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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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