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ADHD Science episode 6 with Kate Anning
124 Plays1 year ago
We welcome Kate Anning from the university of Cardiff to the pod!
Kate's work can be found here: https://profiles.cardiff.ac.uk/research-staff/anningk
She is on twitter @anning_kate
Thanks, and see you in the autumn!
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Transcript
Introduction and Host Updates
00:00:08
Speaker
Hello and welcome to episode 6 of the ADHD Science Podcast. How are you Tess? I have a cold but I'm living. A little bit poorly but you're pushing through because it's nearly the holidays really.
00:00:23
Speaker
Yeah. I mean, I've been off school for quite a while now, but I've been doing work experience, which is very exciting. Experiencing the world of work. I don't think you're going to be excited by work for very much longer, but long may it last.
Guest Introduction: Kate Anning
00:00:37
Speaker
We are going to talk today to Kate Anning, who is a PhD student at the Center for Human Developmental Sciences at Cardiff University. It's another one which is at least to an extent about
00:00:53
Speaker
executive function and I don't make any apology for that because I think it's a really important subject and also a really good companion piece to Alex Hendry's interview last week. Go check that out
Understanding Executive Function in Children
00:01:06
Speaker
if you have them. Go check it out. This is more about, so Alex's stuff is more about how how children react when they really want something and how they kind of use their executive functions when they really want something like for instance
00:01:21
Speaker
biscuits but Kate's is more about maybe older children and doing things that are maybe are not quite so motivating so in a way more relevant for school where you are not really necessarily motivated by the task itself and more by anyway we'll talk about this in the interview but more but just to give you a kind of intro I am aware that we kind of dive into it with these
00:01:50
Speaker
researchers and getting a little bit of an idea of what kind of ideas we're talking about is probably a good way of starting us off. You're so wise. I am very wise so let's let's dive in shall we. Oh you're gonna have a doorbell this week aren't we because you wanted a doorbell. I asked for a doorbell. So who's at the door Tess? I think it might be Kate.
00:02:21
Speaker
Hello, welcome. Welcome, welcome, welcome. So joining us today is Kate Anning. Can you just introduce yourself, Kate? Where are you from and what your kind of title and role is there? Hi, both. I'm Kate Anning. I am a PhD student in my final year of my PhD based at Cardiff University, and I'm based in the Neurodevelopmental Assessment Unit at Cardiff.
00:02:49
Speaker
doing my research with children who are referred to the Neurodevelopmental Assessment Unit for an assessment. So essentially that's an NHS unit, is it? No, it's not. It's funded by the Waterloo Foundation and we work with schools. So we work with schools who then make referrals to us with children aged four to seven.
00:03:17
Speaker
and 047, so that's quite a small window in a sense.
00:03:22
Speaker
of the, of the total kind of neurodevelopmental spread by age. Okay, so that's really interesting. And you work with clinicians and doctors and so forth at the centre and to make, to make diagnosis or just to kind of assess? No, we don't make a diagnosis. So all the children are referred to us for a range of difficulties that they're having at school. So it can be things like memory, self-regulation, emotional difficulties, all sorts of things that
00:03:52
Speaker
prompts the referral from CENCOs and classroom teachers to us. And then we carry out an assessment and make a report which identifies strengths and difficulties in each child. And that goes back to the school. But the processes that we measure are things like attention, language, memory, emotion recognition, specific processes rather than diagnosis. Okay.
Research on Children's Referrals and Tasks
00:04:19
Speaker
Okay.
00:04:20
Speaker
We've gone back to that. Shall we crack on? Because the reason I sort of was turned on to your work was a paper that you published recently. So Tess, do you want to start the questioning? Well, first of all, what question were you asking? I'm not asking. Well, I guess what question were you asking in your research? Yeah. So the question that I was asking in the paper that you were talking about is
00:04:47
Speaker
I had a few questions, actually. First of all, I wanted to see the kinds of reasons that children were referred to us. So all the teachers who made referrals completed a strengths and difficulties questionnaire. And the first thing I did was look at the kinds of difficulties that teachers were reporting, whether it was hyperactivity, emotional difficulties, prosocial problems at school. So I looked at the prevalence of those different difficulties in the sample.
