Interventions Matter:
Supporting Academic
Achievements While
Minimizing Stress
Tony J. Simon & Ingrid N. Leckliter
Cognitive Analysis and Brain Imaging Lab
http://cabil.mindinstitute.org
tjsimon@ucdavis.edu
Funding: NIH 2R01HD04269 (Simon), K99MH086616 (Beaton),
UC Davis CEDD, UC Davis T32 MCRTP (Stoddard/Angkustsiri)
Thursday, July 12, 12
1
Outline of Talk
What is the problem?
Mismatches between abilities and demands - Poor calibration
What are the solutions?
bringing the child’s abilities closer to the worlds demands
bringing the world’s demands closer to the child’s abilities
How well does it work?
Thursday, July 12, 12
2
Outline of Talk
What is the problem?
Mismatches between abilities and demands - Poor calibration
What are the solutions?
bringing the child’s abilities closer to the worlds demands
bringing the world’s demands closer to the child’s abilities
How well does it work?
Thursday, July 12, 12
3
Our Working Hypothesis
Cognitive impairments limit competence
IQ of 75 means operating as a 9-year-old in a 12-year-old’s world
mental representation impairments limit development in domains
like space, time, number
Executive Function impairments limit behavior/emotional regulation
Impaired cognition (borderline IQ) creates/interacts with increased
stress/anxiety to further modulate/challenge development
stress/anxiety increase inattention and decrease cognitive control
Family/School/Community supports further modulate above
interaction & influence “coper/struggler” trajectory
strugglers might experience higher “allostatic load” & psychosis risk
If so, we can target cognitive, emotional and environmental factors for
intervention to improve academics, mental health, family dynamics
Thursday, July 12, 12
4
4
Everyday
Demands
Cognitive
Abilities
Stimulation
Coping
Resources
Thursday, July 12, 12
5
Anxiety & Functional Abilities
N=91, r=0.02;
Adaptive function NOT
related to overall IQ.
Unlike TD/most other NDDs
Adaptive function IS related to
anxiety levels
Angkustsiri et al., submitted
Anxiety levels related to stress
hormone level, maybe psychosis risk
Beaton et al., submitted; Beaton & Simon, 2011
Thursday, July 12, 12
6
Anxiety and Attention
Prelim data from “Hot Cognition” tasks
Dot Probe Threat Bias (Perez-Edgar, ‘11; Roy, Pine, Lissek..)
Emotional Attentional Blink (Lim/Pessoah, ’09)
500ms
or
10ms/image
90ms ISI
500ms
Lag = 1
or
Lag = 2
2500ms
Lag = 3
7
Thursday, July 12, 12
7
Anxiety and Attention
Dot probe RTs suggest 22q group drawn to angry faces (threat bias)
positive scores indicate “vigilance” for angry faces
some evidence of relation to the one fear anxiety index checked so far
8
Thursday, July 12, 12
8
Anxiety and Attention
What does this actually look like? How “distracting” is threat?
Movie #1 a typical child with no emotion bias
Movie #2 a child with 22q11 with a strong threat (i.e. angry face bias)
9
Thursday, July 12, 12
9
Arousal, Anxiety & Inattention
Color Key
Anxiety and ADHD (Venn-Euler Diagram)
ADHD and Anxiety
0.5
1
1.5
Value
2
Anxiety
Anxiety
ADHD
ANXIETY
Neither
ADHD
ADHD
0.4
ANXIETY
0.2
ADHD
22q11.2DS participants
Anxiety+ADHD
14
13
30
34
35
40
41
44
46
48
49
50
52
59
51
47
53
56
26
16
37
6
5
33
15
8
19
22
58
2
1
12
24
42
43
54
10
9
11
23
29
36
38
45
57
4
3
7
18
20
21
27
28
31
32
39
55
0.6
0.8
0
0.2
0.4
0.6
0.8
Michelle Y Deng, Ph.D.
Thursday, July 12, 12
10
Outline of Talk
What is the problem?
Mismatches between abilities and demands - Poor calibration
What are the solutions?
bringing the child’s abilities closer to the worlds demands
bringing the world’s demands closer to the child’s abilities
How well does it work?
Thursday, July 12, 12
11
What is working memory?
