Toward a Science of ConsciousnessTucson2002

April 8-12, 2002Center for Consciousness Studies

University of Arizona

Metacognition in Children with ADHD: Comparison with Controls

Prof. Hélène Poissant, Ph.DUniversité du Québec à Montréal

poissant.helene@uqam.ca

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 observationsFrontal 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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QuickTime™ et un décompresseurPhoto - JPEG sont requis pour visualiser

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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

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 (B.I) Hypothesis

Behavioral Inhibition:

•inhibit prepotent response

•interrupt an ongoing response

•interference (intern or extern)

Barkley (1997, 1998)

Behavioral Inhibition

Working memory (Nonverbal)

Internalization of speech(verbal working memory)

Self-regulation of affect/Self-regulation of affect/Motivation/ArousalMotivation/Arousal

Reconstitution

Motor Control/fluency/syntax

Executive Functions

Behavioral Inhibition

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 affect/motivation/arousal

Self-regulation in the service of goal-directed action...

ReconstitutionAnalysis & Synthesis of B.

Synax of behavior...

Motor control/Fluency/Syntax

Executive Functions

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 ADHDimplying region of the prefrontal cortex related with B.I.

Evidence of neuropsychological dysfunctioning in ADHDimplying 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 Reality level(conform to the fact)

E.g.:«I know that I know» (Brown, 1978; 1987)

«I know that I don ’t know»

E.g.:

«I truly know»

«I truly don ’t know»

Expansion of Brown ’s self-awareness concept ( Poissant, H., 2001)

Secondary ignorance

Metacognitive level Reality level(not conform to the fact)

E.g.:«I don’t know that I know»(Shimamura, 1994)

«I don’t know that I don’t know»(Brown, 1978; 1987)

E.g.:«I truly know»«I truly don ’t know»

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)

Prediction (Brown, 1978; 1987)

E.g.:«I know that I was able to remember an amount x of information»

E.g.:«I know that I am ready to remember an amount x of information»

Poissant, H. (2001)

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

E.g.:«I know that information x is in contradiction with information y»

Poissant, H. (2001)

ParticipantsControl (n = 30, mean age = 8): Public SchoolADHD (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 CPRS-48 (t18.8 = 3.68, p= 0.0016) & on the CTRS-28 (t9.2 = 6.3591, p= 0.0001) compared to Control

Method

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)

TASK

Comparison of means for ADHD and control groups a on perception of lack of information task (metacognitive knowledge)

8,67

6,75

2,67

5,565,39

4,67

0

1

2

3

4

5

6

7

8

9

10

group 1 (6-7) group 2 (8-9) group 3 (10-12)

age groups

num

ber

of q

uest

ions

ADHD

Control

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 metacognitiveKnowledge

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 ofdysfunctions related to prefrontal symptomatology (e.g. ADHD)

3) helps install metacognitively oriented approaches in treatment ofexecutive disorders (Marlowe, 2001)

Correlation between E.F. & Metacognition among Control and ADHDSubjects should be further explored

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Neurology, 6(Suppl.), S9-S12. Biederman, J., Faraone, S. V., Keenan, K., Benjamin, J., Krifcher, B., Moore, C., Sprich-Buckminster, S., Ugaglia, K., Jellinek, M. S., Steingard, R., et al. (1992). Further evidence for family-genetic risk factors in attention deficit

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Brown, A. L. (1987). Metacognition , executive control, self-regulation, and other more mysterious mechanisms. In F. E. Weinert & R. H. Kluwe (Eds.), Metacognition, motivation, and understanding (pp. 65-116). Hillsdale, NJ: Lawrence Erlbaum.

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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 ÉcrementAnnick Léveillé, Christiane ChalfounJosée Delisle, Sarah LecomteMarie-Odile Dade

Funds:Conseil de Recherches en Sciences Humaines du Canada