Executive function and social cognition in the adolescent brain 

Adolescence is a period of development characterized by intense fluctuations in both physical and hormonal change. Research has been sparse in this area, empirical research on neural and cognitive development is still lacking. For such a period that reflects the growth of cognitive flexibility, self-consciousness and changes in identity, the need for further research is apparent.

Beginning to experiment on adolescent brains

Through studies on animals, we have seen that specific sensory regions of the brain go through sensitive periods starting after birth, in which environmental stimulation seems to be crucial fro the normal development of the brain and perceptual capabilities. Experiments suggest that while this is true for animals, it may also be true for humans. During the 1970’s and 1970’s, it was demonstrated that certain brain areas, especially the prefrontal cortex develop far beyond early childhood. Further studies in the decades that followed showed that during the period of puberty and adolescence, the structure of the prefrontal cortex goes through substantial changes. Two important changes highlighted are:

1. Myelination (increasing the transmission speed of neural information)
2. Synaptogenesis (regularly used connections are strengthened and seldom used connections are removed)

Synaptogenesis was first found in 1975 within experiments using cats and was further researched using rhesus monkeys. Synaptic pruning (a period of synaptic destruction) and synaptogenesis in the brain area the prefrontal cortex exist on a differential time line. Proliferation of synapses occurs in the prefrontal cortex during childhood and once again during puberty, however this is followed by a stagnant period and elimination and reorganization of prefrontal synaptic connections following puberty.

An overall decrease in synaptic density as a result of synaptic pruning in the frontal lobes ensues during adolescence. This process is thought to be essential for refining the effectiveness of neural networks. This is especially true when given the sensitive case of sound recognition development.

The adolescent brain seen through MRI

Through the implementation of modern technology, it has become possible to view the brain of living specimens. With the introduction of magnetic resonance imaging, we can non-invasively view the human brain in a detailed three-dimensional visual. This has been instrumental in the furthering of research on the maturation of the frontal cortex of adolescence and onwards into adulthood.

Linear increases in white matter during adolescence

Over the past years, researchers have found one consistent outcome across MRI studies: during adolescence and childhood there is a steady increase in white matter located in certain brain regions. One study found a significant between the white and grey matter levels between two age groups. This increase in white matter has been suggested to be the result of developmental changes by some studies. One study found an increase in white matter in the right internal capsule and left arcuate fasciculus. Both regions are associated with speech so it was hypothesized that the increase in white matter was due to speech development.

Non-linear decreases in grey matter during adolescence

Grey matter, in contrast to white matter, does not seem to follow a linear pattern. Rather it seems to follow a region specific, non-linear pattern. Research has shown that grey matter follows an inverted-U shape in certain brain regions. Studies suggest that grey matter volume in the frontal lobe reaches its peak during puberty, which is then followed by a stagnation period and a steady decline until though adolescence until early adulthood. MRI research on the decline of grey matter throughout adolescence has two explanations:

1. Axonal myelination both facilitates an increase in white matter and a decrease in grey matter
2. The decrease in grey matter is a reflection of the reorganization which occurs during puberty

Examining the role of gender differences in the development of brain structure

Research has shown that there exists a significant difference in the amount of grey and white matter found in males and females. This was particularly true in the area known as the inferior frontal gyrus (IFG). Researchers corrected for the possible confound of total cerebral volume but still they found that males had a significantly higher amount of grey matter. Some researchers believe this difference is a result of differential steroid levels, others believe it may be due to greater hemispheric specialization found in males. As of current research, more study is needed to examine variability in frontal cortex anatomy.

The continuing brain changes after adolescence

Recent research using MRI suggests that the period at which the brain reaches maturity could be later than the end of adolescence. This change is seen especially in the frontal and parietal cortices following post-mortem cellular examinations of human brains which support an extended period of development. The adolescent brain appears to develop in a dynamic nature when looking at the growth of white and grey matter.

Examining the development of executive function

Executive functioning refers to a set of cognitive mechanisms which govern how well we control and coordinate our behavior and cognition. Lesion studies have shown that many of the skills involved in executive functioning are dependent on the frontal lobes. Given that changes occur in the frontal cortex during adolescence, executive functioning might be expected to improve during this period. Behavioral studies have shown that inhibitory control, processing speed, working memory, and decision making continue to develop throughout adolescence.

Examining the development of social cognition

Evidence suggests that the prefrontal cortex is associated with many high level cognitive functions, such as self-awareness and theory of the mind. In tandem with this neural development, puberty marks a great period of change for hormonal development. These two factors combined mark a significant change in social cognition. Research concerning the effects of puberty on social cognition capacitates has been limited.

Looking at perspective taking

The act of perspective taking refers to putting oneself in another’s shoes and it is an essential component for effective social communication. This act of estimating what another individual is thinking is  related to the first-order theory of mind. It is an area of much theoretical debate. One view surmises that we understand others by simulating their actions and cognitions. In support of this, research has shown that similar brain areas are activated when we perform an action and when we see another perform the same action. This is in line with the function of mirror neurons.  

