Working memory (WM) is the cognitive system responsible for the temporary storage and manipulation of information and plays an important role in both learning and focusing attention. Considerable research has documented that many children and adults with ADHD have WM deficits and that this contributes to difficulties associated with the disorder. For an excellent introduction to the role of WM deficits in ADHD, click here.

A simple example illustrates the importance of WM for particular academic tasks. Try adding 3 and 9 in your head. That was probably easy for you. Now trying adding 33 and 99. That was probably more difficult. Finally, try adding 333 and 999. This is quite challenging for most adults even though each calculation required is trivially easy. The challenge occurred because you need to store information – the sum of 3+9 in the one’s column and then ten’s column – as you process the remaining part of the problem, i.e., 3+9 in the hundred’s column, and this taxed your WM. If your WM capacity was exceeded, you could not complete the problem successfully.

This simple problem also illustrates the difference between short-term memory (STM) and WM. Short-term memory simply involves retaining information in mind for short periods of time, e.g., remembering that the problem you need to solve is 333+999. Working memory, in contrast, involves mentally manipulating – or ‘working’ with – retained information and comes into play in a wide range of learning activities. For example, to answer questions about a science chapter, a child not only has to correctly retain factual information but must mentally work with that information to answer questions about it. Thus, when a child’s WM capacity is low relative to peers, academic performance is likely to be compromised in multiple areas.

Because WM deficits play an important role in the struggles experienced by many individuals with ADHD, it is important to consider how different interventions address this aspect of the disorder. In this study, the authors were interested in comparing the impact of Working Memory Training and stimulant medication treatment on the WM performance of children diagnosed with ADHD.

Participants were 25 8-11 year-old children with ADHD (21 boy and 4 girls) who were being treated with stimulant medication. Children’s memory performance was assessed on 4 occasions using the Automated Working Memory Assessment (AWMA), a computerized test that measures verbal short-term memory, verbal working memory, visuo-spatial short-term memory, and visuo-spatial working memory.

At time 1, the assessment was conducted when children had been off medication for at least 24 hours. The second assessment occurred an average of 5 months later and when children were on medication. The third assessment occurred after children had completed 5 weeks of Cogmed Working Memory Training using the standard training protocol (see below). The final assessment occurred approximately 6 months after training had ended. This design enabled the researchers to make the following comparisons:

- WM performance on medication vs. off medication (T1 vs T2)
- WM performance on medication vs. after training (T2 vs. T3)
- WM performance immediately after training ended vs. 6 months following training (T3 vs. T4)

This final comparison provided information on whether any benefits provided by the training had endured.

In addition to measuring STM and WM at each time point, measures of IQ were collected at times 1, 2, and 3.

- Working Memory Training -

WM training was conducted using the standard Cogmed training protocol with each child completing 20-25 training sessions within a 25 day period. The training requires the storage and manipulation of sequences of verbal, e.g., repeating back a sequence of digits in reverse order, and/or visuo-spatial information, e.g., recalling the location of objects on different portions of the computer screen.

Difficulty level is calibrated on a trial by trial basis so the child is always working at a level that closely matches their performance. For example, if a child successfully recalled three digits in reverse order, on the next trial he had to recall four. When a trial was failed, the next trial was made easier by reducing the number of items to be recalled. This method of ‘adaptive training’ is thought to be a key element because it requires the child to ’stretch’ their WM capacity to move through the program.

- Results -

- Impact of Short-Term Memory and Working Memory -

Medication vs. no medication – When tested on medication, Read the rest of this entry »

Neurofeedback – also known as EEG Biofeedback – is an approach for treating ADHD in which individuals are provided real-time feedback on their brainwave patterns and taught to alter their typical EEG pattern to one that is consistent with a focused, attentive state. This is typically done by collecting EEG data from individuals as they focus on stimuli presented on a computer screen. Their ability to control the stimuli, for example, keeping the smile on a smiley face, is contingent on maintaining the particular EEG state being trained. According to neurofeedback proponents, learning how to do this during training generalizes to real world situations and this results in improved attention and reduced hyperactive/impulsive behavior.

