Working Memory Training from a pediatrician perspective, focused on attention deficits

Today we inter­view Dr. Arthur Lavin, Asso­ciate Clin­i­cal Pro­fes­sor of Pedi­atrics at Case West­ern School of Med­i­cine, pedi­a­tri­cian in pri­vate prac­tice, and one of the first providers of Cogmed Work­ing Mem­o­ry Train­ing in the US (the pro­gram whose research we dis­cussed with Dr. Torkel Kling­berg and Dr. Bradley Gib­son). Dr. Lavin has a long stand­ing inter­est in tech­nol­o­gy-as evi­denced by Microsoft­’s recog­ni­tion of his paper­less office- and in brain research and appli­ca­tions-he trained with esteemed Mel Levine from All Kinds of Minds-.

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Key take-aways:

- Schools today are not yet in a posi­tion to effec­tive­ly help kids with cog­ni­tive issues deal with increas­ing cog­ni­tive demands.

- Work­ing Mem­o­ry is a cog­ni­tive skill fun­da­men­tal to plan­ning, sequenc­ing, and exe­cut­ing school-relat­ed work.

- Work­ing Mem­o­ry can be trained, as evi­denced by Dr. Lav­in’s work, based on Cogmed Work­ing Mem­o­ry Train­ing, with kids who have atten­tion deficits.

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Con­text on cog­ni­tive fit­ness and schools

AF (Alvaro Fer­nan­dez): Dr. Lavin, thanks for being with us. It is not very com­mon for a pedi­a­tri­cian to have such an active inter­est in brain research and cog­ni­tive fit­ness. Can you explain the source of your interest?

AL (Arthur Lavin): Through­out my life I have been fas­ci­nat­ed by how the mind works. Both from the research point of view and the prac­ti­cal one: how can sci­en­tists’ increas­ing knowl­edge improve kids’ lives? We now live in an tru­ly excit­ing era in which sol­id sci­en­tif­ic progress in neu­ro­science is at last cre­at­ing oppor­tu­ni­ties to improve peo­ple’s actu­al cog­ni­tive func­tion. The progress Cogmed has achieved in cre­at­ing a pro­gram that can make great dif­fer­ences in the lives of chil­dren with atten­tion deficits is one of the most excit­ing recent devel­op­ments. My col­league Ms. Susan Glaser and I recent­ly pub­lished two books: Who’s Boss: Mov­ing Fam­i­lies from Con­flict to Col­lab­o­ra­tion (Col­lab­o­ra­tion Press, 2006) and Baby & Tod­dler Sleep Solu­tions for Dum­mies (Wiley, 2007), so I not only see myself as a pedi­a­tri­cian but also an edu­ca­tor. I see par­ents in real need of guid­ance and sup­port. They usu­al­ly are both very skep­ti­cal, since they have been promised too many things too many times by “experts”, yet open-mind­ed to ideas with good foun­da­tions. Many pro­fes­sion­als have only the skep­ti­cal frame, since they were edu­cat­ed when sci­en­tists still believed the brain was pret­ty rigid and “untrain­able”. We need much more brain sci­ence-based pro­fes­sion­al devel­op­ment, and appre­ci­ate the great work Sharp­Brains is doing.

AF: Let’s talk about that “train­abil­i­ty” and schools. Most peo­ple still think of “intel­li­gence” as fixed. Now, I recent­ly read a report on how KIPP schools empha­size the train­ing on some basic skills, such as shared atten­tion, as a need­ed foun­da­tion for good aca­d­e­m­ic per­for­mance. So, even if lim­it­ed in scope, it seems some schools are start­ing to under­stand their role in cog­ni­tive devel­op­ment. In your expe­ri­ence, are schools ful­fill­ing their roles as brain gyms, places where young minds get shaped and ready for life?

AL: Good ques­tion. I have been a pedi­a­tri­cian work­ing with schools in the Cleve­land area since 1985, seen all kinds of dis­eases. For exam­ple, I have wit­nessed the grow­ing inci­dence of autism spec­trum dis­or­ders, such as autism and Asperg­er’s. I have also observed how school work has increas­ing­ly become more cog­ni­tive­ly demand­ing, start­ing from kinder­gar­den. There is too much pres­sure today, and a grow­ing num­ber of prob­lems, yet I don’t see that schools are apply­ing the best knowl­edge of how minds work. Just as doc­tors offices are cen­ters of applied med­ical sci­ence, tak­ing the lat­est advances in med­ical research and apply­ing them to the med­ical care of peo­ple, schools should be the best place for applied neu­ro­science, tak­ing the lat­est advances in cog­ni­tive research and apply­ing it to the job of edu­cat­ing minds. Yet, they aren’t, and I can’t blame them , giv­en the wide vari­ety of pres­sures they work under, and the large change in per­spec­tive becom­ing insti­tutes of applied neu­ro­science would take.

A cog­ni­tive gap?

AF: Some read­ers may be skep­ti­cal of the claim that school work is more demand­ing today than, say, 20 years ago. They may say kids are sim­ply becom­ing “lazy”. What do you say to that?

AL: I have nev­er met a lazy kid. All peo­ple want to suc­ceed, in life if not in school. Most chil­dren who strug­gle at school strug­gle might­i­ly to get ade­quate grades. It is true that some are more resilient that oth­ers-if they fail, they will try 10 times hard­er. The ones that are labeled as “lazy” are typ­i­cal­ly ashamed of their lack of capac­i­ty to deal with demands, and resort to an eva­sive strat­e­gy, they try to avoid the whole sit­u­a­tion, run away.

