Our first Brain Training/ Fitness Webinar Series was a success with several hundred participants and great feedback. If you could not participate, you can still review the presentation slides by clicking Here. A key message from the series: it is exciting that our brains remain more flexible, at all ages, than was once thought possible. The implications? Every single owner of a brain can benefit from learning more about how to maintain the "It" in "Use It or Lose It." And which tools, if any, can be helpful. But, remember, there are no magic pills for cognitive health and performance.

Market News

National Neurotechnology Initiative: Neurotech leaders ask for help to support a pending bill on funding for applications of brain research.

Lumos Labs raises $3 m in venture capital:  This website provides a stimulating user experience at a reasonable cost. However, there is no clinical validation showing the efficacy of their specific brain training program. If you are in the market for programs than make brain-related claims, please check out our 10-Question Evaluation Checklist. Click Here.

Report for Brain Fitness Centers: We are happy to see more organizations, from retirement communities to health systems, benefit from our market report to navigate the brain fitness field and make better informed decisions.  

Research

Executive Functions, Education and Alzheimer's Disease: What we find exciting is the growing amount of research showing how specific cognitive skills (attention, memory, etc....) can be improved. An important reason why the search for a "magic pill" will prove elusive is because there is a variety of brain structures and functions to care care of, not just one. An area that deserves more attention: our frontal lobes and so-called executive functions.

Promising Cognitive Training Studies for ADHD: Dr. David Rabiner reports the results from two recent scientific studies highlighting that "cognitive training interventions may provide an important complement to traditional medication treatment and behavior therapy" to help children with attention deficits. 

Education

Cognitive and Emotional Development Through Play: Enough about "exercise" and "training". Dr. David Elkind, author of The Power of Play: Learning That Comes Naturally, discusses the need to build a more "playful culture."

Health & Wellness

Physical or Mental Exercise for Brain Health?: Both are important.  Advice for a couch potato: Be Active. For a teenager: Don't Drop Out of School, Go To College. For a middle age person: Make Sure you Have a Stimulating Job. For a retired person: Find and Try to Master A New Hobby Every Few Years.

Professional Development

Your Trading Brain: Expert or Novice: Information is power, yet, how often do we ask ourselves, "how does my brain work?". Trader and neuropsychologist Dr. Janice Dorn provides an in-depth discussion to help traders make better decisions and be more successful.

Brain Teasers

Brain Games: Spot the Difference. You can exercise your brain without spending a dime. In fact, you may well already be. 

We hope you enjoy this newsletter. Please stay tuned for the next one at the end of June. It will include a fascinating interview with Dr. Arthur Kramer on the cognitive benefits of physical exercise and his cutting-edge cognitive training work with the Navy and air controllers.

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:

1) Not all individuals with ADHD benefit from medication.
2) Among those who benefit, many have residual difficulties that need to be addressed via other means.
3) Some individuals experience adverse effects that prevent them from remaining on medication.
4) Medication treatment does not result in benefits that extend beyond when medication is being taken.

Except for #3 above, the same limitations hold for behavior therapy, which is the other intervention for ADHD that is widely considered to have a strong evidence base at this time.

Because of these limitations, some researchers have pursued cognitive training as an alternative method of treatment. The basic idea behind cognitive training is that important cognitive skills such as attention and working memory can - like any other skill - be strengthened and enhanced with intensive and focused practice. Furthermore, when an individual builds these skills the benefits may endure beyond the time when the actual training is provided.

Although this is a logical and compelling idea, the research base as it applies to individuals with ADHD is rather limited and the idea that attention is a skill that could be strengthened by focused training has not been carefully studied. In fact, when I was preparing a grant application several years ago for an attention training study, I was surprised to locate fewer than 5 studies of this issue. Furthermore, these were generally small preliminary studies that would be considered pilot investigations.

In recent years, however, researchers in the ADHD field have devoted greater attention to examining the potential benefits of cognitive training for ADHD. Below, I review 2 recent studies that highlight the potential value of training oriented approaches.

- Study 1: Computerized Progressive Attentional Training for Children with ADHD -

This study was conducted with 36 6-13-year-old children in Israel who were diagnosed with ADHD. Results from this study were published last year in Child Neurospsychology [Shalev, Tsal, & Mevorach (2007). Computerized progressive attentional training: Effective direct intervention for children with ADHD. Child Neuropsychology, 13, 382-388.]

Participants were randomly assigned to receive 8 weeks of computerized attention training (one hour sessions two times per week) or to a control group. The basic premise of computerized attention training is simple: the program requires children to attend to a variety of computer exercises and to make different responses depending on the stimuli presented. For example, a particularly simple task would require the child to press the space bar each time the number 2 was flashed but to refrain from responding when any other number is flashed. To perform well, the child must sustain their attention and refrain from responding impulsively.

Although other tasks may be far more complicated, and place demands on both problem solving skills and working memory, all tasks require sustained attention to do well. They also become more difficult and longer as the child moves through the training program. Thus, the child receives repeated practice in sustaining attention to increasingly challenging tasks that last for longer time periods. Ideally, the difficulty level adjusts to match the child's ongoing performance so that the child is constantly challenged to perform at their best possible level - not too easy but not too hard.

