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“Brain-training” Games Ineffective for ADHD

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Readers often ask my opinion on the various “brain-training” programs–computer-based activities that ostensibly improve brain functions in children and adults with ADHD.  My personal opinion is that I’ve seen no evidence that these games transfer into real life; that is, one’s scores might show improvement but does real-life functioning? And, in fact, I’ve wondered if these computer-based activities actually exacerbate the problematic addictions that many people with ADHD experience with electronic information.

Now a meta-analysis of existing studies conducted by a team of researchers at two universities casts  doubt on the utility of these programs.

“We found that these treatments are not effective for treating children with ADHD,” said Michael Kofler, assistant professor and director of the University of Virginia Curry School of Education’s Children’s Learning Clinic. “They don’t improve ADHD symptoms or behavior, they don’t improve academic achievement, and in many cases do not improve the cognitive functions they claim to target.”

“Parents are desperate for help,” said psychology professor Mark Rapport, who runs the Children’s Learning Clinic IV at University of Central Florida. “If they can afford it, they are willing to spend the money, and some parents even enroll their children in private schools because they offer these cognitive training programs. But there is no empirical evidence to show those investments are worthwhile.”

Rapport says he initiated the study because many parents whose children are evaluated at the clinic ask if they should invest in the programs. The study is featured in the December issue of Clinical Psychology Review.

The bottom line: Before spending thousands of dollars on these highly marketed programs, please consider the evidence.  You can read more about the study at the University of Virginia site and this University of Central Florida site.

–Gina Pera

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  1. Brigit O'Leary’s avatar

    Thank you Gina, I was wondering for myself and for the older ADDers whom I hand with. Most of us are so active in retirement checking out gluten and sometimes dairy free recipes, GMO- free foods; where did this product come from; and inquiring about so much more. Just try and keep us down! As for dementia, one cannot wonder but what is going on with so many of our friends and family members, younger adults whom are not working, or living at home, or if working and with their own place are not concerned about voting, volunteering (community), or even dating or having children; finding dogs and cats more suitable companions too.
    Indeed. It is a different world and we kids of the 60s (Woodstock era) really are scratching our heads yet too, think that perhaps we are ahead…we still meditate, seek silly joke and fine wine with lots of character and appreciate finally what took us to the gate: our own idea of what it is all about…sort of. So my dear: Thank you for saving us a dollar or $100 and more, be us addled silly or just short a snore when we speak…we are the seniors now, the kids over 60 and it is ok. We will just carry on, ADD or not, and muddle away with delighted news we saved a few thanks to Gina!

    Reply

    1. Gina Pera’s avatar

      Haha! Hi Brigit! Enjoy a bottle of fine wine on me! xo

      Gina

    2. Danielle’s avatar

      I personally subscribe to one of these sites and enjoy it. I do find it helpful, but I’m not using it to help ADHD and I was about to say I’m not a child but in my mid 30s, I am going through a second adolescence of sorts and finding out who I am for the first time and learning some of the same things my 3yo nephew is. I have issues besides ADHD and find that my ADHD meds help some of them and interestingly, Concerta is FDA approved for a type of tachycardia I have. I’m unable to work and find the games help keep my mind active and help my short term memory, which is impaired by meds for other stuff but I must set limits for myself. I don’t think they help ADHD and the site I use doesn’t have programs for various conditions anymore. I think the brevity of each game allows me to play despite having ADHD. I can see how this site could actually make ADHD worse and wouldn’t recommend it for a child.

      IQ tests only measure your ability to take IQ tests. They can be practiced for and if I ever take the MENSA test for real, I’m going to practice rotating 3D objects in my head and learn both oragami and visualizing it in my head first. I have increased my scores in the past by hitting replay on a particularly interesting game all day. Am I getting smarter? I doubt it. Am I getting better brain function? Only with a few games directed at very specific skills like navigating without having to rotate a map, probably because I’m already good at transferring skills from one area to another. Am I getting better at that game? Definitely. Am I having fun? Of course. Did I spend an entire day playing video games, as children with ADHD often do? You betcha.

      I stopped using the site for awhile because I got bored with it. I came back to find a revamped site with more games. My scores on the old ones have dropped of course from lack of practice. But I’ve set limits for myself. Only one replay. I set a time limit. My doctor is recommending brief mildly cognitively challenging activities with low frustration along with low impact exercise and some other stuff to help me recover from worsening symptoms a couple months after 2 concussions too close together and not properly taking care of myself at the time, more due to circumstances beyond my control than things I can control. This site plays right into that because it is fun and offers 15 minute daily training sessions (assuming you don’t touch that replay button). So I do one session a day as part of a broader program.

