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.
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.
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.”
Play is emerging as a theme in this week’s posts. Today, we look at games that can improve children’s attention skills and reduce impulsivity.
At her Parent Smart blog, Dr. Martha Burns, a Speech-Language Pathologist and Adjunct Associate Professor at Northwestern University, highlights Simon Says… and Clap When I Say… as games that can develop impulse control. What is impulse control and why is it important? According to Burns:
An example of impulsivity in a classroom might be yelling out questions , comments or answers instead of raising one’s hand, or popping up from a desk at inappropriate times, or even looking a someone else’s paper during a test. Impulsivity on the playground might include chasing a ball into the street without checking for cars or hitting someone who accidently bumps into you.
Learning to control these impulses, says Burns, “requires us to stay alert and purposeful and it is a skill all of us must master to reduce impulsivity; so that we stop and think before we act.”
Check out Burns’ post for details on these games that can help your child “play attention!”
The Dana Foundation Web site has a good summary of some of the most recent research into the underlying causes of attention challenges. The article outlines two we are familiar with: working memory and processing rates:
One theory holds that the disorder is primarily a problem with working memory–the ability to hold information in temporary storage long enough to act on it appropriately, while another group of theories centers around how information is processed in time.
“There are lots of psychological tests that show that ADHD kids just don’t get the timing of things quite right,” he says. “This would explain very nicely the impulsivity that is seen in ADHD; where they are not getting the very fine-grained timing of social interactions, for example.” In the classroom, this might manifest as blurting out the answer to a teacher’s query before one is called upon.
But the bulk of the article focuses on ADHD as a lack of allocation of attentional resources in the brain. From Philip Shaw, Ph. D., a scientist who studies ADHD at the National Institute of Mental Health:
“A child who is not staying on task in school could be paying attention to what’s going on outside the classroom. So it’s not that they are not doing something that is attention-demanding; it’s just that their focus is on something other than what they’re meant to be doing.” From that perspective, he says, thinking about ADHD as a problem with the allocation of attentional resources makes sense.
This may seem a logical explanation to parents and teachers. As the article points out:
Parents of children with ADHD, for example, may find it hard to fathom that a child who can spend hours engrossed in a video game has a problem with attention. Teachers may be confounded by a student who is fully engaged in a music lesson but is distracted or disruptive in other classwork.
The article continues with a description of the neural network of attention, with particular focus on the executive attention network, which “enables the individual to decide which things to attend to among competing brain activity.”
As the article points out in summary, “each of these theories offers tantalizing clues about what might be going wrong in the brains of children with ADHD, but they do not answer all of the questions.” And so the search continues…
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