By succeeding in the program, the child is demonstrating an increasing ability to sustain their attention to challenging cognitive activities. Although children may get better at attending to the actual computer exercises, however, the important question is whether this generalizes to the classroom and other settings where focused attention is critical for success. If not, become better at attending to the attention training exercises would be of little value.

The attention training program tested in this study was designed to train 4 different aspects of attention: sustained attention (the ability to maintain attention and persist on task until completion), selective attention (the ability to maintain a specific cognitive set in the face of competing distractions), orienting attention (directing one's attention to critical stimuli), and executive attention (allocating attentional resources between competing demands and choosing what to attend to). During each session children were trained on these different types of attention and the tasks become more difficult as children's performance improved.

Children in the control group played computer games - rather then receiving attention training - for the same amount of time. These games also required children to sustain their attention to succeed and became more difficult as children progressed. Thus, the amount of time children spent under adult supervision working on computer activities that became more difficult as they progressed was the same for each group. Unlike children randomly assigned to the attention training group, however, children in the video game control condition were not exposed to activities that focused on training specific components of attention.

Before and immediately following training, parents rated their child's ADHD symptoms using a standardized behavior rating scale (the authors report that parents were blind to which group their child was in). In addition, academic performance was tested pre- and post-training using math problems, reading comprehension problems, and passage copying problems taken directly from children's school books. Standard achievement tests were not used because such tests are not available in Hebrew. Information about whether any children were on medication during the training or during testing was not provided.

- Results -

Encouraging results were obtained. Parents of children in the attention training group reported a significant decline in their child's inattentive symptoms compared to parents of children in the control group. The change in hyperactive-impulsive symptoms was in the same direction but was not significant.

After controlling for academic performance before training, children who received attention training did significantly better than controls in reading comprehension and in their speed of copying passages. Math performance was in the same direction but was not significant.

- Summary and Implications -

The authors conclude that their attention training program produced significant improvements in parents' ratings of inattentive symptoms and on academic tests. This is the first demonstration I am aware of that suggests attention training may improve academic performance.

The authors note several important limitations to their study. First, the sample is relatively small. Second, no behavioral data was obtained from children's teachers. Third, there was no extended follow-up so the duration of the benefits observed at post-test is unknown. To these concerns I would add that the academic results would be stronger if a standardized achievement measure had been used. Finally, I wonder if parents truly remained blind to whether their child was receiving attention training or was in the video game control group.

These limitations not withstanding, these are promising results that highlight the potential of attention training procedures for children with ADHD. A larger controlled trial that addresses the limitations of the current work is certainly warranted.

Note - To my knowledge, this attention training program is not currently available outside of Israel.

- Study 2: The impact of different types of working memory training for children with ADHD -

Working memory is a key cognitive function that allows individuals to hold information in mind for brief periods of time. This ability plays an important role in countless daily tasks including following directions, accurately tracking conversations, reading comprehension, solving complex math problems, and staying focused on a project. Current theories of ADHD that emphasize the critical role of executive functions highlight working memory deficits as an important aspect of the disorder; in fact, research has shown that many individuals with ADHD have poor working memory compared to same age peers without the disorder.

A study published several years ago reported evidence that working memory is a skill that can be improved with intensive training. In a randomized controlled trial conducted with 53 children diagnosed with ADHD, working memory training was found to yield significant gains in non-trained working memory tasks and a reduction in ADHD symptoms as reported by parents (you can find a review of this study Here). Additional controlled studies of working memory training have reported positive results in other groups including younger and older adults without ADHD, typically developing preschoolers, and stroke victims. Until recently, however, additional controlled studies documenting positive effects in children with ADHD have not been reported.

At the May 2008 recent meeting of the American Psychiatric Association, Dr. Christopher Lucas and his colleagues at NYU Medical School presented new data on the use of working memory training in children diagnosed with ADHD. Their study reported on the results of 2 different types of working memory training - auditory training or visual-spatial training - conducted with 46 children aged 7-12 who were participating in an intensive summer treatment program for ADHD.

Participants were randomly assigned to received either auditory or visual spatial working memory training using the computerized training program developed by Cogmed. The idea behind assigning children to these different types of training was to see whether one was more effective then the other; the researchers had hypothesized that children who received visual-spatial training would achieve better results.

A typical auditory training exercise would involve the computer presenting the child with a string of digits, and the child had to subsequently indicate the correct order - either forward or backward - via the keyboard. In a typical visual spatial working memory training task, the child would be required to recall the location of different objects that lit up on the screen. You can view actual examples of the working memory training tasks Here.

Training took place for 30-35 minutes per day, 4 days per week, over a 6-week period so that a target of 25 training days could be provided. Both auditory and visual-spatial training protocols automatically increased the difficulty level of the working memory tasks depending on how well the child is performing, becoming more difficult when the child is successful and easier when the child is struggling. These adjustments are made on nearly a trial by trial basis by increasing or decreasing the number of items to recall. As a result, the child is consistently challenged to work at their maximum performance level without the task becoming so difficult that they become frustrated and give up.