The ability to keep information in
your mind for a short period of time
(seconds) and be able to use the
information in your thinking
A system for temporary storage and
manipulation of information,
necessary for wide range of cognitive
tasks
Working memory is the search engine of the brain
Cogmed America 2011 ©
Center for Excellence in Developmental Disabilities
Thursday, July 12, 12
UCDAVIS
MIND Institute
12
Prospects for Intervention
One program might help with issues
related to Executive Function/ADHD
Cogmed: http://cogmed.com
limited to key Exec. Function domain
costly & not unlimited access
well validated, not yet with 22q11.2DS
BUT, buyer beware. Now purchased by Pearson Testing Inc.
starting to morph into wider product range
possibly beyond evidence base
this was what happened with Fast ForWord
Thursday, July 12, 12
13
Prospects for Intervention
How on earth can you know what works, and for whom?
Sharp Brains: http://sharpbrains.com
neuroscience based community
likely to prioritize evidence base
BUT, buyer beware. This IS a PRO brain training group
NB: I have no affiliation with either of these
Thursday, July 12, 12
14
Prospects for Intervention
How on earth can you know what works, and for whom?
Sharp Brains: http://sharpbrains.com
neuroscience based community
likely to prioritize evidence base
BUT, buyer beware. This IS a PRO brain training group
NB: I have no affiliation with either of these
Thursday, July 12, 12
15
Stress/Anxiety Intervention
Evidence Based Behavioral Approaches
Cognitive Behavioral Therapy (CBT)
high linguistic/conceptual demands
Biofeedback, Meditation, Exercise …
Work with (any) good clinician
Pharmacological Approaches
SSRI - Selective Serotonin Reuptake Inhibitors
Stimulants - ADHD medications
reasonable concerns but safe & effective
Work with pediatrician/psychiatrist
Thursday, July 12, 12
16
Computer Assisted Cognitive Behavior
Therapy for Anxiety
! Developed from Coping Cat;
Individual Cognitive Behavior
Therapy (Kendall & Hedtke, 2006)
! Camp Cope-A-Lot
!
!
!
!
!
12 sessions, Interactive CD
ROM
7- 13 year old youths with
anxiety
First 6-sessions self-guided
Last 6-sessions therapist
coached
http://www.cope-a-lot.com/
Center for Excellence in Developmental Disabilities
UCDAVIS
MIND Institute
Thursday, July 12, 12
17
Stress/Anxiety Intervention
Less Evidence Based but research
supported anxiety program
Turnaround Anxiety Therapy
http://www.myanxiouschild.com/
Work with family member
NB: we don’t have experience
with this AND adult/parental
involvement will modulate
success. BUT does seem to be
based on sound CBT principles
Thursday, July 12, 12
18
Social Skills Training
Strong evidence based for
Social Skills Training as effective
with:
children & adults
a range of disorders
ASD, Schizophrenia, others
Michelle Garcia-Winner is a
leader in this work
http://socialthinking.com
Many medical centers,
universities, other
organizations offer evidencebased social skills group
training
Thursday, July 12, 12
19
Outline of Talk
What is the problem?
Mismatches between abilities and demands - Poor calibration
What are the solutions?
bringing the child’s abilities closer to the worlds demands
bringing the world’s demands closer to the child’s abilities
How well does it work?
Thursday, July 12, 12
20
Outline of Talk
What is the problem?
Mismatches between abilities and demands - Poor calibration
What are the solutions?
bringing the child’s abilities closer to the worlds demands
bringing the world’s demands closer to the child’s abilities
How well does it work?
Thursday, July 12, 12
21
Effect sizes (d) for Cogmed studies with
Control Groups: Nontrained Behaviors
STUDY
CONTROL
GROUP
SAMPLE
d After
Cogmed
d Four to 6months f/u
Klingberg et al
(2005)
Swedish
Nonadaptive
Training
7-12 years,
ADHD
Parent report
Inattn= 1.21
Hyp/Imp= 0.42
>
=
Holmes et al
(2009)
English
Nonadaptive
Training
8-11 years,
WM< 15th
percentile
Classroom Inst.
Task= 0.83
Math Rsng= 0.11
> Task= 0.52
< Math Rsng= 0.49
Dahlin (2010)
Swedish
SpEd as usual
9-12 years,
ADHD & LD
Reading Comp=
0.88
= 0.91
Beck et al (2010)
American
Wait List
7-17 years,
ADHD + (ODD,
Anx., Mood Dis. &
on meds.)