The adolescent brain in action seen through fMRI

With the introduction of fMRI, we have a safe and effective way to examine brain regions.  As an example, through the use of fMRI we were able to examine how response inhibition has developed in addition to examining the structure supporting its development. During studies involving inhibition of a normal response, it was shown that activation of certain brain regions was for the most part the same across age groups.  An exception was a significantly larger volume of activation in the prefrontal of children. In contrast to this, adults showed higher activation in the ventral region of the prefrontal cortex. One suggested reason for this is that children have a heftier dependence on this area than adults.

The confounds on task performance

An issue which has been found when conducting fMRI is that of confounding effect of task performance. If there is a difference in the performance between two groups i.e. one outperforms the other, the results are often difficult to interpret.

Examining the development of social cognition within the brain

In terms of brain regions, the amygdala is an area which has repeatedly been shown to have a high functioning role in facial recognition and emotional processing. Though research in this area has been investigated with adolescents, still little is known about the continued development of facial recognition. Studies have shown that children may identify neutral faces as being more ambiguous than fearful faces, resulting in an increase in activation in the amygdala.

Effect on teenagers

puberty marks a period of synaptic reorganization, and as a result can be more susceptible to experiential input, in particular regarding social cognition and executive functioning. Further studies are needed to examine the further development of brain maturation beyond childhood and the implications this has on cognition. The authors specify questions into which skills undergo perturbation, sensitive periods for improvement and how does the environmental quality impact the changes which occur in the brain.

Mild spastic cerebral palsy: An event-related brain potential study of error detection and response adjustment 

The term cerebral palsy is used to define a number of disorders which affect posture and movement. Cerebral palsy is attributed to damage or abnormal development in the developing brain of fetus’s or infants. Though there are many contributing factors to cerebral palsy, one of particular note are infarcts (tissue death as a result of lack of oxygen) which lead to lesions in white and grey matter tracts. These lesions to white matter tracts are detrimental to executive functioning which has been proven when testing youths with cerebral palsy against a control group without.

The question posed by this study is whether youths with mild spastic cerebral palsy are aware of their errors when carrying out tasks requiring executive functioning.

It has often been the findings of neurocognitive research that poor motor preparation precedes error making. Error detection and the adjustments which follow are measured in this case using response-locked error-related negativity. The brain potential for incorrect responses is markedly higher than those following correct responses.

Method

Participants consisted of 11 patients, with a mean age of 14 years, diagnosed with mild cerebral palsy and a control group of 12 youths without cerebral palsy, with a mean age of 14, recruited from the same city. Though the intelligent quotient of some of the youths with mild cerebral palsy was within the range of learning disabilities, none were classified as being mentally retarded, as their daily lives were intact.

A computer based stimulus recognition task and electroencephalograms were used to record brain activity in the study. The task used was comparable to the Sternberg short-term memory paradigm. Participants were presented with 2 letters to be memorized, then were subsequently shown 4 letters, one or none of which were the letters which were memorized. Using two response buttons, participants would indicate either yes or no whether they identified there target letters in the new set. Reaction time was measured starting when the new set appeared until a button was pressed. Total time for the experiment was about 15 minutes.

Results

The results of the experiment find that the control group made more correct responses and less error responses than the experiment group. In addition, the patient group reacted slower on average than the control group. Error responses were also shown to be slower than correct responses, which proved true for both groups.  

Discussion and conclusion

Given the findings of the study, poor motor preparation appears to be associated with error responses. This is especially salient in the patient group. Error detection was found in both groups and went on to predict better performance. A key point given by the authors is that error monitoring and the adjustment in performance which follows are essential to learning. The research conducted here implies that this process is thankfully present  in the patient group. Additionally, it is proposed that the patient group was more sensitive to their error making than the control group. This suggests that motivation may also be a key to learning in the patient group.

This leads to the suggestion that the patient group possesses an intact top-down capacity for executive functioning in tandem with a diminished motor action system. This calls for further investigation into the period preceding the execution of an action (i.e. pushing the button) to pinpoint the origin of error making in youths with mild cerebral palsy.

Limitations

It must be noted that the study contained a rather small sample size and should be treated as preliminary research.

Mild spastic cerebral palsy: brain state before error making 

While the previous article focused on whether youths with mild cerebral palsy were aware of their own error making and what adjustments they made to avoid future error, the following article asks whether error making is preceded by attentional lapses, by poor motor preparation, or both.

As mentioned in the previous article, the term cerebral palsy is used to define a number of disorders which affect posture and movement. When addressing the subject of quality of life, how well one has a capacity for executive functioning is a relevant question. The term executive functions encompasses a wide range of cognitive faculties including attention control, inhibitory control, and cognitive control. Taken as a whole, executive functioning governs ones capacity to function effectively in life. Recent research indicates that reduced capabilities towards executive functioning has been found in youths with cerebral palsy. This hypothesis is limited, however, for two reasons. Firstly, poor effectiveness by patients with cerebral palsy on executive functioning tasks may be due to their diminished motor system as opposed to deficiencies in cognition. Secondly, weak cognitive skills on cognitive tasks are measured by high error count and slow reaction speed.

