Brain Training

What You Need to Know About Cogmed© Working-Memory Training

Cogmed is more than a video game. This brain-training software program promises to reduce inattention and hyperactivity, and improve memory in people with ADHD. What you need to know to assess it.

Mother and daughter on the computer doing homework

One oft-heard complaint about complementary therapies used to treat attention deficit disorder (ADHD) is a dearth of controlled studies to support their claims. Not so, it seemed, with the working-memory training developed by Cogmed© in conjunction with the Karolinska Institute, a medical university based in Stockholm.

In 2002, Cogmed co-founder Torkel Klingberg published the results of a study that suggested students engaged in working-memory training could improve their scores on standardized tests after roughly five weeks of use. A similar study published in 2008 went a step further, suggesting that a person could boost her IQ by a full point with each hour of working-memory training. Since 2002, more than 25 additional studies have supported the efficacy of the Cogmed© Working Memory Training program on improving ADHD symptoms.

One of them, a study published in the journal Psychology in 2016 said, “Our results suggest that Cogmed© WM training could be an effective training program for children with neurodevelopmental problems, with the best results for children with ADHD or learning problems. These findings add to the accumulating evidence that [Cogmed© Working Memory] training may indeed reduce attention and memory problems, learning difficulties and academic achievement problems, and suggest plasticity of the brain in children with neurodevelopmental problems across a wide age range.”

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There is just one problem: According to “Brain Games Are Bogus” by The New Yorker, “A pair of scientists in Europe recently gathered all of the best research — twenty-three investigations of memory training by teams around the world — and employed a standard statistical technique (called meta-analysis) to settle this controversial issue. The conclusion: the games may yield improvements in the narrow task being trained, but this does not transfer to broader skills like the ability to read or do arithmetic, or to other measures of intelligence. Playing the games makes you better at the games, in other words, but not at anything anyone might care about in real life.”

Other scientists, arguing that previous research lacked careful controls and rigorous cognitive-skills tests, have attempted to reproduce the results of the 2008 study with those enhancements in place. In doing so, teams from Georgia Tech and Case Western Reserve University both found insufficient scientific evidence to support the claim that working-memory training improves intelligence.

Cogmed© stands by its promises and past research, however consumers of this alternative therapy should know that the scientific community is not unanimous in its support of working-memory training.

“[Brain-training companies] claim to grow the brain compared to doing nothing, but they don’t show that brain training is better than just doing healthy things,” says Joel Nigg Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at OHSU. “Are you better off spending half an hour doing brain training, or are you better off spending a half hour taking a walk?”

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ADDitude talked with Bradley Gibson, Ph.D., lead author of the uncontrolled study, published in 2007 by the University of Notre Dame, and Barbara Ingersoll, Ph.D., a clinical associate professor in West Virginia University’s department of behavioral medicine and psychiatry and a Cogmed© trainer, to learn how the program works from two of its proponents. Here is what they said:

What is working memory?

It’s the ability to hold onto information long enough to accomplish a specific goal. You hold a phone number in your mind as you dial it, or you hold a task in mind — organizing your room, say — as you work on it. We use working memory throughout the course of a day.

How does improving working memory help someone with ADHD become more focused?

When you improve working memory, you improve fluid IQ — the ability to solve problems or adapt to situations as they occur. Most people who complete memory training become more alert to their surroundings. They are also more aware of social cues. (Learn about the age-by-age working-memory “milestones” here.)

Parents sometimes report that their kids become more “mature.” They take charge of their hygiene and do chores without being nagged. They remember to bring books and materials to and from school.

How does Cogmed© working-memory training work?

A patient logs on to the working-memory program, which is downloaded on his home computer. He completes eight exercises, each comprising 15 trials. The exercises are in a video-game format — with colorful graphics and crisp sound.

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In one exercise, the child shoots down floating asteroids; in another, he recalls numbers in the reverse order in which they are given; in another, he remembers the sequence in which rows of lights turn on. The patient uses his computer mouse to submit the answers — and earns points along the way.

The program stays a step ahead of the person’s ability, making exercises increasingly difficult. If it’s a child with ADHD, a trainer calls once a week to talk with the parents, troubleshoot, and encourage the child.

At what age can Cogmed© training begin?

The training is rigorous, so few children under seven can stick with it.

How long is the training, and how much does it cost?

Training sessions run five weeks, five days a week, for an hour each day. The fee for Cogmed© Working Memory Training is set by each individual Cogmed© Qualified Practice and varies by location.

Prices begin at roughly $1,500 per session; brain training is not covered by most medical insurance plans.

In your studies, what percentage of patients show improvement after the training?

Children have been studied most extensively, and about 75 to 80 percent of kids show improvement — that is, inattention and hyperactivity are reduced. Karolinska Institute researchers did functional MRIs of the children they studied. The MRIs showed physical changes in the brain’s pre-frontal and parietal regions after completing the training. At six-month and one-year follow-ups, about 80 percent of subjects maintained their working-memory gains or improved on them. (Editors’ note: Cogmed co-founder Torkel Klingberg, M.D., Ph.D., is a professor of cognitive neuroscience at Karolinka Institute and is behind much of the research referenced above.)

Are there any side effects?

There have been no observed side effects. It doesn’t affect other therapies. Most people who participate in the program are on ADHD medication.

Is working-memory training a substitute for medication?

The program does not claim to replace medication. While many individuals with ADHD get good results on ADHD medication, drugs don’t usually manage all symptoms. Improving working memory can address those lingering problems.