Does the working-memory training program called CogMed work for ADHD? That’s the question.
The Working Memory Training bandwagon could soon be screeching to a halt. When it comes to treating ADHD symptoms, at any rate, results from two recent studies undercut previous claims.
Early Concerns About Rush To Acceptance
Years ago, I participated in a list-serve of ADHD professionals. When I questioned the validity of new programs bursting onto the scene such as CogMed (which is discussed below), all hell broke loose.
Psychologists using it in their practice roundly castigated me. We cannot dismiss the bias created by the profit motive.
The fact remained: At that time (circa 2008), woefully insufficient evidence supported offering CogMed to children or adults with ADHD. But that didn’t stop the sales pitch.
The general consensus among list members who’d tried it and also had ADHD? No improved function in life. But they felt they were “doing something important.” Overall, it sounded like an expensive distraction to me.
When offered such “alternatives,” we always must consider the opportunity cost. That is, what are you giving up? Will an adult lose a job or a marriage if legitimate treatment is delays? Will a child fail a grade or suffer other continuing losses to self-esteem?
What are we missing when we pursue the unproven instead of evidence-based interventions such as:
- Cognitive-behavioral-therapy designed to help ADHD-specific issues
- Structural supports (calendars, timers, visual organizing systems, etc.).
As it turns out, my skepticism might have been well-founded. Yes, initial studies were favorable—and had some problematic conflicts of interest. But more recent research counters those studies’ conclusions.
Thanks to David Rabiner, Associate Research Professor at Duke University’s Department of Psychology Neuroscience, I can share with you (below) a sophisticated analysis of the research.
Dr. Rabiner has long performed the excellent service of parsing the research around ADHD in his newsletter, Attention Research Update. You can subscribe to his free newsletter here and read through the substantial archives once you are subscribed.
I appreciate Rabiner’s clear writing style. Still, research terminology can be complex for the average reader. The complete analysis, below, might be “too much information” for some.
So, here is the bottom line, as Dr. Rabiner writes:
What can we conclude from this work?
Despite promising initial reports suggesting that Cogmed Working Memory Training (CWMT) is a potentially effective treatment for ADHD, these studies significantly undercut this conclusion.
This does not mean that there is no utility to CWMT, however, particularly for individuals with demonstrated working memory deficits.
If one’s treatment goal is to enhance working memory, CWMT may have real value.
If the goal is to bring ADHD symptoms under control, however, these findings indicate that for most children with ADHD, CWMT would not currently be considered a reasonable substitute for medication and/or behavior therapy.”
A Closer Look: Cogmed Study For ADHD
Here is the full report from Attention Research Update:
There are several reasons why it is important to develop evidence-based ADHD treatments in addition to medication and behavior therapy.
- Not all children benefit from medication, some experience intolerable side effects, and many continue to struggle despite the benefits provided by medication.
- Behavior therapy can be difficult for parents to consistently implement, and does not generally reduce behavior difficulties to normative levels.
- Furthermore, although both treatments can help manage ADHD symptoms, they generally do not induce changes that persist after treatment ends.
- Finally, despite numerous studies documenting the short- and intermediate term benefits of medication and behavior therapy, their impact on children’s long-term success remains to be clearly documented.
In response to these limitations, researchers have shown growing interest in whether cognitive training—generally done via computer—can induce more lasting changes in children’s ability to focus and attend. One approach that has shown promise in helping youth with ADHD, and which is now widely available, is Working Memory Training.
The Evidence for Working Memory Training
Working Memory Training is based on findings that Working Memory (WM)—the ability to hold and manipulate information in mind for subsequent use—is frequently compromised in youth with ADHD and may contribute significantly to symptoms of inattention. WM deficits also to contribute to the academic struggles that many children with ADHD experience. Developing an intervention to enhance WM in children with ADHD could thus be extremely helpful.
Several published studies suggest that WM training is a promising intervention for children with ADHD.
