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Child Neuropsychology

A blog by Dr Jonathan Reed

  • 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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  • 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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  • You can now try Neurogames for free with the demos online for the basic maths game Nutty Numbers and the reading game Letter Lilies. The games are specially formulated to help children who find learning difficult including children with dyslexia, dyscalculia, ADHD and Learning difficulties. However, they are based on normal child development and so can be used by anyone learning to read or learning maths. I use them clinically in my practice and I have had great feedback from children of different abilities who have played the games. I believe that using games to help children learn holds great promise for the future. So try the games for free here and let me know what you think.

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  • Scientific and technological knowledge is developing very fast. This post is about some of the ways in which we could use this knowledge to help children develop in ways that will help them and change society in the long term. These are just a few examples of what we know and what we could do.

    1. Eliminate dyslexia- not being able to read as well as being difficult for the individual involved also is associated with significant social problems for example approximately 50 % of adult in prison in the UK have difficulty reading and 80% have difficulty with writing. We know how to treat dyslexia (see this post) Eliminating dyslexia has been attempted in one school district in Scotland with great success. Why can’t we do this everywhere?

    2. Teach children how to be happy- There is a large literature on the science of happiness. For example see Paul Martin’s book Making Happy People: The Nature of Happiness and Its Origins in Childhood. We could use this science to teach children how to live happy lives. Helping children develop in this way early on could set up life long patterns. Imagine the effect on society.

    3. Introduce safe internet based social networking for all children. The potential power of computer based social networks is immense. With twitter, facebook and email we can now talk, communicate and work with people from all walks of life and from all over the world. These have the power to expand social networks and work against isolation and xenophobia. School children could from an early age learn to communicate and work with other children all over the world. There are risks for children in terms of social networking which are often highlighted in the media i.e. abuse online- but the key is to develop safe social networks, for example see Moshi Monsters. Developing safe social networks for children at school could have massive benefits for how they see the world from a social perspective.

    4. Improve children’s working memory (short term memory) – see post. Working memory involves holding information in mind and manipulating it. It is involved in listening to instructions, formulating thoughts, planning etc. It is linked with academic and intellectual development. It is a key skill to have as an adult. Difficulties with working memory are also associated with children with neurodevelopmental problems such as ADHD. We have the tools to help improve working memory in children. This is brain training at it’s best. Could this be part of regular school exercises in the same way as PE is?

    5. Develop Computer based learning- so many children become disillusioned with learning and give up. Computer based learning has the power to engage children and deliver learning in new specialized ways. Games designers have worked out with great success how to motivate children. Neuroscientists know how children learn. If we combine knowledge in these two areas we could revolutionize learning. I have started on this process in with Neurogames. Also see the Consularium blog for examples of how this has been tried in innovative ways in schools in Scotland.

    These are just some ideas, but imagine if we could produce a generation of children who were happy, with optimal brain development, with a broad social network, whose brains are primed to learn and think. What would this do for the next generation and for society in the future. We have the knowledge to do this. Could we make it happen? Let me know what you think?

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  • There is a very interesting debate in the US at the moment about how to tackle reading problems (dyslexia). There is increasing interest in the Response to Instruction (RTI) approach- summarized here. This approach focuses on how to teach reading for everyone rather than just identifying and treating children with dyslexia. It is a public health approach focusing on prevention rather than an individual disorder approach focusing on treatment. In the UK the focus is more individual and based on clinical identification of dyslexia- i.e. does this person have dyslexia or not. Parents and teachers need to find someone – often a clinical or educational psychologist to diagnose dyslexia. This in turn depends on the parent or teacher recognizing the problem in the first place and many children seem to slip through the net. The psychologist will normally write a report with recommendations, which in my experience are often not followed. It is an inefficient system. The RTI approach seems to be more about looking at the school population as a whole. They screen the whole school population at a young age and then the children identified with delayed reading are either provided with minimal intervention or if this doesn’t work more intensive intervention. The focus is on how reading is taught (instruction) and how the child responds to this instruction rather than identifying disability. The research findings suggests that instruction accounts for a lot of reading difficulty and there is a large body of impressive research looking at the effectiveness of RTI- see this site for details. There is a reaction from some neuropsychologists who feel that RTI doesn’t address children with more severe deficits and more complex neuropsychological profiles- RTI is a bit of a catch all that misses the more unusual kids. Also there is concern about the use of RTI in practice. Whilst as a neuropsychologist I have some sympathy with this view I feel more strongly that children should be leaving school being able to read especially when the research shows that nearly all children can be taught with the right teaching methods-see previous posts on dyslexia. I don’t think we have got it right in the UK and too many children are failing. I really like the public health aspect that RTI advocates. If a smaller group of children who need further assessment and more intensive intervention could be identified using this approach and that there are then clear referral lines to a psychologist, it would be a better use of resources and may prevent a lot of children having a miserable and unproductive time at school. It should theoretically be possible to eliminate nearly all reading difficulties in the UK. I am aware of the inspiring work of Tommy Mackay who virtually eliminated reading difficulties in one school district in Scotland, but I am not aware of this happening in other places in the UK or of a political will to address this. I would be keen to learn of other people’s experience of this and any other thoughts- please post a comment.

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  • I have just developed a new concept combining my knowledge of neuropsychology with computer games. It is called Neurogames and the games are available for purchase on my new website neurogames.co.uk. At present I have developed four games helping children to develop maths and numeracy. The games are based on the science of the development of reading and numeracy drawing on some of the work from the contributors writing in our book Child Neuropsychology as well as some of the research studies highlighted in this blog. The games take a developmental course mirroring the normal developmental sequence of reading and maths acquisition. The games also draw on my clinical expertise in terms of what helps children with neurodevelopmental difficulties. This includes errorless learning, frequent extrinsic rewards, visual based learning with bright attractive graphics and short game sequences with clear indicators to help children with short attention span. Computer games are also not critical and therefore the social pressure on learning is eliminated. Finally games are fun and Neurogames provides a new fun way of learning. I hope that the games will be helpful for children who find learning difficult whether it be because of a specific difficulty such as dyslexia or dyscalculia or because of a general difficulty such as ADHD, learning disability or brain injury. The games are easily to download and can be purchsed direct from the site. I also hope over the next year to develop more games to help with language and memory development. Let me know what you think.

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  • There is exciting new research emerging showing that well informed interventions can change the brains of children with learning difficulties. A recent study undertaken by Ann Meyler and Tim Keller from Carnegie Mellon’s Center for Brain Imaging shows the effects of this in terms of reading. It is becoming increasingly apparent that the core deficit in dyslexia is a problem with phonological decoding. In terms of brain function this is believed to be associated with a deficit to the left sided parietotemporal region of the brain. In this latest study Meyler and Keller used an fMRI scan to measure blood flow in the brain. They found a deficit in terms of poor blood flow to the parietal region in a group of poor readers. They then taught these children to read using word decoding and reading comprehension tasks. After 100 hours of teaching they rescanned the children and found that blood flow in the parietal region had increased to normal levels. After a year the neural gains persisted suggesting that the teaching had long terms benefits.

    This shows how effective good intervention can be. I think that over the next few years we will see an increasing number of similar studies looking at the effects of well informed interventions on brain activation. It should spark a revolution in how we teach our children. However as is often the case the important point is going to be about getting this information out to the people who teach. For details of this study and other work at Carnegie visit the publications section of this site: http://www.ccbi.cmu.edu/home_set.htm

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