Simultaneously with the Toronto Catholic District School Board axing the Arrowsmith Program, four other neuroplasticity programs are being considered for adoption by the non-sectarian Toronto District School Board. The four are Arrowsmith, Cogmed Working Memory Training, Fast ForWord and Wasdell SMaRts. Two of the programs, Cogmed and Fast ForWord are being used in Toronto schools now. Arrowsmith has been employed in the Catholic Board for the last ten years and had previously participated in a number of studies of effectiveness although none of these studies measured changes in the actual classroom.
Another study assessing Cogmed is scheduled to start this fall under the supervision of Toronto’s Hospital for Sick Children researcher Rosemary Tannock. This study in Ontario’s demonstration school will track 120 students who are severely learning disabled. According to Tannock, “The big question is not just whether Cogmed can improve working memory but will it really improve classroom performance.” A further study using Cogmed is set to begin with students at the University of Toronto.
Even though almost everything we know about the brain has changed in the last decade or so, there is still much misinformation out there and this was the subject of an article on the SharpBrains web site dated June 20th by CEO Alvaro Fernandez which included the Top Ten Brain Training/Cognitive Health Myths. You will find the article on the SharpBrains site here.
The myths are:
1. Genes determine the fate of our brains.
2. Aging means automatic decline.
3. Medication is the main hope for cognitive enhancement.
4. We will soon have a Magic Pill or General Solution to solve all our cognitive challenges.
5. There is only one “it” in “Use It or Lose it”.
6. All brain activities or exercises are equal.
7. There is only one way to train your brain.
8. We all have something called “Brain Age”.
9. That “brain age” can be reversed by 10, 20, 30 years.
10. All human brains need the same brain training.
One that stands out for me is number three. SharpBrain’s response to this myth is, “Non-invasive interventions can have comparable and more durable effects–side effect free.” I was diagnosed with ADHD Primarily Inattentive. My understanding is that this subtype is not usually that responsive to stimulant medication and if it is at all it is usually at low doses. This was the case for me but my low dose was almost too low to have any beneficial effect at all.
The other myth that stands out for me is number seven and SharpBrain’s response to this one is, “Brain functions can be impacted in a number of ways: through meditation, cognitive therapy and cognitive training.”
For those that struggle with medication to temporarily improve working memory, what can be accomplished by cognitive training, meditation and other options is good news but I despair at those out there who are still operating as if the SharpBrain myths were true.
As anyone who reads this blog will know by now, you can change your brain and you can improve your working memory and this begs the question, “By how much?” In an interview conducted for Science Magazine last February, Dr. Torkel Klingberg of the Karolinska Institutet in Stockholm commented on a study he had conducted that demonstrated that working memory training actually changes the structure of the brain, Dr. Klingberg said that the training was associated with changes in the brain’s dopamine system.
I jumped to what I thought was the logical conclusion, when I first heard about the study–that the training increased the number of dopamine receptors (actually D1 receptors) and that this meant there might not be any limit on how great that improvement might be. Like most things involving the brain, it is not that simple. Dr. Klingberg made it clear in the interview that the training changed the density of D1 receptors. He went on to say that either too much or too little is not good and that for most subjects in the study, there was actually a decrease in receptor density and that for some of them there was a very small increase.
From my own experience I know that stimulants such as Ritalin (or its many varients such as Concerta or Biphentin) increase the amount of the neurotransmitter dopamine available to the brain. But it would seem that there is something much more complicated and refined going on with working memory training.
Why is this important? In the interview Dr. Klingberg points out that working memory deficits occur in ADHD, but also in schizophrenia and even the normal aging process. So improving working memory may have a beneficial effect on some of these disorders. Finding the optimal dose of a medication is a tricky issue, especially with stimulants. But it would appear from what Dr. Torkel says that working memory training is self regulating, that, put quite simply, you can’t over do it. It would seem that working memory training is a safe, effective and efficient way of improving working memory and, hopefully having an effect on disorders where deficits in working memory is a factor.
Beyond all this, another study conducted at the Karolinska Institutet, constructed a mathematical model of the brain and using this model discovered a mechanism that restricts the number of items held in working memory to seven.
Over the last few months my path has crossed with several people who are troubled by the fact that they seem to be acquiring label after label from mental health practitioners. The complaint is usually expressed something like this, “I just got used to the idea that I have an attentional disorder and now I’m told I have bi-polar disorder and an anxiety disorder as well.”
