Assessment of neuropsychological function of attention in drop out students returning for diploma completion

... Measure Performance of Returning Drop- outs in Trail Making Test - Form A / 74 Figure 5: Returning Drop- outs' Trail Making Test - Form A Error Rates / 75 ABSTRACT The increasing high school drop- out. .. day; 30% of Hispanic youths are drop- outs; 14% of African American youths are drop- outs; 8% of Caucasian youths are drop- outs; 41-46% of all prisoners are drop- outs; high school drop- outs make... baseline data that have assessed for attention or inattention before students drop- out Such data, of course, not exist Accordingly, "inattention" in drop- outs can only be operationally defined,

ASSESSMENT OF NEUROPSYCHOLOGICAL FUNCTION OF ATTENTION IN DROP-OUT STUDENTS RETURNING FOR DIPLOMA

COMPLETION

DISSERTATION SUBMITTED TO THE FACULTY OF

THE ADLER SCHOOL OF PROFESSIONAL PSYCHOLOGY DISSERTATION CHAIR: JERRY WESTERMEYER, PH.D

BY DONG YOUNG HAN, M.A

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

DEGREE OF DOCTOR OF PSYCHOLOGY

CHICAGO, ILLINOIS JANUARY 21,2008

INFORMATION TO USERS

The quality of this reproduction is dependent upon the quality of the copy submitted Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed-through, substandard margins, and improper alignment can adversely affect reproduction

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Appendix K

Acller School of Professional Psychology

Dissertation Final Submission Form Name of Student YxM^l O ^ ' ) ' ^ ^ ^

Dissertation fatKKvw^ tA KWAẤP^ycUloycM ^VÂC-^Ô

CA-This dissertation has been successfully defended and approved for final submission

Copy of completed form to Registrar

Original retained by student for inclusion with dissertation submitted to the Library

Special acknowledgements are due to Drs Jerry Westermeyer, Larry Maucieri, and Mark Stone Thank you to all for your mentorship, guidance, and respective contributions None of this, as well, could have been possible without the love and support of my family and friends

HI

CURRICULUM VITA - Condensed

DONG (DAN) YOUNG HAN, M.A

Doctor of Psychology - Clinical Psychology

Adler School of Professional Psychology (APA Accredited)

Pre-doctoral Internship - Clinical Psychology

Dreikurs Psychological Services Center (APA Accredited)

Master of Arts - Counseling Psychology

Adler School of Professional Psychology (APA Accredited)

Bachelor of Science - Psychology major/Theology minor

Loyola University Chicago

Rush University Medical Center

Advanced Neuropsychology Extern (07/05-06/06); Clinical Neuropsychology Extern (07/04-06/05)

The University of Chicago Medical Center

Dropout Retrieval - Tuition

• Total amount of allocated funds: $5,385,786.00

Truant's Alternative Optional Education Program

• Total amount of allocated funds: $2,898,070.00

NCLB Chapter I

• Total amount of allocated funds: $471,128.00

NCLB Title I

• Total amount of allocated funds: $16,730.00

Re-Enrolled Student Project

• Award amount: $80,000.00

Adult Education Innovative

PUBLISHED ARTICLES

Hook, J N., Han, D Y., & Smith, C A (submitted) Repeatable Battery for the

Assessment of Neuropsychological Status (RBANS) and Depressive

Complaints in Older Adults Clinical Gerontologist

Han, D Y & Lee, E J (2007) Dementia in the Elderly: The Early Signs, and

When and How to Seek Help Yehyang, 30, 19

Han, D Y & O'Hale, H T (2004) Dropping Out of Traditional Schools: And

the Psychosocial Stressors That Got Them There Alternative Schools Network Bulletin, 2, 6-8

SELECTED PUBLISHED ABSTRACTS/PRESENTATIONS

PUBLISHED ABSTRACTS & CONFERENCE PRESENTATIONS

Pyykkonen, B A., Smith, C A., Han, D Y., Bartt, R., Martin, E., & Stebbins, G

T (2008) Depression Symptoms and Gray Matter Atrophy in Individuals with HIV Infection: Differential Patterns Associated with Unique Symptomatology

Poster session presented at the 36th Annual Meeting of the International

Neuropsychological Society, Waikoloa, HI

Smith, C A., Hook, J., Stebbins, G T., Han, D., Martin, E., Bammer, R., &

Moseley, M (2008) Risky Decision Making and Whole-Brain Defined Normal Appearing White Matter: A Diffusion Tensor Imaging Study

Radiologically-Poster session presented at the 36th Annual Meeting of the International

Neuropsychological Society, Waikoloa, HI

Hook, J N., Han, D Y., & Smith, C A (2008) Effects of Depressive Symptoms

on Older Adults' Performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Submitted for presentation at the 6th

