You can read part 1 here.

Q – In your Harvard Management Update interview, you said that “When what we pay attention to is driven by the last email we received, the trivial and the crucial occupy the same plane.” As well, it seems to be that a problem is our culture’s over-idealization of “always on” and “road warrior” habits, which distract from the importance of executive functions such as paying attention to one’s environment, setting up goals and plans, executing on them, measuring results, and internalizing learning. How can companies better equip their employees for future success? Can you offer some examples of companies who have positive cultures that encourage and reward employees fully put their frontal lobes into good use?

A – As I mentioned above, we are working and living in ways that undermine our ability to strategize, focus, reflect, innovate. Skimming, multitasking and speed all have a place in 21st-century life. But we can’t let go of deeper skills of focus and thinking and relating, or we’ll create a society of misunderstanding and shallow thinking.

To create workplaces that foster strategic thinking, deep social connection and innovation, we need to take three steps:

First, question the values that venerate McThinking and undermine attention. Recently, my morning paper carried a front-page story about efforts “in an age of impatience” to create a quick-boot computer. “It’s ridiculous to ask people to wait a couple of minutes to start up their computer,” explained one tech executive. The first hand up in the classroom, the hyper business-man or –woman who can’t sit still, much less listen – these are icons of success in American society. Still, many of us are beginning to question our adoration of instant gratification and hyper-mobility.

Second, we need to set the stage for focus individually and collectively by rewriting our climate of distraction and inattention. To help, some companies and business leaders are experimenting with “white space” – the creation of physical spaces or times on the calendar for uninterrupted, unwired thinking and connection. Executives are scheduling “quiet time” in their calendars to recapture space for reflection. One architect’s design for a major new government laboratory specifically creates spaces for focus, as well as collaboration. IBM’s global practice of “ThinkFridays” began three years ago when software engineers decided to limit email, conference calls and meetings one day a week in order to focus on their creative, patent work. Now, different teams and departments interpret “ThinkFridays” in varied ways. This pioneering initiative is fluid, flexible and workable – more so than the rigid, top-down policies that ban email one day a week.

Finally, if there’s just one action we can take to spark a “renaissance of attention,” it should be to give the gift of our attention to others. Parents and leaders, in particular, need to role model attention. As contemplative scholar Alan Wallace says, “When we give another person our attention, we don’t get it back. We’re giving our attention to what seems worthy of our life from moment to moment. Attention, the cultivation of attention, is absolutely core.”

Q – Some essential skills to thrive in the Cognitive Age seem to be attention, emotional self-regulation, working memory. These capacities are today understood to be less immutable than once thought, with emerging research opening the way for training programs that, for example, perhaps Fortune 500 companies will want too offer in the future as part of their corporate training and leadership programs, Your view?

A – Remarkably, scientists are now beginning to understand the mysteries and workings of attention and its sister skills of working memory and self-regulation. They are also discovering that attention can be trained, a finding that should revolutionize parenting, education and workplace training. In just five days of computer-based training, the brains of 6-year-olds begin to act like adults on measures of executive attention, one study by Michael Posner found. Torkel Klingberg’s work has shown that boosting short-term memory seems to improve children’s ability to stay on task. We don’t yet know how long-lasting the gains are, but practices such as meditation, computer-based exercises and behavioral therapies are proven to boost focus, awareness, working memory and executive attention. The philosopher/psychologist Williams James thought that attention could not be highly trained by “drill or discipline,” but he was wrong.

Still, there are important caveats to keep in mind. Some researchers question computer-based efforts as too narrow in scope, arguing that people must be taught attention holistically, as a life skill. No brief training regime is likely to be a magic bullet. “Part of the problem in today’s society is that people are looking for extremely quick fixes that have no vision. People are looking to lose 20 pounds for the wedding next week,” neuroscientist Amir Raz of McGill University once told me. “But attention training is a slow process.” As well, machine-based training will not be the only way to strengthen attention. Certainly, technology truly augments the human mind, and our gadgets will evolve to better help us focus and think. Yet it’s a mistake to believe that computers, or pharmaceuticals for that matter, can replace the hard, difficult work that we all face in “upgrading” ourselves.

Q – Neuroscientist Torkel Klinkgerg recently told our readers that “modern life itself may help make us more cognitively able. And emerging tools may enhance our abilities and better prepare us for the demands of the Information Age.” What are the opportunities and the risks you see ahead of us?

A – We now have easy access to reams of data, ever-expanding social networks, and limitless experiences across the planet and in the new frontier of cyberspace. The potential for learning, connection, fulfillment is great. But at the moment, we are not realizing this potential. Despite our scientific and technical achievements, we are squandering our chances to create a high-tech, yet reflective and caring society. And yet I am optimistic. In this time of flux, uncertainty, mistrust and collapse, we may nevertheless be shaken enough to reconsider our taken-for-granted ways of thinking and being. We may be ready to effect change. The task before us – to spark a renaissance of attention – is monumental, and yet it’s as crucial as greening the planet or rebuilding our financial system. For we can only meet the challenges of our day by strengthening, not undermining, our powers of attention.

Maggie, thank you very much for your time and attention.

My pleasure!

—
Maggie’s Book: Distracted: The Erosion of Attention and the Coming Dark Age

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Related articles and resources:

- Part 1 of the interview with Maggie Jackson

- The Overflowing Brain: Most Important Book of 2008

- Top 10 Brain Fitness Books

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 one of two treatment conditions: 36 sessions of neurofeedback training or 36 sessions of computerized attention training. The computerized attention training task was intended to serve as the control intervention. Training was conducted in two 50-minute blocks per sessions, with a short break in-between; children in both groups participated in two to three such training sessions per week.