In one (see helpforadd.com/2005/march for a detailed review), children with ADHD were randomly assigned to high intensity (HI) or low intensity (LI) WM training.
The HI treatment involved performing computerized WM tasks, e.g., remembering the sequence in which lights appeared in different portions of a grid, recalling a sequence of numbers in reverse order, where the difficulty level was regularly adjusted to match the child’s performance by increasing or decreasing the items to be recalled.
This is called “adaptive” training because the difficulty level adapts to match the child’s performance and children are consistently challenged to expand their working memory capacity.
In the LI condition, the tasks were similar but the difficulty remained low throughout, i.e., the number of items did not increase when children responded correctly. For these children, their working memory capacity was not consistently challenged and was not expected to grow as a result. This was considered the control condition.
Each group trained 30-40 minutes per day, 5 days per week, for 5 weeks with training supervised by parents. Parents were supported through weekly phone calls with a trained coach whose role was to help make sure training was implemented as intended.
Results indicated that immediately after treatment, as well as 3 months later, children in the HI group showed improved WM performance compared to LI children.
Furthermore, parent reports indicated significant reductions in ADHD symptoms, particularly inattentive symptoms; these reductions remained evident at 3 months. However, no benefits in ADHD symptoms were evident in reports provided by children’s teachers. Given the importance of improving attention in the classroom, this was a significant limitation.
A subsequent study (see helpforadd.com/2012/july) also used random assignment to HI vs. LI training, and observed the impact on children’s behavior in a controlled classroom setting.
Results indicated significant reductions in off-task classroom behavior among children with ADHD who received HI training. This partially addresses concerns about failure to find teacher reported benefits in other studies. Children also showed gains in non-trained measures of WM.
Results from these studies, along with several others, suggest that Working Memory Training (the specific training system used in these studies was Cogmed Working Memory Training, i.e., CWMT) yields benefits in non-trained measures of WM and reductions in parent-report inattentive behavior. However, no study has found benefits in teacher reported behavior and symptoms.
Concerns About The Evidence
A significant limitation in the evidence for using CWMT to treat youth with ADHD is the absence of teacher-reported benefits.
In addition, some researchers question whether the LI training is an adequate control condition. This is because although children in HI and LI training complete the same number of trials each session, the LI training takes less time each session because it does not become more difficult.
Thus, the conditions differ in ways other than whether difficulty level adjusts to match the child’s performance.
Some have also suggested that parents of LI children may become aware that their child has been assigned to the control group. If parent are not truly “blind” to condition, it could explain parent-reported benefits that have been found.
For these reasons, some have suggested that CWMT should be regarded as no more than a “possibly efficacious” treatment for ADHD and not considered a ‘first-line’ treatment like medication and behavior therapy.
Results from 2 Recent Trials
Two recently published studies provide important new data on the efficacy of CWMT for ADHD:
Working memory training in young children with ADHD: A randomized controlled trial (van Dongen-Boomsma et al., 2014) was conducted with 51 5-7-year old children with ADHD in the Netherlands.
Similar to the studies summarized above, children were randomly assigned to HI vs. LI training. Training consisted of 25 sessions of 15 minutes 5 days a week for 5 weeks; this is the recommended training schedule for younger children. Training was conducted in children’s home and supervised by parents. Training was conducted in children’s home and supervised by parents.
A certified coach contacted parents each week to evaluate the performance and motivation of the child using a standardized questionnaire. Neither child, parents, or coaches knew which condition the child had been assigned to. Because coaches were kept blind to children’s condition, and thus did not receive detailed information on how children were progressing through the exercises, they were unable to provide coaching support to parents as is done in regular clinical practice.
Outcome measures included neurocognitive assessments, parent and teacher reports of ADHD symptoms, and a global assessment of functioning made by study clinicians. Results indicated benefits of HI training on only 1 of 25 outcome measures, a measure of verbal working memory. Importantly, no training related differences were found for parent, teacher, or clinician ratings. The authors conclude that their findings cast “…doubt on the claims that CWMT is an effective treatment in young children with ADHD.”
