Lecture PowerPoint

Neuroscience Update:
Executive Functions
Neurodevelopemental Maturation underlies and Drives Behavior
and Cognition
Prefrontal Cortex is the Seat of Reasoning and Last Region to
Reach Structural Maturity
Moral Reasoning, Judgment, Impulse Control, Planning, Character
and Behavior are directly related to the Biological Maturation of
the Brain
Adolescent Brain is not Structurally
Comparable to the Competent Adult Brain
Maturation of Executive Functions in
Adolescence is Critical for SelfRegulation, Judgment, and Reasoning
•Must be 25 years old
•Must Have a Valid Credit Card
What are they?
 How do they develop?
 Developmental risk factors
 Academic issues
 Social issues
 Role in Dyslexia
Unique Set of Mental Functions
 Regionally specific to the Prefrontal cortex
 Mediated by flexible and dynamic neural networks
 Direct Cognitive and Emotional Functions
 Include Cognitive Initiation and Inhibition, Self
Regulation, Problem Solving, Flexibility, Error
Detection, Organization, Self Monitoring, & Motor
 Orchestrate the Domains of Thought and Action
Conductor of the Orchestra”
Forgetfulness, can’t keep
several things in mind
Distractibility and
Have difficulty following
Difficulty using sense of
time to prepare for
upcoming events and the
Cannot accurately estimate
how much time it will take
to finish a task
Emotional reactivity
Low frustration tolerance
Lack of Initiation
Decreased self awareness
Diminished working
Lack of anticipation
Temper Dyscontrol
Weak self-calming skills
Difficulty reading social
Poor follow through
Low tolerance for boredom
Executive Function
Levels of Analysis
Self Regulation
Working Memory
Organization and
Use of Self-Directed
Speech, Rules, and Plans
Prefrontal Cortex
Initiate, Sustain,
Inhibit, Shifts
Goal Directed, Future
Oriented Actions
NeuroBehavioral Associates
Biological Maturation and EF
•Develops in Fits and Starts
•Vulnerable to Early Insult and Chronic
•Adolescent Brain is Structurally Closer to a
Young Child’s Brain than an Adult’s Brain
•Prefrontal Cortex or Executive Control
Centers are Last to Mature
Ontogeny Recapitulates Phylogeny
Embryonic Development of an Organism follows
the same Path as the Evolutionary History of its Species
Genes – responsible for basic wiring –
forming cells and general connections
Environment: experience is responsible
for fine-tuning, strengthens useful
 Integrated Neural Networks with
Regional Specificity
Early mother-infant interaction is important for the
development of the orbitofrontal cortex during the
first months of life.
 Early life stressful experiences may permanently
damage the orbitofrontal cortex, predisposing the
individual to later life neurobehavioral deficits
 Severe early stress induced by deprivation and abuse
induces changes in the developing brain.
Corticotrophin – releasing factor (CRF)
hypersecretion throughout life is a consequence of
severe abuse in childhood and may underlie the
psychopathology that follows abuse
Abuse leads to a state of chronic hyper-arousal
and specific neurochemical changes occur in the
brains of abused children.
The memory loss of disassociative amnesia
induced by psychological stress may be the result
of the toxic action of high, prolonged levels of
glucosteriods on the hippocampus
Contributors to the risk for ED:
Pregnancy complications
Toxin exposure
Drug/alcohol prenatal
Low birth weight
Post-natal injury
ED possibly related to a birth defect due to a nutritional
deficiency of Omega-3 fatty acids during pregnancy and
while nursing (Ottoboni & Ottoboni, 2003.)
ED/ADHD does not arise from increased sugar intake, food
additives, excessive viewing of television, or poor child
management by parents.
study: Comparison of MRI
scans of young adults, 23-30,
with those of teens, 12-16:
› Areas of the frontal lobe showed the largest
difference between young adults and teens.
› Parietal and temporal areas appeared largely
mature in the teen brain.
› Increased myelination in the adult frontal cortex
related to the maturation of cognitive
processing and other executive functions.
Executive Functions
Cortical Maturation
The shades of blue symbolize
maturing brain functions.