00:05:15
Speaker
And then all the children completed a range of different executive function tasks, which is tasks that measure things like attention, memory, cognitive flexibility and inhibition. And then I wanted to see the relationship between those difficulties in those processes.
00:05:37
Speaker
and symptoms of different disorders like ADHD, autism, oppositional defiance disorder, and anxiety. So I have a few questions. Well, I just want to unpick a few things because I think executive functions come up for us in a previous episode, although they may not go out in order. So that might not be a meaningful thing to say. Yeah, I just wonder if it would be something you've not really covered or not.
00:06:01
Speaker
No, well, I think we've mentioned it, but I think it's always worth digging into. How would you explain executive function? Because it's such an important aspect of all of these conditions. Yeah, I think I use quite a broad definition of executive functions because in young children, the differentiation of these individual processes is less clear.
00:06:25
Speaker
Whereas in older children and adults, there's more clear separation between what memory is and what cognitive flexibility is, whereas children will probably use all these processes at the same time. But I would say it's the top down processes that we use.
00:06:44
Speaker
to carry out goal-directed behavior. So it's when we have to hold instructions in our memory, we have to switch between different tasks, we have to inhibit different responses so that we can focus on our attention on what needs to be done.
00:06:58
Speaker
So what kind of actual things are the kids doing in your research? Because we've had previous guests talking about younger children than you're studying trying to find a sort of smarty in a box, not breaching any confidentiality, because it's all going to be on the podcast. But what are your subjects doing?
00:07:20
Speaker
Yeah, I think the smart inner box sounds like a hot executive function task, which is is designed to be kind of frustrating and involve emotional motivational processes, which I am interested in as well. But for this particular study, I was focused on more abstract executive functions, which is when the tasks that we're asking children to do on emotionally motivating, there's not really any rewards or any kind of
00:07:51
Speaker
So, so children just for the episodic memory task they have to remember a sequence of pictures and show them back to me in the same order. And for the flexibility they have to sort pictures by color and then they have to sort by shape so to switch between those different rules.
00:08:09
Speaker
Surely that's more applicable to a school environment because quite a lot of the time when you're doing tasks in school, there really is no motivation, other than just you've been told to do it. Absolutely. That's very true. You can't have smarties for every task in school. That would be a public health disaster.
00:08:26
Speaker
Yeah, I think it varies a lot because some, you know, some things in school are more motivated, they might be socially motivating situations. But I agree in terms of like the classroom and sitting still and doing maths or kind of academic subjects, you see strong relationships between the executive function tasks that I was describing and those those tasks at school.
00:08:51
Speaker
So, and the other thing I wanted just to unpack because people, not everyone, I think most people who would be listened to a couple of our episodes would know what we mean by ADHD, what we mean by autism, although we're unpacking lots of things about them. Oppositional defiant disorder. I mean, can you just sort of briefly explain how you think
Dimensional Approach to ADHD
00:09:11
Speaker
about that? What you think that, how to think about that most effectively?
00:09:16
Speaker
Yeah, so there's different dimensions of symptoms, a bit like how for ADHD you have attentional symptoms and hyperactive symptoms. With oppositional defiance disorder, you have oppositional symptoms, which is when a child might have an instruction and they'll want to do the opposite thing. And then you also have negative affect symptoms, which is like high emotionality, reacting strongly negatively to a certain situation, being really upset.