A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: A replication in a diverse sample using a control condition. (Chacko et al., 2013). In this second randomized controlled trial, 85 7- to 11-year old-children with ADHD were assigned to HI or LI CWMT.
Training consisted of 5 30-45 minutes per week for 5 weeks; this is the typical session length for children in this age range. Additional trials were added to LI training sessions as needed so that the length of LI and HI training sessions were more comparable. Also unlike the prior study, coaches had complete access to children’s training data so that they could oversee parents as is done in standard clinical practice using CWMT. Outcome measures included parent and teacher ratings of ADHD symptoms, standardized assessments of working memory, computerized assessments of attention, and academic achievement testing.
As reported prior studies, children receiving active training showed significant gains in working memory compared to control children. This was true for both visuo-spatial and verbal working memory.
However, computerized tests of attention showed no significant difference between the groups. The same was true for parent and teacher ratings of ADHD symptoms as well as for measures of academic achievement.
Based on these largely negative results, the authors conclude that CWMT should not be used as a treatment for ADHD.
Summary and Implications
Results from these 2 randomized-controlled trials do not support CWMT as a first-line treatment for ADHD.
In both studies, there was evidence that training produced gains in some non-trained measures of working memory. However, improvements in parent or teacher ratings of behavior were absent.
Given the adverse impact of core ADHD symptoms on academic and behavioral functioning, this is a significant limitation.
In the first study, one could argue that coaches could not use detailed records of children’s training performance to guide their coaching calls with parents, which may have undermined the training effectiveness.
This was not true of the second study where coaching supervision was provided in the standard manner. This second study was also the largest trial of CWMT for ADHD conducted to date and the sample size was sufficient to detect meaningful treatment effects if they were there.
What Can We Conclude From This Research?
Despite promising initial reports suggesting that CWMT is a potentially effective treatment for ADHD, these studies significantly undercut this conclusion.
This does not mean that there is no utility to CWMT, however, particularly for individuals with demonstrated working memory deficits.
If one’s treatment goal is to enhance working memory, CWMT may have real value.
If the goal is to bring ADHD symptoms under control, however, these findings indicate that for most children with ADHD, CWMT would not currently be considered a reasonable substitute for medication and/or behavior therapy.
One final comment. I think it is important to note that many clinicians are using CWMT with children who have ADHD and many have reported that they are obtaining good results.
A number of these are clinicians that I know and respect, and it is difficult to reconcile the negative results reported here with outcomes that are reported by many clinicians who use Cogmed in their practice.
This is an example of where research findings differ from clinical impressions, and I don’t think it is possible to conclude with complete certainty that one is right and the other is wrong.
However, if one looks to the research to make decisions about treatments to recommend for children with ADHD, routinely recommending Cogmed would be inconsistent with the current research base in my view.
How about you?
Have you pursued Cogmed or other “brain-training” programs, for you or your child?
How did it go?
21 thoughts on “New Research Casts Doubt on CogMed for ADHD”
Thanks for looking at my blog. Sometimes I feel like an expert on ADHD but then I remember “if you know one person with ADHD you know one person with ADHD”. I think I got that from your books. One of the big pointers I got from you was, after seeing myself in many of your stories and laughing to myself at how you must have been spying on me, I saw myself in your description of the ADHD spouse who blames his partner for many of his failings. It was a big step up when I quit doing that.
I hope you get to live the happiness trifecta: do what you love, make money and make a difference.
Haha. You sound like a highly evolved person, Joel. 🙂
You know, I couldn’t think about money for the last 20 years. This was a mission. And I treated it like I was in the Peace Corp — but not living in a hut and eating grubs like my former-Peace Corps neighbor used to do in his garden. (He claimed they were tasty!)
Now, I face retirement, so we shall see!
Thanks so much for the kind wishes.
