Workshop Topics. Signs of WM Overload in Daily Life. 11 th Annual School Neuropsychology Summer Institute. Notice of Copyright 2016

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1 Notice of Copyright 2016 Update on Working Memory Interventions Milton J. Dehn, Ed.D. School Neuropsych Institute Summer 2016 This PowerPoint presentation and accompanying materials are copyrighted by Milton J. Dehn and Schoolhouse Educational Services, LLC. The PowerPoint and materials are not to be reprinted, copied, presented, or electronically disseminated without written permission. To obtain permission, Workshop Topics 1. Update to WM Model 2. Cognitive Load 3. WM and Learning 4. Neuropsychology of WM 5. Efficacy of computerized training 6. Far transfer to academics? 7. WM strategies 8. Hands-on WM exercises 9. Accommodations 10.Lumosity and Brain HQ Essentials of Working Memory (released fall 2015) Signs of WM Overload in Daily Life 1. What was I going to say? 2. What did I walk in here to get? 3. Not noticing you made a mistake or forgot something 4. Not remembering steps; directions 5. Having difficulty focusing or dividing attention 6. Unrelated thoughts getting in the way Working Memory Definition 1. Short-term retention + processing = WM 2. WM: the limited capacity to retain information while simultaneously manipulating the same or other information for a short period of time 3. Keeping information in mind from moment to moment 4. STM is part of WM; WM manages STM 1

2 What Is WM? 1. An executive function 1. Metacognitive process 2. Closely related with attention 2. Also a cognitive process 1. Closely related with several cognitive processes Dehn, Journal of Attention Disorders, 18, pp , WM Capacity 1. Is very limited in all humans 2. Storage and processing use same capacity 3. Adults have a STM span of 7 4. Adult WM capacity is 4 chunks 5. As little as 1 chunk in a disabled child 6. Without rehearsal or processing that keeps it active, information is gone within a few seconds 7. Human limitations Baddeley s WM Model Cowan s Model of WM Central Executive Cowan s Embedded-Process Model Long-Term Memory Focus of Attention Phonological Loop Visualspatial Sketchpad Episodic Buffer Activated Items Dehn s Integrated Model of WM New: Activated LTM Integrated Model of Working Memory Executive WM Visualspatial Verbal WM WM Phonological Verbal spatial Active Visual- STM LTM STM Active Visual LTM 1. Recently activated LTM representations 2. WM works with these, going back and forth 3. Up to 20 or more at a time 4. Effectively expands capacity of WM because these are not stored in STM/WM 5. Is part of verbal and visual-spatial WM 6. WM may draw from these more than STM 7. Problem: No way to easily assess this 2

3 WM Components to Assess 1. Phonological STM 2. Visual-Spatial STM 3. Verbal WM 4. Visual-Spatial STM 5. Executive WM Executive WM 1. The component that copes with distraction and interference 2. Integrates visual and verbal 3. Controls and coordinates other components 4. Allocates/focuses attention 5. Involves strategy use 6. Often where the deficiency lies with SLD 7. Close relationship with other executive functions The Big Three Executive WM Processes 1. Inhibiting: Suppressing distractors and interference 2. Shifting: Alternating between different processing tasks or between processing and storage (rehearsal) 3. Updating: Continual replacement of no longer relevant information with current information Distinction Between Executive WM and Verbal and Visual-Spatial WM 1. This is Dehn s model/definition 2. Executive is doing additional processing not necessary for verbal and visual-spatial WM 3. Both have processing and deal with interference 4. When the interference is not specific to the task, it is primarily executive WM 5. For example, processing language is verbal WM, but not executive What WM and Attention Have in Common 1. Both are in dorsolateral prefrontal cortex 2. Both controlled by executive functions 3. Both involve controlled attention 4. Inhibition deficit underlies both ADHD and WM 5. Both respond to Ritalin 6. Problems manifest in similar ways 7. When a student has a WM deficit, the number one thing reported by teachers is that the student has an attention problem WM and Attention 1. The control of attention is part of WM 2. Paying attention is a necessary but insufficient condition for processing and retention in STM and WM 3. Attention problems diminish WM performance in a normal WM 4. If child is paying attention and still can t remember in the moment, it s probably WM 3