Given the previous research conducted by the authors on event-related potential, they  propose that it is the poor motor preparation preceding a stimulus which is casually associated with error making in individuals with cerebral palsy. In accordance to this, the aim of this study was to measure what happens in the brain preceding errors in both the control and patient groups. To accomplish this, 3 event-related potential elements were recorded:

• Motor preparation (frontal late contingent negative variation)
• Attention (parietal P300)
• Response evaluation (parietal error-preceding positivity)

Methods

Participants consisted of 11 patients with cerebral palsy and an average age of 15, and 12 youths with an average age of 14 as a control group. The study design did not differ from that of the previous study. Again, the computer task was administered and responses were recorded as the interval between the new display set and the button press. However the authors were only interested in the 3 successive correct responses preceding an error.

Results

Overall, the patient group had fewer sequences of 3 correct trial than the control group (patient group 41 sequences; control group 47). Both accuracy of responses and reaction speed were not found to be of a significant difference between the groups. It was found that contingent negative variation (motor preparation) was weakened for the patient group preceding an error. Attention (P300) levels preceding error making were shown to be low, however this was true for both groups. In the case of response evaluation (error preceding positivity), the groups did not show a difference in their level of performance monitoring preceding an error.

Discussion and conclusion

The results of the study show a strong indication that youths with mild cerebral palsy experience  poor motor preparation not only preceding an error, but already one trial before the error occurs.  Given that the control group and patient group did not differ on the amplitude of the parietal P300, the authors conclude that the cognitions responsible for response monitoring were similar in both groups. During the trials the patient group showed high levels of cognition control both preceding and following error making. Despite this however, they still made more errors than the control group. The authors propose that the poor motor preparation could be an indicator of a conflict between motor and cognitive exertion.

Ultimately, the goal of the study was to find out if error making in the patient group was associated with weak cognitive abilities. Given that the results indicate the source of error as a weakened motor system, they hypothesize that weak cognitive abilities can be dismissed as the source of error.

Limitations

As with the previous study, the sample size was small. As such it should be taken as a preliminary study. Additionally, the generalizability is questionable, as it only deals with patients with mild cerebral palsy. Other measures of executive functioning would also be an improvement.

Examining a pilot study of methylphenidate, interstimulus interval, and reaction time performance of children with attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is one of the most common found disorders in children. Characterized by inattention and hyperactivity, ADHD is primarily an inherited disorder. Treatment usually involves methylphenidate (MPH), which works by regulating the dopamine system. This often results in a decrease in impulsivity, hyperactivity, and inattention. Despite this, children on MPH still experience deficits in cognitive faculties. Other studies have shown that children with ADHD perform differently depending on the length of a stimulus they are exposed to. If the stimulus is a short interstimulus interval (ISI), the children experience a more positive performance in comparison to a long ISI. A short ISI has been shown to improve memory recognition, vigilance, motor timing, and more. It is thought that both MPH and a short ISI act upon the dopamine levels in the brain. It is proposed that having both of these working at the same time may over-activate the system and lead to detrimental effects. The goal of this study was to measure the isolated and combined effect of MPH and ISI on mean response times and errors of commission.

Procedure

For this study the sample consisted of 13 children (10 boys; 3 girls) diagnosed with ADHD. During the time of the study, MPH was gradually introduced for a two week period, either adjusting to a higher or lower dosage. After the children had been on MPH for 4 weeks, they were tested twice, once after the administration of MPH, and once after a placebo. The task which the participants engaged in was a computer based reaction time test known as Go/No-Go test. This involved pressing a button when the letter Q appeared onscreen and press nothing when the letter O appeared. If the participant responded to the letter O, this was recorded as an error of commission.

Looking at results

The results from the study indicate:

1. Children respond faster on MPH than not on MPH

2. Children respond faster in a condition with a short ISI rather than a long ISI

3. The interaction of ISI and MPH was not significant

4. Children on MPH made more errors of commission during the condition with a short ISI

5. Children on the placebo made fewer errors of commission during the condition with a short ISI

For discussion

This study set out to ascertain whether children with ADHD were able to inhibit responses when they are in a state of over-activation. The findings of the study indicate that children perform better with either MPH or in the presence of a short ISI in comparison with a long ISI. When MPH and a short ISI are combined, they have detrimental effects. The stimulus shift hypothesis is supported by this outcome. This outcome calls into question the optimal dosage levels when treating ADHD.

State regulation and motivation in ADHD

Throughout past research, weak motivation has been shown to be a factor involved in ADHD. Two models exist to try and explain this deficit. The response inhibition model hypothesizes that the majority of problems related to ADHD can be explained by impaired response inhibition. The state regulation model, in contrast, associates ADHD with a motivation deficit which then results in negative outcomes for social functioning and cognition. In the more recent years, studies have investigated the effects of incentives, noise, and the rates of the presentation of stimuli.

