SCHOOL NEUROPSYCHOLOGY MIND, BRAIN & EDUCATION ARTICLES
TABLE OF CONTENTS
WEEK 2 MIND, BRAIN, AND EDUCATION (MBE) / EXERCISE AS SCHOOL INTERVENTION.......................2
Executive Function Treatment and Intervention in Schools – Otero, T.M., Barker, L.A., Naglieri, J. A.
(2014).................................................................................................................................................2
Using Physical Activity to Manage ADHD Symptoms: The State of the Evidence – Betsy Hoza,
Caroline P. Martin, Anna Pirog, and Erin K. Shoulberg (2016)............................................................6
WEEK 5 ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)...........................................................8
Psychological heterogeneity in AD/HD – a dual pathway model of behaviour and cognition –
Edmund J. S. Sonuga-Barke................................................................................................................8
ADHD and academic performance: why does ADHD impact on academic performance and what
can be done to support ADHD children in the classroom? – D. Daley and J. Birchwood..................12
WEEK 6 CLASSROOM INTERVENTIONS FOR ADHD...............................................................................15
ADHD in the Classroom: Effective Interventions Strategies..............................................................15
WEEK 7 NEUROFEEDBACK AS SCHOOL INTERVENTION........................................................................17
Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice – Stefanie
Enriquez-Geppert, Diede Smit, Miguel Garcia Pimenta, and Martijn Arns.......................................17
In-School Neurofeedback Training for ADHD: Sustained Improvements From a Randomized Control
Trial...................................................................................................................................................20
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,WEEK 2 MIND, BRAIN, AND EDUCATION (MBE) / EXERCISE
AS SCHOOL INTERVENTION
Executive Function Treatment and Intervention in
Schools – Otero, T.M., Barker, L.A., Naglieri, J. A. (2014)
https://www-tandfonline-com.proxy-ub.rug.nl/doi/full/10.1080/21622965.2014.897903
Introduction
Executive function (EF) is a broad, overarching term that refers to a variety of cognitive processes
largely mediated by the prefrontal areas of the frontal lobes that encompass both cognitive and
affective constructs including planning, working memory, attention, inhibition, self-monitoring, self-
regulation, and initiation. These multidimensional cognitive constructs are necessary for goal-
directed and problem-solving behavior in all aspects of life, whether academic, vocational, or social.
Cognitive aspects of EF stem from the dorsolateral areas of the prefrontal cortex, while affective
components can be traced to the ventral and medial areas of this brain region. There are three
widely accepted core components of EF: inhibition, working memory, and cognitive flexibility. These
allow the development of higher-order, complex EF constructs such as reasoning, planning, and
problem solving.
EF deficits in childhood have been shown to have a negative impact on academic, social-emotional,
and adaptive functioning later in life, and they are present at all stages throughout development in
children both with and without neurodevelopmental disorders. This has significant implications for
educational programming and intervention selection for both the general and special education
populations within school systems; however, the research base for EF interventions with children and
adolescents is limited.
How Do Children With EF Deficits Present in the School Environment?
Cognitive deficits often manifest as academic difficulties, while affective deficits are often viewed as
behavioral problems. Students with EF deficits often present as disorganized, lack initiation, and can
appear forgetful. Behaviorally, these students likely struggle with resisting temptation, are impulsive,
and do not think before they act. Examples of classroom behavior that may accompany affective
aspects of executive dysfunction include blurting out answers without waiting to be called on or
interrupting someone who is speaking.
Identification of EF Deficits in the School Setting
The identification and assessment of EF deficits in school-aged children can be conducted in several
ways that include both qualitative and quantitative methods. The multidimensional nature of EF
requires the use of various diverse methods of assessment that take into account the fact that EF
constructs such as response inhibition, working memory, planning, and response preparation are
independent in various ways; however, they are also interrelated, as evidenced through factor
analysis, showing that many constructs ‘‘load’’ on several EF factors.
Qualitatively, behavioral observations of how students approach and complete a task, as well as
anecdotal reports from teachers and related school personnel are often a precursor to a referral for a
standardized assessment of EF, which typically utilizes more quantitative methods of assessment.
These quantitative measures, which are norm-referenced, reliable, and valid, can be either direct
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,(individually administered assessments such as the Cognitive Assessment System) or indirect
(behavior rating scales or frequency measures such as the Comprehensive Executive Function
Inventory).
Often in school settings they only look at if the child has a particular disability in 1 of the 13 identified
categories under the special education service of Individuals With Disabilities Education Act of 2004
(IDEA-2004) guidelines. We feel that there is a disconnect between the framework for identification
of disabilities under federal guidelines and the type of comprehensive evaluation that should be
conducted that assesses all psychological processes, including attention, memory, and EF. Currently,
there is no IDEA-2004 category to identify EF deficits (or attention or memory). Typically, we see EF
deficits classified under the category of other health impairment based on a Diagnostic and Statistical
Manual of Mental Disorders-5 diagnosis of ADHD.
