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Child Neuropsychology

A blog by Dr Jonathan Reed

  • The founding father of psychology Sigmund Freud was fascinated by the unconscious mind and made this the centre of his study and practice.  The role of the unconscious in psychology quickly fell out of fashion.  This was because it could not be measured or easily understood.  Initially behaviourism became dominant, based on the objective analysis of observable behaviour.  Later the focus in psychology shifted to studying cognition – the study of thought processes.  Both areas resulted to different psychological therapies for example,  Cognitive Behavioural Therapy (CBT), and different ways of understanding learning.  Over the last decade or so neuropsychology has started to emerge.  Neuropsychology focuses on the relationship between the brain and behaviour (including cognition).  And guess what – as we begin to understand the role of the brain in psychology there is an increasing interest in the role of  unconscious processes (brain actions that we are not aware of consciously) .  Back to the start again- maybe Freud was right all along!

    I wrote about the importance if understanding the relationship between sub cortical structures and the cortex in a previous post. I have also just read a fascinating and very readable book by David Eagleman Incognito: The Secret Lives of The Brain.  This book looks at the dominant role that the unconscious brain plays in everyday human life.  Eagleman argues that most of what we do happens automatically and without our conscious brains being aware.  He gives numerous examples of how unconscious processes control our psychology including our attraction to others, our prejudices, our perception of the world, as well as the more obvious examples of motor control- I would really recommending reading the book to understand the richness of his argument.  He argues that conscious thought processes play a very small role in our lives,  perhaps just to allowing us to think flexibly and set goals (clearly this has big consequences as the achievements and dominance of the human species shows).  Intriguingly he also suggests that maybe our conscious self is not in control at all, but we (it) just think we are.  This was a central point in Chris’s Frith’s excellent although more academic book Making Up the Mind: How the Brain Creates Our Mental World.  Both authors report studies  showing that when you ask someone to tell when they have the urge to lift their finger and scan their brain, the part of the brain responsible for planning the action lights up before they report the urge to lift their finger.  Therefore the unconscious brain is making the decision before they are are consciously aware of it.

    Understanding the role of unconscious processes has important implications for psychology.  David Eagleman discusses in detail the implications for the criminal justice system.  Are criminals to blame for acts committed by unconscious processes (and especially when you add in abusive childhoods, brain injury, learning problems, genetics, which are all out of conscious control)?  I think there are also significant implications for child neuropsychology.  Understanding how our brains work and basing treatment and intervention on this understanding will lead to more effective intervention.  In my practice I work a lot with children with significant learning disabilities and brain injury.  Often they are unable to learn or control emotions and behaviour consciously.  I  look at ways to influence implicit processes  i.e changing the environment rather than expecting individual to change.  Also with my games company Neurogames I integrate implicit learning processes into the games, which I think is what makes them effective.  However we are only just starting to understand these processes and as our understanding increases I expect there to much more focus on sub cortical and unconscious processes in psychology.  This is not entirely easy as we create and develop psychological theories using the conscious parts of our mind, thus we are already biased.  We need to suspend our own perceptions and experience, based on our conscious view of the world and look at the data instead (a bit like theoretical physics).  Understanding how the brain actually works holds promise for major changes in psychological treatment, teaching and social policy.  Maybe we are also on the verge of a revolution in how we see ourselves?   I’ll keep you posted on ideas that emerge.

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  • I want to discuss an important new book for understanding how the brain works, which I have just read and is called Subcortical Structures and Cognition: Implications for Neuropsychological Assessment by Leonard Koziol and Deborah Budding.  Our current understanding of how the brain works using Neuropsychology has traditionally focused on the cortex part of the brain – frontal, temporal, parietal and occipital lobes and has looked at what happens psychologically when there is damage to these particular areas.  From this we understand perception, memory, language etc pretty well.  However we have tended to ignore subcortical brain areas such as the basal ganglia and cerebellum and have considered these areas as being responsible mainly for motor co-ordination.   This new book by Koziol and Budding challenges this view and presents a view of sub cortical structures being central to the way the brain works.  It is a detailed book with many arguments (a summary can be seen on the website here) and needs to be read carefully, but some of the important points for me were:

    1.  The brain responds to the environment in two key ways.  Firstly most of the time it responds in an automatic way (subconscious way using procedural memory) which requires little thought, is fast and is adaptive.  You don’t need to work out how to respond to most everyday occurrences you just do it.  However, when a new situation arises, maybe a threat, maybe something you need to learn, the front part of the brain takes control and thinks about how to respond (i.e. executive function).  Both systems operate in tandem and are connected by the basal ganglia.  The default setting for the brain, however, is to make unfamiliar familiar.  This is more efficient.  Hence there is a drive to turn new information into automatic memory.

    2. Koziol and Budding argue that the basal ganglia is key in determining this process i.e. linking controlled and automatic responses.   It does this by being part of a feedback loop connecting the cortex to the limbic system (thalamus) and acting as a gate between the two. Basically the cortex is stimulated by sensory input and the sub cortex inhibits responses by deciding what information is returned to the cortex.

    3. The other main sub cortical area the cerebellum works to further fine tune responses using a mix of excitation and inhibition.

    4. The book details how and why such a system would have evolved.  This is often missing in neuropsychology accounts.  The book offers a plausible explanation of what any organism needs to function and how brains have evolved to meet these needs.  The key purpose of an organism is to survive.  In order to survive an organism needs to recognise objects, locate objects and detect movement (all cortex functions) and then to know what to do, how to do it and when to act (all mediated by the subcortex).  Koziol and Budding compare the subcortical structures in vertebrates, primates and humans to illustrate this point.