The researchers were interested in 2 basic questions. First, did children who received visual-spatial training show greater gains in working memory performance on non-trained tasks than children who received the auditory working memory training? This was assessed by having children complete a comprehensive working memory assessment before and after training using tasks that differed from what they were actually trained with. It is important to evaluate training using tasks that differ from training activities to see whether training improvements extend to non-trained activities.

The second question was whether visual-spatial working memory training was also associated with behavioral improvements. To answer this question, the researchers examined the number of positive behavior points, i.e., points awarded for behaving appropriately and following camp rules, that children in both groups received from camp counselors between weeks 4 and 6 of the training. The counselors who awarded points were not aware of which training condition children had been assigned to.

This represents a stringent test of working memory training on behavior for several reasons. First, the ratings were being made by blind observers. Second, most children were being treated with medication, and their behavior would already have improved because of this. Third, all children were involved in an intensive behavioral therapy program designed to promote positive behavior. Thus, any improvement from working memory training would be above and beyond gains achieved from treatments that were already in place.

- Results -

Before and after the training, children were tested on several non-trained measures of working memory. Consistent with the researchers' prediction, children who received visual-spatial training performed significantly better on several of these tasks than children who received auditory working memory training.

Of particular interest is that children who received visual-spatial working memory training earned significantly more positive behavior points from the camp counselors. Thus, these children were rated as doing a better job of consistently following camp rules and behaving appropriately.

- Summary and Implications -

Results from this study support the benefits of working memory training for children with ADHD and indicate that training of visual-spatial working memory is especially important. The fact that this training was associated with an increase in positive behavior above and beyond medication and behavior treatments already in place is a very encouraging result.

As with Study 1, this study has several limitations to consider. Although the behavior improvements noted by camp counselors is important, it would also be important to document that such behavioral gains were also observed by parents and teachers. This, however, was not examined in the study. As with Study 1, there was no extended follow-up so the duration of training benefits can not be determined.

- Overall Summary -

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.

As noted above, however, each study has limitations that should be addressed in subsequent work. It is encouraging to see the momentum for such work building and I look forward to reviewing other studies in this important area as they become available.

--- Dr. David Rabiner is a child clinical psychologist and Director of Undergraduate Studies in the Department of Psychology and Neuroscience at Duke University. His research focuses on various issues related to ADHD, the impact of attention problems on academic achievement, and attention training. He also publishes Attention Research Update, a complimentary online newsletter that helps parents, professionals, and educators keep up with the latest research on ADHD.

For related reading, you may enjoy:

- Mindfulness Meditation for Adults & Teens with ADHD

- Working Memory Training: Interview with Dr. Torkel Klingberg

- "But recent advances in psychology and brain science are now suggesting that a child's ability to inhibit distracting thoughts and stay focused may be a fundamental cognitive skill, one that plays a big part in academic success from preschool on. Indeed, this and closely related skills may be more important than traditional IQ in predicting a child's school performance."

- "EF (executive functions) comprises not only effortful control and cognitive focus but also working memory and mental flexibility—the ability to adjust to change, to think outside the box."

- "When the teacher holds up a circle they clap, with a triangle they hop, and so forth. The kids are taught to talk themselves through the mental exercise: "OK, now clap." "Twirl now." This has been shown to flex and enhance the brain's ability to switch gears, to suppress one piece of information and sub in a new one. It takes discipline; it's the elementary school equivalent of saying "I really need stop thinking about next week's vacation and focus on this report."

The main points: executive functions are crucial for success in life, AND they can be trained. I couldn't agree more with the article in that cognitive training should be part of the education curriculum and receive more research dollars to determine exactly how to best do so.

I read another very interesting article on Alzheimer's Disease. Which may look like a completely different topic than the one above...but please bear with me. There is more in common than may meet the eye.

Earlier diagnosis giving Alzheimer's a new voice (Yahoo News):

- "Hayen is part of a growing new movement in Alzheimer's: Patients diagnosed early enough to still be articulate and demand better care and better research."

- "They are giving a voice to a disease whose victims until now have remained largely silent, and powerless."

- "It's a shift with big ramifications."

- "Diagnosis can be difficult. There is no single test for dementia. Memory problems aren't always even the obvious first symptom; Hayen cites unprovoked anger and disorientation."

Those symptoms can be seen as deficits in executive functions, common in Alzheimer's patients, and the brain' frontal lobes get weakened.

What are Executive Functions? What are the Frontal Lobes? Executive Functions are a set of cognitive skills involved in planning and self-regulation, mostly involving our frontal lobes (behind our forehead). This area is the most recent part of our brains in evolutionary terms, and the least hard-wired (or the most "plastic"). The latest to mature, the earliest to decline. Some executive functions include:

- Planning: foresight in devising multi-step strategies.

