Working Memory Presentation Notes from 3-13-12

Georgetown Special Education Parent Advisory Council (SEPAC) Meeting
https://sites.google.com/site/georgetownsepac/home (access from district website)
https://georgetownsepac.blogspot.com
Meeting Minutes, March 13, 2012 – 6:30 pm, Penn Brook Library

March 13, 2012 – Georgetown SEPAC Meeting, 6:30-8:30pm, Penn Brook Library, 68 Elm St., Georgetown: Working Memory: Strengthening the Weak Link in ADD/ADHD Keynote Speaker: Rebecca Shafir, of www.mindfulcommunication.com. Did you know that Working Memory (WM) is the new IQ? Working Memory is the best indicator of academic success; better than IQ scores. Working Memory underlies several functions related to learning and is considered by researchers to be the weak link in persons with ADHD, a neurobiological condition that affects one' s ability to maintain attention. Working memory takes the information we focus on, processes, sorts, and evaluates it, and brings it together with our long-term memory to generate a response, a decision on how to act or think upon the new information. Our working memory is constantly processing new information from the environment, and the way that happens affects our recall of reading material, social interaction, names, and places. The good news is that working memory can be strengthened and improved. In this 90 minute talk, qualified Cogmed Working Memory Training coach Rebecca Shafir will describe working memory's impact on academics and social skills, plus the research behind working memory training. We will also discuss practical, specific strategies to improve and compensate for poor working memory, both at home and at school.
Speech/language Pathologist, communication consultant, and brain fitness expert Rebecca Shafir has been helping children and adults with ADHD and ADHD-like conditions communicate and think more clearly and powerfully at home, at work and in public for more than 25 years.
In the areas of cognitive health, wellness and rehabilitation, Ms. Shafir has served as Chief of the Communications Disorders Department at Choate-Symmes Health Services, Chief of Speech/Language Pathology at the Lahey Clinic Medical Center. For that past ten years she has worked as Clinician/Director of Business Development for the Hallowell Center for Cognitive and Emotional Health, all in Massachusetts, also a practicing speech/language pathologist.
Rebecca Shafir’s award-winning book The Zen of Listening: Mindful Communication in the Age of Distraction from Quest Books, will help all who read it, from families to teachers to leaders in all walks of life!

Working Memory is the ability to hold onto pieces of information in your mind and apply them to achieve a goal. Poor working memory is a core deficit in ADHD, as well as for children with learning difficulties, anxiety disorders, or brain injury. Working memory is what helps us to stay focused on task, to block out distractions, to be aware of our environment, to reason through multifaceted choices, and to perform effectively.

ADHD can mask as at least 30 different diagnoses. ADHD’s three primary symptoms are inattention, hyperactivity, and impulsivity, occurring in more than one setting. The disorder significantly impairs a child’s ability to function in some of the activities of daily life, such as schoolwork and/or relationships with family and friends. Symptoms are usually apparent before the age of 7.

At the Hallowell Center, we commonly see kids who have been underdiagnosed, overdiagnosed, and misdiagnosed. The right medication can be extremely helpful for about 70% of children diagnosed with ADHD. However, it generally only increases working memory function by 10%. Medication helps with focus, but not necessarily with control over focus.

Executive function is a set of cognitive processes, including working memory, problem solving, multi-tasking and more. For people with ADHD, executive functioning is often impaired in areas such as:
- Focusing/high distractibility
- making transitions
- self-monitoring
- self-regulating/decreased inhibition/increased impulsivity
- organizing materials, not losing things
- effective time management
- planning and carrying out tasks
- storing and retrieving information
- recognition of key ideas
- noticing details
- requiring high interest tasks to stave off boredom

Our society today, as it is evolving, does not do a lot to develop executive function. One particular area, family dinnertime table talk, is in great peril. With modern time constraints, we tend to compress discussions that help us think through pros and cons, evaluate new ideas and share opinions on newsworthy items, consider consequences. Conversations that encourage children to reason and develop their critical judgment tend to be shorter than ever before, when they occur at all.