4 WM vs ADHD 1. The majority with ADHD have a WM problem 2. ADHD behavior issues have little to do with WM, except for poor decision-making 3. WM deficit closely related to Inattentive ADHD, not Hyperactive/Impulsive type 4. Divided attention closest to WM 5. ADHD involves mainly visuospatial WM 6. Attention involves arousal & motor inhibition 7. As WM load increases, hyperactivity increases WM & Processing Speed 1. Processing speed accounts for most of the variance in STM span (up to 90%) 2. Slow: Information lost before processing and task completed 3. Slow: Poorer encoding into LTM 4. Faster rehearsal maintains more info. 5. Less of a relationship in adults Cognitive Load Theory 1. WM is a combination of processing & storage 2. Cognitive Load is the processing portion 3. Processing & storage both draw on WM capacity; so it s a balancing act 4. The greater the processing demands/longer the processing, the more info. lost from WM/STM 5. Can focus attention on only 1 aspect of WM at a time; switching is required 6. If focus on retention, processing may suffer Cognitive Load and Span Increasing cognitive load Task Switching (Time Sharing) 1. Switching is a core, general executive process 2. To retain info. in WM, one mus t frequently s witch from processing to refreshing the info. 3. If the processing (load) is demanding, there will be less switching and more info. will be lost 4. Switching is difficult for young children (< 7 years) 5. Example: remember steps while completing an online task Cognitive Load in the Classroom 1. Three sources of cognitive load 1. The materials and their content 2. Instructional methods and teacher behaviors 3. The learner s internal processing 4

5 WM Classroom Overload Examples 1. Long, complex, inconsistent verbalization 2. Requiring two processes simultaneously 3. No time for processing or rehearsal 4. No external memory aids 5. Noisy learning environment 6. No or limited scaffolding (learning supports) 7. Disorganized presentations 8. Too many concurrent demands WM and Learning 1. WM capacity is a general limiting factor for academic learning; specifically, it is necessary for the generation and modification of knowledge stored in LTM (conscious encoding) 2. Direct access and maintenance of several separate elements is necessary to construct new relations in episodic WM and LTM WM and Academic Learning 1. Language and listening comprehension 2. Following directions 3. Learning vocabulary 4. Note taking 5. Reasoning 6. All academic skills and complex learning 7. Moderate correlations up to.5 range 8. WM has higher correlations than STM WM and Classroom Performance 1. Slow to complete quality work because 1. Can t remember directions 2. Loses place and must start over 3. Does not have a consistent strategy 4. Can t hold and process all the information necessary to complete items 5. Loses focus; can t divide attention 6. Switching is difficult 7. Skips steps that create problems 8. Can t monitor work quality at same time Neuroanatomy Prefrontal Cortex Image 5