00:09:46
Speaker
by being told no or something like that. Yeah, so it's kind of those kinds of behaviors that you see in children, but to a more extreme level. Okay. And I suppose because for some people it's quite a controversial diagnosis, but if you're just picking up features of it, you don't necessarily have to worry about that particular question. No, I think a real,
00:10:15
Speaker
kind of strong message for this paper is is to look at these things dimensionally. And we're not we're not using it as a diagnosis, we're just looking at whether children with more of those kinds of behaviors have more difficulty on these executive function tasks. And whether children with more of those kinds of behaviors would benefit from an intervention around these kinds of cognitive processes, rather than diagnosing the disorder, because we're actually looking at
00:10:44
Speaker
at the difficulties that the children are having in terms of their cognitive processes rather than what diagnostic category they would fit into because as we kind of know, but all these things are associated with huge variation. ADHD is a really good example in that not all children with ADHD have the same executive function difficulties and you see so much variation there. But one thing that might contribute to that variation is this high co-occurring
00:11:13
Speaker
other disorders as well, so it might be that symptoms of autism or symptoms of anxiety also affect one's performance on an executive function task as well and might increase the variation that you see within ADHD. So in this experiment, well not experiment, but in this kind of research that you were performing,
00:11:37
Speaker
I use experiment as a wide term, no worry scientists. What did you find? So what I found was that the reasons that teachers refer children showed really high overlap between each other. So children who had high hyperactivity also had high emotion problems, also had high conduct problems. So I saw a lot of overlap between different
00:12:04
Speaker
kind of symptom clusters that we kind of categorize as being separate. Actually, a lot of the children show lots of symptoms in different categories. That was the first thing. The second thing was that there was a lot of variation in the kinds of difficulties on executive function tasks that children had. So about a quarter of children had difficulties with memory, about a quarter had inhibition difficulties, and about a quarter had flexibility.
00:12:34
Speaker
difficulties. But the task that captured the most amount of difficulty in the sample was the attention task. So on this task, children had to follow a moving target around the screen for five minutes. It's quite boring. Oh my God. Children performed kind of below average. About a half of the sample performed below average was 55%.
00:13:03
Speaker
Okay. Well, okay. So how far below average? Because if you average 50% of the general population will be below average. What do you mean by? Over one standard deviation. Over one standard deviation below. So you would expect 20 odd and it's actually 50 odd. Yeah, it's actually more than that. Okay. And then the other main findings were the dimensional results. So
00:13:26
Speaker
controlling for co-occurring symptoms. I found that ADHD symptoms were associated with memory difficulties and inhibition difficulties, autism symptoms with better cognitive inhibition, anxiety with better cognitive flexibility and longitudinal defiance with poorer cognitive flexibility.
Cognitive Flexibility and Autism
00:13:49
Speaker
Oppositional defense with poorer cognitive effects. Yeah. So they had more difficulty on the rule switching tasks. So when they had to switch and sort by color and then sort by shape, they struggled with that switching. Oh, do you think that could be linked to inhibition? Like you've learned how to do it one way and then you're struggling to stop yourself from doing it that same way the second time.
00:14:11
Speaker
Yeah, I think inhibition is a really important part of that task. And also, we know that with, so I'll take some water. Yes, of course.
00:14:27
Speaker
with regulating negative emotions, like when you're upset, that might involve some switching so that you can kind of distract yourself from what you're upset about or think about something else. So it could be an important part of those symptoms as well, particularly in young children who have more of these like emotional outbursts than older children. It could be that cognitive flexibility plays an important part in
00:14:54
Speaker
in regulating those negative emotions as well. Yes, that's fascinating. Because what was the cognitive flexibility relation, the relationship between cognitive flexibility and autism features in your work? Was that? I was waiting. So go on.
00:15:13
Speaker
didn't find a relationship. That's so interesting. Yeah, which is really interesting because that's the kind of that was we hypothesized to find a relationship there. And generally, the literature has suggested that of the executive functions, the one that's most associated with autism would be cognitive flexibility. But we didn't find that. Hmm. I'm just thinking it's setting off in my head this whole
00:15:41
Speaker
emerging idea that actually there's not an awful lot wrong with the way that autistic people think as in that it is flexible. It is inductive. It's just, it doesn't, it's when you, when you put autistic and neurotypical people together, that's when you get problems. Do you see what I mean? So, so there may be an apparent lack of social flexibility, but maybe it's not actually, I mean, obviously we're leaping. Yeah, we have them. But it's difficult. It's an interesting one, isn't it?