- Flexibility: capacity for quickly switching to the appropriate mental mode.

- Inhibition: the ability to withstand distraction, and internal urges.

- Anticipation: prediction based on pattern recognition.

- Critical evaluation: logical analysis.

- Working memory: capacity to hold and manipulate information "on-line" in our minds in real time.

- Fuzzy logic: capacity to choose with incomplete information.

- Divided attention: ability to pay attention to more than one thing at a time.

- Decision-making: both quality and speed.

A highly recommended book, if you are interested in learning more about Executive Functions and Frontal Lobes, is The Executive Brain: Frontal Lobes and the Civilized Mind, by our co-founder Dr. Elkhonon Goldberg. You can read an in-depth interview with him here.

What is exciting about the Cognitive/ Brain Fitness field is the growing amount of research and interventions to improve cognitive skills. I am interviewing Dr. Arthur Kramer in a few days. He will tell us about his research on how to improve executive functions. Please stay tuned!

If you have enough working memory to both be processing this information and developing your own thoughts, you may be thinking now, a) what exactly is Working Memory?, and b) why do we even care?. Well, Dr. Bill Klemm answers those questions, and more, below. Please enjoy one of the most insightful articles on the subject we have seen in a long while, which we are proud to bring to SharpBrains readers.

- Alvaro

How Well People Think Depends On Working Memory

- By  Dr. Bill Klemm

Imagine dialing a phone number by having to look up each digit one at a time in the phone book. Normally, you look up the number and remember all seven digits long enough to get it dialed. Even with one digit at a time, you would have to remember each digit long enough to get it dialed. What if your brain could not even do that! We call this kind of remembering, “working memory,” because that is what the brain works with. Working memory is critical to everyday living. 

Conscious thought involves moving a succession of items through what seems like a virtual scratch-pad. Think of it like streaming audio/video, where “thought bites” move on to the scratch pad where they are fed into a thought process and then moved off the scratch pad to make room for the next thought bite. 

We think with what is in working or "scratch pad" memory. What we know, stored in regular memory, is brought onto the scratch pad in successive stages, each involving subjecting the knowledge to analysis, integration into the current context, and creative re-organization via our thinking processes ("thought engine"). The animated version of this graphic shows item 1 moving on to the scratch pad and then sent on to the "thought engine." This is followed by item 2, then 3, etc. 

Conscious thinking thus requires the ability to hold information “on line” long enough to use it in thinking. Conscious thought thus seems to be a serially ordered process of moving thought bites on to and off of the scratch pad. 

Unconscious Thinking 

What about unconscious thought ... the kind that occurs when you are not paying attention? We know that the subconscious mind is processing information (i.e. “thinking”) all the time, even while we sleep. The evidence for this kind of “sleep learning” is incontrovertible and summarized in my memory improvement book (see http://thankyoubrain.com). Subconscious thinking and its related memories may not involve a scratch pad of working memory. Subconscious thinking could occur as multiple parallel processes and may be more non-linear than conscious thought. However, in the case of dream sleep, which I regard as a form of consciousness, those dreams that I happen to remember do seem to be based on serially ordered “thought bites.” 

A recent study, not explicitly concerning memory, sheds some important light both on how we think and on the role of working memory in thought. In this study, the researchers examined how people make a correct choice. Researchers compared the quality of decisions formed from conscious versus unconscious thinking with that resulting from unconscious thinking. Here is how they studied this issue. In one study, subjects were given information about the attributes of four hypothetical cars, and they were to decide which was the best car, based on the attributes assigned to each car. Analysis conditions were either simple (based on only four attributes) or complex (based on 12 attributes). After reading about the attributes, subjects were assigned to one of two groups: conscious analysis or to an unconscious thought condition. In the conscious condition, they thought about the attributes for four minutes before making a choice. In the unconscious condition, subjects were told they would have to make a choice in four minutes, but they were distracted during that time by being required to solve anagrams. 

Their “thinking” about the problem was thus not allowed to be conscious. 

Not surprisingly, when only four attributes were involved, subjects in the conscious-thought condition made the best choice of car. But when the complex condition of 12 attributes, results reversed. The best car was chosen most reliably in the unconscious-thought condition. 

In a second study, one change was made. Instead of choosing the best car, subjects were asked about their attitudes toward the four cars. Again, conscious thinkers made the clearest distinctions among the cars when only four attributes were considered, but the opposite occurred when 12 attributes had to be considered. 

In another experiment, two stores were selected, one that sold complicated items like furniture and the other a department store that sold simple products. As people left the store, people were asked questions about what they bought, why they bought it, how costly was it, and how much they thought about making the choice. The buyers were categorized as either “thinkers” (those who spent a lot of time consciously making a decision) and “impulse buyers” (who did not spend much time consciously thinking about their choice). Several weeks later, these same people were called to check on how satisfied they were with the purchase. As expected, more post-choice satisfaction was found in the conscious thinker group, but only for the simple items in the department store. For the complex choices in the furniture store, the unconscious thinkers expressed the most satisfaction with their purchases. 