Annual Conference of the American Academy of Clinical Neuropsychology, Boston, MA

Wise, J., Lacy, M., Oliveira, M., Han, D Y & Pyykkonen, B A (2006)

Detecting Neuropsychological Malingering of Mild TBI: Effects of Internet

Based Coaching and Mild TBI Journal of International Neuropsychological Society, 12 (SI), 128

Pyykkonen, B A., Han, D Y., & Lacy, M (2005) HVLT-R and BVMT-R:

Correlation between Recognition Memory Scores Journal of International Neuropsychological Society, 11 (SI), 133

Han, D Y., Anderson, G R., Yumoto, T., & Colon, M (2004, May) Normal

Executive Function in Dropout Students Returning for High School Completion:

V

Findings from the Brief Academic Neuropsychological Test Poster session

presented at the 16th Annual Convention of the Association for Psychological Science, Chicago, IL

Colon, M., Maloy, L., Anderson, G R., Yumoto, T., & Han, D Y (2004, May)

Examination ofLD/BD Students from a Neuropsychological Perspective Poster

session presented at the 16l Annual Convention of the Association for

Psychological Science, Chicago, IL

Han, D Y (2001, September) Psychology of Contemporary Education The 26th

Annual National Middle College Conference, Chicago, IL

O'Hale, H T & Han, D Y (2001, September) Necessity of Social Counseling

and Mentorship in Educating Inner-city Youths The 26* Annual National

Middle College Conference, Chicago, IL

INVITED SYMPOSIA/COLLOOUIA/MEDIA PRESENTATIONS

Han, D Y (2006, September) Dementia with Lewy Bodies: Clinical

Implications Invited presentation for Clinical Neuropsychology Case

Conference, Rush University Medical Center, Chicago, IL

Han, D Y (2006, April) The Impact of Neurological Disorders on the Life Tasks: An Adlerian Perspective Invited presentation for The North American

Society of Adlerian Psychology's Continuing Education Seminar hosted at the Symposium of The Individual Psychology Society, Chicago, IL

Han, D Y (2006, March) Neuropsychological Implications of Lewy Body

Disease: A Case Study and Review of Clinical Diagnosis, Neuropathology, and Treatment Planning Invited presentation for Clinical Neuropsychology Case

Conference, The University of Chicago Medical Center, Chicago, IL

Han, D Y (2005, April) Case ofM: Neuropsychological Implications of

Huntington's Disease Invited presentation for Clinical Neuropsychology Case

Conference, The University of Chicago Medical Center, Chicago, IL

Han, D Y (2003, May) Adolescent Counseling and Education: Considering Urban Subculture and Socioeconomic Status Invited presentation for The North

American Society of Adlerian Psychology's Continuing Education Seminar hosted at the Symposium of The Individual Psychology Society, Chicago, IL

Oellrich, M., O'Hale, H T., & Han, D Y (2002, November) Alternative

Education Chicago, IL WYCC-TV 20

Han, D Y (2002, August) Assessment and Counseling for Adolescents Phoenix,

AZ "Possibilities Radio", KFNX AM 1100

Dissertation Final Submission Form / i

1.4 Assumptions and Limitations / 9

Chapter II: Review of Literature / 12

2.1 The Drop-out Crisis / 1 3

2.2 Lack of National Data on Drop-outs / 1 5

2.3 The Neuropsychology of Attention / 18

2.4 Previous Data on Returning Students' Executive Functions / 21 2.5 Test Selection and Rationale / 27

Chapter III: Methodology / 29

3.1 Samples Employed / 30

3.2 Instruments Used / 30

3.3 Procedures Followed / 35

3.4 Data Analysis / 36

vii Chapter IV: Results / 39

4.1 Demographics and Descriptive Statistics / 40

4.2 Sample Comparisons / 46

Chapter V: Discussion / 50

5.1 Neuropsychological Implications of the Findings / 51

5.2 Psychosocial and Cultural Implications of the Findings / 53

5.3 Returning Population and Hope / 54

5.4 Political Implications of the Findings / 55

5.5 Suggested Future Research / 56

References / 58

Appendices / 62

Appendix A: Informed Consent Form / 62

Appendix B: Demographic Information / 63

List of Tables/64

Table 1: Sample Gender and Age / 64

Table 2: Sample Demographics / 65

Table 3: Reported Reasons for Withdrawal/Dropping Out / 66

Table 4: Elapsed Time between Dropping Out and Returning to

School/67 Table 5: Reported Diagnosis Prior to Returning to School / 68

Table 6: Returning Students' Stroop Performances / 69

ListofFigures/71

Figure 1: Executive Measure Performance of Returning Drop-outs in

Stroop Word Test / 71 Figure 2: Executive Measure Performance of Returning Drop-outs in