Maturation culminates in the
prefrontal cortex, the area
just behind the brow. This is
the seat of Executive
Functions the area that
controls judgment and the
weighing of risks and
Previously this area was
thought to be mature by 18
but studies suggest this area
is not fully developed until
25 or later .
Patient Profile: Premature Birth
Age: 16
Gender: Female
Grade: 10th
Presenting Problem: Grades don’t reflect her
ability, organizational difficulties, problems with
recall and retention, slow to complete
assignments, mild social skill difficulties
Strengths: Caring, empathetic, artistic, well
Birth History: Premature birth at 32 weeks,
respiratory problems requiring
intubation/ventilation, episodes of apnea,
Developmental History: Motor and language
delays, OT/SP prior to Kindergarten, socially
immature, escalating academic difficulties thru
middles and high school
Family History: Unremarkable
The survival of very low birth weight infants has increased dramatically
during the past decade
Studies examining infants born at less than 32 gestational weeks yield
consistent evidence of long term neurocognitive deficits impacting
executive function
Recent studies reveal a very high prevalence of higher-order
neurodevelopmental impairment evident when such youngsters reach
school age
Approximately 50% of ex-preterm infants experience deficits in executive
functioning and other areas cognitive development which require special
academic support.
Unexpectedly high risk of autism. Autism spectrum features may be an
unrecognized feature of very low birth weight infants. Children born
before 31 weeks gestation have a doubled risk for developing an autism
spectrum disorder.
Can We Teach Executive Functions?
A growing body of research indicates that many children start school not
ready to learn not because they do not know their letters or numbers but
because they lack one critical ability:
the ability to regulate their social, emotional, and cognitive behaviors.
Current research shows that self-regulation – often called executive
function -- has a stronger association with academic achievement than IQ
or entry-level reading or math skills.
Based on Russian Psychologist’s Lev Vygotsky’s work
Teaching children to use mental tools to control cognition, emotions, and
Research on Tools of the Mind (Diamond, Barnett,
Thomas, & Munroe, 2007) showed that children
who attended Tools classrooms had higher rates
of self-regulation than closely matched pairs and
that the level of self-regulation correlated with
child achievement in literacy and mathematics.
“Masters of Their Own Behavior”
Executive Dysfunction
NeuroBehavioral Associates
Misunderstandings & Misassumptions
Problem of the “Mind”
not the “Body”
Problem of
Engenders Moralistic
Judgments rather
than a Readiness to
Snap the Whip – Winslow Homer 1872
ADHD most likely polygenetic in nature.
 May involve genes governing DA and NE systems.
 “The 7-repeat allele:” associated with novelty seeking
(more impulsive, excitable, and exploratory). – Steven
Pliszka, MD.
ADHD children show 3-4 percent smaller brain volumes
- NIMH, 2008
2007 NIMH Study:
 Compared brain scans of 446 children with and without
 Brains of children with ADHD develop normally but lagging
behind approximately 3 years.
 Biological differences most evident in the frontal lobes,
temporal grey matter, CN, and cerebellum. Shaw et al., 2007
Structural Differences
Brain Volume
•Children with ADHD had significantly smaller brain
volumes (3%)
• Unmedicated youngsters with ADHD had strikingly
smaller volumes (5.8%) than controls
•Children with ADHD had developmental trajectories
that paralleled controls but on a lower trajectory
Castellanos, F. (2002) JAMA
NeuroBehavioral Associates
Abnormal Brain Anatomy Found With ADHD : Diffusion tensor
imaging shows abnormalities in pathways between the
frontal lobe, cerebellum.
Kate Johnson March 2005
Children with and without ADHD
“Abnormalities in fiber pathways in the frontal cortex, basal ganglia,
brain stem, and cerebellum in the ADHD patients”
“The circuit that connects the frontal lobe and cerebellum is not
efficient in ADHD”
“Fiber pathways abnormalities are less pronounced in children who
have been treated with stimulant medication, compared with those
who have not.”
“Our hope is, in the future, to be able to diagnose ADHD with this
Manzar Ashtari, Ph.D. North Shore-Long Island Jewish Health System
Abnormal Brain Anatomy Found With ADHD : Diffusion
tensor imaging shows abnormalities in pathways
between the frontal lobe, cerebellum.
