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Child Neuropsychology

A blog by Dr Jonathan Reed

  • Infographics are a great way of understanding issues quickly. I have recently come across two very interesting infographics that I wanted to share.

    Firstly the psychology of poverty and it’s impact on mental health.

    The Psychology of Poverty and Its Impact on Mental Health

    This Infographic links with my previous post on poverty and children’s brains.

    The second Infographic is from Open Colleges in Australia and shows a map of the brain looking at different brain areas and strategies to help leaning associated with these areas. This is a great tool for anyone interested in brain functions and learning.

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  • Our ability to control our impulses is a key executive skill that marks us out as human.  Rather than just reacting to the environment we can choose what responses to make in any given situation. However anyone temped by chocolates or distracted by Facebook or Twitter will know that self control can be hard.  It requires some mental effort.   This ability to control impulses develops throughout childhood and individuals differ in their ability.  There are also a number of developmental conditions where individuals have difficulty in self control including ADHD and brain injury.   The ability to self control requires attention and response inhibition (i.e stopping responding automatically).  These abilities are associated with the Prefrontal and parietal areas of the brain.  There has been some research showing it is possible to improve these abilities but these tend to be experiment based and not freely available- see Yang and Posner for example.  I therefore decided to develop another Neurogame based on attention and self control.  It is called Impulse Control and is available in iTunes for iPhone and iPad.  It is my attempt to find a fun way of testing and improving attention and self control.  It is based on the neuropsychological theory behind these functions.  The game is designed for all ages and becomes progressively harder the more you play.  The idea is that by practice you will become better in terms of attention and self control. The game is free and can be found on iTunes.   You can monitor your training using the training report in app feature.  Try it and give your brain a workout and let me know how you get on.

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  • Dyscalculia is a type of specific learning difficulty where individuals have difficulty in understanding basic concepts in maths. It is surprisingly common affecting 6-7% of the population.  However it is not so recognised in the same way that dyslexia (problems with reading) is.  The key problem in dyscalculia seems to be difficulty in understanding numersiories, which is the ability to automatically recognize the number of objects in a set. Understanding Numerosities seems to be neurologically based and is associated with the intraparietal sulcus in the brain.  Treatment for dyscalculia is not readily available.  I was interested therefore to be sent an app called Babakus by a Swedish psychologist Björn Adler.  You can purchase on the iTunes store here.    The app is designed to help people with dyscalculia.  It works on the same principal as an abacus but with real numbers.  Therefore the learner can associate numbers with quantity when performing calculation.  Thus it helps the learner bridge the gap from objects or fingers to numbers when undertaking maths.   The app is well made and worked well in the trials I gave it.  It is a bit fiddly at first and requires reading the guide to work out how it works.  However once you are used to it it works well.  Using it on the iPad gives it a multi sensory element.  The app contains a video teaching guide, instructions and also contains an eBook about dyscalculia by Björn Adler.  The app is relatively expensive at £20.99 in the UK app store, but is I guess good value compared to other interventions for dyscalculia.  Whilst the app is based on the science of dyscalculia, there is no research as yet looking at outcome.  I understand that research is planned, however some caution about the efficacy of the app is needed until then.   I would recommend trying this app if you have a child or young person struggling with understanding basic maths concepts.   It is a welcome tool in an area where there are few good interventions.  (Note: I have no financial interest in this app and have not been paid to review it.)

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  • I have just created a new game that involves working memory as part of the play.  The game is called Memorise and is available free on iTunes .  Memorise allows you to test your visual spatial working memory and to see if you can improve it over time.

    Working memory is the ability to hold information in mind in the short term and manipulate it.

    The reason I chose to develop a game involving working memory is the increasing body of research that shows that working memory can be improved with training and that improving working memory can have a wealth of other benefits.

    Examples in the research include:

    Working memory training can change brain function – see Olesen, Westerberg and Klingberg 2004

    Improve Fluid Intelligence (IQ) see Jaeggi et al 2008

    Reduce some symptoms in ADHD  see Klingberg et al 2005

    Help improve academic achievement see Holmes and Gathercole 2009

    and help individuals with brain injury see Johansson and Tornmalm 2012

    Developing visual spatial working memory seems to be particularly important and is associated with increased brain activity in Frontal and Parietal areas in childhood and similar brain network in adults

    Working memory training basically involves repeated practice at holding information in mind.  This can be boring but with Memorise I have tried to create a fun and motivating game that also produces benefits.  Memorise has some built in rewards to encourage your brain to carry on playing.  Memorise also adjusts according to your level, which reduces the sort of frustration seen in many similar games.   You can download the training report to monitor your performance over time and to see if you can improve your working memory ability.

    Memorise is a fun way to test your working memory and try and improve.  It is not a medical treatment.  If you have a medical condition and want a more detailed and clinically focused approach I would recommend trying the Cogmed program.