6 WM Neuroanatomy Evidence 1. Evidence for each of the five WM components/processes, even phonological storage vs rehearsal 2. Executive WM: dorsolateral prefrontal cortex (dpfc)---shared with attentional control 3. STM processes mainly in parietal and occipital lobes 4. WM processes mainly frontal, temporal, parietal Brain Lobes and STM & WM 1. Frontal (Dorsolateral Prefrontal Cortex): Executive WM 2. Temporal: Episodic WM (especially during LTM encoding and retrieval) 3. Parietal Lobes: Phonological STM and Verbal WM in language processing areas 4. Occipital Lobes: Visuospatial STM and WM Neuropsychology of WM 1. working memory can be viewed as neither a unitary nor a dedicated system. Thus, working memory is not localized to a single brain region but probably is an emergent property of the functional interactions between the PFC and the rest of the brain (D Esposito, 2007) 2. WM is related to integrity (strength) and extent of myelinated axons WM Neurological Basis 1. Individual differences in WM capacity are correlated with the structural integrity of white matter pathways connecting domain general regions with the fronto-parietal network 2. Thus, WM is related to integrity (strength) and extent of myelinated axons 3. WM training increases the integrity of white matter (Takeuchi et al., 2010) 4. Adequate dopamine is also required WM Neuropsych Evidence and PFC Simple STM tasks may not engage Prefrontal Cortex Involved because of its extensive connectivity with other brain regions Involved because it plays a critical role in executive control functions Activated more during reception and response than maintenance interval WM Developmental Changes 1. Young children rely less on the dpfc during WM and STM functioning than do older children and adults 2. Is it because the dpfc has not matured? 6

7 Phonological Short-Term Memory Supramarginal Gyrus 1. Left-hemisphere inferior parietal areas 2. Brodmann s area 40 in parietal lobe is the storage area; Brodmann s is involved in phonological processing; part of #3 below 3. Supramarginal gyrus in parietal lobe is also involved; supramarginal gyrus is involved in language processing 4. Broca s area (language function) in inferior left frontal lobe is subvocal rehearsal area Broca s Area Visuospatial STM and WM 1. Right hemisphere 2. Occipital lobe 3. Inferior frontal areas 4. Visual is occipital 5. Spatial is also parietal (dorsal stream) Other Brain Involvement in General WM Basal Ganglia 1. Striatum: part of the forebrain and the basal ganglia system. Mainly involved with planning movement. 2. Anterior cingulate: a collar around the corpus callosum involved in decision making 3. Dopamine level is important for WM. A deficiency in dopamine can impair WM performance. 7

8 Structures Involved in WM Other Structures WM Process Hemisphere Cortical Area Phonological STM Storage Left Posterior parietal Inferior parietal Brodmann s area 40 Supramarginal gyrus Phonological STM Rehearsal Left Broca s area Anterior temporal frontal Visuospatial STM/WM Right Occipital Premotor cortex Inferior frontal Superior frontal sulcus Intraparietal sulcus Visual only Right Occipital Spatial only Right Parietal Executive WM Bilateral Dorsolateral prefrontal General WM Anterior cingulate Striatum More to Learn About WM Neuroanatomy 1. Complex because of the interaction involved during processing 2. Recent example: rehearsal occurs in lateral temporal cortex (a language area) rather than Broca s area in frontal lobe 3. Nonetheless, pretty clear that rehearsal is taking place in language areas Risk Factors for WM Deficits 1. Concussion/head injury 2. Alcohol/drug abuse 3. Diet/obesity and diabetes 4. Anxiety/depression/stress 5. Dopamine deficiency 6. Extreme prematurity (32 weeks) 1. Poor myelination 7. Language impairment 8. ADHD 9. Anything that stresses or harms the brain Prematurity 1. Hypoxia due to poorly developed lungs can damage hippocampus 2. Poor myelination adds to WM problems 3. Those born prior to 32 weeks have significant risk of memory problems 4. Episodic and everyday memory problems may be more serious than semantic memory problems Assess for Inability to Rehearse 1. Deceptive because immediate response is correct 2. Give child a series of words and ask him/her to repeat 5 times rapidly 3. Children with significant memory problems have difficulty maintaining the sequence during rehearsal 4. Will avoid using rehearsal when directed to do so 8

