Understanding and Addressing Working Memory and ADHD. Lisa Reid, Ed.D., ET/P

Transcription

1 Understanding and Addressing Working Memory and ADHD Lisa Reid, Ed.D., ET/P

2 Overview What is Working Memory and why is it important? How can Working Memory be tested? What does low Working Memory look like? How can we support and improve Working Memory?

3 Try This... Solve the following long division problem in your head: 4281/37

4 Answer: What made calculating that difficult? What processes and skill sets were involved?

5 People can hold 5-9 digits in their mind. The average is 7. Consider this string:

6 Can you remember? Try it backwards.

7 What skill sets are required to complete this task? Write a 5 paragraph essay about Chimpanzees

8 A few. Thought organization Vocabulary Knowledge of how to structure a sentence, paragraph, essay. Understanding of topic and conclusion sentences Reading Reading comprehension Organizing the information you receive/determining what is not important Letter formation skills

9 What is Working Memory and why is it important? Working Memory is a system for temporary holding and manipulation of information during the performance of a range of cognitive tasks such as comprehension, learning, and reasoning. (Baddely, 1986, p. 34) Working Memory allows one to hold several facts or ideas in mind temporarily while working with them to create a product or while seeking to understand them more fully. (Levine, 1999, p. 73)

10 What is Working Memory and Why is it Important? Working Memory is used for: Controlling attention Resisting distraction Organization Complex thinking Problem Solving Remembering tasks

11 What is Working Memory and Why is it Important? Working Memory allows for temporary storage and manipulation of information. It processes all of the stimuli we encounter. It delegates to different parts of our brain to take action. It allows us to block out unnecessary information. It keeps us focused on what matters. It involves ACTIVE, CONSCIOUS processing and storage.

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13 Capacities That Influence Working Memory: Rate of processing incoming information. Ability to accommodate large amounts of data. Adequacy of processing both verbal and visual inputs. (Auditory processing/visual Processing) The strength of attention processing controls. Good resistance to retroactive inhibition. The tendency of intervening thoughts to erase recent input. The use and effectiveness of rehearsal. Freedom from anxiety.

14 Baddely s Model of Working Memory 1. central executive, the master controller which focuses our attention; 2. a phonological loop for temporary storage and rehearsal of verbal and auditory information; 3. a visuo-spatial sketchpad for temporary storage of visual and spatial information, e.g. objects and their locations; and 4. an episodic buffer which allows these different elements to interact with each other and information in long term memory to facilitate comprehension.

15 How Can Working Memory Be Tested? Weschler Pre-School and Primary Intelligence Scale (WPPSI) Picture Memory Zoo Locations Weschler Intelligence Scale for Children (WISC) Weschler Adult Intelligence Scale (WAIS) Digit Span Letter-Number Sequencing Arithmetic Wide Range Assessment for Memory and Learning (WRAML) Test of Memory and Learning (TOMAL)

16 How Can Working Memory Be Tested? Comprehensive Test of Phonological Processing (CTOPP) Rapid Letter Naming Rapid Digit Naming Test of Word Reading Efficiency (TOWRE) Sight Word Efficiency Phonemic Decoding Efficiency Gray Oral Reading Test (GORT) Oral Reading Comprehension

17 What Does Low Working Memory Look Like? Avoidance of work that involves concentration Interrupts or vocalises at inappropriate times Cannot get started on a task Leaves work before it is complete

18 What Does Low Working Memory Look Like? Appears easily distracted Appears anxious Fidgety/Impulsive Writes on hand/uses fingers to count Forgetful

19 What Does Low Working Memory Look Like? You have many unfinished projects because you become distracted and forget about the first project. You plan to do some work at home, but you forget to bring needed items with you. You have to reread a paragraph several times to retain the information. You miss deadlines at work because of your disorganization and inability to follow through on projects. Easily overwhelmed. Poor handwriting

20 What Does Low Working Memory Look Like? Difficulties following multi-step directions Has trouble keeping place in work Problems retaining and processing information. Problems with planning and organization. Inconsistent performance I.e. understands number concepts but gets math facts incorrect. Good results in spelling tests but mistakes in written work Good word reading but difficulty with comprehension

21 What Does Low Working Memory Look Like? Frustration during work completion Forgets what one was going to say. Confusion during extended explanations. A tendency for more immediate needs to undermine the long range intentions (i.e. while sharpening a pencil, a student forgets which sentence he was supposed to copy from the board).