Parent report
DSM-IV Inatt= 1.49
BRIEF
MetaCog= 0.91
Plan/Org= 0.92
Center for Excellence in Developmental Disabilities
Thursday, July 12, 12
Parent report
Inattn= 0.67
Hyp/Imp= 0.42
Classroom Inst.
Reading Comp=
>
=
>
Parent report
DSM-IV Inatt= 1.03
BRIEF
MetaCog= 0.83
Plan/Org= 0.72
UCDAVIS
MIND Institute
22
Monica Melby-Lervåg
Charles Hulme
University of Oslo
University College London and University of Oslo
How Well Does WM Training Work?
It has been suggested that working memory training programs are effective both as treatments for
attention-deficit/hyperactivity disorder (ADHD) and other cognitive disorders in children and as a tool to
improve cognitive ability and scholastic attainment in typically developing children and adults. However,
effects across studies appear to be variable, and a systematic meta-analytic review was undertaken. To
Is Working
Effective?
A Meta-Analytic
Review
be included in the review,
studies Memory
had to beTraining
randomized
controlled
trials or quasi-experiments
without
randomization, have a treatment, and have either a treated group or an untreated control group.
Monica Melby-Lervåg
Charles Hulme
Oslo
University for
Collegeinclusion.
London and University
Oslo
Twenty-three studies with 30 University
group ofcomparisons
met the criteria
The ofstudies
included
involved clinical samples and
samples
of
typically
developing
children
and
adults.
Meta-analyses
It has been suggested that working memory training programs are effective both as treatments for
attention-deficit/hyperactivity disorder (ADHD) and other cognitive disorders in children and as a tool to
indicated that the programs produced
reliable
short-term
improvements
inadults.
working
memory skills. For
improve cognitive
ability and scholastic
attainment in typically
developing children and
However,
effects across studies appear to be variable, and a systematic meta-analytic review was undertaken. To
verbal working memory, these
near-transfer
effects
were
not
sustained
at
follow-up,
whereas for
be included in the review, studies had to be randomized controlled trials or quasi-experiments without
have a treatment, and have either a treated group or an untreated control group.
visuospatial working memory,randomization,
limited
evidence
suggested
that
such
effects
might
be
maintained.
More
Twenty-three studies with 30 group comparisons met the criteria for inclusion. The studies included
involved clinical samples and samples of typically developing children and adults. Meta-analyses
importantly, there was no convincing
evidence
of the
working
memory
training to other
indicated that the
programs produced
reliablegeneralization
short-term improvements inof
working
memory skills.
For
verbal working memory, these near-transfer effects were not sustained at follow-up, whereas for
skills (nonverbal and verbal ability,
inhibitory
processes
in
attention,
word
decoding,
and
arithmetic). The
visuospatial working memory, limited evidence suggested that such effects might be maintained. More
there was no convincing evidence of the generalization of working memory training to other
authors conclude that memoryimportantly,
training
programs
appear
to
produce
short-term,
specific
training effects
skills (nonverbal and verbal ability, inhibitory processes in attention, word decoding, and arithmetic). The
authors conclude that memory training programs appear to produce short-term, specific training effects
that do not generalize. Possible
limitations of the review (including age differences in the samples and
that do not generalize. Possible limitations of the review (including age differences in the samples and
variety of different clinical conditions included) are noted. However, current findings cast doubt on
the variety of different clinicalthe
conditions
included) are noted. However, current findings cast doubt on
both the clinical relevance of working memory training programs and their utility as methods of
cognitive functioning in typically developing children and healthy adults.
both the clinical relevance ofenhancing
working
memory training programs and their utility as methods of
Keywords: working memory training, ADHD, attention, learning disabilities
enhancing cognitive functioning
in typically developing children and healthy adults.
Developmental Psychology
2012, Vol. ●●, No. ●, 000 – 000
© 2012 American Psychological Association
0012-1649/12/$12.00 DOI: 10.1037/a0028228
Review
of 23 working memory training studies with control groups
Keywords: working memory training, ADHD, attention, learning disabilities
Working memory is one of the most influential theoretical
constructs in cognitive psychology. This influence derives, at least
in part, from links between measures of working memory capacity
and a wide variety of real world skills (e.g., Cohen & Conway,
2008), as well as applications to issues in cognitive development
and developmental cognitive disorders (for a review, see Gathercole & Alloway, 2006). Recently, excitement has been generated
by claims that working memory capacity can be trained (e.g.,
Diamond & Lee, 2011; Klingberg, 2010; Morrison & Chein,
2011). Such a result would have important theoretical and practical
implications. To assess these claims, in this article, we present a
systematic meta-analytic review of studies that have examined the
effects of working memory training in both children and adults.
necessary for . . . complex cognitive tasks” (Baddeley, 1992, p.