Thank you for replying to my comment and for your work in the field. I have a follow up to my experience with N-Back training. I think my working memory training topped out. I didn’t keep improving. As you stated in your article above, there is an opportunity cost to any training regime. For me, meditation has provided a bigger bang for the opportunity cost buck. I don’t know how what I do can help children but for me as an adult it is great. I read an ncbi study that claimed that ‘full body meditation’ grew the ACC of the studied group. I can’t find the study now but there are a lot of similar studies with key words: ADHD, meditation, mindfulness and ACC. My current Anti-ADHD training program is my own version of walking meditation. I go for a walk and count backwards by 3, starting at some large number. I have worked up to also focusing on my foot placement, my posture, and the expression on my face. If I daydream I lose count. If I try to focus on too many things I also lose count. After Strattera this walking meditation has probably made the biggest difference in my life.
You care about relationships so you may care more than others about the following ‘testimonial’. The biggest improvement in my life from getting my ADHD symptoms under control has been in the relationships in my life. I suspect that the emphasis on ameliorating ADHD in children is on school and then work. Until recently I would have agreed that lost earning potential is the worse part of ADHD. I’ve been on Strattera for about 13 years and as recent as last year I was thinking that if I had picked an ADHD friendly profession like electrician everything would have been alright. What I have come to realize is that ADHD has also kept me from picking up on the subtle social cues in body language and facial expressions. As I have grown my ability to pay attention generally I have been able to pay attention to my dear wife, who bought me your books by the way. Our relationship is much better now. We are beyond the stage of ‘I guess we can continue to tolerate being married to each other’ and have progressed to something rather pleasant. Now I’m trying to restore a relationship with my adult daughter. Like I said, I thought you might care.
You are correct! I absolutely do care. And I am so grateful for your taking the time to write.
For many years, I was a bit of a lone voice on the Internet. It was the era of “ADHD is a gift” and “Big Pharma is Evil”– with very little counterpoint online.
It was only thanks to the members of my support groups (adults with ADHD and another group for partners of adults with ADHD) that I remained steadfast.
Stories such as yours give me backbone when going up against the naysayers. Because what could possibly matter more than happiness, self-fulfillment, and connection in life?
Why would anyone want to deprive someone with poor vision eyeglasses? It makes no sense to me. There are some very distorted beliefs and motivations behind it, imho.
So glad you and your wife have moved out of the “armed truce” phase! 🙂
P.S. Look what I found on your blog! https://sciencefictionland.wordpress.com/2017/04/05/almost-no-children-in-france-are-medicated-for-adhd-this-is-how-they-define-and-treat-it-annotated/
Excellent take-down of the nonsense around “No ADHD in France.”
I receive e-mail from people with ADHD in France. Some U.S. students studying abroad who had no idea how hard it would be.
If you have money and live in a large city, you can get the medication. But not many choices.
My husband has ADHD and worked in France. All the bureaucracies and nonsense when trying to innovate in business…drove him bonkers.
I came to this site because of searching on cogmed. Since discovering that I am ADD at about age 45 I have been doing everything I can to make myself less so. I take medication, supplements and I eat as ADD friendly as my willpower and the current state of the science allows. Because of what I have learned by running many scientific experiments (that’s sarcasm, I just try stuff on myself) I’m led to wonder if there is a difference between what works on a child with ADD and what works with a motivated adult.
One of the things that I did regularly in the past and do intermittently now is use the free to down load, N-Back training game. When I first started N-Back training it made a big difference. Suddenly I could remember where I parked the car without making a special effort. It didn’t make me not ADD but it helped.
My wife bought me your books. I have not read them cover to cover but I have read a significant proportion of them in ADD fashion. They have helped too.
Welcome aboard the ADHD Roller Coaster!
Yes, definitely there will be differences in what is helpful for a child with ADHD and what is helpful for a motivated adult.
Yet, even within the adult ADHD population, there is a HUGE array of strategies.