      But I think that’s the key. Part of a program and works with my attention span, which is close to nothing at the moment. This long reply has been written in pieces, in fact. I set limits on video games. I do other things. I play piano and ukulele. I read books. I skateboard and ski (not right now). I go for walks. It was more fun with my dog before he had to be put down right after one of those concussions, I’ll admit (so much for avoiding stress). I write. I try to do things with other people, despite finding my dog easier to be with and I must say, with instructions to avoid stress, I’m really missing him. He doesn’t inadvertently say upsetting things but I’m also not alone.

      I didn’t grow up with texting and the net. I played with other kids, even video games. You had to be in the same room. I can see what Brigit is talking about with the dogs and cats comment and I can see the appeal being so much greater for kids now, who text more than talk. It’s not safe for kids to run around the neighborhood anymore in places where it used to be. As a society, we are losing a sense of community. That can’t be helping. It has to be hard for parents who can’t depend on their neighbors to look out for their kids. It’s a different world now, even tougher for kids with ADHD to navigate. What’s left for them seems to be a few good things and a lot of things that just make it worse.

      As an disabled adult with ADHD, I like the games in limited quantities, but not to treat ADHD, rather to work with it for the moment. I think there is value in most video games, even the shooters. They improved my sports photography I used to do as volunteer work as a kid. But honestly, I wouldn’t recommend them for kids with ADHD and certainly not as treatment for it. A longer, more traditional video game with a goal to work toward at the end would be better than these, in limited quantities. There are also a ton of games out there like Word Chums and Flow that develop cognitive skills without the price tag. Combine that with a game of old fashioned tag at the park and you get more for less money. I do think these brain training programs would naturally work better for adults who already have the ability to transfer skills and expect none of them live up to their claims.

      Danielle

      Reply

      1. Danielle’s avatar

        Geez my reply was longer than the post. And the program I use is $10/month and I’m not sure if there was an initial commitment to get that price.

        Danielle

        PS – I did say I write!

      2. Gina Pera’s avatar

        Hi Danielle,

        The “game” interactions you describe sound helpful. We all need to develop “cognitive muscle,” right? In fact, I should probably check out some of these exercises, because I can’t imagine what it means to rotate 3-D objects in my head. :-)

        I hope maybe you can get another dog soon. They are such nice companions for exactly the reasons you describe.

        best,
        Gina

      3. Oren Mason’s avatar

        Thanks for publicizing this, Gina. On the one hand, we could sure use some treatments that work, so this is a bit disappointing. On the other hand, it didn’t make much sense that a genetic condition like ADHD would normalize with some memory games. Guess I won’t be deducting my Sudoku books as a medical expense any more. Oren

        Reply

        1. Gina Pera’s avatar

          hi Oren,

          Thanks for your comment. You know how these meta-analyses go….it all depends on the quality of the studies being analyzed.

          Perhaps other studies will find some benefit. But, really, I’m with you: why would a neurogenetic condition normalize with memory games? I could see, though, how it might help promote mental stamina, and perhaps that helps to develop some cognitive muscle or at least a willingness to apply sustained thought to problem-solving. Still, that’s more difficult to measure.
          g

        2. Dalton Blankenship’s avatar

          I would not throw baby out with the bath water. Not all brain games are the same. LUMOSITY is terrific & has been engineered to take care of the practice effect mentioned above. It depends on what is trying to be learned & it is very specific in the types of cognitive skills it allows to be practiced. But playing the games actually allows one to improve, not to get better simply because one “Knows how to play the game,” ie the practice effect.

          I do not have ADHD; I have a traumatic brain injury due to an auto accident. By playing these games, I could pick & choose ones in the areas where I had damage & was able to see dramatic improvement over time in some games (where I also had anecdotal evidence to support that I was getting better); other games remained very frustrating & low scoring (& had anecdotal evidence supporting no change in my cognitive ability).

          I would at least suggest a trial with them. For one thing, they have a free trial period. Second, the cost is amazingly affordable if you do decide to upgrade. I think I paid less than $10/month for my first year. And the games are fun! (all except that one where I had to try and remember what a bunch of people ordered to eat. That area of my brain is apparently fried for good.)
          I hope this has been helpful.