9 Memory Processes Analyzer 2.0 (MPA) 1. For use with selective, multi-battery testing of memory components and processes 2. Statistically analyzes strengths and weaknesses across 11 memory processes (5 are WM) 3. Identifies statistically significant memory strengths, weaknesses, and deficits 4. Allows memory composites and subtests from more than 30 batteries 5. Unlisted composites/subtests can be entered 6. Includes report with narrative, graph, and tables Link Demo Concussion Case 1. Three concussions 1. 2 nd was 5 months after first 2. 3 rd was 18 months after 2 nd 2. Originally no problem with memory; test scores verify, won spelling bees 3. Severe WM problems after 2 nd concussion 4. No SLD history; original IQ 110, then 97 after 1 st concussion (see MPA results) Post-Concussion Syndrome 1. These are acute effects 2. Headaches, dizziness/vertigo, nausea, light and noise sensitivity, fatigue, hypersomnia/insomnia, irritability, emotional dysregulation, dysmnesia, attention problems, processing speed, working memory 3. There can be long-term effects, such as vertigo The Brain After TBI/Concussion 1. Diminished cerebral blood flow 2. Impaired neurotransmission 3. Indiscriminate release of neurotransmitters due to stretching of axons 4. Damage to cell membranes 5. Increased glucose utilization & hypermetabolism 6. Caution: Do not do memory training until postconcussion/tbi symptoms subside (brain heals) 7. Psychostimulants are effective for WM Post Concussion/TBI Treatment 1. Memory will recover as the brain heals 2. The typical acute effect of concussion is comparable to early dementia 3. There should be a reduction in mental activity and stimulation because placing an energy demand on the brain can compromise recovery 4. Memory exercises when physical symptoms are present is not advised 5. See laminated reference guide: Concussion: A Practical Guide for Educators 9

10 Concussion/TBI Outcomes 1. Vary considerably 2. Difficult to predict 3. Healing takes time 4. Multiple concussions increase risk and damage 5. Long-term impact on memory usually more than people expect 6. Denial from those with the injuries Approaches to Improving WM 1. Reduce the cognitive load 2. Directly increase WM capacity through the use of training exercises 3. Teach strategies that allow more effective use of existing WM capabilities 4. Accommodations 5. Long-term memory strategies 6. Metamemory Concerns About WM Interventions 1. With multiple steps, strategies create too much cognitive load (a dilemma) 2. Exercises need to be almost daily for extended number of weeks 3. Some strategies difficult to generalize; content specific 4. Does improved WM transfer to improved academics? Computerized and Internet-Based Working Memory Training 1. These are exercises, not strategies 1. But they prompt the use of a strategy 2. They work because of brain plasticity 3. Evidence that these exercises improve 1. With practice 2. Untrained WM performance (near transfer) 3. Far transfer to academics: evidence is inconsistent and limited 4. Detailed review in Essentials of WM What is Required to Make a Computerized Exercise Work 1. Must be adaptive 1. Difficulty level constantly adjusted 2. Confirmed by research 2. Consistent high cognitive workloads 1. Has to be challenging enough 3. Extensive practice over a sustained period of time minutes a day for 25 days over 5 weeks min. 4. Processing and storage required during the task 5. See page 8 in manual for guidelines for effectiveness Attribute/Aptitude Treatment Interaction 1. If the skill is dependent on the aptitude, then improving the aptitude should result in an automatic improvement in the skill (this would be far transfer) 2. Naglieri study example 3. Is this assumption faulty? 4. Why should we assume that skills would improve without additional practice? 5. Reading skill and vocabulary level analogy 10