Neurofeedback treatment for ADHD has been controversial in the field for many years and remains so today. Although a number of published studies have reported positive results many prominent ADHD researchers believe that problems with the design of these studies preclude concluding that neurofeedback is an effective treatment. These limitations have included the absence of random assignment, the lack of appropriate control groups, raters who are not ‘blind’ to children’s treatment status, and small samples. For additional background, you can find a recent review I wrote on existing research support for neurofeedback treatment of ADHD – along with links to extensive reviews of several recently published studies -: How Strong is the Research Support for Neurofeedback in Attention Deficits?

- Results from a New Study of Neurofeedback -

Recently, a study of neurofeedback treatment for ADHD was published that addresses several limitations that have undermined prior research [Gevensleben, et al., (2009). Is neurofeedback an efficacious treatment for ADHD? A randomized controlled clinical trial. Journal of Child Psychology and Psychiatry.]

The study was conducted in Germany and began with 102 children aged 8 to 12. All had been carefully diagnosed with ADHD and approximately over 90% had never received medication treatment. About 80% were boys. Children were randomly assigned to Read the rest of this entry »

I wanted to alert you to a very interesting finding published in a recent issue of Science, one of the world’s leading scientific journals.

The study was led by Dr. Torkel Klingberg and his colleagues from the Karolinska Institute in Sweden. The goal was to learn whether Working Memory Training is associated with changes in brain biochemistry, thus suggesting a mechanism by which training may lead to enhanced working memory capacity and a reduction in attention problems. Thus, although Working Memory Training has previously shown promising results as a treatment for working memory and attention difficulties, this was a basic science study rather than a treatment study.

The major finding was that increased working memory capacity following training was associated with changes in brain biochemistry. Specifically, the researchers found changes in the density and binding potential of cortical D1 dopamine receptors in brain regions that are activated during working memory tasks.

Results from this study suggest a biological basis for the improvement in working memory capacity and reductions i Read the rest of this entry »

Like all psychiatric disorders, ADHD is diagnosed based on the presence of particular behavioral symptoms that are judged to cause significant impairment in an individual’s functioning, and not on the results of a specific test. In fact, recently published ADHD evaluation guidelines from the American Academy of Pediatrics (AAP) explicitly state that no particular diagnostic test should be routinely used when evaluating a child for ADHD.

While most ADHD experts would agree that no single test could or should be used in isolation to diagnose ADHD, there are several important reasons why the availability of an accurate objective test would be useful.

First, many children do not receive a careful and comprehensive assessment for ADHD but are instead diagnosed with based on evaluation procedures that are far from optimal.

Second, although AAP guidelines indicate that specific diagnostic tests should not be routinely used, many parents are concerned about the lack of objective procedures in their child’s evaluation. In fact, many families do not pursue treatment for ADHD because the the absence of objective evaluation procedures leads them to question the diagnosis. You can read a review of an interesting study on this issue at www.helpforadd.com/2006/january.htm

For these reasons an accurate and objective diagnostic test for ADHD could be of value in many clinical situations. Two important conditions would have to be met for such a test to be useful.

First, it would have to be highly sensitive to Read the rest of this entry »

As noted in our Market Report, we expect  the field of cognitive training (or “brain fitness”) software to grow in a variety of education and health-related areas over the next years. One of the most promising areas in our view: helping children and adults with attention deficits improve brain function to reduce ADHD symptoms.

I am glad to present this in-depth discussion on the results of two recent high-quality scientific studies. Let me start with Dr. Rabiner’s conclusion:

“Results from these two cognitive training studies highlight that cognitive training interventions may provide an important complement to traditional medication treatment and behavior therapy. Both studies included appropriate control groups, employed random assignment, and had outcome measures provided by individuals who were “blind” to which condition children were assigned to. They are thus well-designed studies from which scientifically sound conclusions can be drawn. They add to the growing research base that intensive practice and training focused of key cognitive skills can have positive effects that extend beyond the training situation itself.”

Without futher ado…enjoy the article!

- Alvaro

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Two New Cognitive Training Studies for ADHD Yield Promising Findings  

– By Dr. David Rabiner

Although medication treatment is effective for many children with ADHD, there remains an important need to explore and develop interventions that can complement or even substitute for medication. This is true for a variety of reasons including:

Read the rest of this entry »

We have talked about the value of meditation before (see Mindfulness and Meditation in Schools), as a form of well-directed mental exercise than can help train attention and emotional self-regulation.  Which other studies have shown how it strengthens specific parts of the brain, mainly in the frontal lobe.

