Prosopagnosia in Children

Although prosopagnosia has been frequently documented in adults, recent research has given added attention to deficits in facial recognition in children. One such patient, identified as K.D., sustained cerebral damage in infancy and since had been unable to recognize people’s faces (Young & Ellis, 1989). However, when tested at ages 8-11 her visual abilities were found to be somewhat impaired, but were no poorer than other children who could recognize faces with no difficulty. She was diagnosed with prosopagnosia, where she could identify a face for what it was, can perceive and imitate facial expressions, but she does not have a recognition of faces that should be familiar to her due to previous experiences with them. It is believed that 2-2.9% of the general population is affected by face recognition difficulties (Bowles et al., 2009). Prosopagnosics use other cues such as voice, clothes, context and nonverbal cues to identify familiar people. This cognitive impairment is similar in both children and adults; with the exception that a child whose functional ability has been impaired at infancy has no memory of what it used to be like to recognize faces.

More recently theoretical models to explain face processing have been assembled using data from case studies of prosopagnosics. Initially face processing is analyzed in a way common to all objects, perceiving the size, orientation and figure-ground relationships (Brunsdon et al., 2006). Next the face is structurally encoded, including an abstract representation that integrates a global general configuration along with its individual unique features. Each feature, such as nose, mouth, ears are given a ‘feature value’ recognized as an individual nose, for example, associated with that person. Recognition occurs when a known individual feature value for each feature group is recalled that is associated with that person. This recall also brings to mind associated personality characteristics and facts about that person. Of course the same information can be recalled from nonfacial cues such as those already mentioned above. Face recognition can give other information about a person, such as facial expression and mood since some cues will be specific to the person and vary from the last time the facial information was processed. However, this model is likely oversimplified, as studies with inherited prosopagnosia have shown. Subjects belonging to the same family expressed a variety of impairments, indicating that prosopagnosia may not be a single trait but a cluster of related subtypes, with individuals having some variety of impairments to the face-processing system (Schmalzl et al., 2008). Another interesting point is that studies employing MRI scanning of the brain have shown that the brain does indicate a recognition of faces, but this is a covert recognition not consciously known by the subject (Jones & Tranel, 2001).

Research into treatment for prosopagnosia have indicated successes in training to teach face recognition (Francis et al., 2002). One study focused on training using a complex mnemonic, incorporating remembering a prominent facial feature, the person’s name and occupation in order to remember photographs of particular people. To relearn a familiar face, they rehearsed semantic information about the person while viewing their photograph. However the improvements in facial memory was person specific and not particular to the stimulus used. Brunsdon et al. were able to successfully treat an 8 year old child with prosopagnosia through studying photos and observing and discussing the major facial features, such as those associated with the eyes, nose, mouth and hair (2006). After an established baseline the child showed significant improvement continuing post treatment, as well as anecdotal evidence that his ability to identify family members had improved. The study identified recognition of eyes and mouth as being most important for face processing. In another study, a 4-year-old girl diagnosed with congenital prosopagnosia was tested by monitoring eye movement recordings when studying faces (Schmalzl et al., 2008). Results of the scans revealed that the child’s scan paths lay outside the internal core features, particularly away from the eye region. Previously the girl had tended to use hair and voice to for recognition cues. The study then turned to focusing the child’s training on directing visual attention to characteristics of the internal features of faces. This precise training was rapidly integrated by the child and showed improvements similar to the study by Brunsdon et al.

Although prosopagnosia affects both children and adults alike, there seems to be more we can learn from studying these cognitive deficits in children. It appears that the underlying problem tends to be with abnormal scan pathing in the prosopagnosic subjects, at least with regards to faces. The treatment seems to be clear, but there are still some questions that merit further study. Why do some children have this abnormal scan pathing? Is there some common reason for why this may be happening in some children but not others? Although in some cases there may be a genetic component, in developmental prosopagnosia environmental factors may contribute the most. Further studies should consider potential environmental effects or particular childhood experiences that could contribute to inducing developmental prosopagnosia. In congenital prosopagnosia, brain-imaging studies can reveal more detailed information about how visual components of the brain develop, and how the brain can correct these physical problems over time.

References

Bowles, D. C., McKone, E., Dawel, A., Duchaine, B., Palermo, R., Schmalzl, L., et al. 2009. Diagnosing prosopagnosia: Effects of ageing, sex and participant-stimulus ethnic match on the Cambridge Face Memory Test and Cambridge Face Perception Test. Cognitive Neuropsychology, 26, 423-455.

Brunsdon, R., Coltheart, M., Nickels, L. & Joy, P. 2006. Developmental prosopagnosia: A case analysis and treatment study. Cognitive Neuropsychology, 23, 822-840.

Francis, D., Riddoch, M. J., & Humphreys, G. W. 2002. “Who’s that girl?” Prosopagnosia, person-based semantic disorder, and the reacquisition of face identification ability. Neuropsychological Rehabilitation, 12, 1-26.