Just remember that people with ADHD aren’t clones. I think of ADHD as “Extreme Human Syndrome.” All ADHD symptoms are human traits; it’s just that people with ADHD have more of these traits, or they have them more severely. How those variable symptoms manifest depends on other aspects of that individual’s make-up. There is much more to individual personality than variable experiences of ADHD.
The bottom line: There are no cookie-cutter answers. Each individual must do some experimentation, some tweaking of the strategies.
The only tool substantiated by a mountain of literature is medication. All the rest is up for grabs.
The Internet and electronic devices have been a boon (and a curse, for their addictive properties) for adults with ADHD. Timers, reminders, and various other offerings mean adults can pick and choose what they need. I’m glad that the N-Back training helps you. I hadn’t heard of it.
Is this it? http://brainscale.net/dual-n-back
Except adults are more likely to benefit from CBT-for-ADHD, compared to people diagnosed as children, because they have lived without benefit of diagnosis for decades. Consequently, they have often developed some poor coping strategies and distorted self-perception and self-talk.
Violetdoors – May 6, 2010 When i first took my son off the concerta he was tanikg, we started with a cleanse for 7 days. After that we started with an Omega 3 mood enhancer by Country life(At wholefoods), and also with Neu b calmd’. We noticed a changed after about two weeks then after about a month it was apparent he was doing much better. Along with the regimen, we also had to make some big changes in his diet.
I probably slduhon’t comment because I studied it as a profession for many years, but indeed, yes, it is very real. It is impossible to say exactly what is a true ADHD vs. other things that appear to be ADHD (Learning Disorders with Inattentive Features, Accommadative Dysfunction, Chemo Brain, etc). Are those ADHD too, or just ADHD-like? It is all the same disorder, or distinctly different? Does dopamine and norepinephrine play slightly different roles in differentiating the types of ADHD? I do enjoy thinking about these questions, and I enjoyed studying the neuroanatomy behind the disease. But it is real; it is a neurotransmission problem, and it is treatable.
Good point. There are many other conditions that mimic ADHD symptoms (or share similar symptoms, I should say), and some often respond to the same medications. For example, I know people suffering post-cancer-treatment with “chemo brain” for whom stimulants have been helpful.
My husband has started using a site called BrainHQ after doing some reading about neuroplasticity. I think there’s definitely “something to” the claims being made about neuroplasticity itself, not to mention some pretty interesting research, but not all of these brain training programs are created equal.
I’ve heard/read from several sources that Lumosity isn’t really effective, they just have the most successful marketing. However, this BrainHQ site claims to have more science backing it up than any others out there. Have you heard of it before or looked into it at all? Just curious where its methods fit in with the others mentioned here, since I have no experience with them.
BrainHQ claims to be able to improve your brain’s ability to pick up on nonverbal social cues, which I have about zero proficiency with (that’s my own judgement, not the site’s). I know a lot of other ADHD people suffer the same. It would be great if something could help us hone those skills.
Unfortunately I can’t report our findings yet because my husband’s ADHD has prevented him from doing the brain training exercises consistently…painfully ironic, but so it goes.
We received the Posit Science DVD as a KPBS premium. It’s been sitting on my shelf a few years. 😉 It was developed by a well-known neuroscientist, Mike Merzenich: http://www.brainhq.com/world-class-science/science-team/dr-michael-merzenich
The program boasts being “backed by science.”
And, as luck would have it, he’s also the CEO of BrainHQ. So, at least you know a scientist of substance is behind it.
I can’t vouch for that system, or any other. I know that the research around CogMed was highly touted — especially in listservs of people claiming to be ADHD profesionals. One cannot blame psychologists for wanting to offer something as “proven” as medication; after all, they can’t prescribe. But I never believed the claims; too many were funded by the company.
And, again, I just saw no evidence for the lateral translation, into life, of whatever was picked up on screen.
I’d think that these exercises might be helpful for people who are in boring jobs or people who are retired and using their brains in other ways. Other than that, I’d much rather see people focus on good nutrition, sleep, exercise, and, if helpful, medication.
