitizedphasicactivity
original responsepattern
reducedtonicactivity
time
reward cue
satiation
27
Experience Dependence
  • Rewarding behaviors that strongly increase
    phasic mesolimbic dopamine activity
  • Smoking
  • Alcohol use
  • Illicit drug use
  • Methamphetamine
  • Cocaine
  • Opiates
  • Gambling
  • Video games
  • These activities down-regulate tonic DA activity.

28
Effects of Chronic DA Activation
normal control
alcoholdependent
normal control
cocainedependent
29
Dopamine and Impulsivity
  • Children with ADHD exhibit low tonic and
    lowphasic mesolimbic activity (e.g., Sagvolden
    et al., 2005).
  • This is a likely neurobiological substrate of
    negative affectivity (Beauchaine et al., 2001).
  • Low mesolimbic activity is highly heritable,
    predisposing to impulsivity and delinquency.
  • Environmental risks during development exacerbate
    this effect (e.g., Poeggel et al., 1999).
  • Exposure to smoking
  • Child abuse and neglect
  • Drug use

30
phasic response
tonic activity
normal
ADHD
ADHD high stressenvironment
reward cue
31
Assessing Reward Sensitivity
  • Incentive-motivation (reward) tasks. Simple
    computer games in which children
  • make money for correct responses during reward
    trials, and
  • make no money for correct responses during
    extinction trials.

32
Task Fixation

33
Task Reward
3.20
34
Task Reward
3.60
35
Task Non-Reward
0.00
36
Striatal Activity Reward
Source Knutson et al., 2001
37
Striatal Activity Reward
Control
ADHD
Source Scheres et al., 2007
38
Implications I Learning
  • Mesolimbic DA responding integral to associative
    learning (Sagvolden, 2005).
  • Phasic DA response signals to other areas of
    brain that an event is important, and that
    learning should take place.

39
normal
normal associative learning gradient
ADHD
ADHD associative learning gradient
Reinforcer(e.g., praise, intrinsic
reward value, etc.)
40
Implications I Learning
  • Mesolimbic DA involved integrally in associative
    learning (Sagvolden, 2005).
  • Phasic DA response initiates signal to other
    areas of brain that an event is important, and
    that learning should take place.
  • Impulsive children often require more trials to
    learn from external events.

41
Implications II Reward Seeking
  • Children low in tonic DA activity experience high
    levels of negative affect and irritability.
  • This leads to impulsive reward-seeking behavior
    to up-regulate chronically aversive mood.
  • Low phasic DA activity means less pleasure from
    reward-seeking behavior.
  • This elicits more reward-seeking and predisposes
    to delinquency.
  • Children in high risk neighborhoods are
    particularly susceptible.

42
Impulsivity Neighborhood Risk
Number of Delinquent Acts
Source Lynam et al., 2000
43
Impulsivity Neighborhood Risk
Violent Delinquency
Source Lynam et al., 2000
44
Interim Summary II
  • Impulsivity is highly heritable (about 80).
  • At the neural level, heritable impulsivity is
    expressed as deficient DA responding.
  • Low DA gives rise to negative affectivity and
    irritability.
  • These aversive mood states lead to reward-seeking
    behavior in efforts to self-stimulate.
  • Environmental risks reinforce brain-based
    vulnerabilities, leading to more serious behavior
    problems
  • ADHD.
  • Conduct problems.
  • Alcohol and drug use.
  • Criminality.

45
Dopamine Extinction (Non-Reward)
anterior cingulate cortex
nucleus accumbens
ventral tegmental area
The Mesolimbic DA System
46
The Anterior Cingulate Cortex
  • Mid-brain structure with complex functions
  • Allocation of attention to important yet
    unanticipated events.
  • Coordination of thought and emotion.
  • Error detection.
  • Error monitoring.
  • Extinction learning.

47
ACC Activity Reward vs. Extinction
Reward
Extinction

Control
ADHD
Source Gatzke-Kopp, Beauchaine et al., 2007
48
Deficient ACC ActivityImplications for Learning
  • Deficient ACC activity during extinction
    (non-reward) likely gives rise to
  • Problems unlearning previously rewarded
    behaviors.
  • Response perseveration.
  • Poor monitoring of ones own mistakes.