22 What Does Low Working Memory Look Like? Difficulties with retrieving information, while at the same time needing to organize thoughts, write or execute a plan can cause output overload. Written work: Difficulty with sentence structure, difficulty staying on topic, missing words, incomplete work. Math computation: Difficulty with complex problem solving due to challenges retrieving all of the parts of a problem while at the same time following multi step directions. Difficulty achieving automaticity with information.

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24 How Can We Support and Improve Working Memory? Use a multi-sensory approach to learning (include manipulatives, draw pictures). Attach visual and auditory to tasks. Break large tasks down into simpler steps (i.e. if you are going to clean your house, make a checklist and move through what needs to be done one step at a time). Use memory aids (analogies, multiplication charts) Use of Accommodative technology - Cowriter, Notability, Voice to text, to reduce output demands. Cowriter

25 How Can We Support and Improve Working Memory? Medication can increase working memory capacity (stimulant) Reduce anxiety by allowing more time for task completion. Be easy on yourself - avoid self-criticism. Make life visual - avoid clutter Set goals before completing projects Participate in activities that increase your fluency with reading, math facts, etc.

26 How Can We Support and Improve Working Memory? Exercise working memory with games (i.e. Simon, Memory, Egg Head, Crossword Puzzles) Reduce multitasking Practice mindfulness - a calm mind processes more effectively Exercise - improves the health of brain cells

27 How Can We Support and Improve Working Memory? Active reading - underlining, drawing pictures and reflecting while reading. Graphic organizers for preplanning. Work on visualization skills s/

28 How Can We Support and Improve Working Memory? Memory Workout Programs (Lumosity, Brain Train, CogMed, Fast Forword, Hearbuilder) Depends on the specific needs and personality of the participant. Learning how to learn. These programs require hard work over a sustained period of time. They can model what it takes to master other skills - the key is to make this learning experience transferable. Length of sessions, and the support of a coach makes a difference in impact. These programs are not recommended to take the place of medication. These programs are not recommended for people with ODD, Conduct Disorder or severe anxiety. Consistency is key. Programs allow for you to see measurable effects

29 Does It Work? Klingberg (2005) Randomized controlled trial of 53 children with ADHD. Half of the participants practiced working-memory tasks that gradually increased in difficulty. The other half completed tasks that did not get harder as the children became better at them. Both groups of children--who were 7 to 12 years old--practiced tasks such as recalling lists of numbers for 40 minutes a day over five weeks. The children who practiced with increasingly difficult memory tasks performed better on two working memory tests--which were different than the practice tasks--than the control group, reported Klingberg in the Journal of the American Academy of Child & Adolescent Psychiatry (Vol. 44, No. 2, pages ) In addition, the parents of children with memory training reported a reduction in their children's hyperactivity and inattention three months after the intervention, while the parents of the control group participants did not.

30 Does It Work? Klineberg (2005) "We have looked at other groups too: adults with stroke, young adults without ADHD, children with...traumatic brain injuries," he says. "A general pattern [we've found] is as long as you have working-memory problems and you have the ability to train, you can improve your abilities." Some researchers suggest that memory training may have more of an effect on motivation than working memory. "It seems to me that children in the training group may have learned to have a better attitude toward the testing situation, whereas children in the control group--who repeated easy problems--may have learned that the testing situation was boring and uninteresting," says Cowan. "The differences that emerged on a variety of tasks could be the result of better motivation and attitude rather than a basic improvement in working memory."

