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Cognitive Training and ADD/ADHD: Interview with Prof. David Rabiner

On Friday we had the opportunity to interview Professor David Rabiner. He is a Senior Research Scientist and the Director of Psychology and Neuroscience Undergraduate Studies at Duke University, and also advocate for children and adults with ADD/ADHD.

Alvaro Fernandez (AF): welcome, Professor Rabiner. Could you first provide us with some background on your research interests?

Prof. David Rabiner: in summary, I will say that my long standing interests have been how to improve the quality of care received by children with ADD/ADHD and how to ensure a positive relationship between children’s social experience and their social cognitive functioning.

One of my first ADD/ADHD-related projects was a NIMH-funded grant to assist primary care pediatricians in providing more evidence-based methods for evaluation and treating children with AD/HD.

Right now I am an an investigator on two research studies. In one that is funded by the National Institute of Mental Health, we are conducting a longitudinal study of a large, community-based sample of youth with ADD/ADHD, and tracking their academic, clinical and behavioral performance over 6-7 years.

The other one is a 3-year grant by the Department of Education, to evaluate how computer-based programs can help kids with ADD/ADHD. We are analyzing the impact of two types of programs: a) Captain’s Log, which is a cognitive training program, and b) curriculum-based programs such as Riverdeep’s Destination Reading and Math.

AF: when will we start to see results from those studies?

DR: for the Mental Health longitudinal one, you may have to wait 4-5 years to see the first papers. For the Department of Education one, some preliminary results will be published in 2008.

AF: can you provide us with some background on the field of Cognitive Training and its applications to help people with ADD/ADHD?

DR: cognitive training rests on solid premises, and some programs already have very promising research results. Cognitive areas, such as attention, or working memory, can be conceptualized as skills and there is growing evidence that like other kinds of skills, they can be developed and improved with concerted practice. (As Professor Rabiner mentions this, I remember Dr. Goldberg’s insistence on the need for “intense mental challenges”).

Some of the most are promising areas are: neurofeedback, which as a whole (not for any specific branded program) is starting to present good research results, and working memory training, led by Dr. Torkel Klingberg, Cogmed and RoboMemo (we recently interviewed Dr. Torkel Klingberg about working memory training and ADD/ADHD, here are the interview notes).

AF: when Mark Katz and I met some school superintendents, he stressed that “attention deficit” is being reframed by the research community as “executive function deficit”. The bottleneck, the problem, is not attention itself, but on reliable and self-directed capacity to execute. Can you please elaborate?

DR: Dr. Russel Barkley, Research Professor of Psychiatry at the SUNY Medical University and Clinical Professor of Psychiatry at the Medical University of South Carolina, has been a key advocate for that view. Several years ago he published a comprehensive theory of ADHD in which he argues that the core problem is a deficit in “behavior inhibition“, and that this deficit interferes with the normal development of important executive functions.

In this theory, the behavioral symptoms that are currently used to diagnose ADHD – including inattention – reflect these underlying executive functioning deficits. There certainly is substantial evidence that individuals with ADHD perform poorer than others – as a group – on a number of executive functioning tasks that require planning, organizational skills, inhibiting responses (as assessed through tasks such as the Stroop test), decision making, working memory and other Frontal lobes executive functions. His theory is generating significant amounts of research and it is likely that our conceptualization of ADHD will continue to evolve in response to new findings.

AF: I understand Dr. Barbara Ingersoll and you are co-leading a panel at the CHADD Conference, in late October in Chicago. What will the panel be about?

DR: the title will be “New and Complementary Approaches to the Assessment and Treatment of AD/HD”, and we will provide an overview and update of research on complementary approaches to the evaluation and treatment of AD/HD, including the use of Quantitative EEG (QEEG) as part of a comprehensive evaluation for AD/HD, current research pertaining to neurofeedback and computerized training of working memory as treatments for AD/HD. We will also highlight the rationale and need for new evidence-based approaches to evaluation and treatment.

AF: I have also seen in CHADD’s agenda that Cogmed’s Dr. Torkel Klingberg will be presenting research on working memory training results. The panel is called Computerized Training of Working Memory in Children with ADHD. (For anyone interested, the description is “Working memory training, an evidence-based method for children with AD/HD, can significantly improve working memory, response inhibition and reasoning and reduce inattentive symptoms. The focus in this presentation is on research studies on working memory and its clinical use today). The intervention was development in conjunction with Karolinska Institute, and is commercialized by Cogmed with the name RoboMemo. The question: what do you recommend parents do when they are looking for new interventions for their children? How can they navigate through multiple companies and centers making a variety of claims?

DR: very relevant question. Parents are always looking for ways to help their children. Not only that, adults with ADD/ ADHD are also a very self-motivated group. However, there have been a number of disappointments. I would recommend parents discuss new interventions with their doctors, and also make informed decisions that include reading peer-reviewed publications, or at the very least being aware of what specific interventions have published results in respectable journals.

AF: how can parents, and anyone who is not a scientist, access those publications you mention?

DR: There are different ways. One, they can search for papers in PubMed. Sometimes the papers themselves are not available in PubMed, but the summaries, abstracts, are. If they want to read the whole article, they can go to any university libraries with free access to Medline.
For people who may not want to read the research papers, but be informed of the highlights of new research developments, I launched Attention Research Update, a free monthly newsletter helps parents, professionals, and educators stay informed about important new research on ADHD.

AF: Prof. Rabiner, this has been very helpful. Thank you for your time.

DR: Thank you. See you in CHADD conference.

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