    Have fun and let me know how you get on.

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  • I have recently been reading a very interesting book on the impact of technology on children.  The Curiosity Cycle by Jonathan Mugan is particularly interesting because Jonathan has a degree in psychology and is a researcher in machine learning.  His area of research is about how robots can learn about the world in the same way that human children do.  He is in a good position to tell us about what is happening with robot development and what we should do about it.

    The book is divided into three parts.  Firstly there is a section on how children construct a view of the world and how this can used to stimulate curiosity .  This section is packed with ideas for parents and teachers about how to encourage curiosity in children.  Jonathan is particularly good at tips for stimulating curiosity in Math, normally a hard subject to be interested in.

    The second section is about how children’s curiosity is shaped by physical exploration (children are embodied creatures- a very current topic) and by interaction with others.  Again there are tips on how to encourage these areas of development.

    Finally and most interesting part for me is how technology is advancing and the impact of this on children’s development.  Jonathan explains in a very thought provoking way how robots and computers are developing and the ways this will shape our children’s lives.   The pace of change he highlights is quite astonishing.   There are going to be many opportunities but also there is some caution -  “Children shouldn’t spend too much time connected since their embodied selves were meant to be out in the sunshine”.  The key point is that while computers and robots are going to be able to do amazing things, where humans have the advantage is in their curiosity.  ”Curiosity will allow your child to go beyond answering questions to asking the right questions and to make inferences beyond the information explicitly given“.

    Overall the book is very clear and readable.  It is thought provoking but also practical.  Jonathan provides a number of media resources.   I would thoroughly recommend to anyone with or working with kids now.  The world is changing and we and our children need to be prepared.

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  • All children should be able to learn to read.  Our scientific understanding of how children learn to read is becoming very advanced.   I have reviewed some the research here.   Now a meta analysis (review of lots of studies) published this month in Psychological Bulletin by Monica Melby-Levag et al shows very strong evidence for the importance of phonological awareness in learning to read.  The blog post by psychologist Daniel Willingham explains in more detail the implications of this. The most notable points are that there is a causal relationship between phonological awareness and reading and phonological awareness seems to be the most important factor in reading development.

    Yet despite this knowledge there are still high levels of poor reading worldwide and in the UK.  A recent report by Department of Education shows that In the UK city of Nottingham 15% of boys (1 in 7) aged 7 had not reached the expected level in reading.

    Somehow the scientific information is not being applied.   Is there anything that can be done about this?

    I believe that technology may have a role to play.  It is possible to incorporate these latest scientific findings about reading into computer games, which help children learn.   I have attempted to do this in a small way in a new app for the iPad called phonics with Letter Lilies which can be downloaded here.  The game is free so available to anyone.  It is based on teaching phoneme awareness.  It is important to point out that whilst there are an number of games that claim to teach phonics most are actually just teaching ABC and letter sounds.  Phonemes are the actual units of sound used when reading.  I believe that there is great potential to teach phonological awareness using games.  I have undertaken some initial research which suggests that these games significantly improve reading, although more research is required to understand this fully.  More background on the games can be found on this website.

    One of the key issues is getting these games out to a wide audience.  I think games which help learning can be a very efficient and cost effective intervention.   Ideally schools should be investing in iPads because they are great ways to learn- see previous post .  One of the problems at present is that there are a large number of apps on the market, many of which have not been designed with much thought.   There is a need to sort and review the ones that are most effective and helpful.  I think that there is tremendous potential in developing iPad games based on science.  There may come a day when children are not leaving school unable to read.

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  • Motor co-ordination is a key factor in development and also seems to be important for general brain regulation and development – see previous post.

    The i-phone and i-pad devices are unique in that they allow you to interact with games and programmes using movement and touch.  They have the potential in my opinion to develop and reinforce motor-co-ordination.  I have chosen 5 apps that I think particularly focus on key aspects of motor  co-ordination.  Games in particular are a fun way of developing skills- they are designed to engage and encourage repetitive play (practice) and all the ones I have chosen start off easy and build in difficulty over time.    Also the apps I have chosen are beautifully designed, often with a good soundtrack and most appeal to adults and children alike.

    My top 5 are:

    1.  For fine motor control –  Doodle Jump This requires fine hand control by tilting the device to allow the character to jump.  It is very intrinsically rewarding resulting in continued practice.

    2 For motor inhibition and regulationWhale Trail .  This game requires tapping the screen to make Willow the whale fly and eat bubbles. The key to success on this game is to inhibit the urge to tap the screen too much or too little and thereby avoid the hazards (thunder clouds) and  follow the rewards (swallowing bubbles).  It is fast moving and you need to anticipate what is going to happen adding an element of motor planning.   Again it is great fun, with a great sound track and very rewarding encouraging you to keep trying (and getting better).