    5. The  basal ganglia acts as a gate to switch responses on and off, which is the key to regulation.  Knowing when to start a behaviour (initiation) and when to decease from a behaviour (inhibition) is key to how we function (and yet is rarely explored). The cerebellum further fine tunes this process.

    6.  Traditionally the sub cortical structures have been though of as mainly involved in motor responses.  However one of the many interesting ideas in the book is that  the same structures may have a similar  function for emotion, behaviour and cognition.  This would make sense from an evolution and developmental point of view.  Undertaking complicated motor sequences such as kicking a ball i.e. judging when to move and adjust can be similar to knowing how to control anger, social response or thoughts.

    7. Why this is important in my opinion is that it starts to offer explanations for disorders of regulation, which are so common in children, e.g. ADHD, TBI, OCD, emotional disorder, motor co-ordination and speech disorders.  Neuropsychology does not provide very good explanations for these disorders at present and yet they are the most common difficulties encountered especially with children.  The key issues in these disorders is regulating and adjusting responses to the environment.

    8.  Another reason the book is important is that it gets away from the view that we need to focus on a single brain area and it’s function and looks instead about how different brain areas act in circuits in relation to one another.  The circuits work by involving different brain areas in feedback loops using excitation and inhibition to regulate the system.   This makes sense biologically, developmentally and from an evolutionary point of view.

    Therefore I would highly recommend this book to anyone interested in neuropsychology and how the brain works.  It challenges existing thinking.  It is a specialist book but is well written and informative.   There are detailed sections on neuropsychological assessment for those interested, although these sections are in my opinion of more limited interest because most tests don’t assess subcortical functions that well.  The important thing the book does for me as well as explaining sub cortical anatomy and function is to start to provide a more coherent framework for understand brain regulation, which I think is fundamental for understanding child neuropsychology.   I think that ultimately this understanding will help us better assess and help children with brain dysfunction and particularly regulation difficulties.

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  • I have been reading an excellent book on personality research called Personality: What makes you the way you are by Daniel Nettle. It is written for the non expert and is easy to read and full of interesting observations. In the UK the psychology of personality has not been very influential on clinical practice. Most Clinical Psychologists do not assess personality, particularly in children and young people. In addition the study of personality has not featured on many university courses and certainly was not part of my undergraduate degree. However, recently I have began to take an interest in this area of psychology because it makes a lot of sense clinically. The children and young people I see have clear personality traits which fit with the current research. Having read Daniel Nettles’ book I believe that there will be a renaissance in personality assessment and understanding over the coming years. There are three key facts driving this, which are:

    1. Researchers studying personality using factor analysis have come to a consensus that there are five main personality factors, which are:

    Extraversion

    Agreeableness

    Conscientiousness

    Openness

    Neuroticism (emotional stability)

    2. The behavioural genetics work fits with the five factor model and also suggests that these traits have a large genetic component.

    3. There is increasing interest in the neuroscience of personality. The five factors are associated with different neural pathways e.g. Neuroticism (amygdala, hippocampus and R dorsolateral prefrontal cortex); Conscientiousness (dorsolateral prefrontal cortex); Extraversion (mid brain dopamine reward systems).

    Given the genetic and neuroscientific evidence it would make sense to consider personality when looking at development, emotional and social difficulties in childhood.

    There are lots of thought provoking issues raised in the book but I will highlight three that I think have major implications:

    Firstly behavioural genetics studies have shown consistently that shared family environment i.e. parents, have little to no effect on development of adult personality (not sure what the Freudians make of this!).

    Secondly that multivariate analysis shows that children’s personality seems to affect the way parent’s treat them rather than the other way round.

    Thirdly : Personality seems to predict quite strongly, certain life experiences. For example high scores on Neuroticism predicts higher likelihood of divorce and low scores on conscientiousness predicts early death. Nettle argues that personality assessment together with IQ are two of the strongest predictors for how you will do in life. It is important to note that the genetics of IQ and personality account for about 50% of variance and environment is also important. There are ways of course that you can alter your environment to influence your life course. However, I think that it is likely that without intervention the genetic biases we all have will lead us in certain directions.

    If you want to find out what your personality is there is a online test at the personality project website where you can take an anonymous personality test as part of an online research study. More information on personality can be found at the main personality project website.

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  • One of my favourite columnists from The Times newspaper Daniel Finkelstein has written a thought provoking column today criticizing the latest report The Good Childhood Enquiry. This report was about how unhappy children are today because of selfish parents. In the column Daniel makes some simple points which I often think about myself when seeing children. The key issue is the extent to which parents influence children’s behaviour and personality. The points he makes are 1- children and parents share the same genes and therefore are likely to be somewhat alike to start with. 2- children who are difficult are going to influence the way their parents react to them. It is easy to be an authoritative parent with a child who is easy to manage- the traffic is not all one way. I happen to believe that parents do have an affect on their children but there are so many other issues affecting development as well. The issues about genetics that Daniel raises are penitent as well as the effect of the peer group, diet, sleep, exercise, brain injury, neurodevelopmental issues etc etc. Finally the column ends with an interesting take on the pros and cons of individualism and it’s effect on social relationships – but you will have to read that HERE yourselves.

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