Dr. Rabiner shares with us, below, an excellent review of a new study that analyzes the benefits of mindfulness for adolescents and adults with attention deficits. He writes that “although this is clearly a preliminary study, the results are both interesting and encouraging.”

- Alvaro
 

Does Mindfulness Meditation Help Adults & Teens with ADHD

– By Dr. David Rabiner

Although medication treatment is effective for many individuals with ADHD, including adolescents adults, there remains an understandable need to explore and develop interventions that can complement or even substitute for medication. This is true for a variety of reasons including:
1) Not all adults with ADHD benefit from medication.
2) Among those who benefit, many have residual difficulties that need to be addressed via other means.
3) Some adults with ADHD experience adverse effects that prevent them from remaining on medication.

Read the rest of this entry »

A very promising cognitive training study was presented last week by Helena Westerberg at the annual meeting of the CNS: Cognitive Neuroscience Society held in San Francisco, and Dr. David Rabiner brings us the highlights.

- Alvaro

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The study was conducted with a general adult population, rather than adults diagnosed with ADHD, as was the case in previous published working memory training studies,

The study was a randomized, controlled trial of working memory training conducted with 55 younger (20-30 years old) and 45 older (60-70 years old) adults. Participants were randomly assigned to receive 5 weeks of active Cogmed Working Memory Training or a placebo training intervention. In the active training group, the difficulty of the working memory training tasks continually adjusted to match the individual’s performance. As a result, individuals were consistently challenged to perform at their highest possible level. In the placebo training group, the difficulty level remained constant across the training period such that improvements in working memory were not expected to occur.

Read the rest of this entry »

A CDC report estimated that, in 2003, 4.4 million youth ages 4-17 lived with diagnosed ADHD, and 2.5 million of them were receiving medication treatment. Now, which is the core deficit underlying ADHD-so that treatments really address it? and how are ADHD and brain development related? Keep reading…

ADHD & the Nature of Self-Control – Revisiting Barkley’s Theory of ADHD

— By David Rabiner, Ph.D

As implied in the title of his book, ADHD and the Nature of Self-Control, Dr. Barkley argues that the fundamental deficit in individuals with ADHD is one of self-control, and that problems with attention are a secondary characteristic of the disorder.

Dr. Barkley emphasizes that during the course of development, control over a child’s behavior gradually shifts from external sources to being increasingly governed by internal rules and standards. Controlling one’s behavior by internal rules and standards is what is meant by the term “self-control”.

Read the rest of this entry »

Neurofeedback is one of the technologies that people often ask us about.  It is a promising intervention in a variety of areas, and has got significant traction in helping kids with ADD/ ADHD. Now, given the significant cost it poses for parents, we need to ask the question: “How Strong is the Research Support for Neurofeedback Treatment of Children with ADHD”?

We are honored to present the thoughts of Duke University’s Dr. David Rabiner, a leading authority on the field, on that important issue. As a bonus, you will enjoy his detailed description and suggestions of how to design a high-quality scientific study. Without further ado, let’s hear Dr. Rabiner speak.

- Alvaro

(Update as of March 2009: Dr. David Rabiner has written an update to the article below based on a newer study. You can read it clicking on link: New Study Supports Neurofeedback Treatment for ADHD)
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How Strong is the Research Support for Neurofeedback Treatment of Children with ADHD? 

Neither of the two prominent approaches to treating ADHD – medication treatment and behavior therapy – are expected to effect long term changes in the child. Medication treatment induces short-term changes in brain activity that is associated with a reduction in symptoms for many individuals. Behavior therapy attempts to create a set of environmental contingencies that promote desired behavior in the child, but which is unlikely to endure when those contingencies are removed.

In recent years, researchers have begun devoting greater attention to the possibility that children – and adults – may be provided with particular kinds of experiences that may induce alterations in brain functioning that are associated with more enduring changes, i.e., they do not dissipate as soon as treatment ends.

Neurofeedback – also known as EEG Biofeedback – is reflective of this approach and has a history that goes back Read the rest of this entry »