          Reply

          1. Gina Pera’s avatar

            Hi Dalton,

            Thanks for sharing your experience. By all means, some might find the games worthwhile. I know that a serious scientist formerly at UCSF, Michael Merzenich, is behind Posit Science. And there is some interesting research to support the games’ claims in some areas.

            When it comes to ADHD, though, some very grand claims have been made about these games. And it can put parents of children with ADHD — and adults, too — in the difficult position of deciding how to allocate scarce treatment dollars. Should they try the games, which can cost several thousand dollars when conducted in psychologists’ offices, therapy, medication? It’s important that consumers have evidence for the claims made so they can make the best decisions.

            best,
            g

          2. Stavros Saripanidis’s avatar

            Hyperactive syndrome and attention-deficit hyperactivity disorder (ADHD) treatment, from the perspective of the holistic method of Maria Summer, Rankweil/Austria.
            Applied Speech therapy (Angewandte Logopaedie)

            Hyperactive syndrome includes the following: intense myokinetic activity, attention disorders, irritability, impulsiveness, communication deficit, of children.

            These children are constantly changing their mental mood. Sometimes, they exhibit behavioral disorders, even aggression.
            Helmut Remschmidt, in his book “Kinder und Jugend Psychiatrie”, reports that this disorder is associated with disturbances in the developmental stages.

            This hyperactivity can be due to organic brain lesions, or be a consequence of the neglecting the child.
            Child hyperactivity leads it to chaos, because it moves in space without purpose.

            The great educator Maria Montessori in her book “The receptive mind” (1978), refers extensively in motion with educational purposes.
            She writes that movement promotes the child’s spiritual growth and personality development.
            “In nature, chaos would reign if every movement stopped, but the same would happen if the movement of beings lacked purpose.” Maria Montessori

            Hyperactivity is characterized by high kinetic activity of the child, but this is without purpose, with children going from one task to another.

            It’s a mental mess, and this leads to lack of concentration-attention, as observed in children and adults with increased impulsivity and irritability.
            This child is not receptive; it is not able to accept the commands of a parent, a teacher, or a speech therapist.

            Since it is not paying attention, the child can neither be positively affected, nor proceed to knowledge. His/her perception suffers, negatively affecting behavior.
            Children with hyperactivity, when they were infants, had shown some predisposition, being restless and irritable.

            As toddlers, no one could employ them in a game for a long time.
            At 6-10 years of age, they still do not know how to play.
            Playing is very important for spiritual growth and personality formation for a child.

            These children leave unnecessarily their position in the classroom, disturbing others, creating discipline problems.
            “Without movement with purpose, there is no perception, learning or knowledge.” Maria Summer (1984)

            In hyperactivity, we should bring the child to movement with purpose. For this to happen, and for the child to learn to observe, they must first come into harmony with their breathing, experience tranquility and relaxation.

            Perception is a continuous process, which is constantly changing with the addition of experience (5-6 years of age), with the ability to discriminate, with the development of abstract thinking.

            So, perception is an important prerequisite for the development of cognitive processes-functions.
            Vision and hearing play an important role in perception.

            A hyperactive child is not growing spiritually, only physically.
            It is wrong to be severe or punish hyperactive children, as this may exacerbate the problem and their disorders.

            Management and treatment of hyperactivity and ADHD, without drugs.
            When affecting the movement of the child, there is a problem in soul-body-breath.

            In our view, hyperactive children should be treated as a whole, holistic method of treatment (ganzheitstherapie).

            This method, developed and perfected by Maria Summer in Rankweil Austria, is for quick and effective treatment of disorders of speech, voice, breathing and learning, in approximately 60 sessions, without medication.

            A child with hyperactivity is constantly anxious and presents respiratory tension, with characteristic high respiration (hochatmung).
            The first steps in treatment are to bring peace, relaxation, harmonious breathing for the child.

            In the beginning, we only try to make the child relax and pay attention, even for a second.
            When we achieve this, we start reinforcing training exercises.

            Later on, when we acquire attention for a longer duration, we assign some simple tasks to perform.
            With relaxation and achievement of diaphragmatic breathing (i.e. low breathing), the child acquires a new boldness-presence.

            Then, we can switch over to different exercises, targeting the acoustic and visual perception.

            Important role in what we do with a hyperactive child plays the pause. A couple of seconds or longer breaks are necessary for the positive outcome of any treatment.