Presence of incentives

Studies on the effect of incentives on response inhibition have produced mixed results. Some studies have shown that incentives increase response inhibition, others found the opposite. The authors suggest the following as possible reasons for these mixed results:

1. Variation in the presentation of the rewards

2. Effort allocation will only take place when arousal deviates from its basic state.

3. Incentives act as signals; an increase in signals means an increase in motor activation

Noise

In accordance with the state regulation model, noise could activate the arousal system. One study showed that white noise was beneficial for the cognitive performance of children with ADHD, but was detrimental to control groups. The explanation for this result is the under-arousal found in ADHD.

Changing the presentation rate of stimuli

The state regulation model dictates that motor activation is effected by the presentation rate of a stimulus. Research has shown that children presented with a fast stimulus presentation rate perform better than when presented with a slow presentation rate. Very few studies have disputed this.

Top-down or bottom-up

From the studies conducted on reaction time and stimuli presentation rate, we see an interaction between motor activation and its control by effort. The researchers question whether this is due to a bottom up deficit in motor activation which in turn is hard to control by the top down effort mechanism, or actually the motor activation mechanism is functional and it is the effort mechanism which is not sufficiently in control. A suggestion is presented to examine the possibilities: to investigate the combined and individual effects of stimuli presentation rates and incentives on reaction time performance.

Looking at psychophysiological studies, dopamine, metabolic energy, and stimuli presentation rates

The following are findings from research conducted:

1. Psychophysiological indices, under slow presentation rates of stimuli, support the hypothesis that ADHD is associated with an effort deficit

2. Response impairments have been associated with either too high or too low levels of dopamine.

3. Results of fMRI research show that ADHD participants use widespread frontostriatal activity, including the thalamus and the cingulate, when involved in accurate response inhibition

4. Cortical excitability in adults is optimized by self chosen stimulation

5. Effort allocation and boredom are negatively correlated

In conclusion

There is a growing accumulation of evidence supporting that cognitive performance of children with ADHD is associated with weak state regulation. The state regulation model is far from perfect. The plausibility of either a top-down or bottom-up deficit must be examined further.

Investigating the dysfunctional modulation of default mode network activity in attention-deficit/hyperactivity disorder

In accordance with the state regulation deficit (SRD) model, individuals with ADHD have difficulty applying mental effort in situations which are suboptimal i.e. when there are either very fast or very slow event rates (ERs). In addition, ADHD has been shown to be associated with a deficit in suppression of the default mode network (DMN) and detriments to performance in tasks requiring effortful engagement. The authors of the study hypothesize that individuals with ADHD would show reduced deactivation in DMN when compared to controls in the tasks. They also predict a failure to modulate DMN activity as a part of ER by the ADHD participants.

Procedure

The sample consisted of 20 adults with ADHD and a control sample of 20 age and gender matched adults. The task to be performed was a simple computer based response task. The task was kept simple to maximize the amount of trials which could be used for the characterization of DMN analysis. During the experiment, fMRI was used to monitor brain activity.

Results and discussion

This study presents evidence for a disparity in the modulation of activity in specific DMN areas by event response in ADHD. Over-activity of DMN was observed only at ER extremes, no group differences were observed at a moderate level. This is in line with the SRD model. Further studies are necessary to test the hypothesis of whether or not individuals with ADHD have problems focusing effort on suppressing DMN interference when in less than ideal or energetically orientated conditions and also to investigate the role of effort allocation impairment on inattention and mind wandering.

Preface

An emotion consists of various components, namely physical arousal, motor expressions, action tendencies and subjective feelings. These components have an effect on social cognitions, attitudes and social interactions. That is why it is important that emotions are signaled during a conversation. This is about the emotion that is being emitted, so the non-verbal communication. Emotions play a role in forming and breaking social relationships. People also like to talk to others about emotions. One of the most important areas of social psychology where emotions are important is within group dynamics. This concerns the effects of 'contagious emotions'; passing a felt emotion over to others. Examples of contagious emotions are laughter and yawning.

What is an emotion?

The James-Lange theory

The James-Lange theory takes a peripheral position (which means that it focuses more on the somatic and autonomous rather than the central nervous system). In addition, it is suggested that someone first perceives an event, after which a physical reaction occurs. Then, only after the sensation of that physical reaction, an emotion occours. The difference between the James-Lange theory and the theories before, was that in the James-Lange theory it was thought that an emotion would come only after the physical reaction and in the theories before the main idea was that that an emotion would come before a physical reaction.