Please report in if those exercises ever pick up for your husband! 🙂
I will do that! It hasn’t felt worth the time or money to me yet, but the promise of improving perception of social cues is almost too much to resist. That’s something meds and organizational skills haven’t helped with. Do you have anything in particular that you recommend?
When you say “perception of social cues,” what exactly do you mean?
Do you mean that when you’re talking about a subject, for example, you don’t notice that someone’s getting bored?
I find the biggest part of trouble-shooting is being precise in identifying the issue.
Optimizing Rx can definitely help with noticing facial expressions, realizing how much time has passed, remembering to ask the person about him/herself, etc. But that’s only if the person 1) knows/cares that these things are important, and 2) isn’t dealing with something else, such as a autistic-spectrum issues.
This book might be a good start, from psychologist and long-time ADHD expert Michele Novotni: http://www.amazon.com/What-Does-Everybody-Else-Know/dp/1886941343
Another book is one that examines the role of fetal androgens in influencing empathy. Dr. Simon Baron Cohen calls autism “extreme male syndrome.” Some women, though, can be farther on the autistic spectrum than some men. They might be really good with “systems” — the polar opposite of empathy, as Baron-Cohen’s model goes. And so they have trouble with reading the emotions of facial expressions. His book contains a quiz, with about 20 facial expressions. Might be worth looking into. It’s called The Essential Difference.
I hope this helps!
I think I tend not to use body language, facial expression, etc. much at all when parsing conversations. So if it’s not said explicitly, I’m not likely to get it. But I’ve also seen a few questionnaires floating around recently that ask things about how well you notice where people stand in a room at a party, who’s talking to whom and at what volume, etc. My husband will often say things like “I felt like it was obvious they were waiting for us to leave” or “I had no idea I needed to tell you that.” I have a feeling meds are a big issue for me right now but I’m not sure what to do about it, but I also feel like there’s a skill set I’m missing. It’s shocking to me how much nonverbal information everyone else is taking in. Even when I remember to stop and think about it, sometimes I still feel totally clueless. Now that I’ve started watching Big Bang Theory, I’m imagining a Sheldon Cooper-style commentary…
In other news, that book is on my to-read list! Maybe I need to prioritize it for my next review on the blog 😉
Jaclyn – are you Scandinavian? 🙂
And yes, could be a meds issue, too.
Or maybe it’s the artist in you, more clued into your own perspective.
Thanks for posting this. ADHD isn’t the only condition I have and I’m glad it’s being studied in girls now. I wonder just how many women my age weren’t diagnosed until adulthood because of the different presentation. I remember getting in trouble a lot when I’d be given a list of tasks to do verbally, like change the cat litter, take out the garbage… And actually those were always the first two on the list and to this day I don’t know a single thing after that. I was not permitted to write it down because “you should be able to remember this.”
The funny thing about that is I had no problem remembering my homework assignments from school. I would copy the problem numbers or chapters to read off the blackboard and not need to look at what I wrote most of the time. Generally, it wasn’t simple like “1-20.” It was more like “1-15 odd numbers only, 23, 27, 30-36, 49, 55-60.” It got complex. Back then, my memory was great and I was recently told that I remember more detail than most people and adding details is a something people do when they are lying (this little tidbit from someone who knows me just well enough to make that observation explains a lot).
But if you aren’t paying attention to something, you can’t form the memory. I don’t know how engaging CogMed is, but if it holds their attention and works for improving working memory, it’s going to show improvement in working memory. Writing down my homework assignments made me pay attention and if I could remember the assignments without looking, I probably could have remembered that list of chores if I could write them down, crumple up the paper and burn it. I just wasn’t interested in chores right after dinner when maybe my homework wasn’t even done yet and I wanted to finish it because I couldn’t play until it was done. I’m willing to bet that a kid with ADHD can remember just as much about his favorite video game as a kid without ADHD. Change that to the most boring class at school and that memory vanishes in the kid with ADHD. Why? YOU CAN’T FORM MEMORIES IF YOU AREN’T PAYING ATTENTION! It’s very close to asking for a sequence of numbers the person never received.