            Without the break, there can be no perception, attention-concentration, or learning.
            The child must learn to wait.

            Movement with purpose and pace precede, and are closely related to the development of speech, perception, spiritual evolution.
            Early perception is that of motion.

            Myokinetic exercises invented and perfected by Maria Summer are not gymnastics, rhythmic exercise, yoga, or meditation.

            Operators should experience exercises themselves before passing knowledge to others.

            Furthermore, the therapist-educator or psychologist should remain calm, without any stress, with proper diaphragmatic breathing, in order to have a positive impact on the child.

            Importantly, he/she should always remain lower in height, or below the height of the child.

            We describe herein some exercises for hyperactive children with ADHD. Proper execution of these exercises is more important than quantity. Proper implementation is difficult to describe and must be experienced by each therapist in practical training sessions.

            Position hedgehog (der IGEL) leads the child to complete relaxation, fetal position, cutting off most external stimuli, allowing it to concentrate on himself.

            With chin to chest, head between legs, body curled forward, arms at sides, the child is kneeling in front of the therapist.

            The therapist, at posture IGEL, is kneeling in front of the child’s head on the floor.
            With his/her fingers perpendicular, remaining perfectly calm, the therapist makes vibrations along the spine of the child, just aside of the vertebrae, from the bottom up to the head, whispering a hum (summen), in various tones.

            mmmmmmmmmmmmmmmmmm…
            mmmmmmmmoooooooooooooooo…
            etc

            The child, after a break of some seconds, repeats the hum, mimicking his therapist.

            At IGEL posture, the child must slowly be rolled forward. When rising up, after completion of the exercise, the child must slowly stretch initially the lower vertebrae and finally the head.

            A big break, of 2-3 minutes, follows, on the floor, on a hard surface, no cushion, chin to chest, cheek leaning down, arms close to the trunk aside of the body, palms facing upward, feet very open, relaxed.

            At this posture of complete relaxation-peace, we observe the child’s breathing. We can spot the characteristic high respiration (hochatmung), by the vibrations of the back and shoulders of the child.

            In this case, the expert therapist intervenes with various exercises and techniques in order to restore diaphragmatic breathing.

            All this is done on the ground, on a hard orthopedic mattress, in a well-ventilated room, with the child wearing overalls and not clothes that restrict his/her movements.

            All exercises for proper breathing function should not be conscious for the child, at whom we never mention the word “breathing”.

            At cobra posture, the child, from the ground face down slowly lifts his head, keeping the chin attached to the chest, and focuses his gaze, for a few seconds, at a distant point.

            When tired, the child returns to the posture of complete relaxation-peace on the ground.

            After a few sessions, when we observe improvement, we pass to attention-concentration exercises, on a wooden table.

            Therapist and child are sitting side by side on a wooden table, with legs at right angles, hands one over the other at the edge of the table, their foreheads resting on their hands.

            The wooden table is a good conductor of pulsations (resonanz) to be transferred from the therapist to the child.

            With hums (summen) in different tones and styles, vibrations are transferred to the child from the therapist.

            mmmmmmmmmmmmmmmmmm…
            mmmmmmmmoooooooooooooooo…
            etc

            In turn, the child, having learned to wait a bit and listen, begins to repeat the hum mimicking his/her therapist.

            Later on, we proceed in short-term tasks, like learning words, concepts, etc.

            In some cases of hyperactivity the swing posture is appropriate. The child is hugged in our arms, in the fetal position, and slight oscillation is performed.

            The therapist must remain completely calm, without breathing wrong.

            In this hug, while gently shaking, the therapist murmurs hums, mainly with the letter mmmmmmmmm.

            Maria Summer would return in the early stages of development when she understood that a child did not have the right experience.

            Athanasios G. Chasapis, Psychologist-Specialist speech therapist using the holistic method.

            Stavros Saripanidis, Consultant in Obstetrics and Gynaecology.

            Chasapis Athanasios studied, for many years, at the speech therapist Center and Institute of breathing run by Mrs. Maria Summer, and participated in many seminars for Advanced Speech Therapy abroad.

            He then transferred and extensively used these practices of the holistic method (speech-voice-breathing-attention-learning disorders-etc.) in his speech therapy Practice in Greece, from 1982 until now.

            He is the author of a forthcoming book in German, which describes extensively the pioneering holistic method of Mrs. Maria Summer, who died in 2007, without leaving a textbook behind.

            Reply

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