What do you think is the major determinant of whether our children excel in school? IQ? Good teachers? Good schools? Good standards and curricula? No, I say it is the students' motivation, or just plain grit. Other teachers think so too.

Education reporter, Libby Nelson, calls attention to the issue of grit in student learning achievement. Teachers and parents sometimes put too much emphasis on intelligence, when the more typical problem in education is that students don't try hard enough and are not sufficiently persistent in trying to achieve excellence.

Indeed, excellence is not even a goal for most students. Many students just want to do the minimum required to pass tests. A few students don't care at all. They just drop out. One student told a teacher friend of mine, "I don't need to learn this stuff. Somebody will always take care of me."

Nelson points to evidence of grit's importance with these examples:

·         West Point cadets who scored highest on a scale of grit were more likely to complete the grueling first summer of training.

·         National spelling bee contestants with more grit ranked higher than other contestants of the same age who had less grit.

·         College admissions officers know how important grit is (more important than SAT tests) but they don't know how to measure it other than grades, which of course may be inflated and inaccurate indicators of grit.

Clearly motivation is essential. I regard motivation as the cornerstone of what I call the "learning skills cycle." Learning begins with being motivated to learn, and successful completion of every step in the cycle strengthens motivation. However, every step in this cycle (organization, attentiveness, understanding/synthesis, memory, and problem solving/creativity) requires a degree of grit—the more, the better.

As applied to specific learning tasks, grit is central to all the ideas in the learning skills cycle. In the case of memory, for example, the well-known strategy of deliberate practice requires disciplined grit. Students diligently need to use established memory principles in a systematic way. This includes constructing a systematic learning strategy that includes organizing the learning materials in an effective way, intense study focus in short periods, elimination of interferences, use of mnemonic devices, and frequent rehearsals repeated in spaced intervals. Learning success depends on mental discipline and persistence.

Students differ enormously in their level of grit. It would be nice if we knew how to teach grit. Surely, parental influence is central. Parents lacking in grit are unlikely to model or teach it to their children. Some schools, especially private schools, teach grit by having high expectations and programs that help students discover the positive benefits that come from having more grit. One of those benefits is confidence, because grit promotes achievement and achievement develops confidence.

Confidence in the ability to learn is necessary for a student to try hard to learn. Here is the area where teaching skills count most: showing students they can learn difficult material and thereby building the confidence to take on greater learning challenges.

Students who have passionate goals are much more likely to invest effort and persistence in doing what is needed to achieve those goals. It is unrealistic to expect grade-school children to have well-formulated career goals. But certainly by early high-school, students should be forming specific lifetime goals. What a career goal is probably does matter as much as having one in the first place. Achieving a goal, regardless of whether it is later abandoned or not, teaches a youngster that grit is necessary for the achievement. The student learns that grit has a payoff.

Grit may not always lead to excellence in students with innate limited abilities. But grit allows such students to "become all they can be," as the Army recruitment slogan claims. Moreover, the benefits of grit perpetuate beyond success at any one learning challenge. Learning anything requires physical and chemical changes in the brain needed to store the positive attitudes that come from learning success and the learning content itself. In other words, the more you know, the more you can know.

Source:

http://www.vox.com/2014/10/9/6835197/grit-kipp-noncognitive-skills-duckworth-teaching

"Memory Medic's new book has just been released: "Improve Your Memory for a Healthy Brain." Smashwords.com

As 2014 year comes to an end, I will continue the Brain Posts tradition of highlighting the Top Ten most viewed posts for the year.

It is always informative to find the posts that generate the most site visits. I am surprised at some of the posts that make the list and at some of the posts that do not.

Here are the posts making the list for 2014 beginning with number 10. Clicking on the post title will link you to the full post.

Naptime Stories Boost Word Learning in Children

This post summarized an interesting study of reading and word memory retention in children. It highlights the importance of sleep for memory consolidation and retention. The time immediately proceeding naps is an important time to use for teaching.

The Genetics of Religious Belief

In April, I reviewed some recent brain research related to religion and religious belief. The number 9 most viewed post examined a twin study of religious belief. This study found important genetic contributions to adult religious belief and attendance. Apparently, genetic brain wiring contributes to our later religious affiliation.

The Social Brain: Weeking Reading Links 

In 2014 I started posting links to a list of abstracts I felt were important. These came from my PubMed searches on specific topics. Some abstracts were later give a full post but many did not. The Weekend Reading links on the Social Brain was popular and ended up number 8 on the Top Ten list.

Is Insomnia Relief Just a Mouse Click Away?

The number 7 ranked post for 2014 was a review of an internet-based cognitive behavioral treatment for insomnia. This study supported the value of this approach and holds the potential to make CBT treatments more accessible and potential more affordable. Look for more studies of using internet and mobile health approaches for the treatment of common medical conditions.