556). Historically, the concept of working memory evolved from
earlier concepts of short-term memory. Short-term memory was
initially seen as a limited capacity memory store that was subject
to rapid loss due to decay (Atkinson & Shiffrin, 1968). A number
of studies have shown that measures of short-term memory, such
as digit span, correlate modestly with measures of higher level
cognitive function, such as IQ (Mukunda & Hall, 1992; Unsworth
& Engle, 2007b), reading (Swanson, Zheng, & Jerman, 2009), and
arithmetic skills (Swanson & Jerman, 2006). In contrast to shortterm memory tasks such as digit span, working memory tasks
involve trying to maintain information in active memory while
simultaneously performing distracting or interfering activities
(Case, Kurland, & Goldberg, 1982; Daneman & Carpenter, 1980).
In this sense working memory capacity could be seen as a limit on
an individual’s ability to repeatedly retrieve information from
permanent or secondary memory that has been lost from the focus
of attention due to competing cognitive activity (for a review, see
Conway et al. 2005; Unsworth & Engle, 2007a, 2007b). Measures
of working memory consistently show higher correlations with
measures of higher level cognitive functions than do simple memory span tasks (for a review, see Engle, 2002).
In practice, a wide range of tasks involving both verbal and
nonverbal materials have been used to assess working memory
skills (see, for example, Alloway, Gathercole, & Pickering, 2006;
Kane et al., 2004). It has been debated as to whether working
memory capacity reflects separable, modality specific (verbal versus visual) systems or a domain-general cognitive capacity. Evidence from large-scale latent variable studies with both children
(Alloway et al., 2006) and adults (Kane et al., 2004) supports the
no sustained verbal WM effects, some lasting visuospatial effects
“no convincing evidence of generalization ... to other skills
Working memory is one of the most influential theoretical
necessary for . . . complex cognitive tasks” (Baddeley, 1992
Thursday, July 12, 12
23
tructs in cognitive psychology. This influence derives, at least
556). Historically, the concept of working memory evolved f
art, from links between measures of working memory capacity
earlier concepts of short-term memory. Short-term memory
a wide variety of real world skills (e.g.,
Cohen
&
Conway,
initially seen as a limited capacity memory store that was sub
The Nature of Working Memory
8), as well as applications to issuesWorking
in cognitive
memory has beendevelopment
defined as “a brain system thatto rapid loss due to decay (Atkinson & Shiffrin, 1968). A num
provides temporary storage and manipulation of the information
developmental cognitive disorders (for a review, see Gatherof studies have shown that measures of short-term memory, s
SPECIALSECTION
& Alloway, 2006). Recently, excitement has been generated
as digit span, correlate modestly with measures of higher le
Monica Melby-Lervåg, Department of Special Needs Education, Unilaims that working Interventions
memory capacity
beCharles
trained
(e.g.,
versity of Oslo, can
Norway;
Hulme, Division
of Psychology andcognitive function, such as IQ (Mukunda & Hall, 1992; Unsw
Shown
to AidOslo,Executive
Review of 6 different
Language Sciences, University College London, London, England, and
mond & Lee, 2011;Function
Klingberg,
2010;
Morrison
&
Chein,
Development
inof Children
& Engle,
2007b), reading
(Swanson, Zheng, & Jerman, 2009),
Department
Special Needs Education, University of Oslo.
approaches
to executive
Correspondence concerning this article should be addressed to Monica
4 tohave
12 Years
OldMelby-Lervåg,
Department of Special
Education, University ofarithmetic skills (Swanson & Jerman, 2006). In contrast to sh
1). Such a result would
important
theoretical
andNeeds
practical
function training.
Oslo, Pb 1140 Blindern, 0318 Oslo, Norway, or to Charles Hulme, Diviofthis
Psychology
and Languagewe
Sciences,
University College
London,term memory tasks such as digit span, working memory ta
ications. To assess these claims, sion
in
article,
present
a
Chandler House, 2 Wakefield Street, London WC1N 2PF, England.