Kate Johnson March 2005
Social Considerations
Executive Functions & Adolescents
Driven by Rapid Development in Prefrontal Cortex
Executive Functions
Delay Gratification
Assess Consequences
Driving accidents leading cause of death
in teenagers.
 Teens with ADHD two to four times
more traffic accidents.
 Collisions 4 times more likely to occur at
Compared Teens on Concerta, Adderall
& Placebo
 Stimulants improved Driving
 Concerta was more effective late in the
evening when most adolescent accidents
2005 Pediatric Academic Societies by Daniel
Cox, Ph.D
44 teen brains examined via fMRI after teens played
violent video game
Less activation of prefrontal portions of the brain.
More activity in the amygdala.
Lingering effects of heightend emotional arousal and
suppressed self-control and concentration remained.
Emotional Difficulties
Mood Swings
Depression & Anxiety
Compulsive Behaviors
Alcohol and Drug
Preoccupation with
Self Mutilation
Risk Taking Behavior
Alcohol and Drug Abuse
Unprotected Sex
Inattention Distractibility
Poor Academic
Planning Difficulties
Test-Taking Difficulties
“Maturity is not simply a matter of slipping
software (learning) into existing equipment.
Instead, the hardware changes. Those
changes partly reflect signals from the
world outside, and seem to be a peculiarly
human adaptation. Think of it as nature’s
way of giving us a second chance.”
Giedd, 2002
The Brain and Reading
Left Temporal Anatomy
Alexia without Agraphia
M. Jules Dejerine
French Neurologist
One of the first reports in the literature
Basis for disconnection syndromes
Memoires de la Societe
De Bologie, 1891
Dejerine’s Patient
51 year old store keeper
Left Cerebral Vascular Accident
Following CVA
Could not read words
Color naming deficit
R homonymous hemianopsia
He could write, but not read what he wrote
He could identify letters
He could only identify words spelled aurally or tacitly
“Linguistic Blindfold”
Samuel T. Orton, M.D. - 1928
 Wife was a Reading Teacher
 Soft Neurologic signs
 Explanation of “Word Blindness”
 Problems with laterality
 Twisted Symbols & Mirror-Writing were
common in poor reading
Brain Morphology
Geschwind & Fuscillo 1966
Described patient with Alexia without Agraphia
Color naming deficit – color perception was intact but
couldn’t match color names with seen colors
 Color naming used as a marker for visual-verbal
 Led Denckla (1972) to search for children with reading
difficulties who might be unable to name colors
 Found children with reading problems hid long latencies
or hesitancies…
“Lack of Automaticity”
Brain Morphology
Galaburda & Kemper - Cellular Abnormalities:
› Clusters of Ectopic neurons in outside layer of the
cerebral neocortex
Ectopias are cellular migration between different
cortical layers
Ectopias prevalent in frontal and perisylvan language
regions of left hemisphere
Ectopias are produced before 6 months of gestation
Found polymicrogyria – multiple narrow, short,
curved gyri
The Neocortex and Cortical Migration
The cerebral cortex is a thin layer of cells about 1.5 to 4
mm thick.
The cortex provides the connections and pathways for
the highest cognitive functions, such as language and
abstract thinking.
The cerebral cortex contains about 25 billion neurons,
more than 62,000 miles of axons, and
300,000,000,000,000 synapses.
Neocortex layer
The thin layer of the
neocortex is dense
with neurons.
Brain Morphology
Galaburda & Kemper 1979:
› Post-mortem structure of severely dyslexic
› Brains were structurally different
› Planum Temporale were symmetrical
› Found cellular abnormalities
Archives of Neurology, 1978
Archives of Neurology, 1979
Brain Morphology
Beaton, 1997:
“It is uncritically accepted...
that Dyslexia is associated with a pattern
of planum asymmetry more often
reversed in direction or reduced in size
among Dyslexic’s.”
Brain and Language, 1997
Morphology of Temporal Lobe
Functional Neuroimaging
Shaywitz et al. - PET Study:
… brain activation patterns provide evidence of
an imperfectly functioning system for
segmenting words into their phonological
… pattern of underactivation in left posterior
brain regions contrasted with relative
overactivation in anterior regions may provide
a neural signature for the phonological
difficulties characterizing dyslexia.