In schools, teaching the information-packed curriculums of today is so demanding that time for information processing and multi-modal understanding of the material is minimal to nonexistent. Time pressures lead teachers to more of a focus on memorization and repetition than on integration of information.

Direct one-on-one conversation time in general is often minimal. What has taken its place is time on the internet, social media, texting, tweeting, facebooking. While all of these do represent a form of communication, they allow both children and adults to participate more passively; immediate response are not necessarily called for; participants are not required to take in another’s presence in a truly active way.

According to a 2009 Kaiser Family Foundation study on Daily Media Use Among Children and Teens,
- 8-18 year-olds devote an average of 7 hours and 38 minutes (7:38) to using entertainment media across a typical day (more than 53 hours a week).
- Those who say their parents do set limits on media consume nearly 3 hours less media per day than those with no rules.
- (64%) of young people say the TV is usually on during meals.
- Just under half (45%) say the TV is left on “most of the time” in their home.
- Seven in ten (71%) have a TV in their bedroom, and half (50%) have a console video game player in their room.
- “The amount of time young people spend with media has grown to where it’s even more than a full-time work week,” said Drew Altman, Ph.D., President and CEO of the Kaiser Family Foundation. “When children are spending this much time doing anything, we need to understand how it’s affecting them – for good and bad.”

One thing we know about high media use, is that heavy users of media do report lower grades in school. Which is not surprising considering that they are missing out on discussions that call on them to think critically, evaluate what is happening, and think through cause and effect.

Working Memory calls primarily on two parts of the brain, the Frontal Lobe – your “brain’s conductor,” which controls attention, motivation, emotional/social judgement, problem solving, decision making, expressive language, motor integration and voluntary movement, and also the Parietal Lobe, which controls tactile perception (touch), awareness of spatial relationships, and most academic skills. The brains of children diagnosed with ADHD tend to show reduced parietal functioning and smaller/less developed/less active frontal lobes.

The children who “grow out” of ADHD are the ones whose brains grow in these two areas as they become adults. Working memory has been found to be one of the last areas/capabilities in the brain to develop. It has also been noted as one of the first capabilities to “go.” Working memory function often begins to decline in people in their 4o’s (sorry!).

The most popular theory of Working Memory used today is Alan Baddeley’s model, which is a three part model/schematic: the Central Executive function (controls/regulates cognitive processes) is comprised of
1) The Phonological Loop – Auditory/Language
2) Episodic Buffer – Short term episodic memory/links to long-term memory
3) Visuo-spatial sketchpad – Visual semantics/movement

Children in elementary school use working memory to build reading comprehension, do mental arithmetic, interact and respond appropriately in social situations.

Middle School presents a very great challenge to working memory, as the complexity and volume of information presented for learning increases drastically. Expectations for doing homework independently, solving multi-step math word problems, writing essays and reports all require an efficient working memory.

Tutors can help students with executive functioning disorders, but they need to teach the student key organizational skills and mnemonics, or strategies to remember important information at the same time they teach the academic skills. Otherwise, their value is only temporary.

Neuropsychological testing can be of great value to parents, children, and the schools. Working Memory tests are fairly good, but they also are conducted in controlled environments. So to fully evaluate a person’s Working Memory capability, it is important for me to assess other factors, such as
- hearing
- visual
- anxiety and depression (both can cause or be caused by Working Memory issues)
- diet – fish oil and vitamin D can both help
- real life descriptions of struggles at home and in the classroom

Because improved working memory function has been shown to improve behavior at home and at school, lessen anxiety, and decrease explosive episodes, it is important to find working memory training tools that are affordable, effective, and make long-range or permanent improvements.