Emotion as a social-psychological construct

Nowadays there is a growing consensus that 'emotion' should not be used as a synonym for 'feeling'. Instead, researchers suggest that feelings are one of the three components in the emotion construct. Other components are the neurophysiological responses and motor expressions. These 3 components together are called the 'emotional reaction triad'. Another component that belongs to this emotion construct is the action tendency, although this is also seen as a behavioral consequence rather than a component of emotion. In addition, the emotion construct includes a cognitive component, because there is always evaluative information processing when it comes to emotion-generating events. The cognitive interpretation of an event is also called an appraisal. An emotion is described as a fierce, dynamic and short process with a clear beginning and an end. This involves as a crisis response, in which the physiological and psychological components interact with each other during an emotion episode. Systems that were previously independent suddenly start working together in synchronization to ensure survival.

Why do we have emotions?

Emotions cost a lot of energy, so why do they exist?

The evolutionary significance of emotions

According to Darwin, emotions exist because they are adaptive and help regulate interactions within social living species (for example, raising eyebrows provides better vision).

Emotions as a social signaling system

Another explanation for the existence of emotions is that, because one person can express emotions, another person can respond to this more easily and this can also lead to a certain tendency towards action.

Emotions provide behavioral flexibility

Emotions are almost automatic, but are more flexible than normal stimulus-response responses. Emotions ensure 'latency time' between stimulus and action, which ensures that people are better at evaluating the situation. During that period, the chance of success and the seriousness of the consequences are examined, after which an optimal response can be chosen. If there is a negative consequence, the motivation to take action will be great. Therefore, emotions have a strong influence on motivation.

Information processing

Information processing which is done people, especially in the social field, usually consists of 'hot cognition'. These are emotional responses that help to evaluate relevant and irrelevant stimuli. The criteria used in the evaluation of stimuli are learned during conversations and are influenced by needs, preferences, goals and values.

Regulation and control

Our feelings are a constant monitor of what is happening, and thus serve as the evaluation and appraisal of the environment, physical changes in the central nervous system and action tendencies. This is a requirement when controlling or manipulating the emotion process.

So, an emotion:

• decouples stimulus and response
• ensures the (correct) action trends through a 'latency time'
• provides signals for the outside world (others)
• feelings can regulate emotional behav, which can be strateic in social interactions

How are emotions elicited and how are they distinguished?

Philosophical notions

It is clear to most philosophers that a certain situation is reacted with a certain type of emotion.

The Schachter-Singer theory of emotion

According to Schachter, two factors are important in eliciting and distinguishing emotions, namely the perception of arousal and cognitions. Arousal is always the same (non-specific) and cognition leads to a label of the emotion (for example fear). In an experiment, arousal was generated in participants by means of an adrenaline injection. This showed that cognitions labeled this arousal for events that were taking place in their environment at that time. Emotions are thus formed by felt arousal and by the cognitive interpretation of the situations that are based on the behavioral model of expression. The results have not been replicated.

Appraisal theory

The appraisal theory of Lazarus consists of primary appraisal (fun / dislike, helps / hinders achievement of the goal) and secondary appraisal (to what extent can the person deal with the consequences of an event, given his or her competences, resources and strength). Lazarus calls this model a transactional model, because the outcome of the event is not only influenced by the nature of the event, but also by the needs, goals and resources of the person. It is different for each person and often leads to a mix of emotions (emotion blend).

Cultural and individual differences in appraisal at events

Culture causes differences in appraisal, for example socialism versus individualism. In a collectivist culture, guilt and shame are seen as the result of immoral things. In an individualistic culture this only applies to guilt and this emotion also lasts longer than in collectivist cultures. So the socio-cultural value can influence someone's emotional life. Individual differences in appraisal also cause different emotional responses.

Are there specific response patterns for different types of emotions?

There is agreement about the differentiation of the emotional component of emotions, but not about the reaction patterns of the peripheral system. James uses proprioceptive feedback (sensory information from organs about physical changes) to differentiate between emotions. Schachter and Singer, on the other hand, believe that non-specific physiological arousal combined with situational factors ensure that emotions can be differentiated. Tomkins spoke about discrete emotions, where he talked about neural programs that can control a certain emotion and the associated facial expression and motor skills.

Wat are motoric expressions?

Facial expressions

Evidence has shown found that facial expressions are universal, even though small differences have been found between cultures due to cultural desirability (display rules). 

Vocal expressions

Emotions are not only recognizable by facial expressions, but also by vocal expressions. Here too there are differences between people and cultures. Emotions in voice are partly universal, even though there are language differences between cultures. This is proof of a partial biological basis of emotions.

Control and strategic manipulation of an expression

Cultural norms about appropriate expression of an emotion are called display rules. It concerns the regulation of 'congenital' systems. In addition to the fact that it is appropriate to control your emotion expression because of cultural norms, it is also important from a strategic point of view. This would allow someone to manipulate someone else. Emotion expression often only comes into being when we see other people and that is why it is seen as a communication tool. But the more an emotion overwhelms us, the harder it is to regulate it.

Physiological changes

Physiological activity is not communicative, but it provides energy. This can ensure that someone is prepared for a specific action. Studies show specific patterns for the emotions fear and anger. These are functional: in case of fear, blood flows to the heart and brain to prevent blood loss. In the case of anger, the blood flows to the muscles for action.