- Description of Training -

Neurofeedback Training – As noted above, neurofeedback entails providing children with real-time feedback on their EEG state so that they become able to learn how to create and maintain a state that is consistent with focused attention. This is done by linking their ability to control what appears on the computer screen to their ability to produce and maintain the EEG state being trained. Technical details of the training protocols are not summarized here but were based on research findings suggesting the specific EEG differences between children with and without ADHD that training should address. For example, one part of training focused on teaching children to elevate their production of higher frequency beta waves and supress the production of lower frequency theta waves. This is based on prior findings that individuals with ADHD tend to have an elevated ratio of theta to beta activity relative (see Neurofeedback/ Quantitative EEG for ADHD diagnosis).

Computerized Attention Training – This treatment was based on a program called ‘Skillies’, described as award-winning German learning software that provides systematic exercises in visual and auditory perception, vigilance, sustained attention, and reactivity. It was considered the ‘control’ condition to which the results of neurofeedback training was compared.

Performing well on the program requires children to sustain their attention to a variety of game-like tasks that become increasingly challenging and that provide children with frequent feedback about their performance. Children thus receive extended practice in ‘paying attention’ for increasing periods to tasks that become increasingly demanding and need to learn to sustain their attention in order to do well. Unlike neurofeedback treatment,however, no direct feedback on EEG state is provided.

- Experimental Controls -

As noted above, children were randomly assigned to treatment condition, which is essential when comparing different interventions. Efforts were also made to make the intervention experience as similar as possible, except for the critical difference as to whether children received direct training in managing their EEG state. Thus, treatment for both groups entailed computer-game like tasks that demanded attention. In both conditions, children were encouraged to develop strategies to focus attention and to practice these strategies at home and school. They also received similar amounts of attention and praise for doing so.

By equalizing as many aspects of the training experience as possible, the researchers could attribute any outcome differences that emerged to critical differences in the programs themselves, i.e., whether feedback on EEG state was provided, as opposed to some extraneous factor such as attention from the experimenters, time spent on a demanding computer task, etc.

In addition to these important controls, efforts were made to keep parents and teachers ‘blind’ to the type of training children received. Thus, parents were only told that their child would receive either of two promising computer-based treatments for ADHD. They also did not accompany their child into the treatment room to observe. Children’s teachers were also not informed about the child’s treatment. Although a number of parents became aware of which treatment their child received, and perhaps some teachers did as well, it is not possible to keep everyone truly ‘blind’ in a study like this.

- Measuring Treatment Outcomes -

The main outcome measure used were parent and teacher ratings of children’s ADHD symptoms. In addition to ratings of core inattentive and hyperactive-impulsive symptoms, ratings were collected on a variety of other behaviors, e.g., oppositional behavior, conduct problems, emotional problems, and social problems. These rating scales were obtained before and after treatment.

To rule out placebo effects as an explanation for any treatment differences found, the researchers also asked parents about their attitudes towards treatment, how motivated they thought their children were, and how satisified they were with their child’s treatment.

- Results -

Preliminary analyses revealed no group differences in parents’ attitudes towards, or satisfaction with, their child’s treatment or in how motivated they felt their child was. These factors thus should not have influenced parents’ ratings of core symptoms.

Results of the parent and teacher behavior ratings indicated the following:

1. Parents of children treated with neurofeedback reported significantly greater reductions in inattentive and hyperactive-impulsive symptoms than parents of control children, i.e,. those who received computerized attention training. The size of the group difference was in a range that would be considered moderate, i.e., about .5 standard deviations.

2. Teachers of children treated with neurofeedback reported significantly greater reductions in inattentive and hyperactive-impulsive symptoms than teachers of control children. The size of the group difference was similar in magnitude to that found for parents, about .5 standard deviations.

3. Apart from these differences in core ADHD symptoms, few group differences were found. However, neurofeedback was associated with greater reductions in parents’ ratings of oppositional and aggressive behavior. Teacher ratings for the two groups did not differ on any of the remaining behavioral measures.

The results summarized above reflect average differences between the groups. The authors also examined the percentage of children in each group that were judged to derive significant benefit where this was defined as at least a 25% reduction in core ADHD symptoms. Fifty-one percent of children in the neurofeedback group met this threshold compared to only 26% of children in the attention training control group. This difference was statistically significant as well.

- Summary and Implications -

This was a well-designed study of neurofeedback treatment for ADHD that used random assignment, blind raters, and included an appropriate control group. Results indicate that neurofeedback treatment yielded significantly greater reductions in parent and teacher ratings of core ADHD symptoms than the comparison treatment. Furthermore, the magnitude of the reductions appear large enough to be clinically meaningful. Although the impact of neurofeedback treatment on other aspects of children’s functioning was less pronounced, significant reductions in parents’ ratings of oppositional behavior were also found.

Overall, these findings add to the research support for neurofeedback as a treatment for ADHD. However, despite the many strengths of this study, there are concerns to note and reasons why some researchers will find a basis for criticizing it. The main concerns – and my own take on them – include the following:

1. Without getting too technical, some researchers will argue that the statistical tests used in this study were not ideal and may have overestimated the advantages of neurofeedback treatment. My sense from examining the data is that the primary findings would hold up even if more conservative statistical tests were employed. However, it would be really nice to see that done.

