Embracing Hope Book

Several brain regions are involved in perseveration. Below is an expanded list from the book. 

Developing a basic understanding can help you better advocate for your child’s needs when talking with doctors, therapists, teachers, or social workers.

A Few More Brain Functions Impacting Perseveration

Your teen’s brain is an intricate network of systems that work together to process and respond to information. When perseveration occurs, certain circuits get caught in a feedback loop.

Prefrontal Cortex (The Brain’s Gear Shifter) 

The Prefrontal Cortex is your child’s mental gear shift that helps them switch between different thoughts and activities.

Your child’s brain might get stuck in one gear, making it hard to shift to new thoughts or activities.

Its Role: Controls cognitive flexibility and the ability to shift between different tasks or thoughts.

Symptoms to Discuss with Professionals:

• • ASD: Shows reduced activation during task-switching, making it harder to shift focus.
  • ADHD: Demonstrates irregular patterns in attention shifting and cognitive flexibility.
  • FASD: Exhibits difficulties in behavioral regulation and mental flexibility.
  • Trauma: Shows altered activation patterns during cognitive shifting tasks.

Anterior Cingulate Cortex (The Brain’s Error Detector) 

This region is like an internal GPS that should help your teen recognize when it’s time to change direction or correct course.

Your child’s brain may not recognize it’s stuck in a loop, making it harder for them to naturally shift away from repetitive thoughts or behaviors.

Its Role: Monitors behaviors and helps detect when changes are needed. When functioning differently, it may not signal effectively that it’s time to shift attention or change activities.

Symptoms to Discuss with Professionals:

• • ASD: Shows reduced error detection during repetitive behaviors
  • ADHD: Demonstrates altered monitoring patterns during task switching
  • FASD: Exhibits difficulties in recognizing when behaviors need adjustment
  • Trauma: Shows hyperactivation during error detection, leading to anxiety-driven perseveration

Hippocampus (The Memory Pattern Processor) 

The hippocampus is the brain’s pattern recognition library. When working differently, it can repeatedly try to retrieve certain memories or thought patterns, making it harder to store new ones or access alternative responses that are on a different shelf.

Your child’s brain may get caught replaying certain memories or thought patterns, making it difficult for them to incorporate new information or ways of responding.

Its Role: Processes and stores memories while helping recognize patterns. When functioning differently, it may reinforce perseverative patterns rather than supporting flexible memory use and new learning as it needs to.

Our Key Findings Across the Four Profiles:

For ASD:

• • Shows altered pattern recognition affecting behavioral flexibility.
  • Demonstrates different memory consolidation patterns during repetitive behaviors.
  • Exhibits unique activation patterns during perseverative episodes.

For ADHD:

• • Reveals modified memory processing affecting task switching.
  • Shows differences in pattern recognition and behavioral adaptation.
  • Demonstrates altered memory consolidation during repetitive tasks.

For FASD:

• • Exhibits structural differences affecting memory flexibility.
  • Shows modified pattern recognition impacting behavioral adaptation.
  • Demonstrates differences in sending memory information and processing it to the wrong place or not sending it at all, affecting perseveration.

For Trauma:

• • Shows altered memory processing affecting behavioral patterns.
  • Reveals modified pattern recognition in stress responses.
  • Demonstrates changes in memory consolidation affecting perseverative behaviors.

Symptoms to Discuss with Professionals:

• • Difficulty incorporating new information during perseverative episodes.
  • Challenges in recognizing alternative patterns or responses.
  • Struggles with applying past learning to new situations.
  • Tendency to repeat familiar patterns even when ineffective.

Dorsolateral Prefrontal Cortex (The Working Memory Commander) 

This is your child’s mental workspace manager. When its function is atypical, it struggles to hold and manipulate information that is needed/required to shift from one thought to another thought or from one activity to another, along with the ability to adapt to new situations and manage complex tasks.

Your child’s brain may have difficulty keeping multiple ideas in mind while trying to switch between them.

Its Role: Manages working memory and helps coordinate complex thought processes. When it works differently than it’s designed, it affects the ability to hold and manipulate information needed for flexible thinking.

Symptoms to Discuss with Professionals:

• • ASD: Shows altered activation during set-shifting tasks.
  • ADHD: Demonstrates reduced activity during working memory tasks.
  • FASD: Exhibits difficulties in maintaining and manipulating information.
  • Trauma: Shows modified patterns during cognitive flexibility tasks.

If your teen struggles with working memory and shifting between tasks, help them by breaking information into small, manageable chunks. A simple example would be making a list to get ready for the day—socks, underwear, t-shirt, etc. You can also use a visual and post it on the back of their door as a guide. When you use verbal cues to guide the transitions, be specific and offer only one or two things at a time.

Parietal Cortex and Frontal Eye Fields (The Attention Directors) 

Think of these areas as our children’s spotlight control system. When working atypically, our kiddo might have trouble shifting the spotlight of attention from one thing to another.

  As we know, our children’s brains often find it challenging to redirect their focus from whatever the subject of perseveration might be to another topic.

Its Role: Controls attention shifting and visual focus. When functioning differently, it affects the ability to disengage and redirect attention.