Subjective feelings

This involves someone's conscious experience about the processes that take place in his or her body.

Dimensions of feeling

Wundt made a three-dimensional system to display the precise nature of all complex emotional states. The three dimensions are: excitement - depression, tension - relaxation, pleasant - unpleasant. There is only evidence for the first and third dimensions and therefore, in other studies, they often use a two-dimensional model of emotions. 

Verbal labeling of feelings

Emotions are socially structured (which means that the social and cultural factors create a reality for an individual). Cultural differences in value judgment systems, social structures, communication habits and other factors influence the emotion experiences and are reflected in culturally specified states of feeling. Feelings that are verbally expressed are influenced more quickly by sociocultural variations than other components of the emotion process. This makes sense because the subjective state of feeling represents the cultural and situational context and the other components of the emotion process.

How can emotion components interact?

Research has shown that the components of emotions are all strongly interconnected.

Catharsis

Catharsis revolves around the interaction of three components of emotion, namely expression, physiology and feeling. Through an expression, a person can calm himself down, reduce his arousal and at the same time change his state of feeling.

Proprioceptive feedback

Proprioceptive feedback (or the facial feedback hypothesis) states the opposite of the catharsis hypothesis. In this case, inhibition of facial expression reduces the intensity of an emotion and emphatic facial expressions can enhance the intensity of an emotion. In an experiment, participants had to hold a pen between their lips or teeth. The participants who used their laughing muscles to hold their pen rated the cartoons they saw as funnier. The effects were even stronger when the participants saw themselves in the mirror and the effects were also stronger with participants with high self-awareness. This has the opposite effect when someone has to smile kindly, while the person is actually furious, because this only reinforces the anger.

Uit onderzoek van het afgelopen decennium blijkt dat een significant aantal zeer jonge kinderen sociaal-emotionele problemen hebben of psychopathologische kenmerken vertonen. In de groep 2- en 3-jarigen betreft het ongeveer 10 tot 15 %, gebaseerd op de gedrags- of sociaal-emotionele problemen die door de ouders gemeld worden. Bovendien blijkt dat de problemen vaak blijvend zijn en de ontwikkeling kunnen verstoren, mits niet wordt ingegrepen. In sommige gevallen kunnen niet-herkende sociaal-emotionele problemen escaleren en/of de effectiviteit van de opvoeders dusdanig verminderen. Daarom is het van belang dat op vroege leeftijd wordt gediagnosticeerd en zo nodig wordt ingegrepen. Er is echter ook weerstand tegen het idee dat 1- tot 4-jarigen ook gedrags- en/of sociaal-emotionele problemen kunnen hebben. Er zijn hiervoor 4 verklaringen te geven:

1. De impact van cognitie en taalontwikkeling van zeer jonge kinderen krijgt meer aandacht dan de mentale gezondheid.

2. De invloed van emotionele ervaringen van zeer jonge kinderen op het sociaal vermogen en cognitief vermogen is pas recentelijk geaccepteerd.

3. Er is sprake van een sociaal stigma wat betreft de mentale gezondheid van kinderen; de ouders vrezen vaak als schuldigen te worden bestempeld wanneer er iets mankeert aan de mentale gezondheid van hun kinderen.

4. In de maatschappij bestaat een soort mythe dat de vroege kindertijd enkel een gelukkige en veilige periode kan zijn in iemands leven. Dat er eventuele sociaal-emotionele problemen kunnen zijn wordt ontkend.

Daarnaast is er ook sprake van vier moeilijkheidsfactoren bij het diagnosticeren van zeer jonge kinderen. In de volgende sectie gaan we hier verder op in.

De 4 moeilijkheidsfactoren bij de diagnosestelling voor zeer jonge kinderen

Diagnoses stellen voor 0- tot 4-jarigen is een proces dat bemoeilijkt wordt door vier factoren:

• De snelle ontwikkelingsovergangen in de vroege kindertijd

• het vinden van valide en betrouwbare meetinstrumenten

• diagnose stellen bij een andere cultuur

• het inschatten van de gevolgen in het dagelijks leven en ontwikkeling van het kind.

De eerste factor

De snelle ontwikkelingsovergangen zorgen voor problemen bij het stellen van een diagnose, omdat de normgerelateerde groep een kleine leeftijdspan heeft om te vergelijken. Zo bedraagt de leeftijdsspan van 0 tot 2 jaar slechts 1maand. Een dreumes van 11 maanden kan dus niet vergeleken worden met een dreumes van 13 maanden, wat betreft de ontwikkeling. Bovendien is er een gebrek aan informatie over de normale sociaal-emotionele ontwikkeling van zeer jonge kinderen. De combinatie van een kleine leeftijdsspan en gebrek aan informatie maakt het diagnosticeren moeilijk. Verder zijn sommige leeftijdsspecifieke gedragingen in de vroege kindertijd, symptomen van sociaal-emotionele problemen op latere leeftijd. Als de problemen gekenmerkt worden door de graad van intensiteit, frequentie en duur wordt diagnosticeren bemoeilijkt. Bijvoorbeeld, agressie op de leeftijd van twee is zeer gewoon. Bij Disruptive Behavior Disorders zijn regelmatige woede-uitbarstingen één van de symptomen. Een tweejarige die woede-uitbarsting heeft is dan ook moeilijk te diagnosticeren. Het is dan ook van belang dat een cluster van gedraging wordt gebruikt bij het diagnosticeren in plaats van enkele symptomen.