Jones, R. D. & Tranel, D. 2001. Severe developmental prosopagnosia in a child with superior intellect.

Schmalzl, L., Palermo, R. & Coltheart, M. 2008. Cognitive heterogeneity in genetically based prosopagnosia: A family study. Journal of Neuropsychology, 2, 99-117.

Schmalzl, L., Palermo, R., Green, M., Brundson, R. & Coltheart, M. 2008. Training of familiar face recognition and visual scan paths for faces in a child with congenital prosopagnosia. Cognitive Neuropsychology, 25, 704-729.

Young, A. W. & Ellis, H. D. 1989. Childhood prosopagnosia. Brain and Cognition, 9, 16-47.

Child Development in an Accelerating Culture: Mindfulness Training

Western society is in an era characterized by an increased speed of the general pace of life, with technological, economic, social and cultural processes influencing our daily behavior and habits (Rosa, 2003). The world today has significantly changed from the times of our own childhood, creating new ways of thinking, interacting with the world and interacting with each other. With this in mind, it is not surprising that this can have unforeseeable effects on the stress levels of children as they grow and learn in this unique environment. Mental difficulties in children that seem to be relatively recent in human history such as ADHD, autism, depression and traumatic stress disorders may be the result of these environmental conditions. One inexpensive and beneficial treatment receiving recent attention is mindfulness meditation.

Mindfulness meditation has been practiced for years and has been found beneficial for coping in adults. There are several components of exercises, and some or all can be beneficially performed. The main idea is based around the focusing of non-judgmental attention on present experiences of any of your senses, with the end goal being that a person will be more aware and responsive to what is happening in the present (Thompson & Gauntlett-Gilbert, 2008). More specifically, mindfulness practice can be broken down to:

• Mindfulness of breathing, paying attention to all the physical sensations associated with inhaling and exhaling
• Body scanning, where one pays attention to any tactile sensations associated with their body and focuses on relaxation of muscle groups
• Walking mindfulness, when taking a leisurely walk paying attention to every minute aspect of the process, focusing on sensations associated with it while ignoring external distracters or feelings about what may be going on around you, actively suppressing negative thoughts that may arise by paying attention to them and dismissing them
• Mindfulness of one sense, paying attention to just one of your senses such as sound, concentrating on each different one in a non-judgmental way as it arrives and letting it go past

This is most often taught in a group setting and can be beneficial since participants can help and support each other as well as share experiences. The group can discuss the session afterwards to provide feedback and clarify what is going on. This has been taught to children as young as 5 years old, although it is generally believed that beneficial clinical work is possible as young as Piaget’s ‘clinical operations’ stage of around 7-12 years of age (Thompson & Gauntlett-Gilbert, 2008).

Results of mindfulness meditation have been quite profound; including increased signals in brain regions related to affect regulation and attentional control and increased dopamine production (Young, 2011). The brain seems to respond morphologically to repeated meditation exercises as well, with increased cortical thickness, with particular increase in gray matter in the left hippocampus, posterior cingulated cortex, temporo-parietal junction and cerebellum. One theory postulates that reduced stress could decrease glucocorticoid levels and modulate the immune system, indirectly affecting brain change.

Burke (2009) performed a meta-analysis of measurable benefits of mindfulness meditation on different age groups of children. Students 4-5 years of age indicated significant improvement on teacher ratings, but not on parent ratings or other measures. In a study of two children ages 10 and 12 with ADHD parents reported increased child compliance during mindfulness training. A non clinical study of 228 children between first and third grade administered mindfulness training reported significant improvements of self rated anxiety, teacher rated attention, social skills and objective measures of selective attention. Another study of 31 children in grades four to six participated in mindfulness meditation along with their parents. Improvements in attention, emotional reactivity and other measures of cognition were noted. Finally, 25 children between nine and twelve years of age taught mindfulness, and reductions were reported in parent rated externalizing behaviors.

At this point there is not a lot of substantial study results, but generally children are reporting increased feelings of well-being and lowered stress. This alone is reason enough to continue researching benefits as well as introducing modifications to the procedure that may prove to be more beneficial if tailored for younger minds. Since we do not as yet fully identified the causes of stress increase, more accurate identification could assist in identifying the full possible benefits of mindfulness meditation.

References

Burke, C. A. 2010. Mindfulness-based approaches with children and adolescents: A preliminary review of current research in an emergent field. Journal of Child and Family Studies, 19, 133-144.

Rosa, H. 2003. Social acceleration: Ethical and political consequences of a desynchronized high-speed society. Constellations, 10, 3-32.

Thompson, M. & Gauntlett-Gilbert, J. 2008. Mindfulness with children and adolescents: Effective clinical application. Clinical Child Psychology and Psychiatry, 13, 395-407.

Young, S. N. 2011. Biologic effects of mindfulness meditation: growing insights into neurobiologic aspects of the prevention of depression. Journal of Psychiatry and Neuroscience, 36, 75-77.