2. Neurofeedback is supposed to work by teaching children to transform their EEG state to one that is characteristic of children without ADHD. However, there were no EEG measures taken in this study. Thus, there is no way to know whether neurofeedback actually resulted in these hypothesized changes in EEG. While this is certainly true, this has more to do with documenting the mechanism by which neurofeedback led to reductions in ADHD symptoms and has nothing to do with whether those reductions actually occurred.

I believe that some neurofeedback practitioners would argue that this may have also diminished the benefits provided by neurofeedback treatment. The reason for this is that training was not matched to the specific EEG parameters that needed to be altered for each individual and that additional benefits would have accrued had this been done. Whether this is actually the case, however, would require additional research to determine.

3. No measures of children’s academic functioning were collected. Because improving academic performance is a critical treatment target for most children with ADHD, the absence of this data is an important study limitation. There is no arguing with this and it is unfortunate that measures of academic performance in the classroom were not collected.

4. No long-term follow up was conducted. There is thus no basis for knowing whether neurofeedback treatment resulted in any enduring benefits. While this is certainly a limitation, it should be noted that neither medication treatment nor behavioral treatment have been shown to have enduring benefits after treatment ends. However, one of the reputed advantages of neurofeedback is that it may result in enduring gains. Thus, adding a long-term follow up to this study would have been an important addition.

5. It is important to remember that when improvement was defined as at least a 25% reduction in core ADHD symptoms, about 50% of children treated with neurofeedback did not meet this threshold. Thus, many children did not derive significant benefit from this treatment even though the benefits averaged across all children were statistically significant.

This is not surprising as no treatment – including medication – will help everyone. However, the rate of non-responders is less than what is typically found in controlled studies of medication treatment and this is important to remain aware of.

Despite these limitations and concerns, my take on this study is that it represents an important addition to the research literature on neurofeedback treatment for ADHD. In the context of other positive findings that have been reported for neurofeedback, it provides additional basis for regarding this as an extremely promising treatment approach for some children with ADHD.

– 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.

Related articles by Dr. Rabiner

- Neurofeedback/ Quantitative EEG for ADHD diagnosis

- Promising Cognitive Training Studies for ADHD

- Mindfulness Meditation for Adults & Teens with ADHD

- How Strong is the Research Support for Neurofeedback in Attention Deficits?

- Self-Regulation and Barkley’s Theory of ADHD

Thank you for your interest, attention and participation in our SharpBrains community. As always, we appreciate your comments and suggestions.

Summit of the Global Agenda

How can we persuade business leaders, policy-makers and researchers of the urgency to develop and promote an integrated “Healthy Living” agenda focused on maintaining lifelong physical and cognitive health, vs. the usual mindset focused on dealing with specific diseases and problems once they arise?

In The Future of the Aging Society: Burden or Human Capital?, I summarize some of the key themes discussed at the World Economic Forum event in Dubai on November 7-9th. The world is aging – and in healthier ways. But our healthcare and retirement systems are on track to go bankrupt – their premises are outdated. The current disease-based research agenda compounds the problem. Solutions? 1) Promote Healthy Lifestyles that help Maintain Physical and Cognitive Functional Abilities, 2) Redesign Environments to Foster Health, Engagement and Financial Security, 3) Develop an Integrated Healthy Living & Aging Research Agenda. Specifically, we could work with the UN and Global 2000 companies to move forward a new agenda.

Planet Earth 2.0: A New Operating System: Imagine seeing a top sheik in Dubai, wrapped in traditional Arab clothing, exclaim “Yes We Can” (a la Obama) in front of the 800 global experts, adding that “we build the future with our own hands”. Some of the attendants of the World Economic Forum’s Summit of the Global Agenda urged us to “reboot” the system. More than a “reboot”, we may have to upgrade to a new global “Yes We Can” operating system.

Brain Fitness Research

Neuroplasticity and the Brain That Changes Itself: Laurie Bartels reviews the excellent book by Norman Doidge, explaining that “the neuroscience behind Doidge’s book involves neuroplasticity, which is the brain’s ability to rewire itself. This means that the brain – our intelligence – is not something fixed in concrete but rather a changing, learning entity.”

Can We Pick Your Brain re: Cognitive Assessments?: In our view, a critical component in the maturity of the brain fitness market will be the availability of inexpensive, valid and reliable objective cognitive assessments,  to help measure how our brain functions change over time and identify priorities for targeted improvements. Dr. Joshua Steinerman asks if you would be up for them?

Use It (Properly) or Lose It

Physical and mental exercise to prevent cognitive decline: The American Medical News, a weekly newspaper for physicians published by the American Medical Association, just published an excellent article on the importance of physical and mental exercise. We are very happy to see efforts like these to train physicians and health professionals in general,  given that most of them were trained under a very different understanding of the brain than the one we have today.

Brain Fitness 2: Sight & Sound: PBS recently announced the second installment of their popular Brain Fitness Program show, to start airing soon.

MetaCarnival #1: a conversation across the blogosphere: We often insist on “Novelty, Variety and Challenge” as key ingredients for good “brain exercise”. There are many ways to mix those ingredients – you may enjoy this one, the first interdisciplinary gathering of blogs and blog carnivals covering health, science, anthropology, general advice and more.

