Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News


Cognitive Neuroscience and ADD/ADHD Today

Some days ago we men­tioned atten­tion deficits and exec­u­tive func­tions, as part of a review of Cog­ni­tive Neu­ro­science and Edu­ca­tion. Let me explore that in more depth now, hav­ing just met a num­ber of very inter­est­ing researchers, doc­tors and experts at CHADD con­fer­ence, and wit­nessed the first baby steps of a com­ing rev­o­lu­tion.

First, 3 clar­i­fi­ca­tions are in order:

- CHADD is the main con­fer­ence for pro­fes­sion­als involved in ADD/ADHD work. Our part­ners in Cogmed and I attend­ed it last week

- “Atten­tion” and exec­u­tive func­tion­ing are rel­e­vant to every human being. They are not bina­ry (either I have good atten­tion, or I have an atten­tion deficit), but a skill, a mus­cle, that can be more or less devel­oped, and that is sub­ject to devel­op­ment and train­ing.

- ADD/ADHD (atten­tion deficit dis­or­der) is diag­nosed accord­ing to lists of symp­toms that med­ical pro­fes­sion­als eval­u­ate. It is a neu­ro­bi­o­log­i­cal prob­lem, with well-researched frontal lobe and exec­u­tive func­tion­ing impli­ca­tions, but the assess­ment today only takes into account rat­ing scales of symp­toms.

A num­ber of par­tic­i­pants in CHADD con­fer­ence last week dis­cussed how we could feel the first steps of a rev­o­lu­tion in the under­stand­ing and treat­ment of ADD/ADHD and, by exten­sion, in the main­stream under­stand­ing of what the Frontal Lobes of our brains are, and why, and how, each of us could take care of them thanks to well-designed Brain Fit­ness Pro­grams. A chronol­o­gy of events in the con­fer­ence to share that feel­ing:

- Wednes­day: Cogmed orga­nized a pri­vate meet­ing with the 15 US-based clin­i­cians (from pedi­a­tri­cians to neu­ropsy­chol­o­gists and child psy­chi­a­trists) who have start­ed to offer RoboMemo to their patients with work­ing mem­o­ry deficits‑a con­di­tion in many kids and adults with ADD/ADHD. We heard incred­i­ble tes­ti­mo­ni­als from peo­ple like Dr. Bar­bara Inger­soll, Dr. Arthur Lavin, and oth­ers. Not only that, but Dr. Torkel Kling­berg pre­sent­ed some pre­lim­i­nary data com­ing from the work in the Karolin­s­ka Insti­tute and a repli­ca­tion study done in by Bradley Gib­son at NotreDame Uni­ver­si­ty (he and his team are doing very inter­est­ing work on cog­ni­tive train­ing of exec­u­tive func­tions).

- Thurs­day: Mark Katz won a well-deserved award and talked about his inter­est in resilience and emo­tion­al endurance. Emo­tion­al man­age­ment and self-moti­va­tion being key areas, Mark Katz and I lat­er had a great con­ver­sa­tion on resilien­cy and emo­tion­al endurance. In short, he is writ­ing a new book on the impor­tance of “turn­ing points” that enable all of us, includ­ing peo­ple brought up in dif­fi­cult con­texts (with many risk fac­tors, such as ADD/ADHD), over­come life dif­fi­cul­ties by attach­ing new mean­ings to our expe­ri­ences and our lives, devel­op­ing a sense of mas­tery, and find­ing at least one area in our lives where we can suc­ceed and build self-con­fi­dence around.

- Also on Thurs­day, Dr. Rus­sel Barkley, Research Pro­fes­sor of Psy­chi­a­try at the SUNY Med­ical Uni­ver­si­ty and Clin­i­cal Pro­fes­sor of Psy­chi­a­try at the Med­ical Uni­ver­si­ty of South Car­oli­na, gave the open­ing keynote speech in which he showed pre­lim­i­nary find­ings from his research on adults with ADD/ADHD and con­clud­ed that most rel­e­vant symp­toms to diag­nose an adult with ADD/ADHD involve exec­u­tive func­tion­ing and frontal lobe prob­lems. We have talked about this ear­li­er, but in short: exec­u­tive func­tions reside in our brain’s frontal lobes (behind our fore­head), and deal with abil­i­ties such as inhi­bi­tion, work­ing mem­o­ry, orga­ni­za­tion to time and future events, emo­tion­al man­age­ment, self-moti­va­tion, and plan­ning.

- Fri­day: 2 great pre­sen­ta­tions by Dr. Torkel Kling­berg on Cogmed’s work­ing mem­o­ry train­ing pro­gram, RoboMemo, were very well received by a large audi­ence. Torkel intro­duced us to exist­ing research on the effects of work­ing mem­o­ry train­ing not only in the ADD/ADHD field (includ­ing the effect on dopamine cre­ation and recep­tor den­si­ty), but also in stroke reha­bil­i­ta­tion, and nor­mal chil­dren and adult devel­op­ment and aging.

- Sat­ur­day: Mark Katz and a good num­ber of oth­er peo­ple were very inter­est­ed in watch­ing an amaz­ing video on atten­tion (if you have 2 min­utes, please try it)

As I left the con­fer­ence I was think­ing about how to best sum­ma­rize these new find­ings and their impli­ca­tions, and for­tu­nate­ly came across an Edi­to­r­i­al titled The Role of Intel­lec­tu­al Process­es in the DSM‑V Diag­no­sis of ADHD, writ­ten by Jour­nal of Atten­tion Dis­or­ders Edi­tor-in-Chief and neu­rop­shy­chol­o­gist Dr. Sam Gold­stein and Jack A. Naglieri (August 2006).