What all this says is that simple decisions are best made by careful conscious thought. But for complicated decisions, the best choices may result from “deliberation without paying attention,” that is letting the thinking be done by the unconscious mind. I interpret these results to reflect the dependence of conscious thought on scratch-pad memory and the relative independence of subconscious thought on scratch-pad memory. Conscious thought is very effective as long as it can work on information that it can hold on-line in working memory. But working memory has limited capacity. Therefore it cannot be very effective when the amount of information needed for high-quality thought exceeds the carrying capacity of working memory. 

The corollary of this new evidence about working memory and thinking processes is that if we had a bigger working memory, we might think better. 

Working Memory Load Affects Paying Attention 

Paying attention is pre-requisite to learning. The ability to pay attention seems to be affected by how much information (load) is being carried in working memory. These principles have been elucidated in human experiments that tested the assumption that attending to relevant details in a learning situation requires that the details be held in working memory. Having other, non-relevant, information in working memory at the same time serves as a distraction, lowering attention and interfering with memory formation. 

In this experiment, participants performed an attention task that required them to ignore pictures of distracter faces while holding in working memory a string of digits that were in the same order (low memory load) or different order (high memory order) on every trial. The test thus was one of multi-tasking, one task being holding the digits in working memory and the other task being identifying whether a name flashed on the screen was that of a famous politician or a pop star, while a contradictory face was projected. For example, the name Mick Jagger would have the face of Bill Clinton superimposed, and the task was to know that Mick Jagger is a pop star, not a politician. 

The attention performance degraded severely with high working-memory load. That is, the distracting faces created confusion when subjects were also required to hold mixed-order digits in working memory at the same time. 

The point is simple. It is hard to think about two complicated things at once. The growing trend, especially among young people, to multi-task may seem wonderful. But actually, multi-tasking is most likely to interfere with focused attention and, in turn, degrade memory formation, recall, and thinking quality. 

Training Working Memory and IQ 

Studies have shown that it is possible to train ADHD children to have better working memories. This led researchers in Japan to try to develop a simple working memory training method and to test whether this method can increase the working memory capacity and whether this has any effect on a child's IQ. Children ages 6-8 were trained 10 minutes a day each day for two months. The training task to expand working memory capacity consisted of presenting a digit or a word item for a second, with one-second intervals between items. For example, a sequence might be 5, 8, 4, 7, with one-second intervals between each digit. Test for recall could take the form of "Where in the sequence was the 4?" or "What was the third item?" Thus students had to practice holding the item sequence in working memory. With practice, the trainers increased the number of items from 3 to 8. 

After training, researchers tested the children on another working memory task. Scores on this test indicated that working memory correlated with IQ test scores. That is, children with better working memory ability also had higher IQs. When first graders were tested for intelligence, the data showed that intelligence scores increased during the year by 6% in controls, but increased by 9% in the group that had been given the memory training. The memory training effect was even more evident in the second graders, with a 12% gain in intelligence score in the memory trained group, compared with a 6% gain in controls. As might be expected, the lower IQ children showed the greatest gain from memory training. 

So in conclusion, it seems that working memory capacity can be increased by training and that such training can even raise IQ, at least in young children. 

Benefits of Increasing Working Memory 

Accumulating evidence seems to indicate that working memory, with proper training, can be improved in anyone, even adults. I recently found a research report in which lasting improvements in brain function were produced in healthy adults by only five weeks of practice on three working-memory tasks that involved the location of objects in space. Subjects performed 90 trials per day on a training regimen (CogMed). MRI scans showed increased activity in the cortical areas that were involved in processing the visual stimuli. Brain activity increases in these areas appeared within the first week and grew over time. 

Similar results have been reported by other investigators. In a few cases, where different kinds of stimuli were used, memory training induced a decrease of brain activity in certain areas, which is interpreted to indicate that the trained brain did not have to work as hard. While we clearly don’t understand things very well, it seems clear that working memory training not only improves memory capability but also causes lasting changes in the brain. 

Help Your Working-Memory Capacity 

I just read a fascinating book on increasing teacher awareness of the importance of working-memory capacity for teaching and learning strategies. Many youngsters have working memory limitations, and they usually do not grow out of them. This is a major and serious cause of low grades, poor learning skills, poor confidence, and life-long diminished motivation to learn. 

Limited working-memory capacity impairs the ability to think and solve problems. I was told once by a middle-school teacher that her “special needs” students could do the same math as regular students, but they just can’t remember all the steps. This clearly reflects a limited working-memory capacity. If the demands made on working memory could be lessened, better thinking could result. 

Certain strategies can help to reduce the load on working memory. Teachers should model and students should employ the following devices: 

• Provide help, cues, mnemonics, reminders.
• KISS (Keep It Simple, Stupid!)(example: use short, simple sentences, present much of the instruction as pictures/diagrams).
• Don’t present so much information. Less can be more.
• Facilitate rehearsal, using only relevant information and no distractors.
• Get engaged, by taking notes, and creating diagrams and concept maps.
• Attach meaning from what is already known. (The more you know, the more you can know).
• Organize information in small categories.
• Break down tasks into small chunks. Master each chunk sequentially, one at a time. 