“Diverse
activities
have been
shown to in active memory w
E-mail: monica.melby-lervag@isp.uio.no
or c.hulme@ucl.ac.uk
ematic meta-analytic review of studies
that have examined
the
involve
trying
to maintain
information
improve
children’s
executive
functions:
1
cts of working memory training in both children and adults.
simultaneously performing distracting or interfering activi
computerized training, noncomputerized
(Case,
Kurland,
& martial
Goldberg,
games,
aerobics,
arts, 1982;
yoga, Daneman & Carpenter, 19
In
this
sense
working
memory
capacity
could be seen as a limi
Wof Working Memory
mindfulness, and school curricula.
All
The Nature
successful programs
repeated practice
an individual’s
abilityinvolve
to repeatedly
retrieve information f
Working memory has been defined as “a brain system that
and
progressively
increase
the
challenge
to been lost from the fo
permanent or secondary memory that has
executive functions. Children with worse
ides temporary storage and manipulation of the information
of attention
due to competing cognitive activity (for a review,
executive functions benefit most from these
Conway
et al.thus,
2005;
& Engle, 2007a, 2007b). Measu
activities;
earlyUnsworth
executive-function
of working
memory
consistently
show gaps
higher correlations w
training may
avert widening
achievement
later. Toofimprove
functions,
focusing than do simple m
measures
higher executive
level cognitive
functions
narrowly
on (for
themamay
not besee
as effective
as
onica Melby-Lervåg, Department of Special Needs Education, Uniory span
tasks
review,
Engle, 2002).
also
addressing
emotional
and
social
ty of Oslo, Oslo, Norway; Charles Hulme, Division of Psychology and
Indevelopment
practice, a and
wide
range of tasks involving both verbal
physical development.
uage Sciences, University College London, London, England, and
nonverbal materials have been used to assess working mem
rtment of Special Needs Education, University of Oslo.
skills (see, for example, Alloway, Gathercole, & Pickering, 20
orrespondence concerning this article should be addressed to Monica
Kane et al., 2004). It has been debated as to whether work
y-Lervåg, Department of Special Needs Education, University of
memory capacity reflects separable, modality specific (verbal
Pb 1140 Blindern,Thursday,
0318 Oslo,
or to Charles Hulme, DiviJuly 12,Norway,
12
24
sus visual) systems or a domain-general cognitive capacity. E
of Psychology and Language Sciences, University College London,
dence from large-scale latent variable studies with both child
dler House, 2 Wakefield Street, London WC1N 2PF, England.
How Well Does EF Training Work?
controlling for IQ, gender, social class, and more
(8). Since “self-control’s effects follow a [linear]
gradient, interventions that achieve even small
improvements in self-control for individuals
could shift the entire distribution of outcomes in a
salutary direction and yield large improvements
in health, wealth, and crime rate for a nation” (8).
Adele Diamond1* and Kathleen Lee1
To be successful takes creativity, flexibility, self-control, and discipline. Central to all those are
executive functions, including mentally playing with ideas, giving a considered rather than an
impulsive response, and staying focused. Diverse activities have been shown to improve children’s
executive functions: computerized training, noncomputerized games, aerobics, martial arts, yoga,
mindfulness, and school curricula. All successful programs involve repeated practice and
progressively increase the challenge to executive functions. Children with worse executive functions
benefit most from these activities; thus, early executive-function training may avert widening
achievement gaps later. To improve executive functions, focusing narrowly on them may not be as
effective as also addressing emotional and social development (as do curricula that improve
executive functions) and physical development (shown by positive effects of aerobics, martial arts,
and yoga).
hat will children need to be successful? What programs are successfully
helping children develop those skills
in the earliest school years? What do those programs have in common?
Four of the qualities that will probably be key
to success are creativity, flexibility, self-control,
and discipline. Children will need to think creatively to devise solutions never considered before. They will need working memory to mentally
work with masses of data and see new connections among elements, flexibility to appreciate different perspectives and take advantage of
serendipity, and self-control to resist temptations
and avoid doing something they would regret.
Tomorrow’s leaders will need the discipline to
stay focused, seeing tasks through to completion.
All of those qualities are executive functions
(EFs), the cognitive control functions needed when
you have to concentrate and think, when acting
on your initial impulse might be ill-advised.