49
Summary
  • Impulsivity is highly heritable and confers risk
    for poor school readiness and problems with self
    regulation.
  • Examining neural processes of impulsive children
    suggests deficiencies in both
  • a. Associative learning of new information, and
  • b. Extinction (unlearning) of no longer useful
    old information.
  • The same neural deficiencies that affect learning
    also predispose to negative affectivity,
    irritability, and low motivation.
  • These neural deficiencies can be detected in
    preschool, and confer risk for later delinquency
    (Crowell, Beauchaine et al., 2005).
  • Early intervention is essential because
  • a. Neural vulnerabilities are amplified by
    environmental risk.
  • b. Interventions become increasingly ineffective
    in older children.

50
What do Effective Interventions Look Like?
  • Parent training for effective behavior management
    at home.

Source Beauchaine, Webster-Stratton, Reid,
2005.
51
Parenting Progression of Impulsivity
PeerNomination
ParentReport
.54
.06
Conduct Problems
InterviewerImpression
Hyperactivity
Teacher Report
Observed Behavior
.77
.59
CoerciveParental Discipline
Observed Nattering
Harsh Discipline
Observer Impression
Source Patterson et al., 2000
52
What do Effective Interventions Look Like?
  • Parent training for effective behavior management
    at home.
  • Teacher training for effective behavior
    management in the classroom.
  • Child training of effective strategies for
    managing trait impulsivity.

Source Beauchaine, Webster-Stratton, Reid,
2005.
53
What do Effective Interventions Look Like?
Preventing and Treating Behavior Problems in
Young Children A Parent-Teacher-School
Partnership
Carolyn Webster-Stratton, Ph.D. University of
Washington Department of Family and Child Nursing
Tomorrow, 330-5 p.m.
54
The Prefrontal Cortex
anterior cingulate cortex
pre-frontal cortex
nucleus accumbens
ventral tegmental area
The Mesocortical DA System
55
The Prefrontal Cortex
56
The Prefrontal Cortex
  • Responsible for executive functions
  • Long term planning
  • Inhibitory control over behavior
  • Overriding strong emotions
  • Complex reasoning and thought processes.
  • Among the last brain areas to develop fully.
  • Coordinates with mesolimbic structures to
    regulate behavior.
  • PFC neurodevelopment is compromised by both
    mesolimbic deficiencies and adverse environmental
    experiences (e.g., Poeggel et al., 1999).

57
Gray Matter Development
Source Gogtay et al., 2004
58
Acknowledgements
National Institute of Mental Health University
of Washington Royalty Research Fund Sharon
Brenner Hilary Mead Jane Chipman-Chacon
Kate Shannon Sheila Crowell Jamila Reid Lisa
Gatzke-Kopp Patrick Sylvers Emily Neuhaus
Carolyn Webster-Stratton Penny Marsh
Numerous UW undergraduate RAs
59
A Similar Talk Can be Viewed on University of
Washington TV Brain Science as a Means of
Understanding Delinquency in Youth
http//www.uwtv.org/programs/displayevent.asp?ri
d3402
60
(No Transcript)
61
Cardiac Responses to Reward
  • Sympathetic nervous system (SNS)-linked cardiac
    activity may serve as a proxy for central DA
    activity
  • Heart rate acceleration facilitates approach
    behaviors.
  • Approach-related behaviors requires energy
    mobilization, a function served by the SNS.
  • Increases in cardiac output are facilitated by
    SNS-mediated changes in contractile force of the
    left ventricle.
  • DA infusions into mesolimbic structures induce
    SNS-mediated increases in cardiac output (van den
    Buuse et al., 1998).

62
Assessing SNS-Linked Cardiac Activity
Pre-ejection period
63
Tonic PEP and Delinquency
98 96 94 92 90 88 86
90 86 82 78 74 70 68
Delinquent
ADHD
Non-delinquent
Non-ADHD
1 2 3 4 5 6 7
Adolescents
1 2 Preschoolers
64
Phasic PEP During Reward
adolescence
middle school
preschool
No conductproblems
Non-delinquent
NoADHD


ConductProblems
ADHD
Delinquent
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