De tweede factor

Hoewel er onderzoek wordt gedaan naar de normale ontwikkeling van zeer jonge kinderen en nieuwe meetinstrumenten worden ontwikkeld, voldoen de huidige meetinstrumenten niet om op zichzelf de problematiek bij de kinderen vast te stellen. Het advies luidt om informatie te verzamelen met meerdere instrumenten vanuit meerdere bronnen, om zo een completer en duidelijker beeld te krijgen van de ontwikkeling van het kind. Meetinstrumenten om de gevolgen van de stoornis bij zeer jonge kinderen vast te stellen zijn zeldzaam. De Vineland adaptive Behavior Scale is zo`n meetinstrument. Dit instrument kan het huidige functioneren van het kind goed meten. Echter of een vertraging van de ontwikkeling komt door psychopathologische redenen kan bij dit instrument niet worden vastgesteld. De conclusie is dan ook dat er geen meetinstrument is die de gevolgen van sociaal-emotionele problemen op zeer jonge leeftijd kan weergeven.

De derde factor

Over het algemeen bevatten testen die worden ingevuld door ouders meetfouten. Deze meetfouten komen voort uit de partijdigheid van de ouders ten opzicht van hun kind. Als de ouders afkomstig zijn uit een cultuur die afwijkt van de dominante cultuur, wordt dit effect versterkt. Daarnaast zijn de dagelijkse routine en de opvoeding gekleurd door cultuur. De diagnosticus moet dan zich bewust worden van de cultuur en kijken of gedragingen van het kind cultuurafhankelijk is. Op deze wijze zijn vooroordelen en meetfouten te voorkomen. Bij culturele verschillen wordt door de DSM outline for culturale formulation aangeraden om met de familie te praten over:

• moeilijkheden of stress van het kind

• hoe het gedrag van het kind gezien wordt in de cultuur

• culturele verklaringen voor het gedrag

• ervaringen van ouders en voorkeur voor behandeling van het kind

De vierde factor

Bij zeer jonge kinderen valt moeilijk te beoordelen hoe een stoornis of een sociaal-emotioneel probleem het dagelijks leven en de ontwikkeling wordt beïnvloed. De reden hiervoor is dat het leven van het kind en de opvoeders op een dergelijke wijze met elkaar verweven is. De gevolgen voor het kind enerzijds en het gezin anderzijds zijn moeilijk te onderscheiden. De gevolgen moet worden in ieder geval worden beschreven op deze 4 gebieden:

• Het aanpassingsvermogen in verschillende omgevingen van het kind

• De ontwikkeling van nieuwe vaardigheden en kennis van het kind

• Het sociaal functioneren en de relaties van het kind

• De fysieke gezondheid van het kind

De opvoeders spelen een actieve rol bij de regulatie van de emoties en het gedrag van het kind. Aldus, de opvoeders kunnen een bepaalde invloed hebben op het kind zodat, de gevolgen en zelfs symptomen van de stoornis niet zichtbaar zijn. Bijvoorbeeld, de ouders ontwijken situaties waar het kind het negatieve gedrag vertoont. Om deze reden is het gepast de gevolgen van de stoornis niet alleen te beschrijven voor het kind maar ook voor het gezin. In de volgende sectie gaan we hier verder op in.

Het gezin en de familie

Het is cruciaal om de omgeving van het kind te begrijpen wanneer de sociaal-emotionele ontwikkeling van het kind wordt onderzocht. Het is namelijk niet ongebruikelijk dat, bepaalde probleemgedragingen van het kind specifiek zijn voor de context of de opvoeder. Er zijn 4 stappen voor het schetsen van een duidelijk beeld van de familiesituatie.

1. identificeren van het gezin (de primaire opvoeders) en de huidige relatie met het kind en elkaar in beeld krijgen.

2. identificeren van de familie (secundaire opvoeders), de familie is in deze context niet per se biologisch verwant aan het kind.

3. De wederkerige interactiepatronen tussen kind en primaire opvoeders in kaart brengen.

Deze wederkerige interactiepatronen hebben invloed op sociaal-emotioneel gedrag en ontwikkelen zich. Deze relatie is dan ook van groot belang voor het welzijn van het kind. De volgende meetinstrumenten meten de interactiepatronen:

• The Nursing child assesment satellite

• Clinical Problem-Solving Procedure

• Emotional Availability Scale

• Parent-child early relational Assessment

Naast het analyseren van het gezin en de familie zouden risicofactoren die buiten het gezin liggen moeten worden meegenomen in het onderzoek, bijvoorbeeld armoede.