EFs depend on a neural circuit in which the prefrontal cortex is central. Core EFs are cognitive
flexibility, inhibition (self-control, self-regulation),
and working memory (1). More complex EFs
include problem-solving, reasoning, and planning. EFs are more important for school readiness than is intelligence quotient (IQ) (2). They
continue to predict math and reading competence
throughout all school years [e.g., (3)]. Clearly, to
improve school readiness and academic success,
targeting EFs is crucial. EFs remain critical for
success throughout life [in career (4) and mar-
riage (5)] and for positive mental and physical
health (6, 7).
Children with worse self-control (less persistence, more impulsivity, and poorer attention
regulation) at ages 3 to 11 tend to have worse
health, earn less, and commit more crimes 30 years
later than those with better self-control as children,
What Programs Have Been Shown to Help Young
Children Develop These Skills?
There is scientific evidence supporting six approaches for improving EFs in the early school
years. Tables S1 and S2 provide details on each
intervention and their outcomes.
Computerized training. The most researched
approach, and one repeatedly found successful, is
CogMed (Pearson Education, Upper Saddle River, NJ) computerized working-memory training
(9–13), which uses computer games that progressively increase working-memory demands.
Youngsters improve on games they practice (Fig. 1),
and this transfers to other working-memory tasks.
Groups studied have been typically developing
children (12) and those with attention deficit hyperactivity disorder (ADHD) (10, 13) or poor
working-memory spans (9). Benefits usually do
not generalize to unpracticed EF skills (14). Three
studies (9–11) included controls who played the
same training games without increasing difficulty; those controls did not show the same gains.
Two studies looked 6 months later and found EF
benefits remained (9, 13). For math, gains were
Downloaded from www.sciencemag.org on September 1, 2011
REVIEW
1
University of British Columbia and Children’s Hospital,
Vancouver, BC V6T 2A1, Canada.
*To whom correspondence should be addressed. E-mail:
adele.diamond@ubc.ca
Fig. 1. A teen working at a CogMed game. [Photo courtesy of CogMed]
www.sciencemag.org
SCIENCE
VOL 333
19 AUGUST 2011
959
Randomized, controlled comparison
(Khanna
& Kendall, 2010)
! 49 children with anxiety disorders ages 7 to 13-years
! Random assignment
Evaluators blind to treatment condition
! Computer-assisted CBT vs Individual CBT vs Computer-linked
education, support and attention condition (CESA)
!
CA-CBT (Camp
Cope-A-Lot)
81% principal anxiety diagnosis
no longer present at posttreatment
Child and parent more satisfied
than with CESA;
CA-CBT = I-CBT
I-CBT (Coping Cat)
70% principal anxiety diagnosis
no longer present
Child and parent more satisfied
than with CESA
I-CBT = CA-CBT
CESA (attention/
education control)
19% principal anxiety diagnosis
no longer present
Child and parent satisfaction
CESA< CA-CBT and I-CBT
Center for Excellence in Developmental Disabilities
UCDAVIS
MIND Institute
Thursday, July 12, 12
25
CBT & medication yields substantial
improvement
(Walkup, Albano, Piacentini et al. 2008)
! 488 Children 7 to 17-years with anxiety disorders
! Random assignment
!
evaluators blind to all treatment assignments
! 12-weeks, multi-site trials
55% very much to
much improved
0.45 effect size
60% very much to
much improved
0.31 effect size
Sertraline & CBT
combined (N=140)
81% very much to
much improved
0.86 effect size
Placebo drug
24% very much to
much improved
Sertraline only
(N analyzed= 133)
Cognitive Behavioral
Therapy (CBT) only
(N=139)
(N=76)
Center for Excellence in Developmental Disabilities
Thursday, July 12, 12
UCDAVIS
MIND Institute
26
Conclusions
We do now understand a lot about what needs to be fixed
huge amount can be done without stem cells/brain surgery
instead, well validated methods, with skilled providers are widely
available and don’t require 22q11.2DS expertise
Much energy is going into novel, technological interventions
these are “works in progress” trying to translate basic
neuroscience into effective treatments
any of these might work for your child, but no evidence yet for
wide ranging, long-lasting effects
few Random Controlled Trials - the “gold standard”
Decades of training studies show above pattern so the big Q:
Will “Brain Training” be different? More studies and time will tell
Thursday, July 12, 12
27