Several ways to improve working memory for people of all ages have been found effective:
• Medication (generally helps around 70% of people formally diagnosed with ADHD)
• Diet & Exercise – Read SPARK: The Exercise Revolution, by John Ratey
o www.johnratey.com - Try asking the kids to do 25 pushups before school!
o John Ratey is also co-author with Dr. Edward Hallowell of Delivered from Distraction.
• Stress Management – biofeedback, neurofeedback, slow/deep breathing, visualization, meditation
• Positive Immersion-based learning – using high-interest, fun game-like situations, such as chess or martial arts to build cognitive skills and learning style awareness
• Socialization - Constructive conversation and dialog to build critical thinking
• Compensation Strategies – practicing note/study/test taking strategies and time management techniques, calendars, setting schedules/deadlines, clearly define goals, monitor progress.
• Executive Function Coaching – one on one consultative support, with or without assistive technologies/computerized brain training
• Computerized brain training (of frontal and parietal lobes)
o http://www.inspiration.com/ - Inspiration and Kidspiration software For visual mapping, outlining, writing and making presentations, etc.
o http://www.positscience.com/ - Brain Training Software
o http://www.learningbreakthrough.com/ - a “strength-based” treatment for ADHD, dyslexia and other learning difficulties.

One of the most effective computer-based brain training programs, considered by many “a new breed of intervention,” is called Cogmed Working Memory Training (by Pearson). Improvements can be expected in reading comprehension, math skills, language development, on-task behavior, and more. Use of Cogmed must be supervised by a psychiatrist. Training is done at home on a PC. The program requires a commitment of 5 weeks, 30-40 minutes a day (15 for children ages 4-7). The program includes coach support for the 25 sessions, and 100 additional sessions after that.

Ideal candidate clients should basically like video games and not be too anxious. There are 3 different programs, one for 4-7 year olds, one for 7-17 year olds, and one for adults. Each has different graphics and reward systems, fishes for the younger ones, robots for the older ones, not a lot for adults.

Cogmed, supervised by a psychiatrist, runs around $1600, while Learning Breakthrough, generally much less or unsupervised, runs around $400. While LB has helped many people, its results are somewhat less evidence-based at this time than those of Cogmed.

A supervised program will be much more customized to the client. Targeted outcomes become our goals. We ask, if you could make your life easier in 3-5 ways, what would those be, and generally zoom in on making those ways happen in an engaging way, such as improving reading comprehension, writing skills, math skills, easily completing/keeping track of/not losing homework, confidence in taking on the challenge of a complex project, increased sense of self-control over appropriate social responses at home or at school.

Parents and teachers almost uniformly report improved social skills, taking initiative, remembering instructions and completing assignments more independently in students who have used the Cogmed program.

Cogmed can also be extremely helpful for concussion/head injury clients, as well as those diagnosed with LD NOS or certain students on the autism spectrum disorder.

Dr. Hallowell through The Hallowell Center in Sudbury, MA www.drhallowell.com is working on a series for teachers, focusing on building executive function skills, supporting children with ADHD, clarifying the different approaches.

One more helpful approach to working memory deficits, especially those caused by anxiety, is a program called Heartmath. The emWave2 desktop system helps a child or adult learn to calm themselves down before trying to focus on a goal. Through simple to learn exercises and games, with a pulse sensor that attaches to the ear, the program collects and translates HRV (heart rate variability) data into user-friendly, fun graphics. Clients find that this program, which could be used by a student to begin their day, builds resistance to stress, increases energy, promotes focus, mental clarity and emotional balance. See www.heartmath.com The system costs $229 and needs to be supervised by a trained psychologist for maximum benefit.

(yellow) Handout: Working Memory Constraint Checklist
Do you or your child…..
- Get easily distracted when doing something not so interesting? Yes/No
- Have trouble waiting for a turn to talk? Yes/No
- Struggle with reading comprehension? Yes/No
- Struggle with doing mental math calculations? Yes/No
- Struggle with getting started? Yes/No
- Struggle with completing a task? Yes/No
- Have difficulty planning and organizing with multiple steps? Yes/No
- Often seem restless and on the go? Yes/No
- Lose belongings frequently? Yes/No

If you answered yes to 3 or more of these questions, consider Cogmed Working Memory Training as an option for intervention. Call Rebecca Shafir M.A.CCC, a qualified Cogmed coach with the Hallowell Center in Sudbury, MA at 978-287-0810 x117 or her West Newbury, MA office 978-255-1817 for more information. Also see www.cogmed.com.