I have been in pain since I was 17. That’s over half my life and I no longer work so my brain isn’t stimulated the way it used to be either. There is at least one study out there (I would have a citation if I could handle a screen bigger than an iPhone) showing that being in pain for more than 6 months causes cognitive just like the aging process. This was done on people in pain for 6 months and I did the math and it put me at my parents age. My husband has been saying he feels like he is getting dumber. We are at that turning point and this study was 6 months of pain. I’m just shy of 20 years of pain! I’m also on multiple meds that affect my memory. I’ve always thought it was just the meds making me feel dumber. I’ve had many discussions with my psychiatrist about my memory and sometimes he tells me straight up I probably can’t remember something because I wasn’t paying attention so there’s not enough information to form a memory.
A few years ago, a friend told me about Lumosity. When I’m well enough, I do it every day because it’s fun and I like justifying video games somehow. But I also hope there is something to the neuroplasticity thing and it’s helping me. They let you know what percentile you’re in compared to other Lumosity users and my scores are actually pretty high and most of them have gone up with regular use. Part of it has been learning the games but they have made it adaptive now so that’s less of a factor. There is one exception. My score for attention isn’t bad but it’s far lower than any of the others and doesn’t really improve despite the fact that I like the games. If I wasn’t treated for ADHD, I’m sure that score would be horrible.
I was able to maintain good grades using intellect to compensate for ADHD. I was often more interested in what was out the window than what the teacher was saying. I relied heavily on the textbook, hated doing 50 math problems where there were 3 problems with different numbers several times and I got it after 2 or 3, struggled with some subjects but managed to do okay, often had my head on my desk not looking at the blackboard but somehow when a teacher called on me, managed to pick up my head just long enough to give the right answer and then go back to my nice state of half-sleep. Perhaps my motivation for paying attention at all was that a couple correct answers would get them to stop trying to embarrass me and I was tired. I learned to hide my figeting because my parents didn’t like it. Really the biggest way my ADHD showed at school was junior year math, which I liked. We were seated alphabetically and I ended up in the front row right at the teacher’s desk next to a kid named Brian. I didn’t know him before this class. He was a senior and I was a year ahead in math. We would talk throughout the whole class, voices low enough not to disturb the class. The pace was boringly slow for both of us and the teacher stopped all his attempts at keeping us from doing this when we would not only answer the question but add on the final answer to what was 1/4 of the way through being taught because we had already worked it through and yes we were talking about other things but both doing very well in the class. It’s probably lucky we were in the corner. That’s something I could have been in trouble for but wasn’t. I think I got lucky a lot with stuff like that and my fear of getting in trouble was greater than my lack of impulse control and teachers at my school gave warnings and saw me as a good kid so the only call home was for reading an “inappropriate” book during free reading in 8th grade English and then “lying” about my mother giving it to me to read and the teacher confiscated it. I waited for that call with great anticipation. No one liked that teacher and my mom wanted her book returned to me. It was a romance novel with an innocuous name and cover and with no smartphones or computers in the classroom I can guess what kind of book that teacher read. I had just finished reading “Satanic Verses” because I wanted to know what was in it that made people try to hunt down the author and kill him and I guess that book was fine but not the one my mom wanted me to read.
My problems were actually mostly at home. I do have some of the boy traits but now that girls are being studied I can REALLY look back and see it. I mean my parents had to PAY me to shut up. And my rates went up quickly and I still never made much money. That’s probably obvious. Recently my uncle wanted a turn to talk and did something much more effective. He handed me a shiny metal object and that kept me quiet much longer. I’m not talking a quarter either. This was interesting. It had a complex design and texture and looked different when I tilted or turned it. I wanted to keep it but I knew I couldn’t. I ran my fingers over it to feel the textures and looked at it from every angle. I even asked to see it again after I gave it back. I really wanted this but knew he could get in a lot of trouble if he let me keep it (it wasn’t a weapon or anything). It was OK for him to have but even though it became a souvineer of previous work, he probably can’t give it away even though, to quote him, “it’s useless.”