11 Near to Far Transfer Near: Untrained measures of WM Intermediate: Related cognitive processes, such as fluid reasoning Daily functioning Far: Academics Example of Near Transfer 1. Klingberg, Fernell, Oleson, et al. (2005) 1. Randomized, controlled, double-blind study 2. Subjects with ADHD, ages Effect size of Rapport et al., (2013) meta-analysis of 25 studies found near transfer effect size of Studies with ADHD children only 3. Schwaighofer et al., 2015 meta-analysis of 47 studies: WM effect sizes of.37 to.72 Examples of Intermediate Transfer 1. Jaeggi, Buschkuehl, Jonides, and Perrig (2008) WM training improved fluid reasoning 2. Subjects with ADHD often have had reduced behavioral symptoms of inattention following working memory training (Green et al., 2012). 3. Alloway and Alloway(2009) reported gains in crystallized intelligence 4. Schwaighofer et al., 2015 meta-analysis of 47 studies: effect size on cognitive skills was Examples of Far Transfer 1. In a study by Loosli, Buschkuehl, Perrig, and Jaeggi (2012), WM training resulted in significantly enhanced reading performance in typically developing children. 2. Improvements in reading comprehension were reported by Dahlin (2011) 3. Mathematics reasoning, mathematics skills, and performance have been reported in some studies (Swanson, Jerman, and Zheng, 2008). Transfer and Maintenance 1. Most working memory exercises have good near transfer but poor far transfer to academics 2. Why does it not far transfer and maintain, given learning s dependence on WM? 1. Exercises are more STM than WM; don t meet trainee s WM needs 2. Not enough time allowed for transfer to occur 3. Lack of motivation and effort 4. Trainee does not do anything to maintain after training Cogmed Training Details 1. Adaptive, game-like, internet-based training, records everything 2. Has preschool, school age, and adult levels sessions, 30 minutes each with 8 exercises out of 12, over 5 weeks 4. Child can do without assistance 5. Does not encourage use of strategies 6. Video 11

12 Research on Cogmed Training 1. Improved WM, especially visual-spatial 2. Fluid reasoning sometimes improved 3. Math sometimes improved 4. Parents reported reduction in motor activity and inattention 5. ADHD children improved in WM 6. Those with low WM improve the most 7. Young (elementary age) improve the most 8. Holmes et al. found substantial and sustained gains in WM and math Gathercole s Initial Study 1. Holmes, Gathercole, and Dunning (2009). 2. substantial and sustained gains in WM 3. Math ability also improved significantly 6 months following training 4. Dehn: Could it be that we are not waiting long enough for far transfer to academics to occur? Gathercole Studies of Cogmed 1. Dunning, Holmes, & Gathercole (2013) 2. Responded to experimental design criticisms 1. Randomized, controlled, double-blind study year-olds 4. Significant improvements on untrained measures of WM 5. These gains maintained a year later 6. No gains in academics Articles on Cogmed Controversy Shipstead, Z, Hicks, K. L., & Engle, R. W. (2012). Cogmed working memory training: Does the evidence support the claims? Journal of Applied Research in Memory and Cognition 1, Melby-Lervag, M., & Hulme, C. (2012). Is working memory training effective? A metaanalytic review. Developmental Psychology, DOI: /a Criticism of Cogmed Melby-Lervag & Hulme (2012) conducted a meta-analytic review of 23 studies that met stringent experimental design criteria. Their meta-analysis found that nearly all of the studies produced short-term improvements in practiced skills. However, the authors concluded that there was no convincing or consistent evidence for far-transfer (generalization) to related functions and skills. Experimental Design Issues Shipstead et al., (2012): 1. No random assignment 2. No control group 3. No pre and post testing 4. No double blind 12

13 Cogmed Research Controversy 1. Two recent studies have concluded that the claims are largely unsubstantiated 2. No control group 3. Younger kids respond better 4. Not everyone improves 5. Is it just practice effects? 6. Recent study with proper design (Gray et al ) WM improved, but still poor far transfer Dehn s Views on Cogmed 1. Majority of kids will benefit 2. Cost is an issue; timely feedback is an issue 3. Maintaining practice schedule is concern 4. Parents not trained to supervise practice 5. In general, may be too superficial 6. Cogmed discourages strategies; Dehn introduces when subject hits wall 7. Probably best for ADHD/WM co-morbid Dehn s Example of Cogmed Far Transfer 9 th grader with low visual-spatial WM Struggles with math; C-D grades, A-B grades in other subjects Cogmed training over summer; high motivation and effort WM scores improved Math teacher/tutor reported unexplained gain Math grades up to a B average WM Gains Can Be Maintained Dunning et al. (2013) conducted a randomized, controlled trial investigation. They found that adaptive, computerized training led to improvements on multiple, untrained tests of working memory, with some gains sustained for more than a year Dehn s Example of Poor Maintenance Low WM and mild reading disability Hands-on WM training exercises for 3 months Significant improvement in WM scores and gains in reading Six months later, WM score had returned to baseline Why? Why WM Brain Training Works the experience of taxing WM to its limits over a sustained period of time may induce long-term plasticity through either improving the efficiency of neuronal responses or extending the cortical map serving WM. The training program may also promote self-awareness and the development of compensatory strategies. Westerberg et al., 2007). 13