Top 15 Brain Teasers and Games for Mental Exercise: Over the last 2 years we have published close to 100 puzzles, teasers, riddles, and every kind of mental exercise (without counting our in-depth interviews with top neuroscientists). Which ones have proven most stimulating for you. Let us know. Here is a selection of our Top 15 teasers.

Final Details

Please share this newsletter with your friends and colleagues if you haven’t done so already.

Have a Happy Thanksgiving!

Dr. Posner, many thanks for your time today. I really enjoyed the James Arthur Lecture monograph on Evolution and Development of Self-Regulation that you delivered last year. Could you provide a summary of the research you presented?

I would emphasize that we human beings can regulate our thoughts, emotions, and actions to a greater degree than other primates. For example, we can choose to pass up an immediate reward for a larger, delayed reward.

We can plan ahead, resist distractions, be goal-oriented. These human characteristics appear to depend upon what we often call “self-regulation.” What is exciting these days is that progress in neuroimaging and in genetics make it possible to think about self-regulation in terms of specific brain-based networks.

Can you explain what self-regulation is?

All parents have seen this in their kids. Parents can see the remarkable transformation as their children develop the ability to regulate emotions and to persist with goals in the face of distractions. That ability is usually labeled ‘‘self-regulation.’’

The other main area of your research is attention. Can you explain the brain-basis for what we usually call “attention”?

I have been interested in how the attention system develops in infancy and early childhood.

One of our major findings, thanks to neuroimaging, is that there is not one single “attention”, but three separate functions of attention with three separate underlying brain networks: alerting, orienting, and executive attention.
1) Alerting: helps us maintain an Alert State.

2) Orienting: focuses our senses on the information we want. For example, you are now listening to my voice.

3) Executive Attention: regulates a variety of networks, such as emotional responses and sensory information. This is critical for most other skills, and clearly correlated with academic performance. It is distributed in frontal lobes and the cingulate gyrus.

The development of executive attention can be easily observed both by questionnaire and cognitive tasks after about age 3–4, when parents can identify the ability of their children to regulate their emotions and control their behavior in accord with social demands.

“Executive attention” sounds similar to executive functions.

Executive functions are goal-oriented. Executive attention is just the ability to manage attention towards those goals, towards planning.

Both are clearly correlated. Executive attention is important for decision-making (how to accomplish an external goal) and with working memory (the temporary storage of information). For example, given that you said earlier that you liked my monograph,  I have been thinking of the subheadings and sections there as I provide you my answers, using my working memory capacity.

You said that each of the three functions of attention are supported by separate neural networks.

Neuroimaging allows us to identify sets of distributed areas that operate together. Different techniques allow us to see different things. For example, fMRI lets us see the activation of areas of grey matter. A more recent technique, diffusion tensor, is focused instead on the white matter. It detects connectivity among neurons, it helps us see a map of networks.

How many networks have been identified so far?

So far, a number of networks have been identified. For an illustration, you can see the wonderful interactive Brain Map by the University of Texas, San Antonio (Note: http://www.brainmap.org/).

Let me mention another fascinating area of research. There is a type of neuron, named the Von Economo neuron, which is found only in the anterior cingulate and a related area of the anterior insula, very common in humans, less in other primates, and completely absent in most non-primates.  These neurons have long axons, connecting to the anterior cingulate and anterior insula, which we think is part of the reason why we have Executive Attention. Diffusion tensor allows us to identify this white matter, these connections across separate brain structures, in the live brain. From a practical point of view, we can think that neural networks like this are what enable specific human traits such as effortful control.

What is effortful control?

It is a higher-order temperament factor consisting of attention, focus shifting, and inhibitory control – both for children and adults. A common example is how often you may make plans that you do not follow through with. A test often used to measure executive attention is the Stroop Test (you can try it here). Effortful control has been shown to correlate with the scores on executive attention at several ages during childhood, and imaging studies have linked it to brain areas involved in self-regulation.

Good parenting has been shown to build good effortful control, so there are clear implications from this research.

Tell us now about your recent research on attention training

Several training programs have been successful in improving attention in normal adults and in patients suffering from different pathologies. With normal adults, training with video games produced better performance on a range of visual attention tasks. Training has also led to specific improvements in executive attention in patients with specific brain injury. Working-memory training can improve attention with ADHD children.

In one recent study we developed and tested a 5-day training intervention using computerized exercises. We tested the effect of training during the period of major development of executive attention, which takes place between 4 and 7 years of age.

We found that executive attention was trainable, and also a significantly greater improvement in intelligence in the trained group compared to the control children. This finding suggested that training effects had generalized to a measure of cognitive processing that is far removed from the training exercises.

A collaborator of our lab, Dr. Yiyuan Tang, studied the impact of mindfulness meditation with undergrads to improve exec attention, finding significant improvements as well. We hope that training method like this will be further evaluated, along with other methods, both as possible means of improving attention prior to school and for children and adults with specific needs.

Can you explain the potential implications of this emerging research on Education and Health?

It is clear that executive attention and effortful control are critical for success in school. Will they one day be trained in pre-schools? It sounds reasonable to believe so, to make sure all kids are ready to learn. Of course, additional studies are needed to determine exactly how and when attention training can best be accomplished and its lasting importance.

In terms of health, many deficits and clinical problems have a component of serious deficits in executive attention network. For example, when we talk about attention deficits, we can expect that in the future there will be remediation methods, such as working memory training, to help alleviate those deficits.

Let me add that we have found no ceiling for abilities such as attention, including among adults. The more training, even with normal people, the higher the results.