Trail Making Tests / 72 Figure 3: Executive Measure Performance of Returning Drop-outs in

Stroop Word and Color Word Tests / 73 Figure 4: Executive Measure Performance of Returning Drop-outs in

Trail Making Test - Form A / 74 Figure 5: Returning Drop-outs' Trail Making Test - Form A Error

Rates / 75

2

ABSTRACT

The increasing high school drop-out rate has been a silent epidemic for a number

of years Yet, there is a significant lack of data to help understand why Some have suggested that possible pre-existing attentional deficits may be a significant factor in the etiology of the drop-out epidemic (Barriga, Doran, Newell, Morrison, Barbetti, & Robbins, 2002) However, there are limited data to support such a hypothesis The present study examined the attentional performance of 70

students (43 males and 27 females; mean age =18) who dropped out of their traditional school settings, but later returned for diploma completion Participants were administered eight neuropsychological measures of attention (Stroop Word, Color, & Color-Word; Trails Form A, B, & L; and the Digit Span and Digit Symbol-Coding subtests of the Wechsler Adult Intelligence Scale - III) to

determine whether or not specific deficits were present The performances on all attentional measures were average, suggesting intact attentional functioning in this population The present findings were consistent with that of Han, Anderson, Yumoto, & Colon (2004), which revealed average executive functioning

performances in a similar sample Also similar to Han et al (2004), the current participants' performances were somewhat better (faster) on the speeded task (Trails A), and somewhat worse (slower) on the more complex task (Trails B), relative to national norms The data also illustrated that the most commonly identified reason for dropping out was due to poor grades (14%) This may be due

to various psychosocial stressors as opposed to attentional deficits, as the second most reported reason for dropping out was due to family problems (13%)

Although Life-style/hanging out with the wrong crowd (10%) was similarly endorsed, reported issues of gang-related reasons (6%) and incarceration (3%) were comparatively lower

CHAPTER I INTRODUCTION

1.1 General Statement

Increasing high school drop-out rate has been a silent epidemic for a number of years; in fact, a student drops out of school every nine seconds in America (Martin & Halperin, 2006) Students who withdraw from high school do

so for a number of reasons: poor school performance, poor school attendance, gang related issues, disciplinary issues, family problems, pregnancy, etc., which frequently follow a long developmental history of multiple and variable conflicts (Jimerson, Egeland, Sroufe, & Carlson, 2000) Subsequently, many of these students are thought to have poor academic achievement and problems with attention, behavioral inhibition, etc (Barriga, Doran, Newell, Morrison, Barbetti,

& Robbins, 2002)

However, at least for the drop-out population who elects to return for their diploma completion, executive functions (i.e., problem solving abilities, cognitive flexibility, inhibition, and set-shifting, etc.) appear to be relatively intact, which may be at least in part related to their corresponding level of motivation towards diploma completion Accordingly, these data further suggest a more significant role of psychosocial stressors identified by Jimerson et al (2000) in contrast to possible neuropsychological or neurobehavioral pre-existing deficits (Han,

Anderson, Yumoto, & Colon, 2004) Subsequently, it can be further hypothesized that these students may not show substantial deficits in measures of attentional function, similar to the results of executive measures provided by Han et al

6

(2004) By utilizing the neuropsychological measures of attention, the current study examined in this sample, the students' level of functioning in generalized cortical and reticular activating systems, i.e., attention

1.2 Statement of the Problem

Currently, more than one million students drop out of American high schools every year, while graduation rates are, at best, only up to 70 percent of all students nationally (Maxwell, 2007) Also, of the 30 percent of all students that fall by the waste side, more than a third of these high school drop-outs across the nation leave their academic settings before completing the ninth grade (Schemo, 2006)

While the rate of high school students withdrawing from their traditional school settings has reached an epidemic proportion (Jones, 2005; Greater West Town Community Development Project, 2003) and the subsequently interrelated societal complications have been well documented (Ad Counsel, 2003), current review of the literature is significantly limited regarding the information on the attentional functioning of high school drop-outs, let alone returning students Also, despite the data that many of these students may have poor academic achievement and problems with attention, behavioral inhibition, etc (Barriga et al., 2002), limited studies are available to further validate this theory and to explore the

"drop-out" issue Additionally, the "problem with attention" as a variable in

students identified by Barriga et al (2002) is not operationally defined as an

inability in attentional functions Accordingly, inattention in this context is

defined more as a socio-behavioral trait rather than a neuropsychological deficit Subsequently, the misuse of these data may misrepresent the idea that drop-out population may have pre-existing and underlying neuropsychological deficits in attention Although this may be the case for some individuals, little is known regarding the ratio between the drop-outs' true neuropsychological deficits in attention and inattention as a socio-behavioral reaction to psychosocial stressors

