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

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


UMI Number: 3310330

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Appendix K

Acller School of Professional Psychology
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ii
ACKNOWLEDGEMENTS
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.

Phone:(312)201-3155
Email: dhan(5),adler.edu
EDUCATION
08/08
08/08
03/04
05/00

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

PROFESSIONAL/CLINICAL EXPERIENCE
06/06-present
07/04-06/06

07/01-08/06
08/01-05/02

Psychometrician/Neuropsychometrist
Rush University Medical Center
Advanced Neuropsychology Extern (07/05-06/06);
Clinical Neuropsychology Extern (07/04-06/05)
The University of Chicago Medical Center
Assistant Principal

Truman Middle College
Psychotherapy Extern
Dreikurs Psychological Services Center

GRANTSMANSHIP
07/00-06/07
07/00-06/07
07/00-06/07
07/00-06/07
07/06-06/07
11/04-10/05

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


iv
• Award amount: $18,000.00
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 RadiologicallyDefined Normal Appearing White Matter: A Diffusion Tensor Imaging Study.
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.


vi
TABLE OF CONTENTS
Dissertation Final Submission Form / i
Acknowledgements / ii
Curriculum Vitae / iii
Abstract / 2
Chapter I: Introduction / 4
1.1 General Statement / 5
1.2 Statement of the Problem / 6
1.3 Statement of Purpose / 8
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

viii
Table 7: /-test Results of Attention Performances between Groups / 70
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


3

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


5

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


7

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 predrop-out stage by assessing individual risks, such as behavioral features, truancy,
psychosocial stressors, etc., current review of the literature is limited to the
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

9

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


11

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


13

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;


15

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 sociobehavioral 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,