Let me ask your take on that eternal question, the roles of nature and nurture.

There is a growing number of studies that show the importance of interaction between our genes and each of our environments. Epigenetics is going to help us understand that question better, but let me share a very interesting piece of research from my lab where we found an unusual interaction between genetics and parenting.

Good parenting, as measured by different research-based scales, has been shown to build good effortful control which, as we saw earlier, is so important. Now, what we found is that some specific genes reduced, even eliminated, the influence of the quality of parenting. In other words, some children’s development really depends on how their parents bring them up, whereas others do not – or do to a much smaller extent.

Too bad that we do not have time now to explore all the potential ethical implications from emerging research like that…let me ask a few final questions. First, given that we have been talking both about formal training programs (computer-based, meditation) and also informal ones (parenting), do we know how formal and informal learning interact? what type can be most effective when, and for whom?

Great question. We don’t know at this point. A research institute in Seattle, funded by the National Science Foundation, is trying to address that question. One practical issue they address is the influence of bilingual education on cognition.

How can SharpBrains readers access the computer-based attention training program you talked about earlier?

Researchers and parents can download the program, which is aimed at kids aged 4 to 6. The computerized exercises are available on www.teach-the-brain.org. Click on learning tools and follow attention.
Finally, what can we expect from your lab in the next years?

We will hear soon if we obtain the NIH proposal to train children at age 5 and then follow-up over the years, compared to a control group. The program I mentioned earlier showed good short-term results, but we would like to track those kids over time and see what happens. For example, we will examine whether or not an early intervention might translate into a “snowball effect” of higher levels of cognitive and school performance.

References:

- Tang, Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., et al. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17152-17156.

-Rueda, M.R., Rothbart, M.K.. & Saccamanno, L. & Posner, M.I. (2005) Training,maturation and genetic influences on the development of executive attention. Proc.U.S Nat’l Acad of Sciences 102, 14931-14936.

- Rueda, M.R., Posner, M.I., & Rothbart,M.K. (2005) The development of executive attention: contributions to the emergence of self regulation. Developmental Neuropsychology 28, 573-594.

Major Implications from Brain Research

Should Social-Emotional Learning Be Part of Academic Curriculum?: It is clear by now that our brains are more than cognitive machines. For example, emotions can either enhance or inhibit our ability to learn. Daniel Goleman explores the implications of “new studies that reveal how teaching kids to be emotionally and socially competent boost their academic achievement.” Brought to you in partnership with Greater Good Magazine.

Retain older workers beyond retirement: BusinessWeek covers a best practice in a topic of growing importance: how large companies, such as American Express, can retain older workers in productive ways beyond a set arbitrary retirement age. As Dr. Art Kramer told us recently, “as a society, it is a massive waste of talent not to ensure older adults remain active and productive.”

BrainTech and Sustainable Brains: Building on a recent quote by John Doerr about clean technology trends, we wonder… “If Energy is the mother of all markets…who would be the father of all markets?” The Human Brain, perhaps?

Health and Research

What You Can do to Improve Memory (and Why It Deteriorates in Old Age): Is there anything we can do besides “exercise like crazy, eat healthy foods that you don’t like all that much, pop your statin pills, and take up yoga?” Yes: focus, focus, focus, suggests Dr. Bill Klemm.

News and Events

Cognitive Health News August 2008: This is a roundup of recent brain health news and our commentary, including the growing adoption of Dakim and Nintendo products, the cognitive impact of videogames, and the cognitive dimension of the obesity crisis.

Exercise your brain at these events: Alvaro will present the main findings from our market research at multiple conferences in the US, Canada and Dubai during the rest of  the year.

Where does the “Feeling of Knowing” comes from?: Dr. Ginger Campbell shares some insights from her recent interview with neurologist Robert Burton (author of On Being Certain: Believing You Are Right Even When You’re Not).“While it might be true that one can learn to become more aware of the emotional signals coming from one’s body, Dr. Burton argues that “gut feelings” or intuition should not be assumed to be true without testing.”

Resources for Brain Health Across the Lifespan: Laurie Bartels shares a list of interviews, video, articles, and books that go hand-in-hand with the brain-related topics we cover.

Brain teaser

Can you use mental self rotation to read a map?: please check out this teaser by Dr. Pascale Michelon, one of our favorites so far.

We hope you have enjoyed this newsletter. We encourage you to stay tuned for our September editions, since great content is coming. We will soon publish an interview with Lee Woodruff, co-author of the book In An Instant: A Family’s Journey of Love and Healing, and discuss the spectacular cognitive recovery of her husband, ABC reporter Bob Woodruff, who experienced a traumatic brain injury in Iraq in 2006. We will also interview Dr. Mike Posner, eminent cognitive neuroscientist, to explore recent findings on attention and attention training and their implications.

If you haven’t done so already, make sure to subscribe to our newsletter (above) and our RSS feed (on the right).

Below you have the profiles of some of our Contributors and links to their best articles with us so far. Enjoy!

Dr. Pascale Michelon has a Ph.D. in Cognitive Psychology and has worked as a Research Scientist at Washington University in Saint Louis, in the Psychology Department. She conducted several research projects to understand how the brain makes use of visual information and memorizes facts. She is now an Adjunct Faculty at Washington University, and teaches Memory Workshops in numerous retirement communities in the St Louis area.      Social Connections for Cognitive Fitness.  Teaser: Boost your visuospatial skills. Brain Plasticity: How learning changes your brain. Teaser: Words in your brain, learn as you exercise!.