31 Johns Hopkins study into working memory Demonstrated that groups of college students who engage in regular working memory exercises show 30% better retention in working memory than those who engage in the exercises only once, or not at all. The most effective approach was a system that requires people to remember a constantly updating sequence of visual and auditory stimuli. The study showed changes in brain activity in the frontal cortex of the brain which is the area used for higher learning.

32 Does It Work? Alloway (2008) When first graders were tested for intelligence, the data showed that intelligence scores increased during the year by 6% in controls, but increased by 9% in the group that had been given the memory training. The memory training effect was even more evident in the second graders, with a 12% gain in intelligence score in the memory trained group, compared with a 6% gain in controls. As might be expected, the lower IQ children showed the greatest gain from memory training.

33 Does It Work? Kaufman The evidence suggests that the activities that show the strongest and most widespread effects on cognitive functioning are those that target the "whole person," such as traditional martial arts training and enriched school curricula. I think we often underestimate the extent to which multiple aspects of development-- cognitive, physical, social, and emotional-- all feed off each other.

34 Do They Work? Working memory interventions may improve focus and attention to a large and meaningful degree, but they shouldn't be expected to increase high-level critical reasoning skills or magically alleviate all of the symptoms of a learning disability. To improve logical and critical reasoning, one ought to actually engage in reasoning training. To reduce the symptoms of a learning disability, it's important to engage in comprehensive interventions that specifically targets the symptoms (e.g., phonological decoding interventions for people with dyslexia). -memory-training/

35 Nutley (2015) Students in grade 4 (age 9 10). All students in one classroom (n = 20) completed Cogmed Working Memory Training (CWMT) whereas children in the other classroom (n = 22) received education as usual. Performance on nationally standardized tests in math and reading was used as outcome measures at baseline and two years later. At grade 6, reading had improved to a significantly greater extent for the training group compared to the control group For math performance the same pattern was observed with a medium effect size. This is the first study of long-term (>1 year) effects of WM training on academic performance. We found performance on both reading and math to be positively impacted after completion of CWMT. Since there were no baseline differences between the groups, the results may reflect an influence on learning capacity, with improved WM leading to a boost in students capacity to learn.

36 Cautious Optimism... More research needs to be done. Over 80 studies, some positive, some not, have been done on Cogmed. Studies suggest that something s happening but it is a new science. If you compare it to the gold standard of medication for ADHD, where there are decades of studies, we re just nowhere near that.

37 To maintain improvements in focus and concentration requires getting in the habit of concentrating and manipulating complex material in your mind. Let's not downplay the importance of working memory improvements, even if they don't generalize to other cognitive skills. I think we owe it to those who are truly suffering day in and day out from the inability to control their train of thought. Kaufman

38 Does It Last? Some studies have shown impacts lasting between 1-2 years. Some longer. Impact is not always immediate. However, Repeated practice and challenge is essential to maintaining improvements in any kind of cognitive training or else they'll very likely decline rapidly. This shouldn't be shocking. To keep growing and improving intellectually requires constant engagement in intellectually challenging material.

39 What Is CogMed? Consists of 25 training sessions done online, each minutes long (variations to that protocol are now fully available). Each session consists of a selection of various tasks that target the different aspects of working memory. The training is done online at home, in school, or at work. The standard program is five weeks long with five sessions every week, again now with variations available in beta. It is a rigorous program designed to improve working memory through intensive and systematic training. The training is available through professional channels around the world. The training is always led by a Cogmed Qualified Coach who works with the user to provide structure, motivation, and feedback on the progress.

40 What Is Cogmed?

41 Conclusion Training working memory has shown to be an effective way to increase IQ. Over 80 peer reviewed studies have shown brain training to be effective. CogMed has been found to be the most effective in many studies. Many additional studies have been completed which show improvement in abilities related directly to the brain training tasks but do not see the skills as necessarily transferable. Personality, learning profile and motivation all come into play. The whole person must be considered. There are many ways to exercise working memory that are low cost or free. The consistency and accountability associated with organized programs have shown to make a major difference in outcome.

42 Questions? Dr. Lisa Reid, Ed.D., ET/P 3900 Birch Street, #103 Newport Beach, CA