Ben is a 12-year-old with ADHD, who used to have trouble in school. His grades were below average, and he was easily distracted, unable to remember much of the material taught in class. Ben struggled with homework assignments and studying for tests. He felt defeated, and was frustrated by his parents' attempts to get him to study harder. He put in the extra effort, but nothing seemed to help.
Ben's parents decided to work with Ari Tuckman, Psy.D., a clinical psychologist in West Chester, Pennsylvania. Tuckman uses Cogmed, a computer-based brain training program, in his practice. In five weeks, Ben completed 20 training sessions, playing the science-based computer games at Tuckman's office.
The results were surprising. His working memory improved, he retained more information in class, and he got higher grades on tests and quizzes. And the success made Ben feel better about himself.
"Working memory is the ability to hold information in your mind for several seconds, manipulate it, and use it in your thinking," says Tuckman. "It is central to concentration, problem solving, and impulse control."
People with ADHD can't always hold on to information because their attention gets hijacked. They are distracted by things around them and by new thoughts that come to them. Improving your working memory capacity enables you to pay attention, resist distractions, manage your emotions better, and learn.
Researchers have developed high-tech therapies that sharpen working memory and improve focus in children and adults with ADHD. Brain-training programs are not designed to replace ADHD medication, which helps manage core symptoms. They are adjunctive therapies that benefit ADHDers in ways that medication doesn't.
"The potential for brain training as a new therapeutic tool is phenomenal," says Amit Etkin, Ph.D., assistant professor in the department of psychiatry and behavioral sciences at Stanford University. "By understanding brain circuitry, we can tailor interventions that medication or psychotherapy do not access or improve. The great advantage is that these programs are not invasive, have minimal side effects, and are, for the most part, fun."
Two programs used to beef up working memory are Cogmed and Interactive Metronome. They've both been around for many years, are based in solid research, and are used in a clinician's office and/or at home with supervision. Both programs are developed for 7- to 12-year-olds, although both have more recently started offering programs for teens and adults, as well.
Here are the whys and wherefores of each program, so you can decide which might be right for your child.
Interactive Metronome (IM) has 10 years of peer-reviewed research behind it. Sessions can be done in an office with a trained coach, at home under a coach's supervision, or virtually at home. This program challenges the user's working memory by synchronizing a range of hand and foot exercises with a precise computer-generated tone heard through headphones. A child tries to match the rhythmic beat with repetitive motor actions. An auditory-visual guidance system gives immediate feedback, measured in milliseconds, and keeps score. IM improves the brain's timing through exercise and practice. Better timing sharpens focus, coordination, planning, and processing speed.
"Neurons that are firing are engaged in cognitive activities," says Kevin McGrew, Ph.D., director of the Institute for Applied Psychometrics/Research and science director for Interactive Metronome. "If we can increase neuro-efficiency with different types of environmental manipulations, the neurons will fire more frequently and process cognitive information more efficiently. It's like spraying WD-40 on the brain cells, to better synchronize the communication system that affects executive functioning and controlled attention."
April Christopherson, OTR-L, a neurological and developmental occupational therapist and director of occupational therapy at The Shandy Clinic, in Colorado Springs, uses Interactive Metronome with children and adults. "A lot of kids with ADHD have their auditory processing system firing at the same time as their visual and motor systems. A neurotypical person might be able to sit still in a classroom, listen to the teacher, write down what he needs to, and maintain focus. IM trains a child's brain to coordinate all of this sensory processing."
It takes persistent, consistent training to create new neural pathways. "I ask kids to do a minimum of 30,000 repetitions over the course of treatment," says Christopherson. "With the IM home system, I access each child's hours and scores online, to see how many repetitions he's done and how many days he has trained this month. If he's not keeping up, I lock his program until he comes into the office and gets back on track."
One of Christopherson's clients, a six-year-old named Peter, had been receiving speech and occupational therapy for two years, but his problems still held him back in school. Peter was enrolled in a six-week (18 sessions) course of IM. Sometime around the fifth week, Peter's mother observed that he communicated his needs more clearly, was less frustrated, and was able to complete tasks without being reminded to do them. In school, he paid more attention in class. At a parent-teacher meeting, Peter's teacher asked his mother if she had changed his medication. The only thing that was new was the IM therapy.