00:16:08
Speaker
Yeah, we put forward several explanations for why we might have found this and one that we did think about was
00:16:15
Speaker
that the task is administered on an iPad and the researcher just sits next to the child. So there's very minimal social interaction. And all of the rules and things like the switch, now switch to color, now switch to shape is all said by the iPad, not the researcher. And there's a lot of visual prompts as well that kind of guide the child onto which responses they need to be making. So in terms of like, what kind of
00:16:43
Speaker
processes are involved, visual, spatial reasoning. And, and some of the processes that we know are associated with strength in autism as well are involved on that kind of task. And we did reduce the social demands and the language element, they didn't have to use any language, they just, you know, tap the answers. So it's less demanding than a lot of other
00:17:07
Speaker
flexibility tasks or a questionnaire that talks about flexibility in real life situations. It's a very different kind of process to the one that we were looking at, which is very kind of pure, what we think cognitive flexibility is. That is very interesting. Do you think it's less about the actual cognitive function itself and more just about the way that it manifests?
Implications for Interventions
00:17:31
Speaker
Like,
00:17:32
Speaker
Yeah, I think it's, it's really hard to kind of strip everything down. And I think for our for this experiment, we did try and use the purest measures possible where we didn't add environmental demands in there. But I think language and things like that are really important confounding variables to think about, particularly if you're looking at a relationship between autism and executive functioning. I mean, I don't know nearly enough about autism to
00:17:59
Speaker
participate massively in their suspect of the conversation. You know a bit about it. We've never looked at it in psychology. I don't have it. So the only things I know about autism are from TikTok and from what you've said on the podcast. TikTok is a very valid source of information. TikTok is a terrible source of information. All right. I don't know it. Fine. So maybe we should probably dive into
00:18:28
Speaker
autism in a bit more detail at a future date. But we'll talk about Dr Kay about her research. Because you mentioned intervention. So are you also in this paper or in future papers looking at intervention? I know we're jumping forward to a future question as well. Yeah, I think interventions is really interesting area. And I think the paper highlights a lot about how interventions should be done as well as what potential interventions could be developed.
00:18:57
Speaker
as a result. So I think one thing to think about is that we did find so much variation in our samples. So there is this need for a needs-based assessment before delivering an intervention. So rather than just using diagnosis to determine what kind of intervention would be beneficial, this research suggests that it's also important to first establish that the child has a problem in the area that you're trying to target as well as
00:19:28
Speaker
Maybe an attention difficulty or... So I suppose just the implication of what you're saying is that knowing that a child has ADHD doesn't necessarily tell you what executive function intervention is going to work for them. Exactly, yeah. And that's got huge implications. And a lot of studies that have looked at the effectiveness of an executive function intervention in an ADHD sample
00:19:57
Speaker
might not have a pre-measure of executive functioning. Well, they just look at ADHD kids or people as a block. Yeah, I think I think first it's important to establish that there is a difficulty there before you then target it. Yeah, of course. And yeah, I mean, you Kate's team gets children who are having learning problems or behavioral problems in class. Yes.
00:20:25
Speaker
Okay, we'll just, we'll cut this bit out. I think that. Well, let, let, let us ask the question. Let's ask the question because then we can edit and then we can. Sorry about all that. I always, I always mess this one up. Do you find that you get more children with behavioral problems or learning problems? I think we get both. Um, but I think that.
00:20:48
Speaker
We do see more children who are easily identifiable by teachers, so that probably means they have more behaviours at school. What's really interesting is that we get some children who are referred and school might think that they have a learning problem when actually we find that in a one-to-one environment, it's very quiet, there's no other children around. They can do quite well on our assessment, so we can say actually,
00:21:18
Speaker
there's not a learning problem here. It's the classroom environment which is causing more difficulty than the actual academic task or the difficulty of the task that you're asking the child to do. It's more the environment that is making it difficult for them. But we do also have children who do struggle on
00:21:39
Speaker
you know, executive function tasks as well. So it's really varied, but I think the likelihood of referral does go up if a child has more externalising behaviours in the classroom, because they're just more likely to be identified by teachers and just prompts more of a response.