Although heuristics may be inferred by exploring this population's drop-out stage by assessing individual risks, such as behavioral features, truancy, psychosocial stressors, etc., current review of the literature is limited to the

pre-identification of the risks and the rate of withdrawals among this population (Jones, 2005; Metzer, 1997; Greater West Town Community Development

Project, 2003; Ad Counsel, 2003) Accordingly, there is a realistic need for an establishment of a baseline, assessing the level of attentional functioning in this population The subsequent research question is the following: "What is the level

of generalized cortical and reticular activating system functioning in the high school drop-out population returning for diploma completion; and was there a correlative pre-existing neuropsychological deficit in their attentional functioning prior to dropping out?"

8

1.3 Statement of Purpose

Again, very little is known regarding the ratio between the drop-outs' true neuropsychological deficits in attention and inattention as a socio-behavioral reaction to psychosocial stressors This study attempted to determine whether possible deficits in measures of attentional function and related brain functioning are correlatively attributable as students' pre-existing conditions, to less than optimal school functioning, subsequent administrative withdrawal (dropping out), and the students opting to continue high school completion at an alternative

setting

This study attempted to accomplish a baseline of attentional functioning for the aforementioned population as they are marginalized, and with limited representation and information Accordingly, this study may play a contributory role in assessing appropriate methods for prevention and intervention Additional implication includes the use of the analysis of attention among this population, as

a variable that may be widely inferred as one of the contributing factors to a systemic problem, without the necessary corresponding data; examples include incorrect inferences (due to insufficient data) regarding students dropping out of high school, having possible ADHD, etc It was hypothesized that the returning students may not show substantial deficits in measures of attentional function, similar to the results provided by Han et al (2004) This study examined the generalized cortical and reticular activating system's neuropsychological test

functioning in a sample of North American high school drop-outs returning for diploma completion

1,4 Assumptions and Limitations

It was assumed that there will be no significant differences in the

attentional functions between the retrieved drop-out students and the normative data The eight research hypotheses were the following:

HI: The performance of the drop-out group is in the average range when compared to the performance of the normative group on the Stroop Word test

H2: The performance of the drop-out group is in the average range when compared to the performance of the normative group on the Stroop Color test

H3: The performance of the drop-out group is in the average range when compared to the performance of the normative group on the Stroop Color-Word test

H4: The performance of the drop-out group is not significantly different from the performance of the normative group on the Trail Making Test - Form A

H5: The performance of the drop-out group is not significantly different

from the performance of the normative group on the Trail Making Test - Form B

10

H6: The performance of the drop-out group is not significantly different from the performance of the normative group on the Trail Making Test - Form L

H7: The performance of the drop-out group is not significantly different from the performance of the normative group on the Digit Span subtest of the Wechsler Adult Intelligence Scale - III

H8: The performance of the drop-out group is not significantly different from the performance of the normative group on the Digit Symbol subtest of the Wechsler Adult Intelligence Scale - III

As per the study done by Han et al (2004), which demonstrated no

significant differences in the executive functions between the retrieved drop-out students and the normative data, the current study was assumed to provide similar results; particularly since attention and corresponding processing speed are

participating variables in the operational definition of executive functioning: cognitive flexibility, inhibition, set-shifting, self-monitoring and/or self-awareness

The sample used in the study consisted of 16 to 21-year-old students who dropped out of their traditional high school setting but have returned for diploma completion The sample was limited to urban students who are current residents

of the city of Chicago The sample was also limited to exclude all students under the age of eighteen without the consent of their parent/legal guardian The sample also excluded any former students who wished to participate but did not yet return

to a diploma completion program The reported reasons and stressors contributing

to their reasons for dropping out of high school vary significantly: poor school performance, poor school attendance, gang related issues, disciplinary issues, family problems, pregnancy, etc However, it was the assumption of the study that attention, along with executive function as per Han et al (2004), may not be a significant variable that may have contributed to the returning students' initial status as high school drop-outs

CHAPTER II

REVIEW OF LITERATURE

2.1 The Drop-out Crisis

According to Martin & Halperin (2006) of the American Youth Policy Forum, every nine seconds in America, a student becomes a dropout