14 Brain Evidence Many studies document changes in brain activity levels during WM load (e.g., Oleson et al., 2004), indicating that WM is working more efficiently Working memory training may also increase dopamine levels and/or dopamine utilization. WM Training Impact on Brain 1. Takeuchi et al. (2010) 2. Adaptive training with 2 N-Back visual tasks 3. Increase in white matter correlated with amount of training & improved performance 1. Axons and myelination 4. Mainly adjacent to the corpus callosum and in white matter parietal region 5. Increased transfer of info, at the dorsolateral prefrontal cortex, location of executive WM Problems with Online Training 1. Not done frequently enough or long enough 2. Completely oral exercises are not available 3. Do not encourage strategies or teach metamemory 4. May not be challenging enough 5. Don t match well with learner s WM needs 1. E.g., executive WM 6. Motivation and guessing 7. Timed responding 8. Doesn t apply well to academic learning More Benefits to Improved WM Than Just Academics 1. WM is a core cognitive and metacognitive function 2. Performance efficiency 3. Grades 4. Attention 5. Daily Functioning (see adult studies) 6. Increased dopamine 7. Increased connectivity and mylenation Improved Attention Spencer-Smith & Klingberg (2015) Meta-analysis of 12 studies of WM training effect on attention Subjects with and without ADHD Effect size of.33 on inattention in daily life Conclusions 1. What s wrong with experimentation at this stage? 2. Consider gains other than achievement 3. Not enough time and practice allowed for far transfer to occur 4. Research on other training options needs to be conducted 5. Questions/discussion 14

15 Working Memory Interventions 1. These are evidence-based; brain-based 2. One-on-one, small group, classroom wide 3. Includes direct and consultation/training 4. Through trained parents/teachers sometimes 5. Kindergarten through adulthood Teaching WM Strategies 1. High potential---case of 80 digit span 2. More fully utilize the executive aspect of WM 3. Is not taught with computerized training Rehearsal Strategies 1. Most have by age 10; 1 st graders can learn 2. Students with severe WM deficits cannot maintain sequence during rehearsal 3. First aloud, then subvocal 4. Increase length of list as student improves 5. Good maintenance if overlearned 6. Academic benefits reported in research (Ornstein, Naus, & Stone, 1977) Ways of Practicing Rehearsal 1. Say entire span and then have student practice saying entire span 4-5 times 2. Trainee repeats first word until next delivered then adds next word to the repetition (cumulative method) 3. Teach trainee to rapidly switch between processing and rehearsing Using Rehearsal with Switching 1. Switching back and forth between the processing and rehearsal 2. Switching with rehearsal helps maintain the information in STM while processing the same or other information 3. Require trainee to use rehearsal with switching for most WM exercises 4. Switching is embedded in all WM exercises Rehearsal as an Exercise 1. Goal is to build span and maintain sequence 2. Other goal: Some oral-to-oral WM practice 3. Have student repeat sequence 4-5 times 4. Listen to see if student maintains correct sequence; answer is not necessary 5. Have the student say the words faster 6. Can be serial or cumulative 15

