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Child Neuropsychology

A blog by Dr Jonathan Reed

  • Everyone is a psychologist.  By that I mean that everyone tries to work out why people behave the way they do.  This is an inbuilt social drive that helps us to interact normally.  It is based on theory of mind which is about understanding other people’s mental states and intentions.  Lack of theory of mind is the key disability in Autism.   In my work I find that most people have a strong belief about why someone is behaving the way that they do (although in my work I think that it is often a wrong belief).

    I think we base our understanding on why others behave  the way that they do on what we think about ourselves and our cultural norms.  This is essential to group cohesion.  No one can truly know how another person is thinking but we automatically make an educated guess.  The difficulty comes when normal behaviour breaks down.   We know that in some individuals behaviour and personality changes dramatically with acquired frontal brain injury- see the case of Phineas Gage.   I see similar difficulties in my work with children with head injury, neurodevelopmental disorders and sometimes those with a history of abuse and neglect.  With these children I see very challenging behaviour that doesn’t respond to normal parenting or behaviour modification.  I will write about why this is in more detail at a later date (to with difficulties in development of frontal brain areas). In general though behavioural control is more complicated than it seems.

    I was particularly struck by this difficulty in understanding why some people behave the way they do when reading a research paper looking at the most extreme of behaviours, murder.  Why does someone comit murder?  The paper looks at 77 inmates or defendants charged with murder in the US and referred for neuropsychological assessment.  The sample is self selected because they were referred for clinical assessment rather than randomly chosen for research.  However, the sample characteristics are striking.  Some of the key facts are:

    • 49.4% had a developmental disorder in childhood.  (36.4% had ADHD)
    • 87% had a brain injury (self reported and 10% had documented evidence)
    • 85% had a history of substance abuse.
    • 45% had a psychiatric history
    • 35% had a history of abuse in childhood.

    From the neuropsychological assessment the mean IQ was 84 , which is a standard deviation below the norm.  Mean working memory was 87 which is low average.  The mean logical memory score was 68 which is very low indicating significant memory problems.  The sample also had a high rate of assessed executive function difficulty (executive function is the cognitive ability associated with the front area of the brain).

    You will need to read the paper to find all the details because there are so many interesting factors in the sample.   However, taken together the majority of the sample had some form of brain damage/ disorder or abuse stemming from childhood (which as I have discussed here often leads to developmental brain damage).   Exactly what is going on in their heads can never be know and the neuropsychological factors don’t explain the trigger or situation in which the murder took place.  However, it is clear that there are neurological and neurodevelopmental factors going on here, and given what we know about these in childhood and from case studies, it is unclear how much control such individuals have in a given situation.  I don’t offer this as an excuse to let people off and certainly I think many of these people are extremely dangerous.  But the results may shake our assumptions  (based on our own theory of mind) as to why people behave the way that they do.  Consider this next time you hear about a murder in the News.  Also the results may point to the importance of prevention in terms of early identification and treatment of childhood neurological problems and childhood abuse.  So many of these people’s problems seem to stem from experiences and events in their childhoods.

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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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  • There is an interesting article in the Sunday Times this week entitled ‘how to make your child more intelligent’. It seems to be based in part on a new book by Richard Nisbett entitled ‘Intelligence and How to Get it: Why Schools and Cultures Count. Whilst the article makes a number of important points the overall tone feels a bit like the old nature/ nurture debate, which I thought was over years ago. The article starts by stating that ‘Over recent years most experts have concluded that intelligence is largely genetic in origin, and that nurture does relatively little to raise an individual’s potential’. I am not sure which experts they are referring to here as anyone who knows anything about the genes and IQ literature knows this not to be true. The relationship between IQ and genes has been researched very thoroughly. The consistent finding is that genes account for about 50% of variance, which leaves 50% due to environmental factors. The article seems to try and overemphasize the role of environment and diminish the role of genes. It states ‘demolishing the finding of twin studies is part of the argument against genes controlling intelligence.’ This is the argument that twins who are adopted and reared apart have similar IQ. The article argues that twins who are adopted and reared apart have a similar environment in that adopted parents are highly likely to give their children a good start in life. This seems a highly tenuous argument. Are all adoptive environments the same? Would this produce such consistent findings? Also would this argument hold for all the twin studies looking at heritability in schizophrenia, autism, ADHD etc. Dismissing twin studies is a familiar ploy of people who want to dismiss the genetic factors and one I thought had died years ago. It undermines what is otherwise a good argument. The results for the gene and IQ studies are very consistent and researched in some detail. It seems silly to me to claim that genes don’t have an effect on brain and psychological development. You don’t need to knock the gene studies to show that environment is important. The gene studies already do this.

    Another factor that points to the importance of genes in IQ is that clinical experience and research suggests that IQ is remarkable stable through lifetime. Twins actually become more similar in IQ scores as they get older. Something must be driving this. IQ doesn’t change easily, although there are obvious environmental factors at work. Certainly it is clear from the Flynn effect that IQ has been steadily rising over the last 100 years (obviously genes are not evolving that fast). There is a lot of research on environmental factors influencing IQ. IQ is a complex concept that is not totally understood, but from the research there are some candidates for strong environmental factors that have an impact on IQ development. These include having a stimulating early environment, good early nutrition, an environment rich in language and literacy. There is also research showing how targeted computer games may raise IQ. There are other suggestions in the article although i am not sure about the research to back them up – I am certainly not aware of the value of meditation on IQ, encouraging self control or having bigger babies to name a few mentioned in the article.