As mentioned earlier, students who withdraw from high school do so for a number of reasons: poor school performance, poor school attendance, gang

related issues, disciplinary issues, family problems, pregnancy, etc., which

frequently follow a long developmental history of multiple and variable conflicts (Jimerson et al., 2000) Additionally, the complexity of this issue increases as the mentioned variables interrelate to facilitate additional stressors, such as poor attendance due to gang problems, leading to poor school performance and

subsequent family problems Psychosocial conflicts such as these invariably may contribute to individual socio-behavioral and rather logical responses such as inattention, distractibility, depression, agitation, state of hyper arousal, etc

Consequently, the current situation of high school student attrition rate in the United States, due to self-selected withdrawal process (dropping out), has reached an epidemic proportion in the recent past (Jones, 2005) Again, more than one million students drop out of American high schools every year, while

graduation rates are, at best, only up to 70 percent nationally; graduation rate for black and Hispanic students, particularly males, are closer to only 50 percent (Maxwell, 2007) Also to stress again is the fact that many of these students do not even reach success in their first year of high school; more than a third of high

14

school drop-outs across the nation leave their academic settings before completing the ninth grade (Schemo, 2006)

According to the local data presented by the Greater West Town

Community Development Project (2003), Chicago Public High Schools graduated 60,814 students between 1999 and 2002 In that same academic period, 64,057 students have dropped out from Chicago Public High Schools; the number of students dropping out exceeded the number of students graduating by 3,243 between 1999 and 2002 In 2002, the number of high school students dropping out of Chicago Public Schools (17,404) reached the highest level ever recorded and it has been increasing Within this cohort data set, 23% of all CPS freshmen have dropped out, and 74% of the drop-outs never completed their sophomore year

There are a number of societal complications that are interrelated with the current trend A number of socio-economic, cultural, and developmental factors are affected by this trend According to the research published by the national Ad counsel (2003), at least 1,300 students drop out of school every day; 30% of Hispanic youths are drop-outs; 14% of African American youths are drop-outs; 8% of Caucasian youths are drop-outs; 41-46% of all prisoners are drop-outs; high school drop-outs make 42% less money in the workplace than high school graduates; 50% of drop-outs are unemployed; drop-outs are three times as likely

to face poverty and to receive public assistance than are high school graduates;

while 72% of students aged 10-13 say they would like to talk to their parents more about schoolwork

2.2 Lack of National Data on Drop-outs

Unfortunately, the current literature and available data are limited to the identification of the risks and the rate of withdrawals among this population, while there are significantly limited data regarding the information on the

attentional functioning of high school drop-outs, let alone returning students Also, publicly available data are often dated, making it difficult for independent

researchers to infer any updated trends This may be at least in part due to the fact that such population is difficult to track, especially when there is little to no

published federal and state policies to track and intervene with students dropping out of secondary education Even when the drop-outs return to complete their secondary education, there is little to no uniformed policy in tracking their

progress and attrition nationally (Samuels, 2007)

However, even with such limitations, available literatures tend to hastily speculate pre-existing deficits in drop-out population, without clarifying the definition of "pre-existing deficits." Drop-out students are simply thought to have poor academic achievement and global problems with attention, behavioral

inhibition, executive functioning, among many other "deficits" (Barriga et al., 2002) However, the "problem with attention" as a variable in students identified

by Barriga et al (2002) cannot be operationally defined as an inability in

16

attentional functions, as no task-specific baseline assessment was done on this population It would be impossible to infer such deficit in drop-outs; unless there are national baseline data that have assessed for attention or inattention before students drop-out Such data, of course, do not exist Accordingly, "inattention" in drop-outs can only be operationally defined, at best, as a possible socio-

behavioral trait, and not as a neuropsychological deficit Given this scenario, an operational definition of attentional deficit remains ambiguous especially when it pertains to drop-outs

However, the current literature, or lack there of, continues to default to an unclear definition of attentional deficit This ambiguity serves to misrepresent the idea that drop-out population may have pre-existing and underlying

neuropsychological deficits in attention Although this may be the case for some individuals, little is known regarding the ratio between the drop-outs' true

neuropsychological deficits in attention, and inattention as a rather contextually appropriate socio-behavioral reaction to psychosocial stressors

Again, given that there is no formal baseline assessment of attention in high school students (before dropping out); some heuristics may be inferred by exploring the students' individual socio-behavioral risks instead These may include behavioral features, truancy, psychosocial stressors, etc as opposed to

risks attributed to pre-existing neuropsychological deficits (Jones, 2005; Metzer, 1997; Greater West Town Community Development Project, 2003; Ad Counsel,

2003) It is also important to note the shortcomings of the latter assumption as it conceptualizes such a significant socio-cultural phenomenon (i.e., dropping out)

as a unitary variable (i.e., pre-existing "brain damage") To simply brush off such

a complex social phenomenon as possible brain damage, especially without

supporting data, is far from being sufficient The literature on neuropsychology already warns of the shortcomings associated with unitary conceptualization of