16 Why Hands-On, WM Exercises 1. Compliance with online training is a concern 2. Oral responding not allowed with online training 3. A trainer, parent, or peer administers these 4. Adapt by requiring a longer span as progress is made Guidelines for Hands-On, WM Exercises minutes a day, every other day 2. About 5 minutes with each type of exercise 3. When span of a given length is mastered, increase the span 4. Lower the span when it is too difficult 5. Require child to use rehearsal and switching strategies Exercises: Using Math to Build WM Complete calculations Remember the answers in sequence = = 6 Response: 7, 6 Allow trainee to rehearse between cards Practice N-Back Task (Exec. WM) 1. It works because constant updating, switching, and inhibition are required 2. Found to promote growth of white matter in brain 3. Challenging task but easily administered 4. Remember stimulus n-items back 5. Any kind of stimuli can be used 6. Parents and children can practice at home 7. n-back task n-back practice 8. The strategy 9. Span improvement will be slow at this task; count number of trials correct N-Back Procedures 1. Display items one at a time for 1-2 seconds 2. Start over after 1 st error 3. Should get 10 consecutive correct 3 times before going to next N minutes, 4 times per week 5. More challenging: A double n-back 6. Establish baseline 7. Encourage strategy use Oral WM Exercises 1. Letters, numbers, words, sentences 2. Non-words are ideal 3. Remember last word in sentence 4. Teach serial and cumulative rehearsal and how to apply to a variety of tasks 16

17 Oral Example: Listening Span 1. The task: remember the last words in sequence. 2. Short sentences presented orally. 3. The processing: the trainee must answer a question 4. Example: Do cats bark? Do cars have different shapes? Then, trainee says, Bark, shapes. General WM Accommodations 1. Extended testing time 2. Repeating information 3. Simplify verbal information 4. Providing written checklists and reminders of step-by-step procedures 5. One task at a time 6. Slow down presentation 7. Preferential seating to reduce distraction 8. Provide prompts and cues Basic Reading Skills Accommodations 1. Support student during decoding and blending 2. Prompt by saying the first phoneme in a syllable if student forgets before blending 3. Say the segmented phonemes/syllables slowly after student has sounded them out 4. Have student say blended word smoothly again after correct pronunciation Reading Comprehension Strategies 1. Student previews and skims the passage to activate relevant prior knowledge so that long-term memory supports WM 2. If partially read previously, review what was read before 3. Have student pause after each sentence and paragraph and visualize 4. Allow silent reading when comprehension is the priority over oral reading fluency WM and Written Language Deficits 1. Have the student express it orally first 2. Teacher functions as scribe 3. Teacher stores it and says what student said as student writes 4. Teacher writes part of sentence so that student just needs to use closure to finish 5. Teach student to switch between rehearsing the sentence and writing parts of it Written Language Accommodations 1. Shorten writing assignment 2. Allow shorter sentences 3. Allow opportunity to revise after feedback provided 4. Allow abbreviations and symbols in first draft 5. Provide notes, note-taker, or partially completed class notes in classes where notetaking is required 17

18 Lumosity 1. Numerous exercises; more than memory 2. Has N-Back exercises 3. Exercises based on research 4. Are adaptive and appropriate 5. Affordable plans, such as yearly 6. Can monitor learner s progress 7. Best to select appropriate games rather than allow Lumosity to control individual s program 8. Should be 13 years of age to use DEMO Brain HQ 1. Affordable plans, such as yearly 2. Variety of WM exercises 3. Well designed, challenging, cover a wide range of ability and age 4. Has verbal WM exercises, e.g., listening to a conversation 5. More real world exercises 6. WM exercises also under other categories 7. DEMO Memory Interventionist Training For school psychologists and related professionals Taught by Dr. Dehn Taught once per year, beginning in fall CEU s from Kids, Inc. 36-hour course Includes neuropsych assessment of memory Case study with supervision Details: milt@psychprocesses.com alservic es.co m 18