AF: You men­tion a “lack of capac­i­ty to deal with demands”. Is that gap grow­ing? The equa­tion has 2 com­po­nents: capac­i­ty and demands. In terms of capac­i­ty, let me men­tion that recent­ly, the French Edu­ca­tion Min­istry just intro­duced men­tal arith­metic as part of the cur­ricu­lum. I remem­ber, as a kid, spend­ing many hours in the math class where the teacher would require us to per­form a pro­gres­sive­ly com­plex sequence of men­tal cal­cu­la­tions-which is good train­ing for skills such as work­ing mem­o­ry. Mem­o­ry train­ing was important.

AL: Great point. For exam­ple, years ago we had to mem­o­rize long texts, which, no mat­ter what the con­tent was, was a great way to train and build our atten­tion span, work­ing mem­o­ry, and to devise strate­gies to learn. Today, there are less oppor­tu­ni­ties for such training.

In terms of demands, I can see how com­plex home­work assign­ments are these days even in 3–4rd grade. Kids need to plan and pre­pare a whole matrix of tasks that require good orga­ni­za­tion­al work to com­plete. They need to sequence what they do today, tomor­row, the day after. The major dif­fi­cul­ty, for which such young brains may not be ful­ly ready, is to deal with an over­whelm­ing amount of infor­ma­tion and demands, and execute.

Work­ing Mem­o­ry and Atten­tion Deficits (more about WM at www.aboutworkingmemory.org)

AF: that seems to imply a high­er need for good exec­u­tive func­tions than years ago. A kid needs to have good work­ing mem­o­ry to retain, pri­or­i­tize and sequence much infor­ma­tion into action­able plans, and then exe­cute them, as I had the for­tune to dis­cuss with Mark Katz some months ago. From my pre­vi­ous inter­views with Dr. Kling­berg and Dr. Gib­son, we know that a com­mon prob­lem with many kids with diag­nosed atten­tion deficits is, indeed, work­ing mem­o­ry (the abil­i­ty to hold in mind and manip­u­late sev­er­al units of infor­ma­tion). Can you explain what you see in your work with schools?

AL: I am afraid that many schools are too quick to diag­nose ADD/ ADHD and con­sid­er drugs as the only poten­tial inter­ven­tion. The label itself can be mis­lead­ing and coun­ter­pro­duc­tive. School psy­chol­o­gists have won­der­ful exper­tise in eval­u­at­ing sub­ject-relat­ed prob­lems and describ­ing atten­tion­al deficit symp­to­ma­tol­ogy, but are not trained or asked to com­plete neu­ropsy­cho­log­i­cal pro­files of a child’s cog­ni­tive func­tions. Up to a point, many kids with atten­tion prob­lems would ben­e­fit from edu­ca­tion­al, not med­ical, inter­ven­tions to improve cog­ni­tive func­tions such as work­ing mem­o­ry. I am see­ing it first hand, hav­ing used Cogmed Work­ing Mem­o­ry Train­ing (also called RoboMemo) with 15 pre-screened kids: 80% of them pre­sent­ed a sub­stan­tive improve­ment. With 50%, the results we have seen have been dramatic.

AF: Please give us some exam­ples, so our read­ers can bet­ter under­stand what work­ing mem­o­ry is and its role in aca­d­e­m­ic per­for­mance and dai­ly life.

AL: Let me give you 3 vignettes, all 3 with diag­nosed atten­tion deficits, who showed clear ben­e­fit not only on cog­ni­tive func­tion­ing but also on AD/HD rat­ing scales.

Patient 1: 11-year-old boy, very impul­sive, even on med­ica­tion. Does­n’t do home­work, con­stant­ly for­gets chores. After the 5‑week pro­gram, he is able to sit down and lis­ten instruc­tions, engag­ing in few­er argu­ments with his par­ents. He can do bet­ter men­tal math- for the first time in his life able to do so with­out using his fin­gers. He finds that fol­low­ing school and doing home­work is eas­i­er, grades have improved dramatically.

Patient 2: 16-year-old girl with ADD. She has trou­ble exe­cut­ing home­work, often telling par­ents she had done it when she real­ly had­n’t. Her par­ents thought she liked to lie. Yet, when I talk to her, she is clear­ly more ashamed than dis­hon­est. The work­ing mem­o­ry train­ing pro­gram helps her devel­op a much improved per­cep­tion of time. For exam­ple, she starts to man­age her show­er time bet­ter, being aware of when 5 min­utes have passed-instead of spend­ing 30 min­utes in the show­er, as before. Much improved school work, lying at home has dropped dramatically.

Patient 3: 19-year-old boy in col­lege, who often became par­a­lyzed when he was faced with com­plex chal­lenges. He had a tough time with the cog­ni­tive train­ing pro­gram, but after a while he start­ed learn­ing new strate­gies and devel­op­ing self-con­fi­dence, and show­ing marked improve­ment. Now, he can break com­plex tasks into man­age­able pieces . His atten­tion­al deficits appeared to threat­en his oppor­tu­ni­ties in his fam­i­ly busi­ness. Unable to keep track of change at the cash reg­is­ter, lines at the busi­ness would grow and cus­tomers get angry, leav­ing him out of con­sid­er­a­tion for key start-up employ­ment in the busi­ness. Now he can man­age day-to-day chal­lenges such as these, and the door to being part of the fam­i­ly busi­ness is now open. He can sequence tasks and exe­cute then with a clear plan in mind, with­out being dis­tract­ed and los­ing sight of that plan.

AF: Dr. Lavin, this is all very excit­ing news, that open the way for new inter­ven­tions, new poli­cies, a new under­stand­ing of what “edu­ca­tion” and “learn­ing” is and how to “edu­cate” mil­lions of young minds and equip them for life suc­cess. Thank you very much for your time.

AL: Thank you. I real­ly appre­ci­ate all the work you are doing to bring the lat­est neu­ro­science research and appli­ca­tions to pro­fes­sion­als like me and to par­ents at large.