Symptoms to Discuss with Professionals:

• • ASD: Shows atypical patterns in attention switching, particularly with visual information. Your child may have difficulty moving their attention away from specific visual details or patterns.
  • ADHD: Demonstrates irregular activation during attention shifts, making it harder to disengage from the current focus to another area of focus. This can appear as “hyperfocus” on certain activities while struggling to shift to new tasks.
  • FASD: Exhibits challenges in coordinating attention shifts, especially in visually complex environments. Your child might perseverate on visual aspects of tasks or objects.
  • Trauma: Shows altered attention patterns, particularly when triggered by specific visual or environmental cues. This can manifest as difficulty disengaging from trauma-related stimuli.

Here are a few questions you might ask the various professionals–

1. 1. How do attention patterns affect daily activities for my child?
   2. What strategies work best for supporting attention shifts?
   3. Are there environmental modifications that might help my child?
   4. What signs can I look for that will help me indicate there is attention system overload with my child

Amygdala (The Emotional Persistence Center) 

The amygdala is your child’s emotional smoke detector. When it’s oversensitive, it can keep sounding the alarm even when the situation has changed twenty minutes earlier.

Your child’s brain-wiring might maintain emotional responses longer than typical, making it harder to shift away from certain thoughts or behaviors.

Its Role: It processes emotional responses and maintains emotional states. When its functioning is off, it can prolong emotional responses and reinforce perseverative patterns beyond what we think should be “normal”.

Symptoms to Discuss with Professionals:

• • ASD: Shows prolonged emotional activation during repetitive behaviors.
  • ADHD: Can demonstrate intensified emotional responses affecting task switching.
  • FASD: Often exhibits difficulty in emotional regulation during transitions.
  • Trauma: Shows heightened emotional reactivity maintaining perseverative cycles that look like your teen is “troubled”.

Mention MRI scans showing prolonged brain activity

Basal Ganglia (The Habit Formation Center) 

Think of this as your teen’s autopilot symptom that is running a program of habits. While it’s great for learning routines, it can sometimes get stuck running the same program repeatedly (and in a ridge fashion).

Your child’s brain might have difficulty disengaging from established patterns or routines because the autopilot is malfunctioning.

Its Role: Controls habit formation and behavioral patterns. When misfiring, it can strengthen repetitive behaviors instead of helping your teen shift between activities.

Symptoms to Discuss with Professionals:

• • ASD: Shows enhanced activity in habit-forming circuits.
  • ADHD: Demonstrates irregular pattern formation and breaking.
  • FASD: Exhibits strong habit formation with difficulty in pattern breaking.
  • Trauma: Shows altered habit-learning patterns affecting behavioral flexibility.

Sensory Cortices and Thalamus (The Sensory Processing Network) 

The Sensory Cortices and Thalamus work together as a sensory filter and relay station. Just as a sound mixer helps balance different audio inputs, these brain regions should help process and filter sensory information. When they don’t work as they should, the system can get stuck processing certain sensations, and cause distortion, which can lead to perseverative responses:

Your teen’s brain might become overwhelmed with or fixated on specific sensory inputs, making it harder to shift attention or change behaviors.

Its Role: The two work together to process and integrate sensory information from the environment to avoid an overload of stimuli. When functioning atypically, it can lead to both over-focus on certain sensory inputs and/or they can have trouble filtering others out. Either direction can add to the perseveration.

Symptoms to Discuss with Professionals:

• • ASD: Shows intense focus on specific sensory experiences, particular textures, sounds, or visual patterns and demonstrates difficulty shifting attention from preferred sensory inputs.
  • ADHD: Exhibits challenges filtering relevant from irrelevant sensory information, can become stuck processing certain sensory experiences, and shows irregular patterns in sensory integration during tasks.
  • FASD: Demonstrates altered sensory processing patterns, can perseverate on sensory experiences that feel overwhelming, and can show difficulty integrating multiple sensory inputs.
  • Trauma: Exhibits heightened sensitivity to certain sensory triggers, may show persistent responses to sensory reminders of past experiences, and often demonstrates altered filtering of sensory information.

Consider asking the professional you’re working with—

1. 1. How does sensory processing affect my child’s daily functioning?
   2. In what ways can sensory overwhelm trigger perseverative behaviors?
   3. Are there strategies for managing sensory input across different environments I can be aware of or plan for?
   4. What are the warning signs that indicate sensory system overload in my child?

Broca’s Area and Wernicke’s Area (The Language Processing Centers) 

These areas are your child’s language production and comprehension system. Like a radio that gets stuck between stations, when these areas work differently, your child might repeat certain phrases or get stuck in particular communication patterns.

Our children’s brains might have trouble shifting between different types of verbal expression or get caught in repetitive language patterns.

Its Role: Manages language production (Broca’s) and comprehension (Wernicke’s). If it functions differently than designed, it can lead to verbal perseveration and difficulty shifting conversation topics.

Symptoms to Discuss with Professionals:

• • ASD: Repeats phrases or scripts (echolalia), often gets stuck in particular topics of conversation, and can show difficulty shifting to new conversation topics.
  • ADHD: Persists in talking about current interests, has trouble pausing or shifting conversations, and may repeat questions despite receiving answers.
  • FASD: Shows patterns of repetitive questioning, has difficulty modifying language based on social cues, and can perseverate on specific verbal routines.
  • Trauma: Repeatedly verbalizes specific concerns or experiences, can show difficulty shifting away from trauma-related topics, and often uses repetitive language patterns for self-soothing. The pattern has formed, which is like hitting a wall or getting stuck in a loop.