Considerations for the Selection of Treatment Methods and Interventions in the School Setting
Diamond (2012) outlines six general principles regarding EF training that must be considered when
selecting EF interventions for children:
- Those who most need improvement benefit the most.
- Transfer effects from EF training are narrow.
- EFs should be challenged throughout training (i.e., demands must continue to increase to see
effects).
- Repeated practice is key.
- Whether EF gains are produced depends on how an activity is done.
- Outcome measures must test the limits of the children’s EF abilities to see a benefit from
training.
Several factors must be considered before an intervention to target EF deficits is selected within the
school setting. The first thing to consider is the child’s age and current level of developmental
functioning. Certain EF interventions work better for certain age groups. Complex executive skills
develop later in life and are built upon the development of three broad EF constructs: inhibition,
working memory, and cognitive flexibility. Furthermore, certain neurodevelopmental disorders such
as ADHD and ASD tend to present with a specific profile of EF impairments and must be taken into
consideration during intervention selection. The efficacy of specific interventions with special
populations should also be taken into consideration. A careful review of the diagnostic information
available to the multidisciplinary team is necessary and should be comprehensive in nature, so all
areas of suspected impairments across all relevant domains of functioning, including EF, should be
considered. Tasks that measure EF should be relatively unfamiliar so that a child has to develop a way
to solve the problem.
Based on what we know about the limited generalization of most EF interventions, accurate
diagnosis must drive intervention selection; otherwise, the child will not respond and critical
developmental time will be wasted, with deficits likely increasing with age and negatively impacting
the child’s ability to develop higher-order EF skills. School personnel also need to consider
demographic, cultural, and other environmental factors to determine if the child exhibits a pattern of
strengths and weaknesses across settings, and they should use this information when designing
treatment plans, as interventions that focus on a child’s strengths and involve the support of the
family are often more successful. Finally, school personnel must answer the question of what is
feasible to implement within the confines of the educational environment.
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, Treatment Methods and Intervention Strategies
Treatments Outside of the Scope of the School Setting
Knowledge of the efficacy of psychopharmacological interventions and neurofeedback is essential for
consultation with parents and for providing additional resources and referrals to families or other
professionals who desire additional information or support.
Computerized Training
Computerized training of EF typically targets working memory and/or attention. These types of
interventions use repeated practice and reinforcement in attempts to produce structural changes in
the brain, thus improving working memory/EF. Redistribution refers to the change in patterns of
brain activity within the same neuroanatomical locations before and after working-memory training,
which leads to increased efficiency of specific cognitive-processing tasks while reducing the demands
on attention. Reorganization refers to the activation of new brain areas following cognitive training
and is assumed to lead to a qualitative change in the processes used to solve the trained task.
Computerized programs have the greatest treatment integrity of all intervention strategies described
as they remove the chance of human error in implementation and allow for the accurate and precise
measurement of multiple behaviors that are beyond the scope of a single examiner (i.e., reaction
times, latency, impulsive responding). Within the school setting, computerized EF interventions
implemented within a group setting are appealing, as they reduce the need for additional resources
such as increased personnel, quickly provide rich data with minimal effort on the part of the
interventionist, and monitor and continuously adapt the difficulty of the task based on the child’s
performance on a given trial.
Research conducted on the efficacy of these computerized interventions and the transfer of skills to
other cognitive-processing tasks has presented with mixed results. Transfer effects are narrow
among EF constructs; computerized training aimed at improving working memory may yield
improvements within that specific area of EF but not others, such as inhibition or speed and
efficiency of cognitive processing. Schneiders and colleagues (2012) demonstrated how auditory
adaptive working-memory training resulted in reduced brain activity in the right inferior frontal gyrus
when presented with an auditory task following training, but these results were not seen in a visual
task, indicating that the training was effective within a specific modality (auditory) and suggesting
that the brain became more efficient as a result of the training. As the brain becomes more efficient,
it required less energy to perform specific tasks.
Computerized working-memory training programs appear to produce short-term, specific training
effects at best that do not generalize among the multitude of cognitive constructs that are classified
as EF. Results also indicated that effects are not sustained on follow-up measures. Computerized
approaches also present a financial consideration, which is an important factor for public education
systems.
Strategy Instruction
Luke (2006) defined strategy instruction as a student-centered approach that supplies struggling
learners with tools and techniques to understand and learn new material or skills while allowing for
the direct and immediate application to practice in various areas of school and life. Teachers should
use instructional methods that incorporate scaffolding and modeling techniques and allow students
ample time for practice. Traditionally, older children and adolescents benefit more from strategy
instruction than do younger children.
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