NPR reports that a shortage of drugs used to treat attention challenges, including ADHD, has left parents scrambling to fill prescriptions for their kids. In some cases, parents who are also medicated for attention challenges are having to share their medication with a child.
According to the story, affected drugs include Adderall and the active ingredient in Ritalin.
Full article, including a link to audio of a Morning Edition story covering the shortages is on NPR’s Web site.
Be Amazing Learning client Sami Merit was featured on San Francisco Bay Area ABC 7 News, as part of a story that looked at Fast ForWord use at home and at an Oakland elementary school.
Hooray Sami!
http://abclocal.go.com/kgo/story?section=news/health&id=8195812
Today’s NY Times reports on a planned study of the effectiveness of Posit Science’s Brain Fitness Program on veterans who suffered traumatic brain injuries (TBI) in combat. Posit Science was founded by Dr. Michael Merzenich, whose research into neuroplasticity forms the basis for the Fast ForWord programs.
Dr. Merzenich’s core claim is that brain structure is always changing, based on what people do and what they pay attention to. By doing specific brain exercises that focus and refine attention, he says, you can adjust the underlying structure of your brain. It is well established that this happens when we learn a new skill, like dancing. The question is, Can the same processes be employed to correct for brain damage?
Psychologists and others observing the study range from the cautiously optimistic (quoted in the Times, Gary Abrams, director of neurorehabilitation at U.C.S.F. and head of the T.B.I. support clinic at the San Francisco VA Medical Center, says “It is theoretically reasonable, but will it actually work to help veterans?”) to the skeptical (also cited, in the Times, Dr. P. Murali Doraiswamy, a Duke University psychiatrist, is “not convinced that gains translate into long-term benefits that can be generalized to daily challenges like remembering where the car is parked”).
The study will involve 132 veterans suffering from TBI. They’ll undergo a battery of cognitive tests before the program, and again 3 and 6 months after the program.
The Times article also makes a critical point that we frequently make about the neuroplasticity-based programs (Fast ForWord and Cogmed) that we use with struggling learners: the programs are different because they address the underlying cognitive deficits, rather than compensatory strategies.
This weekend’s NY Times Magazine is all about health – everything from the toxicity of sugar to the question of whether cell phones cause cancer. One article that caught our eye (at least after a cup of morning coffee) asks “How little sleep can you get away with?”
David Dinges, the head of the Sleep and Chronobiology Laboratory at the Hospital at the University of Pennsylvania has asked just this question, and the answer is: you should really try to get 8 hours. Dinges’ 2003 study assigned dozens of subjects to three different groups: some slept four hours, others six hours and others, for the lucky control group, eight hours — for two weeks in the lab. The study used a measure called psychomotor vigilance task, or PVT. PVT is a “tedious but simple if you’ve been sleeping well. It measures the sustained attention that is vital for pilots, truck drivers, astronauts. Attention is also key for focusing during long meetings; for reading a paragraph just once, instead of five times; for driving a car. It takes the equivalent of only a two-second lapse for a driver to veer into oncoming traffic.”
The results?
Those who had eight hours of sleep hardly had any attention lapses and no cognitive declines over the 14 days of the study. What was interesting was that those in the four- and six-hour groups had P.V.T. results that declined steadily with almost each passing day. Though the four-hour subjects performed far worse, the six-hour group also consistently fell off-task. By the sixth day, 25 percent of the six-hour group was falling asleep at the computer. And at the end of the study, they were lapsing fives times as much as they did the first day.
The six-hour subjects fared no better — steadily declining over the two weeks — on a test of working memory in which they had to remember numbers and symbols and substitute one for the other. The same was true for an addition-subtraction task that measures speed and accuracy. All told, by the end of two weeks, the six-hour sleepers were as impaired as those who, in another Dinges study, had been sleep-deprived for 24 hours straight — the cognitive equivalent of being legally drunk.
These results are particularly interesting in light of a study recently published in the journal SLEEP that indicated that loss of an hour of sleep per night among children with ADHD had a significant impact on their ability to remain focused and sustain attention From a Science Daily article summarizing the research: “The study suggests that even moderate reductions in sleep duration can affect neurobehavioral functioning, which may have a negative impact on the academic performance of children with ADHD.”
Results of multivariate analyses of variance show that after mean nightly sleep loss of about 55 minutes for six nights, the performance of children with ADHD on a neurobehavioral test deteriorated from the subclinical range to the clinical range of inattention on four of six measures, including omission errors (missed targets) and reaction time. Children with ADHD generally committed more omission errors than controls. Although the performance of children in the control group also deteriorated after mean nightly sleep loss of 34 minutes for six nights, it did not reach a clinical level of inattention on any of the six measures.