"organicity" (or "brain damage") when discussing such a complex variable as attention (Lezak, Howieson, & Loring, 2004)

This pattern of insufficient unitary conceptualization can be seen clinically, all around us, particularly regarding attention As an example, the literature also suggests an over-diagnosis and overuse of medication for ADHD among

schoolchildren (LeFever, Arcona, & Anonuccio, 2003) This is no surprise Such data highlight the prevalence in the misuse of an ambiguous definition when discussing attention, and the shortcomings of an "easier" unitary

conceptualization of attention and its disorders Given the over-diagnostic trend of ADHD found by LeFever et al., it is important to note that there may be a trend to assume psychological disorders in students demonstrating difficulties, as opposed

to exploring the etiology of their symptoms which may be socio-behavioral in nature, particularly those induced by exogenous stressors The trend to lean on pre-existing pathology (with inattention being merely one of many) seems to be pessimistic in nature, and far from sufficient Exploring the etiology of socio-

18

behavioral traits of attentional problems would prove to be a more pragmatic approach

2.3 The Neuropsychology of Attention

The neuropsychology of attention is a complex system to understand Even with the brain's substantial capacity to process multiple amount of

information simultaneously, it is still inherently limited in its process (Strauss, Sherman, & Spreen, 2006) The effectiveness of the human brain is demonstrated through its ability to select specific information for further processing (Banich, 2004) In essence, attention can be conceptualized as the gateway for information flow to the brain (Cohen, 1993)

However, this "gateway" concept remains difficult to operationalize for the purpose of a study, as the concept of attention has been all over the place in psychology, especially depending on the context of the empirical question posed Initially, the idea of attention as a measurable variable was often rejected, at least until the relatively recent emergence of the cognitive sciences Brought with this emergence are the renewed interests in the concept of attention; ultimately further dividing into explorations of automatic processes taking part in attention and the conscious selection of sensory information (Kolb & Wishaw, 2003)

However, in order to accurately differentiate contextually appropriate

attentional problem from that of a clinical deficit, e.g., undiagnosed ADHD, one must have a working definition of attention that is not split by different methods

of conceptualization The International Neuropsychological Society (INS)

Dictionary of Neuropsychology defines attention as the " processes that enable

an individual to engage in certain cognitive operations while ignoring others Thus, attention involves a selective awareness or responsiveness Attention also refers to the ability to focus and maintain interest for given task or activity" (Loring, 1999) This operational definition of attention is notably differentiated from automatic processing, as this definition requires one's conscious effort to focus, and maintain interest for a specific task For the purpose of this study, this clinical definition of conscious processing of attentiveness, specifically pertaining

to the ability to focus, will be used throughout the study

As complex as it is, attention still does not have to be a grossly arbitrary construct Whether or not attention is the consequence of neural signaling, it is still possible to identify the neural correlates of attention through functional imaging studies Attention can be defined as the ability to focus, as a precondition for conscious behavior, which can also be mapped neurophysiologically

Specifically, given the INS dictionary definition of attention, the reticular

activating system (RAS) can be conceptualized as the geographic definition of attention The major portion of the reticular activating system can be found in the midbrain, or the mesencephalon, which is a small area just forward of the

hindbrain (Lezak et al., 2004)

20

As for the functional conceptualization of attention, Knudsen (2007) defines the fundamental components of attention as the following general

structural model This includes four core processes with working memory at the

center First, working memory, or the immediate memory that "works",

temporarily stores information for further analysis Second, competitive selection

process determines and selects prioritized information to gain access to working

memory Third, top-down sensitivity control process regulates signal intensity in

information channels that compete for better access to working memory,

influencing the selection of new information This mediates voluntary control of

attention in a recurrent loop Fourth, Bottom-up saliency filters enhance the

response to infrequent stimuli, and/or stimuli of instinctive or learned biological relevance

Accordingly, the neural correlate of attention, via the four core processes,

is functionally apparent through enhanced firing, e.g., can be seen through

imaging studies These can also be behaviorally observed through subsequent eye movements; and, these can be mapped on the frontal eye fields (FEF) on the dorsolateral frontal cortex, which contain a retinocentric spacial map A variety of these spacial maps are also stretched out to the parietal cortex Particularly, the lateral intraparietal area (LIP) contains a saliency map and is interconnected both with the FEF and with sensory areas (as the parietal cortical region is primarily dominated by sensory circuitries) Also, subcortically, the superior colliculi (as

their primary function is related to vision) mediate certain automatic responses that influence attention, like orienting to a highly salient stimulus All these neural correlates are of course, under the assumption of an intact RAS functioning