Doing these things not only helps the thinking process, but will also promote the formation of lasting memories. The process of converting working memory into permanent form is called consolidation, and I will explain that next time. 

--- W. R. (Bill) Klemm, D.V.M., Ph.D. Scientist, professor, author, speaker As a professor of Neuroscience at Texas A&M University, Bill has taught about the brain and behavior at all levels, from freshmen, to seniors, to graduate students to post-docs. His recent books include Thank You Brain For All You Remember and Core Ideas in Neuroscience.

Related articles on Working Memory Training

- Can Intelligence Be Trained? Martin Buschkuehl shows how

- Working Memory Training: Interview with Dr. Torkel Klingberg

- Working Memory Training for Adults

Sources 

1. Repovs, G and Bresjanac, M. 2006. Cognitive neuroscience of working memory: a prologue. Neuroscience. 139: 1-3. 

2. Dijksterhuis, A. et al. 2006. On making the right choice: the deliberation-without-attention effect. Science. 311: 1005-1007. 

3. Wajima, Kayo, and Sawaguchi, T. 2005. The effect of working memory training on general intelligence in children. Society for Neuroscience Abstracts. Abstract 772.11. 

4. de Fockert, J. W. et al. 2001. The role of working memory in visual selective attention. Science. 291: 1803-1806. 

5. Olesen, P. J., Westerberg, H., and Kingberg, T. 2004. Increased prefrontal and parietal activity after training of working memory. Nature Neuroscience. 7: 75-79. 

6. Gathercole, Susan E., and Alloway, Tracy P. 2008. Working Memory and Learning. Sage Publications, 124 pages. 

7. Gathercole, Susan E., and Alloway, Tracy P. 2008. Working memory and learning. Sage Publications, . 124 pages. 

Mindfulness and Meditation in Schools

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.

Because of the widespread interest in new ADHD interventions - particularly non-pharmaceutical approaches - I try to cover credible research in this area whenever I come across it. I was thus pleased to learn about a very interesting study of mindfulness meditation as a treatment for adults and adolescents with ADHD that was published in the Journal of Attention Disorders [Zylowka, et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD. Journal of Attention Disorders, 11, 737-746.]

According to the authors, "...mindfulness meditation involves experiential learning via silent periods of sitting meditation or slow walking and purposeful attention to daily activities. Relaxation, although often induced during the training, is not the sole goal of the activity; rather, the main activity is a cognitive and intention-based process characterized by self-regulation and attention to the present moment with an open and accepting orientation towards one's experiences."

In recent years, mindfulness meditation has a new approach for stress reduction and has been incorporated into the treatment for a variety of psychiatric disorders, including depression, anxiety, and substance abuse. Of special relevance to the treatment of ADHD are findings that meditation has the potential to regulate brain functioning and attention. For example, research has demonstrated that mindfulness meditation can modify attentional networks, modulate EEG patterns, alter dopamine levels, and change neural activity.

As conceptualizations of ADHD now increasingly recognize the importance of executive functioning and self-regulation in the disorder, mindfulness meditation - which can be thought of as a type of attention/cognitive exercise program that is focused in improving self-regulation - is a complementary treatment that is well worth investigating. However, although a few small studies of meditation training in children with ADHD have yielded promising results, no research on the use of mindfulness training in adolescents and adults with ADHD has been published.

- Participants -

Participants were 24 adults and 8 adolescents (62% female) diagnosed with ADHD following a comprehensive evaluation. Eight participants fell 1 symptom short of meeting full diagnostic criteria and were considered to have "probable ADHD." The average age was 48.5 for adults and 15.6 for adolescents. About two-thirds were being treated with stimulant medication and continued on medication during the study. As with many adults and adolescents diagnosed with ADHD, the majority had struggled with other psychiatric disorders in their lifetime, with mood disorders being particularly common.

- Mindfulness Training -

Mindfulness meditation is described as involving 3 basic steps: 1) bringing attention to an "attentional anchor" such as breathing; 2) noting that distraction occurs and letting go of the distraction; and, 3) refocusing back to the "attentional anchor".

This sequence is repeated many times during the course of each meditative session. As the individual becomes better able to maintain focus on the attentional anchor, the notion of "paying attention to attention" is introduced and individuals are encouraged to bring their attention to the present moment frequently during the course of the day.

By directing one's attention to the process of paying attention, to noticing notice when one becomes distracted, and to refocusing attention when distraction occurs, mindfulness meditation training can be thought of as an "attention training" program. As such, examining the impact of such training on individuals with ADHD becomes a very interesting question to pursue.

- Mindfulness Training Program -

The mindfulness training program lasted for 8 weeks; each week included one 2.5 hour training session and daily at-home practice sessions.

