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Toward a Science of Consciousness
Tucson2002
April 8-12, 2002
Center for Consciousness Studies
University of Arizona
Metacognition in Children with ADHD: Comparison with Controls
Prof. Hélène Poissant, Ph.D
Université du Québec à Montréal
[email protected]
Statistics on ADHD
- 1% - 3% American school-aged population
- 5% - 10 % other problems/ psychiatric disorder :comorbidity
- Boys are about 3X more likely than girls to develop ADHD
- 30% - 50% still manifest symptoms in adulthood
- 25 % fathers and 17 -25% mothers of ADHD children
have this condition
Psychiatric observations: DSM-IV(APA, 1994)
9 symptoms of Inattention (ADD)
9 symptoms of Hyperactivity/Impulsivity (ADHD)
Neurobiological observations
Frontal dysfunction:
dorsolateral prefrontal cortex (fig.1)
Reduction in size/activity:prefrontal lobe, basal ganglia &
striatum
PET scan: brain areas that control attention used less glucose
(fig.2)
ERP: ADHD make more errors and react more slowly than
controls in tests of sustained attention
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Concurrent explanations of ADHD
- DSM-IV definition of ADHD : insufficient
- deficiency in Attention filtering of ADHD : insufficient
- “control” of impulsivity is a main component of ADHD
- child with ADHD is “hyper-respondent” rather than hyperactive
Barkley,1997,1998
Neuropsychological Evidences
B. I. Tests distinguish ADHD and Control:
ADHD:
•More CPT- Omissions errors;
•More Stroop- Interference and - Word errors;
•Other tests: WCSR; Trail Test; Porteus Mazes; Rey-Osterrieth; Verbal
Fluency; Tower of Hanoi; Time Estimation
Barkley,Grodzinsky & DuPaul,1992; Grodzinsky & Diamond 1992
Behavioral Inhibition (B.I) Hypothesis
ADHD children have a deficit in B.I.
- Desinhibited
prepotent responses
- Perseveration of ongoing responses
- Poor interference control
Cognitive implication:
•Reduced reflection
•Poor self-questioning
•Deficient rule-governed behavior (instruction)
•Etc.
Barkley (1997, 1998)
Behavioral Inhibition:
•inhibit prepotent response
•interrupt an ongoing response
•interference (intern or extern)
Barkley (1997, 1998)
Behavioral Inhibition
Executive Functions
Working memory (Nonverbal)
Internalization of speech
(verbal working memory)
Reconstitution
Self-regulation of affect/
Motivation/Arousal
Motor Control/fluency/syntax
Behavioral Inhibition
Executive Functions
N-V. working
memory
Holding events in
mind
Retrospective
function
Prospective function
Self-awareness
.
.
Internalization of speech/
V. working memory
Description and reflection
Self-questioning
.
.
.
Self-regulation
Reconstitution
affect/motivation/arous Analysis &
al
Synthesis of B.
Self-regulation in the Synax of behavior
service of goal-directed .
action
.
.
.
.
.
Motor control/Fluency/Syntax
Motor control/ fluency/ syntax
• inhibition of task irrelevant responses
• execution of goal-directed responses
• goal-directed persistence
• sensitivity to response feedback
• behavioral flexibility
• task re-engagement following disruption
Executive function & Metacognition
Both:
•Higher order functioning
•Under governance of prefrontal regions
•Late to mature
Different settings:
Executive function: neuropsychological setting
Metacognition: cognitive developmental setting
Metacognitive Hypothesis
Since:
Evidence of neurobiological dysfunctioning in ADHD
implying region of the prefrontal cortex related with B.I.
Evidence of neuropsychological dysfunctioning in ADHD
implying executive functions related with B.I.