00:22:00
Speaker
So what is the gender kind of skewing of proportions of the children who are? That's very closely linked to what we were just talking about. So we see less girls than boys. I think it's about, it varies between a quarter to a third girls over time. But I think for the paper that I've just written, I think it's 25% girls.
00:22:30
Speaker
I mean, that's about the referral rates for that age group. I mean, I think it equalizes when they get a bit older. But at the early primary, that's about right in terms of referral rates. Yeah. And you see more internalizing difficulties in girls. But I think that what we'd be worried about is that girls also mask a lot and they also have more internalizing difficulties that maybe don't get noticed by teachers. It's not that they necessarily aren't.
00:23:00
Speaker
also struggling. Oh, we have a whole episode about that, don't we, Tess? Very interesting one. I find masking so interesting. Yeah. This is because you're essentially going to pick up the ones who aren't as masking as effectively. Yeah. Next question. What does this mean for people looking after ADHD people?
00:23:27
Speaker
And I think the main thing, the main take home message is that it's that it's never a one size fits all.
Comorbidity and School Strategies
00:23:34
Speaker
And I think it's also really good to be aware that ADHD is highly comorbid with lots of other things as well. So to keep an eye out for other emerging conditions as well, like anxiety, other difficulties that can co occur with ADHD. And
00:23:56
Speaker
but also thinking about what difficulties that child actually has rather than what they might think someone they actually might struggle with. Yes, yes, yes. I mean, how difficult
00:24:11
Speaker
Resource-wise, say a school has got a child who's exhibiting these difficulties or struggling in school. I'm particularly interested, although this is an ADHD podcast, that the cohort who are showing oppositional defiant behaviours in class and the fact that they've got cognitive differences, that's so interesting to me. How would a school assess these within the obviously limited resources that they have? Or can they? Or what should they do?
00:24:39
Speaker
That's a really good question. I think that it's also good to have interventions on offer to just try out. And I think things like breaking down tasks into chunks, giving children movement breaks, opportunities for moving around and breaking tasks down.
00:25:04
Speaker
Yeah, limiting distractions. It's always worth having those things on offer and seeing if they help. Anyway, I don't think you need to do an assessment before you try out one of those instructions because they're quite easy to try out, breaking a task down or letting a child jump around or limiting distractions. They are all things that schools can probably do relatively easily. And then if it works great, that might indicate that
00:25:33
Speaker
they've targeted something that's a difficulty for that child. They don't have to necessarily be guided by gut diagnosis. I mean, this is really interesting. And again, the kids who are not particularly ADHD-ish but are really misbehaving, thinking about their cognitive flexibility and their emotional regulation is just as important.
00:25:52
Speaker
don't need to have a need to have executive function problems as well. Like these, these things can can happen separately as well. And I think having interventions on offer, and what this research shows as well is that children who are below the average age of diagnosis, they're really young, but they still have these difficulties. So you don't really need to wait for a diagnosis to then put a support in place.
00:26:18
Speaker
Yeah, it's the symptoms are there, they're there. Yeah, you don't, I mean, gosh, what an important message. You don't have to wait for a diagnosis to start the intervention. I'm going to have a t-shirt printed with that written on it. Yeah, it's a constant, constant message that we have to keep pumping out. Right, for technical reasons, we haven't got much. We haven't got lots of time left. It's my fault. So what does this mean to ADH people themselves? I think it means that
00:26:49
Speaker
in the same way as a one size fits all thing that you don't have to think that because you have ADHD, it means that you have these certain difficulties. It's good to realize that there's this huge variation and that you're not gonna look like someone else who also has ADHD and you might struggle with different things. I think just to be aware that you might be different to other people, even though you have the same diagnosis, I think it's a good thing to know.
00:27:19
Speaker
I look a lot like you and we both have ADHD. Yeah. We don't have the same pattern of executive function. No, I know. I'm just kidding. I mean, it's not that dissimilar really.
00:27:31
Speaker
enormously forgetful. We're probably a bad example because I think our executive function profile is probably not that difficult. Dad, the joke is that you're my dad. I am not dad. Sorry about that. I will never make a joke again. Yeah, never make a joke. That was terrible. What? I didn't go down long with you. Oh, well, I'm not a very humorous person. Yes, you are. Whatever. Long day.
