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Child Neuropsychology

A blog by Dr Jonathan Reed

  • I recently wrote that too many educational computer games look too educational and are not fun to play.  I have recently, however, come across a couple of causal games that although they don’t set out to be educational actually are, but are also addictive and fun.   Casual games are simple, cheap games that are easy, yet compelling to play.   The first game Drop 7  by area/code is a game involving numbers but also works a bit like Tetris.  To play 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.  I think that this game, without intending to, actually reinforces numerosities,  which is the ability to automatically recognise the number of objects in a set.  Understanding Numerosities is associated with the intraparietal sulcus in the brain and is the foundation for the development of mathematical thinking.  Individuals with dyscalculia (maths dyslexia) have difficulties with this concept.   I don’t think the designers knew this and just designed an addictive clever game.   But it would be interesting to research whether this does actually help children and especially those with developmental dyscalculia to develop in terms of maths.   In the meantime at the least it is a good fun way for children to reinforce automatic number understanding.

    The second game by one of my favourite casual gaming companies Popcap is called Bookworm.  In this game you have a grid of letter tiles and have to create words out of them.  You get points for the complexity of the word.  You also have to use up a burning tile before it reaches the bottom of the page (it goes down one step every time).  It is a fun, fast moving, compelling game but improves word knowledge and spelling at the same time.  Popcap are great at developing addictive simple games such as Bejeweled and Peggle.  It is great to see that they can use the same principles to create games that are educational.

    I should note that both games are also just fun for adults and children to play.  Me and my children enjoying playing them as well as other games just to relax.  They are great on the iphone.  I am sure that they are good at producing increased levels of dopamine (the reward neurotransmitter) in my brain!

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  • I am a avid user of Twitter and find all sorts of interesting information on there. As with the web, however it is difficult to sort out what is important. It also moves so fast that it is hard to keep track. This post highlights some important tweets I have seen regarding advances in neuroscience in the last two weeks.

    1. Repairing brain cells- Researchers at the Montreal NeurologicaI Institute and Hospital (The Neuro) and McGill University group at Montral University have developed a new technique to help repair damaged nerve cells. The study was in the October 7 issue of Journal of Neuroscience. They show that it is possible to use plastic beads coated with a substance that encourages adhesion to help cells grow and form new synapses. You can read about this study here

    2 Gene therapy. A study reported in Nature News investigated possible gene therapy for Parkinson’s disease. Parkinson’s disease is a neurological condition affecting motor control and is associated with a depleted neurotransmitter, dopamine. Stéphane Palfi, a neurosurgeon at the French Atomic Energy Commission’s Institute of Biomedical Imaging in Orsay, and his colleagues simulated Parkinson’s disease in monkeys and then injected the monkeys’ brains with three genes essential for synthesizing dopamine. They saw significant improvements in motor behaviour after just two weeks, without any visible adverse effects. “We don’t see any problems in these monkeys,” says Palfi. One animal even exhibited sustained recovery more than 3.5 years later. You can read about this study here.

    3. Understanding brain development. Researchers at the Stanford University School of Medicine have identified a key molecular player in guiding the formation of synapses. The paper, published online Oct. 8 in the journal Cell, looks at the interaction between neurons and astrocytes. The relationship is complicated but to quote from the report in science daily “It is commonly agreed that the precise placement and strength of each person’s trillions of synaptic connections closely maps with that person’s cognitive, emotional and behavioral makeup. But exactly why a particular synapse is formed in a certain place at a certain time has largely remained a mystery. In 2005, Barres took a big step toward explaining this process when he and his colleagues discovered that a protein astrocytes secrete, called thrombospondin, is essential to the formation of this complex brain circuitry.

    In this new study, Barres, lead author Cagla Eroglu, PhD, and their colleagues demonstrate how thrombospondin binds to a receptor found on neurons’ outer membranes. The role of this receptor, known as alpha2delta-1, had been obscure until now. But in an experiment with mice, the scientists found that neurons lacking alpha2delta-1 were unable to form synapses in response to thrombospondin stimulation.

    The researchers stimulated neurons with thrombospondin and found, those neurons produced twice as many synapses in response to stimulation than did their ummodified counterparts. Understanding this key mechanism could help explain children’s brains development and why this goes wrong for some children. Understanding the biochemistry holds out hope for future treatments. You can read the full report here.

    4. Computer games and rehabilitation. Every week there are reports on how computer games can help learning. As you will see from previous posts on this blog I am great believer in the potential of computer games for rehabilitation and learning. Just one interesting post this week shows an initiative to help individuals with strokes to regain movement using computer game technology. Read about it here.

    This is just a small selection of the information I am finding on Twitter. It shows some of the advances that are being made to understand and help individuals with neurological illness. You can follow me on Twitter here.

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  • I have just seen the preliminary findings of the first independent research study on Neurogames, the games I have developed to help reading and maths. The study was undertaken on 20 children aged 4 to 6. 10 children were given the computer games to play for 20 mins twice a week for 13 weeks at school. 10 children were not given the game and received normal teaching in a different class. Both groups were tested on standardized reading and maths tests (WIAT) before and after the intervention. The results show that the computer game group had an average maths score of 102 (average) before using the games which rose to 123 (above average) after playing the game for 13 weeks. The average group reading score before playing the games was 101.7, which increased to 114.9 after the game. In contrast the children not playing the game started with a reading score of 106.4 and this increased to 109.1 over time. Their maths score started at 103.6 and increased to 109.9. Therefore the study shows that exposure to the Neurogames for 13 weeks lead to substantial increases in maths and reading compared to the control group. These are preliminary findings and they need to be independently reviewed and published but they indicate what may be possible with computer based learning.