Acute Brain Response to Exercise in Healthy Adults

There are both acute and chronic effects of exercise on the brain. The number 6 most viewed post this year highlighted a study of acute effects of exercise on healthy adults. The study used advanced brain imaging techniques and demonstrated changes in the pattern of blood flow distribution with exercise. These changes may contribute to the known beneficial effects of exercise on brain plasticity.

Merry Christmas and Happy Holidays! I will post the top five viewed posts next week.

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My research training is in psychiatric epidemiology. 

Alcohol and drug dependence have been two of my topic areas of research.

So I found a recent novel study of the epidemiology of illicit drug use in Europe intriguing.

Typical methods of looking for the prevalence of drug use in populations are direct diagnostic interviews and studies of emergency room attendees or autopsy cases with medical complications of drug use.

However, Christopher Ort from Switzerland along with a host of European colleagues took an interesting approach to studying illicit drug use in European populations.

They conducted population wastewater illicit drug concentration analyses using liquid chromatography. They examined changes in illicit drug concentrations over time and across a number of cities and regions in Europe.

This approach is slightly messy (pun intended) but logically follows a reasonable argument: high illicit drug concentrations in waste water reflects high drug use in the population producing the waste.

Their full text manuscript can be accessed by clicking on the PMID link below. But for the few lazy readers of my blog here are the five highest ranked European cities by the five illicit drug classes. This list is produced by me through the precise method known as "eyeballing" from charts in the manuscript. Countries are listed after municipalities where waste water was sampled when city first makes a list.

Cannabis

1. Amsterdam, Netherlands
2. Paris, France
3. Novisad, Serbia
4. Antwerp, Belgium
5. Utrecht, Netherlands

Amphetamines

1. Eindhoven, Netherlands
2. Antwerp
3. Gothenburg, Sweden
4. Ninove, Belgium
5. Helsinki, Finland

Methamphetamine

1. Prague, Czech Republic
2. Budweis, Czech Republic
3. Oslo, Norway
4. Bratislava, Slovakia
5. Dresden, Germany

Cocaine

1. Antwerp
2. London, England
3. Zurich, Switzerland
4. Amsterdam
5. Barcelona, Spain

MDMA (Ecstasy)

1. Eindhoven
2. Utrecht
3. Amsterdam
4. Antwerp
5. Zurich/Barcelona (Eyeball tie)

The authors note their findings for the prevalence of illicit drugs in wastewater generally match regional prevalence estimates for drug use using other methods.

They note wastewater samples can be done by day of the week to follow chronological patterns of drug use (no surprise levels of drugs in wastewater samples are higher on the weekend). Additionally, this approach may be a valuable secondary source of trends in regional drug use over longer periods such as years.  

I found the differences in metabolite rankings for amphetamine versus methamphetamine interesting. The methamphetamine rank list is made up of more cities with lower per capita incomes. 

This suggests possible local production of methamphetamine while amphetamine is more likely diverted from pharmaceutical grade manufacture.

This study did not include samples from the U.S., South America, Japan, China or Russia so it only reflects the cities listed in the methods section of the paper. 

Again, click on the citation PMID link below if you are interested in getting into more detail of this study. I would be interested in any comments from readers in Europe on whether these results seem valid.

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Ort C, van Nuijs AL, Berset JD, Bijlsma L, Castiglioni S, Covaci A, de Voogt P, Emke E, Fatta-Kassinos D, Griffiths P, Hernández F, González-Mariño I, Grabic R, Kasprzyk-Hordern B, Mastroianni N, Meierjohann A, Nefau T, Ostman M, Pico Y, Racamonde I, Reid M, Slobodnik J, Terzic S, Thomaidis N, & Thomas KV (2014). Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis. Addiction (Abingdon, England), 109 (8), 1338-52 PMID: 24861844

All children, if given the chance, will play, preferably with other children. The games they play

are often creative, rough and tumble, and of course―fun. Some consequences are obvious:

·         Fun is a positively reinforcing emotion. It makes kids happy.

·         Play encourages exploration with fewer constraining boundaries than the drone of regular life.

·         Play is an effective way to socialize and make friends.

·         Play stimulates initiative and engagement, rather than passively observing what others do.

But there is another less obvious reason, one that is biological. In a review in the American Journal of Play (yes, there really is a scholarly journal on play), evidence is provided from controlled studies in rats and some primates. These studies show that when young animals are encouraged to play they develop improved social competence, cognition, and emotional regulation later in life. Play experience also makes them more adaptable to unexpected situations.

It is true that play is not a developmental feature in all species. The capacity (and need) for play is most evident in higher mammals with developed neocortex and that live in complex social environments. Play fighting is adaptive in predator species, like bears and lions that depend on aggression for survival as adults. In all species that exhibit juvenile play, play is a developmental tool that promotes the neocortical executive control regions to control other neural systems.