Reut Gruber, PhD, assistant professor in the department of psychiatry at McGill University and director of the Attention, Behavior and Sleep Laboratory at Douglas Mental Health University Institute in Montreal, Québec, quoted in the Science Daily article, has advice for parents:
“The reduction in sleep duration in our study was modest and similar to the sleep deprivation that might occur in daily life,” Gruber said. “Thus, even small changes in dinner time, computer time, or staying up to do homework could result in poorer neurobehavioral functioning the following day and affect sustained attention and vigilance, which are essential for optimal academic performance.”
…
“An important implication of the present study is that investments in programs that aim to decrease sleep deprivation may lead to improvements in neurobehavioral functioning and academic performance,” she said.
I don’t know about you, but we’re going to go take a nap.
Auditory processing describes what happens when the brain recognizes and interprets sounds. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. For many students, something is adversely affecting the processing or interpretation of this information. As a result, these students often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example: “Tell me how a chair and a couch are alike” may sound to a child struggling with auditory processing like “Tell me how a hair and a cow are alike.”
These kinds of problems are more likely to occur when the child is in a noisy environment or is listening to complex information.
The Temporal Dynamics of Learning Center (TDLC) at the University of California is one of six Science of Learning Centers funded by the National Science Foundation. Its purpose is “to understand how the element of time and timing is critical for learning, and to apply this understanding to improve educational practice.”
What is the role of timing in learning? From the TDLC Web site:
When you learn new facts, interact with colleagues and teachers, experiment with new gadgets, or engage in countless other learning activities, timing plays a role in the functioning of your neurons, in the communication between and within sensory systems, and in the interactions between different regions of your brain. The success or failure of attempts to communicate using gestures, expressions and verbal language also depend on timing.
In short, timing is critical for learning at every level, from learning the precise temporal patterns of speech sounds, to learning appropriate sequences of movements, to optimal training and instructional schedules for learning, to interpreting the streams of social signals that reinforce learning in the classroom.
Learning depends on the fine-scale structure of the timing between stimuli, response, and reward. The brain is exquisitely sensitive to the temporal structure of sensory experience:
- at the millisecond time scale in the auditory system;
- at the second time scale in reinforcement learning;
- at the minute time scale for action-perception adaptation; and
- at the day-to-week time scale for consolidation and maturation.
Each level of learning has its own temporal dynamics, and its own timing constraints that affect learning. These levels are not independent, but instead, timing constraints at one level affect learning at another level in a nested way. For example, the dynamics at the cellular level, which is often on the order of milliseconds, implement learning on the whole-brain and behavioral level on much longer time scales, including memories that last a lifetime.
The past decade of neuroscience research demonstrates that the intrinsic temporal dynamics of processes within the brain also reinforce and constrain learning. For example, we have discovered that slow learners tend to have slow “shutter speeds” in terms of how their brains take in and process information. For some poor readers, the underlying problem is the their inability to perceive fast acoustic changes in speech sounds (phonemes) that must be accurately perceived in order to learn letter-sound correspondence rules for reading.
Fortunately, says the TDLC Web site, “Neuroscience-based training regimes that improve this temporal processing ability improve both spoken and written language learning in struggling readers.”
One such training program is the Fast ForWord program, which can be an effective intervention for children with struggling with processing rates because it goes right to the cause of the problem, strengthening the gray matter in the area of the brain responsible for processing auditory information. With Fast ForWord, children are first exposed to sounds that are modified to enhance the minute acoustic differences between similar speech sounds. As children demonstrate proficiency and build new neural pathways, the program automatically reduces the level of modification, until eventually students are challenged to process normal speech sounds.
When their brains are processing speech sounds at peak efficiency, students can better recognize and discriminate the rapidly changing sounds that are important for discriminating phonemes (the smallest units of speech that distinguish one word from another). As a result, they will more easily:
Research conducted at the University of Michigan and Eckerd College, and published in the current issue of Personality and Individual Differences suggests that adults with ADHD are more creative than their non-attention-impaired peers. The research also indicates that adults with ADHD are “ideators” (they like to generate ideas), while non-ADHD adults tend to be “clarifiers” (who prefer to define and structure problems) and “developers” (who who elaborate or refine ideas and solutions).
We frequently think about ADHD as a disability, and it can have crippling effects on students’ ability to focus in a classroom setting and to adjust academically and socially. However, as study co-author and associate professor at the University of Michigan Priti Shah says (quoted in a Science Daily article summarizing the research): “Individuals who are not succeeding as well academically may benefit from understanding that there may be tradeoffs associated with ADHD. With extra motivation to overcome difficulties in planning, attention, and impulsivity, they may be able to take greater advantage of their creative strengths.”
