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Child Neuropsychology

A blog by Dr Jonathan Reed

  • Our rehabilitation company Recolo is now offering the Cogmed working memory training program. Working memory is the ability to hold information in mind for a short period of time and to be able to use this information in your thinking. Problems with working memory are associated with a number of childhood conditions including ADHD, brain injury and poor academic achievement.

    We decided to provide the Cogmed working memory training in the UK because the research literature on it is impressive. It is effective in improving working memory in 80% of cases. The improvements have been demonstrated in neuropsychological tests, fMRI changes and rating scales. It can also be demonstrated at the neurotransmitter level- see previous post for details. It has been shown to be effective in improving working memory difficulties in children with ADHD and in adults with strokes. Klingberg is the main researcher in this area and his lab website contains copies of all the most important research papers. In particular the 2002 and 2005 papers are important Working memory training has also recently been shown to improved academic functioning in children with low working memory (Holmes et al 2009).

    The program we offer includes computer training using a game format. The game adjusts itself depending on the level of ability of the person training i.e. if the child finds a task difficult it will lower the demand- if child is doing well demands increases. We monitor performance centrally so we can see how the training is progressing. We also provide weekly coaching to ensure motivation The program lasts for 5 weeks (25 sessions). All these features and the research make this training in my opinion unique and different from other brain training programs.

    We can provide working memory training for children from the age of 4 to young adults up to age 25. If you are in the UK and would like to find out more please contact us on 020 7617 7180 or email care@recolo.co.uk or visit our website.

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  • There is a lot of debate particularly in the media about the pros and cons about computer use with children. I believe that there are some fantastic potential benefits in developing computer games to teach children. Here are 5 of them:

    1. Dissemination of information- Our knowledge about child neuropsychological development is increasing all the time. But there is a problem communicating this to teachers and parents and applying this knowledge. Computer game based learning allows this knowledge to be disseminated to a large number of children. An example is dyslexia (by this I mean difficulties in learning to read). As neuropsychologists we know how reading develops, what part of the brain is involved, how to intervene to improve reading and how this changes the brain areas involved. And yet there are thousands of children who leave school every year unable to read. Developing computer games to address dyslexia using up to date knowledge is possible. Simple computer based learning can spread best practice to everyone (national and international).
    2. Motivation-One of the problems in teaching is in motivating children who find learning difficult or unrewarding. Computer games designers are the experts in motivation especially for kids. I rarely see kids even with severe ADHD who can’t sustain motivation for computer games. Computer game based learning allows educators to combine these motivating factors with learning.
    3. Effectiveness-It is possible to test the effectiveness of computer games based learning programmes in easier ways than it is to assess human taught programmes. Computer games are a standardised procedure that can be easily tested. In this way we combine scientific method with education to determine which programmes are most effective. This in turn will drive development resulting in more effective games over time. This fits with government priorities in producing evidence based learning interventions.
    4. Addressing reasons for learning difficulties. As well as targeting a direct area such as reading it is possible to address indirect reasons for learning difficulties using computer games. A prime candidate is working memory. Whilst it is possible to target and improve working memory directly (see post), it is also possible to use computer games to minimize the demand on working memory with learning programmes by using techniques such as error free learning. It is possible to reduce the need for verbal instructions for children who find listening difficult. It is also possible to reduce attention demands by using visually stimulating action based games.
    5. Computer are patient. As a teacher or parent it can be very frustrating teaching the same thing to a child who just ‘doesn’t get it’. The child also picks up on this and is often anxious about failure. Computers can be very patient. They will repeat the same procedure in the same tone time and time again. Some clever games can lower or raise the demands on the child automatically depending on how the child is doing. The child can work at their own pace and level.

    Therefore in my opinion for all these reasons it makes a lot of sense to develop computer game based learning on a widespread basis. At the moment I think the field is in it’s infancy. To produce good computer game based learning requires a combination of great games design, cleaver programming to build in some of the important factors discussed above and expertise in teaching/ child neuropsychological development. There are thousands of learning games out there but very few based on knowledge of neuropsychological development, with good game play and research to show their effectiveness. I hope that this will change- it could change a lot of children’s lives.

    For an example of a computer game based learning using neuropsychological knowledge visit my games site- Neurogames.

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  • A new study published in Science spells out how brain training may work at a biochemical level. One of key candidates for effective brain training is working memory. Working memory is the ability to hold information in mind in the short term. We use it in mental maths, remembering instructions and it is a key component in childhood learning in general. Difficulties with working memory are seen in a variety of childhood disorders including ADHD and brain injury. Previous studies have shown that working memory can be improved by training. Studies have also shown that training working memory produces changes to the frontal and parietal parts of the brain. This latest study shows how the changes occur at the biochemical level. The key neurotransmitter here is dopamine, which is particularly prevalent in these frontal areas. This study in Science shows that 14 hours cognitive training using a computer game resulted in changes in the density of dopamine receptors. These are exciting findings showing that change to brains at a fundamental level is possible using computer based learning. It has major implications for the treatment of disorders such as ADHD as well as learning in general. The important lesson is that brain training needs to be focused on specific brain areas and functions, namely the areas that have the most plasticity.

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  • There has been a lot of discussion in the media recently about the use of fish oil to improve learning and behaviour. Is there any substance behind the claims or is it just a fad? Fish always used to be known as brain food and there are good physiological reasons to expect fish oil to help neurodevelopment. Fish oil is a type of polyunsaturated fatty acid (PUFA) containing omega 3. Omega 3 fatty acids make up about 20% of brain and heart membrane. They are thought to speed up nerve and muscle signalling. Many children today have diets very low in fish. One would think therefore that fish oil supplements would help, especially for children with low fish diets. The evidence, however, is not strong. Research in 2005 by Alexandra Richardson and Paul Montgomery from Oxford University showed that omega 3 resulted in improvements with reading, spelling and behaviour (see the Food and Behaviour Research website). However, after these promising initial findings the research hasn’t been so positive.

    The National Institute for Health and Clinical Excellence (NICE) review on treatment for ADHD showed that the evidence does not support using omega 3 in the treatment of ADHD. http://www.nice.org.uk/Guidance/CG72/Guidance/pdf/English

    A large study was recently carried out in Durham UK with about 3000 children taking fatty acid supplements but there have been concerns about the way the trial was carried out, at the large number of pupils dropping out and the results are disappointing. The difficulties with the study are summarised here on the bad science website.

    One of the leading advocates of the positive effects of fish oil on brain development is Professor John Stein, professor of physiology at Magdelen College, Oxford (and interestingly the brother of famous fish chef Rick Stein). He is currently undertaking a study looking effects on the behaviour of boys in a Young Offenders Institute and this may provide some answers. See http://news.bbc.co.uk/1/hi/health/7618888.stm.

    Until then the jury is still out on the effectiveness on fish oil on neurodevelopment. There are some promising signs and from a biological perspective it does seem make sense, however, the evidence is not there at the moment to make clinical or policy recommendations. I will post any updates on this topic here.

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