Play fighting is especially interesting because the juveniles must construct and obey certain rules. They intuitively recognize that they must not bite too hard, for example, and must give the opponent at chance to win sometimes or at least hold their own in the contest. The juveniles are clearly learning self-control, which will serve them well as adult. This reminds me of the touch football games that kids play.

Species that most obviously exhibit juvenile play are humans, dogs, cats, and ravens. In species where adults play, play can have immediate functions such as defusing social tensions and dominance relationships. Rats are an interesting case. They engage in juvenile play much more than other rodent species. Adult rats seem to exhibit novel mental capabilities, especially those involving social interactions that are not so prominent in other rodents.

When members of a play-oriented species are denied access to juvenile play, they can become dysfunctional adults. For example, rats raised in social isolation show physical and chemical deficiencies in their brains and they have behavioral abnormalities linked to impaired executive control function. They show excessive anxiety to stressful or fear-inducing situations. They over-react to benign social interactions. They are less able to coordinate movements with a partner, both in sexual and non-sexual contexts. They are less able to solve mental tasks. Similar problem are seen in monkeys deprived of juvenile play. Being raised by a surrogate mother is emotionally and intellectually devastating, but less so if the surrogate is robot-like and can interact in play-like behavior with the infant.

Juvenile play sculpts the brain to be more adaptable later in life. In modern human society, juvenile play is often obstructed by such externals as over-scheduling, too much adult supervision, and too many restrictions. The restrictions are often for reasons of safety, which is understandable in today's world. When I was a child, we had a lot more freedom to play, and in safety. It was not unusual in the summer time for a kid to leave home after breakfast and not return until supper, going alone to a park or neighbor kid's house to play unsupervised as we wished. Sadly, that is too much freedom these days. In this respect, the "good old days" really were the "good old days."

Source:

Pellis, S. M., Pellis, V. C., and Himmler, B. T. (2014). How play makes for a more adaptable brain. Ame. J. Play. 7 (1) 73-98

"Memory Medic's new book has just been released: "Improve Your Memory for a Healthy Brain." Smashwords.com

Prescription opiate abuse is a significant problem in the United States.

I have previously written about this issue in several previous posts.

One important factor for clinicians and patients is the need to identify high-risk populations that may be more vulnerable to opiate abuse and dependence.

One obvious group would be those with alcohol or another non-opiate abuse diagnosis. Additionally, some psychiatric disorders are associated with increased risk for substance abuse including opiate abuse.

Given these high-risk markers, it would be encouraging if there would be evidence prescription opiate use is limited in those with substance abuse or a primary psychiatric disorder.

Unfortunately, there is not much evidence for restriction of opiate prescribing in high-risk populations.

Daniel Hackman and colleagues found the opposite finding in a study of patients with a substance abuse or primary psychiatric diagnosis in a dual diagnosis clinic.

Patients (N=201) in this clinic had prescription drug use reviewed for a period of 12 months and found the following key findings:

• Subjects received an average of 4.0 prescriptions for an opiate by medical personnel not associated with the dual diagnosis clinic
• These prescriptions resulted in the dispensing of an average of 213 opioid pills
• Concurrent benzodiazepine prescriptions were also common in this population
• Medicare or Medicaid coverage was associated with higher rates of opiate prescription compared to patients without insurance coverage

There are several take-home messages from this study.

First, some high-risk populations for opiate abuse seem to be more likely to get prescription opiates from a medical provider. From the current study, it does not appear clinicians are restricting prescription opiates to those most likely to misuse or abuse these drugs.

Second, concurrent benzodiazepine and opiate prescription use is common in this dual diagnosis group. This is important because accidental overdose deaths commonly find the combination of opiates and benzodiazepines in toxicology analysis.

I am not suggesting that no legitimate reasons exist for careful opiate prescription use for the treatment of pain in those with a dual diagnosis. However, this population needs to be carefully assessed and monitored when prescribing opiates in the clinical setting.

Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link in the citation below.

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Hackman DT, Greene MS, Fernandes TJ, Brown AM, Wright ER, & Chambers RA (2014). Prescription drug monitoring program inquiry in psychiatric assessment: detection of high rates of opioid prescribing to a dual diagnosis population. The Journal of clinical psychiatry, 75 (7), 750-6 PMID: 25093472

Relapse rates are high in treatment samples of adults with cocaine dependence.

Cognitive behavioral therapy (CBT) is a common standard of care for cocaine dependence.

A recent clinical trial from Switzerland examined the use of financial prize incentives to augment standard CBT in the treatment of cocaine dependence.

Sixty subjects participated in this trial with the following inclusion criteria: least 18 years of age, had a DSM-IV diagnosis of cocaine dependence with at least one positive cocaine urine drug screen at baseline.

