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

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

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

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

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

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

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

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

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

- Working Memory Training -

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

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

- Results -

- Impact of Short-Term Memory and Working Memory -

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

Here you have the March edition of our monthly newsletter covering cognitive health and brain fitness topics. Please remember that you can subscribe to receive this Newsletter by email, using the box at the top of this page. I know I am biased – but do believe this Newsletter issue might well be our best so far. I hope you find the time to enjoy it!

Bird’s Eye View

Brain Fitness Survey: Over 2,000 thoughtful responses to our January survey (Thank You!) reinforce the need for public awareness initiatives and quality information to help evaluate and navigate lifestyle and product claims, as well as the need for more research, an expanded healthcare culture, as more. Given this context, we are publishing The SharpBrains Guide to Brain Fitness in May 2009, a book with 18 Interviews with Scientists, Practical Advice, and Product Reviews, in addition to our annual market report for professionals and executives (to be published in April). If you have ideas to help us promote the book, please reply to this email and let us know!

Lifelong Learning

What started as an academic dispute regarding disclosure of conflict of interest is now snowballing into the mainstream media, due to the over-reaction by JAMA editors as reported in this Wall Street Journal blog post, JAMA editor calls Critic a “Nobody and a Nothing”

In summary, Dr. Jonathan Leo, the “Critic”, dared to draw attention to 2 important points regarding a study comparing the efficacy of therapy vs. medication published in the Journal of the American Academy of Medicine (JAMA) – one of the most prestigious scientific publications:

1) The study results were presented and reported in a biased way, since they favored one specific intervention, a drug, while ignoring another one, therapy-based, that had equally statistically significant effects.

2) Both the lead author of the study and one of the main experts asked to comment on the study in several media outlets had undisclosed and unreported conflicts of interest. JAMA could have done a 5-minute Google search to identify and report the conflict of interest of the lead author (received a variety of revenues from the drugmaker).

Dr. Leo has summarized the continuing matter in several impressive letters. The 2 main ones, in chronological order:

Clinical Trials of Therapy vs. Medication: Even in a Tie, Medication Wins(BMJ)

- “Central to the idea of evidence-based medicine is that the choices made by patients and doctors to use a certain treatment should at least in part be based on scientific studies published in peer reviewed academic journals. For a patient diagnosed with Read the rest of this entry »

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

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

- Results from a New Study of Neurofeedback -

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

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

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

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

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

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

Cognitive Training Can Alter Biochemistry Of The Brain (Science Daily)

- “Researchers at the Swedish medical university Karolinska Institutet have shown for the first time that the active training of the working memory brings about visible changes in the number of dopamine receptors in the human brain.”

- “”Brain biochemistry doesn’t just underpin our mental activity; our mental activity and thinking process can also affect the biochemistry,” says Professor Torkel Klingberg, who led the study.”

- “Changes in the number of dopamine receptors in a person doesn’t give us the key to poor memory,” says Professor Lars Farde, one of the researchers who took part in the study. “We also have to ask if the differences could have been caused by a lack of memory training or other environmental factors. Maybe we’ll be able to find new, more effective treatments that combine medication and cognitive training, in which case we’re in extremely interesting territory.”

Comment:  couldn’t agree more with “Maybe we’ll be able to find new, more effective treatments that combine medication and cognitive training, in which case we’re in extremely interesting territory.” This study adds a very important angle to the growing literature on working memory training, showing a more fundamental, structural impact, that once thought (such as the well-known effect that “cells that fire together wire together”). The computerized cognitive program used in the study was Cogmed working memory training.

More on Torkel Klingberg’s research:

- Article written by Torkel Klingberg on The Overflowing Brain & Information Overload

- His recent book, which was The SharpBrains Most Important Book of 2008: The Overflowing Brain: Information Overload and the Limits of Working Memory

- 2006 Interview with Dr. Klingberg: Working Memory Training and RoboMemo: Interview with Dr. Torkel Klingberg

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

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

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

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

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

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

Insurance company Allstate and brain fitness software developer Posit Science just announced (see press release Protecting Pennsylvania Drivers, One Brain at a Time) a very intelligent initiative:

Video exercises aid driving skills (Chicago Tribune)

-”Allstate, which called the Posit program “potentially the next big breakthrough in automobile safety,” said it expects its software exercises to reduce risky driving maneuvers by up to 40 percent and improve stopping distance by an average of 22 feet when traveling at 55 miles per hour.”

-”We’ll look to see whether over the next six to nine months there will be a reduction in” the number of accidents between the group participating in the video exercises and those sitting out, said Tom Warden, assistant vice president of Allstate’s research and planning center.

I am fortunate to interview Tom Warden, Assistant Vice President and Leader of Allstate’s Research and Planning Center, based in Menlo Park, California.

Alvaro Fernandez: Tom, thank you for your time. Can you please explain the context behind this new initiative that you just announced?

Tom Warden: Our research center is constantly looking for new ideas to improve the driving behavior of drivers of all ages. Recently we have paid extra emphasis on ways to improve the safety of older drivers.

Let me provide some background here. Allstate, as a company, has always been one of the pioneers in helping to introduce new safety measures. For example, we were among the pioneers in the 60s to advocate for mandatory use of seating belts, given research studies on the benefits for drivers and passengers alike. More recently, we helped lobby for wider adoption of airbags, an effective but expensive way of protection that only became mainstream when manufacturers were required to include them.

Let’s talk now about your agreement with Posit Science. What will happen over the next months?

The first thing we are doing is to conduct a research study to analyze the real-life impact of Posit Science InSight, a computer-based cognitive training program, on accident rates. We know that as drivers get older Read the rest of this entry »

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

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

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

Without futher ado…enjoy the article!

- Alvaro

——————

Two New Cognitive Training Studies for ADHD Yield Promising Findings  

– By Dr. David Rabiner

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

Read the rest of this entry »