Levels of Analysis
§Left Superior
Temporal Gyrus
§Broca’s Area
Rapid Naming
Weak Writing
Verbal Fluency
Reading Fluency
NeuroBehavioral Associates
Denckla & Rudel, 1972, 1974, 1976
Rapid Automatized Naming Test – RAN
 Traced to Geschwind’s description of Dejerine’s: “Alexia
without Agraphia”
“Lack of Automaticity”
Strong prediction of reading success
 Taxes executive control of language system
 Reid Lyon recommended as Kindergarten screening tool
Annals of Dyslexia, 1999
RAN represents separate function from
phonological processing
Unique contribution to reading beyond
phonological awareness
Poor readers can be subtyped
Phonological Deficit only
RAN Deficits only
Phonological & RAN Deficits
Double – Deficit Model
Bowers & Wolf, 1993
RAN discriminates between good and poor
readers with ADHD
Deficits in letter word fluency and RAN
characterized ADHD – RD children
LWF is executive task requires a rulegoverned, self-monitored search of the lexicon
Zone of convergence linking ADHD to RD
concerns the executive aspects of languageOverlap Zone
Attention Deficit/
Dyslexia and Adults
Dyslexia and Adults
DTI is a MRI technique that allows visualization and
characterization of the brain’s white matter tracts.
DTI measures the diffusion of water molecules in brain tissue
Diffusion is isotropic (equal in all directions) in CSF and cell
bodies but anisotropic (greater in one direction than another)
in axons that comprise white matter
White matter tracts are myelinated neuronal fiber tracts that
connect one brain region with another
Myelin prevents the diffusion of water through the walls of
the axon
DTI can measure the orientation and
direction of white matter tracts
 DTI allows assessment of the coherence
or strength of white matter tracts
 DTI provides a quantitative index of the
organization of large white matter tracts
connecting brain regions
Diffusion Tensor Imaging
The goal of diffusion tensor imaging is to image the
microstructure of the brain’s white matter tracts
Red is left to right
Green is front to back
Blue is top to bottom
Water inside the white matter tracks can only diffuse in the
same direction as the actual white matter fibers.
In gray matter water diffuses in many directions, having
ellipsoids that are more ball shaped. Water in white matter
will have ellipsoids as in the picture above. These tensors can
mathematically be combined to do fiber tracking, also called
Fractional Anisotropy
Fractional anisotropy (FA) is a scalar value between zero and one that
describes the degree of anisotropy of a diffusion process. A value of zero
means that diffusion is isotropic, i.e. it is unrestricted (or equally restricted) in
all directions. A value of one means that diffusion occurs only along one axis
and is fully restricted along all other directions.
FA is a measure often used in diffusion imaging where it is thought to reflect
fiber density, axonal diameter, and myelination in white matter.
Isotropic Diffusion
Anisotropic Diffusion
Diffusion Tensor Imaging
There is a rapidly expanding body of literature addressing the
capability of diffusion-tensor imaging to depict normal white
matter and subtle age- and pediatric disease state–related
perturbations in white matter that are not visible at routine MR
imaging .
FA and ADC are two of the most widely used diffusion-tensor
indices. FA is considered a marker of axonal integrity: White
matter maturational changes are expressed in part as
increases in FA
Diffusion Tensor Imaging
•Diffusion-tensor imaging reveals differences in white matter
structure between dyslexic and age-matched normal-reading
•Age-related maturational changes in white matter depicted at
diffusion-tensor imaging in dyslexic children differ from these
changes in normal-reading children.
Microstructure of Temporo-Parietal White Matter as a Basis for
Reading Ability: Evidence from Diffusion Tensor Magnetic
Resonance Imaging
Torkel Klingberg, Maj Hedehus, Elise Temple, Talya Salz, John D.E Gabrieli, Michael E
Moseley, Russell A Poldrack
Department of Psychology, Stanford University, California 94305, USA
Neuron, Vol. 25, 493-500, February, 2000
Compared Adults with and without Dyslexia
White matter diffusion anisotropy in the temporo-parietal region
of the left hemisphere was significantly correlated with reading
scores within both the reading impaired and control groups
Greater anisotropy may reflect greater communication between
cortical area involved in visual. auditory, and language processing
Neural Changes following Remediation in Adult
Developmental Dyslexia
Guinevere F. Eden, Karen M. Jones,Katherine Cappell, Lynn Gareau, Frank B. Wood,
Thomas A. Zeffiro, Nicole A.E. Dietz, John A. Agnew, and D. Lynn Flowers
Neuron, Vol. 44, 411-422, October 28, 2004
Examined adults with and without dyslexia
Utilized fMRI
Behavioral changes in adults receiving reading intervention
correlated with:
-- increased activity in the left hemisphere regions engaged
by normal readers
--compensatory activity in the right perisylvan cortex.