Exclusion criteria included: current psychotic disorder, current severe alcohol or benzodiazepine dependence, serious medical illness, pathological gambling, language impairment, methylphenidate use and active homelessness.

All subjects received 18 manual-based CBT sessions over 24 weeks targeted towards a goal of cocaine abstinence.

Half of the subjects received an additional treatment intervention labelled prize-based contingency management: 

• Subjects with cocaine negative urine samples (taken twice weekly in weeks 1-12 and weekly during weeks 13-24) were eligible to earn prizes
• Prizes were determined from a patient drawing from 500 chips in a bowl
• 250 chips were non-winners
• 219 had a value of $2 traded for food or hygiene rewards
• 30 had a value of $20 with a voucher for prizes in this price range
• One jumbo prize valued at $500 was present and could be traded for a television or vacation prize

Interestingly, the number of chips that was drawn started at one with the first cocaine free drug sample and increased by one with each consecutive negative sample up to a maximum of 15 chips.

Subjects relapsing after a period of abstinence returned to a one chip reward restart with the next clean urine sample.

The study failed to find a large statistically significant effect for the addition of prize-based contingency management.

However, those in the prize-based contingency management group had higher rates of clean urine samples beginning at weeks 8, 9 and 10 as well as several other later time points.

Additionally, the prize group had higher cocaine clean urine rates at 6 months follow up (66% vs 45%) although this did not reach statistical significance.

One issue with this study is the small sample size with limited power to detect clinically significant differences between treatment. The trend for improvement with adding the prize intervention suggests the potential merit of conducting a similar study using larger samples, possibly in several settings and nations.

The authors note the cost for the incentives in their design averaged $576 over the 24 week study. This additional cost is non-trivial and will need to be examined in larger samples.

Readers with more interest in this clinical trial can access the free full-text manuscript by clicking on the free full-text link in the PMID link below.

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Petitjean SA, Dürsteler-MacFarland KM, Krokar MC, Strasser J, Mueller SE, Degen B, Trombini MV, Vogel M, Walter M, Wiesbeck GA, & Farronato NS (2014). A randomized, controlled trial of combined cognitive-behavioral therapy plus prize-based contingency management for cocaine dependence. Drug and alcohol dependence, 145C, 94-100 PMID: 25456571

Finding a specific genes linked to specific neuropsychiatric disorders has been a key research strategy.

However, this strategy has not been entirely successful.

One problem with this unitary approach is the diagnostic overlap and comorbidity common to neuropsychiatric disorders such as mood disorders and autism.

A promising alternative strategy is to focus on genes that share risk with more than one neuropsychiatric condition.

Amit Lotan from Israel along with colleagues from the Netherlands, Germany and the U.S. recently published a study of common and distinct genetic components in six major neuropsychiatric disorders.

Their study used large genome wide association databases mined from the National Human Genome Research Institute linked to the following six neuropsychiatric disorders:

• Anxiety disorders
• Attention deficit/hyperactivity disorder
• Autism/autism spectrum disorders
• Bipolar disorder
• Major depression 
• Schizophrenia

Using a variety of genetic and molecular biology strategies, the research team examined human and mouse genes common to more than one neuropsychiatric disorder as well as genes unique to only one of the six disorders.

The key findings of the study including identification of 15 genes common to five of the six disorders. 

The genes identified in this analysis shared known activity in neuronal function known as postsynaptic density. Additionally, these shared genes are known to influence immune as well as brain function.

Additionally, the research identified two genetic components shared by all six of the disorders. These two components were involved in neuronal projection, synaptic activity, CNS development and cellular process. In total, these two genetic components contributed to 20-30% of the genetic load.

Obviously, 20-30% is a significant shared genetic contribution but it leaves important genetic contributions specific to each of the six conditions. 

The authors conclude in their discussion:

".. it could be hypothesized that a common (pathologic) molecular infrastructure located to neural projections, cytoplasm (or possibly both) may be necessary to induce a primary vulnerability to develop a neuropsychiatric disorder. Further distinct molecular processes which build-up on top of this common infrastructure ultimately lead, in certain patients, to the development of one or another specific neuropsychiatric disorder."

This type of study provides significant insight into the complexity of genetic influences in neuropsychiatric disorders.

Examining shared genetic influences in different conditions can aid in understanding common pathophysiology mechanisms for distinct neuropsychiatric disorders. Additionally, these types of studies show the limitations of current diagnostic classification systems and may aid in future refinement of diagnostic systems.

Readers with more interest in this research can access the free full-text manuscript by clicking on the PMID link in the citation below. 

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Lotan A, Fenckova M, Bralten J, Alttoa A, Dixson L, Williams RW, & van der Voet M (2014). Neuroinformatic analyses of common and distinct genetic components associated with major neuropsychiatric disorders. Frontiers in neuroscience, 8 PMID: 25414627