00:27:58
Speaker
So what's next? Oh my God, what's next question? What's next question? What next question is it for you? What's your next question? Because I remember you mentioned that you've got lots of research that you might be able to talk about. So what else are you up to right now? What's next for you? So the next thing I'm looking at is hot executive functions.
Research on Hot Executive Functions
00:28:21
Speaker
So how these processes are engaged in more
00:28:26
Speaker
motivating contexts with rewards and things like that and how the children in our sample do on those tasks as well and whether there are dimensional associations there between how children do on those tasks and these same symptom dimensions.
00:28:44
Speaker
And of course, the emotional side of things will kind of throw a whole curve ball into it, and it's much more social, so you might find different things with the autistic kids and the ODD kids, amazing stuff. And so will you come back and tell us all about it when you've got some more data? And I've managed to source that off, count, so we've got more time to record. We've got a full hour, that'll be great. Yeah, definitely.
00:29:14
Speaker
Okay, all right. Was there anything else you wanted to ask Tessa? No, I've got my three minute long question out of the way. Every time I have a question on this podcast takes me three minutes to get it out of me. Every time these poor editors have to go back and fix my stuttering. Two solid minutes before I can actually get my words straight.
00:29:34
Speaker
But you're still a vital component. Thank you. I feel like my role as the breaker downer of complex things has kind of drifted a bit because sometimes you'll say complicated terms and I'll know what they mean. Yes. And then I won't pick up on them. Do you think we need to replace you with your younger brother? Yes, we'll be on board. You'll do a much better job. Because he's not from psychology.
00:30:00
Speaker
That's a fair point Tess, but you're still doing it. I don't think we overloaded people today and we did bring it back to some... I feel like you're picking up on the more than I am, which is concerning. Well, I'm used to it. Talking to people about this stuff is my job. All right, well Kate, we've now started talking to each other, which is always a sign that we want to kind of...
Conclusion and Future Plans
00:30:24
Speaker
wrap it up so that we can talk about each other in our own house. Thank you very, very much for joining us. How would people be able to catch up with your work or the work of the NDAU? I've got it down, Neurodevelopmental Assessment University, NDAU. How would people find out more about your work? Yeah, I think if they go on to the Cardiff University
00:30:53
Speaker
and our website. That would be great. You can give me a follow on Twitter. OK.
00:31:00
Speaker
We'll put your handle, I don't know what it is, I can't remember. I don't know what it is either. So so many researchers just not into it at all. I think it's very, it's very laudable. We'll put it in the description slash show notes. Yes, exactly right. We'll do that. So that's fine. We'll get off you and so thank you very much for joining us. Thank you so much. It's been lovely talking to you. All right, thanks very much. Bye.
00:31:26
Speaker
So, that was Kate. Bye, Kate. That is the end of our series. No. We have got a couple in the bag for next series. Yes. If you have suggestions of researchers. We have a few suggestions people come in of interesting people to talk about or talk to, but if they're not researchers, that's not really the brief of our podcast. We want to talk about people who are researching this subject.
00:31:56
Speaker
I mean, you never know. But anyway, if you've got a topic that you think might be interesting, we can find someone who's looking into it because it is quite an active area of research. Anyway, that is our series. We are not going to put our podcast out until at least September at this point because you're too busy over the summer. I'm very busy over the summer. Basically, we can't get pinned down tests to any kind of times in the next six weeks.
00:32:21
Speaker
I just want to say it's been a great pleasure to present with Tess and to interview all of our lovely researchers. It has been lovely. Just want to note, it's not deliberate that all of our researchers are women, but it's probably a good thing just to note that. It sort of encourages me that science can perhaps move away from a male dominated into a more diverse
00:32:50
Speaker
area. Girl power! We were just waiting to say that. I was like Tess was poised to do some kind of intervention. And it was that. Okay. Right. Well, there you go. Okay. Thank you very much. Bye. Bye.