Behavioral plasticity involves two distinct neural mechanisms
Children’s Reading Performance is Correlated with
White Matter Structure Measured by Diffusion
Tensor Imaging
Gayle K. Deutsch, Robert F. Dougherty, Roland Bammer, Wai Ting Siok, John D.E. Gabrieli,
Brian Wandell
Cortex, Vol. 4, 354-363, 2005
Examined children with a wide range of reading performance levels
Utilized DTI
White matter structure as measured by FA and CI significantly correlated with
behavioral measures or reading, spelling, and rapid naming
Lower FA, reflecting diminished white matter organization, was associated
with lower performance scores
Findings support importance of the left temporo-parietal neural pathways in
the development of reading skills
Functional and Morphometric Brain Dissociation
between Dyslexia and Reading Ability
Fumiko Hoeft,*†‡ Ann Meyler,§ Arvel Hernandez,* Connie Juel,¶ Heather Taylor-Hill,* Jennifer L. Martindale,* Glenn
McMillon,* Galena Kolchugina,* Jessica M. Black,*¶ Afrooz Faizi,* Gayle K. Deutsch,* Wai Ting Siok,*‖ Allan L. Reiss,†
Susan Whitfield-Gabrieli,*** and John D. E. Gabrieli
Examined adolescents with and without dyslexia
Utilized fMRI techniques
Found patterns of both hypoactivation and hyperactivation
Hypoactivation reflected functional atypicalities related to dyslexia itself
Hyperactivation reflected processes related to current reading levels independent
of dyslexia
Hypoactivation is related to the cause of dyslexia
Hyperactivation is associated with the consequence of dyslexia-compensatory
Prediction of Children's Reading Skills using
Behavioral, Functional, and Structural
Neuroimaging Measures
Fumiko Hoeft, Takefumi Ueno, Allan L. Reiss, Ann Meyler, Susan Whitfield-Gabrieli, Gary H. Glover,
Timothy A. Keller, Nobuhisa Kobayashi, Paul Mazaika, Booil Jo, Marcel Adam Just, John D.E. Gabrieli
Behavioral Neuroscience, Vol 121(3), 602-613, Jun 2007
Examined children of varying reading abilities at both the beginning and end of
the school year
Utilized fMRI while performing a phonemic awareness task, behavioral
measures, and structural brain measures
Specific patterns of brain activation during phonological processing and white
matter densities predicted decoding skills at the end of the year
Combined behavioral and brain imaging techniques predicted outcome better
than either alone
Neuroimaging may be useful in identifying those children at risk for poor
decoding and reading skills
Tract-based spatial statistics of diffusion tensor imaging
in adults with dyslexia.
Richards T, Stevenson J, Crouch J, Johnson LC, Maravilla K, Stock P, Abbott R,
Berninger V.
Department of Radiology, University of Washington, Seattle, WA 98195, USA.
Am J of Neuroradiology 2008 June; 29(6) : 1134-1139
Compared 7 normal adult readers with 14 adults with dyslexia
Utilized DTI
Higher FA values in adult normal readers versus adults with dyslexia
Stronger functional connectivity in the bilateral inferior frontal gyrus of adult
normal readers
Expands past studies demonstrating left temporal-parietal differences
Supports disconnections in structural, as well as functional, connectivity in
the development of dyslexia
Simple Developmental Dyslexia in Children:
Alterations in Diffusion-Tensor Metrics of White
Matter Tracts at 3 T1
Radiology. 2009 Jun;251(3):882-91. Epub 2009 Apr 3
Findings at 3.0-T DT imaging suggest that white matter differences in
dyslexic children are not limited to the portion of the brain traditionally
considered to be integral to word recognition and processing.