Conceptual link between B.I & metacognition theories
We infer that:
ADHD children may experience difficulty in metacognition
Poissant, 2001; 2002
Self-awareness
Metacognitive level
E.g.:
«I know that I know»
(Brown, 1978; 1987)
«I know that I don ’t know»
Reality level
(conform to the fact)
E.g.:
«I truly know»
«I truly don ’t know»
Expansion of Brown ’s self-awareness concept ( Poissant, H., 2001)
Secondary ignorance
Metacognitive level
E.g.:
«I don’t know that I know»
(Shimamura, 1994)
«I don’t know that I don’t
know»
Reality level
(not conform to the fact)
E.g.:
«I truly know»
«I truly don ’t know»
(Brown, 1978; 1987)
Expansion of Brown ’s self-awareness concept ( Poissant, H., 2001)
Knowing what we know
Level of confidence (in our
own’s responses) (Brown, 1978; 1987)
E.g.:
«I know that I was able to
remember an amount x of
information»
Poissant, H. (2001)
Prediction (Brown,
1978; 1987)
E.g.:
«I know that I am
ready to remember an
amount x of
information»
Knowing what we need to know
Perception of lack of
information
(Markman, 1978)
Perception of
inconsistencies of
information
(Markman, 1978)
E.g.:
«I know that I need a
certain kind of information
to succeed in task A
Poissant, H. (2001)
E.g.:
«I know that information x
is in contradiction with
information y»
Method
Participants
Control (n = 30, mean age = 8): Public School
ADHD (n=17, mean age = 9): Clinic & Special Education Class
Age group 1= 6-7;
Age group 2= 8-9;
Age group 3= 10-11.5
1st- 6th grades
Montreal suburban; same SE background
ADHD have a higher score on the Hyperactivity Index of the CPRS48 (t18.8 = 3.68, p= 0.0016) & on the CTRS-28 (t9.2 = 6.3591, p=
0.0001) compared to Control
TASK
Perception of Lack of Information TASK (“Knowing-What-we-Need-to-Nnow”)
Experimenter (E) gives verbally &individually to each child (C) the instructions regarding the
performance of a Magic Trick and a Game of Cards
The instructions were designed to be incomplete.
E performs, while he describes it, a magic trick in front of C. First, E shows an empty cup, a
plate, a penny and a sheet of paper. E makes sure that C sees that the cup is empty. Then, E
puts the plate on the empty cup. Then, E wraps the penny in the paper sheet and puts it on the
plate. Finally, E makes the wrapped penny slips from the plate into the cup.
(In reality, E pretends to wrap the penny, and let it fall on his own lap. Then E puts the
unwrapped penny into the cup, without letting the child know about it).
C must discover what E had “forgotten ” : To mention how the penny could be find
unwrapped into the cup, since it was wrapped in the first place.
During the attempt of C to do the Magic Trick, E asks a series of ten questions (10) to help
the child discover the missing information (same kind of instruction for the Game of Cards)
RESULTS
ANOVA (age groups x diagnosis): F (2,41) = 3.24, p = 0.0493*
Simple effects:
•In ADHD: age group 3 performs better than age group 2 (p=
0.0057**) and, than age group 1 (p = 0.0021**);
•In Control: no age group effect
Control perform in a more stable manner than ADHD
•No difference between ADHD and Control
(see fig. 4)
DISCUSSION
“Knowing-What-We-Need-to-Know” is an aspect of metacognitive
Knowledge
ADHD and Control did not perform in the same manner across ages
on K-W-N-K:
In younger ADHD subjects, the delay in performance of K-W-N-K is
progressively fulfilled as ADHD subjects become older
Controls perform in a stable manner across ages
ADHD subjects act as if they take a longer time to reach the Control
performance
FUTURE RESEARCH
A comprehension of the link between Executive Functions &
Metacognition is beneficial in mutual ways:
1) contributes external validity to standard measurement of E.F
2) gives opportunity for metacognition to be part of assessment of
dysfunctions related to prefrontal symptomatology (e.g. ADHD)
3) helps install metacognitively oriented approaches in treatment of
executive disorders (Marlowe, 2001)
Correlation between E.F. & Metacognition among Control and ADHD
Subjects should be further explored
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Thanks
•Dr. Antonio Trottier, M.D.: Clinique Neuro Rive-Sud (ADHD)
•École Le Déclic & C. Mercier (ADHD)
•École Paul-de-Maricourt (Control)
Graduate students:
Linda St-Onge, Claudia Écrement
Annick Léveillé, Christiane Chalfoun
Josée Delisle, Sarah Lecomte
Marie-Odile Dade
Funds:
Conseil de Recherches en Sciences Humaines du Canada