I understand their discomfort as I believe everyone wants to think of themselves as normal, functional and worthy of their own self esteem. But just thinking of yourself as normal doesn’t make it so. Besides that, it really seems like sweeping the problem under the carpet. Decades ago a friend of mine began seeing a psychiatrist who told him in the first visit to pretend he was normal until he was normal. Of course the psychiatrist would analyze his actions and thoughts over a period of time and offer advice and direction that would lead him to being normal. Another friend, only a year ago, when I raised the issue of my ADHD, asked me, “Why can’t you just think of yourself as normal?” My reply astonished even me at the time when I said, “I don’t want to think of myself as normal. I want to be normal.” I went on to explain that I thought that my journey began with finding out what wasn’t working for me, such as focus and attention, and then I could do something about it. This is what I have tried to do with medication. I would go about it differently now that I know about neuroplasticity and that problems with working memory seem to be at the heart of ADHD and that you can improve working memory. In other words I would be looking for a more permanent kind of change than what medication provides. To me this represents the hope provided by the new research in neuroscience–that the brain can change and we can change it.
In addition, multiple disorders do not necessarily equate to multiple causes or underlying problems. In fact one job of the diagnostician, as I undertand it, is to find the primary disorder. In many cases treatment of this disorder will have a beneficial effect across the board. A few years ago I read a book entitled Shadow Syndromes written by John Ratey, who co-wrote Driven to Distraction with Edward Hollowell. Ratey’s thesis is that there are a number of disorders that seem to have a common underlying cause which he calls ‘noisy brain’. This spectrum of noisy brain disorders would include Bi-Polar, Tourettes Syndrome, Obsessive Compulsive Disorder, Anxiety Disorders, Mood Disorders. I know that ADHD, which would be included in the noisy brain spectrum, almost always occurs with co-morbidities as they are known, that would be in the ‘noisy brain’ spectrum. It seems a forgone conclusion that if you could alleviate the ‘noisy brain’ problem you would also alleviate symptoms of the co-occurring conditions or co-morbidities.
The idea of multiple diagnoses would then not really matter if you could just treat ‘noisy brain’. I don’t know that ‘noisy brain’ is related to problems with working memory but I would be willing to bet on it. If this is the case, improving working memory could have a positive effect on all of these ‘noisy brain’ disorders and that I find that encouraging and hopeful…
For the most part in this blog I try to avoid what may look like blatant promotion of Cogmed Working Memory Training and I have explained my relationship with them in the first post. In short, I do marketing work in Canada for them. However, to get to the point of this post, with the recession and the mass lay-offs that are occurring I recalled an article I wrote for HR Professional a year ago. HR Professional is the journal of the Human Resources Professionals Association of Ontario. Don’t let the Ontario part mislead you, this is one of the largest professional associations in North America. Anyway, to get back to the point, the thesis of the article was that in building a case to fire an employee, a supervisor may turn up what looks like poor performance but could actually be symptoms of problems with working memory and they were listed in the article. For the sake of convenience these symptoms could include work turned in late or not at all, persistent lateness, inability to get along with co-workers. Anyone familiar with HR practices knows the cost in time and revenue in building a case for dismissal, dismissing an employee and the cost of hiring a replacement. The cost of Cogmed Working Memory Training, which has a record of improving working memory in 80% of people who go through the training, is about $1,500 and this cost would certainly be less than the cost of firing any employee in any organization and you get to turn an underperforming employee into a valuable asset. Some analysts say the recession may have bottomed out. Regardless, smart employers, looking to the future, know that now is the time to start to rethink their HR practices including those around individual dismissals. Layoffs don’t usually involve much of a selection process and it is acceptable to most employers that one cost of doing it is losing some good employees. As the recovery begins, individual dismissals, once again, will become a fact of life but why fire an employee who could become a genuine asset to the organization. Retaining an employee and turning him into a valuable corporate asset is good for the company, good for the bottom line and, of course, will ensure the employee’s loyalty for a long time to come. Taking a step back and having another look at what is behind the poor performance of under performing employees could pay off in the long run. If it is a working memory problem it may be worth having a go at trying to improve it with Cogmed Training or something similar.
When I presented this argument to Bob Redford, an independent consultant in labor/management relations in Canada, his only comment was, “Well, when you look at the math its pretty much a no-brainer…”