Gregory Kellett has a masters in Cognitive Neurology/Research Psychology from SFSU and is a researcher at UCSF where he currently investigates the psychophysiology of social stress.      Relaxing for your Brain’s Sake. Stress and Neural Wreckage: Part of the Brain Plasticity Puzzle.

	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.     Working Memory Training for Adults. How Strong is the Research Support for Neurofeedback in Attention Deficits?. Self-Regulation and Barkley’s Theory of ADHD.
       Â	Greater Good Magazine, a UC-Berkeley-based quarterly magazine that highlights ground breaking scientific research into the roots of compassion and altruism.      Robert Sapolsky on Peace Among Primates: Part 1, Part 2. Part 3. Daniel Goleman: The Power of Mindsight. Jill Sutie: Mindfulness and Meditation in Schools.
	John Medina, author of “Brain Rules,” is a developmental molecular biologist and research consultant. He is an affiliate professor of Bioengineering at the University of Washington School of Medicine. He is also the director of the Brain Center for Applied Learning Research at Seattle Pacific University. His article on exercise and the brain was selected by the Harvard Business Review (Feb 2008) as one of its “Breakthrough Ideas for 2008.”      Brain Rules: science and practice.
	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.      New Neurons: Good News, Bad News.
	Prof. Schlomo Breznitz is the Founder and President of CogniFit. Previously, he served as the Lady Davis Professor of Psychology and the founding director of the Center for Study of Psychological Stress at the University of Haifa. He has also been visiting professor at the London School of Economics, Berkeley, Stanford, and National Institutes of Health.      Maximize the Cognitive Value of Your Mental Workout.
	eduwonkette is an anonymous blogger who writes a fantastic Education Week blog described as “Through the lens of social science, eduwonkette takes a serious, if sometimes irreverent, look at some of the most contentious education policy debates.”      Schools: what should they do, and for whom?.
	Drs. Simon Evans and Paul Burghardt currently collaborate in the University of Michigan’s Department of Psychiatry, and the Molecular and Behavioral Neuroscience Institute to study the effects of nutrition and exercise on brain function. They host the Brain Fit for Life blog and are collaborating on an upcoming book on the subject.      Preventive Medicine for Brain Health.
	Once a Knight Ridder columnist, Joanne Jacobs now blogs on education at joannejacobs.com. Her book, Our School: The Inspiring Story of Two Teachers, One Big Idea and the Charter School That Beat the Odds, is available online and in book stores.      The First Step Is Failure.
	Shannon Moffet has an MD from Stanford University School of Medicine, and is in her residency in emergency medicine at Highland Hospital in Oakland, CA. Her book on the brain (and eight dynamic brain-mavens, including Robert Stickgold) is The Three Pound Enigma: The Human Brain and the Quest to Unlock its Mysteries. Moffett recently appeared on The Brain Fitness Program, which aired nationwide on PBS.      Sleep, Tetris, Memory and the Brain.
	Larry McCleary, M.D, (blog) is a former acting Chief of Pediatric Neurosurgery at Denver Children’s Hospital. He is trained and has practiced as a pediatric neurosurgeon and has completed post-graduate training in theoretical physics. His scientific publications span the fields of metabolic medicine, tumor immunology, biotechnology and neurological disease. He is the author of The Brain Trust Program: A Scientifically Based Three-Part Plan to Improve Memory, Elevate Mood, Enhance Attention, Alleviate Migraine and Menopausal Symptoms, and Boost Mental Energy (Perigee Trade, 2007).      Why is Brain Evolution Meaningful Today to Improve Our Brain Health.

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 at least 30 years. It involves providing individuals with real-time feedback on their brainwave activity in order that they may learn to alter their typical EEG pattern to one that is consistent with a focused and attentive state. According to neurofeedback proponents, when this occurs, improved attention and reduced hyperactive/impulsive behavior will result. Furthermore, this change is likely to endure because it reflects a basic alterantion in an important aspect of brain functioning.

In this article, I’ll take a look at some of the controversy surrounding neurofeedback treatment and attempt to highlight some of the strengths and limitations in the existing published research.

- Controversy Surrounding Neurofeedback Research –

Neurofeedback treatment for ADHD has been a source of substantial controversy in the field for many years and remains so today. Although there are a number of published studies in which positive results have been reported, many prominent ADHD researchers feel that given significant limitations to the design and implementation of these studies, neurofeedback should be considered a promising, but unproven treatment.

This position is summarized in the CHADD fact sheet on alternative and complementary interventions, which includes the following statement about neurofeedback:

“It is important to emphasize, however, that although several studies of neurofeedback have yielded promising results, this treatment has not yet been tested in the rigorous manner that is required to make a clear conclusion about its effectiveness for AD/HD. The aforementioned studies can not be considered to have produced persuasive scientific evidence concerning the effectiveness of EEG biofeedback for ADHD.

Controlled randomized trials are required before conclusions can be reached. Until then, buyers should beware of the limitations in the published science. Parents are advised to proceed cautiously as it can be expensive – a typical course of neurofeedback treatment may require 40 or more sessions – and because other AD/HD treatments (i.e., multi-modal treatment) currently enjoy substantially greater research support.”

You can find the complete CHADD fact sheet Here.

What Does an ‘Ideal’ Treatment Study Look Like?

Before reviewing some recent neurofeedback studies, it would be useful to consider what an ‘ideal’ treatment study entails. This will provide a context against which recent neurofeedback studies can be evaluated.

