Your ADHD Brain — Only Stronger
The proponents of Cogmed’s working memory training gush about the improved focus and organizational skills in teens with ADHD who use the alternative therapy. Can this brain training for ADHD improve symptoms?
Having tried a flock of touted traditional and alternative strategies to manage my son’s ADHD, I was skeptical about the wondrous claims made for working memory brain training for ADHD.
Clinical psychologist Charles Shinaver, Ph.D., a former director of outpatient and assessment services at Deaconess Psychiatric Hospital and spokesperson for Cogmed — one of the most popular of such programs — insists that the training transformed his own ninth-grader. His son, he says, wound up earning “the best grades of his life,” teaching himself Farsi, mastering the guitar, and making so many friends that his parents had to “shut down our taxi service… to keep our sanity.”
Dared I hope for a similar miracle for my son, Buzz, and me, given that both of us have been diagnosed with attention deficit disorder (ADHD)? Shinaver’s anecdotal enthusiasm aside, several recent peer-reviewed studies in scientific journals suggest that Cogmed’s intensive, five-week training may improve the capacity for focus in kids with ADHD, leading to the Holy Grail of self-control. So it would seem that the program is worth a try, despite the twin hurdles of high price ($1,000) and heavy investment of time.
How It Works — and Why
Working memory — the ability to hold information in your head while you’re trying to achieve a specific goal — is a core problem for many children and adults who have ADHD. A working memory deficit can flummox you during the simplest tasks of daily life, such as trying to figure out why you opened the refrigerator door or keeping track of a conversation. Poor working memory is a strong predictor of academic failure and a major threat to self-esteem.
This explains the lure of working memory training. The neuroscientist Adele Diamond, Ph.D., an international expert in children’s cognitive development, based at the University of British Columbia, describes Cogmed — software developed by Swedish researcher Torkel Klinkberg in conjunction with Stockholm’s Karolinska Institute — as both “the most researched” computer-training program of its kind “and the one that was repeatedly found to be successful.”
Independent researchers who did controlled studies of the training have found that participants improved in several areas, including planning and organization, motivation, and attention. Scientists at the Karolinska Institute have also confirmed that Cogmed training physically changes the brain. MRI brain scans have shown changes in the pre-frontal and parietal regions at the end of the five-week training period.
My 15-year-old son and I certainly needed some of those brain changes. As I describe in my recent book, Buzz: A Year of Paying Attention, Buzz has struggled in school, under-achieving academically and repeatedly being suspended for bad behavior, while I’ve had trouble controlling my temper, especially with him. I’ve also dropped my share of balls juggling work and house-wifery.
We decided to try it. All I’d have to do — ha! — was convince my reluctant, skeptical teen to complete roughly 40 minutes of brain-training exercises, five days a week, for five weeks.
The biggest surprise was that this turned out to be easier than I’d expected. Conveniently, my son owed me $166 for a recent mishap involving a smashed, glass-framed poster in the hall outside of our family therapist’s office. He signed a contract in which he promised to complete the exercises or pay for the damage. He finished the training, on time, with few complaints.
I could soon tell that it wasn’t just the money that motivated him. The Cogmed exercises are adaptive — they get easier or harder, depending on your performance — and when you do well, the rewards are immediate and powerful. Each time you get something right, you hear pleasant music and “see” your success mapped out on a bar graph. As you do better, your computer monitor flashes encouragement, such as “Great!” “Go-go-go!” or “You Rock!” If you mess up, there’s no punishment, only silence.
If only we parents of children with ADHD could be so consistent!
Additionally, the Cogmed program involves guidance from a coach, who checks in on you each week by phone. Psychologist Ari Tuckman, Psy.D., filled this role for us, calling my son and me to discuss our progress and cheer us on. Tuckman captured my gym-rat son’s imagination by comparing the exercises to weightlifting; daily repetitions make you stronger.
Programmed for Success?
The training consists of eight simple, memory-tuning exercises. The software prompts you, for instance, to listen to a string of numbers and recite them backwards, or to watch sections of a grid light up in sequence, and then copy the pattern. It’s not exactly scintillating stuff, but over time, I found myself enjoying and getting better at the drills. I suspect my son shared this experience. The program provides graphs that chart your progress, and both of us watched our lines go steadily upward. Tuckman kept telling my son how much better he was doing than I was — another powerful motivator for him.
The obvious question for consumers is how this proficiency translates into real-world skills. Cogmed representatives say 80 percent of those who complete the training experience “significant change.” I looked for signs of improvement, both in Buzz and me, and didn’t see anything dramatic.
At the start of Week 3, I forgot my purse when I went out to dinner. On the other hand, after only a couple of weeks, it seemed that my son was making more eye contact, and having fewer and less intense temper tantrums. Amid one of our most difficult summers ever, full of cabin fever and conflict, we had some unusually calm conversations. Furthermore, after Buzz hacked into my Facebook account, sending goofy messages to my friends — alas, not unusual behavior for him — he apologized, which wasn’t exactly on par with teaching himself Farsi, but, for him, was extraordinary.
Results Over Time
Tuckman tells me that the changes often take time to appear — sometimes several months after the training is completed — so I’m staying hopeful.
Meanwhile, I’m pondering two questions: 1) Might it be that anything else that was going on in our lives this summer — from family therapy to the fact that my son was out of school for a couple of months-helped improve his behavior? This is something only a controlled study could tell us, and I had only my anecdotal experience. 2) What role did our expectations play in the improvements we saw?
A great deal of research has been done on the placebo effect, all of it suggesting that expectations matter mightily. It’s also a no-brainer that when a parent directs intense, positive attention toward a child — from closely monitoring his diet to schlepping her to violin lessons — it’s bound to have a positive effect.
Might it be that my son was being perceptibly nicer because I’d been sending him my own “You Rock!” signals every time he completed a day of Cogmed training? I’ll probably never know, but I am convinced it didn’t hurt.