    So overall, yes I believe we can encourage children to be more intelligent (although as IQ as currently assessed is a comparison measure it will be difficult to measure this) and I applaud the article for highlighting this. I think we should try. But don’t dismiss the influence of genes. That influence is always there and if ignored can result in my opinion in insidious effects such as a lack of social mobility. Parent’s genes are important in part in determining early child environments (i.e. stimulating, language rich environments with high levels of nutrition) and therefore IQ development. This is a political question. I think that overall improved IQ and literacy should lead to a better society (although many other factors are important too). To achieve this early intervention by the State will be probably be needed. We will need to understand the whole picture if we are to move forward.

    PS the article does contain a good section demolishing the race, genes and IQ argument and should be read for that alone.

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  • The world of genetics is moving so fast it is hard to keep up. Luckily one of my favorite writers on the subject Robert Plomin (together with Oliver Davies) has written an update on the genetics of child psychology and psychiatry in the Journal of Child Psychology and Psychiatry. There is a lot of information in the article regarding the latest genetic findings but the issue that stuck me most was about how our understanding about how genes work is changing. My understanding of genes was the classic model described succinctly by Plomin and Oliver as a gene is a sequence of DNA that is transcibed into messenger RNA which is then translated into amino acid sequences, the building block of protein”. The proteins then build to form brain structure, neurotransmitters etc.

    The hunt has been on to find the genes that affect behavior and illness using this classic DNA process. There have been successes with a number of single gene neurological disorders identified such as Huntington’s Chorea and PKU. For these conditions the gene has been located and the sequence from gene to protein to behavior is well documented. Unfortunately this process has not worked in discovering the genes for most other psychological/ psychiatric disorders or for behavior in general. Although it is clear that there is a substantial genetic component in behaviors such as IQ, reading and language and disorders such as ADHD and Autism, as shown by twin studies, the actual genes responsible have not been found. Recent arguments have focused on the idea that many genes may be involved in combination to influence such behaviors. Plomin’s article however also raises another difficult issue. There may also be a problem with the standard DNA model as an explanation for gene- behavior effects. There are a number of puzzles regarding the standard coding DNA model. Firstly there are far fewer of these traditional genes than expected (about 24,000 in humans). Also they only make up about 2% of DNA, the other 98% were said to be junk, a byproduct of evolution. Another factor is how little these traditional genes vary between individuals and species for example simple worm like creatures called called nematodes have 19000 genes compared to the 24000 in humans. Are we not that much different to nematodes? Chimpanzees share 99.4% of DNA coding genes with humans.

    Plomin and Oliver show that part of the problem may be that we have not focused on the way that RNA works. Out of the 98% thought to be junk DNA about 1/2 does produce RNA but not the type of RNA that codes for amnio acids. Instead the non coding RNA ‘plays an important role in regulating the expression of the protein coding DNA‘. RNA is also much more complicated than once thought and many different types of RNA have now been identified, including microRNA, tRNA, snRNA, rasiRNA, snoRNA, etc. How RNA works is explained in detail in the article but that explanation is too detailed to describe here other than to say that there is much more variation between individuals and species in terms of their RNA profile and that it is the RNA that may hold the key to understanding more complex gene behavior effects. The implication of these findings according to Plomin and Oliver is that we should be analyzing the whole genomes of individuals rather than searching for individual genes. This is becoming cheaper and easier to do but so far the results are still very limited.

    My take home message from the article was that genes and their effects are not as simple as most people believe and as much of the media describes. It is very unlikely that we will find the gene for Autism, for IQ or for being gay. Instead such behavior is likely to be the result of a complex interaction of many different genes, with different types of RNA dictating how the genes are expressed which in turn will probably be influenced by factors in the environment. Hugh discoveries are being made all the time but I think the more that is known the more complex it all seems.

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  • I have recently been reading Malcolm Gladwell’s new bookOutliers: The Story of SuccessI have to say that I found a lot of it irritating as I thought his arguments were very polemic and with lots of flaws, although he is a great storyteller and writer. There are however, two interesting chapters on high IQ in the book. As a neuropsychologist who assesses IQ, I sometimes get people telling me that they or their children have very high IQ’s normally over 150 and sometimes over 200. I am never sure when this comes from as on the most commonly used test of IQ in the US and UK, the Wechsler scales, the highest IQ you can get is 160. In Gladwell’s chapter he discusses the case of Chris Langan a person with one of the highest IQ’s in the US, with an IQ of 195.

    I think a lot of people think that having a high IQ is a very valued attribute and thus claim to have a high IQ in order to impress. What people don’t seem to realize is that IQ is not an interval scale i.e. like a ruler, getting higher in equal measures. Instead IQ is a comparison scale, it compares your score to others. About 50% of the population have an IQ between 90 and 110 making this level of IQ normal. A further 46 % have either a high IQ from 111-130 or a low IQ between 89 and 70. Only 2% have an IQ below 70 (classed as a learning disability) and 2% or 2 in a 100 people have an IQ above 130. An IQ above 148 would place you in the top 1 out of 1000 people. However a high IQ isn’t always a good thing. Gladwell describes how Chris Langan’s life has been one of underachievement, he now lives on a farm looking after animal with a relatively quite life. Gladwell also looked at a long term study of a group of very high IQ kids who had been followed up. They also hadn’t done that well. Gladwell argues that whilst a higher than average IQ predicts good education etc beyond a certain point (about 120) ‘having additional IQ points doesn’t seem to translate into real world advantage’ (p79).

    In my clinical practice I have only rarely seen children with an IQ over 130 and those that I have seen seem to have found it difficult. They tended to be socially isolated partly because they couldn’t relate to their peers. But also a good proportion of these children had a social communication disorder (Asperger’s syndrome). In a way a very high IQ is abnormal. Only a very few people have it and there must be some odd process in development/evolution for it to occur. It doesn’t seem to give any particular benefit and often is associated with difficulties. So my advice is to be careful in wishing for a very high IQ for you or your child in this regard it is probably better to be average or high average.

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