1.Nancy K. Rollins, MD,
2.Behroze Vachha, MD, PhD,
3.Priya Srinivasan, MS,
4.Jonathon Chia, MS,
5.Joyce Pickering, PhD,
6.Carrol W. Hughes, PhD and
7.Barjor Gimi, PhD
A dual DTI approach to analyzing white matter in
children with dyslexia
Psychiatry Res. 2009 Jun 30;172(3):215-9. Epub 2009 Apr 5
John C. Carter,a Diane C. Lanham,b Laurie E. Cutting,bcd Amy M. Clements-Stephens,b Xuejing Chen,a Muhamed
Hadzipasic,a Joon Kim,a Martha B. Denckla,bcef and Walter E. Kaufmann
Used voxel-based (VBA) and region-of-interest (ROI) diffusion tensor imaging (DTI)
Examined white matter (WM) organization in 7 children with dyslexia and 6 agematched controls.
Both methods demonstrated reduced fractional anisotropy (FA) in the left superior
longitudinal fasciculus (SLF) and abnormal orientation in the right SLF in dyslexics.
Application of this complementary dual DTI approach to dyslexia, which
included novel analyses of fiber orientation, demonstrates its usefulness for
analyzing mild and complex WM abnormalities.
Children with Dyslexia Lack Multiple Specializations
Along the Visual Word-Form (VWF) System
Sanne van der Mark, Kerstin Bucher, Urs Maurer, Enrico Schulz, Silvia Brem,
Jsabelle Buckelmüller, Martin Kronbichler, Thomas Loenneker, Peter Klaver,
Ernst Martin, Daniel Brandeis
Neuroimage, vol. 47(4), 1940-9. Oct 2009
Examined children with and without dyslexia
Utilized fMRI to examine activation of the left inferior occipito-temporal cortex
(VWF area)
Presented real word, pseudowords, and false fonts
Children with dyslexia showed impaired specialization for both print and
Brain connectivity in non-reading impaired children and
children diagnosed with developmental dyslexia.
Odegard TN, Farris EA, Ring J, McColl R, Black J.
University of Texas Arlington, Arlington, TX 76019-0528, United States. [email protected]
Neuropsychologia, 2009
Diffusion Tensor Imaging (DTI) was used to investigate the relationship between white matter and
reading abilities in reading impaired and non-reading impaired children.
Seventeen children (7 non-reading impaired, 10 reading impaired) participated in this study.
The data replicated previous results seen across multiple studies and extended findings to include
measures of both real word and pseudoword decoding.
Negative correlations were observed in the left posterior corpus callosum between fractional
anisotropy (FA) values and both measures of decoding.
Positive correlations between FA values and real word and pseudoword decoding were observed in
the left superior corona radiata.
This extension of findings regarding correlations between the corona radiata and reading
skills suggests an important direction for future research into the neurological substrates of
White Matter Microstructural Differences Linked to
Left Perisylvian Language Network in Children with
Sheryl L, Rimrodt, Daniel J. Peterson, Martha B. Denckla, Walter E. Kaufmann,
Laurie E. Cutting
Department of Developmental Cognitive Neurology, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, USA
Cortex, vol. 46(6):739-49, June 2010
Examined children with and without dyslexia
Utilized DTI to examine white matter structure
FA decreases in dyslxia in LIFG and left temporo-parietal white matter
Positive corelation of FA to reading speed in a left posterior cicuit
Found differences in fiber orientation in Left anterior perisylvan language pathway
Links an atypical white matter structure in dyslexia to atypical fiber orientation in
reading circuits of the left perisylvan language network
“To find a convergence of MRI evidence… linked to an identifiable structure …Brings
us closer to understanding how dyslexia happens”
Altering cortical connectivity: remediation-induced
changes in the white matter of poor readers.
Keller TA, Just MA.
Center for Cognitive Brain Imaging, Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
[email protected]
Examined whether 100 hr of intensive remedial instruction affected the white matter of
8- to 10-year-old poor readers utilizing DTI.
Prior to instruction, poor readers had significantly lower FA than good readers in a
region of the left anterior cerebral white matter
The instruction resulted in a change in white matter (significantly increased FA), and in
the very same region.