Weekly training sessions followed a consistent format. The sessions began with a short meditation, followed by a discussion of at-home practice, the introduction and practicing of new exercises, planning for at-home practice sessions for the following week, and a closing sitting meditation. The at-home practice sessions consisted of "...gradually increasing formal meditation and various mindful awareness in daily living exercises." For the at-home practice sessions, participants received 3 CDs containing guided sitting meditations that began at 5 minutes and increased to 15 minutes.

To adapt traditional mindfulness meditation practice to the unique needs of adolescents and adults with ADHD, several modifications to traditional practice were made. First, the 8-week program included educational information on the symptoms, etiology, and biology of ADHD. Second, sitting meditations were shorter than required in similar programs (45 minutes of at-home practice is typically recommended) and walking meditation could be substituted for sitting meditation. Third, visual aids were incorporated to help explain mindful awareness concepts. And, fourth, a loving-kindness mediation, i.e., an exercise of wishing well to self and others) was incorporated at the end of each session to address the low self-esteem often associated with ADHD.

- Measures -

Pre- and posttest assessments included individual self-report scales of ADHD, depression, and anxiety as well as several cognitive tests that were administered when participants were off medication. Attention was assessed using a computerized assessment called the Attention Network Test that measures 3 aspects of attention: alerting (maintaining a vigilant state of preparedness), orienting (selecting a stimulus among multiple inputs), and conflict (prioritizing among competing tasks). Neuropsychological tests that assessed working memory and the ability to shift attention sets (Trails A and B) were also included. At the end of the training, participants were also asked to rate their overall satisfaction with the training.

- Results -

Seventy-eight percent of participants (25 of 33) completed the study. On average, participants attended 7 of the 8 weekly training sessions. Adults reported an average of 90 minutes and 4.6 sessions per week of at-home meditation practice; adolescents averaged 43 minutes and 4 sessions of weekly at-home practice. Both adolescents and adults who completed the program reported high levels of satisfaction with it - average scores above 9 on a 1 to 10 satisfaction scale.

Seventy-eight percent of participants reported a reduction in total ADHD symptoms, with 30% reporting at least a 30% symptom reduction (a 30% reduction in symptoms is often used to identify clinically significant improvement in ADHD medication trials). Because the majority of participants were receiving medication treatment, for many these declines represent improvement above and beyond what benefits were already being provided by medication.

On neurocognitive test performance, significant improvements were found on the measure of attentional conflict and on several other neuropsychological tests (i.e., Stroop color-word test and Trails A and B) but not for measures of working memory.

For adults, significant reductions in depressive and anxiety symptoms were reported. Comparable reductions in these symptoms were not evident in adolescents.

- Summary and Implications -

Results from this study indicate that mindfulness meditation training may be a beneficial complementary treatment approach for adolescents and adults with ADHD. Positive findings include: 1) the absence of any reported adverse events; 2) highly favorable ratings of the treatment by participants; 3) reductions in self-reported ADHD symptoms reported by over three quarters of participants, even though the majority were already being treated with medication; 4) significant improvement on several of the neuropsychological measures; and, 5) reductions in depressive and anxiety symptoms for the adults.

The authors are appropriately cautious in discussing their findings and suggest that the study supports the "...feasibility and potential utility of mindfulness meditation in at least a subset of adults and adolescents with ADHD." They are careful to note, however, that this was a pilot study with a small sample, and that the reported pre-post changes in behavioral and neurocognitive measures should be "...considered exploratory given the absence of a control group and reliance on self-report measures of psychiatric symptoms."

Given the promising results obtained in this pilot study, there is a clear need for a more extensive research on mindfulness meditation training as an intervention for ADHD. In the meantime, although mindfulness meditation could not be considered a scientifically supported treatment for ADHD, it may have benefits as a complementary treatment and is highly unlikely to have any adverse effects.

I find it both encouraging and exciting that there seems to be growing interest among ADHD researchers to explore the scientific support for complementary approaches such as mindfulness meditation training and to subject a wider range of treatments subjected to rigorous scientific research. This has not always been the case and it would be wonderful if this trend were to continue. I hope that the authors of this study are already in the midst of the controlled trial that they call for and will certainly continue to cover these kinds of interesting investigations in Attention Research Update as they appear in the literature.

--- Dr. David Rabiner is a child clinical psychologist and Director of Undergraduate Studies in the Department of Psychology and Neuroscience at Duke University. His research focuses on various issues related to ADHD, the impact of attention problems on academic achievement, and attention training. He also publishes Attention Research Update, a complimentary online newsletter that helps parents, professionals, and educators keep up with the latest research on ADHD.

For related and mindful reading, you will enjoy:

- Mindfulness and Meditation in Schools for Stress Management

- From Meditation to Mindfulness Based Stress Reduction (MBSR)

- On being positive

- Well: When a Brain Scientist Suffers a Stroke

"Dr. Taylor recounts the details of her stroke and the amazing insights she gained from it in a riveting 18-minute video of her speech at the Technology, Entertainment, Design Conference in Monterey, Calif., last month."