De ontwikkeling

Een ander aandachtspunt dat moet worden meegenomen in het onderzoek zijn de ontwikkelingen op andere domeinen. Met name taalachterstand, want kinderen met taalachterstand hebben een verhoogd risico op sociaal-emotionele en gedragsproblemen. De volgende meetinstrumenten kunnen worden gebruikt voor de meeting van ontwikkeling.

• The Ages and Stages Questionnaires: Parent-Completed, Child Monitoring System. Dit meetinstrument meet de communicatie, grove motoriek, fijne motoriek, probleemoplossend vermogen en sociaal vermogen van kinderen tussen 4 en 60 maanden. Dit meetinstrument heeft een hoge betrouwbaarheid en een acceptabel validiteit.

• The Macarthur Communicative Development Inventory Short Form. Dit meetinstrument meet de productieve vocabulaire van kinderen tussen 12 en 26 maanden. Dit meetinstrument heeft een hoge betrouwbaarheid.

• The Brigance Infant and Toddler Screen. Tweeledig meetinstrument de infant version is te gebruiken voor kinderen 0 en 11 maanden en de toddler version is te gebruiken voor kinderen van 12 tot 36 maanden. Het instrument meet de fijne en grove motoriek, zelfstandige vaardigheden, luister en spreek taalvaardigheden en sociaal-emotionele vaardigheden. Dit instrument heeft een acceptabel betrouwbaarheid en validiteit

• The language Development Survey. Dit instrument meet de taalachterstand van kinderen van 18- 35 maanden. Dit instrument heeft een hoge validiteit en betrouwbaarheid.

Naast meetinstrumenten voor specifieke domeinen zijn er twee testen die de gehele ontwikkeling meten;The Mullen Scale of Early learning en Bayley Scale of Infant Development.

De ideale situatie

In de introductie is het belang onderstreept van vroege detectie van sociaal-emotionele problemen. In de ideale situatie worden alle zeer jonge kinderen gediagnosticeerd op het consultatiebureau. Het diagnoseproces heeft drie stappen. Stap 1 is een algemene test, die op het consultatiebureau doorlopen wordt. Zodoende, worden kinderen die risico lopen geïdentificeerd. Het is belangrijk, dat het meetinstrument zo wordt afgesteld dat de balans tussen valse identificatie en juiste identificatie goed is. Een balans is goed wanneer, 80 % of meer kinderen juist geïdentificeerd worden.

De volgende screening instrumenten kunnen worden gebruikt:

• The Ages and Stages Questionnaire- Social-emotional version

• The Brief Infant Toddler Social Emotional Assessment

Deze meetinstrumenten moeten nog getest worden op de validiteit in de kliniek, met andere woorden het is nog onduidelijk of deze meetinstrumenten juist zijn afgesteld. Bij Stap 2 wordt een kindrapport ingevuld door de ouders. Tevens, wordt geïnformeerd naar de zorgen van de ouders en teken van verstoring in de dagelijkse routine. Bij stap 3 wordt een uitgebreide diagnostische evaluatie gedaan met meerdere testen of één uitgebreide test. De volgende drie meetinstrument zijn adequaat voor een uitgebreide meting voor sociaal-emotionele problemen:

• Infant -Toddler Social and Emotional Assessment. Meetinstrument voor kinderen van 12 tot 36 maanden

• Child Behavior Checklist. Meetinstrument voor kinderen van18 tot 60 maanden.

• Preschool Age Psychiatric Assessment. Meetinstrument voor kinderen tussen 24 en 60 maanden.

De uitkomst van deze testen wordt verwezen naar een interventie of alsnog geconcludeerd dat er geen sprake is van sociaal-emotionele problemen.

De aanpassingen

Het is niet alleen nodig om een meetinstrument aan te passen voor de sociaal-emotionele problematiek van zeer jonge kinderen, maar ook de criteria van sommige stoornissen moeten worden aangepast. Zeer jonge kinderen kunnen namelijk:

• Andere symptomen vertonen

• Minder frequent of intens de symptomen vertonen bij depressie

• De vereiste symptomen liggen buiten de cognitieve capaciteit van het kind, bijvoorbeeld bij Posttraumatic Stress Disorder (PTSD)

• De symptomen zijn nog niet aanwezig

Conclusie

Dit artikel beschrijft de noodzaak om te diagnosticeren op zeer jonge leeftijd, maar ook de obstakels van diagnosticeren op deze leeftijd. Op dit moment is er een discrepantie tussen de huidige situatie en de ideale situatie. Onderzoek naar psychopathologie bij zeer jonge kinderen en het ontwikkelen van adequate meetinstrumenten zijn nodig om de ideale situatie te realiseren.