    3  For motor planning- Bumpy Road .  This requires trying to move a car along a bumpy road by lifting the road beneath.  The game requires anticipating ahead by moving the car not too fast, jumping and avoiding hazards (rivers).   This is a beautiful app that is just fun to play for the graphics and music alone.

    4 For developing visual motor co-ordination –  Dexteria - This is a more formal teaching app focusing on tapping, letter formation and pinching objects (fine motor control).  This is definitely aimed at children but is the best example I have come across of a comprehensive  motor co-ordination teaching app.  There are timed elements which are challenging.  The app allows you to monitor progress over each session showing improvement over time.

    5 For visual motor planningFlight control – With this game you have to guide airplanes into land by tracing their flight path into the airport.  It requires anticipating future events and altering plans when you see that two planes may crash.  It gets hard when lots of planes are coming into land together .

    So if you want to improve your or your child’s motor co-ordination playing with these apps may well help.  Although I am not aware of research in this area from a clinical point of view these apps all tap abilities that are important for development of visual motor-co-ordination (and perhaps wider brain regulation).  They are also brilliantly designed, addictive and fun.

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  • Imagine being able to remember everything you have ever learnt or experienced.   Well I have just read a fascinating book Total Recall by Graham Bell of Microsoft labs which suggests that we may soon be able to do this using digital technology.  He set up a project to see whether he could digitally record everything that happened to him, in essence to create a virtual memory.

    In order to learn and remember there is the need to encode information, store and retrieve it.  We now have the technology to do all three of these cheaply and efficiently.  We presently have lots of digital recording devices including, cameras, voice recorders, word processors, emails, answering machines, scanners, PDA’s etc, that can encode information into a virtual memory.   We have very large storage capacity in the case of hard drives (you can now store vast amounts of information even on mobile devices quite cheaply) that can act as a memory store.  In terms of memory retrieval we have sophisticated search engines either on the web or built into computers to find what we need to remember.  This is the first time in history that all three components of digital memory- encoding, storage and retrieval are available in such a cheap and easy to use way.

    The implications for this are potentially huge.  In terms of personal enhancement it should be possible to have digital devices that store and retrieve everything that happens to you. No more forgetting what you have done, where you have been, facts about the world etc.   Your whole life experience could be stored on a device for future reference.  Maybe in the future when you are no longer around people will be able to review your life through such a device.  Bell documents how he records every telephone call, uses Sensecam to record all he sees, stores all his photos, scans every document and bill he receives, stores every email, stores all his medical records  and every web page he has ever seen.  Using a program he has devised he can search for any specific piece of information (memory) and retrieve it easily.  In the future it will be possible to record personal health data such as blood pressure, diet and alcohol intake and even how many steps you take on the same device and integrate it into your memory, which will make healthcare appointments much more efficient.  The book is a fascinating read and Bell believes that this is one of the key trends for the future and that we will all be able to access such technology within the next 10 years.

    As well as personal enhancement this technology has huge implications for neuropsychological rehabilitation.  One of the most devastating consequences of child brain injury is impairment of memory.  There are some techniques that we can use to help with memory retrieval (see previous post ) but these are slow and take a lot of effort to work.  It would be far easier and more efficient to use technology to compensate. It should be possible to equip children (and adults) with memory impairment with a handheld device that will enable them to recall what they have experienced and compensate for their learning and memory problems.  This would revolutionise care for individuals with amnesia and dementia.

    I would love to use this type of technology myself.  I am one of those people who wants to learn and experience everything.  I read avidly, try to keep up with the rapidly expanding neuropsychology literature and try to experience as much as possible while I can.   However the ratio of knowledge that I retain and can retrieve I think is pretty small relative to the amount of input.   At present looking at Bell’s book and the technology available, the issue is about integrating existing technology in order to create a device or program that automatically records, stores and retrieves information.  It can’t be that hard to do as much of the technology is already available.  The challenge will be creating a user friendly program or device that works seamlessly.  Ideally there would be psychology input to match the technology with human experience.   I am not aware of any company undertaking this work at present but please let me know if anyone knows whether anything like this is being created.  Maybe one day we will all be able to achieve total memory recall of everything we have ever experienced.  It could change the world as we know it.

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  • Children and adults learn and develop through play.  I am a great believer that playing computer games as well as being fun can be good for your brain.  I have therefore created a list of 10 great games that I think require very specific areas of neuropsychological function to play.  Some even have research to show that they can change brain and neuropsychological function. These games are for a range of different ages and come in different formats.  Let me know of others that could be included in the list.