Again, given the importance of working memory highlighted by Knudsen (2007), the current study utilized an appropriate measure of working memory, often used in clinical settings along with other attention measures, i.e., WAIS-III Digit Span

2.4 Previous Data on Returning Students' Executive Functions

In the International Neuropsychological Society (INS) Dictionary of Neuropsychology, Loring (1999) elaborates and defines executive function as the following:

Cognitive abilities necessary for complex goal-directed behavior and adaptation to a range of environmental changes and demands Executive function includes the ability to plan and anticipate outcomes (cognitive flexibility) and to direct attentional resources to meet the demands of non-routine events Many conceptualizations of executive function also include self-monitoring and self-awareness since these are necessary for

behavioral flexibility and "appropriateness." Because of individual

variability and changing task demands required to demonstrate executive functions, they are often difficult to assess with standardized measures Cerebral localization also remains elusive and controversial Regions of

22

the prefrontal cortex may play a special role in recruiting other brain areas

in a series of distributed networks that handle different components of executive functions, depending on the processing demands of the specific task (p 64)

Given this INS definition, attention may be conceptualized as one of the crucial components of executive function Whether it is cognitive flexibility, problem-solving, self-monitoring and/or self-awareness, all variables appear to include involvement of attentive processing Subsequently, one may even

hypothesize that intact executive function may infer intact attentional function

Accordingly, data exploring the drop-out population's executive abilities have set the stage for the current attention study According to data explored by Han et al (2004), evaluation of the returning drop-outs' executive abilities found normal level of performances After assessing the pattern of these students'

executive functioning ability, at least for the drop-out population who elected to return for their diploma completion, normal attentional abilities in this sample have also been documented The returning students' average performances on the executive function measures were suggestive of average attentional abilities, as these measures are also known to test for attentional properties, i.e., Trails A, Stroop Word and Color

Similar to the current attention study, Han et al (2004) examined

performance of 66 students who had withdrawn and returned for diploma

completion at an alternative high school program Students were between 17 and

20 years of age, including 30 females and 36 males Most self-reported reasons for dropping out of their previous school were due to poor attendance and poor grades All but eleven students were returning after being out of high school for less than five months

The following tests were administered in this study: Trails A and B,

Stroop (Word, Color, and Color-Word) and Cancellation of 4's Data were

analyzed in the following steps First, comparisons were made to typically

developing individuals and then to LD/BD students from data collected by

Anderson and Yumoto (unpublished) using ANOVA/ANCOVA analyses for the three groups with age as the covariate Then MANCOVA was used to identify any interaction effect(s)

While the LD/BD population showed significantly lower performance from the national norms and the returning students, there were no significant differences between the returning students and normative samples on all but Stroop Word, which actually showed higher performance among returning

students; F(l, 129)=17, p=.00004 (fig 1) There was a significant interaction between the performances of returning students on the Trails A and Trails B They seemed to show higher performance on the Trails A; Wilks lambda=.94821, F(2, 131)=3.5779, p=.03070 (fig 2) There was also a significant interaction between the performances of returning students on the Stroop Word and Stroop

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Color-Word They seemed to show higher performance on the simpler tasks but not the complex tasks; Wilks lambda=83965, F(2,128)=12.222, p= 00001 (fig 3)

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There were also trends suggesting higher speed of performance in the returning students (Trails A, Stroop Color, and Cancellation of 4's) while the error rates also seemed slightly higher (fig 4 & 5)

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Through this, Han et al (2004) demonstrated that the students attending alternative high school completion programs appear to show no remarkable level

of problems in executive function measures As mentioned earlier, one could hypothesize that these students initially left school primarily due to their

psychosocial stressors, i.e gang related issues, disciplinary issues, family

problems, pregnancy, etc which may contribute to poor attendance and poor grades, rather than preexisting neuropsychological deficits of executive function and behavior It can be further hypothesized that executive function deficits, if any, in the returning student population, may be compensated by their motivation

to continue with their diploma completion

In terms of the interactions between Trails A/B and the Stroop

Word/Color-Word, the data suggested higher performance on the simpler tasks but not the complex tasks There were also findings suggesting slightly higher

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error rates in the Trails A and B These results may be demonstrating the

influence of preexisting psychosocial stressors on their learning styles they have developed from previous school settings All in all, the Han et al (2004) data concluded that the performance of the students attending alternative high schools appeared to be no different from students in normative settings

Subsequently, this study made a significant political statement as well

Unfortunately, although federal acts such as No Child Left Behind address the

necessity to increase national educational standards, there are little to no

published guidelines for retrieving drop-out students at the federal level Majority

of the retrieval programs across the nation are currently funded at the state level, and are susceptible of being cut at any given fiscal year