- Cases Without Borders: Psychotherapy for All: An Experiment

"The clinic is at the forefront of a program that has the potential to transform mental health treatment in the developing world. Instead of doctors, the program trains laypeople to identify and treat depression and anxiety and sends them to six community health clinics in Goa, in western India."

- Attention Deficits That May Linger Well Past Childhood

"Dr. Philip Shaw, the National Institute of Mental Health psychiatrist who led the imaging study, was surprised and dismayed to see the results taken up to bolster that brand of doubt. “The findings, if anything, are very good evidence of yet another major biological difference between kids with A.D.H.D. and typically developing children,” he said. “The study was very much a question about the biology of A.D.H.D., and I think the findings certainly would feed into the idea of A.D.H.D. as being a very real problem with a very clear biological basis.”

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- "I qualify as a clinical psychologist in September and would like to work in Latin America for 6 months to a year afterwards."

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Highlights from The State of the Brain Fitness Software Market 2008 report include:

1) 2007 was a seminal year for the US Brain Fitness software market, which reached $225 million in revenues – up from an estimated $100 million in 2005.

2) Over 20 companies are offering tools to assess and train cognitive skills to four customer segments: consumers; healthcare and insurance providers; K12 school systems; and Fortune 1000 companies, the military, and sports teams.

3) The Nintendo Brain Age/ Brain Training phenomenon has driven much of the growth. The consumer segment grew from a few million in 2005 to an estimated $80 million in 2007.

4) There is major confusion in the market, so education will be key. Users and buyers need help to navigate the maze of products and claims.

5) Over 400 residential facilities for older adults have launched computerized “brain fitness centers.” Sales to the healthcare and insurance provider segment grew from $35 million in 2005 to an estimated $65 million in 2007.

6) More than five programs have shown results in randomized controlled trials. Cognitive functions that can be trained include: visual and auditory processing, working memory, attention, and decision-making.

7) A product has obtained 510(k) FDA clearance for rehabilitation of stroke and Traumatic Brain Injury patients. Another product is being used by a growing network of ADHD specialists.

8) Large-scale, fully-automated cognitive assessments are being used in a growing number of clinical trials. This opens the way for the development of inexpensive consumer-facing, baseline cognitive assessments.

9) The potential for K12 Education remains largely untapped due to limited research linking cognitive training to academic performance.

10) Companies, sports teams and the military are finding opportunities to improve productivity. The aging workforce will make this a must.

The report tracks developments at over 20 public and private companies offering tools to assess and train brain functions and provides important industry data, insights and analysis to help investors, executives, entrepreneurs, and policy makers navigate the opportunities and risks of this rapidly growing market. The report discusses the implications of cognitive science on healthy aging and a number of disorders such as attention deficits, dyslexia, stroke and traumatic brain injury, schizophrenia, autism, mild cognitive impairment, and Alzheimer’s disease. The report also provides information and frameworks to help institutional buyers make informed purchase decisions about brain fitness programs.

Table of Contents
List of Figures
Companies Included
End Notes

A few accolades for the report:

"Finally, an insightful and complete overview of the science, companies and trends in the brain fitness field. A must-read for everyone offering products and services to boomers and elders."
- Gloria Cavanaugh, former President & CEO of the American Society on Aging and founding Board member of the National Alliance for Caregiving.

"This groundbreaking report provides a definitive overview of the emerging brain training market --- an important category to watch for every gaming and healthcare executive and investor. SharpBrains' comprehensive report defines a clear scope for the market and also charts its evolution, path and key trends."
- Tim Chang, Principal at Norwest Venture Partners.

"Brain health and function is becoming a top priority in our society. This is as true for school children as it is for corporate executives or aging baby-boomers. It is a typical misconception about the brain that there is only one general intelligence to care about. It has been shown that there are many different cognitive abilities each of which may be trained systematically. While physical exercise increases the rate of formation of new nerve cells, mental exercise promotes their survival. It is in this context that an explosion of new "brain-training" software modalities have been developed.
The 2008 State of the Brain Fitness Software Market report is a timely analysis of the status of this new and emerging market. Preliminary results from scientific investigations evaluating several of the programs suggest not only short-term improvement in the trained skills, but a more long lasting and extended response spanning related mental functions. The review clearly states that the impact of mental training on brain aging and dementing disorders remains unknown, but it profiles each approach regarding degree of scientific scrutiny, market segment, modality, and specific parameter being trained. Healthcare and psychology professionals will benefit immensely from this state of the art, comprehensive overview and insightful analysis."
- Larry McCleary, M. D., former acting Chief of Pediatric Neurosurgery at Denver Children's Hospital.

The report is available either in electronic format or hardcopy, both priced at $495. To learn more, and purchase, click Here. We are offering a 10% discount to our blog readers in honor of Brain Awareness Week (Discount Code "BAW2008"), valid until March 20th.

Related information:

- We first announced this report in this MIT/ ASA/ SmartSilvers Panel

- The video of the entire 1.5 hour panel is available in Google Video.

- This post featured the main highlights of the event.