The research validating the effectiveness of Cogmed Working Memory Training at improving attention skills keeps rolling in. Science Daily recently highlighted research by psychologists from Ohio State University, published in the November/December 2010 issue of the Journal of Clinical Child & Adolescent Psychology:
Researchers found significant changes for students who completed the program in areas such as attention, ADHD symptoms, planning and organization, initiating tasks, and working memory.
The study asked parents and teachers to complete observational surveys before and after training, as well as in a 4-month post-training follow up:
Results showed that parents generally rated their children as improving on inattention, overall number of ADHD symptoms, working memory, planning and organization and in initiating tasks. These changes were evident both immediately after treatment and four months later.
One interesting aspect of this study is that unlike previous efficacy studies for Cogmed, this one included students who were on and off medication for their ADHD:
“Most kids with ADHD are on some kind of medication, so it helps to know how this intervention works in these cases,” said study co-author Steven Beck.
In this sample, 60 percent of the students were on medication. The results showed the program was equally effective regardless of whether they were on medication or not.
“Medication for ADHD does not help directly with working memory, and the training program does, so it can be useful,” Beck said.
Solid foundational and efficacy research is a common characteristic of the learning programs we offer. It’s great to see additional research that documents the success of Cogmed with an ever-larger population of struggling learners.
CNN’s Health Minute feature recently highlighted the use of a life coach by a college student with ADHD:
A little different from our approach, which focuses on the foundational cognitive skills that underlie attention (and other learning) challenges. But clearly helpful as a scaffold to keep this student on track.
A post at Scientific Learning’s New Science of Learning blog highlights the importance of memorization in early schooling: math facts, counting to 100, reciting a poem, or recalling sight words are all examples of memorization tasks that are prevalent in the early grades.
Memorization, it turns out, is not a particularly advanced skill, centered as it is in the hippocampus of the brain, which is, evolutionarily, one of the oldest parts of the brain:
A great deal of learning in the elementary grades involves the hippocampus. Memorization of spelling rules likes “i before e except after c,” math facts, reading of “sight” words that cannot be sounded out, and geographical facts, just to name a few, demand good memorization skills (hippocampus function.). Reading curriculum used before 1970, like those used when the goal was memorization of the “Dolch” sight words, also stressed memorization skills.
Different from memorization is working memory. Working memory is the cognitive function responsible for retaining, manipulating and using information. We use working memory to delegate the things we encounter to the parts of our brain that can take action. Because of this, working memory is critical for staying focused on a task, blocking out distractions, and keeping us updated and aware about what’s going on around us. And, unlike sight word memorization, working memory is critical for grasping a phonics-based approach to reading, which is prevalent in most American curricula.
As young readers develop, working memory takes on more importance. For example, to gain meaning from text, a student’s working memory must be sufficiently developed to remember the beginning of a sentence when she get to the end. Or the first sentence of a paragraph when she gets to the last.
We have previously highlighted a recent study, published in May 2010 in the Journal Reading and Writing (link is to abstract only), which examined the relationship between working memory and reading achievement, hypothesizing that working memory problems can be a root cause of poor reading comprehension. The researchers found working memory measures were “related with children’s word reading and reading comprehension.”
Even if working memory is more important than memorization for developing reading and other learning skills, we can’t completely abandon memorization (as evolutionarily primitive as it may be). For example, in its report “Foundations for Success” (2008), the National Math Panel emphasized the importance of developing automatic recall of addition, subtraction, multiplication and division facts in order to adequately prepare for algebra and beyond.
Evidence abounds that physical exercise can enhance cognitive functioning. As we previously posted:
- A study at the University of Illinois compared performance on a cognitive test between higher and lower fit 9 and 10 year old students. The higher-fit students performed better on the test, and brain scans indicated they had larger basal ganglia, a part of the brain responsible for impulse control and response resolution.
- A second study by the same researchers compared performance on complex memory tasks between high fit and low fit 9 and 10 year olds. The study found better performance in high fit students, and brain scans showed larger hippocampi, the portion of the brain associated with complex memory tasks.
Over at SharpBrains, Dr. David Rabiner examines a study, recently published in the Journal of Attention Disorders, which looked at whether an extended physical training program can have a positive impact on students struggling with ADHD.
The data is generally positive, suggesting that a physical exercise routine can positively impact fitness, behavior (as observed by parents and teachers) and attention and inhibition response (as measured by neuropsychological assessments). However, as Dr. Rabiner points out:
It is important to put these positive findings into an appropriate perspective. First, even though the activity program was associated with improve ments in several areas, children continued to show clinically elevated difficulties even in areas where improvements were seen. Thus, there was no evidence that the exercise program reduced children’s difficulties into the normative range.
Dr. Rabiner suggests more research is necessary, but that this study suggests that “a vigorous physical activity program could certainly be valuable for many children with ADHD for a variety of reasons, even if the ultimate impact of exercise on core ADHD symptoms is not yet known.”
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