1. There are two types of ADD/ADHD, and they are very dif­fer­ent in nature, diag­no­sis and inter­ven­tion

A) ADHD-Com­bined: which Dr. Gold­stein calls a “self-reg­u­la­tion deficit”, because the main prob­lem lies in exec­u­tive func­tions. This can be con­cep­tu­al­ized as “a fail­ure of self-con­trol with­in the con­text of pre­frontal lobe func­tions” (Dr. Elkhonon Gold­berg, 2001), and the main prob­lem seems to lay on poor behav­ioral inhi­bi­tion (Barkley, 1997). “poor plan­ning and antic­i­pa­tion; reduced sen­si­tiv­i­ty to errors; poor orga­ni­za­tion; impaired ver­bal prob­lem-solv­ing and self-direct­ed speech; poor rule-gov­erned behav­ior; poor self-reg­u­la­tion of emo­tions; prob­lems devel­op­ing, using and mon­i­tor­ing orga­ni­za­tion­al strate­gies; and self-reg­u­la­tion and inhi­bi­tion prob­lems (Barkley 2003). Gold­berg suc­cinct­ly sum­ma­rizes this frontal lobe dys­func­tion, based on his men­tor Alexan­der Luri­a’s work, as “poor plan­ning and fore­sight, com­bined with dimin­ished impulse con­trol and exag­ger­at­ed affec­tive volatil­i­ty (p.179 of Exec­u­tive Brain)

B) ADHD-Inat­ten­tive: kids and adults with selec­tive atten­tion prob­lems. This would be the true “atten­tion deficit”

2. Sug­gest­ed impli­ca­tions for diag­no­sis and inter­ven­tion: espe­cial­ly for kids and adults with ADHD-Com­bined, Dr. Gold­stein writes that “chil­dren who are poor in plan­ning and poor in math cal­cu­la­tion improved con­sid­er­ably when pro­vid­ed an inter­ven­tion that helped them bet­ter use their plan­ning process­es and be less com­pul­sive and more thought­ful and reflec­tive when com­plet­ing aca­d­e­m­ic work.


This is part of where Brain Fit­ness pro­grams such as Cogmed work­ing mem­o­ry train­ing help, hav­ing been shown to gen­er­al­ize to oth­er cog­ni­tive areas such as prob­lem solv­ing (Ravens) and response inhi­bi­tion (Stroop test-see below). For bet­ter con­text, you can read my con­ver­sa­tion with Pro­fes­sor David Rabin­er on cog­ni­tive train­ing.

Through­out this post, we have been using 2 con­cepts, plan­ning and inhi­bi­tion, that you can try your­self in 2 fun games based on neu­ropsy­cho­log­i­cal assess­ments:

- Plan­ning: Tow­ers of Hanoi

- Inhi­bi­tion: Stroop Test

Final­ly, let me men­tion some promis­ing areas of research.

- The so-called “Dopamine effect”: whether dopamine recep­tor den­si­ty can be influ­enced by cog­ni­tive train­ing.

- Objec­tive assess­ments for ADD/ADHD, such as cog­ni­tive bat­ter­ies (which need to be psy­cho­me­t­ri­cal­ly-sound assess­ments), and/ or EEG biofeed­back. Specif­i­cal­ly, cog­ni­tive bat­ter­ies should help iden­ti­fy kids and adults with spe­cif­ic weak­ness (for instance, say­ing that “my Man­darin flu­en­cy is not that good) ver­sus hav­ing a seri­ous deficit or “bot­tle­neck” (say­ing “not speak­ing Man­darin flu­en­cy is pre­cise­ly my main prob­lem, if I could solve it first, then many good things good fol­low).

- Larg­er repli­ca­tion stud­ies for work­ing mem­o­ry train­ing.

- Bet­ter assess­ment and inter­ven­tions designed specif­i­cal­ly for adults.

For more infor­ma­tion on Exec­u­tive func­tions, you can check the excel­lent review in the Amer­i­can Jour­nal of Psy­chi­a­try, of Dr. Elkhonon Gold­berg’s book The Exec­u­tive Brain

That’s it for now. Am par­tic­i­pat­ing today and tomor­row at the Seri­ous Games Sum­mit in DC, so will write from a dif­fer­ent per­spec­tive for the rest of the week.

Leave a Reply...

Loading Facebook Comments ...

8 Responses

  1. CS Tan says:

    What­ev­er the out­come of more research into the caus­es of ADHD, I believe that the best treat­ment remains using a mul­ti-pronged strat­e­gy which cov­ers med­ica­tion and behav­iour­al ther­a­py. It is how­ev­er easy to say but dif­fi­cult to imple­ment because from where I come from, most doc­tors don’t know how to treat ADHD prop­er­ly.

  2. Alvaro says:

    Hel­lo CS,

    For the time being, a mul­ti-pronged strat­e­gy com­bin­ing both med­ica­tion and behav­iour­al ther­a­py. Now, that is not a “treat­ment”.

    The more researchers dis­cov­er, the more they will be able to help devel­op more fun­da­men­tal inter­ven­tions hat address the under­ly­ing deficits, in more durable/ struc­tur­al ways.

    Thank you for your com­ment

Leave a Reply

Categories: Attention and ADD/ADHD, Cognitive Neuroscience, Education & Lifelong Learning, Health & Wellness, Peak Performance, Professional Development, Uncategorized

Tags: , , , , , , , , , , , , , , , , ,

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

Search in our archives

Follow us and Engage via…

RSS Feed

Watch All Recordings Now (40+ Speakers, 12+ Hours)