    1 Portal 2 (PC/Mac) Probably one of my favourite games.  Portal 2 requires good executive function (associated with frontal areas of brain).  In particular you need to be able to problems solve and plan ahead in this game.  Also it is a beautifully designed game, showing what computer games can achieve in terms of entertainment.

    2 Call of Duty 4 (X box)- An exciting fast paced game that requires good speed of processing and visual attention.   There are a number of academic papers such as this one by Bjorn Hubert-Wallender, C. Shawn Green and Daphne Bavelier Stretching the limits of visual attention: the case of action video games that show games like these can actually improve visual attention and speed of processing.  It seems that this only applies to really fast paced games such as Call of Duty. (note Call of Duty is for age 16 and above).

    3. Tetris (ipad) A classic arcade style game that keeps you focused.  There is research by Haier et al from University of California to suggest that playing this game results in increased cortical thickness. There is also research by Emily Holmes from the University of Oxford to suggest that playing Tetris can help with symptoms of PTSD.

    4 Drop 7 (iphone).  To play this game you have to drop different balls with numerals inside into rows or columns and try and ensure that the numerals and the number of balls match i.e. every time you line five balls up the ones with the numeral 5 in them disappears.  This reinforces the neuropsychological concept of Numerosities, which is the ability to automatically recognise the number in a set.   Difficulties with this concept seem to be the underlying disability in dyscalculia ( specific deficit in maths).

    5 New Super Mario Brothers (Wii) The Wii version allows two people to play together and work in collaboration to progress through levels and therefore involves social co operation.  This would be an ideal game to play with a child with Autistic Spectrum Disorder ASD.  Playing alongside side children with ASD on a shared task  can be better than trying to directly interact with them. It is also fun to play with children and adults of all ages.

    6. Where’s Wally (ipad).  This game requires a very specific form of attention called selective attention.  This is the ability to spot a stimulus within an array of other information. This game may be helpful for children with attention difficulties.  The ipad version is particularly good with changing goals and rewards.

    7. Ball frenzy (ipad)  A good simple but addictive game requiring good visual motor co-ordination.  Similar to marbles.

    8 Bookworm (iphone).  A game requiring word finding and spelling.  This isn’t specifically designed as an educational game and is by Popcap who are great at designing addictive casual games.  It is fast moving and you are motivated by completion and reward rather than focusing on the educational side.

    9. Connect Four (ipad).  Another simple game  but requiring good executive function.  You need to resist the impulse to act immediately and plan your response.  I and colleagues have long believed that playing this game with children is a better assessment of executive function than many formal tests.

    10 Nutty Numbers (ipad)  I have including the game I have developed to help with numeracy for young children because there is research to show that it is effective in children’s development of numeracy.

  • I am really excited about the prospects of using the ipad to help children learn.  As I have previously discussed there are some important advantages in using the ipad, especially with younger children and children who find learning difficult.  I am developing games on the ipad to help learning and rehabilitation (see Nutty Numbers).   I am also clinically involved in rehabilitation and looking to find ways to help children with neurological conditions.   As a result I have looked in detail at what sort of apps are available.     My impression from studying the itunes educational app charts and trying out various games is that there is generally a lack of good quality educational apps that I could recommend.   Although I want to promote my own apps, I would also like to recommend apps to help particularly children who are finding learning hard or are in rehabilitation.  Whilst there are a lot of nice looking apps about there is mainly a lack of substance.  The sort of features I would like to see in apps and would recommend parents to look for include:

    1.  Is the app based on learning theory?  There is increasing knowledge about how children learn.  Are the educational apps utilising this?

    2. For younger children are there spoken instructions rather than written instructions?  Clearly young children can’t read and therefore will need a parent supervising them if the instructions require reading. The ipad will work best when children can explore and learn under their own initiative.

    3. What happens if the child gets an answer wrong?  It can be very frustrating receiving a big cross or a sound effect indicating a mistake sound, especially if you don’t know the answer.   This is a particular problem for children who find learning difficult.  Several experiences of this will turn most children off.

    4.  What are the reward structures?  Research has shown that positive affirmations (i.e. letting the child know that they are doing well) are very powerful by themselves in learning.  Any educational apps should have several layers of reward structure.

    5.  Is there any research showing that the app improves learning?  For example Nutty numbers has been shown to significantly increase numeracy compared to a control group in a published experimental study.

    6.  Is there a randomised presentation?  Just going through the same structure each time does not encourage learning.

    These are some of the criteria that I consider important and have used to develop my apps.   I would like to see other educational apps with these features. I think this would help develop the field of games based learning and realise some of it’s potential.  Potentially many children could be using tablet devices such as the ipad to learn and develop.  I have written previously about the advantages of game based learning.  However, at present in my opinion it is still a field in it’s infancy.    I hope it does develop and that I can contribute to this.  I would be keen to hear of any other recommended educational apps fulfilling some of the criteria above.

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