The FA increase was correlated with improvement in phonological decoding ability,
clarifying the cognitive locus of the effect.
The results demonstrate the capability of a behavioral intervention to bring
about a positive change in cortico-cortical white matter tracts.
PMID: 20005820 [PubMed - indexed for MEDLINE]PMCID: PMC2796260 [Available on 2010/12/10]
Neural Systems Predicting Long-Term Outcome in
Fumiko Hoeft, Bruce D. McCandliss, Jessica M. Black, Alexander Gantman, Nahal Zakerani, Charles
Hulme, Heikki Lyytinen, Susan Whitfield-Gabrieli, Gary H. Glover, Allan L. Reiss, John D. E. Gabrieli
J. Neurosci. Vol. 31 (26) 9641-9648, 2011
Examined children with and without dyslexia over a 2.5 year period to determine if
brain imaging (fMRI & DTI) can predict future long term gains in dyslexia
Greater right prefrontal activation during a reading task that demanded
phonological awareness and right superior longitudinal fasciculus white matter
organization significantly predicted future reading gains in dyslexia
This method predicted significantly above chance (72% accuracy) which child
would or would not improve reading skills in dyslexia.
Behavioral measures (testing) were at chance
Right prefrontal mechanisms may be critical for reading improvement in dyslexia,
perhaps identifying structures necessary for compensation
What do we know…
What do we think we know…
Dyslexia and ADHD involve both structural and functional
connectivity abnormalities and regional specificity
Connectivity abnormalities are developmental rather than
acquired or the consequence of reduced reading practice
Left temporo-parietal hypoactivation and reduced
connectivity is related to etiology of dyslexia
White matter organization is weaker in left posterior brain
Right prefrontal activation during reading and right superior
longitudinal fasciculus white matter organization predicted
future reading gains in dyslexics-Neuroprognosis
What do we know…
What do we think we know…
Greater than normal white matter connectivity in the corpus
callosum which may reflect an atypical reliance on right
hemishphere regiions for reading
Greater preintervntion activation in the right IFG and greater
white matter intergrity in the right SLF, on rhyme task,
predicts greaterimprovement in reading over the next 2.5
DTI may be helpful in measuring response to reading
Remediation is associated with increased activation and
connectivity in left tempopro-partietal and frontal regions
What do we know…
What do we think we know…
Psychometric testing predicted gains in decoding, accounting
for 65% of variance
Fuunctional and structural imaging predicted gains in decoding
accounting for 57% of variance
Combined behavioral testing and brain imaging accounted for
81% of variance-Neuroprognosis
Event-Related Potentials (ERP’s) may predict fuure language and
reading problems in infants and children before reading
ERP response to language sounds within 36 hours of birth
predict children who will go on to become dyslexic by age 8
with 81% accuracy-Neuroprognosis
“The New Revolution”
Educational Neuroscience- Mind Brain and Education
Laura-Ann Petitto Kurt Fischer
Combination of Brain Imaging and Behavioral
Measures for Diagnosis
Better Prediction of At Risk Children
Predict capacity for Response to Intervention
Possibility of Prevention
Measure the Response to Intervention
Shape Educational Policy and Practice
Shape Health Care Policy-Insurance
Guide Family Decision-Making
The Frontal Lobes : The Seat of Civilization
“An Interpretation of Michelangelo's Creation of Adam”
JAMA 1990
The Creation of Adam (1508-1512) ceiling of the Sistine Chapel ...
Meshberger, M.D. described an anatomically accurate image of the human
brain portrayed behind God.
On close examination, borders in the painting correlate with sulci in the inner
and outer surface of the brain, the brain stem, the basilar artery, the pituitary
gland and the optic chiasm. God's hand does not touch Adam, yet Adam is
already alive as if the spark of life is being transmitted across a synaptic
Below the right arm of God is a sad angel in an area of the brain that is
activated on PET scans when someone experiences a sad thought. God is
superimposed over the limbic system, the emotional center of the brain and
possibly the anatomical counterpart of the human soul. God's right arm
extends to the prefrontal cortex, the most creative and most uniquely human
region of the brain.
*Frank Lynn Meshberger, M.D., JAMA #14 October 1990
NeuroBehavioral Associates

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