Ideally, treatment studies are designed so that if positive results are obtained, all possible explanations for those results besides the treatment itself have been eliminated. This requires 2 basic elements: random assignment and an appropriate control group.

Random Assignment

Imagine that you are testing a new medication treatment for ADHD with 50 children who have been carefully diagnosed. In a random assignment study, whether each child is assigned to the treatment or control condition is determined by chance – you could flip a coin and give the medicine to the ‘heads’ and nothing to the ‘tails’. This insures that any differences that might exist between children who get the medication and those who don’t are purely chance differences. At the end of the study, if those who received the medicine are doing better, you could feel confident that this is probably due to the medicine itself, and not to differences that may have been there before the treatment even started.

What if you didn’t use random assignment, but let each child’s parents choose whether their child is in the treatment or control group? In this case, it is possible that children in the 2 groups differed in important ways before the treatment began. If children who received the medication were doing better at the end of the study, it might be because of differences that were there to start with.

For example, parents who chose the medicine might be more willing to pursue other ways to help their child than those who didn’t. The fact that children who received the medication were doing better at the end of the study might thus have nothing to do with the medicine itself, but reflect other things their parents were doing to help them. No matter how hard you might try to rule out these other possible explanations – and I’m sure you can think of many others – you could never do this with certainty. Thus, I might reasonably doubt that your new medication is really effective.

What about control groups?

Even with the random assignment example above, however, your study would still have an important problem. Because children in the control group received nothing, everyone knows who is being treated and who isn’t. If you ask parents how their child is doing 4 weeks later, this could very possibly bias their reports. Parents whose child received medication may report their child is doing better simply because they expect the medicine to help. Parents of children in the control condition may be biased against seeing improvement because they know their child was not treated.

Thus, if parents of treated children reported more improvement than parents of control children, I could still reasonable question that the new medication was truly helpful. Even if reports from teachers yielded similar findings, I would argue that teachers might have learned when children were getting medication. While this may be a low probability event, you couldn’t completely rule it out. If I was a real skeptic about your new medication, your study would not be all that convincing.

The way around this is to create a situation where no one knows – not the parents, child, teachers, researchers, or anyone else – whether the child is receiving medication. With medication studies, this is relatively simple to do: children in the control condition are given a placebo pill that looks just like the real medication but that has no active ingredients. Because no one knows who is getting medication and who isn’t, possible biases in parents’ and teachers’ reports at the end of the study are thus eliminated. This way, if children in the medication condition are doing better at the end of the study than children getting placebo, it is harder to doubt the benefits of your medication. In fact, there would be no reasonable basis for such doubt, especially if you repeated the study and found the same results.

Three Representative Neurofeedback Studies

With this as a background, let’s take a brief look at 3 recent neurofeedback studies and see how they fare on the critical dimensions of incorporating random assignment and an ‘ideal’ control group.

- Study 1 -

In an interesting study by Vince Monastra and his colleagues [Monastra et al. (2002). The Effects of Stimulant Therapy, EEG Biofeedback and Parenting Style on the primary symptoms of ADHD. Applied Psychophysiology and Biofeedback, 27, 249.] one hundred 6-19 year-olds with ADHD were treated over 12 months. Some parents chose a treatment plan that included medication, behavior therapy, and school consultation. Other parents chose to add neurofeedback to their child’s treatment.

After 12 months, children whose treatment included neurofeedback back were doing better than the other children according to both parents and teachers. They also showed ‘normal’ EEG scans while the other children still had the EEG pattern characteristic of ADHD. Even more impressive was that neurofeedback treated children maintained these benefits after medication was discontinued for a week. You can read a detailed review of this study Here.

- Study 2 -

In a study by Fuchs et al (2003), parents of thirty-four 8-12-year-old children with AD/HD chose either stimulant medication or neurofeedback treatment for their child. After 3 months, children in both groups showed significant and comparable reductions in AD/HD symptoms according to parents and teachers. Laboratory tests of attention also showed equivalent improvement. A comprehensive review of this study is available at Here

- Study 3 -

In an especially interesting study, (Levesque, J., Beauregard, M., & Mensour, B. 2006. Effect of neurofeedback training on the neural substrates of selective attention in children with AD/HD: A functional magnetic resonance imaging study. Neuroscience Letters, 394, 216-221.) twenty 8-12-year-old children with ADHD were randomly assigned to receive neurofeedback treatment – 40 1-hours sessions – or a wait-list control condition.

At the end of the study, treated children were doing significantly better than control children according to parents. They also did better on several objective, laboratory measures of attention. Especially noteworthy was that fMRI scans used to measure brain activity during a complex cognitive task showed significant change for treated children but no change for control children.

You can find a detailed review of this study Here.

So, what’s wrong with these studies?

I suspect the answer to this question is obvious. While the first 2 studies yielded impressive results, neither included random assignment. Thus, as discussed above, it is not possible to conclude that it is the neurofeedback treatment specifically that made the difference. Instead, differences that may have been present before treatment began and/or after treatment started could be responsible. While this may be unlikely, it can’t be entirely discounted.

The third study included random assignment so this is not a problem. It should be noted, however, that with only twenty participants, treatment and control groups are more likely to differ at the start of the study than if a larger sample had been randomly assigned.