Given the normal functioning in the executive domain of their

neuropsychological profile, it can be argued that executive deficit may not have played a significant role in this population's decision to initially drop-out from school Accordingly, it can further be argued that any fiscal threat to academic programs designed to retrieve this population would hinder reintegration of normal functioning students, who demonstrate the desire to return to mainstream education This current study on this population's attentional function attempted

to replicate the findings

2.5 Test Selection and Rationale

There is a host of measures of attention for the diagnostic purposes in clinical settings; some are evidenced to be more valid and reliable than others The following measures were selected for the study: Stroop (Word, Color, & Color-Word), Trail Making Test (Forms: A, B, & L), and two subtests of the Wechsler Adult Intelligence Scale - III (WAIS-III), i.e., Digit Span and Digit Symbol Many of these measurement tools are commonly used in clinical and neuropsychological assessments and have well-established validity and reliability Additionally, the utility of the aforementioned measurement tools for the purpose

of assessing attention has been standardized by national normative data (Heaton, Miller, Taylor, & Grant, 2004; Mitrushina, Boone, Razani, & D'Elia, 2005)

Specifically, the wide utility of the Trail Making Tests in assessing

orientation and attention has been well documented over time Although most reports of reliability have been confounded with large variability, with reliability above 60 with some being in the 90s, Trail Making is widely utilized as one of the choice measures in the global assessment of brain functioning; specifically attentional functioning (Groth-Marnat, 2003; Lezak et al., 2004; Strauss et al., 2006) Additionally, the Digit Span and Digit Symbol - Coding subtests of the WAIS-III require the subjects to pay close attention to the tasks at hand, while assessing for attentional ability, processing speed, and working memory (Groth-Marnat, 2003), making them appropriate for the battery used for this study

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The Stroop Test is a measure of cognitive control that assesses the ease with which an individual can sustain a goal while suppressing a habitual response

in favor of a less familiar one (Strauss et al., 2006) Given its wide use, the

Golden version of the Stroop test was utilized as one of the measures of attention

in this study However, it should be noted that the characteristics of the normative sample such as sample size, mean, and standard deviation are not clearly provided

in the manual, making it difficult to undergo an independent samples Mest to evaluate corresponding hypotheses Instead, the study used the manual's scoring formula to derive at the test performances of the drop-out group

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3.1 Samples Employed

This study examined the attentional performances of 70 students (43 males and 27 females) from an urban alternative high school in Chicago, Illinois, which

is designed to retrieve drop-outs for diploma completion All students were

between 16 and 21 years of age, with the mean age of 18 Self-reported reasons for dropping out of their previous school were gathered, along with information regarding the length of time with drop-out status prior to the admission to the

program (i.e., via self-report demographic questionnaire - appendix b) Sample

selection was systematic in its approach as it was on a volunteer basis All

students were offered extra credit in their science class for participation (as

approved by the school administration); their classes also provided additional options for extra credit assignments in order that no students were penalized for opting not to participate in the research Exclusion criteria included any students who did not initially drop-out from a traditional high school, and any former students who have not returned for diploma completion

3.2 Instruments Used

The following tests were administered, scored, and analyzed to investigate the proposed hypotheses: Stroop (Word, Color, & Color-Word), Trail Making Test (Forms: A, B, & L), and two subtests of the Wechsler Adult Intelligence Scale - III (WAIS-III), i.e., Digit Span and Digit Symbol All measures were administered individually, in a quiet setting outside of the classroom The

completion time for the battery after filling out the demographic questionnaire

{appendix b) was approximately 15-25 minutes

Stroop Test (Golden version - Forms: Word, Color, & Color-Word) The

Stroop Test is a measure of selective attention and cognitive flexibility originally developed by Stroop (1935), and has been utilized through multiple versions over decades, e.g., Golden version, Victoria version, Comalli/Kaplan version, Dodrill version, Trenerry version, etc One of the most widely used is the Golden version

of the Stroop Color and Word Test (Golden, 1978; Golden & Freshwater, 2002), which boasts wide clinical and experimental applications Given its wide use, the Golden version was utilized as one of the measures of attention in this study

The Golden version of the Stroop test reports reliabilities of 89

(Word), 84 (Color), and 73 (Color-Word; N = 450) for a group administered version, and reliabilities of 86, 82, and 73, respectively (N = 30), for the

individual version (Golden, 1975) In addition, in assessing for validity,

correlations among test trials tend to be moderate to high for the Golden version, while slightly higher than the competing Victoria version, suggesting that the Golden version is tapping similar abilities within the test When compared to other measures of attention, the Golden version of the Stroop's interference score correlates moderately well with others such as the difference score between Trails

A and B (.55) (Strauss et al., 2006)