I no longer question my diagnosis of ADHD. I have the symptoms. I can look back and see them from childhood when I didn’t have a ton of other health issues and got by on luck, fear and intelligence. The meds help. But most of all, I am an adult and was given a shiny metal object to calm me down and it worked!
I’ve been paying for a Lumosity subscription for a long time, maybe 5 years. I don’t always use it as much as I should, but I use it regularly often enough to keep it, and I’ve gone for long periods doing a training session a day, sometimes playing more because it’s fun. They’ve improved it a lot and there are new games being added often now and it’s adaptive, so learning a game (like with bird watching, for example, I didn’t know the names of most of the birds so it took more turns to get letters when I first started but after I learned the names of the birds, my scores for that game became more reflective of how much it was helping because I didn’t have birds where I couldn’t figure out what it was without all the letters). Other than an initial bump in my score and percentile from just learning the games, my attention has stayed flat while my scores for other areas creep up during periods when I’m using it nearly every day, even memory, which is impaired by meds. So I can see how memory would show improvement if the program is able to hold your attention if memory is also measured by something that holds your attention. But I got a new neurologist recently and he did a mini neurocognitive eval as part of his initial testing that involved distracting me and his conclusion was “you are good at math and your memory sucks.” My response was “I didn’t need to pay you to get that information.” He was trying to be funny and so was I and both of us had valid points. I was there for something else. But as far as Lumosity is concerned, my memory is good and the only reason for that is it holds my attention and doesn’t translate at all into real life. So I have Lumosity measuring both working memory and attention under these artificial conditions and it says my memory is improving (with expected drops from certain med changes) and everything is generally improving, all except my attention, which it has undividedly once I start, so while the two are related, I really don’t see how improving working memory would improve attention and I have data on myself that doesn’t translate into the real world, just like CogMed didn’t translate into the real world, showing everything but attention improving.
I actually don’t even understand the hypothesis, actually, at least not in the real world. Attention is needed for memory. I don’t see how improving memory has any effect on attention. But then again I can walk around with a fake smile for months and not get any happier from the act of smiling, only from not spreading around my bad mood. I have had muscular injuries from mentally traumatic events get successfully treated after time has passed and it brings up emotions surrounding the event. I may be making a cognitive connection before I realize it. But you can smile without being happy. You can act happy without being happy. You can’t remember data you didn’t get. So I really don’t even see how this could work indirectly.
Thank you for one of the most interesting comments I can imagine on this topic!
Gina, your readers should probably know how attractive systems like CogMed are to professionals who treat ADHD. The idea–as a businessman–that I could buy a system, hire a tech to run it and earn money without using any of my own time is very attractive. It takes an ethical stance to resist the allure of CogMed and similar “adjunctive therapies”.
CogMed was worth a try; it would have been wonderful had it worked. The hope that one little tug on the Gordian knot of ADHD might untie the whole thing is very seductive and very wrong. So far, the adjunctive therapies that actually work are very time intensive: cognitive behavioral therapy, exercise, IEP’s, and meditation.
Thanks for making the evidence clear on this. We need to ditch the ineffective therapies and keep moving forward with effective ones.
Oren Mason MD
founder, director Attention MD
author “Reaching For A New Potential”
I’m glad that you connected the dots instead of me.
The mere implication of it in that listserv drew a firestorm of personal attacks on me.
Which is why I left it in disgust. They were not ADHD professionals.
For an in depth discussion of the entire body of Cogmed research, please visit …..
Sorry, Kathryn with Pearson, owner of Cogmed. I don’t allow advertising on my blog, especially the kind that comes disguised as a comment.
Pearson has an advertising and marketing budget, and I’m sure my blog’s readers have had ample exposure to it.