The bigger problem is that the control condition is not a very strong one in that everyone knew who received neurofeedback treatment and who did not. This may have biased parents’ ratings, although it is difficult to argue that it could have biased children’s performance on the lab-based attention tests or on the fMRI scan. Perhaps, however, it wasn’t the specific feedback on EEG states that neurofeedback provided, but simply the attention children received during the 40 hours of training, that was the important factor. Although unlikely in my opinion, this can’t be definitely ruled out.

What would an ‘ideal’ neurofeedback study look like?

This may be pretty clear now as well. The most conclusive test of neurofeedback treatment would include random assignment and a control condition that closely matched the neurofeedback condition. For example, children could receive video game coaching from a supportive adult for the same time period. Or, even better, they could do exactly what children getting the neurofeedback were doing but not receive direct feedback on their EEG states. If positive treatment results were still found, it would indicate that obtaining EEG feedback and learning to control one’s EEG state is why neurofeedback treatment works.

I’ve been told by people who know much more about neurofeedback than I that such a study, while difficult to do, is technically possible. I am not aware of such a study having been published; if you are, please let me know.

I should point out that there would be important ethical concerns with such a study. Neurofeedback treatment typically occurs over a period of months. Children who were receiving ’sham’ neurofeedback would be getting a treatment that no one expected to be helpful for a sustained time period.

A more reasonable alternative might thus be to provide children with a treatment of known efficacy – such as medication – during the neurofeedback trial. If this were given to children in the real and sham conditions it would not create a confound because both groups would be receiving it. After neurofeedback was completed, one could see whether children who got the real treatment were doing better – i.e., did neurofeedback add anything to medication – and whether these benefits persisted after medication was temporarily stopped.

What can we conclude about neurofeedback until such a study is done?

It would be terrific if a study like the one outlined above were completed. Unfortunately, however, I think it is a real possibility, however, that we will never see such a study. This would be a large and expensive undertaking and obtaining funding for it would not be easy.

In the interim, my own view is that existing support for neurofeedback should not be so readily discounted because of the study limitations discussed above. Here’s why I think this is the case.

The way treatment was ‘assigned’ in the first 2 studies summarized is very similar to what happens when parents seek treatment for their child. That is, parents investigate different options and decide which one they want for their child.

This is what happened in these studies – some parents chose neurofeedback for their child and some did not. When neurofeedback was chosen, children were found to benefit on both ’subjective’ parent reports as well as on more ‘objective’ assessments. This does not mean that neurofeedback would ‘work’ for children randomly assigned to receive it. It also does not mean that reason neurofeedback works by providing specific training in learning how to manage one’s EEG state. It is for these reasons that neurofeedback is understandably regarded as an unproven treatment approach for ADHD at this time by many ADHD researchers.

However, these studies do provide a solid basis for suggesting that if parents choose to pursue neurofeedback for their child, there is a reasonable chance that their child will benefit even though we can’t be sure that it is the specific EEG training that is responsible for the benefits. Thus, although the efficacy of neurofeedback has yet to be conclusively confirmed in a randomized, placebo-controlled trial, it is important to place this limitation in the context of the supportive research evidence that has been accumulated.

Providing this context can help families better understand the strengths and limitations of the existing research on neurofeedback and enable them to make a better informed decision about whether to consider this treatment option for their child.

— 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.

Other articles by Dr. Rabiner:

Promising Cognitive Training Studies for ADHD.

Mindfulness Meditation for Adults & Teens with ADHD.

Working Memory Training for Adults.

Self-Regulation and Barkley’s Theory of ADHD.

If you haven’t read Dawkins’ classic book The Selfish Gene…it is never too late to enjoy it!

There are some “memes” floating now around bloggers and I have been “tagged” (included) by 2 of them. So here you have:

1) On good daily habits: this is the original post, and here are Hueina’s My Simply Successful Secrets.

My “Simply Sucessful Secrets” habits that I follow close to every day, in more or less that sequence:

• Perform 10-15 minutes of breathing exercises to improve grounding, balance, and breathing capacity
• Spend 10 minutes visualizing and writing down the key objectives for the day
• Eat a nice and healthy lunch-never in front of the computer
• Read something completely unrelated to my work in the evening
• Kiss and compliment my wife before going to sleep-never go unhappy/ stressed to sleep

2) On “5 things you may not know about me”. Senia: thanks for your patience…

• I defined myself as a “Learning micro-organism” in the Stanford class that probably influenced me the most. I love learning, and learning about learning-which is what led me to learning about how the brain works
• Originally from Bilbao, in the Spanish Basque Country, and very proud of it, I am now very happy to be living in the global community of the San Francisco Bay Area
• When I was working very very hard in consulting company McKinsey & Company, I started to take salsa dancing lessons-probably one of my wisest decisions ever
• The other one was to marry my wife Lisa and celebrate a World Wedding Tour to share the party with friends…instead of asking everyone to come to meet us, and given how much we love to travel…we decided to take the wedding on the road, including printing some tour T-shirts…
• My role models are the social entrepreneurs, many of them friends by now, who devote their lives to solving social problems in very pragmatic and scalable ways. My wife and I have been active in networks such as Ashoka and The Schwab Foundation for Social Entrepreneurship, so I am then very proud that SharpBrains has just been nominated for the The Tech Museum Awards – Technology Benefiting Humanity.

I tag, for both memes:

• Bora from A Blog Around The Clock
• Brett from Trading Psychology
• Michelle from Trading Mike
• Stephanie from idealawg
• Jane from NakedMedicine

Enjoy the final hours of the weekend!