    I think that this also shows the importance of scientifically evaluating computer games based on learning. At present whilst there are many educational or brain training games on the market very few are being scientifically evaluated to see if they are effective. There are lots of games that look very good and claim to be brain training or educational but don’t seem to me to have any rationale let alone any evidence. For computer games based learning to develop in my opinion more research has to happen. Computer games lend themselves to scientific study given that they can be seen as a standardised intervention (i.e. they are the same each time they are given) and are easy and ethical to administer. Games can also be developed to incorporate the lasted scientific knowledge- see previous post for discussion on this. I intend to encourage other researchers (please contact me if interested) to independently evaluate the Neurogames with a larger number of children next and also with children with different neurodevelopmental disorders such as dyslexia and dyscalculia. I hope that over the next few years there will be an increasing body of research showing which games and which elements of games are effective in learning and neuropsychological development. This could lead to a revolution in education and rehabilitation.

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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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  • In the past few weeks there have been a number of stories in the UK media about violent behaviour by young people such as Ben Kinsella being stabbed, the robbery, torture and murder of the two French students. In the Times last week there was a story about record numbers of children being excluded from school at a young age for aggressive behaviour. It is difficult to make sense of these stories and they obviously cause concern. I tend to think about the neuropsychological reasons why such behaviour occurs. Obviously there can be a number of explanations for violent behaviour but I thought I would mention three important developmental factors to consider.

    1. Development of Self Regulation. Through development children learn to self regulate their behaviour and emotions. There seems to be a neurological correlate to this. Primitive emotions and behaviours are driven by the brain stem, the hypothalamus and the limbic system, which is present at birth. Over time the cerebral cortex develops to regulate this primitive system. Initially this involves the ventral prefrontal cortex (VPC) and the anterior cingulate cortex (ACC). This process seems to happen in early childhood and is associated with reactive control. This is a more sub conscious control involving inhibiting impulsive emotional responses which would include aggressive outbursts. This normally develops through the experience of being parented, whereby the parent provides external regulation which becomes internalized over time by the child. Later (age 4 to 6) the Dorsal-lateral pre frontal cortex develops allowing self control. This results in more effortful conscious control over emotions and behaviour. Children learn to use internalized strategies to regulate themselves. This development process can go wrong for a variety of reasons including brain injury, developmental ADHD and also lack of adequate parenting. The result is individuals who have poor control over emotional impulses including aggressive impulses. These processes can also be temporarily affected by drugs and alcohol. To read more about this developmental process see chapter 13 self regulation and the developing brain by Rebecca Todd and Marc Lewis in our book Child Neuropsychology: Concepts, Theory, and Practice

    2. Development of Empathy- this is the drive to identify another persons emotions and thoughts and to respond to these with appropriate emotion (Davis 1994 Empathy: A Social Psychological Approach (Social Psychology)
    This seems to develop very early in most children’s lives (at about 14 months). It is different to Theory of Mind which seems to be about understanding other peoples thought’s. The classic disorder of empathy is a person described as a psychopath. They understand other peoples thoughts but feel no emotion in relation to this and as a result have nothing to stop them hurting others. Empathy seems to be related to gender in that males are more likely to show less empathy. A few children in my experience seem to lack empathy as a developmental disorder. Sometimes this seems to occur for children with traumatic childhoods with experience of early violence, but in my experience it is rare. It seems to be associated with the inferior frontal gyrus (IFG), which in turn is associated with a discrete network of brain processes involving face processing (fusiform gyrus, inferior occipital gyrus), emotion (amygdala, insula, ventral stratum and other structures) and with action perception (mirror system). To read more about this see chapter 14 social neuroscience by Simon Baron-Cohen and Bhismadev Chakrabarti in our book Child Neuropsychology: Concepts, Theory, and Practice

    3. The third important factor is social processes. Classic social psychology from H.Tajfel has shown how social identity influences group behaviour. Individual placed in a group would quickly begin to favour and maximise the benefits to their group at the detriment of other groups even when they didn’t know the other members of their group. Group identity is very powerful and may explain some of the gang behaviour in inner cities i.e. why gang members hate members of other gangs. Also there are the studies on social influence by Stanley Milgram. In this study volunteers delivered what they thought where powerful electric shocks to others when told to do so by someone in authority. This authority effect may explain the way that leaders in a group will influence other lower members . This is particularly pertinent in gangs with children- the younger children being influenced by older members. These social influences may also explain state controlled violence where leaders get subordinates to carry out violence on their behalf. It seems to me that social influences can override individual brain processes. This is an important factor in gang related violence – much of which is a problem in London UK at the moment. Children will do what older gang members want through the influence of authority and also start to hate other groups/gangs through social identity processes. There are likely to be wider social influences in society but I will leave that to the sociologists to explain.

    These factors don’t explain all the reasons for violent behaviour but they are important and may be helpful in thinking how to prevent violent behaviour developing. Certainly help with early parenting skills for parents with young children at risk would help with development of self regulation. Early identification and treatment for disorders of regulation such as ADHD and brain injury is important. Early screening for signs of empathy disorder is an option to be explored (treatment options for this are at a very early stage). Finally realizing the negative social influences of groups or gangs is important. The social influences surrounding the gang will be more powerful than the individual within the gang (and perhaps by a certain age their parents) can control. To try and prevent violence in inner cities it is necessary to disrupt the gang itself and find other ways for children to meet their social needs. In the meantime unless these issues are addressed in childhood we will continue to have news headlines about young people being killed and others being jailed for life- not a good option for either or for us.

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