Alicia Lage, psychologist authorized to practice health activities and neuropsychologist at SINAPSIS Clinic, explains how to carry out the rehabilitation of attention and inhibition in a case of ADHD through the NeuronUP platform.

The work of SINAPSIS

SINAPSIS is a psychology and speech therapy center, recognized as a health center by the Xunta de Galicia, located in the town of Burela in the province of Lugo.

Our clinic was created with the purpose of guaranteeing specialized care for children and adolescents and adults through a multidisciplinary intervention based on interventions that have shown greater empirical support, hence our confidence in the NeuronUP platform for the rehabilitation of attention and inhibition in ADHD.

The importance of assessment and diagnosis for the design of an intervention program

ADHD is a neurobiological disorder involving noradrenergic circuits, a pathway that controls maintenance functions of learning, attention and memory systems, and dopaminergic circuits, whose fundamental functions are the maintenance of motor tone, motivation and reward systems, and memory and attention processes.

Assessment processes

Based on the executive functions protocol of Tirapu et al. based on factor analysis (Tirapu, Cordero, Luna, Hernáez, 2017), the processes involved to perform an assessment are: processing speed, attention, working memory, access to memory information stores, verbal and motor inhibition, cognitive flexibility, planning, branching and decision making.

Assessment as a starting point for the rehabilitation of attention and inhibition in ADHD

The results of this assessment and its interpretation lead to the design of an individualized intervention plan tailored to the needs of each ADHD patient for effective rehabilitation.

Neuropsychological rehabilitation of attention and inhibition in ADHD

It is a broader concept than cognitive stimulation. It involves reducing the impact of conditions that are disabling for the client and allowing him/her to reach an optimal level of social integration (WHO, 2001). In this way, it includes different types of intervention, which can be divided into four main groups: cognitive rehabilitation, behavior modification, intervention with families, and social, educational or professional readaptation.

Rehabilitation according to the approach

Compensation: consists of the reorganization of functions to minimize or overcome the individual’s functional limitations. Its objective is to improve functionality in daily life. The resources are external aids and environmental adaptations.

Restoration/Rehabilitation: consists of direct training of lost, damaged or impaired function. Its objective is to improve cognitive function through repetitive exercises and tasks of increasing complexity. In addition, it involves “bottom-up” mechanisms, with low-level processes leading to the recovery of high-level processes.

Substitution: it is the construction of a new method of response that replaces the damage produced. That is why its objective is the search for new ways to solve the problem. The resources are the optimization of the preserved systems.

Neuropsychological processes that we work on through NeuronUP

Selective and sustained attention

Posner and Petersen’s 1990 model is one of the most widely accepted since its initial formulation.

After years of research on the types of attention, there is now a relative consensus in maintaining the existence of three anatomically and functionally distinct attentional networks that work in close relationship, firstly, the alertness network and the executive network, which are located in the forebrain cortex. Secondly, the orientation network, which is located mainly in posterior regions.

Based on the observation of the clinical symptoms of patients with brain injury and attentional complaints, the clinical model that stands out is the model of Sohlberg and Mateer, based on theoretical concepts of Posner and Petersen, and Baddley and Hitch’s working memory. Therefore, attention would be divided into five components: focused attention, sustained attention, selective attention, alternating attention and divided attention.

The alertness network is related to increasing and maintaining a state of vigilance and readiness to respond to a possible imminent stimulus. On the other hand, sustained attention is the ability to maintain attention on a stimulus for prolonged periods of time, also known as phasic alertness, the neural correlate is found in the frontoparietal thalamic network. In contrast, the orienting network is based on the selection of the information to be attended to and that which will be ignored, which according to the starting clinical model would be selective attention.

Motor and verbal inhibition

Inhibition processes also appear as a very consistent factor in the different factorial analyses. Although in some it is called interference control or selective attention, since it is necessary to control interferences and distracters. As for the brain regions involved in this process, studies coincide in the participation mainly of the orbital prefrontal cortex and the anterior cingulate.

Bibliographical References

Tirapu-Ustárroz J, Bausela-Herreras E, Cordero-Andrés P. Model of executive functions based on factor analysis in children and school population: meta-analysis. Rev Neurol 2018; 67: 215-25.

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